[Nickel allergy and orthodontics]. / Nikkelallergie en orthodontie.

Nickel hypersensitivity is a common problem, especially among young females, with a prevalence of 5 to 10%, increasing to 30%. In comparison with the oral mucosa, skin is more sensitive to an allergic reaction. The oral mucosa is less sensitive to nickel due to the difference in anatomical structure and the presence of pellicle. Nickel is used in many orthodontic appliances. Due to corrosion nickel ions can be released into the oral cavity. The extent of the corrosion of the appliance depends on the pH, the composition of saliva and plaque, temperature and mechanical loading. In spite of the relatively high amount of nickel processed in orthodontic appliances nickel allergies are rare. In cases of nickel-hypersensitivity, nickel-free appliances should be used.

A method to improve the nutritional quality of foods and beverages based on dietary recommendations.

OBJECTIVE: The increasing consumer interest in health prompted Unilever to develop a globally applicable method (Nutrition Score) to evaluate and improve the nutritional composition of its foods and beverages portfolio. METHODS: Based on (inter)national dietary recommendations, generic benchmarks were developed to evaluate foods and beverages on their content of trans fatty acids, saturated fatty acids, sodium and sugars. High intakes of these key nutrients are associated with undesirable health effects. In principle, the developed generic benchmarks can be applied globally for any food and beverage product. Product category-specific benchmarks were developed when it was not feasible to meet generic benchmarks because of technological and/or taste factors. RESULTS: The whole Unilever global foods and beverages portfolio has been evaluated and actions have been taken to improve the nutritional quality. The advantages of this method over other initiatives to assess the nutritional quality of foods are that it is based on the latest nutritional scientific insights and its global applicability. CONCLUSIONS: The Nutrition Score is the first simple, transparent and straightforward method that can be applied globally and across all food and beverage categories to evaluate the nutritional composition. It can help food manufacturers to improve the nutritional value of their products. In addition, the Nutrition Score can be a starting point for a powerful health indicator front-of-pack. This can have a significant positive impact on public health, especially when implemented by all food manufacturers.

Moderate alcohol consumption and postprandial plasma lipids in men with different risks for coronary heart disease.

BACKGROUND: Moderate alcohol consumption is associated with a reduced coronary heart disease (CHD) risk. Epidemiologic studies have provided conflicting data which suggests that CHD protection may be modulated or may not be modulated by a person's CHD risk profile. METHODS: We examined the effects of moderate alcohol consumption (35 g/day) on postprandial lipoprotein metabolism in two groups of healthy middle-aged men who had different plasma total cholesterol, triglyceride concentrations, and body mass index (BMI), which are three major risk factors for CHD; 11 men had lower plasma lipids and BMI (L-men) and 11 men had higher plasma lipids and BMI (H-men). The effects of alcohol on postprandial lipoprotein metabolism were studied in a crossover design after an acute moderate alcohol intake both after a period of abstinence (alcohol-free beer) and after a period of moderate alcohol consumption (alcohol containing beer). RESULTS: Moderate alcohol consumption changed plasma total cholesterol, total triglycerides, and HDL composition in the postprandial period. Alcohol-induced changes were essentially the same over time in both L-men and H-men. However, changes occurred at a different overall plasma concentration for total cholesterol and total triglycerides. Also, the postprandial response to an acute moderate alcohol dose after a period of abstinence seemed not to essentially differ from the response to an acute moderate alcohol dose after a 4-week period of moderate alcohol consumption. CONCLUSIONS: These results suggest that men who differ in risk for CHD, based on plasma lipids and BMI, but without previous or underlying disease, have a similar postprandial lipid response to a moderate dose of alcohol.

Effect of consumption of phenols from olives and extra virgin olive oil on LDL oxidizability in healthy humans.

A high intake of olive oil has been proposed as an explanation for the low incidence of coronary heart disease in Mediterranean countries, but it is unclear whether olive oil offers specific benefits beyond a low content of saturated fat. Some types of extra virgin olive oil are rich in non-polar phenols, which might be taken up by plasma LDL particles and protect these from becoming atherogenic by oxidative modification. In a pilot study we found that consumption of 47 g fortified olive oil containing 31 mg phenols significantly increased the lag time of LDL oxidation from 112 +/- 5 min before to 130 +/- 7 min 2 h after the meal. However, this study was not controlled, and in the current study we therefore investigated whether olive oil phenols increase the lag time of LDL oxidation in postprandial samples when compared with a control group. Twelve healthy men and women consumed four different olive oil supplements with a meal on four separate occasions: one similar to the supplement in the pilot study (positive control); one containing mainly non-polar olive oil phenols; one containing mainly polar olive oil phenols; and one without phenols (placebo). Lag time significantly increased 2 h after the meals with the positive control (8 +/- 2 min), the polar phenols (8 +/- 2 min), and the placebo (8 +/- 2 min), but not after the non-polar phenols (-0.4 +/- 3 min). Increases were not statistically different between supplements. These results indicate that the lag time of LDL-oxidation is increased after consumption of a meal. This increase is probably due to non-specific meal or time effects and not to phenols from olives or olive oil. Furthermore, these findings stress the need for adequate controlled studies to avoid misinterpretations of the data.

Amount of fat in the diet affects bioavailability of lutein esters but not of alpha-carotene, beta-carotene, and vitamin E in humans.

BACKGROUND: Fat-soluble vitamin E and carotenoids are regarded as being protective against chronic diseases. Little is known about the effect of dietary fat on the bioavailability of these compounds. OBJECTIVE: The objective of this study was to assess the effect of the amount of dietary fat on plasma concentrations of vitamin E and carotenoids after supplementation with these compounds. DESIGN: During two 7-d periods, 4 groups of 14-15 volunteers received daily, with a low-fat hot meal, 1 of 4 different supplements: vitamin E (50 mg), alpha- plus beta-carotene (8 mg), lutein esters (8 mg lutein), or placebo. The supplements were provided in a low- or high-fat spread supplied in random sequence during either of the 2 experimental periods. RESULTS: As anticipated, plasma concentrations of vitamin E, alpha- and beta-carotene, and lutein were significantly higher in the supplemented groups than in the placebo group. The amount of dietary fat consumed with the hot meal (3 or 36 g) did not affect the increases in plasma concentrations of vitamin E (20% increase with the low-fat spread and 23% increase with the high-fat spread) or alpha- and beta-carotene (315% and 139% with the low-fat spread and 226% and 108% with the high-fat spread). The plasma lutein response was higher when lutein esters were consumed with the high-fat spread (207% increase) than with the low-fat spread (88% increase). CONCLUSION: Optimal uptake of vitamin E and alpha- and beta-carotene requires a limited amount of fat whereas the amount of fat required for optimal intestinal uptake of lutein esters is higher. 2000;71:-93.

A single dose of tea with or without milk increases plasma antioxidant activity in humans.

OBJECTIVE: To investigate the effect of black and green tea consumption, with and without milk, on the plasma antioxidant activity in humans. DESIGN: In a complete cross-over design, 21 healthy volunteers (10 male, 11 female) received a single dose of black tea, green tea (2 g tea solids in 300 ml water) or water with or without milk. Blood samples were obtained at baseline and at several time points up to 2 h post-tea drinking. Plasma was analysed for total catechins and antioxidant activity, using the ferric reducing ability of plasma (FRAP) assay. RESULTS: Consumption of black tea resulted in a significant increase in plasma antioxidant activity reaching maximal levels at about 60 min. A larger increase was observed after consumption of green tea. As anticipated from the higher catechin concentration in green tea, the rise in plasma total catechins was significantly higher after consumption of green tea when compared to black tea. Addition of milk to black or green tea did not affect the observed increases in plasma antioxidant activity. CONCLUSIONS: Consumption of a single dose of black or green tea induces a significant rise in plasma antioxidant activity in vivo. Addition of milk to tea does not abolish this increase. Whether the observed increases in plasma antioxidant activity after a single dose of tea prevent in vivo oxidative damage remains to be established. European Journal of Clinical Nutrition (2000) 54, 87-92

Relationship between visceral fat and PAI-1 in overweight men and women before and after weight loss.

This study was aimed at evaluating the relationship between visceral fat accumulation and plasma plasminogen activator inhibitor-1 (PAI-1) levels in healthy, obese men and women undergoing weight loss therapy. The subjects, 25 men and 25 premenopausal women, aged between 26 and 49 years, with an initial body mass index between 28 and 38 kg/m2, received a controlled diet for 13 weeks providing a 4.2 MJ/day energy deficit. Magnetic resonance imaging was used to measure visceral and subcutaneous abdominal fat. Our results show that before weight loss visceral fat was significantly correlated with PAI-1 in men (r = 0.45; p<0.05), but not in women (r = -0.15; ns). The association between visceral fat and PAI-1 in men remained significant after adjustment for age and total fat mass, and multiple linear regression analysis showed a significant independent contribution of visceral fat to plasma PAI-1 levels. Both visceral fat areas and PAI-1 levels decreased significantly with weight loss in both men and women. Changes in visceral fat area were related to changes in PAI-1 in women (r = -0.43; p = 0.05) but not in men (r = -0.01; ns); however, this association in women disappeared after adjustment for total fat mass. We conclude that there is a relationship between visceral fat and PAI-1 in obese men but not in obese women, and that PAI-1 levels decrease substantially (52%) by weight loss, but this change is not related to changes in visceral fat mass per se.

Long-term results of segmental repositioning of the maxilla in cleft palate patients without previously grafted alveolo-palatal clefts.

Eleven patients (9 UCLP, 2 BCLP) were treated with segmental osteotomies with or without osteotomies at the Le Fort I level and simultaneous bone grafting of the alveolo-palatal clefts at adult age. These patients were clinically and radiographically evaluated after a mean follow-up period of 59 months (range 39-110 months). One patient showed complete dentoalveolar relapse, whereas the skeletal stability after miniplate fixation proved to be adequate in all cases. Only one patient presented with a persisting oro-nasal fistula. In six cases, the alar base asymmetry had improved to such an extent that further nasal corrections were not necessary. The procedure described is a reliable technique to graft the alveolo-palatal cleft and reposition the dentoalveolar segments simultaneously in those adult cleft palate patients who had no previous alveolar bone grafting.

Visceral fat accumulation in relation to sex hormones in obese men and women undergoing weight loss therapy.

In 70 healthy obese subjects (37 men and 33 premenopausal women; aged 27-51 yr; body mass index, 28-38 kg/m2), associations between the initial amount of visceral fat and sex hormone levels were studied as well as between changes that occurred in response to a 4.2 mJ/day deficit diet for 13 weeks. Magnetic resonance imaging was used to quantify the visceral fat depot. In women, an abundance of visceral fat was significantly associated with diminished levels of sex hormone-binding globulin and free 17 beta-estradiol/free testosterone (T) ratio and to elevated levels of free T after adjustment for age and total fat mass. In men, no significant relationships could be found between visceral fat accumulation and any of the sex hormones. Mean total fat loss was 11.3 +/- 3.3 (+/- SD) kg. In women, loss of visceral fat was significantly related to rises in the sex hormone-binding globulin level and the free 17 beta-estradiol/free T ratio independent of total fat loss, whereas in men, only the association between visceral fat loss and increased estrone level reached statistical significance. In conclusion, in obese premenopausal women, visceral fat predominance seems to be related to a relatively increased androgenicity. In obese men, sex steroid levels appear not to depend on the amount of visceral fat. In obese women, but not in obese men, visceral fat loss seems to be accompanied by a relative reduction in androgenicity.

Effect of a weight cycle on visceral fat accumulation.

Magnetic resonance imaging was used to study the effect of a single weight cycle on three fat depots: the visceral and subcutaneous abdominal depots and the subcutaneous depot at the trochanter level. Obese subjects (17 men, 15 women) were examined before and after weight-loss intervention and 67 wk after intervention. They lost 12.9 +/- 3.3 (mean +/- SD) kg body wt during intervention and regained 11.9 +/- 5.1 kg during follow-up. Weight regain did not result in greater body fatness than before weight loss (initial fat mass: 34.3 +/- 6.1 kg, final fat mass: 32.8 +/- 7.7 kg; P = 0.047). There was no indication of a preferential deposition of visceral fat after weight regain (initial visceral fat area: 120 +/- 41 cm2, final visceral fat area: 110 +/- 48 cm2; P = 0.087). On the contrary, there was a slight tendency to accumulate subcutaneous fat at the expense of visceral fat. It is concluded that weight loss followed by weight regain neither leads to a greater body fatness nor to a larger amount of visceral fat compared with before weight loss.

Relative effects of weight loss and dietary fat modification on serum lipid levels in the dietary treatment of obesity.

The independent effects of weight loss and dietary fat modification on serum lipids were investigated in two groups of healthy moderately obese men and women. In one group (sequential group, n = 19), a weight-stable low-fat, low-saturated-fat diet (Low-Sat) was given for 7 weeks (= dietary modification), followed by a 4.2 MJ/day deficit Low-Sat diet for 13 weeks (i.e., weight loss alone). Another group (simultaneous group, n = 22) received a 4.2 MJ/day deficit Low-Sat diet for 13 weeks (i.e., weight loss+dietary fat modification). Each group was subject to an initial weight-stable high-fat, high-saturated fat diet for 3 weeks and a final weight stable Low-Sat diet for 3 weeks. Both groups lost similar amounts of body weight, about 13 kg, and had similar overall changes in total cholesterol, low density lipoprotein (LDL), cholesterol, high density lipoprotein (HDL) cholesterol, the HDL/LDL ratio, and triglycerides. Analysis of the separate effects of the Low-Sat diet without energy restriction and of weight loss in the sequential group showed that weight loss per se was responsible for about 50% of the total reduction in total cholesterol, and for about 60% and 70% of the fall in LDL cholesterol and triglycerides, respectively. Fat modification without weight loss reduced HDL cholesterol by 11.1% and the HDL/LDL ratio by 7.7%, while weight loss per se led to increases in HDL cholesterol of 12.5% and in the HDL/LDL ratio of 24.0%. We conclude that the effects of reduction in fat and saturated fat intake and weight loss are additive.(ABSTRACT TRUNCATED AT 250 WORDS)

Circadian rhythms of appetite at different stages of a weight loss programme.

A group of 28 healthy obese people (16 women, 12 men) rated their appetite each whole hour of the day during nine separate days at three different stages of a dietary intervention study of 24 weeks. The first stage was an introduction period of eight weeks in which subjects were weight stable. The second stage was a weight reduction period of 13 weeks in which subjects lost about 0.85 kg/week of body weight. In the third stage of three weeks subjects were weight stable again. The slimming diet, which contained predominantly sweet items, had an energy content which was 1000 kcal (4.2 MJ) below the individually estimated daily energy expenditure. The results showed that appetite for a meal increased in the first week of the weight reduction period of 13 weeks but returned to the baseline level within 4-8 weeks. Appetite for something savoury remained elevated during the entire weight reduction period, and returned to the baseline level in the stabilization period. Appetite for something sweet did not change. The circadian rhythms of the different types of appetite remained unchanged at all stages during the diet intervention programme. Different types of appetite (e.g. sweet, savoury) had different patterns over the day.

The effect of a natural high-fibre diet on faecal and biliary bile acids, faecal pH and whole-gut transit time in man. A controlled study.

Dietary fibre possibly protects against colonic cancer by effects on bile acid metabolism. We investigated the effect of a natural high-fibre diet on secondary bile acid formation. Twelve healthy subjects on an habitual low-fibre diet (for 4 weeks) consumed a high-fibre menu for 10 weeks (experimental group). A control group of 10 subjects consumed their regular high-fibre diet during this period. Faecal and biliary acid composition, faecal weight, faecal pH and gut transit time were studied before and after 6 and 10 weeks of fibre addition. Changes in the experimental group were compared to changes in the control group. The concentration, but not the excretion, of the secondary faecal bile acids was reduced in the experimental group. Faecal weight increased, faecal pH dropped and gut transit time was not altered. The biliary deoxycholic acid content decreased and the cholic acid content increased after 6 weeks, but returned to baseline values after 10 weeks of fibre addition. This study shows that a natural high-fibre diet lowers secondary faecal bile acid concentration through an increase in stool weight. The 7 alpha-dehydroxylation of primary bile acids is probably not or only transiently inhibited.

Abdominal diameters as indicators of visceral fat: comparison between magnetic resonance imaging and anthropometry.

The aim of the present study was to investigate the usefulness of abdominal diameters to indicate visceral fat, their relationship with serum lipids and their capability of detecting changes in visceral fat. Before and after weight loss, visceral and subcutaneous fat, and the sagittal and transverse diameters were assessed by magnetic resonance imaging (MRI) in forty-seven obese men and forty-seven premenopausal obese women with an initial body mass index of 31.0 (SD 2.4) kg/m2. In a subsample (n 21), diameters, were also measured by anthropometry in the standing and supine positions. They were strongly correlated with the diameters derived from the MRI scans. Serum levels of total and HDL-cholesterol and triacylglycerol were measured before weight loss. In women the sagittal diameter correlated less strongly with visceral fat than anthropometrically-assessed waist circumference and waist:hip ratio (WHR). In men these associations were comparable. Changes in visceral fat with weight loss were more strongly correlated with changes in the sagittal diameter and sagittal:transverse diameter ratio (STR) than with changes in waist circumference or WHR in men. In women, changes in the anthropometric variables and the separate diameters (except STR) were not associated with visceral fat loss. In men, but not in women, both the sagittal diameter and the visceral fat area were related to serum lipids. It is concluded that the sagittal diameter and STR may have advantages over waist circumference and WHR in men, particularly in assessing changes in visceral fat, but this could not be demonstrated in women. The ability to predict visceral fat from circumferences and diameters or their ratios is, however, limited in obese men and women.

Visceral fat loss measured by magnetic resonance imaging in relation to changes in serum lipid levels of obese men and women.

The effect of weight reduction on serum lipids in relation to visceral fat accumulation was studied in 78 healthy obese subjects (40 premenopausal women and 38 men) aged 27-51 years and with an initial body mass index of 30.7 +/- 2.2 kg/m2 (mean +/- SD). The subjects received a 4.2 MJ/day energy-deficit diet for 13 weeks. Magnetic resonance imaging was used to assess abdominal fat areas before and after weight loss. Weight reductions of 12.6 +/- 3.2 kg in men and 11.7 +/- 3.8 kg in women resulted in larger reductions in the fasting serum levels of total cholesterol (p < 0.05), low density lipoprotein cholesterol (p = 0.06), and triglycerides (p < 0.01) and a larger increase in the high density lipoprotein cholesterol/low density lipoprotein cholesterol ratio (p = 0.05) in men compared with women. Men also lost more visceral fat (p < 0.0001), whereas the reductions in the total and subcutaneous abdominal fat depots were similar. In women, visceral fat loss was significantly related with an increase of the high density lipoprotein cholesterol level, independent of the degree of total fat loss. In men, however, no significant correlations were observed between changes in visceral fat and any of the serum lipids. Comparisons of average changes in obese men and women suggest that visceral fat loss is associated with an improvement of the serum lipid profile. However, correlation analysis does not support a critical role of visceral fat in determining serum lipid concentrations on an individual level, except for an improvement of the high density lipoprotein cholesterol level with visceral fat loss in obese women.

Waist-hip ratio is a poor predictor of changes in visceral fat.

Magnetic resonance imaging was used to study the effect of weight loss on three fat depots: the visceral and subcutaneous abdominal depots and the subcutaneous depot at trochanter level. Changes in fat depots were compared with changes in circumference measures and the waist-hip ratio (WHR) in obese men (n = 38) and women (n = 40). Mean weight loss was (mean +/- SD) 12.9 +/- 3.5 kg (P < 0.001). The proportional reduction of fat was largest in the visceral depot (men 40%, women 33%). Less fat was lost subcutaneously, especially at trochanter level (men 29%, women 26%). WHR decreased significantly in both sexes (P < 0.001). Change in WHR was not significantly related to the absolute reduction in visceral fat. Total body-fat loss showed a stronger association with subcutaneous fat loss than with visceral fat loss. The findings suggest that fat distribution may change with weight loss, particularly by the loss of visceral fat, but changes in WHR are not appropriate for evaluating changes in this fat depot.

[Diagnosis of dento-skeletal deformities]. / Diagnostiek van dento-skelettale afwijkingen.

The diagnosis of dento-skeletal deformities is discussed. The suggestion has been made to use a simple classification, which leaves room for a descriptive diagnosis. The descriptive diagnosis should include aspects related to the maxillofacial skeleton, the soft tissues and the dentoalveolar part. A soft tissue analysis will help to assess the main deformity which is often a combination of factors, frequently located in both jaws. A recommendation is made to include a physical therapist, speech therapist and psychologist in the team.

Visceral fat accumulation in obese subjects: relation to energy expenditure and response to weight loss.

Seventy-eight healthy obese subjects, 40 premenopausal women and 38 men aged 27-51 yr received a 4.2 MJ/day energy-deficit diet for 13 wk. Resting metabolic rate (RMR) and diet-induced thermogenesis (DIT) were measured by indirect calorimetry. Abdominal subcutaneous and visceral fat areas were calculated from magnetic resonance imaging scans before and after weight loss. Before weight loss, visceral fat accumulation was positively correlated with higher levels of RMR (P < 0.05) and DIT (P < 0.01) in women but not in men. The mean weight reduction was 12.2 +/- 3.5 (SD) kg. In men but not in women, an initially large visceral fat depot was associated with a reduced loss of weight and total fat mass (P < 0.05). Within each sex, an initial abundance of visceral fat was significantly related to a larger loss of visceral fat (P < 0.001) and in men to a smaller loss of subcutaneous fat (P < 0.05). These results suggest that there may be gender differences in the associations between visceral fat accumulation and components of energy expenditure (RMR and DIT) in obese subjects. Obese subjects with an initial abundance of visceral fat do not lose more body weight but more visceral fat than subjects with less visceral fat.

Changes in fat-free mass in obese subjects after weight loss: a comparison of body composition measures.

Estimates of body composition by densitometry were made in 84 apparently healthy subjects (42 men, 42 women) with a mean age of 40 +/- 6 years (mean +/- s.d.), before and after weight loss. The initial body mass index (BMI) was 30.7 +/- 2.3 kg/m2 and the achieved weight loss on a 4.2 MJ/day energy deficit diet for 13 weeks was 12.2 +/- 3.7 kg. The results by densitometry were compared with estimates obtained by four other techniques: deuterium oxide dilution, skinfold thickness, bioelectrical impedance (three equations) and BMI (two equations). The fat-free mass (FFM) loss estimated by densitometry in men and women was 2.8 +/- 1.8 kg and 1.3 +/- 1.3 kg respectively. The dilution technique gave comparable results with densitometry. The losses of FFM assessed by skinfold thicknesses, BMI and impedance equations were almost similar, but significantly larger than the reduction in FFM measured by densitometry. These deviations were mainly the result of significantly larger differences from densitometry before compared to after weight loss. No correlation was found between change in FFM by densitometry and change in resistance measured by the bioelectrical impedance method in both sexes. It is concluded that application of published prediction formulae in weight loss studies are less appropriate and will lead to changes in FFM that are significantly different from the changes estimated by densitometry or deuterium oxide dilution.

Combined mandibular vertical ramus and body step osteotomies for correction of unusual skeletal and occlusal anomalies.

A technique is described involving the combined use of mandibular ramus osteotomies and body step osteotomies. The combined use of these osteotomies enables the surgeon to solve some of the most complicated skeletal and occlusal problems. The method has proved to be safe in that no complications have occurred in the 7 patients reported.