Changes in plasma triacylglycerol concentrations among free-living hyperlipidemic men adopting different carbohydrate intakes over 2 y: the Dietary Alternatives Study.

We reported previously that low-fat, high-carbohydrate diets containing < 26% of energy as fat and > 57% of energy as carbohydrate induce hypertriacylglycerolemia (hypertriglyceridemia) in hypercholesterolemic but not in combined hyperlipidemic (CHL) subjects. Because subjects may not consistently adhere to an assigned diet long term, we examined the extent to which plasma triacylglycerols (triglycerides) increase at four consistently reported carbohydrate intakes at intervals of up to 2 y. Three hundred seventy-two subjects reported consistent carbohydrate intakes of < 45%, 45-51.9%, 52-59.9%, or > or = 60% of energy on food records for 3, 12, and 24 mo. Among hypercholesterolemic subjects reporting a carbohydrate intake > or = 60% of energy, triacylglycerols increased by 0.25, 0.18, and 0.27 mmol/L (22, 16, and 24 mg/dL) over baseline at 3, 12, and 24 mo, respectively (P < 0.01 in each instance), and 0.32 mmol/L (28 mg/dL) above the group with a carbohydrate intake 52-59.9% of energy (P < 0.05) after 3 mo. No statistically significant effects were observed among CHL subjects, but compared with baseline, triacylglycerols decreased during the first 3 mo (-0.29 to -0.04 mmol/L, or -26 to -4 mg/dL), were unchanged over 12 mo, and were increased after 24 mo in three of four carbohydrate intake strata (0.27-0.36 mmol/L, or 24-32 mg/dL). These data confirm our previous observation that a moderately but not extremely low-fat, high-carbohydrate diet can be used long-term without deleterious effects on plasma triacylglycerols in the management of hypercholesterolemia, whereas CHL is unaffected by the amount of carbohydrate ingested.

Changes in vitamin and mineral intakes and serum concentrations among free-living men on cholesterol-lowering diets: the Dietary Alternatives Study.

Nutritional adequacy of diets with 18-30% of calories from fat was investigated in men with elevated serum cholesterol (n = 396) at the end of diet classes and 1 and 2 y later. On 4-d food records, intakes of vitamin A, beta-carotene, folate, vitamin C, magnesium, vitamin B-6, iron, thiamin, and riboflavin increased from baseline whereas niacin, selenium, vitamin E, and zinc decreased. Median zinc intake, 80% of the recommended dietary allowance (RDA) at baseline, decreased to approximately 75% of the RDA, most markedly when intakes of meat, fish, and poultry were limited to 85 g/d. Nutrient densities generally increased. Of the serum nutrients measured, median beta-carotene and vitamin C increased, whereas vitamin B-6, iron, and zinc were unchanged. Below-normal values were fewer for vitamin C and magnesium. Diets similar to the National Cholesterol Education Program Step-Two Diet [less than 7% saturated fatty acids, less than 200 mg cholesterol/d] appeared to provide increased levels of most micronutrients both short and long term to men receiving comprehensive dietary counseling.

Lipid-lowering medication and risk of injury.

Meta-analyses of early primary prevention trials of lipid-lowering therapies suggested increased risk of injury deaths among treated persons. Our population-based case-control study examined the association of lipid-lowering medication use with fatal and nonfatal injuries in 298 cases and 332 controls. No increased injury risk was observed among current (OR = 0.46, 95% CI 0.18-1.21) or past users (OR = .92, 95% CI 0.44-1.95), after adjustment for behavioral disorders, medical conditions, and health status. Stratified analyses did not reveal sub-groups at significantly increased risk. These results, consistent with recent clinical trials and meta-analyses, suggest no increased injury risk associated with lipid-lowering medications.

Absence of behavioral differences in young normotensive adults as a function of parental history of hypertension.

It has been previously demonstrated that mildly hypertensive subjects show deficits in their performance on various sensory-perceptual, cognitive, and psychomotor tests relative to matched normotensive control subjects, and that these behavioral deficits are reversible following treatment with antihypertensive medication. To examine whether these deficits are an outcome of elevated blood pressure, rather than preceding the hypertensive state, normotensive offspring of hypertensives and normotensives were administered a test battery. Results showed that with minor exceptions, offspring of hypertensives and offspring of normotensives performed similarly on the tests. These results suggest that the behavioral deficits seen in hypertensives arise subsequent to the onset of elevated blood pressure.

Influence of age, sex, and family on Type A and hostile attitudes and behaviors.

We describe the influence of age, sex, and family on Type A and hostility indices that have been related to rates of coronary heart disease (CHD). The sample consisted of 120 girls and 95 boys (ages 6 to 18 years) and 141 women and 120 men (ages 31 to 62 years) from 142 families residing in an upper middle class community. Results showed little familial aggregation of Type A and hostility. Adults had higher Structured Interview (SI) Potential for Hostility ratings than did children, whereas children had higher Minnesota Multiphasic Personality Inventory (MMPI)-derived Hostility scores and SI Anger-In ratings than did adults. Male adults and male children had higher SI Potential for Hostility ratings and MMPI-derived Hostility scores than did their female counterparts. The heightened hostility of males may account, in part, for their heightened risk of CHD relative to females'.

Predicting participation in a dietary intervention to lower cholesterol among individuals with hyperlipidemia.

Adult men and women (N = 8,748) were given blood cholesterol tests and completed a measure of fat intake and a staging questionnaire that assessed readiness to adopt a cholesterol-lowering diet. Eligibility for the trial was based on plasma cholesterol levels and self-reported dietary intake. Of 772 eligible participants, 545 (70.6%) agreed to join. In multivariate analyses, joiners did not differ from nonjoiners by age, total cholesterol levels, or self-reported dietary fat intake. Women were more likely than men to join the study. Individuals in the preparation stage (defined on the basis of a staging algorithm derived from the transtheoretical model of change) were more likely to join the trial than were precontemplators. An understanding of the determinants of participation in a dietary intervention may be important in the enhancement of high-risk individuals' acceptance of recommendations to make dietary changes.

Effect of cholesterol-lowering diets on indices of depression and hostility.

Increased injury deaths have been reported among treatment groups in cholesterol lowering trials, leading to speculation that lipid lowering may result in behavioral disorders. We investigated this in 319 men enrolled in a 2-year trial of lipid lowering diets who completed measures of depression and hostility at entry and 24 months later. Mean Beck Depression Inventory (BDI) scores were lower after 24 months (3.8 versus 3.3,p<0.05) and Symptom Checklist 90-Revised (SCL-90) depression and hostility scores were unchanged. After adjustment for potential confounding, 24-month hostility and BDI scores were unrelated to lipid changes. A small inverse association of borderline statistical significance (B=0.034,p=0.08) was noted between 24-month SCL-90 depression scores and lipid changes. Lipid lowering diets had no significant adverse effect on psychological function and are consistent with current dietary recommendations.

Promoting adherence to low-fat, low-cholesterol diets: review and recommendations.

Evidence that lowering blood cholesterol levels reduces risk of coronary heart disease has prompted widespread recommendations that hyperlipidemic individuals undergo dietary therapy. However, the extent to which people can adopt and maintain diets to lower lipids is unclear. In our article, we review what is currently known regarding adherence to low-fat diets and present an approach to dietary counseling for lowering cholesterol that incorporates elements of behavioral self-management and social learning theory. We discuss specific recommendations for counseling hyperlipidemic patients based on the Dietary Alternatives Study. Recommendations include providing patients with an adequate knowledge base to make dietary changes, using goal setting and self-monitoring to help patients initiate dietary changes, enlisting support from the patient's family, and enhancing self-efficacy to promote long-term dietary maintenance.

Hemispheric asymmetries and early infantile autism.

The observation that language disorders constitute a major symptom of early infantile autism has led some researchers to speculate that the autistic syndrome may be a result of brain damage to the left hemisphere. Such speculation has fostered a number of studies in which attempts have been made to link autism with ostensibly positive signs of left hemisphere damage, such as left-handedness and preferences for "right hemisphere" functional and cognitive activities. In the present review, contributions to this area are systematically reviewed. Studies attempting to demonstrate that an unusually high incidence of left-handedness occurs in autistic samples are examined. Functional and morphological studies examining patterns of asymmetry in autistic samples are reviewed. It is shown that most studies on handedness fail to account adequately for the role that age of subjects may play in the manifestation of left-handedness. A simple cause-and-effect model of abnormal cerebral asymmetry and autism is rejected in favor of a more integrative yet parsimonious model that specifically attempts to explain the language disorder common to autism.

Hostility, social support, and perceptions of work.

The aim of this study was to determine whether hostility and perceived availability of social support are related to perceptions of the work environment. The W.W. Cook and D.M. Medley (1954) Hostility (Ho) scale; the Interpersonal Support Evaluation List (S. Cohen, R. Mermelstein, T. Kamarck, & H. Hoberman, 1985); and measures of collegiality, time pressure, and job dissatisfaction were completed by 204 attorneys (159 men and 45 women). After controlling for age, gender, and other job characteristics, high Ho scores were related to lower perceived supportive collegiality at work. Low perceived availability of social support was related to greater job dissatisfaction. Neither hostility nor social support was associated with perceptions of time pressure at work. These findings suggest that hostility and availability of social support may be an important pathway linking certain job characteristics to cardiovascular disease and other illnesses.

Effect of meditation training on aspects of coronary-prone behavior.

52 undergraduates who had volunteered to receive meditation training were placed into either high or low time-urgency groups based on their scores on Factor S of the Jenkins Activity Survey. Subjects then either received training in Clinically Standardized Meditation followed by 3 1/2-wk. of practice or waited for training during that period. Analyses of scores on a time-estimation task and of self-reported hostility during an enforced waiting task indicated that meditation significantly altered subjects' perceptions of the passage of time and reduced impatience and hostility resulting from enforced waiting.

Anagram solution time and effects of distraction, sex differences, and anxiety.

A single-solution anagram task was administered to high and low test-anxious 32 male and 32 female undergraduates under conditions of high and low external distraction. No significant main effects were found linking solution times to either test-anxiety level or the presence or absence of distracting stimuli. Following a planned post hoc analysis which assigned the anagrams into 'hard' or 'easy' categories, a significant main effect for level of test anxiety was found for the 'hard' anagrams, indicating that test anxiety debilitates performance only when the criterion task is especially difficult. Difficulty of anagrams also significantly interacted with subjects' sex, test anxiety, and distraction. The results are discussed in terms of the hypotheses that distracting stimuli may produce increases in arousal during difficult tasks and that these increments may either compromise or improve performance, depending upon the level of test anxiety which is viewed as a determinant of the initial arousal level of the subject.

Attention-deficit/hyperactivity disorder and learning disabilities in adults.

Attention-Deficit/Hyperactivity Disorder (ADHD) is a developmental disorder which begins in childhood. It is now recognized that ADHD persists into adolescence and adulthood in the majority of cases. Significant psychiatric comorbidity, particularly substance abuse, antisocial personality disorder, and mood and anxiety disorders occurs in adolescent and adult ADHD. Perhaps one fifth of childhood cases of ADHD may also have co-morbid learning disorder. Significant legal, academic, social, and occupational problems have been observed in adults with ADHD. The clinician faces a diagnostic and treatment challenge in trying to determine whether ADHD and learning disabilities (LDs) are present in the adult patient. Treatment and recommendations for accommodations in institutions of higher education and the workplace may rest on accurate discrimination between ADHD and LD.

Changes in plasma lipids and dietary intake accompanying shifts in perceived workload and stress.

Plasma lipids, dietary intake, and self-reported stress and workload were assessed in 14 employees twice before major work deadlines (high workload), and once during a comparatively quiescent period of work (low workload). Increases in self-reported stress and workload between the high and low workload periods were significantly positively associated with increases in plasma total cholesterol, although lipid levels were not increased in the group as a whole during the high workload periods. Dietary intake of calories, total fat, and percentage of calories from fat were significantly higher during high workload during a period of high workload is associated with elevated total cholesterol and that dietary intake of foods which raise cholesterol levels is also increased. Further studies of larger groups of subjects may be required to show a frank increase in cholesterol with increased workload.

Discriminant validity of the Wender Utah Rating Scale for attention-deficit/hyperactivity disorder in adults.

The authors examined the factor structure and discriminant validity of the Wender Utah Rating Scale (WURS) in adults seeking evaluation for attention-deficit/hyperactivity disorder (ADHD). Three factors (Dysthymia, Oppositional/Defiant Behavior, and School Problems) accounted for 59.4% of the variance. In a stepwise discriminant function analysis, age and childhood school problems emerged as significant variables. The classification procedure correctly classified 64.5% of patients. Among those who did not have ADHD, only 57.5% were correctly classified compared with 72.1% among those with ADHD. The WURS is sensitive in detecting ADHD, but it misclassifies approximately half of those who do not have ADHD.