Low vitamin D levels have become less common in primary hyperparathyroidism.

UNLABELLED: We compared temporal trends in serum 25-hydroxyvitamin D and parathyroid hormone (PTH) in two primary hyperparathyroidism (PHPT) cohorts recruited 20 years apart. The prevalence of 25-hydroxyvitamin D levels <20 and <30 ng/mL declined by 30-50 %, respectively, and was accompanied by lower PTH. In the older cohort, higher PTH may be due to lower 25-hydroxyvitamin D. INTRODUCTION: Vitamin D deficiency may exacerbate PHPT. Whether there have been temporal trends in 25-hydroxyvitamin D (25OHD) levels in PHPT is unclear. The prevalence of low vitamin D levels (25OHD <20 and <30 ng/mL) and associated biochemical and bone mineral density (BMD) profiles were assessed in two PHPT cohorts recruited over 20 years apart. METHODS: This is a cross-sectional comparison of serum 25OHD levels, calciotropic hormones, and BMD between two PHPT cohorts recruited at the same hospital: the "old" (N = 103) and "new" (N = 100) cohorts were enrolled between 1984 and 1991 and between 2010 and 2014, respectively. RESULTS: Mean 25OHD levels were 26 % higher in the new cohort (23 ± 10 vs. 29 ± 10 ng/mL, p < 0.0001). Levels of 25OHD <20 and <30 ng/mL declined from 46 and 82 %, respectively, to 19 and 54 % (both p < 0.0001). Supplemental vitamin D use was common in the new (64 %) but not the old cohort (0 %). The new cohort demonstrated 33 % lower serum PTH levels (p < 0.0001). Neither serum nor urine calcium differed. BMD was higher in the new cohort at all skeletal sites (all p < 0.001). CONCLUSION: With the rise in vitamin D supplementation over the last two decades, low 25OHD levels are no longer common in PHPT patients in the New York area. Those with 25OHD <20 and <30 ng/mL have declined by over 50 and 30 %, respectively. The lower mean PTH levels in the new cohort are most likely accounted for by higher vitamin D intake. Whether improved vitamin D status also underlies the relatively higher BMD in the more vitamin D replete cohort of PHPT patients is unknown.

Predictors of CNS injury as measured by proton magnetic resonance spectroscopy in the setting of chronic HIV infection and CART.

The reasons for persistent brain dysfunction in chronically HIV-infected persons on stable combined antiretroviral therapies (CART) remain unclear. Host and viral factors along with their interactions were examined in 260 HIV-infected subjects who underwent magnetic resonance spectroscopy (MRS). Metabolite concentrations (NAA/Cr, Cho/Cr, MI/Cr, and Glx/Cr) were measured in the basal ganglia, the frontal white matter, and gray matter, and the best predictive models were selected using a bootstrap-enhanced Akaike information criterion (AIC). Depending on the metabolite and brain region, age, race, HIV RNA concentration, ADC stage, duration of HIV infection, nadir CD4, and/or their interactions were predictive of metabolite concentrations, particularly the basal ganglia NAA/Cr and the mid-frontal NAA/Cr and Glx/Cr, whereas current CD4 and the CPE index rarely or did not predict these changes. These results show for the first time that host and viral factors related to both current and past HIV status contribute to persisting cerebral metabolite abnormalities and provide a framework for further understanding neurological injury in the setting of chronic and stable disease.

Fortification of cheese with vitamin D3 using dairy protein emulsions as delivery systems.

Vitamin D is an essential vitamin that is synthesized when the body is exposed to sunlight or after the consumption of fortified foods and supplements. The purpose of this research was to increase the retention of vitamin D(3) in Cheddar cheese by incorporating it as part of an oil-in-water emulsion using a milk protein emulsifier to obtain a fortification level of 280 IU/serving. Four oil-in-water vitamin D emulsions were made using sodium caseinate, calcium caseinate, nonfat dry milk (NDM), or whey protein. These emulsions were used to fortify milk, and the retention of vitamin D(3) in cheese curd in a model cheesemaking system was calculated. A nonemulsified vitamin D(3) oil was used as a control to fortify milk. Significantly more vitamin D(3) was retained in the curd when using the emulsified vitamin D(3) than the nonemulsified vitamin D(3) oil (control). No significant differences were observed in the retention of vitamin D(3) when emulsions were formulated with different emulsifiers. Mean vitamin D(3) retention in the model system cheese curd was 96% when the emulsions were added to either whole or skim milk compared with using the nonemulsified oil, which gave mean retentions of only 71% and 64% when added to whole and skim milk, respectively. A similar improvement in retention was achieved when cheese was made from whole and reduced-fat milk using standard manufacturing procedures on a small scale. When sufficient vitamin D(3) was added to produce cheese containing a target level of approximately 280 IU per 28-g serving, retention was greater when the vitamin D(3) was emulsified with NDM than when using nonemulsified vitamin D(3) oil. Only 58±3% of the nonemulsified vitamin D(3) oil was retained in full-fat Cheddar cheese, whereas 78±8% and 74±1% were retained when using the vitamin D(3) emulsion in full-fat and reduced-fat Cheddar cheese, respectively.

Fortification of Cheddar cheese with vitamin D does not alter cheese flavor perception.

Currently, dietary guidelines for vitamin D consumption are under review, considering new information that >50% of the US population is vitamin D deficient, and may lead to a recommendation of a higher dietary intake of this vitamin. Vitamin D fortification of cheese aims to improve the current availability of fortified dairy foods beyond liquid milk. However, cheese is susceptible to undesirable flavor changes during long-term cheese ripening, and cheese bacteria and enzymes may degrade added vitamins. To test the retention of vitamin D(3) in Cheddar cheese curd, cheese milk was fortified initially during manufacture at a level of 150 IU/serving, using commercial sources that contained vitamin D(3) in powder, oil, or emulsion form, with and without homogenization of the fortified milk. When fortification was done directly to the cheese milk, we found that more than 80% vitamin D(3) was retained in cheese curd, irrespective of homogenization or form of fortification. Further, Cheddar cheese was fortified with the emulsion form of vitamin D(3) directly in cheese milk at 200 and 400 IU/serving to test stability and flavor changes. Vitamin D(3) fortified in this manner was stable for up to 9 mo in Cheddar cheese. Consumer acceptance and descriptive analysis of flavor profiles of cheese were also conducted and showed that vitamin D(3) fortified cheeses were equally liked by consumers, and cheese taste and flavor remained unaltered with vitamin D(3) addition even after aging for 9 mo.

Vitamin D deficiency in HIV-infected postmenopausal Hispanic and African-American women.

UNLABELLED: We evaluated vitamin D status in HIV+ and HIV- postmenopausal African-American (AA) and Hispanic women. Most women (74-78%) had insufficient 25-hydroxyvitamin D (25OHD) levels, regardless of HIV status. 25OHD was lower in AA women and women lacking supplement use, providing support for screening and supplementation. Among HIV+ women, 25OHD was associated with current CD4 but not type of antiretroviral therapy. INTRODUCTION: To evaluate vitamin D status and factors associated with vitamin D deficiency and insufficiency in HIV-infected (HIV+) postmenopausal minority women. METHODS: In this cross-sectional study, 89 HIV+ and 95 HIV- postmenopausal women (33% AA and 67% Hispanic) underwent assessment of 25OHD, 1,25-dihydroxyvitamin D, parathyroid hormone, markers of bone turnover and bone mineral density by dual energy X-ray absorptiometry. RESULTS: The prevalence of low 25OHD did not differ by HIV status; the majority of both HIV+ and HIV- women (74-78%) had insufficient levels (<30 ng/ml). Regardless of HIV status, 25OHD was significantly lower in AA subjects, and higher in subjects who used both calcium and multivitamins. In HIV+ women on antiretroviral therapy (ART), 25OHD was directly associated with current CD4 count (r=0.32; p<0.01) independent of age, ethnicity, BMI, or history of AIDS-defining illness. No association was observed between 1,25(OH)(2)D and CD4 count or between serum 25OHD, 1,25(OH)(2)D or PTH and type of ART. CONCLUSIONS: In postmenopausal minority women, vitamin D deficiency was highly prevalent and associated with AA race and lack of supplement use, as well as lower current CD4 cell count. These results provide support for screening and repletion of vitamin D in HIV+ patients.

Therapy of hypoparathyroidism with intact parathyroid hormone.

UNLABELLED: Hypoparathyroidism, a disorder characterized by low parathyroid hormone (PTH), is generally treated with oral calcium and vitamin D supplementation. We investigated the effects of PTH(1-84) treatment in 30 hypoparathyroid subjects for 24 months. PTH(1-84) treatment in hypoparathyroidism significantly reduced supplemental calcium and 1,25-dihydroxyvitamin D requirements without generally altering serum and urinary calcium levels. INTRODUCTION: Hypoparathyroidism, a disorder characterized by low PTH, is associated with hypocalcemia, hypercalciuria, and increased bone mineral density (BMD). Conventional therapy with calcium and 1,25-dihydroxyvitamin D can maintain the serum calcium concentration, but doses are high, and control is variable. We investigated the effects of human PTH(1-84) treatment in hypoparathyroidism. METHODS: Thirty subjects with hypoparathyroidism were treated in an open-label study of PTH(1-84) 100 µg every other day by subcutaneous injection for 24 months, with monitoring of calcium and vitamin D supplementation requirements, serum and 24 h urinary calcium excretion, and BMD by dual energy X-ray absorptiometry. RESULTS: Requirements for supplemental calcium decreased significantly (3,030±2,325 to 1,661±1,267 mg/day (mean±SD); p<0.05), as did requirements for supplemental 1,25-dihydroxyvitamin D (0.68±0.5 to 0.40±0.5 µg/day; p<0.05). Serum calcium levels and 24 h urinary calcium excretion were mostly unchanged at 24 months. BMD increased at the lumbar spine by 2.9±4% from baseline (p<0.05), while femoral neck BMD remained unchanged and distal one third radial BMD decreased by 2.4±4% (p<0.05). CONCLUSION: PTH(1-84) treatment in hypoparathyroidism significantly reduces supplemental calcium and 1,25-dihydroxyvitamin D requirements without generally altering serum and urinary calcium levels.

Fortification of reduced-fat Cheddar cheese with n-3 fatty acids: effect on off-flavor generation.

The objective of this study was to fortify 50% reduced fat Cheddar cheese with n-3 fatty acids and evaluate whether this fortification generated specific off-flavors in the cheese. Docosahexaenoic (DHA) and eicosapentaenoic (EPA) fatty acids were added to the cheese to obtain 3 final fortification levels [18, 35, and 71 mg of DHA/EPA per serving size (28 g) of cheese] representing 10, 20, and 40% of the suggested daily intake level for DHA/EPA. The presence of oxidized, rancid, and fishy flavors as a function of fortification level and cheese aging (6 mo) was evaluated using a sensory descriptive panel. No differences were found in the oxidized and rancid flavors as a consequence of DHA/EPA fortification, with only slight intensities of these flavors. The presence of fishy off-flavor was dependent on the fortification level. Cheeses with low fortification levels (18 and 35 mg of DHA/EPA per serving size) did not develop significant fishy off-flavor compared with the control, whereas at the highest fortification level (71 mg of DHA/EPA per serving size) the fishy off-flavor was significantly stronger in young cheeses. The fishy flavor decreased as a function of age and became nonsignificant compared with the control at 3 mo of storage. Even though fishy flavors were detected in the fortified cheeses, the DHA/EPA content during storage remained constant and complied with the suggested values for food fortification. Results obtained from this research indicate that 50% reduced-fat Cheddar cheese aged for 3 mo can be used as a vehicle for delivery of n-3 fatty acids without generation of off-flavors.

Milk and cheese from cows fed calcium salts of palm and fish oil alone or in combination with soybean products.

Twenty cows were used in a randomized block design experiment for 6 wk to determine the influence of feeding partial ruminally inert Ca salts of palm and fish oil (Ca-PFO), alone or in combination with extruded full-fat soybeans or soybean oil, on milk fatty acid (FA) methyl esters composition and consumer acceptability of milk and Cheddar cheese. Cows were fed either a diet containing 44% forage and 56% concentrate (control) or a diet supplemented with 2.7% Ca-PFO (FO), 5% extruded full-fat soybeans + 2.7% Ca-PFO (FOESM), or 0.75% soybean oil + 2.7% Ca-PFO (FOSO). Total dietary FA content in the control, FO, FOESM, and FOSO diets were 4.61, 6.28, 6.77, and 6.62 g/100 g, respectively. There was no difference in nutrient intake, milk yield, or milk composition among treatments. Conjugated linoleic acid (CLA) C(18:2) cis-9, trans-11 isomer, C(18:1) trans-11 (VA), and total n-3 FA in milk from cows on the control, FO, FOESM, and FOSO treatments were 0.56, 1.20, 1.36, and 1.74; 3.29, 4.66, 6.34, and 7.81; 0.62, 0.69, 0.69, and 0.67 g/100 g of FA, respectively. Concentrations of CLA, VA, and total n-3 FA in cheese were similar to milk. A trained sensory panel detected no difference in flavors of milk and cheese, except for acid flavor below a slightly perceptible level in cheese from all treatments. Results suggest that feeding Ca-PFO alone or in combination with extruded full-fat soybeans or soybean oil enhanced the CLA, VA, total unsaturated and n-3 FA in milk and cheese without negatively affecting cow performance and consumer acceptability characteristics of milk and cheese.

Consumer acceptability of conjugated linoleic acid-enriched milk and cheddar cheese from cows grazing on pasture.

Two experiments were conducted to study the consumer acceptability attributes of conjugated linoleic acid (CLA)-enriched milk and cheese from cows grazing on pasture. In experiment 1, 15 cows were fed either a diet containing 51% alfalfa hay plus corn silage and 49% concentrate [total mixed ration (TMR)], were grazed on pasture, or were grazed on pasture and received 3.2 kg/d of a grain mix. The grain mix contained 75% full-fat extruded soybeans (FFES), 10% corn, 10% beet pulp, and 5% molasses. During the final 3 wk of the 6-wk experiment, milk was evaluated for sensory attributes. In experiment 2, 18 cows were fed similar diets as in experiment 1, except replacing the group of cows grazed on pasture and receiving the grain mix was a group of cows grazed on pasture and receiving 2.5 kg/d per cow of the FFES; Cheddar cheese was manufactured from milk. Average CLA contents (g/100 g of fatty acid methyl esters) were 0.52, 1.63, and 1.69 in milk and 0.47, 1.47, and 1.46 in cheese from cows fed a TMR, grazed on pasture, and grazed on pasture and fed the grain mix, respectively. An open and trained panel evaluated CLA-enriched milk for mouth-feel, color, flavor, and quality and evaluated cheese for color, flavor, texture, and quality. Open and trained panel evaluations of milk and cheese showed no differences among treatments for any of the attributes, except that the trained panel detected a more barny flavor in milk from cows grazing pasture compared with milk from cows fed the TMR only. Results suggest that consumer acceptability attributes of CLA-enriched milk and cheese from cows grazing pasture is similar to those of milk and cheese with low levels of CLA.

Use of complementary and alternative medicine among Dominican emergency department patients.

This small, pilot study examined presenting complaint, brief health history, use of complementary and alternative medicine (CAM), and sociodemographic characteristics, among patients attending the emergency department (ED) of a large urban hospital. The sample (n = 50) was primarily Dominican and of low socioeconomic status. Almost half had used CAM for their presenting complaint or another health problem during the past year, most commonly in the form of medicinal plants made into herbal teas. CAM users were more likely to be female, longer-term residents of the United States, and to have also used religious practices for health problems. Subjects who had used CAM for any problem other than the presenting complaint during the past year rated its effectiveness higher than subjects who had used CAM for their presenting complaint. In conclusion, it is likely that a significant proportion of Dominican ED patients use CAM, suggesting that they should be asked about their CAM use during triage.

Conjugated linoleic acid content of milk and cheese from cows fed extruded oilseeds.

Extruded oilseeds were fed to 24 dairy cows to study the influence on the conjugated linoleic acid content of milk and cheese. Cows were fed one of three diets that contained forage and grain in a ratio of 47:53. A control diet containing 13.5% soybean meal was compared with diets containing 12% full fat extruded soybeans or 12% full fat extruded cottonseed. The control, extruded soybean, and extruded cottonseed diets contained 2.73, 4.89, and 4.56% fatty acids, respectively. Measurements were made during the last 5 wk of the 8-wk experiment. The DM intakes and 3.5% fat-corrected milk yields were higher for cows fed the extruded soybean and extruded cottonseed diets than for cows fed the control diet. A tendency for lower fat and protein contents in the milk of cows fed the extruded soybean and extruded cottonseed diets was detected. Most of the C18 fatty acids were increased in the milk and cheese when extruded soybeans and cottonseeds were fed. The conjugated linoleic acid content in milk and cheese increased a mean of 109% when full fat extruded soybeans were fed and increased 77% when cottonseeds were fed compared with the conjugated linoleic acid content when the control diet was fed. Processing the milk into cheese did not alter the conjugated linoleic acid content. The conjugated linoleic acid content of milk and cheese can be increased by the inclusion of full fat extruded soybeans and full fat extruded cottonseeds in the diets of dairy cows.

Chemical, physical, and sensory characteristics of mozzarella cheese fortified using protein-chelated iron or ferric chloride.

Mozzarella cheese containing 25 and 50 mg of iron/kg of cheese was manufactured from milk that had been fortified with casein-chelated iron, whey protein-chelated iron, or FeCl3. Chemical, physical, and sensory characteristics were compared with those of a control cheese. Physical properties were assessed by testing melting, apparent viscosity, and browning of heated cheese. Cheeses were evaluated by trained panelists for the presence of metallic flavors, oxidized flavors, and other undesirable flavors. Addition of 25 mg iron/kg of cheese had no effects on the physical properties of Mozzarella cheese. Apparent viscosity of cheese fortified with 50 mg of iron/kg of cheese tended to be slightly higher than the control cheese, although this difference was not statistically significant at all storage times. Cook color was not affected by iron fortification. No increase in chemical oxidation (measured using thiobarbituric acid assay) was observed between the control and iron-fortified cheeses. Slight but statistically significant increases in metallic flavors, oxidized flavors, and off-flavors in the iron-fortified cheese were observed by the trained sensory panel, but the flavor defects were of very low intensity. For metallic flavors, oxidized flavors, and off-flavors, the control cheese scored 1.5, 1.5, and 1.3, respectively; the iron-fortified cheese scored 2.1, 2.0, and 1.6 based on a nine-point scale (where 1 = not perceptible to 3 = slightly perceptible). Sensory scores for iron-fortified cheese made using casein-chelated iron or whey protein-chelated iron was not significantly different from those of cheese made using ferric chloride. When used on pizza, consumer panels rated the iron-fortified cheeses as comparable with the control cheese.

Bone loss and turnover after cardiac transplantation.

Cardiac transplantation is associated with increased prevalence and incidence of fracture, and rapid bone loss has been reported during the first posttransplant year. To define further the pattern and etiology of bone loss after cardiac transplantation, we enrolled 70 patients (52 men and 18 women) in a prospective 3-yr study. Bone densitometry (BMD) and biochemical indexes of mineral metabolism were performed before and at defined times after transplantation. Despite supplementation with elemental calcium (1000 mg/day) and vitamin D (400 IU/day), the mean rate of bone loss during the first year was 7.3 +/- 0.9% (+/- SEM) at the lumbar spine and 10.5 +/- 1.1% at the femoral neck. The rate of bone loss slowed (P < 0.001 compared to year 1) at both sites (0.9 +/- 0.9% and 0.1 +/- 1.0%, respectively) during the second year. During the third year, lumbar spine BMD increased at a rate of 2.4 +/- 0.8%/yr (P < 0.02 compared to year 2), but femoral neck BMD did not change. At the radius, the rate of decline in BMD was negligible during the first year (0.9 +/- 0.5%), but was significant during the second (2.1 +/- 0.6%; P < 0.01) and third (2.9 +/- 0.8%; P < 0.03) years. Evaluation of the pattern of bone loss during the first year demonstrated that mean lumbar spine BMD decreased rapidly during the first 6 months, after which there was no further decline. In contrast, femoral neck BMD continued to fall at an annualized rate of 8.2 +/- 1.3% during the second half of the year. The pattern and rates of bone loss were similar in men and women. Biochemistries revealed decreases in serum testosterone and osteocalcin and increases in all bone resorption markers 1 and 3 months after transplantation, with a return to baseline by 6 months. Higher rates of bone loss were associated with greater exposure to prednisone, lower serum concentrations of vitamin D metabolites, greater suppression of osteocalcin, higher levels of bone resorption markers, and, in men, lower serum testosterone concentrations. We conclude that rapid bone loss is primarily confined to the initial year after transplantation. During the first 6 months, bone loss is accompanied by alterations in markers of bone turnover consistent with biochemical uncoupling of bone formation and resorption. Greater exposure to glucocorticoids, lower serum concentrations of vitamin D metabolites and testosterone, and higher bone turnover were associated with more rapid bone loss.

Manufacture and quality of iron-fortified yogurt.

Yogurts (nonfat and low fat) were manufactured and fortified with 10, 20, and 40 mg of iron/kg of yogurt. Growth of starter culture bacteria and nonstarter culture bacteria as well as lipid oxidation of the yogurts were monitored over 30 d of storage at 4 degrees C. Sensory characteristics of the yogurts were determined during that time by a trained panel of judges, and consumer panels were used to test acceptability of iron-fortified yogurt. Counts of Lactobacillus delbrueckii ssp. bulgaricas and Streptococcus thermophilus after 1 d of storage in iron-fortified skim yogurts were 7.0 x 10(8) cfu/ml, which were not significantly different from numbers in unfortified yogurts. Counts decreased to 2.5 x 10(8) and 1.9 x 10(8) cfu/ml for L. delbrueckii ssp. bulgaricus and S. thermophilus, respectively, after 30 d of storage. Fortifying yogurt with iron did not support the growth of Pseudomonas fluorescens or Escherichia coli. No significant increases in chemical oxidation, as measured using the thiobarbituric acid assay, were detected as a consequence of iron fortification. Trained panelists scored all yogurts for oxidized, metallic, bitter, and other off-flavors in the range of "not perceptible" to "very slightly perceptible". Iron-fortified yogurts had slightly higher oxidized flavor scores than did the control yogurt. There was no increase in metallic, bitter, or other off-flavors. The consumer panel did not detect any significant differences in the appearance, mouthfeel, flavor, or overall quality between fortified and unfortified flavored yogurts. All yogurt samples were liked by the consumer panelists, suggesting that yogurt is a suitable vehicle for iron fortification.

Visual responses in teleosts. Electroretinograms, eye movements, and circadian rhythms.

We have recorded ocular potentials in response to brief flashes of light from two teleosts, the white perch (Roccus americana) and the green sunfish (Lepomis cyanellus). The animals were respired and maintained in an alert state for up to 2 d. Responses were recorded with corneal and transcleral electrodes. The responses of green sunfish were composed of electroretinogram (ERG) and eye movement potentials, whereas the responses in white perch contained only the ERG. Injection of curare abolished the sunfish eye movement potentials, unmasking the ERG. Observation under infrared illumination established a direct relationship between eye movements and the fast potentials which could be abolished by curare. We found no evidence of circadian changes in the amplitude of the ERG b-wave of either species. However, our results combined with those of a previous study of sunfish ocular potentials (Dearry, A., and B. Barlow, Jr. 1987. J. Gen. Physiol. 89: 745-770) suggest that the sunfish visual system exhibits rhythmic changes in oculomotor responses, which appear to be controlled by a circadian oscillator.

A comparison of conductivity-based hematocrit determinations with conventional laboratory methods in autologous blood transfusions.

An investigation was made of the accuracy of a portable hematocrit measurement device (Stat-Crit) on the infusate of an autologous blood transfusion system. Baseline hematocrit values were determined by three methods on in vivo blood samples of surgical patients immediately after the start of surgery, and again on the first product of the autologous blood retrieval system. At baseline, there were no significant differences in the values determined by the Stat-Crit (33.4% +/- 6.2%, mean +/- SD) and those determined by the microcentrifuge technique (33.8% +/- 4.7%) or by the Coulter method (33.5% +/- 4.5%) (P = 0.9). In contrast, hematocrit values determined on infusate samples by the Stat-Crit (36.6% +/- 4.8%) were significantly lower than those determined by the microcentrifuge technique (51.2% +/- 5.9%) or by the Coulter method (51.6% +/- 5.8%) (P = 0.0001). This study confirms close agreement of hematocrit values derived by the conductivity of whole blood in normal samples with those determined by conventional laboratory techniques, but indicates that this method will report falsely low readings in situations where plasma has been replaced by crystalloid, as in patients who have received large transfusions of processed autologous blood.