RESUMEN
BACKGROUND: During acellular replacement of an acute blood loss, hyperoxic ventilation (HV) increases the amount of O2 physically dissolved in the plasma and thereby improves O2 supply to the tissues. While this effect could be demonstrated for HV with inspiratory O2 fraction (FiO2) 0.6, it was unclear whether HV with pure oxygen (FiO2 1.0) would have an additional effect on the physiological limit of acute normovolemic anemia. METHODS: Seven anesthetized domestic pigs were ventilated with FiO2 1.0 and subjected to an isovolemic hemodilution protocol. Blood was drawn and replaced by a 6% hydroxyethyl starch (HES) solution (130/0.4) until a sudden decrease of total body O2 consumption (VO2) indicated the onset of O2 supply dependency (primary endpoint). The corresponding hemoglobin (Hb) concentration was defined as 'critical Hb' (Hbcrit). Secondary endpoints were parameters of myocardial function, central hemodynamics, O2 transport and tissue oxygenation. RESULTS: HV with FiO2 1.0 enabled a large blood-for-HES exchange (156 ± 28% of the circulating blood volume) until Hbcrit was met at 1.3 ± 0.3 g/dl. After termination of the hemodilution protocol, the contribution of O2 physically dissolved in the plasma to O2 delivery and VO2 had significantly increased from 11.7 ± 2 to 44.2 ± 9.7% and from 29.1 ± 4.2 to 66.2 ± 11.7%, respectively. However, at Hbcrit, cardiovascular performance was found to have severely deteriorated. CONCLUSION: HV with FiO2 1.0 maintains O2 supply to tissues during extensive blood-for-HES exchange. In acute situations, where profound anemia must be tolerated (e.g. bridging an acute blood loss until red blood cells become available for transfusion), O2 physically dissolved in the plasma becomes an essential source of oxygen. However, compromised cardiovascular performance might require additional treatment.
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Anemia/sangre , Oxígeno/sangre , Respiración Artificial/métodos , Anestesia , Animales , Femenino , Hemodilución , Hemodinámica , Hemoglobinas/análisis , Masculino , Miocardio/metabolismo , PorcinosRESUMEN
BACKGROUND: Alicaforsen is an antisense oligonucleotide inhibitor of intercellular adhesion molecule 1 protein expression with activity in subjects with ulcerative colitis and pouchitis. AIM: To compare the effects of alicaforsen enema to standard of care mesalazine (mesalamine) enema in subjects with mild to moderate active left-sided ulcerative colitis. METHOD: A randomized, double-blind, active-controlled multicentre clinical trial. Subjects received a nightly enema of 120 mg alicaforsen (n=55), 240 mg alicaforsen (n=50), or 4 g mesalazine (n=54) for 6 weeks, followed by a 24-week monitoring period. The primary end point was Disease Activity Index at week 6. Clinical improvement, remission and relapse were secondary end points. RESULTS: No significant difference was observed between treatment arms in the primary end point. However, the median duration of response to alicaforsen enema treatment was two- to threefold longer (128 and 146 days) in comparison with mesalazine (54 days). Complete mucosal healing occurred in 24% of the 240 mg alicaforsen group, when compared with 17% in the mesalazine. CONCLUSIONS: Alicaforsen enema demonstrated an acute response and safety profile similar to mesalazine enema, but was differentiated by a more durable response. The extended length of remission suggests that alicaforsen enema treatment may have a disease modifying effect.
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Antiinflamatorios no Esteroideos/administración & dosificación , Colitis Ulcerosa/tratamiento farmacológico , Fármacos Gastrointestinales/administración & dosificación , Mesalamina/administración & dosificación , Oligodesoxirribonucleótidos Antisentido/administración & dosificación , Tionucleótidos/administración & dosificación , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antiinflamatorios no Esteroideos/efectos adversos , Relación Dosis-Respuesta a Droga , Método Doble Ciego , Esquema de Medicación , Enema , Femenino , Fármacos Gastrointestinales/efectos adversos , Enfermedades Gastrointestinales/inducido químicamente , Humanos , Masculino , Mesalamina/efectos adversos , Persona de Mediana Edad , Oligodesoxirribonucleótidos Antisentido/efectos adversos , Oligonucleótidos Fosforotioatos , Tionucleótidos/efectos adversos , Resultado del TratamientoRESUMEN
BACKGROUND: Alicaforsen is an antisense oligonucleotide designed to inhibit expression of human intercellular adhesion molecule 1. Previous clinical studies have demonstrated activity of alicaforsen enema in ulcerative colitis and pouchitis. AIM: To determine the minimally effective dosing regimen of alicaforsen enema in subjects with mild to moderate left-sided ulcerative colitis. METHODS: Randomized, placebo-controlled, double-blind, two-dose ranging multicentre study. One hundred and twelve subjects were equally randomized to receive one of four alicaforsen enema regimens or placebo daily for 6 weeks. Primary end point was Disease Activity Index at week 6. Secondary end points included evaluation of clinical improvement, relapse rates and durability of response. Analysis of data were performed on the intent-to-treat population. RESULTS: No significant difference was observed between treatment arms and placebo in the primary end point. A prolonged reduction in mean% Disease Activity Index relative to baseline was observed in the daily 240 mg alicaforsen enema treatment arm in comparison with placebo from week 18 (51% vs. 18%, P=0.04) to week 30 (50% vs. 11%, P=0.03). CONCLUSIONS: Alicaforsen enema was safe and well tolerated at all doses studied. The durability of the response to alicaforsen enema treatment may suggests a disease-modifying effect.
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Colitis Ulcerosa/tratamiento farmacológico , Fármacos Gastrointestinales/administración & dosificación , Oligodesoxirribonucleótidos Antisentido/administración & dosificación , Tionucleótidos/administración & dosificación , Adulto , Anciano , Método Doble Ciego , Esquema de Medicación , Enema , Femenino , Fármacos Gastrointestinales/efectos adversos , Hemorragia Gastrointestinal/etiología , Humanos , Masculino , Persona de Mediana Edad , Oligodesoxirribonucleótidos Antisentido/efectos adversos , Oligonucleótidos Fosforotioatos , Recto , Recurrencia , Tionucleótidos/efectos adversos , Resultado del TratamientoRESUMEN
BACKGROUND: Alicaforsen is a phosphorothioate-modified antisense oligodeoxynucleotide designed to sequence-specifically reduce intercellular adhesion molecule 1 messenger RNA levels. AIMS: To determine the systemic and local bioavailability of alicaforsen, and its activity when administered as a once daily enema in subjects with active ulcerative colitis. METHODS An open-label study was conducted to assess the relative absorption (local and systemic pharmacokinetics) and pharmacologic activity of alicaforsen enema in subjects with active ulcerative colitis. Fifteen subjects received nightly enemas of alicaforsen (240 mg) for a treatment period of 6 weeks. Alicaforsen concentrations in plasma and colonic tissue biopsies were determined. Disease activity index and multiple measurements including endoscopy were used to assess alicaforsen activity in these subjects. RESULTS: Plasma concentrations of parent alicaforsen represented < 0.6% mean bioavailability when compared with historical intravenous area under the plasma concentration-time curves. Concentrations of the intact oligonucleotide in mucosal colonic tissue biopsies were orders of magnitude higher than those observed in plasma. A 46% reduction in mean Disease Activity Index and 33% rate of remission as defined by complete mucosal healing were observed at the end of treatment. Conclusion These data confirm that alicaforsen enema provides local treatment for a local disease with little meaningful systemic exposure.
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Colitis Ulcerosa/tratamiento farmacológico , Fármacos Gastrointestinales/administración & dosificación , Oligodesoxirribonucleótidos Antisentido/administración & dosificación , Tionucleótidos/administración & dosificación , Absorción , Adulto , Área Bajo la Curva , Disponibilidad Biológica , Colon/química , Relación Dosis-Respuesta a Droga , Esquema de Medicación , Enema , Femenino , Fármacos Gastrointestinales/sangre , Fármacos Gastrointestinales/farmacocinética , Humanos , Mucosa Intestinal/química , Masculino , Persona de Mediana Edad , Oligodesoxirribonucleótidos Antisentido/sangre , Oligodesoxirribonucleótidos Antisentido/farmacocinética , Oligonucleótidos Fosforotioatos , Tionucleótidos/sangre , Tionucleótidos/farmacocinética , Resultado del TratamientoRESUMEN
OBJECTIVE: To investigate the impact of prophylactic hyperoxic ventilation with Fio2 0.6 on the physiologic limit of acute normovolemic anemia. DESIGN: Prospective, controlled, randomized experimental study. SETTING: Experimental animal laboratory of a university hospital. SUBJECTS: Fourteen anesthetized domestic pigs. INTERVENTIONS: Animals were randomly ventilated with either Fio2 0.21 (group 0.21, n = 7) or Fio2 0.6 (group 0.6, n = 7), and acute anemia was induced by isovolemic blood-for-hydroxy-ethylstarch (HES) exchange using a 6% HES solution (130/0.4). MEASUREMENTS AND MAIN RESULTS: The blood-for-HES-exchange was continued until a sudden decrease of total body oxygen consumption indicated the onset of oxygen supply dependency (primary end point); the corresponding hemoglobin (Hb) concentration was defined as "critical" (Hb(crit)). Secondary end points were changes in myocardial function, central hemodynamics, oxygen transport, and tissue oxygenation. Compared with room air ventilation (Fio2 0.21), hyperoxic ventilation with Fio2 0.6 enabled a larger blood-for-HES-exchange (139%, 124/156) of circulating blood volume vs. 87% (68/94, p < .05), until Hb(crit) was reached (1.5 g/dL [1.4/2.1] vs. 2.4 g/dL [2.0/2.8], p < .05). At Hb 2.4 g/dL (i.e., Hb(crit) in group 0.21), animals of group 0.6 still presented with superior oxygen transport, tissue oxygenation, and hemodynamic stability. However, hemodynamic and oxygen transport variables were found deteriorated more severely at Hb 1.5 g/dL (i.e., Hb(crit) of group 0.6) compared with group 0.21 at Hb 2.4 g/dL. CONCLUSION: During cell-free volume replacement, hyperoxic ventilation with Fio2 0.6 generates a readily usable plasmatic oxygen reserve and thereby increases the tolerance toward acute normovolemic anemia.
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Anemia/metabolismo , Hemodilución/efectos adversos , Hemoglobinas/metabolismo , Terapia por Inhalación de Oxígeno , Oxígeno/sangre , Anemia/etiología , Anemia/fisiopatología , Animales , Pérdida de Sangre Quirúrgica , Volumen Sanguíneo , Hemodinámica , Consumo de Oxígeno , Estudios Prospectivos , Distribución Aleatoria , PorcinosRESUMEN
OBJECTIVE: To assess the reliability of dosing through two budesonide multidose dry powder inhalers (DPI) as derived from the in-vitro variability of the fine particle dose (FPD) and the in-vivo variability of the lung deposition at different flow rates. METHODS: The same two DPIs [device N (Novolizer) and device T (Turbuhaler)] were compared in both studies. In the in-vitro study, the variability of the FPD, measured at flow rates of 30-100 L/min, was determined for equal flow rates and at comparable maximal inspiratory pressures (MIP). In the in-vivo study in healthy subjects (scintigraphic, randomised, crossover design) the variability of the lung deposition was determined at targeted flow rates of 45, 60 and 90 L/min for device N, and at 60 L/min for device T. RESULTS: The variability of the FPD was lower with device N than with device T by 34%-86%. The differences were statistically significant for flow rates of 60, 70, 90 and 100 L/min (not significant for 40, 50 and 80 L/min) in the in-vitro study. Results for comparable MIPs showed analogous differences (79%, p = 0.004, at the clinically relevant MIP of 4.5 kPa). The variability of the lung deposition was clearly lower with the device N than with the device T. The difference was statistically significant (p = 0.029) at a comparable targeted flow rate of 60 L/min. CONCLUSIONS: Thus, this study showed that device N is likely to improve the reliability of inhalation therapy by reducing both the variability of the delivered drug and that of the lung deposition. The reliability of inhalation therapy and consequently the quality of long-term control of asthma and the patient's compliance might improve when choosing the DPI with the better characteristics.
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Broncodilatadores/administración & dosificación , Budesonida/administración & dosificación , Pulmón/metabolismo , Nebulizadores y Vaporizadores , Administración por Inhalación , Broncodilatadores/química , Broncodilatadores/farmacocinética , Budesonida/química , Budesonida/farmacocinética , Estudios Cruzados , Humanos , Tamaño de la Partícula , PolvosRESUMEN
OBJECTIVE: To evaluate the safety and efficacy of an enema formulation of alicaforsen, an antisense inhibitor of intercellular adhesion molecule, after 1, 3, and 6 months. METHODS: This was a randomised, placebo controlled, double blind, escalating dose multicentre study in 40 patients with mild to moderately active distal ulcerative colitis (disease activity index (DAI) 4-10). Patients were assigned to four dosing cohorts of 10 patients each (eight active, two placebo). Each patient received 60 ml of alicaforsen enema (0.1, 0.5, 2, or 4 mg/ml or placebo) once daily for 28 consecutive days. Safety and efficacy (DAI and clinical activity index) scores were evaluated up to six months after initiation of dosing. RESULTS: At day 29, alicaforsen enema resulted in dose dependent improvement in DAI (overall p = 0.003). Alicaforsen 4 mg/ml improved DAI by 70% compared with the placebo response of 28% (p = 0.004). Alicaforsen 2 and 4 mg/ml improved DAI status by 72% and 68% compared with a placebo response of 11.5% at month 3 (p = 0.016 and 0.021, respectively). Specifically, DAI improved from 5.6 to 1.6 and from 6.3 to 2.5 in the 2 and 4 mg/ml groups compared with placebo (7.5 to 6.1). None of the patients in the 4 mg/ml group compared with 4/8 placebo patients required additional medical or surgical intervention over baseline during the six month period after starting the enema treatment. The safety profile was favourable. CONCLUSIONS: Alicaforsen enema showed promising acute and long term benefit in patients with mild to moderate descending ulcerative colitis. Alicaforsen enemas had a favourable safety profile. These findings require verification in larger randomised controlled clinical trials.
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Colitis Ulcerosa/tratamiento farmacológico , Fármacos Gastrointestinales/uso terapéutico , Oligodesoxirribonucleótidos Antisentido/uso terapéutico , Tionucleótidos/uso terapéutico , Adulto , Relación Dosis-Respuesta a Droga , Método Doble Ciego , Enema , Femenino , Fármacos Gastrointestinales/administración & dosificación , Fármacos Gastrointestinales/efectos adversos , Humanos , Molécula 1 de Adhesión Intercelular/inmunología , Masculino , Persona de Mediana Edad , Oligodesoxirribonucleótidos Antisentido/administración & dosificación , Oligodesoxirribonucleótidos Antisentido/efectos adversos , Oligonucleótidos Fosforotioatos , Índice de Severidad de la Enfermedad , Tionucleótidos/administración & dosificación , Tionucleótidos/efectos adversos , Resultado del TratamientoRESUMEN
BACKGROUND: Pouchitis is the major long-term complication of ileal pouch-anal anastomosis for ulcerative colitis. The incidence of pouchitis is as high as 50% several years after surgery. Two-thirds of pouchitis patients suffer recurrence. Of those who recur, one-quarter suffer from chronic, unremitting pouchitis. Current treatments for this disorder are disappointing. AIM: To determine whether a topically administered enema formulation of ISIS 2302 (alicaforsen), an antisense inhibitor of intercellular adhesion molecule-1, can improve the clinical symptoms, endoscopic mucosal appearance and mucosal histology in patients with chronic, unremitting pouchitis, a disorder in which this molecule is over-expressed. METHODS: In an open-label, uncontrolled study, 12 patients with chronic, unremitting pouchitis were treated with 240 mg alicaforsen antisense enema nightly for 6 weeks. Clinical evaluation and endoscopy were performed at baseline and at weeks 3, 6 and 10. Pouchoscopy with biopsy was carried out at baseline and at weeks 6 and 10. The primary end-point was the reduction from baseline of the Pouchitis Disease Activity Index (PDAI) at week 6. Secondary end-points included the PDAI at week 10. Safety was evaluated by analysing the adverse events, vital signs and laboratory parameters. RESULTS: After 6 weeks of nightly alicaforsen enema, a statistically significant (n = 12, P = 0.001) reduction in the PDAI from baseline (11.42) to week 6 (6.83) was observed. Mean reductions in the endoscopy sub-score from baseline (5.25) to week 3 (3.08) and week 6 (2.58) were statistically significant (P = 0.0039 and P = 0.0005, respectively). The mean reductions in clinical symptom sub-score from baseline (3.75) to week 3 (2.33) and week 6 (2.25) were also statistically significant (P = 0.0156 and P = 0.0117, respectively). Ten of the 12 patients achieved a mucosal appearance score of 0 or 1 at endoscopy. Five of the 12 patients (42%) had a non-statistically significant decrease in the histology component of their PDAI from baseline to week 6. By week 6, seven of the 12 patients (58%) were in remission, as defined by PDAI < 7, with a mean decrease from baseline in PDAI score of six points. The alicaforsen enemas were well tolerated and no serious side-effects were noted. CONCLUSIONS: Antisense enema to intercellular adhesion molecule-1 is safe and well tolerated. In an open-label trial, it appeared to improve the PDAI score, clinical symptoms and endoscopic mucosal appearance. It may also improve the histology. In the light of the responses observed in this trial, a randomized, placebo-controlled trial is warranted.
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Fármacos Gastrointestinales/administración & dosificación , Molécula 1 de Adhesión Intercelular/metabolismo , Oligodesoxirribonucleótidos Antisentido/administración & dosificación , Reservoritis/tratamiento farmacológico , Tionucleótidos/administración & dosificación , Administración Rectal , Adolescente , Adulto , Anciano , Anastomosis Quirúrgica/efectos adversos , Colitis Ulcerosa/cirugía , Enema/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Oligonucleótidos Fosforotioatos , Reservoritis/etiología , Resultado del TratamientoRESUMEN
STUDY OBJECTIVES: To evaluate the chest radiographic filling pattern associated with partial liquid ventilation (PLV) with the perfluorochemical perflubron (LiquiVent; Alliance Pharmaceutical Corp; San Diego CA) as a function of dose and timing. DESIGN: Post hoc review of chest radiographs by three independent observers with correlation to clinical variables. SETTING: Phase II randomized, uncontrolled, prospective, multicenter clinical trial. PATIENTS: Sixteen adult patients with diffuse bilateral infiltrates consistent with acute lung injury and a PaO(2)/fraction of inspired oxygen (FIO(2)) ratio < 300 with positive end-expiratory pressure of 13 cm H(2)O and FIO(2) > or = 0.5. INTERVENTIONS: All patients were treated with either a 10-mL/kg or 20-mL/kg loading dose of perflubron followed by maintenance dosing at 3-h intervals to protocol-determined levels. RESULTS: There was a significant relationship between inhomogeneous radiographic filling during the first 48 h of treatment and the use of the lower loading dose of perflubron. Inhomogeneous radiographic filling (in 5 patients) was associated with a lower high-dose/FIO(2) ratio at 24 h compared with the remaining patients. These differences resolved by 48 h. There were no other statistically significant correlations identified. CONCLUSIONS: The radiographic appearance of PLV with perflubron appears to depend on the dose administered. Lower doses can be associated with both inhomogeneous radiographic filling and a transient deterioration in oxygenation during the first 24 to 48 h of treatment.
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Ventilación Liquida , Síndrome de Dificultad Respiratoria/diagnóstico por imagen , Síndrome de Dificultad Respiratoria/terapia , Adolescente , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , RadiografíaRESUMEN
Fat Watch was a four-year campaign carried out in cooperation with retailers and industry, aiming at a reduction of fat consumption by 10% among the Dutch population. Mass media and supermarkets were the main conveyers of the message. Supermarkets participated well in the first (53%) and in the third year (51%), but to a lesser extent in the second year (36%). Campaign awareness in the target group (household shoppers for food) was relatively high in the first year (60%), but dropped in the next two years (40% and 32%, respectively). Combined with prominent mass media messages and with promotional activities of food products by suppliers, supermarkets seem a good channel for dissemination of nutrition information. Fat Watch has proved that cooperation of governmental, industrial and retail organizations for several years with respect to nutrition education activities is possible in the Netherlands.
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Dieta con Restricción de Grasas , Grasas de la Dieta/efectos adversos , Conducta Alimentaria , Educación en Salud/organización & administración , Promoción de la Salud/organización & administración , Encuestas sobre Dietas , Humanos , Medios de Comunicación de Masas , Países Bajos , Evaluación de Procesos y Resultados en Atención de Salud , Evaluación de Programas y Proyectos de SaludRESUMEN
We introduce a multidimensional scaling procedure that attempts to derive a spatial representation of stimuli unconfounded by the effect of subjects' degrees of familiarity with these stimuli. The proposed model assumes that stimulus unfamiliarity produces a tendency for a subject to anchor his/her dissimilarity judgments towards a reference value on the response scale. The input data needed to perform such analyses are the degree of stimulus familiarity along with the dissimilarity judgments for all pairs of stimuli. In a Monte Carlo study, we investigate the extent to which the procedure recovers known parameters. Furthermore, empirical applications; of the model to positioning studies of magazines and banks in the Netherlands are provided.
RESUMEN
OBJECTIVE: A combined marginally deficient status of thiamin, riboflavin, vitamin B6 and vitamin C may affect physical performance, but the relative contribution of each vitamin can only be speculated. In a previous study we did not find any effect of restricted intake of vitamin C individually. Therefore, the functional effect of restriction of thiamin, riboflavin or vitamin B6, individually or in conjunction, was investigated. METHODS: A double-blind, 2 x 2 x 2 complete factorial experiment on the effects of thiamin, riboflavin and vitamin B6 restriction on physical performance was executed with 24 healthy men. During 11 weeks of low vitamin intake, the subjects were given a daily diet of regular food products providing no more than 55% of the Dutch Recommended Dietary Allowances (RDA) for thiamin, riboflavin and vitamin B6. Other vitamins were supplemented at twice the RDA level. RESULTS: In vitamin-restricted subjects, blood vitamin levels, erythrocytic enzyme activities and urinary vitamin excretion decreased and in vitro erythrocytic enzyme stimulation increased. Short-time vitamin restriction had no harmful effects on health. A significant overall decrease was observed in aerobic power (VO2-max; 11.6%), onset of blood lactate accumulation (OBLA; 7.0%) and oxygen consumption at this power output (VO2-OBLA; 12.0%), peak power (9.3%), mean power (6.9%) and related variables (p < 0.01). However, the observed performance decrements could not be attributed to marginal deficiency for any of the vitamins studied. CONCLUSION: The absence of vitamin-specific effects on performance decrements due to thiamin, riboflavin and vitamin B6 restriction suggests quantitatively similar but non-additive effects of these B-vitamins on mitochondrial metabolism.
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Aptitud Física/fisiología , Deficiencia de Riboflavina/fisiopatología , Deficiencia de Tiamina/fisiopatología , Deficiencia de Vitamina B 6/fisiopatología , Adulto , Método Doble Ciego , Metabolismo Energético/fisiología , Eritrocitos/enzimología , Prueba de Esfuerzo , Flavina-Adenina Dinucleótido/sangre , Humanos , Lactatos/sangre , Masculino , Mitocondrias/metabolismo , Consumo de Oxígeno/fisiología , Deficiencia de Riboflavina/sangre , Deficiencia de Riboflavina/orina , Deficiencia de Tiamina/sangre , Deficiencia de Tiamina/orina , Factores de Tiempo , Transcetolasa/sangre , Deficiencia de Vitamina B 6/sangre , Deficiencia de Vitamina B 6/orinaRESUMEN
The nutritional status (assessed by anthropometric indices, and biochemical and hematological variables in blood) of three groups of elderly women (aged > or = 65 years) was evaluated within the framework of the Dutch Nutrition Surveillance System. The groups were composed of women living in a nursing home (n = 51), women living in service flats and receiving their dinners from the nursing home kitchen (n = 29), and women living independently (n = 52). Mean blood levels of folate, pyridoxal 5'-phosphate, 25-hydroxyvitamin D, alpha-tocopherol, vitamin C, albumin, selenium and total cholesterol were significantly (p < 0.05) lower among nursing home women. Among these women a biochemical deficiency was frequently found for 25-hydroxyvitamin D (73%), pyridoxal 5'-phosphate (57%), vitamin C (38%), selenium (30%) and folate (28%). These nutritional risks were largely independent of each other. Since folate and pyridoxal 5'-phosphate were associated with several clinicochemical indicators, health status may be an important determining factor for this unfavorable situation. Low 25-hydroxyvitamin D concentrations were associated with limited exposure to ultraviolet radiation and nonusage of vitamin D supplements. We conclude that dietary intake variables are not the only determinants of a marginal nutritional status among nursing home women. Use of foods with a high nutrient density should be encouraged, whereas other preventive measures are needed to improve vitamin D status.
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Hogares para Ancianos , Casas de Salud , Estado Nutricional , Anciano , Deficiencia de Ácido Ascórbico/epidemiología , Calcifediol/deficiencia , Femenino , Deficiencia de Ácido Fólico/epidemiología , Estado de Salud , Humanos , Países Bajos , Fosfato de Piridoxal/deficiencia , Selenio/deficiencia , Deficiencia de Vitamina E/epidemiologíaRESUMEN
To assess the iodine supply in The Netherlands after the revision of the goiter prophylaxis measures (Bread Act of 1982, with an increase of iodine content of bread salt) the data of a nationwide survey among Dutch elderly people conducted in 1984/1985 were analysed. Iodide excretion in 24 h urine samples was used as the main iodine status indicator. The data were compared with data on iodine nutriture obtained among an elderly population in The Netherlands before the revision of goiter prophylaxis. High prevalences (greater than or equal to 37%) of low iodine excretion (less than 0.78 mumol/24 h; 100 micrograms/24 h) were found for Dutch elderly people. Mean urinary iodide excretion was 0.95 mumol/24 h (121 micrograms/24 h) for men and 0.79 mumol/24 h (100 micrograms/24 h) for women which is low, especially among women, in comparison with the United States recommended dietary allowance (118 mumol/day = 150 micrograms/day). Consistent positive associations of iodide excretion were found with urinary potassium and sodium excretion, bread consumption and total iodine intake. Bread, as the iodine carrier chosen for goiter prophylaxis in The Netherlands, was found to be the main dietary iodine source. No improvement in iodine nutrition was found among the elderly studied in 1984/1985 in comparison with an elderly population seen in 1981. Therefore, it is concluded that the present measures regarding goiter prophylaxis in The Netherlands might be of limited effectiveness.
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Bocio/prevención & control , Yodo/administración & dosificación , Yodo/orina , Anciano , Femenino , Alimentos Fortificados , Humanos , Masculino , Países Bajos , Encuestas NutricionalesRESUMEN
STUDY OBJECTIVE: The aim was to investigate whether dietary factors cluster in a favourable or unfavourable way and to characterise the groups identified by lifestyle and sociodemographic variables. DESIGN AND SETTING: This cross sectional study was based on data of the 1987-1988 Dutch national food consumption survey (DNFCS), obtained from a panel by a stratified probability sample of the non-institutionalised Dutch population. PARTICIPANTS: 3781 adults (1802 males and 1979 females) of the DNFCS, aged 19 to 85 years, were studied. MEASUREMENTS AND MAIN RESULTS: To estimate dietary intake two day food records were used. Lifestyle factors were collected by structured questionnaire and sociodemographic variables were available from panel information. Cluster analysis was used to classify subjects into groups based on similarities in dietary variables. Subsequently, these groups were characterised by sociodemographic and lifestyle factors as well as by the consumption of food groups. Eight clusters were found. In comparison with the guidelines, the dietary quality in four clusters was poor. The cluster with the poorest dietary intake (high intake of fat, cholesterol, and alcohol; low intake of dietary fibre) showed on average a high consumption of animal products (except milk), fats and oils, snacks, and alcoholic beverages, and a low consumption of fruit, potatoes, vegetables, and sugar rich products. Smoking, body mass index, dietary regimen on own initiative, hours of sleep, gender, age, socioeconomic status, and day of the week were found to discriminate among the clusters. CONCLUSIONS: Cluster analysis resulted in substantial differences in mean nutrient intake and seems useful for dietary risk group identification. Undesirable lifestyle habits were interrelated in some clusters, but an exclusive lifestyle for health risk has not been found.
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Dieta , Estilo de Vida , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Análisis por Conglomerados , Estudios Transversales , Registros de Dieta , Encuestas sobre Dietas , Ingestión de Energía , Alimentos , Humanos , Lactante , Persona de Mediana Edad , Países Bajos , Factores de Riesgo , Factores SocioeconómicosRESUMEN
To evaluate the iodine status of Dutch adults we used three different iodine status indicators, namely urinary 24-hour iodide excretion (I/24 h), iodide/creatinine ratio in 24-hour urine samples (I/Cr) and 24-hour iodide excretion per kilogram body weight (I/kg). Additionally, the habitual daily iodine intake was calculated. Men had higher mean I/24 h and mean iodine intake than women. No differences between men and women were found for mean I/Cr and mean I/kg. Relatively high (greater than or equal to 18%) prevalences of low values for the different iodine status indicators were found, especially for I/24 h. The intraindividual variance for all three indicators was high. Risk assessment regarding iodine supply, based on urinary iodide excretion, depends on the indicator used, and therefore caution is called for when drawing conclusions. Our results do not argue against the usage of I/24 h as iodine status indicator. More research is needed to solve the question whether iodine requirement depends on such factors as body size, body composition and physical activity.
Asunto(s)
Yodo , Estado Nutricional , Adulto , Peso Corporal , Creatinina/orina , Femenino , Humanos , Yoduros/orina , Yodo/administración & dosificación , Masculino , Persona de Mediana Edad , Países BajosRESUMEN
In this study the impact of the Dutch dietary guidelines diet on various health status parameters was examined. Twelve apparently healthy men aged 35-52 years were given both the guidelines diet (G) and the 'average' Dutch diet (D) in a controlled eight-week study period with a cross-over design. Compared with the D diet, the G diet contained less fat (accounting for 35 per cent vs 44 per cent of total energy intake), about half the amounts of saturated and monounsaturated fatty acids and twice the amount of polyunsaturated fatty acids. The G diet was given either as a high-sugar or as a low-sugar variant (25 per cent and 15 per cent of total daily energy intake, respectively). Serum total, LDL- and HDL-cholesterol decreased during the four-week G diet from 5.76 to 4.99, from 3.95 to 3.35 and from 1.13 to 1.03 mmol/l respectively. Also the apo-lipoprotein A-I, A-II and B concentrations decreased in subjects on the G diet. Blood pressure and body composition did not change significantly. Urinary pH and the excretion of sodium and potassium were significantly lower for the G diet. It is concluded that the combined factors in the Dutch guidelines diet, irrespective of amount of sugar, has favourable effects on total and LDL-cholesterol levels, whereas the decrease of the concentrations of HDL-cholesterol and of apo-A-I and A-II is less desirable. The changes in urinary mineral excretion, in particular of sodium, during the G-diet is considered as a positive effect.
Asunto(s)
Dieta , Estado de Salud , Adulto , Apolipoproteínas/sangre , Presión Sanguínea , Composición Corporal , HDL-Colesterol , LDL-Colesterol/sangre , Grasas de la Dieta/administración & dosificación , Humanos , Masculino , Persona de Mediana Edad , Natriuresis , Potasio/orinaRESUMEN
Insight into the occurrence of and the association between certain socio-economic variables and life-style characteristics is necessary for preventive nutrition and health policy. The prevalence of and the interdependencies among these variables were examined in 1930 men and 2204 women aged 19 to 85 who participated in the Dutch National Food Consumption Survey 1987-1988. Dietary data were based on a two-day record. The associations among discrete variables were analysed using log-linear models. Analysis of covariance was used to explore the effects of the aggregate socio-economic status (SES) on dietary intake and anthropometry, whereas differences in food intake and SES were assessed by the non-parametric test of Kruskal and Wallis. In comparison to subjects with a high SES in people with a low SES a higher proportion of smokers (48 vs 32 per cent) was observed, a higher prevalence of obesity (39 vs 28 per cent), a higher percentage of heavy coffee drinkers (greater than six cups per day, 23 vs 17 per cent), and more subjects who skipped breakfast (19 vs 11 per cent). In the highest SES class more subjects used nutritional supplements (18 vs 11 per cent), more subjects followed a dietary rule (five vs two per cent), such as a vegetarian diet, and a higher proportion used more than three alcoholic drinks per day (19 vs 15 per cent). A higher SES was associated with a lower fat intake, but the differences (expressed as per cent of energy intake) were rather small and even absent among women when the contribution of alcohol to energy was not taken into account. In general, dietary intake among subjects in higher SES groups tended to be closer to dietary recommendations. The results indicate that a lower SES is accompanied by a higher prevalence of several indicators of an unhealthy life-style.
Asunto(s)
Encuestas sobre Dietas , Estilo de Vida , Adulto , Anciano , Anciano de 80 o más Años , Antropometría , Escolaridad , Conducta Alimentaria , Femenino , Humanos , Modelos Lineales , Masculino , Persona de Mediana Edad , Países Bajos , Factores SocioeconómicosRESUMEN
Associations between blood pressure and nutrition-related variables (body mass index, dietary intake, and 24-hr excretion of sodium, potassium, magnesium, and calcium in the urine) were investigated in men (n = 138) and women (n = 117) 65-79 years old not using drugs known to affect blood pressure and not on a diet. Among men, body mass index was positively and creatinine clearance was inversely associated with systolic blood pressure, whereas body mass index and urinary sodium:potassium ratio were positively associated with diastolic blood pressure. Among women, both age and urinary calcium:creatinine ratio were positively associated with systolic as well as diastolic blood pressure. Coffee consumption was positively correlated with blood pressure and urinary calcium:creatinine ratio among the women. From the results it appears that, besides "normal" weight, increased potassium intake and urinary excretion may exert a protective effect among elderly men against hypertension when sodium exposure is relatively high. The positive association between urinary calcium:creatinine ratio and blood pressure among the women may be partly due to coffee consumption.
Asunto(s)
Anciano , Presión Sanguínea/fisiología , Fenómenos Fisiológicos de la Nutrición/fisiología , Análisis de Varianza , Índice de Masa Corporal , Calcio/orina , Creatinina/orina , Femenino , Humanos , Magnesio/orina , Masculino , Países Bajos , Vigilancia de la Población , Potasio/orina , Análisis de Regresión , Sodio/orinaRESUMEN
To assess the food intake and to evaluate the relationship between socioeconomic status (SES) and food consumption of northeastern Thai children a dietary survey was carried out among 108 urban and rural 3-8-year-olds in Sakon Nakhon province. Energy and nutrient intakes were assessed by the 24 hour recall method and calculated with local food consumption tables. Urban children consumed significantly more eggs and products containing animal proteins than rural children. In urban areas the percentage of users of meat, eggs, and fruit was significantly higher than in rural areas; fish was consumed more frequently in rural areas. As compared with the FAO/WHO RDA (Recommended Daily Allowances) all children showed a very inadequate supply of energy, calcium, iron (except urban children), vitamin A, thiamin, riboflavin, and niacin. The mean daily protein intake was almost equal to or higher than the calculated requirements. Children of lower socioeconomic background showed a lower fat intake, a lower contribution of fat to the energy intake, and a higher contribution of carbohydrates to the energy intake than children from families with a higher SES. This study shows that nutrient intakes far below recommended intakes are common among the examined northeastern Thai children and of a serious nature, and that much more emphasis needs to be given to increase the energy or food intake rather than the protein content of their grossly inadequate diets.