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The author presents the hypothesis that no single nutrient or class of food by itself significantly affects risk for most cancers. Rather, it is the dietary pattern or the mix of nutrients and foods that affects cancer risk. And the overall caloric intake or perhaps the caloric balance is central to whether a particular dietary pattern will affect cancer risk. Supporting evidence for this hypothesis, as well as implications if correct, is also presented.
A novel model of nutritionally induced hypertension in the rat is described. Dietary obesity was produced by providing sweet milk in addition to regular chow, which elicited a 52% increase in caloric intake. Despite 54% greater body weight gain and 139% heavier retroperitoneal fat pads, 120 days of overfeeding failed to increase systolic pressure in the conscious state (125 +/- 8 vs. 121 +/- 4 mmHg in chow-fed controls) or mean arterial pressure under urethan anesthesia (71 +/- 4 vs. 63 +/- 3 mmHg). In contrast, mild hypertension developed in intermittantly fasted obese animals (a 21-mmHg increase in systolic blood pressure measured in the conscious state and a 16-mmHg increase in mean arterial pressure under anesthesia relative to chow-fed controls). The first 4-day supplemented fast was initiated 4 wk after the introduction of sweet milk, when the animals were 47 g overweight relative to chow-fed controls. Thereafter, 4 days of starvation were alternated with 2 wk of refeeding for a total of 4 cycles. A rapid fall in systolic blood pressure (12 +/- 2 mmHg at 2 days) accompanied the onset of supplemented fasting and was maintained thereafter (2.7 +/- 2.6 mmHg further decrease during the latter half of the fast). With refeeding, blood pressure rose precipitously (13 +/- 3 mmHg in the 1st 2 days), despite poststarvation anorexia. Blood pressure tended to rise slightly over the remainder of the realimentation period (5.2 +/- 2.8 mmHg). After the 4th supplemented fast, hypertension was sustained during 30 days of refeeding. Cumulative caloric intake in starved-refed rats fell within 2% of that in chow-fed controls.(ABSTRACT TRUNCATED AT 250 WORDS)
OBJECTIVES AND METHODS: In this study, the relationship of physical activity with aerobic capacity and health checkup results were examined among 288 men aged 45.7 (mean) +/- 8.13 (SD) years. Physical activity was evaluated from a 3-day activity record and expressed as metabolic-equivalent (MET) (/day). Total caloric intake was evaluated from a 3-day dietary record. VO2 max was measured as the index of aerobic capacity, and body mass index (BMI), waist-hip ratio (WHR), % fat, and increase in body weight from 20 years old were used as indices of body composition. RESULTS: In multiple regression analysis, MET value, % fat, WHR and increase in body weight from 20 years old were independently and significantly associated with VO2 max. As MET value was a significant predictor, it may be important to evaluate physical activity not only during leisure time, but also throughout the whole day. In addition, preventing total body fat and abdominal fat increase seemed important to maintain and to increase aerobic capacity. To grasp the pattern of physical activity more precisely, subjects were classified into 6 groups (A: sedentary, B: sedentary + walking, C: sedentary + brisk walking, D: sedentary + exercise, E: active, F: active + exercise), and each variable was compared using one-way analysis of variance and post-hock test analysis (Tukey method). MET value increased in the order of groups A, D, E and F. Groups D and E showed no significant difference in the VO2 max and MET value, while both groups showed significantly higher values than those of group A. Therefore, aerobic capacity differed not only according to the presence of habitual exercise, but also according to whether the subjects had an active daily life. When sedentary, it seemed important to be active for about 1-hour/day. Regarding body fat, group F showed the lowest value in each variable. Systolic and diastolic blood pressures, and blood triglyceride levels were highest in group A and lowest in group F, suggesting the effects of an active daily life and habitual exercise. In group A, the total caloric intake was also highest. Therefore, improving the total lifestyle, including diet, was also considered necessary. CONCLUSIONS: Classification of subjects according to their pattern of physical activity may be useful in health education settings to increase physical activity and to prevent life-style-related diseases.
Maintenance of appropriate stores of metabolic fuels depends on carefully matching caloric intake to caloric expenditure. Achieving such 'energy balance' is a product of complex interactions of peripheral hormones with effector systems in the central nervous system (CNS) that regulate food intake and energy expenditure. Leptin is a hormone that is made in the adipocytes, circulates in the blood and interacts with receptors in the CNS. These receptors can be found in two different types of systems. One effector system is termed 'anabolic' and is activated by low levels of leptin during negative energy balance. This system (exemplified by the hypothalamic neuropeptide Y system) increases food intake and decreases energy expenditure to facilitate the regaining of lost energy stores. The other effector system is termed 'catabolic' and is activated by high levels of leptin during positive energy balance. This system (exemplified by the hypothalamic melanocortin and corticotrophin-releasing hormone systems) decreases food intake and increases energy expenditure to facilitate the loss of excess energy stores. Further understanding of these systems is necessary to develop adequate treatments for disorders of energy balance, such as obesity and wasting.
Fourteen infants with congenital heart disease were investigated for failure to thrive. Assessment of intestinal function revealed minor absorptive abnormalities (mild steatorrhea in three patients, bile salt loss in four patients), delayed gastric emptying, and abnormal triglyceride loading tests. Low caloric intake (88.3 +/- 19.3 kcal/kg/day) seemed the main reason for failure to gain weight. Weight accession and cardiorespiratory rates were monitored daily during voluntary intake, a high-caloric diet by mouth, and nasogastric tube feeding. Providing 169 +/- 29 kcal/kg/day by tube resulted in weight gain with mild and transient elevation of respiratory rate at the end of the meal and increased heart rate 90 min after the meal. This regimen is a metabolically inexpensive and efficient method of supporting weight gain in children with congenital heart disease.
The urinary estrogen profile was studied in the midfollicular phase twice, and diet four times during 1 yr in 10 premenopausal breast cancer (BC) patients consuming an omnivorous normal Finnish diet and in two control groups, one consuming an omnivorous (n = 12) and the other a lactovegetarian (n = 11) diet. Total fat intake in relation to caloric intake was almost identical in all three groups. Only with regard to grain fiber intake did the BC patients differ significantly from both other groups. No differences were found between the groups with regard to urinary excretion of 13 individual estrogens and total estrogens, with the exception of 4-hydroxyestrone (4-OH-E1), which was significantly lower (P less than 0.05) in the BC group than in the vegetarians. A high carbohydrate to protein ratio in the diet had a negative correlation with the excretion of 2-hydroxyestrogens and 2-hydroxyesterone (2-OH-E1) to 4-OH-E1 ratio. The BC group had significantly higher urinary 2-OH-E1 to E1 ratio (P less than 0.05) compared to the vegetarians. The 2-OH-E1 to 4-OH-E1 ratio was highest in the BC group (= 7.1) and differed significantly from that of the omnivores (= 4.3; P less than 0.02) and vegetarians (= 3.6; P less than 0.005). This ratio showed a negative correlation with intake of carbohydrates, starch, total and grain fiber. Urinary excretion of 4-OH-E1 correlated positively with total and grain fiber intake and plasma SHBG. Protein intake correlated positively with urinary 2-methoxy-E1 excretion, and retinol intake positively with catechol estrogen, E1 and E2 excretion. It is concluded that estrogen production and urinary estrogen profile in premenopausal breast cancer patients is normal with the exception of a low 4-OH-E1 excretion and high urinary 2-OH-E1 to 4-OH-E1 ratio. This ratio, which seems to depend on diet, is the only urinary estrogen parameter separating premenopausal BC patients from the control omnivorous and lactovegetarian women.
We assessed plasma levels and removal rates of oxalate in 24 patients on chronic peritoneal dialysis (CPD) for oxalosis-unrelated renal failure. The ion-chromatographic (IC) measurements of oxalate in plasma, dialysate, and urine (in seven patients with residual renal function) were used to calculate peritoneal and renal clearances of oxalate. The serum state of saturation with calcium oxalate was calculated by means of a computer-based model system. Patient data were compared with those from 19 healthy individuals. Peritoneal clearance of oxalate was 6.3 +/- 4.7 mL/min, ie, 8% of the normal renal clearance. As a result, both plasma oxalate and calcium oxalate saturation were higher than in controls and did not overlap. Plasma was supersaturated with calcium oxalate in only two of 24 patients (8%). Removal of oxalate by dialysis was related to the amount of fluid infused. Overall removal of oxalate (dialysate plus urine) was similar to 24-hour excretion of normal subjects and was taken as a measure of its generation. Oxalate generation rate was dependent on protein (whole and animal) intake, but not on caloric intake or pyridoxine status. Pyridoxine supplementation, 75 and 300 mg daily for 1 months, was not effective in reducing plasma levels or generation rates of oxalate. Residual renal function had a minor influence on oxalate patterns. We conclude that current programs are adequate to maintain oxalate balance in patients on CPD under basic conditions.
The relationship of dietary intakes to subsequent development of coronary heart disease (CHD) during a 6-year follow-up period was investigated in 7705 men of Japanese ancestry, ages 45 to 68 and living in Hawaii. Data on the intakes of calories and nutrients were obtained by 24-hr diet recall interviews at the base-line examination. An index for ingestion of traditional Japanese diet (Japanese diet score) was also calculated for each man. The men who subsequently developed myocardial infarction or died of CHD generally ate less than those who remained free of CHD, with statistically significant differences for total calories, total carbohydrate, complex carbohydrate or starch, simple carbohydrate other than sucrose, vegetable protein, alcohol, and Japanese diet score. However, when other major risk factors for CHD were taken into account, the negative association with CHD remained statistically significant only for alcohol and, to a lesser extent, total carbohydrate intakes. The lower total caloric intakes in CHD cases, largely due to decreased alcohol and carbohydrate intakes, could not be accounted for by either under-reporting of food consumption among obese men or diminished physical activity in CHD cases.
INTRODUCTION: Basque ball players (BBPs) make repeated hand strikes to the ball which involves continuous mechanical trauma. OBJECTIVE: The aim of this work is to describe the hematological variations and changes in iron metabolism occurring in BBPs as a result of acute and continuous practice of this special sport native to Northern Spain. METHODS: 40 healthy male subjects volunteered to participate in this study: 11 subjects who exercise moderately (control group) but do not play Basque ball sport and 29 professional BBPs were studied in two situations: before a match (BM group) and after a match (AM group). The following hematological parameters were determined: red blood cell count (RBC), hemoglobin and hematocrit; MCV, MCH and MCHC. The following variables were measured in serum: iron, ferritin, transferrin, transferrin saturation, proteins, and lactate dehydrogenase (LDH). Proteins and hemoglobin were determined in urine. RESULTS: The BM group showed lower hematocrit, MCV, hemoglobin and serum transferrin levels, and higher LDH than controls. The AM group showed higher RBC, hemoglobin, serum proteins, iron, transferrin and LDH levels, lower plasma volume, and higher urine hemoglobin and protein levels than the BM group. CONCLUSIONS: Basque ball playing induces hemolysis and increases the plasma capability to quench free iron, but its clinical consequences on iron metabolism do not seem to be enough to take an iron intake proportional to the caloric intake. In order to prevent, in the long term, the development of anemia in these peculiar sportsmen, it would be useful that medical teams observe urine blood losses and oxidative stress in these BBPs.
Five surgical infants, ages 3 to 30 days, were studied while receiving peripheral total parenteral nutrition for a period of 2 weeks. By a randomized sequence, either 10 or 20% safflower oil emulsion was infused the first week, followed by the alternate solution during the second week. Caloric intake was 80 to 100 cal/kg/day, of which lipids comprised one-third to one-half. No adverse side effects were noted. Eosinophilia developed in three patients, but otherwise no changes in hematologic and biochemical parameters, including liver enzymes, were noted. Weight gain averaged 11.1 g/kg/day during the study period and was similar for the 10 and 20% solutions. Intravenous fluid intake averaged 21 ml/kg/day less during the week of the patients received 20% fluid emulsions. The 20% safflower oil emulsion proved comparable to the 10% solution in both safety and efficacy and enabled significant reduction of fluid intake while maintaining infused caloric levels.
For 110 apparently healthy Norwegian captains on ocean-going ships a near maximal bicycle exercise test revealed a pathological exercise electrocardiogram for 10.0%, while the corresponding results for a comparable group of Oslo men and a group of Norwegian sea pilots were 4.6 and 11.8%, respectively. The significant difference in prevalence between the captains and Oslo men could not be explained by differences in serum lipids, blood pressure, or a family history of coronary heart disease. The captains were taller and more physically fit than the Oslo men, but they were significantly heavier and had a more rapid age decline in physical performance capacity and a higher prevalence of heavy smokers. Ten of the 11 captains with a pathological exercise electrocardiogram were, or had been, heavy smokers (greater than or equal to 20 cigarettes/d). A high caloric intake in relation to caloric expenditure, heavy smoking, and poorly defined factors such as stress, irregular workhours, and varying climatic conditions are factors to be considered as explanations for these findings. The claim by captains that they have a higher risk than average for developing coronary heart disease was to some extent corroborated in the present study.
The amount of alcohol intake has been increasing in Japan. We investigated whether this might affect dietary habits in middle-aged men. In 1989, we conducted a health examination of 809 Japanese males aged 40-69. Food and nutrient intakes were estimated from 24-hour dietary recall. Mean values of total energy, protein, fat, and carbohydrate were evaluated according to alcohol intake. Consumption of total calories and proteins, especially animal proteins, increased and carbohydrate intake decreased proportionately with the amount of alcohol intake. Meat, fish, and soybean intake were increased in heavy drinker, along with niacin, sodium, and phosphorus intake. Despite their higher caloric intake, moderate and heavy drinkers were not more obese than non- or light-drinkers. Japanese heavy drinkers took more animal protein and sodium instead of carbohydrate compared to non- and light- drinkers. In our series, heavy drinking was not related to obesity.
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Blood rheology is influenced by metabolism and nutrition. We investigated this issue in 41 elite athletes exercising 13+/-0.9 hr/wk (mean age: 23.9+/-0.67 yr; mean VO2max: 52.6+/-2.3 ml/min/kg body weight) with a standardised nutritional questionnaire suitable for sports medicine. Calorie intake (% of recommended intake) was negatively correlated with the RBC disaggregability threshold (r=-0.505, p=0.01). There were negative correlations between fibrinogen and protein intake (% of the total caloric intake r=-0.787, p=0.0008; amount in g/kg/day r=-0.597, p=0.03). Accordingly, the RBC disaggregability threshold was also correlated negatively with protein intake (r=-0.508, p=0.05). Lipid intake (g/kg/day) was negatively correlated with the RBC disaggregability threshold (r=-0.564, p=0.03) and positively to the hematocrit/viscosity ratio (r=0.531, p=0.03). Carbohydrate intake (g/kg/day) was positively correlated with whole blood viscosity (r=0.517, p=0.04) and negatively to the hematocrit/viscosity ratio (r=-0.4863, p=0.05). In addition fibrinogen was negatively correlated with hematocrit (r=-0.4129, p=0.036) and positively with a host of aggregation parameters (p<0.001). Therefore fibrinogen levels and red cell rheology exhibit correlations with the nutritional status in athletes. Low protein intake appears to be associated with (mildly) raised fibrinogen and aggregability, and low calorie intake is associated with lower RBC disaggregability.
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The authors compare the protein sparing effect of two diets, exclusively intravenous, including the same protein intake, but a different caloric intake, 21 calories/gm nitrogen for diet "A" (20 cases); 138 calories/gm nitrogen for diet "B" (20 cases). This has been observed during the six post-operative days of major visceral surgery: oesophagectomy, total gastrectomy, colic or rectocolic exeresis, sequestrectomy for acute pancreatitis, lots having been drawn for the diets. Daily nitrogen balances have been made and plasmatic and urinary levels of amino-acids have been measured before surgery and on the third and fifth post-operative days. Statistical exploitation is done by variance analysis (linear model of three factors) with a 99% confidence ratio: 1) Patient factor has no influence whatsoever on cumulative nitrogen balance. 2) Time factor arises only on the fourth post-operative day and only in the hypocaloric diet, leading to catabolism. 3) Metabolic condition is determinant. On no cancerous disease, superiority of hypercaloric diet is well demonstrated. On cancerous disease, nitrogen loss is only significantly different on 4th and 5th post-operative day: hypercaloric diet gives a better nitrogen balance.
In 12 preterm infants (mean gestational age: 28.9 weeks; mean birthweight: 1230 g) (Group 1) the serum concentrations of urea and alpha-amino-nitrogen were studied during the 32nd and between the 36th and 37th week of post-conceptional age. In 9 preterm infants with a mean gestational age of 34.6 weeks (mean birthweight: 1860 g) (Group 2) the same parameters were estimated during the 36th or 37th week of postconceptional age. In all male infants (group 1: n = 6; group 2: n = 5) the excretion of nitrogen in urine and stools were measured during a 48 h balance period. During the study all infants were fed with human milk enriched with 3 g of a bovine human milk fortifier (Eoprotin, Milupa AG, Germany) per 100 ml human milk (mean protein intake: 3.4 g/kg.day; mean caloric intake: 132.5 kcal/kg.day). Despite the similar protein and energy intakes on all study days the serum concentrations of urea and alpha-amino-nitrogen were significantly higher during the 36th or 37th postconceptional week if compared to those found during the 32nd postconceptional week. This was accompanied by elevated renal excretion of total nitrogen due to an increased excretion of urea in the older infants. The nitrogen excretions in stools were low during both study periods. During the period 36 and 37 weeks of postconceptional age no differences could be found for all parameters studied between the both groups of different gestational ages. The data of the present study suggest that in preterm infants with postconceptional age of 37 weeks or more protein intakes of 3.4 g/kg.day and more may exceed the requirements of these infants. Thus, supplementation of human milk with protein is not necessary after the 37th week of postconceptional age if feeding volumes of 170 ml/kg.day or more are tolerated.