Profile of Uncontrolled Hypertensive patients attending the Specialist Hypertension Clinic, University Hospital of the West Indies

The purpose of this study was to describe the knowledge of hypertension, its management, anthropometric measurements, blood pressure (BP), medication use, and current lifestyles of patients with persistent hypertension. Patients (n=80) attending the Specialist Hypertension Clinic at the University Hospital of the West Indies (UHWI) who had a baseline systolic BP> 140 mmHg and/or a diastolic BP> 90 mmHg were invited to participate in the study. Blood pressure, height, weight, waist and hip circumferences were measured. Body mass index (BMI) and waist/hip ratio (WHR) were calculated. A pretested questionannaire with 40 items eliciting demographic data, level of activity, dietary habits, knowledge of hypertension, medication compliance, use of alternative medicines, and substance use was administered to each participant. Mean BMI for men was 27.65 (95 percent CI 25.7 - 29.6); mean BMI for women was 30.89 (95 percent CI 26.1 - 35.7). In men, there was an association between BMI and WHR, r = 0.62, p<0.05, an association between BMI and diastolic BP and a negative association between BMI and activity level (r= -0.42, p<0.05). Although the majority of both men and women were classified as obese, only 12 percent of men and 7 percent of women recognized diet and overweight as contributing to high blood pressure. Reported diets tended to be high in fat, salt and meats and low in vegetables and fruits; the majority of the participants were sedentary. Medication compliance was good, with a mean of only four days of medications missed per month. These findings suggest that to lower blood pressure in this population, the use of nonpharmacologic theraphy involving lifestyle changes such as improved diet, weight loss and increased physical activity will be important.(AU)

Thyrotoxic vomiting: a case report

A post menopausal female with severe vomiting and weight loss in association with elevated hormone levels is presented. Signs and symptoms of thyrotoxicosis were not evident at presentation. Possible pathophysiological mechanisms and treatment are discussed. Antithyroid therapy with carbimazole and propranlol induced rapid resolution of her symptoms and marked improvement in well-being. Radioactive iodine ablation of her thyroid gland was performed later and she has remained asymptomatic.(AU)

Nutrition supplementation in patients with HIV infection

OBJECTIVE: To evaluate the use of high-energy, high protein, oral, liquid, nutrition supplementation and nutrition counselling on the weight status of patients infected with the human immuno-deficiency virus (HIV) with and without secondary infections. DESIGN: prospective, descriptive, intervention trial. Follow-up clinic visits were scheduled every 1 to 3 weeks for at least 6 weeks to monitor weight, gastrointestinal symptoms, number of supplements consumed, and incidence of secondary infections. SUBJECTS/SETTING: community-based, HIV-infected patients, with and without acquired immunodeficiency syndrome (AIDS) defining illness, who were receiving outpatient medical care at Deaconess Hospital, 17 patients were evaluated. INTERVENTION: dietary counselling consisted of recommendations to consume a high protein diet (1.5 g/kg ideal body weight); select foods that minimize gastrointestinal complications; and at least one high-energy, high-protein, oral, liquid, nutrition supplement daily. MAIN OUTCOME MEASURES: Energy intake from the supplements and weight change over time in relation to whether a secondary infection occurred. STATISTICAL ANALYSIS: Means, standard deviations, and frequency. RESULTS: At the time of entry to the study, the patients with pre-existing weight loss (16 of 17) were 14 ñ 8 percent below their usual body weight. On average, patients consumed 11 ñ 4 supplements per week for 6 ñ 3 weeks. The majority (12 out of 17) were able to gain or maintain weight. Overall weight gain was 1.1 ñ 2.2 kg. Only 5 of 17 patients lost weight, 4 of whom developed a secondary infection during the study (i.e, after enrollment in the study). All of those who developed a secondary infection were classified as having AIDS and had lower mean CD4 counts at baseline than those who did not develop a secondary infection. Although those who developed a secondary infection had a higher incidence of weight loss, their consumption of oral supplements per week was greater than that of those without a secondary infection. APPLICATIONS/CONCLUSIONS: In patients with HIV infection and in the early stages of AIDS without a secondary infection, weight gain and/or maintenance was achieved with a high-energy, high-protein, oral, liquid, nutrition supplement in conjunction with nutrition counselling. The majority of patients who developed a secondary infection, however, lost weight despite the use of supplements and counselling (AU)

Jamaican service club members beliefs about some chronic diseases (Part II) - abstract

This survey sets out to examine Jamaican Service Club members' beliefs about prevention strategies for hypertension, hypercholesterolemia and obesity; the prevalence of modifiable risk factors and to estimate self-reported cardiovascular risk. Kiwanis, Lions and Rotary Club members completed questionnaires which assessed their knowledge of specific strategies to prevent hypertension, hypercholesterolemia and obesity. Service clubs in Kingston, Jamaica were sampled at their regular monthly meetings. Among the 320 members, 253 were males, 67 were females and the majority (61.4 per cent) of respondents had attended university. Respondents demonstrated moderate to high accuracy in their ability to identify prevention strategies for hypertension, hypercholesterolemia and obesity. The majority of respondents (85.9 per cent) reported normal blood pressure levels, and a non-smoking habit (84.8 per cent). However, as many as 31.8 per cent of respondents indicated that their blood cholesterol levels had never been measured. More females (49.3 per cent) than males (27.0 per cent) had never measured their blood cholesterol level. Despite widespread awareness of the importance of exercise for decreasing the risk of hypertension, hypercholesterolemia and obesity, only 36.7 per cent of males and 27.3 per cent of females participated in aerobic activity three times a week. Since exercise appears to be the limiting factor for improving cardiovascular health, programme planners who seek to improve cardiovascular health among service club members need to offer effective strategies for translating individuals' knowledge about the importance of exercise into a personal fitness programme. The highest cardiovascular risk score was derived by those who never participated in aerobic exercise (1.13), compared to those who exercised three times a week (.66). Maximum cardiovascular score was 3.5, minimum 0.0. Those who had attempted to lose weight within six months of the survey (1.00) had a significantly higher risk score than those who had never attempted weight loss (.56) (p<.05), suggesting that chronic dieters were largely unsuccessful at achieving permanent weight loss. Females (.93) had a higher cardiovascular risk compared to males (.77), although the difference was not statistically significant. History of attempted weight loss and aerobic exercise were the only significant predictors of cardiovascular risk (AU)

An agenda for nutritional sociology in the Caribbean

Since the 1980s the field of nutritional sociology has taken off, particularly in the USA. Unfortunately, Caribbean sociologists have been slow to capitilize on this expanding area of enquiry. In this paper I outline a number of areas in which sociology can improve our understanding of nutritional behaviour in the Caribbean (AU)

Very low calorie diets and pre-fasting prolonged QT interval: a hidden potential danger

The asssociation of torsade de pointes and a prolonged electrocardiographic QT interval is well described. A prolonged QT interval may be congenital or acquired in several ways - by the use of anti-arrhythmic agents exemplified, by the presence of hypocalcaemia or hypokaemia, by the use of psychotropic drugs, and by the presence of intrinsic cardiac disease or bradycardias. Possible less well appreciated is the potiental for drastic weight loss to prolong the QT interval, as the present case report illustrates. A young woman weighing 244 pounds lost 24 pounds in two weeks with a consequent prolongation of QTc interval from pre-diet value of 0.57 seconds to 0.72 seconds at administration, when severly symptomatic paroxysms of torsade de pointes were recorded. Successful therapy with lignocaine and prompt re-feeding supressed the arrhythmia and, three days later, the QTc was reduced to almost its pre-diet state. A (UK) DHSS report offers guidelines in the use of very low caloric diets. This case suggests that a pre-diet electrocardiogram should be carefully assessed for QT prolongation before initiation of dieting to achieve serious weight loss (AU)

Arteriomesenteric duodenal occlusion associated with strongyloidiasis

Arteriomesenteric occlusion of the distal duodenum may occur in clinical conditions which result in narrowing of the angle between the aorta and superior mesenteric artery. Two patients with arteriomesenteric duodenal occlusion associated with Strongyloides stercoralis infection are described. In one patient the mechanism of occlusion appeared to be significant weight loss and associated visceroptosis, while in the other patient increased diameter of superior mesenteric vessels was the major factor. Strongyloidiasis, a curable parasitic infection, should be considered in patients presenting with arteriomesenteric occlusion of the distal duodenum. (AU)

A comparison of the response of thirteen muscles in the rat to dietary restriction

Information derived from a sample of a particular muscle or the entire muscle is often assumed to be characteristic of skeletal muscle in general. There has been little experimental work designed to validate this assumption which has important implications in clinical situations such as severe protein-energy malnutrition in which gross muscle wasting is a characteristic feature. This project was designed to gain information on the changes that take place in a number of muscles in the rat exhibiting severe muscle wasting following dietary deprivation. Eight male albino rats aged 5 weeks and weighing 100g were starved for 33 days and then fed a 1 percent protein diet for 20-22 days. Control animals were albino male rats of the same initial age and body weight. The 13 muscles examined were those of the trunk (rectus abdominis, diaphragm and psoas), thigh (gluteus), hind-limb (quadriceps, tibialis anterior, gastrocnemius and soleus), and fore-limb (Triceps, biceps, brachialis, Flexor carpi radialis and Extensor carpi ulnaris). Estimations on the whole muscle were made of wet weight, dry weight, fat free dry weight, cellular protein, extracellular protein, DNA and RNA. The results showed that the muscles of the experimental animals underwent similar compositional changes in response to the dietary restriction. The changes of four small fore-limb muscle were not characteristic at times. Overall the muscles lost 19 percent wet weight, 17 percent dry weight and 18 percent fat free dry weight. The total water content decreased by approximately 2 percent, cellular protein by 20 percent and total muscle RNA by 44 percent. Extracellular protein increased by 35 percent. There was no significant difference in the total DNA and fat content of nearly all the muscles of control and experimental animals. Although the muscles responded similarly to the dietary treatment the extent of change varied. Caution must be exercised when extrapolating these changes to the entire musculature (Summary)

An evaluation of different approaches to the dietary management of maturity-onset diabetes in obese patients in Kingston, Jamaica

The present study was designed to examine the factors involved in the disappointing degree of dietary control of some maturity-onset diabetic patients and to investigate ways of improving the present method of treatment. Lack of understanding of the diet and deficiency in knowledge of the diabetic condition had been cited as the principal underlying causes of poor weight loss. These were the areas on which emphasis was placed throughout the study. Evaluation was achieved by the institution of a nutrition education programme, where patients were introduced to the causation of diabetes, its relationship to obesity and the principles of dieting. In addition, a diet was devised which was more in keeping with the socio-economic background of the patients, and presented visually in the form of a manual. Analysis of the attitudes of the patients was also attempted with the use of questionnaires. The present system of dietary treatment was found to be deficient in certain areas. In particular there was not enough emphasis on individuality and verbal instruction and there was inadequate use of the services of the dietitian. Also, appointments were not frequent enough to allow for sufficient contact between doctor and patient. Although slight improvements occurred in weight loss when more attention was paid to the diet and education, it was not significant enough to confirm these as the principal causes. However, analysis of attitudes revealed that these may play the most important role. Positive attitudes could be influenced by treatment taking on a sociological slant, with contact both on the individual level and in group sessions. Weight loss was shown to be associated with a lowering of blood glucose levels and therefore every effort should be made to control maturity-onset diabetics on diet alone before tablet therapy is introduced (AU)

Weight change and risk of heart attack - abstract

Weight reduction has been shown to reduce cardiovascular risk factor levels such as blood pressure and blood cholesterol, but the longer term consequences of weight loss on coronary heart disease (CHD) morbidity and mortality are less certain. The effect of weight change over a five-year period on the subsequent risk of myocardial infartion (MI), fatal and non-fatal, during the 6.5 years of further follow-up has been examined in a prospective study of 7735 middle-aged men, taking into account the confounding risk factors of age, social class, smoking status at baseline and, five years later, blood pressure, blood cholesterol and initial body mass index (BMI), as well as pre-existing hypertension and diabetes mellitus. Analyses were restricted to the 6445 men (318 cases) who had no diagnosis of CHD at entry and no new MI event prior to weight change. Over half (56 percent) showed little weight change, gaining or losing less than 4 percent of body weight; 31 percent gained and 13 percent lost weight. The lowest risk was seen in men who gained 4 to 10 percent of body weight. Substantial weight gain ( > 10 percent) was associated with a significantly increased risk of MI, even after adjustment for confounding factors (RR = 1.55 : 95 percent CI, 1.0, 2.4). Weight loss ( > 4 percent) was also associated with increased risk of an MI, but this increase was reduced to non-significant levels after adjustment for other factors (RR = 1.1 : 95 percent CI, 0.5, 2.2). While these results suggest that considerable weight gain ( > 10 percent) increases risk of CHD, they do not provide any evidence that weight loss is beneficial in midddle-age in relation to risk of heart attack and indicate the need for careful evaluation of any new health strategies relating to weight loss (AU)