EFFICACY OF A LIPID-LOWERING DIET ON KEY FATTY ACID RATIOS AND OMEGA-3 INDEX IN HYPERLIPIDEMIC SUBJECTS.

Polyunsaturated fatty acid (PUFA) dietary intake, status and serum key fatty acid (FA) ratios may aid in cardiovascular disease-related risk assessment. The aim of this study was to investigate the effects of lipid-lowering diet on key FA ratios in serum phospholipids and omega-3 index in erythrocyte phospholipids in moderately hyperlipidemic subjects. The study included 41 subjects, mean age 56±6 years. Nutritional habits were evaluated by food frequency questionnaire. Participants followed lipid lowering diet for 12 weeks. Energy intake of omega-6 and omega-3 FA was changed from 7.6% and 0.6% to 5.7% and 1.2%, respectively. Marked decrease in four FA ratios in serum phospholipids, i.e., omega-6/omega-3, arachidonic acid (AA)/eicosapentaenoic acid (EPA), AA/docosahexaenoic acid (DHA), AA/(EPA+DHA) and omega-3 index (EPA+DHA) was found in study subjects after lipid-lowering diet. Total cholesterol/high-density lipoprotein (HDL), low-density lipoprotein (LDL)/HDL and triacylglycerol/HDL-cholesterol ratios positively correlated with all FA ratios, and negatively correlated with total omega-3 levels in serum phospholipids and omega-3 index in erythrocytes. Total serum omega-3 levels showed strongest association with lipoprotein ratios and positive correlation with homeostatic model assessment (HOMA) index. In conclusion, lipid-lowering diet resulted in decreased serum key FA ratios, increased omega-3 levels, and improved insulin sensitivity that may lead to a lower risk of cardiovascular disease in subjects with moderate hyperlipidemia.

Work motivation and job satisfaction of health workers in urban and rural areas.

Background/Aim: Motivated and job satisfied health professionals represent a basis of success of modern health institutions. The aim of this study was to investigate whether there was a difference in work motivation and job satisfaction between health workers in urban and rural areas in the region of Central Serbia. Methods: The study included 396 health professionals from urban setting, and 436 from a rural area, employed in four randomly selected health facilities. An anonymous questionnaire was used for data gathering. Statistical analysis was performed using χ2, Student t-test, Spearman's correlation coefficient, and logistic regression analysis. Results: Urban health professionals were significantly more motivated and job satisfied than respondents from rural area. In relation to work motivation factors and job satisfaction of health professionals in urban and rural areas, there were no significant differences in working conditions and current equipment, and in terms of job satisfaction there were no significant differences in relation to income either. Conclusion: In order to increase the level of work motivation and job satisfaction of health workers in rural areas, apart from better income, they should get more assistance and support from their supervisors, and awards for good job performance; interpersonal relationships, promotion and advancement opportunities, managerial performance and cooperation at work should be improved; employment security should be provided, as well as more independence at work, with professional supervision of health workers.

[The relationship between C-reactive protein and subclinical carotid arteriosclerosis in military pilots].

BACKGROUND/AIM: Inflammation plays a key role in the physiopathology of arteriosclerosis. C-reactive protein (CRP) and common carotid artery intima-media thickness are independent predictors of cardiovascular events and diabetes mellitus in apparently healthy men, but relationship between them is not fully elucidated. The aim of the study was to assess the cross-sectional relationship between CRP and cardiovascular risk factors with common carotid artery intima-media thickness in military pilots as representatives of healthy men. METHODS: We studied 161 military pilots (age 38 +/- 6 years) free of cardiovascular disease and diabetes mellitus. Traditional and metabolic risk factors were determined. Plasma CRP was measured by immunonephelometry. The common carotid artery intima-media thickness was measured by ultrasonography in the posterior wall of both common carotid arteries. RESULTS: A total of 66.5% subjects had common carotid artery intima-media thickness > 0.9 mm (p < 0.01). The mean CRP plasma concentration was significantly higher in the subjects with common carotid artery intima-media thickness > 0.9 mm than in those with common carotid artery intima-media thickness < or = 0.9 mm. In a simple regression analysis age adjusted CRP was associated with common carotid artery intima-media thickness (beta = 0.285, p < 0.01), and only high density lipoprotein cholesterol was not associated with common carotid artery intima-media thickness. The association between CRP and common carotid artery intima-media thickness remained highly significant after controlling for body mass index, blood pressure, total cholesterol, low density lipoprotein cholesterol, triglycerides, glycosylated hemoglobin and smoking (p < 0.01). Controlling for glucose, triglycerides to high density lipoprotein cholesterol ratio, and total cholesterol to high density lipoprotein cholesterol ratio resulted in some reduction in the strength of the association, but including waist circumference in the regression made the relationship no longer significant (p = 0.119). Body mass index (beta = 0.352; p < 0.01), total cholesterol to high density lipoprotein cholesterol ratio (beta = 0.334; p < 0.01) and age (beta = 0.190; p = 0.036) were the independent predictors of common carotid artery intima-media thickness. CONCLUSIONS: In the studied group of healthy men CRP per se is not an independent predictor of early arteriosclerosis, and may mediate the effect of certain traditional risk factors, especially visceral obesity, on promoting aterogenesis.

[Effect of acclimation on changes in water and electrolyte homeostasis in soldiers during exertional heat stress].

BACKGROUND/AIM: Exertional heat stress is a common problem in military services. The aim of this study was to exemine changes in body water and serum concentrations of some electrolites in soldiers during exertional heat stress (EHST), as well as effects of 10-day passive or active acclimation in a climatic chamber. METHODS: Forty male soldiers with high aerobic capacity, performed EHST either in cool (20 degrees C, 16 degrees C WBGT-wet bulb globe temperature), or hot (40 degrees C, 25 degrees C WBGT) environment, unacclimatized, or after 10 days of passive or active acclimation. The subjects were allowed to drink tap water ad libitum during EHST. Mean skin (Tsk) and tympanic (Tty) temperatures and heart rates (HR) measured physiological strain, while sweat rate (SwR), and serum concentrations of sodium, potassium and osmolality measured changes in water and electrolite status. Blood samples were collected before and immediately after the EHST. RESULTS: Exertional heat stress in hot conditions induced physiological heat stress (increase in Tty, HR, and SwR), with significant decrease in serum sodium concentration (140.6 +/- 1.52 before vs. 138.5 +/- 1.0 mmol/l after EHST, p < 0.01) and osmolality (280.7 +/- 3.8 vs. 277.5 +/- 2.6 mOsm/kg, p < 0.05) in the unacclimatized group. The acclimated soldiers suffered no such effects of exertional heat stress, despite almost the same degree of heat strain, measured by Tty, HR and SwR. CONCLUSION: In the trained soldiers, 10-day passive or active acclimation in a climatic chamber can prevent disturbances in water and electrolitic balance, i.e. decrease in serum sodium concentrations and osmolality induced by exertional heat stress.

[Influence of orlistat therapy on serum insulin level and morphological and functional parameters of peripheral arterial circulation in obese patients].

BACKGROUND/AIM: Insulin resistance is related to accelerated atherosclerosis, whereas weight loss is associated with the increasing insulin sensitivity, the improvement of functional and the morphological parameters of arterial circulation, and the reduction of cardiovascular morbidity and mortality. The aim of our study was to evaluate the influence of orlistat treatment on serum insulin level and functional and morphologic parameters of peripheral arterial circulation. METHODS: We conducted a prospective, randomized, double - blind, placebo - controlled study. Thirty patients with body mass index over 30 kg/m2 normotensive, nonsmokers, without clinically manifested cardiovascular disease or diabetes were randomly assigned either orlistat (120 mg, 3 times daily; n = 20) or placebo (n = 10) in a double - blind manner. All of the patients were on individually calculated hypocaloric diet. The follow-up period was 24 weeks. Arterial pressure, fasting serum glucose and insulin level, triglycerides, total cholesterol and low density lipoprotein-cholesterol were determined at the beginning, following 3 and 6 months. Also, the intima - media thickness of right superficial femoral artery and the mean blood flow velocity were determined with ultrasonography. RESULTS: Inside the period of 3 and 6 months, there were the greater reductions of body mass index, arterial pressure, fasting glucose and insulin level, total cholesterol, low density lipoproteins, as well as the greater reductions of mean velocity blood flow and peripheral pulse pressure in the orlistat group vs the placebo group (p < 0.01). Greater reductions in the waist circumference and intima - media thickness were registered following 6 months in the orlistat vs the placebo group (p < 0.01). CONCLUSION: In the group of obese patients orlistat therapy reduced risk factors, serum insulin level and improved early arterial functional changes as assessed with the reductions of the mean velocity blood flow and peripheral pulse pressure following 3 months. The regression of morphological changes, as assessed with the reduction in intima - media thickness, was feasible over the six - month period.

[Cigarette smoking in military pilots and intima-media thickness of the carotid arteries].

BACKGROUND: It is well known that smoking is associated with an increase in arterial wall thickness. However, most studies of this problem have been undertaken in age and sex heterogenous groups, as well as in patients with already present other conventional risk factors. The aim of this study was to assess the effect of cigarette smoking on arterial wall thickness of the common carotid artery in asymptomatic pilots. METHODS: The imaging of intima-media thickness of the posterior wall of the distal 1 cm of both common carotid arteries was performed using a B mode ultrasound device, in 39 pilots (37.05 +/- 6.66 years), for whom smoking was the single cardiovascular risk factor. Comparisons were made with 49 non-smokers (35.12 +/- 7.39 years). RESULTS: The posterior walls of both common carotid arteries were thicker in smokers (left, p < 0.05; right, p > 0,05). Intima-media thickness was significantly lower on the right side than on the left side in both smokers and non-smokers (p < 0.01). CONCLUSION: Cigarette smoking as the single cardiovascular risk factor was associated with the wall thickness of the carotid arteries in our study. This finding indicated that early atherosclerosis was already present in pilots-smokers entering middle age.