Carnitine status of pregnant women: effect of carnitine supplementation and correlation between iron status and plasma carnitine concentration.

BACKGROUND/OBJECTIVES: It has been shown that plasma carnitine concentrations markedly decline during gestation in women. The reason for this, however, is unknown. One objective of this study was to investigate the effect of carnitine supplementation on plasma carnitine concentrations in pregnant women. The second objective was to investigate the hypothesis that reduced plasma carnitine concentrations during gestation are caused by a reduced carnitine synthesis because of a diminished iron status. SUBJECTS/METHODS: Healthy pregnant women (n=26) were randomly assigned in two groups receiving either a L-carnitine supplement (500 mg L-carnitine per day as L-carnitine L-tartrate) (n=13) or placebo (n=13) from the 13th week of gestation to term. RESULTS: In the control group, there was a marked reduction of plasma carnitine concentration from the 12th week of gestation to term. This reduction was prevented by the supplementation of carnitine. In the control group, there was a positive relationship between the parameters of iron status (mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH) and ferritin) and plasma concentration of carnitine (P<0.05). Moreover, there were inverse correlations between the concentrations of ferritin and the carnitine precursor gamma-butyrobetaine in plasma, and between gamma-butyrobetaine and carnitine in plasma (P<0.05). CONCLUSIONS: This study confirms that plasma carnitine concentrations decline in the course of pregnancy, an effect that can be prevented by the supplementation of carnitine. Data of this study, moreover, suggest that the decline of plasma carnitine concentration during pregnancy could be caused by a reduced rate of carnitine biosynthesis, possibly because of an inadequate iron status.

Nutritional fats and the risk of type 2 diabetes and cancer.

Dietary factors are important predictors for the risk of diabetes type 2. Increased consumption of fibre-rich foods, fruits and vegetables as well as limited amounts of total and saturated fats are essential elements in the prevention of diabetes type 2. The association between these dietary factors and the appearance of diabetes was not only present in cohort studies but were also major elements in the dietary part of the two large diabetes prevention trials (Finnish Diabetes Prevention Study, Diabetes Prevention Program). There is also strong evidence for a relation between obesity and total fat intake and the incidence of certain types of cancers. There is a significant correlation between total fat intake and the risk of cancer; however, it is much weaker than that of the effect of red meat. Recommendations to decrease red meat intake, particularly processed meat, may decrease the risk of colorectal and prostate cancer and may have beneficial effects on breast cancer as well, although this evidence is less compelling. Overall, recommendations focused on controlling or reducing body weight by regular physical activity and avoidance of excessive energy intake from all sources, particularly from fat and saturated fats, by increasing consumption of fibre-rich carbohydrates, vegetables and fruits are effective in decreasing the risk for type 2 diabetes by more than 50% in high-risk individuals. Similar dietary patterns are likely to diminish the manifestation of certain forms of cancers. These conclusions are in agreement with current recommendations for cancer prevention as propagated by the American Cancer Society.

Nutritional supplements combined with dietary counselling diminish whole body protein catabolism in HIV-infected patients.

BACKGROUND: Weight loss and protein malnutrition are frequent complications in HIV-infected patients. The effect of an oral nutritional supplement combined with nutritional counselling on whole body protein metabolism was assessed. MATERIALS AND METHODS: HIV-infected individuals with a body mass index < 21 kg m-2 or CD4-T cells < 500 micro L-1 in stable clinical condition were randomly allocated to [1] receive either oral nutritional supplements (containing 2510 kJ, complete macro- and micronutrients) and dietary counselling (n = 8), or [2] identical monitoring but no supplements or specific nutritional advice (controls, n = 7). Whole body leucine kinetics and leucine oxidation rate were determined by [1-13C]-leucine infusions and lean and fat mass were measured before and 12 weeks after intervention. RESULTS: Leucine oxidation (protein catabolism) decreased in the group receiving nutritional intervention from 0.33 +/- 0.02 to 0.26 +/- 0.02 micromol kg-1 min-1 after 12 weeks (P < 0.05; P < 0.05 vs. control group) but remained unchanged in the control group. Whole body leucine flux showed a tendency to decrease in the intervention group from 1.92 +/- 0.19 to 1.73 +/- 0.14 micromol kg-1 min-1 (P = 0.07) and remained unchanged in the control group (2.21 +/- 0.16 and 2.27 +/- 0.14 micromol kg-1 min-1, respectively). Lean body mass determined by bioelectrical impedance analysis increased in the nutritional intervention group from 84 +/- 2 to 86 +/- 2 per cent (P < 0.05) and fat mass decreased from 17 +/- 2 to 14 +/- 2 per cent (P < 0.05) of total body weight whereas neither mass changed in the control group. Nutritional intervention had no significant effect on lymphocyte CD4 counts, on plasma TNFR 55, TNFR 75 and ILR 2 concentrations and on quality of life. CONCLUSIONS: The data demonstrate an anticatabolic effect of nutritional supplements combined with dietary counselling in HIV-infected subjects. They suggest that diminished whole body protein catabolism resulted in a change of body composition (increased lean mass, decreased fat mass).

Accelerated post-glucose glycaemia and altered alliesthesia-test in Seasonal Affective Disorder.

BACKGROUND: Little is known about the link between mood, food and metabolic function in Seasonal Affective Disorder (SAD). METHODS: We investigated this link in a combined glucose tolerance-alliesthesia test in eight SAD patients in winter before and after one week light therapy, and in summer. RESULTS: SAD patients exhibited faster post-glucose glycaemic and insulin responses (p <0.05), and increased hedonic ratings of high concentrated sucrose solutions (p <0.035) when depressed in winter than when euthymic (one week after light treatment or in summer). CONCLUSIONS: The rapid glycaemic and insulin responses to an oral glucose load may be a result of accelerated gastric emptying. LIMITATIONS: The number of studied patients was rather small and no control group was studied in parallel. CLINICAL RELEVANCE: the more rapid post-glucose glycaemia may impair glucose homeostasis in depressed SAD patients.

Arousal responses to inspiratory resistive loading during REM and non-REM sleep in normal men after short-term fragmentation/deprivation.

The arousal response to inspiratory resistive loading in normal men is known to be high during REM sleep compared to non-REM sleep. We investigated whether we could observe the same pattern, i.e. brisk arousal from REM sleep compared to non-REM sleep, in normal subjects who had undergone short-term sleep fragmentation/deprivation prior to the investigation. The arousal response to the repeated application of an external inspiratory resistance of 25 cm H2O/l/s was determined during REM and non-REM sleep in 10 healthy men after a single night with 4 hours of acoustically fragmented sleep. The percentage of arousals to non-arousals occurring within 2 minutes of the load application was significantly higher during REM sleep than during either of the non-REM sleep stages 2 and 3/4 and decreased significantly from stage REM to stage 2 and from stage 2 to stage 3/4. The mean time to arousal in REM was significantly shorter than in non-REM stage 3/4. The duration of sleep (comparing the results of the first with the second half of the sleep period time) did not modify the arousal response in stages 2 and 3/4. Despite short-term sleep fragmentation/deprivation the night before the study, the arousal response to external inspiratory resistive loading was brisker during REM than non-REM sleep in the healthy subjects studied. The responses were of the same magnitude as those induced in prior studies without pretest sleep disturbance. This is different from what is seen in patients with sleep apnea, where breathing disorders are worst during REM sleep and sleep fragmentation/deprivation leads to rapid deterioration of arousal responses to the spontaneously occurring airway occlusions.

[Why does nutrition therapy so often fail in non-insulin-dependent diabetes? What measures bring success?]. / Woran scheitert die Ernährungstherapie bei nicht-insulinabhängigem Diabetes? Welche Massnahmen bringen Erfolg?

It is a common belief among physicians that nutritional therapy in type II diabetic subjects is inefficient because the patients do not comply with the recommendations. Failure of a therapeutic response leads to feelings of guilt in patients, followed by frustration, and refusal of further treatment. The physician rapidly starts with drug or insulin therapy before the effects of diet treatment are assessable. Nutritional recommendations for diabetics are basically the same as for non-diabetics. Successful dietary treatment of obese type II diabetic subjects requires realistic goals regarding weight loss. Frequent mistakes are that an ideal body weight is aimed for, and that the patients are asked to omit only carbohydrates in the diet. Splitting of the meals, and distribution of carbohydrate-containing foods to individual meals during the day are important components of a meal plan. The patient should also be counciled how to avoid visible and invisible dietary fats. Exchange lists are frequently administered, but they fail, because they are too complicated. Only a part of decompensated type II diabetic subjects respond to weight loss. The response is evident already after a few [2.3 kg] weight loss. Other diabetic subjects fail to improve their glucose control after weight loss. These patients require an alternative treatment, i.e. oral antidiabetic agents or insulin. Frequently behavior therapy is of advantage in obese type II diabetic subjects, in addition to longterm dietary treatment. Dieticians should be involved in all difficult cases since they have the necessary experience to perform this longterm treatment.

A new method of tooth replantation and autotransplantation: aluminum oxide ceramic for extraoral retrograde root filling.

After an initial clinical test phase, the new method of replantation and transplantation with the use of aluminum oxide ceramic for retrograde root filling may be viewed as possible differential indications to other methods, even to apicectomy in the molar region. Twenty-three of the twenty-five replantations and eight of the nine transplantations may be regarded as having been successful. Contraindications are cases of wide apical foramina and oval or octagonal root canal cross sections.

Aluminum oxide ceramic pins for retrograde root filling--experiences with a new system.

Retrograde root filling is, under certain conditions, the last chance to keep the functional ability of the teeth. With a new method using aluminum oxide ceramic pins for retrograde root filling, we believe that this aim may be achieved with greater success than with other methods. A success rate of 95% (out of a total of 164 teeth) after 1 year is the result of our investigation. The requirements of retrograde root filling are met in a high degree because of the excellent biologic compatibility of the ceramic material and the high marginal tightness with the use of conical pins.

Phosphocreatine content and intracellular pH of calf muscle measured by phosphorus NMR spectroscopy in occlusive arterial disease of the legs.

Energy metabolism of calf muscle was assessed non-invasively by phosphorus (31P) NMR spectroscopy in eleven patients with symptomatic arterial occlusion and in seven matched controls. Phosphocreatine (PCr) content and pH values decreased during non-ischaemic foot exercise to lower values in severely afflicted patients but in all patients, as a group, they were not significantly decreased compared to controls. In contrast, recovery from ischaemic exercise (arterial occlusion by a tourniquet) demonstrated significant differences between patients and controls. Intracellular pH and PCr recovered more slowly in patients than in controls; PCr recovery proceeded exponentially with a recovery half-time of 203 +/- 74 s in patients compared to 36.7 +/- 5.5 s in controls (P less than 0.02). Phosphocreatine (PCr) recovery after ischaemic exercise correlated significantly with the degree of arterial stenoses as assessed by Doppler ultrasound (r = 0.739, P = 0.019) and by angiography (r = 0.885, P = 0.005), suggesting that the degree of large vessel stenoses limits the postischaemic increase in mitochondrial oxidative phosphorylation. Reactive blood flow after ischaemia failed to correlate with PCr recovery or with the degree of arterial stenoses. Phosphorus (31P) NMR spectroscopy provides, therefore, quantitative parameters of muscle energy metabolism in patients with peripheral arterial occlusions.