Carnitine transporter and holocarboxylase synthetase deficiencies in The Faroe Islands.

Carnitine transporter deficiency (CTD) and holocarboxylase synthetase deficiency (HLCSD) are frequent in The Faroe Islands compared to other areas, and treatment is available for both disorders. In order to evaluate the feasibility of neonatal screening in The Faroe Islands we studied detection in the neonatal period by tandem mass spectrometry, carrier frequencies, clinical manifestations, and effect of treatment of CTD and HLCSD. We found 11 patients with CTD from five families and 8 patients with HLCSD from five families. The natural history of both disorders varied extensively among patients, ranging from patients who presumably had died from their disease to asymptomatic individuals. All symptomatic patients responded favourably to supplementation with L: -carnitine (in case of CTD) or biotin (in case of HLCSD), but only if treated early. Estimates of carrier frequency of about 1:20 for both disorders indicate that some enzyme-deficient individuals remain undiagnosed. Prospective and retrospective tandem mass spectrometry (MS/MS) analyses of carnitines from neonatally obtained filter-paper dried blood-spot samples (DBSS) uncovered 8 of 10 individuals with CTD when using both C(0) and C(2) as markers (current algorithm) and 10 of 10 when using only C(0) as marker. MS/MS analysis uncovered 5 of 6 patient with HLCSD. This is the first study to report successful neonatal MS/MS analysis for the diagnosis of HLCSD. We conclude that CTD and HLCSD are relatively frequent in The Faroe Islands and are associated with variable clinical manifestations, and that diagnosis by neonatal screening followed by early therapy will secure a good outcome.

Structure of human holocarboxylase synthetase gene and mutation spectrum of holocarboxylase synthetase deficiency.

Holocarboxylase synthetase (HLCS) is an enzyme that catalyzes the incorporation of biotin into apo-carboxylases, and its deficiency causes biotin-responsive multiple carboxylase deficiency. The reported sequences of cDNA for human HLCS from liver, lymphocyte, and KG-1 myeloid cell lines differ at their 5' regions. To elucidate variations of the human HLCS mRNA and longer 5' cDNA ends, we performed screening of the human liver cDNA library and rapid amplification of the cDNA ends (RACE). Our results suggest the existence of three types of HLCS mRNA that start at different exons. The first type starts at exon 1, and the second type starts at exon 3, and both are found in various human tissues. The third type, corresponding to the cDNA from the KG-1 cell, starts at exon 2 of the HLCS gene. Various splicing patterns from exons 3-6 were also observed. None of the variations of cDNA found created a new initiation codon. Mutation screening from exons 6-14, therefore, was sufficient to detect amino acid changes in HLCS in patients. Our direct sequencing strategy for screening mutations in the HLCS gene revealed mutations in five Japanese patients and seven non-Japanese patients. Our analyses involving 12 Japanese and 13 non-Japanese patients and studies by others indicate that (1) there is no panethnically prevalent mutation; (2) the Arg508Trp, Gly581Ser, and Val550Met mutations are found in both Japanese and non-Japanese populations; (3) the IVS10+5G-->A mutation is predominant and probably a founder mutation in European patients; (4) the 655-656insA, Leu237Pro, and 780delG mutations are unique in Japanese patients; (5) the spectrum of the mutations in the HLCS gene may vary substantially among different ethnic groups.

PAHs in dated sediments of Ashtabula River, Ohio, USA.

Polycyclic aromatic hydrocarbons (PAHs) in dated sediments from Ashtabula River, Ohio, were determined, and a chemical mass balance (CMB) model was used to apportion sources. Three cores (AR-1,AR-2,AR-3) were dated by correlating uranium-supported 210Pb peaks with 1964, 1972, 1977, and 1979 maxima in the discharge record for Ashtabula River. These cores had sedimentation rates between 7.1 and 4.4 cm/year, while a fourth (AR-4) exhibited a much higher rate of 27.8 +/- 18 cm/year. The highest PAH concentration was 11,500 ng/g found in layer 6 of AR-1 (1986), and the lowest was 621 ng/g found in layer 8 of AR-2 (1982). The source contributions to the total PAH concentrations estimated by the CMB model are 0.1-2.2%, 16.8-22.8%, and 78.1-83.8% for wood burning (WB), coke oven (CO), and highway dust (HWY), respectively. Petroleum generated PAHs have maximal contribution during 1977-79, and wood burning PAHs show minimal emissions during 1975-77 in accordance with U.S. consumption records and other studies. Among six PAH markers, only phenanthrene may be subjected to aerobic biodegradation or photolysis with an apparent half-life of 0.005-0.025 year. No anaerobic degradation was observed based on the CMB model. The model works well for the nonmarker compounds, fluoranthene, and benzo[b]fluoranthene/benzo[k]fluoranthene.

Water quality before and after deep tunnel operation in Milwaukee, Wisconsin.

The mitigative effects of the deep tunnel for temporary storage of storm water and sewage, on the water quality of the Milwaukee, Menomonee, and Kinnickinnic Rivers are investigated. The analysis is based on data from the Milwaukee Metropolitan Sewerage District's overflow and surface-water quality monitoring program. Statistical analysis of water quality parameters (BOD, phosphorus, suspended solid, fecal coliform counts, zinc, and chloride) in the three rivers indicates that Menomonee River benefits the most from the deep tunnel. Fecal coliform counts inside the CSO area, and to a certain extent BOD and zinc levels, exhibit the most significant decline after 1994 when the tunnel came on line. These conclusions are based on t-test comparisons of regional averages incorporating spatial and temporal correlations from 1991 to 1993 and 1994 to 1997. The results from t-tests are complemented and confirmed with results from Mann-Kendall tests for trend. Suspended solids and chloride do not decrease after 1994.

A mutation in the gene for the neurotransmitter receptor-clustering protein gephyrin causes a novel form of molybdenum cofactor deficiency.

Gephyrin was originally identified as a membrane-associated protein that is essential for the postsynaptic localization of receptors for the neurotransmitters glycine and GABA(A). A sequence comparison revealed homologies between gephyrin and proteins necessary for the biosynthesis of the universal molybdenum cofactor (MoCo). Because gephyrin expression can rescue a MoCo-deficient mutation in bacteria, plants, and a murine cell line, it became clear that gephyrin also plays a role in MoCo biosynthesis. Human MoCo deficiency is a fatal disease resulting in severe neurological damage and death in early childhood. Most patients harbor MOCS1 mutations, which prohibit formation of a precursor, or carry MOCS2 mutations, which abrogate precursor conversion to molybdopterin. The present report describes the identification of a gephyrin gene (GEPH) deletion in a patient with symptoms typical of MoCo deficiency. Biochemical studies of the patient's fibroblasts demonstrate that gephyrin catalyzes the insertion of molybdenum into molybdopterin and suggest that this novel form of MoCo deficiency might be curable by molybdate supplementation.

The intrinsic factor-vitamin B12 receptor and target of teratogenic antibodies is a megalin-binding peripheral membrane protein with homology to developmental proteins.

The present report shows the molecular characterization of the rat 460-kDa epithelial glycoprotein that functions as the receptor facilitating uptake of intrinsic factor-vitamin B12 complexes in the intestine and kidney. The same receptor represents also the yolk sac target for teratogenic antibodies causing fetal malformations in rats. Determination of its primary structure by cDNA cloning identified a novel type of peripheral membrane receptor characterized by a cluster of eight epidermal growth factor type domains followed by a cluster of 27 CUB domains. In accordance with the absence of a hydrophobic segment, the receptor could be released from renal cortex membranes by nonenzymatic and nonsolubilizing procedures. The primary structure has no similarity to known endocytic receptors but displays homology to epidermal growth factor and CUB domain proteins involved in fetal development, e.g. the bone morphogenic proteins. Electron microscopic immunogold double labeling of rat yolk sac and renal proximal tubules demonstrated subcellular colocalization with the endocytic receptor megalin, which is expressed in the same epithelia as the 460-kDa receptor. Furthermore, megalin affinity chromatography and surface plasmon resonance analysis revealed a calcium-dependent high affinity binding of the 460-kDa receptor to megalin, which thereby may mediate its vesicular trafficking. Due to the high number of CUB domains, accounting for 88% of the protein mass, we propose the name cubilin for the novel receptor.

Clinical course, early diagnosis, treatment, and prevention of disease in glutaryl-CoA dehydrogenase deficiency.

BACKGROUND: Glutaryl-CoA dehydrogenase deficiency (GDD) is a recessively inherited neurometabolic disorder associated with encephalopathic crises and severe extrapyramidal symptoms. Treatment regimens including glucose and electrolyte infusions during acute illnesses, oral carnitine supplementation and/or a low-protein or lysine-restricted diet have been recommended, but their efficacy has been documented only on an anecdotal basis. SUBJECTS AND METHODS: We conducted a retrospective analysis of 57 patients with proven GDD-relating appearance and severity of neurological disease to age and clinical status at diagnosis, glutaric acid levels in body fluids, and different treatment regimens. RESULTS: Thirty-six patients were diagnosed after the onset of neurological disease (symptomatic group), twenty-one before (presymptomatic group). Carnitine levels were found to be reduced in all patients at diagnosis. In the symptomatic group, macrocephaly had been present around birth and was followed by rapid postnatal head growth in 70% of the children. The patients often showed symptoms such as hypotonia, irritability, and jitteriness followed by an acute encephalopathic crisis occurring on average at 12 months of age. Common neuroimaging findings included frontotemporal atrophy, subependymal pseudocysts, delayed myelination, basal ganglia atrophy, chronic subdural effusions and hematomas. In four patients the latter two findings were initially misinterpreted as resulting from child abuse. Other important misdiagnoses in older siblings who were affected and went undiagnosed include postencephalitic cerebral palsy, dystonic cerebral palsy and sudden infant death syndrome. Metabolic treatment did not convincingly improve the neurological disease, although it may have prevented further deterioration. Symptomatic treatment with baclofen or benzodiazepines was effective in reducing muscle spasms. Children in the presymptomatic group were diagnosed because of familiarity for the disease (n = 13), macrocephaly and/or additional minor neurological signs in infancy (n = 6), or acute encephalopathy, which was fully reversible after prompt treatment (n = 2). After diagnosis, all children were treated with oral carnitine, fluid infusion during intercurrent illnesses and, in addition, a diet was started in 13 of the 21 children. All 21 children except one (born prematurely at 31 weeks) have continued to develop normally up to now. Mean age at report is 6.3 years with a range from 6 months to 14.8 years. In older patients, the neuroradiological changes, present in infancy as in the symptomatic patients, became less prominent and in one girl disappeared. CONCLUSIONS: In presymptomatic children with GDD, the onset of neurological disease can be prevented by vigorous treatment of catabolic crises during illnesses together with carnitine supplementation. The importance of dietary therapy remains unclear and needs further evaluation. The potential treatability of GDD calls for increased attention to early presenting signs in order to recognize the disorder and to initiate treatment before the onset of irreversible neurological disease.

[Seasonal affective disorders]. / Saesonrelaterede affektive lidelser.

In 1984 Rosenthal described for the first time the syndrome "Seasonal Affective Disorder", SAD, characterized by annual recurrent depressive episodes in the autumn and winter months possibly followed by mania/hypomania in the summer months. The depressive phases showed atypical symptoms such as hypersomnia, carbohydrate-craving, and weight gain. Melatonin seems to be an indicator of disturbed circadian rhythm rather than the cause of SAD. The importance of other circadian and annual biological rhythm in relation to SAD and other depressive syndromes is quite unknown. SAD differs from classical manic-depressive disorders by frequency, severity, symptomatology, and the typical seasonal variations, and is probably not a subgroup of the classical affective disorders, but an extreme variation of the normal seasonal affective variations seen in the general population. Light therapy can be used successfully in depressive states in SAD.

[Determination of serum ferritin: ideas for avoiding induced ferropenia in blood donors]. / Determinación de ferritina sérica: consideraciones para evitar ferropenia inducida en donantes de sangre.

PURPOSE: To evaluate blood donation as a cause of iron deficiency. MATERIAL AND METHODS: Serum ferritin levels were determined by enzymoimmunoassay with an SRItm autoanalyser in 500 blood donors of both sexes chosen at random and in 200 suitors for blood donation, used as control group. Iron deficiency was defined by ferritin values below 15 ng/dL. Age, sex, total number of blood donations and those carried out in the last year were all correlated for the statistical analysis, performed with the SPSS/PC+ pack. RESULTS: The mean ferritin value in men was 86.0 ng/dL, and in women this was 27.1 ng/dL. With respect to the control group, blood donors showed increased iron deficiency, 7.4% for men and 11.8% for women. Highly significant direct correlation was found in male donors between total donations, last-year donations and age, and between total number of donations and age in female donors; highly significant inverse correlation was found between total number of donations, last-year donations and ferritin levels among the male donors, while these correlations lacked significance in the female donors. When correlating last-year donations with mean ferritin levels in women, low, although constant, ferritin values were seen, whereas a marked descent was found in men. Iron deficiency was strikingly spread among women, ranging between 21% of those with one blood donation to 46% in those with 4 donations during the last year; in men, iron deficiency was present in 14% of those with 4 or more blood donations in the last year. With respect to total number of blood donations and mean ferritin values, iron deficiency was found in 50% of the women with 8 donations and in 12.8% of men with 14 donations. Ferritin levels decrease in blood donors with aging beyond two blood donations in both sexes. CONCLUSIONS: 1st) Iron deficiency related to blood donation is demonstrated. This deficiency is clearly seen in men after the first blood donations and is more intense in women, as their previous reserves are lower. 2nd) Ferritin is the best marker for estimating iron deposits, and enzymoimmunoassay is the technique of choice as it seems easy to perform and is automatic. 3rd) Determining ferritin levels in the first blood donation seems advisable in order to assess previous deposits and to evaluate yearly the state or iron reserves. 4th) Iron supplement is advisable during the 4 first donations in regular blood donors and in those with iron deficiency, with ferrous sulphate at a dose of 100 mg/day for 10 days.

Increased urinary loss of uric acid in adults with acute respiratory failure requiring mechanical ventilation.

INTRODUCTION: The purpose of this study was to test a hypothesis of increased urinary excretion of uric acid as an indicator of adenosine triphosphate (ATP) degradation in adult patients with acute respiratory failure, and to look for a correlation to the clinical outcome. STUDY DESIGN: Prospectively 31 patients with acute respiratory failure were studied. The patients were divided into two groups according to the clinical outcome: the need for solely supplemental oxygen (group 1), death or mechanical ventilation (group 2). METHODS: Uric acid was determined by spectrophotometry. RESULTS: Mean uric acid excretion was 39 mumol/kg (range, 7 to 92 mumol/kg) body weight/per 24 h in group 1 (16 patients) compared with 65 mumol/kg/24 h (range, 8 to 253 mumol/kg/24 h) in group 2 (13 patients were mechanically ventilated, and two patients died). The difference was highly significant (p less than 0.0001). CONCLUSION: Increased amount of urinary uric acid was related to the severity of acute respiratory failure in adults.

Effects of dietary purified eicosapentaenoic acid (20:5 (n-3)) and docosahexaenoic acid (22:6(n-3)) on fatty acid desaturation and oxidation in isolated rat liver cells.

The effects of dietary supplementation of eicosapentaenoic acid (20:5(n-3), EPA) and docosahexaenoic acid (22:6(n-3), DHA) on the metabolism of polyunsaturated fatty acids were studied in isolated rat liver cells. Both pure EPA and pure DHA and a mixture of the two n-3 fatty acids in different doses were used. The supplementation of moderate amounts of n-3 fatty acids suppressed the activity of delta 6-desaturase (50%) and to a smaller extent of the delta 5-desaturase (60-70%) compared to controls. When higher doses of dietary purified EPA and DHA were used, this inhibitory effect on the delta 6- and delta 5-desaturase activities disappeared. The delta 4-desaturase activity seemed to be unaffected by the feeding conditions used. The supplementation of the n-3 fatty acids in the diet at all dose levels used increased the beta-oxidation of all the polyunsaturated fatty acids, especially of linoleic acid, linolenic acid and eicosapentaenoic acid. The results suggest an increase both in peroxisomal and mitochondrial beta-oxidation. The peroxisomal beta-oxidation of n-3 fatty acids seemed to be particularly increased.

Effects of clofibrate feeding on essential fatty acid desaturation and oxidation in isolated rat liver cells.

The effects of clofibrate feeding on the metabolism of polyunsaturated fatty acids were studied in isolated rat hepatocytes. Administration of clofibrate stimulated the oxidation and particularly the peroxisomal beta-oxidation of all the fatty acids used. The increase in oxidation products was markedly higher when n-3 fatty acids were used as substrate, indicating that peroxisomes contribute more to the oxidation of n-3 than n-6 fatty acids. The whole increase in oxidation could be accounted for by a corresponding decrease in acylation in triacylglycerol while the esterification in phospholipids remained unchanged. A marked stimulation of the amounts of newly synthesized C16 and C18 fatty acids recovered, was observed when 18:2(n-6), 20:3(n-6), 18:3 (n-3) and 20:5(n-3), but not when 20:4(n-6) and 22:4(n-6) were used as substrate. This agrees with the view that extra-mitochondrial acetyl-CoA produced from peroxisomal beta-oxidation is more easily used for fatty acid new synthesis than acetyl-CoA from mitochondrial beta-oxidation. The delta 6 and delta 5 desaturase activities were distinctly higher in cells from clofibrate fed rats indicating a stimulating effect.

Glutaryl-coenzyme A dehydrogenase deficiency: a distinct encephalopathy.

Clinical course, diagnostic and therapeutic management, and neurodevelopmental outcome were evaluated in 11 patients with glutaryl-coenzyme A dehydrogenase deficiency. In 9 patients macrocephalus was present at or shortly after birth and preceded the neurological disease. In 7 children an acute illness resembling encephalitis appeared after a period of normal development; 2 had developmental delay and progressive "dystonic cerebral palsy." Later, all 9 displayed typical signs of a disorder of the basal ganglia. In 1 patient with macrocephalus the disorder was diagnosed before the onset of neurological disease; in another it was diagnosed prenatally. Computed tomography and magnetic resonance imaging scans revealed severe generalized cerebral atrophy, most striking in the frontal and temporal lobes in 10 patients. Further deterioration was halted after initiation of treatment consisting of low-protein diets, special formulas low in lysine and tryptophan, and supplements of riboflavin and L-carnitine. Only 1 patient showed a slight clinical improvement. Later, dietary therapy was discontinued in 2 older patients and relaxed in a third without observed adverse effects. Two patients in whom treatment could be initiated before the onset of neurological symptoms have developed normally. However, duration of follow-up (6 and 29 months) does not yet allow classification of glutaryl-coenzyme A dehydrogenase deficiency as a treatable disorder. Total body production of glutaric acid, reflected in the daily urinary output, was efficiently reduced by therapeutic measures. Levels of glutaric acid in plasma and cerebrospinal fluid remained unchanged, which may in part explain the overall unsatisfactory outcome. All patients presented with a severe secondary deficiency of carnitine.(ABSTRACT TRUNCATED AT 250 WORDS)

Dietary n-6 fatty acids inhibit the incorporation of dietary n-3 fatty acids in thrombocyte and serum phospholipids in humans: a controlled dietetic study.

The effect of a high dietary intake of n-6 fatty acids (36 g daily) vs a low intake (4-6 g daily) on the incorporation of fatty acids from a dietary supplementation of n-3 fatty acids (6 g daily) was studied for 8 weeks in 15 healthy, normolipaemic volunteers. The importance of a high (43.6) vs a low (20.6) energy percentage from fat was also investigated in the participants on a low n-6 intake. Fatty acid analyses of serum and thrombocyte phospholipids showed a marked increase in docosahexaenoic acid (22:6 (n-3), DHA) and especially eicosapentaenoic acid (20:5 (n-3), EPA) in both the high and low n-6 groups after 14 days, but the changes were significantly greater in the low n-6 diet groups. Changes of the ratio between EPA and arachidonic acid (20:4 (n-6), AA) in phospholipids followed an identical pattern in serum and thrombocytes. This indicates that thrombocytes are influenced by the fatty acid composition in serum. The results showed that incorporation of n-3 fatty acids in phospholipids was reduced by a high intake of dietary n-6 fatty acids in the cells and lipid fractions studied. The observed effect of dietary n-6 fatty acids was independent of the energy percentage provided by dietary fat. In order to obtain an optimal effect of n-3 supplementation, the intake of linoleic acid has to be considered and kept at a low level. The serum content of cholesterol was unaffected, but the concentration of triacylglycerol was reduced during the supplementation period.

Molecular characterization of medium-chain acyl-CoA dehydrogenase (MCAD) deficiency: identification of a lys329 to glu mutation in the MCAD gene, and expression of inactive mutant enzyme protein in E. coli.

A series of experiments has established the molecular defect in the medium-chain acyl-coenzyme A (CoA) dehydrogenase (MCAD) gene in a family with MCAD deficiency. Demonstration of intra-mitochondrial mature MCAD indistinguishable in size (42.5-kDa) from control MCAD, and of mRNA with the correct size of 2.4 kb, indicated a point-mutation in the coding region of the MCAD gene to be disease-causing. Consequently, cloning and DNA sequencing of polymerase chain reaction (PCR) amplified complementary DNA (cDNA) from messenger RNA of fibroblasts from the patient and family members were performed. All clones sequenced from the patient exhibited a single base substitution from adenine (A) to guanine (G) at position 985 in the MCAD cDNA as the only consistent base-variation compared with control cDNA. In contrast, the parents contained cDNA with the normal and the mutated sequence, revealing their obligate carrier status. Allelic homozygosity in the patient and heterozygosity for the mutation in the parents were established by a modified PCR reaction, introducing a cleavage site for the restriction endonuclease NcoI into amplified genomic DNA containing G985. The same assay consistently revealed A985 in genomic DNA from 26 control individuals. The A to G mutation was introduced into an E. coli expression vector producing mutant MCAD, which was demonstrated to be inactive, probably because of the inability to form active tetrameric MCAD. All the experiments are consistent with the contention that the G985 mutation, resulting in a lysine to glutamate shift at position 329 in the MCAD polypeptide chain, is the genetic cause of MCAD deficiency in this family. We found the same mutation in homozygous form in 11 out of 12 other patients with verified MCAD deficiency.

Prospective study of EDTA clearance among patients in long-term lithium treatment.

EDTA clearance as a measure of the glomerular filtration rate was followed up to 10 years in 14 patients in long-term lithium treatment. The results in the lithium-treated patients were identical to the results in a standard population.

Long-term treatment of chronic bronchitis with positive expiratory pressure mask and chest physiotherapy.

Long-term treatment of chronic bronchitis with chest physiotherapy with or without positive expiratory pressure (PEP) by mask was studied in 43 patients randomly allocated to PEP treatment (PEP group, 20 patients) and conventional chest physiotherapy (control group, 23 patients). After instruction, the treatments were self-administered twice daily for 12 months (34 patients) and 5 months (9 patients). Twice weekly, patients filled in a diary concerning symptoms. The PEP group had significantly less cough and less mucus production. The number of acute exacerbations were calculated from the diaries and were lower in the PEP group compared to the control group, and 85 percent of the patients in the PEP group were free from acute exacerbations versus 48 percent in the control group. The PEP group also used less antibiotics and mucolytics. The PEP group had a small increase in FEV1 of mean 62 ml compared to a small decrease of 43 ml for the control group. Treatment with a simple PEP device can reduce morbidity in patients with chronic bronchitis and may preserve lung function from a more rapid decline.

Increased neurotransmitter biosynthesis in phenylketonuria induced by phenylalanine restriction or by supplementation of unrestricted diet with large amounts of tyrosine.

Seven phenylketonuria (PKU) patients aged 15-24 years were allowed unrestricted diet for 3 weeks. Three of these patients performed well on unrestricted diet according to visual reaction time variability (RTv 50-100 ms) and did not show significant changes when returning to the phenylalanine-restricted diet (RTv 70-100 ms). Neither did the concentrations of homovanillic acid (HVA) and 5-hydroxyindoleacetic acid (5-HIAA) in cerebrospinal fluid (CSF) change significantly. Four of the patients, however, performed rather poorly (RTv 120-220 ms) on unrestricted diet and improved significantly (P less than 0.03) when the diet was restored (RTv 70-150 ms). The improvements were accompanied by significant (P less than 0.01 and P less than 0.02) increases (mean 52% and 109%) in CSF levels of HVA and 5-HIAA. Five PKU patients aged 15-23 years were allowed unrestricted diet or unrestricted diet supplemented with various amounts of tyrosine (106-194 mg/kg per 24 h). Two of these patients performed very well on unrestricted diet (RTv 60 ms) and showed little change when the unrestricted diet was supplemented with tyrosine (RTv 70 ms and 80 ms). The three other patients, who performed rather poorly (RTv 120-220 ms), improved significantly (P less than 0.03) when the unrestricted diet was supplemented with tyrosine (RTv 70-140 ms). HVA in CSF increased significantly (P less than 0.01) with the tyrosine supplement when the amount exceeded a threshold of approximately 80 mg/kg per 24 h.(ABSTRACT TRUNCATED AT 250 WORDS)

Fat consumption and schizophrenia.

This report describes the statistical association between the average ratings of course and outcome of schizophrenia in 8 national centres participating in the World Health Organization international 2-year follow-up study (1) and the amount of fat in the average national diets as published by the Food and Agriculture Organization of the United Nations (2). Highly significant correlations were found between favourable ratings of course and outcome of schizophrenia and a low percentage of total fat (r = 0.80-0.90; P less than 0.05) and of fat from land animals and birds (composed mainly of saturated fat) (r = 0.91-0.95; P less than 0.01). High percentage of fat from vegetables, fish and seafood (having a relatively high content of unsaturated fatty acids) tended to be associated with a favourable course and outcome (r = 0.23-0.50; P greater than 0.10). A multivariate analysis revealed that 97% (P = 0.0002) of the variation in the overall outcome of schizophrenia between the national centres could be explained by the combined variation in the percentages of fat from land animals and birds and from vegetables, fish and seafood, respectively, in the national diets. These results suggest that the course and outcome of schizophrenia may be influenced through diet. They should encourage investigators to perform controlled clinical trials of low-fat diets with a sufficient amount of essential fatty acids.