The limit of anemia tolerance during hyperoxic ventilation with pure oxygen in anesthetized domestic pigs.

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.

Safety and efficacy of two dose formulations of alicaforsen enema compared with mesalazine enema for treatment of mild to moderate left-sided ulcerative colitis: a randomized, double-blind, active-controlled trial.

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.

A phase II dose ranging, double-blind, placebo-controlled study of alicaforsen enema in subjects with acute exacerbation of mild to moderate left-sided ulcerative colitis.

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.

Bioavailability and therapeutic activity of alicaforsen (ISIS 2302) administered as a rectal retention enema to subjects with active ulcerative colitis.

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.

Variability of fine particle dose and lung deposition of budesonide delivered through two multidose dry powder inhalers.

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.

Dose-response relationships regarding vitamin B-6 in elderly people: a nationwide nutritional survey (Dutch Nutritional Surveillance System).

The dietary intake and biochemical status of vitamin B-6 in 476 apparently healthy Dutch elderly people (aged 65-79 y), who were not using drugs known to affect vitamin B-6 metabolism, were evaluated. Intake of vitamin B-6 per gram protein was related to biochemical data, namely plasma pyridoxal 5'-phosphate (PLP) and cofactor stimulation of aspartate aminotransferase in erythrocytes (AST-AC). Based on a cutoff point of 2.02 for AST-AC, approximately 9% of the elderly people not using vitamin B-6 supplements had a marginal vitamin B-6 status. About 7% were using vitamin B-6 supplements. Dietary intake of vitamin B-6 per gram protein was negatively related to AST-AC. Vitamin B-6 intakes per gram protein higher than 0.020 mg were necessary to ensure an AST-AC value less than 2.02. At high PLP values AST-AC hardly varied. The results seem to indicate a higher requirement of vitamin B-6 in elderly people than in younger adults.

Thiamin, riboflavin, and vitamins B-6 and C: impact of combined restricted intake on functional performance in man.

A double-blind study of combined restriction of thiamin, riboflavin, and vitamins B-6 and C was carried out with 23 healthy males. During 8 wk of low vitamin intake, 12 deficient subjects consumed daily a diet of normal food products, providing maximally 32.5% of the Dutch Recommended Dietary Allowances (RDA) for thiamin, riboflavin, vitamins B-6 and C. Other vitamins were supplemented at twice the RDA. Eleven control subjects consumed the same diet but with a supplementation of twice the RDA of all vitamins. In deficient subjects blood vitamin levels, urinary vitamin excretion, and erythrocytic enzyme activities decreased; in vitro enzyme stimulation increased. Vitamin depletion had no ill effects on health, physical activity, and mental performance. A significant decrease was observed in aerobic power (VO2max) and onset of blood lactate accumulation (p less than 0.001) of 9.8 and 19.6%, respectively. A combined restricted intake of thiamin, riboflavin, and vitamins B-6 and C causes a decrease in physical performance within a few weeks.

Vitamin A intervention: short-term effects of a single, oral, massive dose on iron metabolism.

A group of 134 school children aged 3-9 y, with signs of conjunctival xerosis, from the rural area of the Sakorn Nakhon province in Northeast Thailand were selected for a controlled study on the short-term effect (2 wk) of a single, oral high dose of vitamin A on iron metabolism. After collection of the baseline data, children within villages were randomly assigned to receive the capsules (n = 65) or serve as control subjects (n = 69). Two weeks after supplementation significant increases of retinol, retinol-binding protein, hemoglobin, hematocrit, serum iron, and saturation of transferrin were found in the supplemented group. Ferritin concentrations did not change significantly. These short-term changes completely exclude seasonal effects and change in morbidity. This study provides further evidence of a causal association between vitamin A and iron metabolism. In areas where vitamin A deficiency is endemic, periodic massive vitamin A dose programs can also improve iron status of the population.

Iron metabolism and vitamin A deficiency in children in northeast Thailand.

To investigate the association between vitamin A and iron metabolism, two studies were carried out: a cross-sectional study and an intervention trial. The cross-sectional analysis was carried out in 1060 children aged 1-8 y. Multiple-regression analysis was used to adjust for effects of age, gender, indices of the protein nutritional status, and infections. Retinol was significantly associated with hematocrit, serum Fe, transferrin, ferritin, and saturation of transferrin (%ST). To obtain further evidence as to whether this observed association is a causal one, an intervention trial was carried out. After collection of the baseline data of 300 children, 166 children with a hemoglobin concentration less than 7.5 mmol/L were selected. A random sub-sample of 78 children received vitamin A capsules; the other children served as control subjects. Two months after supplementation significant differences, adjusted for age, were found for retinol, retinol-binding protein, serum Fe, and %ST between the supplemented and the control group. After 4 mo none of the indices were found to be significantly different between the supplemented and the control group. Periodic massive doses of vitamin A may play a role in improving the Fe status as well.

Effects of moderate alcohol consumption on platelet function, tissue-type plasminogen activator and plasminogen activator inhibitor.

Short-term effects of moderate alcohol consumption on platelet function, tissue-type plasminogen activator (t-PA) and plasminogen activator inhibitor (PAI) were studied in two age groups of volunteers (20-30 and 45-55 years), each consisting of eight healthy males. The alcohol (30 g in red port and wine) was consumed during a standard dinner. Two blood samples were drawn: one in the postprandial phase, and one the next morning after fasting overnight. Alcohol consumption tended to increase platelet aggregation and production of hydroxy fatty acids, reduced plasma t-PA activity and increased PAI activity in the postprandial phase. After the overnight fast the effects on t-PA and PAI had disappeared whereas at that time alcohol consumption tended to decrease platelet function. The effects of alcohol on t-PA and PAI activity appeared mainly in the older age group, whereas the t-PA activity in this group was already much lower, irrespective of alcohol consumption.

An enema formulation of alicaforsen, an antisense inhibitor of intercellular adhesion molecule-1, in the treatment of chronic, unremitting pouchitis.

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.

Clinical correlation with changing radiographic appearance during partial liquid ventilation.

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.

Prolonged survival in an adult with cystic fibrosis.

Cystic fibrosis in patients over 40 is rare. We report a 52-year-old woman in whom cystic fibrosis was confirmed by sweat analysis. This patient represents the oldest cystic fibrosis patient (with confirmatory sweat chlorides) ever described. We conclude that any patient with the appropriate clinical presentation, regardless of age, should be investigated for cystic fibrosis.

Effects of moderate alcohol consumption on platelet aggregation, fibrinolysis, and blood lipids.

To investigate the effect of moderate alcohol consumption on blood constituents related to cardiovascular disease, 12 male volunteers consumed (instead of their usual alcoholic drinks) four different standardized amounts of red wine in addition to their habitual diet. Each dose was given to the subjects during a period of 5 weeks in a randomized order, all subjects receiving the four doses. They consisted of 0, 2, and 4 glasses/d, providing 0, 23, and 46 g alcohol/d as well as in "binge drinking" (14 glasses in the weekend, comparable to an average of 2 glasses/d). The results showed a clear dose-related response to the drinking for several blood constituents. Most marked was a decrease in the tissue-type plasminogen activator activity and to a lesser degree an increase in plasminogen levels. Collagen-induced platelet aggregation was reduced, affecting all parameters measured. Levels of HDL3-cholesterol, gammaglutamyltransferase, and urate showed a small but significant increase. No change was noted in the levels of alkaline phosphatase, alanine-aminotransferase, aspartate-aminotransferase, bile acids, folate, fibrinogen, the ADP-induced platelet aggregation, platelet secretion, or in hematologic values. The results are only partially in accordance with the presumed protective action of moderate drinking on the cardiovascular system and show a stronger response to the consumption of alcohol in coagulation and fibrinolysis factors than in blood lipids.

Clustering of dietary variables and other lifestyle factors (Dutch Nutritional Surveillance System).

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.

Iodide excretion before and after revision of goiter prophylaxis (Dutch Nutrition Surveillance System).

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.

Food preferences and aversions and dietary pattern in anorexia nervosa patients.

Food intake, meal frequency and occurrence of vomiting and purging were assessed in 20 female patients with anorexia nervosa (AN) by two dietitians by means of a dietary history over the past month. Ten lean healthy women and 10 of normal weight served as two groups of controls. Two self-administered questionnaires, consisting of 51 questions each were developed and applied: one to get an insight into food preference and food aversion, another to evaluate the dietary pattern. A significant difference in energy intake was found between the patient group and both control groups, but not between the two control groups. Self-induced vomiting and weekly laxative use was only mentioned by the patients with AN. Between the patients and the controls significant differences were found in preference and aversion for several food products such as sugar, potatoes, meat, dates and bananas as well as in eating habits. Stepwise discriminant analysis of the data of the two questionnaires resulted in eight food items and three dietary pattern statements which specify group differences. It is concluded that the questionnaires used reveal important differences between anorexia patients and control subjects in attitudes towards foodstuffs, and can be a useful tool for early diagnosis when validated in larger samples of patients and controls.

Vitamin D status, parathyroid hormone and sunlight in Turkish, Moroccan and Caucasian children in The Netherlands.

At the end of the winter circulating concentrations of 25-hydroxyvitamin D (25-OHD) in Asian and Mediterranean immigrants in northwestern European countries are usually very low. This may lead to vitamin D deficiency and eventually to rickets. Children are more prone to develop vitamin D deficiency. The vitamin D status of 8-year-old Turkish, Moroccan and Caucasian children was assessed by measuring plasma concentrations of 25-OHD and parathyroid hormone (PTH) and related to the cumulated global sun radiation (CGSR). The study population was selected from school children in The Hague and Rotterdam (The Netherlands). In each city blood samples were examined from 40 migrant children and a Caucasian reference group (n = 40) (matched for age and sex). Children in The Hague were examined at the end of the winter and early spring (February/April) and those in Rotterdam in late spring and early summer (May/June). Mean plasma 25-OHD concentrations for the migrant children in both cities were significantly lower than for the Caucasian reference group. The lowest 25-OHD values were measured in migrant children in The Hague: 42 per cent of the Turkish and 23 per cent of the Moroccan children had plasma levels less than 20 nmol/l. In these groups hyperparathyroidism (PTH greater than 85 pmol/l) was significantly more prevalent. With all pooled data a significant correlation between plasma 25-OHD and PTH was observed (r = -0.24; P less than 0.001). Regression analysis indicated that the relationship between both variables did not differ among the three ethnic groups. As expected, 25-OHD concentrations were higher for increased CGSR. Differences in 25-OHD level are mainly explained by differences in skin pigmentation and calcium intake between Mediterranean and Caucasian children. The secondary hyperparathyroidism observed in some children confirms that migrant children have a higher risk of developing nutritional rickets when living in areas with a moderate climate.

Dutch dietary guidelines: impact on blood lipids, blood pressure, body composition and urinary mineral excretion of Dutch middle-aged men.

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.

Diet and other life-style factors in high and low socio-economic groups (Dutch Nutrition Surveillance System).

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.