Diet and reproductive hormones: a study of vegetarian and nonvegetarian postmenopausal women.

In comparison with matched nonvegetarian women, postmenopausal vegetarian women were found to have lower urinary levels of estriol and total estrogens, lower plasma prolactin levels, and higher plasma sex hormone-binding globulin (SHBG) levels. These differences were not explained by differences in body weight or obesity. Plasma SHBG levels were highly correlated with plasma high-density lipoprotein cholesterol levels, which were also higher in vegetarians than in nonvegetarians. These hormonal differences may explain the lower rates of endometrial and possibly breast cancer that have been observed previously in vegetarian women.

Fish oil-induced changes in apolipoproteins in IDDM subjects.

The aim of this study was to examine the effect of Max EPA (a commercially available fish oil preparation) on serum cholesterol lipoproteins and apolipoproteins in insulin-dependent diabetic (IDDM) men with dosages that were likely to be acceptable to patients. Twenty-two male IDDM patients aged 20-41 yr, 6 of whom had retinopathy, were recruited from the Royal Perth Hospital diabetic clinic. After screening, subjects were divided into three groups. Six of the subjects without retinopathy were randomly selected and allocated to a control group. The remaining 16 patients (10 without and 6 with retinopathy) received a fish oil supplement. All subjects were advised to maintain their usual dietary patterns. Sixteen patients, including the 6 with retinopathy, were instructed to take 15 Max EPA fish oil capsules/day with meals. Patients in the control group did not take Max EPA. Three weeks of Max EPA supplementation without other dietary modification led to a significant rise in total cholesterol (P less than 0.01), which could be accounted for by increases in low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol. The increase in HDL cholesterol was explained by a 33% rise (P less than 0.001) in its HDL2 subclass. Changes in apolipoproteins were examined and showed that the level of apolipoprotein A-I increased after ingestion of fish oil and correlated significantly (P less than 0.05) with the rise in HDL cholesterol.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of alcohol and caloric restrictions on blood pressure and serum lipids in overweight men.

We have examined the independent and combined effects on blood pressure and blood lipids of alcohol restriction and weight loss in overweight male drinkers with a view to assessing overall effects on cardiovascular risk of two widely promoted nonpharmacological approaches for hypertension. Eighty-six men with a mean age of 44.3 years, a mean regular alcohol intake of 440 ml/wk (five or six standard drinks per day), a mean blood pressure of 137.4 mm Hg systolic and 84.8 mm Hg diastolic, and a mean body mass of 92.5 kg entered a controlled two-way factorial study. The subjects were randomly assigned to four groups for an 18-week intervention in which members of two groups drank only low-alcohol beer, thereby reducing their alcohol intake by 374 ml/wk, while those of the other two groups continued their normal alcohol intake. Within the low and normal alcohol intake groups subjects either continued their usual diet or reduced their caloric intake by 4,200-6,300 kJ/day (1,000-1,500 kcal/day) (with protein, fat, and carbohydrate provided as 15%, 30%, and 55% of total calories, respectively). Calorie reduction and alcohol restriction caused weight losses of 7.5 (p less than 0.001) and 2.1 (p less than 0.01) kg, respectively. Calorie reduction and alcohol restriction were associated with decreases in systolic blood pressure of 5.4 (p less than 0.001) and 4.8 (p less than 0.01) mm Hg, respectively, and in diastolic blood pressure of 4.2 (p less than 0.001) and 3.3 (p less than 0.01) mm Hg, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of a lacto-ovo vegetarian diet on serum concentrations of cholesterol, triglyceride, HDL-C, HDL2-C, HDL3-C, apoprotein-B, and Lp(a).

The effect of intervention with a lacto-ovo vegetarian diet on serum concentrations of cholesterol, triglyceride, total high-density lipoprotein cholesterol (HDL-C), HDL2-C, HDL3-C, low-density lipoprotein cholesterol, apoprotein-B, apoprotein-HDL, and Lp(a) was studied in 19 men and 17 women. Most weekday meals were obtained from a single source and dietary records were completed to assess the changes in nutrient intakes. Blood was collected in the 6th wk of each dietary period. Because of strong correlations between many of the changes in nutrient intakes, principal component (factor) analysis was used followed by stepwise multiple regression analysis to identify associations between changes in diet and changes in lipid, lipoprotein or apoprotein levels. Three principal components accounted for 92.0% of the variation in lipid levels: factor 1 represented an increase in saturated fat, total fat, monounsaturated fat, cholesterol, and energy intake: factor 2 represented an increase in fiber and polyunsaturated fat, and decrease in protein intake; factor 3 an increase in total carbohydrate, complex carbohydrate, and energy intake. Where a change in a variable was significantly associated with change in diet, one factor appeared primarily responsible for the change; total cholesterol (factor 2, p = 0.034); triglyceride (factor 3, p = 0.005); apo-HDL (factor 1, p = 0.014); HDL2-C (factor 2, p = 0.023), HDL3-C (factor 3, p = 0.015). A borderline significant association was seen for total HDL-C (factor 2, p = 0.055).

Physical fitness and plasma HDL cholesterol concentrations in male business executives.

Endurance fitness has been measured objectively (physical work capacity at pulse rate of 170/min W170) in a group of middle-aged executives, and related to a number of other physical characteristics and aspects of coronary risk status: FEV1, blood pressure, adiposity smoking habit, alcohol consumption, plasma levels of total and non-high density lipoprotein cholesterol, triglyceride and high density lipoprotein cholesterol (HDL-C). The primary question was whether HDL-C levels could be shown to be related to endurance fitness levels over the range encountered in a fairly homogeneous population and hence whether there could be value in terms of lipid coronary risk status in encouraging a moderate increase in physical activity. HDL-C levels were significantly related to W170. Fitness also separated the subjects in terms of adiposity, but not in terms of the other variables studied. Even though the trend was toward an index of physical activity being able to separate the subjects in terms of HDL-C, this was not as clear-cut as the division in terms of endurance fitness. Alcohol and smoking were associated with higher triglyceride levels, but not with HDL-C. The variables mid-abdominal skinfold thickness, triglyceride, non-HDL-C and endurance fitness accounted for 53% of the variation in HDL-C levels in this population. Alterations in the levels of these probably related variables might be expected to have appreciable effects on levels of HDL-C.

An examination of the effect of combined cyclical hormone replacement therapy on lipoprotein(a) and other lipoproteins.

Lipoprotein(a) (Lp(a)) is an independent marker of cardiovascular disease which is relatively unresponsive to treatment with most of the commonly prescribed lipid lowering drugs. Concentrations of Lp(a) increase after the menopause, and the primary aim of this study was to determine whether combined hormone replacement therapy was effective in lowering levels of Lp(a) in postmenopausal women. An open longitudinal study was conducted among 42 women who had undergone a spontaneous menopause and were attending the outpatient clinic of the Prince of Wales Hospital, Hong Kong. All subjects were treated with 2 mg oral estradiol daily and 5 mg medroxyprogesterone acetate for 12 days each calendar month. Fasting blood samples for lipoprotein measurement were taken before the commencement of treatment and at 6 and 12 months. Lp(a) levels showed a skewed distribution with a median value before treatment of 9.45 mg/dl (range 1.47-95.62 mg/dl). After 6 months, there was a reduction to 7.70 mg/dl (1.12-72.59 mg/dl) (P < 0.01), and after 12 months the median concentration was 7.14 mg/dl (0.63-69.23 mg/dl) (P < 0.001 0-12 months). There were also significant reductions in the concentrations of apo B from 116.13 to 111.62 mg/dl and LDL-C from 3.02 to 2.74 mmol/l (P < 0.05), plus a lowering of TC of borderline significance. Apo A-I increased from 162.56 to 173.35 mg/dl (P < 0.01), but there were no significant changes in HDL-C or the HDL-C subfractions. TC, LDL-C, apo B and TG concentrations were higher and HDL-C and HDL2-C concentrations were lower when blood was sampled during combined treatment with estrogen and progesterone than when estrogen was being taken alone. Levels of Lp(a) were also lower during the estrogen only phase of treatment, but none of these differences were statistically significant. This study demonstrates that combined cyclical hormone replacement therapy is effective in reducing concentrations of Lp(a). The trend towards a more atherogenic lipid profile during the combined phase of treatment suggests that attention should be given to the timing of blood sampling in future studies of this nature.

Effects of alcohol consumption on serum lipoprotein-lipid and apolipoprotein concentrations. Results from an intervention study in healthy subjects.

Serum levels of cholesterol, triglyceride, cholesterol in low density lipoprotein (LDL) and in high density lipoprotein (HDL) and its major subfractions, and of apolipoproteins A-I, A-II and B were measured in 48 healthy men at the end of two 6-week periods in which they consumed normal alcohol (5.0%, v/v) or low alcohol (0.9%, v/v) beer, respectively. Other dietary and behavioural variables were kept constant. Mean levels of triglyceride, HDL cholesterol, HDL2- and HDL3 cholesterol, and apolipoproteins A-I and A-II were higher at the end of the normal compared with the low alcohol periods, and levels of LDL cholesterol were lower. Body weight was greater at the end of the normal alcohol period than at the end of the period of low alcohol but multiple regression analysis suggested that the changes in lipoprotein-lipid and apolipoprotein levels were due primarily to the change in alcohol consumption rather than concomitant changes in body weight. This study confirms an effect of alcohol on both major subfractions of HDL and on its major apolipoproteins.

Plasma calcium and cortisol as predisposing factors to alcohol related blood pressure elevation.

Mechanisms by which alcohol consumption might cause hypertension were examined in 30 pairs of healthy drinking (greater than 275 g ethanol per week) and teetotal men closely matched for age and obesity. Both systolic and diastolic blood pressures were significantly higher in the drinkers. Plasma calcium levels correlated with diastolic blood pressures (r = 0.51, P = 0.004) in drinkers only. After adjusting for plasma albumin, diastolic pressures increased by 6.9 mmHg for each 0.1 mM increment of plasma calcium. It is proposed that regular alcohol consumption predisposes to hypertension by facilitating calcium accumulation in cells involved in blood pressure regulation. In the combined population of drinkers and teetotallers plasma cortisol correlated positively with diastolic pressure (r = 0.35, P = 0.012) and negatively with plasma potassium (r = -0.38, P = 0.006); this suggests a role for the pituitary/adrenal axis as a significant determinant of blood pressure differences between healthy subjects.

The combined effects of aerobic exercise and alcohol restriction on blood pressure and serum lipids: a two-way factorial study in sedentary men.

OBJECTIVES: To determine whether vigorous exercise and alcohol restriction have additive and independent effects in reducing blood pressure in sedentary male alcohol drinkers. Also to assess whether 4 weeks of vigorous exercise could offset the fall in high-density lipoprotein cholesterol (HDL-cholesterol) usually observed after alcohol restriction. DESIGN: Seventy-five sedentary men were randomly assigned to drink low-alcohol beer or continue their normal drinking habits. Within these two groups subjects were further assigned either to a vigorous exercise programme of three 30-min sessions a week of cycling at 60-70% of maximum workload or to a control light-exercise programme. RESULTS: Seventy-two subjects completed the trial. Alcohol consumption fell by 85% in the low-alcohol group. Fitness increased by 10% following vigorous exercise, with a significant improvement in maximum oxygen uptake. After adjustment for weight loss, a significant effect of alcohol restriction in reducing both systolic and diastolic blood pressure was demonstrated. There was no effect of vigorous exercise on blood pressure. Serum total cholesterol, low-density lipoprotein cholesterol and apolipoprotein B were not influenced by alcohol restriction or vigorous exercise. However, alcohol restriction significantly reduced triglyceride, HDL-cholesterol, its subfractions HDL2-cholesterol and HDL3-cholesterol, and its major apolipoproteins apo A-I and apo A-II. These reductions were unaffected by moderate exercise. CONCLUSIONS: This study provides further evidence that alcohol restriction results in reductions in blood pressure in men who are regular alcohol drinkers. However, a simultaneous increase in fitness did not lead to lower blood pressures than those achieved with alcohol restriction alone, and was unable to offset alcohol-related falls in HDL-cholesterol, its subfractions and its major apolipoproteins.

Effects of fluvastatin on lipid profile and apolipoproteins in Chinese patients with hypercholesterolemia.

The effects of fluvastatin treatment on lipid profile and apolipoproteins were assessed in a group of 31 Chinese patients with hypercholesterolemia, maintained on a constant low-fat diet. Some patients had the additional cardiovascular risk factors of hypertension and non-insulin-dependent diabetes mellitus, and 6 patients had familial hypercholesterolemia. Baseline lipid levels were measured after a 4-week placebo period, and these were repeated after 4 weeks of treatment with fluvastatin 20 mg daily, and after 4 weeks of treatment with fluvastatin 40 mg daily. Total cholesterol, low density lipoprotein cholesterol, and apolipoprotein (apo) B were each reduced to the same extent with the 2 doses of fluvastatin (-20%, -26%, and -20%, respectively). Triglycerides and very low density lipoprotein cholesterol were also reduced by about 12% with the 2 doses of fluvastatin. Apo A-I was increased by 7% and high density lipoprotein cholesterol (HDL-C) was increased by 10% with the 40 mg dose. The increase in HDL-C was due to increases in both HDL2-C (18%) and HDL3-C (7%). Lipoprotein(a) levels did not show any significant change with the 2 doses of fluvastatin in this short-term study. One patient developed reversible asymptomatic elevation of liver enzymes with the higher dose of fluvastatin; otherwise the drug was well tolerated and no patients had to be withdrawn from the study.

Pseudohyponatraemia, hypercholesterolaemia, and primary biliary cirrhosis.

A 62 year old woman with primary biliary cirrhosis was found to have a plasma sodium concentration of 115 mmol/l. Follow up showed this to be a "pseudohyponatraemia" due to a massively raised serum cholesterol concentration of 78 mmol/l. Electrophoresis of serum lipoproteins and of the lipoproteins and apolipoproteins in fractions isolated on density-gradient ultracentrifugation showed that the major portion of the serum cholesterol was being transported with lipoprotein-X. Low density lipoprotein-cholesterol concentration was also raised. Lipoprotein-X contained, in addition to albumin and apolipoprotein C, apolipoprotein E. This case is of interest because of the degree of hypercholesterolaemia, its association with pseudohyponatraemia, and the unequivocal demonstration of apolipoprotein E associated with lipoprotein-X.

IgD multiple myeloma with thoracic spine compression due to epidural extra-osseous tumour spread.

On initial presentation of a patient with IgD multiple myeloma there were no features to suggest an unusual variant. Two months later she developed spinal cord compression due to an IgD plasmacytoma. This complication of IgD myeloma has rarely been reported. During the course of the disease and using the routine laboratory protocol for investigating and identifying paraproteins, including IgD, the patient's results became indistinguishable from those in Bence-Jones proteinuria myeloma.

Relationship of plasma HDL-cholesterol to testosterone, estradiol, and sex-hormone-binding globulin levels in men and women.

The significance of sex hormone levels in determining variation in high-density lipoprotein cholesterol (HDL-C) concentrations was studied in healthy Seventh Day Adventists (vegetarians) and Mormons. These groups were selected to avoid the confounding effects of alcohol consumption and cigarette smoking on HDL-C concentrations. Multivariate analysis showed that testosterone has a strong negative association with HDL-C in men (t = 3.99, P less than 0.001) and women (t = 2.04, P less than 0.05) when controlled for other variables including the concentration of sex-hormone-binding globulin (SHBG). Sex-hormone-binding globulin showed an independent positive association with HDL-C in men (P less than 0.001) and women (P less than 0.001). We postulate that the sex hormones affect HDL-C levels by regulating the activities of two important enzymes involved in the production and catabolism of HDL, namely, lipoprotein lipase and hepatic endothelial lipase. Other factors contributing independently to variation in HDL-C levels in this study were, in men, age and triglyceride, and in women, apoprotein-HDL, triglyceride, systolic blood pressure, heart rate, body mass index, and triceps skinfold thickness. Plasma estradiol concentrations were not significantly associated in either sex.

Urinary excretion of testosterone and estradiol in Chinese men and relationships with serum lipoprotein concentrations.

Urinary excretion of total and free testosterone and estradiol was measured in 46 healthy Chinese men, along with serum concentrations of total testosterone and estradiol and the calculated free (unbound) concentrations. Associations with serum concentrations of total, low-density lipoprotein (LDL), high-density lipoprotein-2 (HDL2), and HDL3 cholesterol, apolipoproteins (apos) A-I and B, lipoprotein(a) [Lp(a)] were studied. Serum total and free testosterone concentrations were positively correlated with HDL and HDL2 cholesterol and apo A-I. Serum total and free estradiol levels showed borderline-significant negative associations with total and LDL cholesterol levels. Among urinary variables, total estradiol excretion was negatively associated with apo B levels and showed borderline-significant associations with total and LDL cholesterol. Adjustment for potential confounders, including age, body mass index (BMI), and waist to hip ratio (WHR), strengthened the associations between urinary total estradiol and serum total cholesterol, LDL cholesterol, and apo B. Urinary free estradiol showed a significant correlation with HDL3 cholesterol. Urinary excretion of total testosterone was significantly negatively associated with serum cholesterol and LDL cholesterol levels only after controlling for confounding variables. There were no significant associations between hormone variables and Lp(a) values. This study suggests that variation in sex hormone production accounts for some of the variation in serum lipid levels.

Comparison of diets supplemented with fish oil or olive oil on plasma lipoproteins in insulin-dependent diabetics.

This study was designed to compare changes in high-density lipoprotein (HDL)- and low-density lipoprotein (LDL)-cholesterol in normolipidaemic male insulin-dependent diabetics (IDD) following dietary supplementation with either the fish oil concentrate Max EPA or olive oil. The contribution of the small quantity of cholesterol in Max EPA to these changes was also examined. Twenty-seven subjects were matched in groups of three and randomly allocated to one of three treatment groups of nine subjects each. Subjects were given 15 1-g capsules of oil daily for 3 weeks, consisting of either Max EPA, olive oil, or olive oil to which was added the same amount of cholesterol as contained in Max EPA, respectively. There was a significant increase in eicosapentaenoic acid, and a decrease in arachidonic acid, in the platelet membrane phospholipids of subjects taking Max EPA. In this group, there was an approximately 30% increase in serum HDL2-cholesterol (0.59 +/- 0.07 to 0.77 +/- 0.11 mmol/L, mean +/- SEM; P less than .01) and a corresponding decrease in HDL3-cholesterol (0.79 +/- 0.03 to 0.71 +/- 0.03 mmol/L; P less than .05). Although total and LDL-cholesterol concentrations were also higher after Max EPA, the changes were not significant. Triglycerides were significantly decreased by Max EPA. There were no significant changes in lipids in the groups given olive oil. These results show that compared with olive oil, dietary supplementation with Max EPA substantially increases HDL2-cholesterol in insulin-dependent diabetics. This is most likely due to a selective effect of omega 3 fatty acids.(ABSTRACT TRUNCATED AT 250 WORDS)

Dietary fish oils increase serum lipids in insulin-dependent diabetics compared with healthy controls.

The effect of daily dietary supplementation with fish oil on serum lipids and platelet total phospholipid fatty acids was examined in male normolipidemic insulin-dependent diabetics and normal controls. They were given 15 g/d of fish oil as Max EPA (equivalent to 2.7 g/d of eicosapentaenoic acid) for 3 weeks. The diabetics showed a rise in total cholesterol, attributable to increases in LDL- and HDL-cholesterol. The increase in HDL-cholesterol was largely due to a rise in its HDL2 subclass. There was also a decrease in triglycerides in both groups. Similar changes in lipids were seen in the normal controls, although these were not significant. The more pronounced effect in diabetics suggests an altered metabolic response to omega-3 fatty acids in that disorder. However, the results indicate that the possible detrimental effect of the rise in total and LDL-cholesterol following fish oil may be offset by the increase in the protective HDL2 subclass.

Hyperhomocysteinaemia and premature coronary artery disease in the Chinese.

OBJECTIVES: To examine the prevalence of hyperhomocysteinaemia and compare it with the classic risk factors and vitamin status in Hong Kong Chinese patients with premature atherosclerotic coronary artery disease. DESIGN: Case-control study. SETTING: General hospital and community. SUBJECTS: Forty five patients (39 males) with significant coronary artery disease confirmed by angiography (32 post myocardial infarction) and 23 healthy volunteers (17 male), all aged less than 55 years. INTERVENTION: Standardised methionine-loading test. MAIN OUTCOME MEASURES: Coronary artery disease, risk factors. RESULTS: More patients than controls had fasting hyperhomocysteinaemia (10/45 v 2/23, P = 0.122), post-methionine hyperhomocysteinaemia (17/45 v 1/23, P = 0.008), and an abnormal response to methionine (15/45 v 1/23, P = 0.015). A history of smoking was more frequent in patients (3/23 v 25/45, P = 0.002). Sixteen of 17 patients with hyperhomocysteinaemia but only nine of 28 with normohomocysteinaemia were smokers (P = 0.0002). Fasting plasma cholesterol concentrations (mean (SD)) were higher in hyperhomocysteinaemic patients (6.41 (1.58) mmol/l) than in controls (5.53 (0.90) mmol/l) (P = 0.042). Serum vitamin B-12 was not reduced and serum folate was higher in hyperhomocysteinaemic patients (35 (4) nmol/l) than normohomocysteinaemic patients (26 (9) nmol/l) (P = 0.009). CONCLUSIONS: Although the prevalence of hyperhomocysteinaemia in Hong Kong Chinese is similar to that in white subjects, hyperhomocysteinaemia is not an independent risk factor for coronary artery disease and is associated with smoking. This may be of some consequence in view of the change to a more Western diet with more animal protein, and therefore methionine, coupled with a high frequency of cigarette smokers in this region. The causes of the hyperhomocysteinaemia are multifactorial but in this pilot study a deficiency of folate and/or vitamin B-12 did not seem to be one of them.

Validity of "corrected" calcium values.

Individual values for the regression of plasma total calcium on albumin vary by more than can be accounted for by analytical imprecision alone; the range (-x +/- 2 S.D.) being 0.004--0.031 mmol/g. Individual regression coefficients (R) are constant with time. Furthermore, a large proportion of individual R values differ from a general population regression by more than can be accounted for by analytical error. Three adjusted calcium reference ranges were derived from the data. Two employed constant correction factors, the general population R value (0.013 mmol/g) and the mean of the individual R values (0.018 mmol/g). The reference range which utilised each individuals' own R value was smaller and therefore potential more useful than the ranges using constant factors.

Relationships between age, body weight, physical fitness and sex-hormone-binding globulin capacity.

The associations between sex-hormone-binding globulin capacity (SHBG), age, body mass index (BMI), and physical fitness have been studied in 34 men and 36 women. Multivariate analysis was used to look for independent associations with SHBG. The data indicate that when controlled for a number of other factors SHBG levels are related, in men but not in women, to age (positively, p less than 0.001) and BMI (negatively, p less than 0.001).

The effect of 50 grams of glucose orally on a number of biochemical variables.

The values of a number of biochemical variables have been studied before and after a 50-gram load of glucose orally. Reductions which were statistically significant were found for sodium, potassium, urea, total protein, albumin, calcium, phosphorus, urate, bilirubin, alkaline phosphatase, but not for bicarbonate, creatinine, creatine kinase, lactate dehydrogenase, aspartate aminotransferase, cholesterol, triglyceride or chloride. The magnitude of the changes was generally not great, but could be clinically appreciable. The differences may need to be taken into account in comparing population studies.