Improved nutrition after the detection and treatment of occult gastroparesis in nondiabetic dialysis patients.

Malnutrition in dialysis patients is of multifactorial etiology and is associated with greatly increased morbidity and mortality. A low serum albumin level is one of the most powerful predictors of death and may persist despite optimization of the dialysis prescription. We retrospectively reviewed our experience in improving nutrition in nondiabetic patients with unexplained hypoalbuminemia. Using radionuclide solid-phase gastric emptying scans, we identified 6 patients who had occult gastroparesis. These patients (one on hemodialysis and five on peritoneal dialysis) were then treated with prokinetic medications (erythromycin elixir or metoclopramide) selected on the basis of their effectiveness in improving the scanning results after being given intravenously. Gastric emptying half-times improved from a median of 122 minutes (range, 95 to >300 minutes; normal, < or = 90 minutes) to 12 +/- 2 minutes (mean +/- SEM). The serum albumin increased from 3.3 +/- 0.04 g/dL to 3.7 +/- 0.08 g/dL at 3 months, with every patient's value higher than 3.5 g/dL. This improvement was statistically significant (P = 0.008) over the 5-month period of observation, which encompassed the 2 months before and 3 months after treatment. There was a linear improvement (P = 0.008) that showed a quadratic trend (P = 0.078) for a plateau at the final sampling point. The serum blood urea nitrogen, creatinine, and hematocrit levels remained unchanged (P > 0.1). We conclude that gastric emptying scans are valuable in identifying occult gastroparesis in high-risk patients and can guide the selection of prokinetic therapy, which may significantly increase serum albumin levels.

Diet and lung cancer 20+ years later: more questions than answers?

A critical review of epidemiological studies on diet and lung cancer over the last 20+ years has not provided overwhelming evidence that higher consumption of vegetables, fruit, low-fat/low-cholesterol foods or such micronutrients as carotenoids, selenium and vitamins A, C or E is associated with reduced lung cancer risk. Results from case-control studies have been more positive, with about one half showing fruit and vegetables or their associated micronutrients to be associated with reduced risk. However, most results from cohort and serum micronutrient studies, which avoid the problems of inaccurate accounting of diet and recall bias, were statistically insignificant. Moreover, although most studies were conducted on white male smokers in North America and Europe, the few studies which found significant contrary trends were among subjects of different backgrounds, i.e., black American males and Chinese women in China. Since male smokers vs. nonsmokers in Europe, North America and Japan have been shown in other studies to be lower consumers of fruit/vegetables, and less likely to pursue "perceived healthier lifestyles," the possibility that some of the epidemiological findings on diet and lung cancer are artifactually due to inadequate adjustment for behavioral correlates of smoking and health seekers in a particular society must be considered. This is especially true with recent chemoprevention trials showing higher lung cancer incidence and deaths among consumers of beta-carotene supplements vs. placebo.

Lung cancer risk and mutagenicity of tea.

To study the possible association between drinking tea and lung cancer, epidemiological and experimental materials were collected from the Chinese population in Hong Kong. In a retrospective study of 200 female lung cancer patients and 200 matched controls, all subjects were interviewed concerning their eating habits, smoking histories, and lifetime exposures to environmental pollutants. Analysis of the data demonstrated an adjusted and statistically significant increased lung cancer risk of 2.7 among those who drank green tea. Several brands of tea commonly drank in Hong Kong were assayed for mutagenicity using Ames' assay. Significantly elevated levels of mutagenic activity were found to be present after metabolic activation using cell-free extracts of cecal bacteria from rats. These data suggest that further research is needed to understand the possible consequences to human health of ingestants taken at low doses but long duration over the normal lifespan, and the possible interactive effect between mutagens in tea and other ingestants and inhalants in human cancer etiology.

Life-history correlates of environmental tobacco smoke: a study on nonsmoking Hong Kong Chinese wives with smoking versus nonsmoking husbands.

Studies to evaluate the effects of environmental tobacco smoke (ETS, passive smoking) often use nonsmoking wives with smoking discordant husbands. To see whether there were differences in exposures and behavior patterns among never-smoked wives with never-smoked vs ever-smoked husbands, the life-history profiles of 136 ever-married women with mean age of 59 were analyzed on 97 quantifiable variables. Overall, the results demonstrated that wives with never-smoked husbands had 'healthier' lifestyles than wives with smoking husbands. The former were better off in terms of socio-economic status, more conscientious housewives, ate better diets, and had better indices of family cohesiveness. They also fared better in variables that reflected health status with lower frequencies of the following: miscarriages/abortions, inhaling through the mouth, chronic cough, and chest X-rays. The differences were usually largest when comparing wives of never-smoked vs heavily smoking (greater than 20 cigarettes/day) husbands. The results indicate some correlates of passive smoking that can act as important confounders when evaluating health risks among families with smoking husbands.

Concepts of disease causation, treatment and prevention among Hong Kong Chinese: diversity and eclecticism.

The health beliefs, knowledge, and choices of therapeutic intervention for 25 common ailments were described and analyzed for the Chinese in Hong Kong. Acceptance of the co-existence of the ideas and treatment regimens from both Western and Chinese medical traditions were prevalent. For health problems in which Western medicine has already isolated a specific causative agent or developed effective treatment or preventive methods, many informants were familiar with these biomedical concepts, and even more expressed willingness to use these methods to alleviate their symptoms. In addition, however, there was a group of views on causation, treatment, and prevention that arose from folk observations or Chinese classical medicine that supplemented the views imported from the West. This occurred when the etiological factors for specific health problems were not well understood or identified in biomedicine, or when other environmental factors, usually attributed to 'lifestyle', were identified by informants as mediating factors affecting risk for disease from the individual's point of view. These latter views helped explain why some become ill and others do not, although all may have been exposed to the same etiological agent identified in biomedicine.

The use of food to treat and prevent disease in Chinese culture.

Interviews of 50 Chinese families in Hong Kong in 1981 indicated that the proper selection, timing and preparation of food was the most salient lay method of dealing with the prevention and treatment of some 59 common symptoms and illnesses. The food prescriptions and proscriptions were based on the traditional concept of maintaining body homeostasis through avoidance of: (1) excess 'hot'/'cold' or 'wet'/'dry' qualities of body energy; (2) disturbance of energy flow; or (3) inadequate energy levels. Various health problems were classified as being due to imbalances of these energy states. Excess 'hot'/'cold' or 'wet'/'dry' ailments were dealt with by increased consumption of foods of the opposite character; those due to disturbance of the normal flow of energy was avoided by the reduced intake of 'irritating' or 'poisonous' foods; and various tonics were believed to raise the amount of energy flow in the body. A rich knowledge of complex dietary rules was found to be prevalent among the lay public because the traditional rules filled explanatory and behavioural niches left open in Western medicine. Dietary manipulation was used to complement Western medicine in the multiple stages of the disease process by playing a predominant role at the beginning and end of the period of pathogenesis.

Do cooking fuels pose a risk for lung cancer? A case-control study of women in Hong Kong.

Two hundred female lung cancer patients and 200 female district controls in Hong Kong were interviewed about their previous use of various types of cooking fuels to assess whether any association could be found with lung cancer risk. Mixed results were found when the data were analyzed in terms of ever-exposed vs never-exposed duration, and relationship with smoking. Cases were found to have slightly more exposure to kerosene, whereas controls were likely to have used the cleaner, but more expensive, liquid petroleum gas (LPG) type of fuel. Because the evidence was conflicting if evaluated in terms of consistency, strength, specificity, and coherence of the associations, it was concluded that the small differences in exposure levels between the cases and controls probably reflected their socio-economic circumstances rather than risk for lung cancer. No interaction effect was found between kerosene exposure and smoking.