Divergent thinking: strategies and executive involvement in generating novel uses for familiar objects.

Although the Alternative Uses divergent thinking task has been widely used in psychometric and experimental studies of creativity, the cognitive processes underlying this task have not been examined in detail before the two studies are reported here. In Experiment 1, a verbal protocol analysis study of the Alternative Uses task was carried out with a Think aloud group (N=40) and a Silent control group (N=64). The groups did not differ in fluency or novelty of idea production indicating no verbal overshadowing. Analysis of protocols from the Think aloud group suggested that initial responses were based on a strategy of Retrieval from long-term memory of pre-known uses. Later responses tended to be based on a small number of other strategies: property-use generation, imagined Disassembly of the target object into components and scanning of Broad Use categories for possible uses of the target item. Novelty of uses was particularly associated with the Disassembly strategy. Experiment 2 (N=103) addressed the role of executive processes in generating new and previously known uses by examining individual differences in category fluency, letter fluency and divergent task performance. After completing the task, participants were asked to indicate which of their responses were new for them. It was predicted and found in regression analyses that letter fluency (an executively loading task) was related to production of 'new' uses and category fluency was related to production of 'old' uses but not vice versa.

Inverse relationship between serum Lp(a) levels and first-phase insulin secretion.

Relationships between serum Lp(a) levels and insulin metabolism were investigated in 147 healthy nonobese men attending an executive health-screening program. Each subject received an IVGTT with measurement of plasma levels of glucose, insulin, and C-peptide. An inverse relationship was seen with the first-phase plasma insulin response when subjects were stratified into quartile ranges of the serum Lp(a) distribution. This relationship was supported by mathematical modeling analyses of these data, which revealed an inverse relationship between serum Lp(a) levels and first-phase pancreatic insulin secretion and plasma insulin responsiveness to glucose.

Effect of body mass index and fat distribution on insulin sensitivity, secretion, and clearance in nonobese healthy men.

The effects of variation in body mass index (BMI; kg/m2) and body fat topography on insulin sensitivity, secretion, and clearance were determined in a group of 146 nonobese nondiabetic males. Volunteers underwent an i.v. glucose tolerance test, with determination of plasma glucose, insulin, and C-peptide levels. BMI was taken as a measure of overall adiposity, while skinfold thickness ratios were used to assess the centrality of fat distribution and the localization of central fat within the trunk. Measurements of insulin sensitivity, secretion, and clearance were obtained by mathematical modelling of the i.v. glucose tolerance test concentration profiles. Increasing BMI and centrality of fat distribution had no significant effect on glucose tolerance, but were independently associated with diminished insulin sensitivity and increased insulin secretion. The elevation in secretion occurred almost entirely during the second phase of pancreatic insulin release. These results show that the variations in insulin sensitivity and secretion that have often been reported in obesity are also present in a group within the normal range of BMI. However, the absence of any decrease in hepatic uptake, also reported in the obese, indicates that this might be an additional mechanism recruited to maintain glycemic control at higher levels of adiposity. Localization of central fat in the lower trunk was correlated with elevated first phase insulin secretion, but no concomitant change in insulin sensitivity. There may, therefore, be a direct effect of the distribution of central fat on insulin secretion.

Insulin resistance, secretion, and metabolism in users of oral contraceptives.

Studies of insulin employing the oral glucose tolerance test demonstrate marked differences between the effects of different oral contraceptives, but provide little insight into the underlying disturbances. We investigated the metabolic basis of these disturbances by computer modelling of iv glucose tolerance test glucose, insulin, and C-peptide concentration profiles. Insulin resistance, secretion, and metabolism were evaluated in 296 oral contraceptive users and 95 nonusers. Four estrogen/progestin combinations, with similar estrogen but differing progestin contents, and 1 progestin-only formulation were studied. Effects on iv glucose tolerance test glucose, insulin, and C-peptide concentrations varied according to progestin content, with levonorgestrel-containing combinations having the greatest effect, followed by desogestrel and norethindrone. However, these formulations increased insulin resistance to a similar extent. The progestin-only formulation did not affect insulin resistance. Levonorgestrel combinations increased second phase pancreatic insulin secretion by 60-90%, but did not affect the insulin half-life. The desogestrel combination increased the insulin half-life by 28%, but did not affect insulin secretion. The effects of different combined oral contraceptives on glucose tolerance test glucose, insulin, and C-peptide concentration profiles appears to be due to a combination of estrogen-induced insulin resistance and progestin-associated changes in insulin half-life.

PIP: Results of intravenous glucose tolerance tests on glucose, insulin, and C-peptide in women using combined and progestin-only oral contraceptives were analyzed by several computer models to dissect the effects of the steroids on insulin resistance, secretion, ad clearance. 391 subjects used monophasic, triphasic, or progestin-only oral contraceptives containing ethinyl estradiol and levonorgestrel, desogestrel or norethindrone. They consumed 200 g carbohydrate daily for 3 days, then fasted 12 hours before being tested between pill cycle Day 15-21 or menstrual cycle Day 21-27. Results of IVGTTs were analyzed for net glucose elimination constant; minimal model of glucose disappearance, to estimate insulin resistance; minimal model of posthepatic insulin delivery, for 1st and 2nd phase insulin response, insulin elimination constant and half-life. Pancreatic insulin secretion modeling also gave the fractional hepatic insulin throughput index, and elimination constants for insulin and C-peptide. There were significant differences in duration of oral contraceptive use, parity and age among study groups. The levonorgestrel combination increased glucose, insulin and C-peptide areas, the desogestrel combination increased only glucose and insulin areas, and the norethindrone combination only the glucose area. All combined pills, but not the norethindrone progestin-only pill, reduced the glucose elimination constant. Combined pills reduced insulin sensitivity 30-40%. Desogestrel increased insulin concentrations at the zero and 20 minute points, while levonorgestrel raised insulin after 30-45 minutes lasting for the rest of the 180-minute test. Levonorgestrel combinations increased 2nd phase pancreatic insulin secretion 60-90%, but did not change insulin half-life. The desogestrel combination increased insulin half-life 28%, but did not affect insulin secretion. Orals did not affect the hepatic insulin throughput index. The results suggest that estrogen causes insulin resistance, while progestins modify the response. Thus, the effects of oral contraceptives on oral ad intravenous glucose tolerance is similar, while insulin half-life varies with the progestin. It may be prudent to look for better estrogens or alternative routes to prevent estrogen-associated insulin resistance in contraceptive users.

The evaluation of sodium valproate in the treatment of Nelson's syndrome.

It has previously been reported that sodium valproate (Epilim) lowers plasma ACTH levels in Nelson's syndrome. This report describes further experience with its use. Ten patients with Nelson's syndrome were treated with sodium valproate (600-1200 mg/day) for 5-32 weeks. Plasma ACTH was measured by cytochemical methods and RIA. Initial treatment for 5-12 weeks significantly (P less than 0.005) lowered plasma ACTH from a pretreatment mean of 2460 +/- 1870 ng/liter to 480 +/- 330 ng/liter, and the ACTH circadian rhythm was restored in two patients. On discontinuing treatment, plasma ACTH levels remained suppressed for 3 weeks and rose to pretreatment values in 5-12 weeks. Two patients' plasma ACTH levels failed to show a second response to treatment, while a third patient had a favorable second response to treatment over 32 weeks. In six patients, skin pigmentation lightened with treatment, and in one patient, a reduction in size of a pituitary microadenoma, demonstrated radiographically, occurred with treatment. gamma-Aminobutyric acid and sodium valproate were shown to be ineffective in inhibiting ACTH secretion from cultured pituitary tumor cells from a patient with Nelson's syndrome. The results show that sodium valproate is effective in some cases of Nelson's syndrome. We suggest that it reduces the hypersecretion of ACTH by enhancing gamma-aminobutyric acid function in the hypothalamus, thereby inhibiting the release of corticotropin-releasing factor.

Low density lipoprotein metabolism by cultured skin fibroblasts from atherosclerotic patients.

The aim of this study was to determine whether an abnormality in low density lipoprotein (LDL) metabolism could be demonstrated in fibroblasts cultured from normolipidaemic subjects with atherosclerosis. Seventeen male subjects aged 30-55 years with normal plasma lipid concentrations were divided into 2 groups on the basis of the presence or absence of proven coronary artery and/or peripheral vascular disease. LDL metabolism was assessed in cultured fibroblasts obtained from each of these subjects. After 6 h incubation with 125I-labelled LDL, it was found that binding, uptake and degradation of the lipoprotein were all significantly higher in cells from the atherosclerotic group of subjects than the controls. Variations in cellular LDL metabolism were also correlated with 4 risk factors for cardiovascular disease. Plasma LDL concentration in the atherosclerotic subjects was found to be inversely related to LDL binding and degradation. Subject age was inversely related to LDL degradation in both groups of subjects. No association was demonstrated in either group of subjects between LDL metabolism and glucose intolerance, or between LDL metabolism and cigarette smoking. It is concluded from these results that cellular LDL binding may constitute a factor in determining the rate of atheroma formation, which is independent of other cardiovascular risk factors.

Variation in serum lipid and lipoprotein levels associated with changes in smoking behaviour in non-obese Caucasian males.

A population of healthy male caucasians was analysed with respect to lipid and lipoprotein parameters, according to differences in current and previous smoking patterns. High density lipoprotein (HDL) cholesterol, and the HDL2 subfraction were significantly higher in non-smokers compared to current smokers. In ex-smokers, the levels of these 2 parameters increased with the length of time since giving up the habit, until levels were no longer distinguishable from non-smokers. A similar increase was observed for weight, although both triglyceride and very low density lipoprotein (VLDL) levels decreased. Low density lipoprotein (LDL) levels showed no significant variation in any of the comparisons. Lower alcohol consumption in both the ex-smokers, and in the non-smokers may account partially for the changes in triglyceride and VLDL, although the same observation is contrary to the effects observed in both HDL and HDL2.

The effect of cholestyramine on the faecal excretion of bile acids and neutral steroids in familial hypercholesterolaemia.

The faecal excretion of total bile acids was measured in two normal subjects and in seven patients with familial hypercholesterolaemia (four heterozygotes and three homozygotes) in the untreated state and during treatment with near-maximal doses of cholestyramine. There were no significant differences between the three groups. The increase in bile-acid excretion in response to cholestyramine was as great in the homozygotes as in the normal subjects. It is concluded that familial hypercholesterolaemia is not generally due to an inherited defect in the mechanisms for catabolizing cholesterol to bile acids.

Transport kinetics of plasma free fatty acid, very low density lipoprotein triglycerides and apoprotein in patients with endogenous hypertriglyceridaemia: effects of 2,2-dimethyl, 5(2, 5-xylyoxy) valeric acid therapy.

The effects of C1-719 on plasma lipid and lipoprotein concentrations have been examined in four patients with endogenous hypertriglyceridaemia maintained on an isocaloric diet for a period of 6 months. During therapy (400 mg/day) the mean plasma triglyceride and cholesterol concentrations were reduced by 35% and 15% respectively, while the administration of 800 mg/day reduced these by 49% and 31%. This hypolipidaemic effect was due to a reduction in the circulating level of very low density lipoproteins (VLDL) without a change in their composition. Before treatment the plasma VLDL triglyceride turnover, and FFA flux, were higher than that of normal subjects maintained on a similar diet. The plasma VLDL B-apoprotein turnover was similarly higher than in the controls. Administration of C1-719 decreased the plasma VLDL triglyceride turnover, FFA flux and VLDL B-approtein turnover. The drug reduced the insulin response following a glucose load with some decrease in glucose levels. The results suggest that the increase in plasma triglyceride concentration in patients with endogenous hypertriglyceridaemia is due to increased production of plasma VLDL triglyceride and its apoptein associated with an enhanced supply of FFA for hepatic triglyceride synthesis. C1-719 exerts a hypolipidaemic effect through a reduction of VLDL production, consequent upon inhibition of lipolysis as well as decreased synthesis of the apoprotein carrier. These effects could in part be explained by an improvement in peripheral tissue responsiveness to insulin and decreased exposure of the liver to high levels of insulin. However, a direct effect of the drug on adipose tissue and liver metabolism has to be considered.

Apolipoprotein B gene variants are involved in the determination of serum cholesterol levels: a study in normo- and hyperlipidaemic individuals.

We have investigated the frequencies of 3 restriction fragment length polymorphisms (RFLPs) of the apolipoprotein B (apo B) gene in normo- and hyperlipidaemic individuals. In individuals with type III hyperlipidaemia, the allele frequency for the RFLP detected with XbaI was significantly different from the allele frequency in normolipidaemic individuals and in those with other types of hyperlipidaemia. No significant difference in allele frequency was found among these groups for the RFLPs detected with MspI or EcoRI. Within a sample of 62 normolipidaemic individuals, homozygotes for the X2 allele (cutting site) of the XbaI RFLP had a significantly higher serum cholesterol level than homozygotes for the XI allele, with individuals of the genotype X1X2 having an intermediate value (X2X2 mean 5.71 mmol/l, X1X1 mean 4.81 mmol/l, X1X2 mean 5.30 mmol/l). There were also significant differences in serum triglyceride levels in individuals with different XbaI genotypes. In these normolipidaemic individuals there was no correlation between the EcoRI and MspI RFLP genotypes and levels of any serum lipid variable. Information from the XbaI and EcoRI RFLPs was used in conjunction to define apo B haplotypes. These haplotypes are a more precise measure of the genotypic variation, and they explain a greater fraction of the serum cholesterol and triglyceride levels than the single-site polymorphisms considered separately. This study suggests that variations in the gene for apo B are associated with the determination of serum cholesterol and triglyceride levels both in patients with type III hyperlipidaemia and in the normal population.

Lipoprotein analyses in varying degrees of glucose tolerance. Comparison between non-insulin-dependent diabetic, impaired glucose tolerant, and control populations.

Atherosclerosis is the major cause of death in diabetic patients. Lipoproteins and lipids are frequently altered in non-insulin-dependent diabetes. These lipoprotein alterations are of interest because of their possible role in the origin of the accelerated atherosclerosis found in diabetes. Because of the link between lipoproteins and diabetes, serum lipids and lipoproteins were measured in 215 middle-aged patients (107 female, 108 male) with varying degrees of glucose tolerance: control subjects, subjects with impaired glucose tolerance (IGT), and patients with non-insulin-dependent diabetes mellitus (NIDDM). In male subjects, levels of fasting total triglycerides were significantly greater in those with NIDDM compared with control subjects. In female subjects, fasting total cholesterol levels were significantly greater in NIDDM compared with IGT. Both high-density lipoprotein (HDL) cholesterol and HDL2 cholesterol values were significantly lower in both sexes with NIDDM compared with control subjects. Low-density lipoprotein (LDL) cholesterol levels were elevated in the male subjects with IGT. No differences in HDL cholesterol or its subfractions were seen in both sexes with IGT compared with control subjects. Bivariate analyses showed that the reduced HDL cholesterol and HDL subfraction levels were most closely associated with both total triglycerides and weight. This study shows that reduced HDL cholesterol and HDL2 cholesterol levels occur in NIDDM, whereas persons with "impaired glucose tolerance" do not have the dramatic alterations in HDL levels.

The relation of growth hormone to altered carbohydrate metabolism in women taking oral contraceptives.

Oral glucose tolerance tests were performed on a group of women before and during oral contraceptive administration and the plasma glucose, insulin, and growth hormone levels were studied. A significant impairment of glucose tolerance and an altered insulin response were observed in women taking oral contraceptives. The women had higher plasma growth hormone levels in the fasting state but this is not of primary aetiological significance in the development of altered carbohydrate metabolism.

Observations on some effects of L-triiodothyronine on carbohydrate and lipid metabolism in man.

Fasting serum lipid levels and changes in plasma glucose, fatty acid non-esterified (Nefa), and blood pyruvate levels during intravenous glucose tolerance tests were measured in 13 normal subjects before and one, five, and 15 days after the administration of 1-triiodothyronine (T3) calculated as 6 mug/kg body weight. Significant increases in the mean basal metabolic rate and the mean fasting plasma Nefa level occurred within 10 to 17 hours of a single dose of T3, while a rise in the mean fasting plasma glucose concentration just failed to achieve significance. Fasting concentrations of blood pyruvate and serum triglyceride were unaffected. A significant fall in serum cholesterol levels was produced and lasted at least five days. All other indices returned to normal by five days.During intravenous glucose tolerance tests performed at intervals after T3 administration no change in plasma glucose levels from control values was seen. Mean plasma Nefa and blood pyruvate levels, however, were significantly raised above control values during the early stages of the test 10 to 17 hours after T3. The relationship between these findings and those observed in clinical thyrotoxicosis is discussed.

Comparison of haematological indices between women of four ethnic groups and the effect of oral contraceptives.

Six-hundred-and-eighty-two women volunteers from four ethnic groups--Black, Indian, Oriental and White took part in a study to assess differences in haematological indices between the groups. This study was part of a broad investigation into the metabolic effects of oral contraceptives. The effect of the oral contraceptive (OC) on haematological indices was analysed but not found to be significant. The haemoglobin concentrations were lower than normal laboratory reference values for White subjects in 12.5% of Indian, 16.5% of Black and 4.3% of Oriental control groups respectively. All the White control group were within the normal range. These findings were considered in relation to age, weight, pregnancies, smoking, alcohol consumption, nutritional status, and disorders of haemoglobin synthesis. A deficient iron intake accounted for the high incidence of low haemoglobin in the Indian group in whom low transferrin saturation and serum ferritin were observed. With the possible exception of inherited disorders of haemoglobin synthesis, none of the factors we considered could account for the low haemoglobins found in the Black group. Separate reference values for haematological indices in different ethnic populations are considered.

Associations between insulin sensitivity, and free fatty acid and triglyceride metabolism independent of uncomplicated obesity.

Insulin resistance is associated with hypertriglyceridemia and elevated free fatty acid (FFA) concentrations in obese and diabetic individuals, but it is unclear to what extent this relationship is independent of obesity and is present in healthy individuals. We studied 92 healthy middle-aged males selected from the top, middle, and lowest quintiles of the insulin sensitivity index (Si) determined in a group of 182 men using the minimal model of glucose disappearance. Plasma FFA, triglyceride, glucose, insulin, and C-peptide concentrations were measured during a 3-hour intravenous glucose tolerance test (IVGTT). The low-Si (most insulin-resistant) group had more central body fat distribution (subscapular/triceps skinfold thickness) and a higher median body mass index (BMI) of 26.8 (range, 21.1 to 41.1) kg.m-2 compared with the middle- and high-Si groups with BMIs of 24.9 (19.1 to 31.5) and 23.7 (18.8 to 33.2) kg.m-2 (P < .05). Relatively minor glucose intolerance in the low-Si group was no longer significant when central adiposity was accounted for. Glucose tolerance was maintained by increased insulin secretion, leading to IVGTT insulin responses twofold and fourfold higher in the middle- and low-Si groups, respectively, compared with the high-Si group (P < .01). Fasting FFA and triglyceride concentrations were increased in the low-Si group relative to the other groups independent of BMI or central adiposity (P < .01). During the IVGTT, FFA decreased to similar minimum concentrations in all three groups. Triglyceride concentrations during the IVGTT increased above their minimum levels, particularly in the low-Si group (P < .001).(ABSTRACT TRUNCATED AT 250 WORDS)

An apparently anomalous relationship between insulin and C-peptide concentrations in their initial response to intravenous glucose.

Intravenous glucose tolerance tests (IVGTTs) with determination of plasma glucose, insulin, and C-peptide concentrations were performed in 136 men and 154 women. It was found that in 4% of men and 12% of women the plasma concentration of insulin exceeded that of C-peptide during the initial response to glucose. Subjects exhibiting this phenomenon had lower fasting and post-glucose C-peptide concentrations than those who did not; however, there were no statistically significant differences in glucose or insulin concentrations. The phenomenon was age-related, being absent from individuals aged 35 years and under, while in older age groups it appeared to be more prevalent in women than in men, suggesting an additional effect of menopause. However, in three follow-up IVGTTs performed in a subgroup of postmenopausal women over a period of 18 months, the phenomenon failed to recur in any of the individuals who first exhibited it, although it did occur in others. Our observations suggest the existence of an age-related but intermittent decrease in pancreatic insulin secretion, which does not lead to any significant change in plasma insulin concentrations, possibly as a result of reduced hepatic uptake of insulin. One consequence appears to be an excess of insulin over C-peptide during the early part of the IVGTT, which is probably related to the different distributional kinetics of the two peptides.

Lipid and carbohydrate metabolic risk markers for coronary heart disease and blood pressure in healthy non-obese premenopausal women of different racial origins in the United Kingdom.

Metabolic risk markers for coronary heart disease (CHD) were determined in apparently healthy females of differing racial origins residing in the United Kingdom. The females were of black (n=122), Oriental (n=144), South Asian (n=128), and white (n=271) origin, premenopausal, non-obese, and aged 16-45 years. In comparison to whites, South Asians had lower serum high-density lipoprotein (HDL) cholesterol and HDL2 cholesterol and higher fasting and oral glucose tolerance test plasma insulin responses. Black females had higher fasting plasma and oral glucose tolerance test insulin and lower serum triglyceride and glucose compared with white females. Orientals differed from whites in having higher fasting and oral glucose tolerance test insulin concentrations. Resting systolic or diastolic blood pressures, total serum cholesterol, HDL3 cholesterol, and low-density lipoprotein (LDL) cholesterol did not differ between groups. Whereas previous studies have demonstrated similar differences in representative samples from different ethnic communities, our results clearly demonstrate that differences also exist in young healthy females, individuals considered to have the least risk of CHD.

Insulin resistance, secretion, and elimination in postmenopausal women receiving oral or transdermal hormone replacement therapy.

Estrogen/progestin steroid combinations adversely affect glucose tolerance and insulin resistance, but their effects in combined hormone replacement therapy (HRT) have rarely been evaluated. We studied 61 untreated symptomatic postmenopausal women randomized to receive oral (conjugated equine estrogens, 0.625 mg/d continuous + levonorgestrel, 0.075 mg/d for 12 days of each 28-day cycle) or transdermal therapy (estradiol 17 beta, 0.05 mg/d continuous + norethindrone acetate, 0.25 mg/d for 14 days of each 28-day cycle). An untreated control group of 30 postmenopausal women not seeking HRT was also studied. Intravenous glucose tolerance tests (IVGTT) were performed at baseline and 3, 6, and 18 months later. Mathematical modeling analysis of plasma glucose, insulin, and C-peptide concentration profiles provided measures of insulin resistance, secretion, and elimination. There were no changes in glucose or insulin concentrations with transdermal therapy. Oral therapy caused a deterioration of glucose tolerance and an increased overall plasma insulin response, apparently due to a reduction in the immediate plasma insulin response to glucose. This may have resulted from increased hepatic insulin uptake, uncompensated for by an increase in first-phase pancreatic insulin secretion. Neither treatment caused significant insulin resistance compared with baseline, but with the oral treatment insulin resistance was greater during the combined phase compared with the estrogen-only phase. Thus the oral regimen affected both insulin delivery and insulin resistance. The transdermal regimen had relatively few effects on insulin metabolism.

Case studies in working memory: a case for single cases?

Patterns of cognitive deficit in single neuropsychological cases are common sources of evidence for theories of normal cognition. In particular, the working memory model has benefited from data obtained from a number of contrasting patients, in some cases resulting in modifications of the working memory model. In this paper, patterns of data from short-term memory patients and anarthric patients are compared with patterns of data from normal subjects. The patterns of patient data that were unlike those patterns typically found for groups of normal subjects, could be incorporated within a modified version of the articulatory loop component of the working memory model. However a small number of individual normal subjects also did not show the pattern that is reported on the basis of average performance of groups of normal subjects. This causes some difficulty in interpreting those data from such 'aberrant normal' patterns, and those data from single patients with functional cognitive deficits. The implications of these findings for the interpretation of neuropsychological data are discussed in the context of the working memory model, but with the intention of making a general point pertaining to the development of functional models of cognition. It is argued that single case studies should continue to provide a useful source of evidence, providing that care is exercised in considering the implications of such data for models of normal cognition.

Rising cholesterol levels in children with familial hypercholesterolaemia.

Reference ranges (5th to 95th percentile) for fasting total serum cholesterol concentration were calculated for 571 unrelated children aged 4-19 years, without known predisposition to hypercholesterolaemia. Values were 3.31-5.81 mmol.l-1 for boys and 3.20-5.66 mmol.l-1 for girls, without significant differences between sexes at any age, compared to our laboratory reference ranges for men (3.46-6.87 mmol.l-1) and women (3.00-6.38 mmol.l-1). A further 85 children, each with a first degree relative with Familial Hypercholesterolaemia (FH), were studied. Initially, 39 had high cholesterol concentrations suggestive of FH. Repeated serial measurements were carried out in 18 of the 46 apparently unaffected children. Seven of these showed marked increases in serum cholesterol over 1-7 years, reaching concentrations above the 95th centiles of the appropriate reference ranges. The annual rate of increase was significantly higher than in the 11 who remained normocholesterolaemic. In 3 of these 7 children, diagnosis of FH was confirmed retrospectively, using recombinant DNA technology to show that each had inherited the defective allele of the LDL-receptor gene from an affected parent. Thus, serial cholesterol measurements may be needed to confirm or exclude FH in potential heterozygotes, while DNA studies can be used for definitive diagnosis in some families.