Modulating absorption and postprandial handling of dietary fatty acids by structuring fat in the meal: a randomized crossover clinical trial.

BACKGROUND: Prolonged postprandial hypertriglyceridemia is a potential risk factor for cardiovascular diseases. In the context of obesity, this is associated with a chronic imbalance of lipid partitioning oriented toward storage and not toward ß-oxidation. OBJECTIVE: We tested the hypothesis that the physical structure of fat in a meal can modify the absorption, chylomicron transport, and further metabolic handling of dietary fatty acids. DESIGN: Nine normal-weight and 9 obese subjects were fed 40 g milk fat (+[(13)C]triacylglycerols), either emulsified or nonemulsified, in breakfasts of identical composition. We measured the postprandial triacylglycerol content and size of the chylomicron-rich fraction, plasma kinetics of [(13)C]fatty acids, exogenous lipid oxidation with breath-test/indirect calorimetry, and fecal excretion. RESULTS: The emulsified fat resulted in earlier (>1 h) and sharper chylomicron and [(13)C]fatty acid peaks in plasma than in spread fat in both groups (P < 0.0001). After 2 h, the emulsified fat resulted in greater apolipoprotein B-48 concentrations (9.7 ± 0.7 compared with 7.1 ± 0.9 mg/L; P < 0.05) in the normal-weight subjects than did the spread fat. In the obese subjects, emulsified fat resulted in a 3-fold greater chylomicron size (218 ± 24 nm) compared with the spread fat (P < 0.05). The emulsified fat induced higher dietary fatty acid spillover in plasma and a sharper (13)CO(2) appearance, which provoked increased exogenous lipid oxidation in each group: from 45% to 52% in normal-weight subjects (P < 0.05) and from 40% to 57% in obese subjects (P < 0.01). CONCLUSION: This study supports a new concept of "slow vs fast fat," whereby intestinal absorption can be modulated by structuring dietary fat to modulate postprandial lipemia and lipid ß-oxidation in humans with different BMIs. This trial was registered at clinicaltrials.gov as NCT01249378.

13C tracer recovery in human stools after digestion of a fat-rich meal labelled with [1,1,1-13C3]tripalmitin and [1,1,1-13C3]triolein.

Lipid metabolism studies focus mainly on oxidation and storage but rarely on faecal elimination, which is needed to assess total lipid distribution during the postprandial period. The purpose of the present work was to set up and validate the analysis of lipid tracers in stools, with an aim of later using this methodology in studies of postprandial lipid tracer metabolism. Eight subjects received a mixture of [1,1,1-(13)C3]tripalmitin and [1,1,1-(13)C3]triolein with a fat-rich meal. The nature and amounts of (13)C lipids excreted in stools during 3 days post-dose were determined by gas chromatography/mass spectrometry (GC/MS) and gas chromatography/combustion/isotope ratio mass spectrometry (GC/C/IRMS) analysis of fatty acid methyl esters (FAMEs) from total fatty acid (TFA), free fatty acid (FFA) and triacylglycerol (TAG) fractions. The results were expressed as the Cumulative Tracer Recovery of the administered dose (CTR%). The quantities and labelling of FAMEs were higher in FFA than in TAG, indicating that label loss was not due to a lack of digestive lipase activity. The labelling was higher for C16:0 than for C18:1. The CTRs were 7.03 ± 0.77% and 6.87 ± 0.91%, respectively, in TFA and FFA for [1-(13)C] C16:0, while they were 0.60 ± 0.15% and 0.51 ± 0.11% for [1-(13)C] C18:1 (mean ± sem). By studying the kinetics of lipid excretion from subjects, two groups emerged. The first one showed rapid excretion in stool #1, whereas the second showed slower excretion in stools #2-#3. A significant difference was found in the FFA in stool #1 for C16:0 (p < 0.01) and C18:1 (p < 0.05). Individual excretion kinetics showed marked variability. Nevertheless, the CTR over the 3-day study period was substantial and homogenous for all subjects. These results confirm that the assessment of faecal elimination is of great importance when establishing total lipid distribution during the postprandial period and validate the analysis of cumulative tracer loss during 72 h post-tracer ingestion.

Comparison of high-temperature conversion and equilibration methods for the determination of d31-palmitic acid oxidation in man using continuous-flow isotope ratio mass spectrometry.

During nutritional interventions, the ingestion of d(31)-palmitic acid and H(2)(18)O allows the assessment of dietary fatty acid oxidation from cumulative (2)H recovery in urine and the estimation of the total body water pool (TBW) from (18)O dilution. Continuous-flow isotope ratio mass spectrometry (CF-IRMS) coupled to either equilibration or high-temperature conversion (HTC) techniques permits (2)H- and (18)O-enrichment measurements in biological fluids. Thus it was of great interest to compare these methods applied to the determination of dietary fatty acid oxidation. The linearity, accuracy and correlation between CF-equilibration and CF-HTC were first checked using (2)H- and (18)O-enriched water and urine samples. Urine samples from 14 subjects were then measured with both methods. The (2)H and (18)O raw data were normalised against calibration lines. The final aim was to study the impact of the normalised raw results on physiological data (i.e. TBW and d(31)-palmitate recovery). No significant difference was observed between the (18)O- and (2)H-enrichment measurements depending on the analytical method used. The TBW volumes calculated from the (18)O enrichments measured either with CF-equilibration or CF-HTC were not significantly different: respectively, 45.1 ± 1.0 L or 45.7 ± 1.0 L (mean ± sem, p = 0.09). The palmitic acid oxidation results obtained from the (2)H-enrichment measurements and the TBW from CF-equilibration vs. CF-HTC were not significantly different (p ≥ 0.26): with δ(2)H values of, respectively, 16.2 ± 1.6% vs. 16.2 ± 1.1% at 8 h, 18.7 ± 2.0% vs. 17.6 ± 1.3% at 12 h and 21.7 ± 1.9% vs. 21.5 ± 1.3% at 3 days post-dose (mean ± sem). Thus, even if CF-HTC was preferred because it was more practical to carry out, both methods allow the study of dietary lipid oxidation in man and generate similar results.

Impact of a resistant dextrin with a prolonged oxidation pattern on day-long ghrelin profile.

OBJECTIVES: The effects of a new resistant dextrin ingested at breakfast on day-long metabolic parameters and ghrelin profile at subsequent lunch were investigated. METHODS: In this randomized, single-blinded, crossover study, 12 healthy men ingested a standardized breakfast with 50 g of NUTRIOSE 10, a resistant dextrin (RD), or of maltodextrin (Malto) and a standardized lunch 5 hours later. Both products (RD and Malto) were derived from corn naturally rich in (13)C to follow their metabolic fate (by using stable isotope analysis). Oxidation and fermentation patterns were assessed by simultaneous (13)CO(2)/H(2) breath testing. The appearance of exogenous (13)C-glucose in plasma, glycemia, insulinemia, nonesterified fatty acids (NEFAs), and ghrelin concentrations were measured for 10 hours following breakfast ingestion. RESULTS: With RD, H(2) excretion (fermentation) was significantly enhanced compared with Malto, whereas the appearance of (13)CO(2) (oxidation) was significantly prolonged (p < 0.0001). Following breakfast, ghrelin secretion was significantly less inhibited and NEFA concentration was higher with RD (p < 0.05), but unexpectedly, both remained lower after lunch and up to T600 minutes. According to the reduced bioavailability of RD compared with Malto, the appearance of (13)C-glucose in plasma (p < 0.0001) and glycemic and insulinemic responses to breakfast (p < 0.05) were significantly reduced. CONCLUSIONS: Ingestion of this new resistant dextrin at breakfast decreased ghrelin concentrations in response to the subsequent lunch, even if the caloric load ingested at breakfast was lower. This effect may be linked to the prolonged fermentation/oxidation pattern seen in the late postprandial phase (up to 10 hours after ingestion at breakfast), and thus prolonged energy release with the resistant dextrin.

Effect of postprandial modulation of glucose availability: short- and long-term analysis.

Low glycaemic index (LGI) foods have been proposed as potential means to decrease postprandial glucose excursions and thus to improve diabetes management. We modulated glucose availability of cereal products and thus their glycaemic index to study the metabolic effect of LGI foods on daylong glucose control acutely and in the long term following a 5-week GI intervention diet in free-living subjects. In this randomised, parallel trial, two groups of nineteen overweight subjects followed an ad libitum 5-week intervention diet in which usual starch was replaced by either LGI or high GI (HGI) starch. During the exploration days (days 1 and 36), subjects ate their assigned 13C-labelled test breakfast (LGI or HGI), and total and exogenous glucose kinetics (using stable isotopes), postprandial concentrations of glucose, insulin, lipid profile and nutrient oxidation were assessed after the test breakfast and a standardised lunch. At day 1, LGI breakfast significantly decreased post-breakfast glycaemic response with a parallel decrease in exogenous and total glucose appearance (P < 0.05). Post-lunch and post-breakfast glycaemic responses were positively correlated (r 0.79, P < 0.0001). Following the 5-week diet, difference between the groups in terms of glucose kinetics and response was maintained (no significant interaction group x time) but tended to decrease over time for the post-breakfast glycaemic response. Post-lunch and post-breakfast glycaemic responses remained positively correlated (r 0.47, P = 0.004). Modulation of postprandial glucose availability at breakfast decreased plasma exogenous glucose appearance and improved glucose control at the subsequent lunch. After 5 weeks, these effects were maintained in healthy subjects but remained to be confirmed in the longer term.

Validation of pentaacetylaldononitrile derivative for dual 2H gas chromatography/mass spectrometry and 13C gas chromatography/combustion/isotope ratio mass spectrometry analysis of glucose.

A reference method to accurately define kinetics in response to the ingestion of glucose in terms of total, exogenous and endogenous glucose is to use stable-isotope-labelled compounds such as 2H and 13C glucose followed by gas chromatography/mass spectrometry (GC/MS) and gas chromatography/combustion/isotope ratio mass spectrometry (GC/C/IRMS) analysis. The use of the usual pentaacetyl (5Ac) derivative generates difficulties in obtaining accurate and reproducible results due to the two chromatographic peaks for the syn and anti isomers, and to the isotopic effect occurring during acetylation. Therefore, the pentaacetylaldononitrile derivative (Aldo) was validated for both isotopes, and compared with the 5Ac derivative. A correction factor including carbon atom dilution (stoichiometric equation) and the kinetic isotopic effect (KIE) was determined. Analytical validation results for the 2H GC/MS and 13C GC/C/IRMS measurements produced acceptable results with both derivatives. When 2H enrichments of plasma samples were < or = 1 mol % excess (MPE), the repeatability (RSD(Aldo Intra assay and Intra day) <0.94%, RSD(5Ac Intra assay and Intra day) <3.29%), accuracy (Aldo <3.4%, 5Ac <29.0%), and stability of the derivatized samples were significantly better when the Aldo derivatives of the plasma samples were used (p < 0.05). When the glucose kinetics were assessed in nine human subjects, after glucose ingestion, the plasma glucose 2H enrichments were identical with both derivatives, whereas the 13C enrichments needed a correction factor to fit together. Due to KIE variation, this correction factor was not constant and had to be calculated for each batch of analyses, to obtain satisfactory results. Mean quantities of exogenous glucose exhibit marked difference (20.9 +/- 1.3g (5Ac) vs. 26.7 +/- 2.5g (Aldo)) when calculated with stoichiometric correction, but fit perfectly when calculated after application of the correction factor (22.1 +/- 1.3g (5Ac) vs. 22.9 +/- 1.9g (Aldo)). Finally, the pentaacetylaldononitrile derivative, used here in GC/C/IRMS for the first time, enables measurement of 2H and 13C enrichments in plasma glucose with a single sample preparation.

Physical inactivity differentially alters dietary oleate and palmitate trafficking.

OBJECTIVE: Obesity and diabetes are characterized by the incapacity to use fat as fuel. We hypothesized that this reduced fat oxidation is secondary to a sedentary lifestyle. RESEARCH DESIGN AND METHODS: We investigated the effect of a 2-month bed rest on the dietary oleate and palmitate trafficking in lean women (control group, n = 8) and the effect of concomitant resistance/aerobic exercise training as a countermeasure (exercise group, n = 8). Trafficking of stable isotope-labeled dietary fats was combined with muscle gene expression and magnetic resonance imaging-derived muscle fat content analyses. RESULTS: In the control group, bed rest increased the cumulative [1-(13)C]oleate and [d(31)]palmitate appearance in triglycerides (37%, P = 0.009, and 34%, P = 0.016, respectively) and nonesterified fatty acids (NEFAs) (37%, P = 0.038, and 38%, P = 0.002) and decreased muscle lipoprotein lipase (P = 0.043) and fatty acid translocase CD36 (P = 0.043) mRNA expressions. Plasma NEFA-to-triglyceride ratios for [1-(13)C]oleate and [d(31)]palmitate remained unchanged, suggesting that the same proportion of tracers enters the peripheral tissues after bed rest. Bed rest did not affect [1-(13)C]oleate oxidation but decreased [d(31)]palmitate oxidation by -8.2 +/- 4.9% (P < 0.0001). Despite a decreased spontaneous energy intake and a reduction of 1.9 +/- 0.3 kg (P = 0.001) in fat mass, exercise training did not mitigate these alterations but partially maintained fat-free mass, insulin sensitivity, and total lipid oxidation in fasting and fed states. In both groups, muscle fat content increased by 2.7% after bed rest and negatively correlated with the reduction in [d(31)]palmitate oxidation (r(2) = 0.48, P = 0.003). CONCLUSIONS: While saturated and monounsaturated fats have similar plasma trafficking and clearance, physical inactivity affects the partitioning of saturated fats toward storage, likely leading to an accumulation of palmitate in muscle fat.

Modulation of the postprandial phase by beta-glucan in overweight subjects: effects on glucose and insulin kinetics.

Decreasing the postprandial glucose response is potentially of major importance to public health when low-glycemic index or high-fibre content foods are associated with a decreased risk of diabetes. We investigated in overweight subjects the effect of adding beta-glucan (BG) to a polenta (Pol) meal on postprandial metabolism and glucose bioavailability using stable isotopes. In this single-blind, randomized, crossover trial, 12 subjects ate two meals containing Pol with (Pol + BG) or without (Pol) 5 g BG. Concentrations of glucose, insulin, C-peptide, nonesterified fatty acids, triacylglycerol, total and exogenous glucose kinetics were assessed for 6 h postprandially. The kinetics of total and exogenous glucose importantly differed between the meals, but not the quantity of total and exogenous glucose appearing in plasma. Less total and exogenous glucose appeared during the first 120 min after the Pol + BG meal; the phenomenon was then reversed (both p < 0.0001). After 120 min, glucose and insulin responses declined, but remained higher after the Pol + BG meal (p < 0.05) in parallel to the inhibition of lipolysis. The endogenous glucose production (EGP) was significantly more inhibited after the Pol + BG meal. The addition of BG slowed the appearance of glucose in plasma, resulting in longer-lasting insulin secretion which exerted a prolonged inhibition of EGP and lipolysis.

Daily intake of conjugated linoleic acid-enriched yoghurts: effects on energy metabolism and adipose tissue gene expression in healthy subjects.

Conjugated linoleic acid (CLA) is a group of positional and geometric isomers of conjugated dienoic derivatives of linoleic acid. The present study was designed to determine whether 14-week CLA supplementation as triacylglycerols (3.76 g) with a 50 : 50 combination of the two main isomers (35 % cis-9, trans-11 and 35 % trans-10, cis-12) added to flavoured yoghurt-like products was able to alter body composition in healthy subjects and to alter the expression of several key adipose tissue genes (PPAR gamma, lipoprotein lipase (LPL), hormone-sensitive lipase (HSL) and uncoupling protein 2 (UCP-2)). Forty-four healthy subjects were randomly assigned to consume daily either a CLA-supplemented yoghurt-like product or a placebo yoghurt for 98 d. There were no significant effects of CLA supplementation on body weight, fat mass or free fat mass. Basal energy expenditure expressed as kg free fat mass increased significantly in the CLA group (123.3 (SEM 2.5) kJ/kg free fat mass per d on day 98 v. 118.7 (SEM 2.3) kJ/kg free fat mass per d on day 0, P = 0.03). PPAR gamma mRNA gene expression increased significantly with CLA supplementation (53 (SEM 20) %, P < 0.01) and a significant reduction in mRNA levels of HSL was observed ( - 42 (SEM 7) %, P = 0.01). The levels of UCP-2 and LPL mRNA were not affected. The present results suggest that a 98 d supplementation diet with a 50 : 50 mixture of the two CLA isomers cis-9, trans-11 and trans-10, cis-12 in a dairy product was unable to alter body composition, although a significant increase in the RMR has been induced. Moreover, changes in mRNA PPAR gamma and HSL in adipose tissue were recorded.

Effect of physical inactivity on the oxidation of saturated and monounsaturated dietary Fatty acids: results of a randomized trial.

OBJECTIVES: Changes in the way dietary fat is metabolized can be considered causative in obesity. The role of sedentary behavior in this defect has not been determined. We hypothesized that physical inactivity partitions dietary fats toward storage and that a resistance exercise training program mitigates storage. DESIGN: We used bed rest, with randomization to resistance training, as a model of physical inactivity. SETTING: The trial took place at the Space Clinic (Toulouse, France). PARTICIPANTS: A total of 18 healthy male volunteers, of mean age +/- standard deviation 32.6 +/- 4.0 y and body mass index 23.6 +/- 0.7 kg/m(2), were enrolled. INTERVENTIONS: An initial 15 d of baseline data collection were followed by 3 mo of strict bed-rest alone (control group, n = 9) or with the addition of supine resistance exercise training every 3 d (exercise group, n = 9). OUTCOME MEASURES: Oxidation of labeled [d(31)]palmitate (the main saturated fatty acid of human diet) and [1-(13)C]oleate (the main monounsaturated fatty acid), body composition, net substrate use, and plasma hormones and metabolites were measured. RESULTS: Between-group comparisons showed that exercise training did not affect oxidation of both oleate (mean difference 5.6%; 95% confidence interval [95% CI], -3.3% to 14.5%; p = 0.20) and palmitate (mean difference -0.2%; 95% CI, -4.1% to 3.6%; p = 0.89). Within-group comparisons, however, showed that inactivity changed oxidation of palmitate in the control group by -11.0% (95% CI, -19.0% to -2.9%; p = 0.01) and in the exercise group by -11.3% (95% CI, -18.4% to -4.2%; p = 0.008). In contrast, bed rest did not significantly affect oleate oxidation within groups. In the control group, the mean difference in oleate oxidation was 3.2% (95% CI, -4.2% to 10.5%; p = 0.34) and 6.8% (95% CI, -1.2% to 14.7%; p = 0.08) in the exercise group. CONCLUSIONS: Independent of changes in energy balance (intake and/or output), physical inactivity decreased the oxidation of saturated but not monounsaturated dietary fat. The effect is apparently not compensated by resistance exercise training. These results suggest that Mediterranean diets should be recommended in sedentary subjects and recumbent patients.

The dispersion state of milk fat influences triglyceride metabolism in the rat--a 13CO2 breath test study.

BACKGROUND: Milk fat, which has different structures in the various dairy products, is a major and controversial lipid source in the Western diet. However, information about the digestion fate of milk fat depending on its supramolecular structure for a given composition is scarce. AIM OF THE STUDY: In this study, 13CO2 breath tests were performed with fasted rats force-fed different dairy preparations of similar composition but differing in fat suprastructure in order to highlight differences of general lipid metabolism. METHODS: Each preparation consisted of a NaCl solution, anhydrous milk fat labelled with a 13C mixed triacylglycerol, casein (as native phosphocaseinate powder with some lactose), and dipalmitoylphosphatidylcholine. Milk fat was either fed (i) unemulsified consecutively to the aqueous phase, or emulsified as (ii) coarse droplets of approximately 10 microm covered mainly with the phospholipid, or (iii-iv) fine droplets of approximately 1 microm covered mainly with casein, force-fed either in the liquid state or in a semi-crystallized state. 13C abundance in expired air samples was measured by isotope ratio mass spectrometry; results were expressed as 13C enrichment and were submitted to an ANOVA analysis. RESULTS: The 13CO2 excretion curves of the unemulsified preparation and the coarse emulsion were similar and presented a sharp peak, both significantly different from the fine emulsion curves characterized by a nearly linear cumulative recovery. The crystalline state of the fine emulsion droplets and the viscosity of these emulsions did not affect significantly their excretion curves. The lipid metabolization (indicated by the 13C recovery) was significantly slower for the fine droplets coated with casein than for the large droplets coated with the phospholipid and the unemulsified fat. For the latter, a single 13C peak rapidly appeared, while for small droplets coated with caseins, 13C excretion was continuous up to 6 h. CONCLUSIONS: Global lipid metabolism based on oxidation to CO2 was decreased with smaller compared to larger emulsified milk fat particles with different coatings. These data support the concept that dairy products with different fat suprastructures are digested and metabolized differently.

Contamination of syringe plungers during the sampling of cyclophosphamide solutions.

The presence of cytotoxic agents in the urine of operators and in their environment has been demonstrated. The pharmacokinetics of the urinary elimination of cyclophosphamide suggests that these drugs are absorbed cutaneously during handling. In the framework of a more general study on the contamination of hospital environment, the present study addresses the possible presence of cytotoxic agents on the plungers of syringes. The report is based on results indicating that the bacterial contamination of a plunger may result in the contamination of the solution being sampled. The study was divided into two phases. The first phase consisted in measuring the contamination of the plungers of eight syringes used for handling cyclophosphamide. Cyclophosphamide was analysed by gas chromatography-mass spectrometry with a detection limit of 0.1 ng/ml. The aim of the second phase was to localize the contamination on the plunger and thus determine the amount of drug that comes into contact with the gloves of the operators. The contamination was quantified by measuring the activity of metastable technetium. The results of the first phase showed that all the plungers were contaminated with cyclophosphamide amounts varying from 3.7 to 445.7 ng. The second phase showed that the infiltration of liquid onto the plunger depended on the solution being sampled. Almost no infiltration was seen with labelled water, but contamination appeared after the first sampling of a cyclophosphamide solution, then increased as a function of the number of times the plunger was pushed in and out. These results indicate that cyclophosphamide solutions infiltrate onto the plungers of syringes. They suggest that the general procedure for handling cytotoxic agents should be modified, and a regular replacement of syringes should be enforced. They also partly explain why the gloves of 50-90% operators are contaminated after a single preparation. The contamination seems to depend on the type of solution sampled and the number of samplings. Initial investigations by the manufacturer of the syringes had shown that the acid pH of cyclophosphamide solutions may affect the lubricant of the joint. Our study demonstrates that the contamination of plungers is one of the sources of environmental contamination for health workers handling antineoplastic agents, even in the absence of manipulation errors. More generally, these results demonstrate that the exposure of operators cannot be clearly described unless all existing sources of contamination in their environment are identified. The implementation of suitable procedures should thus take into account all possible sources of contamination, including technical facilities such as the use of a safety cabinet or an isolator.

Splanchnic tissues play a crucial role in uremic glucose intolerance.

OBJECTIVE: Determine the mechanism of glucose intolerance in chronically uremic subjects. DESIGN: Comparison of doubly labeled oral glucose tolerance tests. SUBJECTS: Seven nondialyzed chronically uremic subjects (creatinine, 420 +/- 104 micromol/L) and 7 healthy subjects, matched for age and body mass index. INTERVENTION: Plasma glucose was labeled by an infusion of dideuterated glucose started 120 minutes before ingestion of 1 g/kg of naturally 13C-enriched corn starch glucose. Glucose levels and oxidation were monitored for 330 minutes after glucose ingestion. RESULTS: Uremic subjects had normal fasting plasma glucose levels and impaired glucose tolerance with high plasma insulin (P <.001 versus controls). Glucose tolerance was impaired because of an increased total rate of appearance of glucose (cumulated on 330 minutes: uremic, 1,231 +/- 42 mg/kg/330 min, controls, 1,031 +/- 64; P <.05). Peripheral glucose uptake was increased (P <.05) because of an increased nonoxidative disposal (P =.051). CONCLUSIONS: Although peripheral glucose uptake resisted the stimulatory effect of the high insulin levels, glucose tolerance was impaired through splanchnic metabolic disturbances: reduced splanchnic glucose uptake and increased endogenous glucose production. The respective contribution of these abnormalities remains to be determined.

[Analysis of cyclophosphamide in the urine of antineoplastic drugs handlers]. / Recherche de cyclophosphamide dans les urines de manipulateurs de cytotoxiques.

The first study in which amounts of cyclophosphamide were found in the urine of nurses handling cytotoxic drugs using gas chromatography was published in 1984. We carried out a similar investigation on six pharmacy technicians involved in the preparation of antineoplastic agents (25,000 doses per year) but the analysis was performed with a more sensitive method: gas chromatography-mass spectrometry (LOQ = 0.1 ng/ml). Cyclophosphamide was found in two urine samples (out of 104) from two different workers. The rates detected were just above the limit of quantification. No correlation was found between the amounts of cyclophosphamide handled and the urinary excretion. The mean urinary levels measured in this study are lower than those reported by other investigators. In addition, only 1.9% of the collected samples are positive to cyclophosphamide. The drug was detected for two different technicians during two different sampling periods, suggesting that pollution is not repeated. No relationship could be seen between urinary detection of cyclophosphamide and individual or general work in the cytotoxic preparation unit. As supported by recent datas, transdermal resorption seems to be the most important way of incorporation. Further investigations are necessary to prove this hypothesis if we want to prevent occupational exposure of people handling these drugs.