Growth, tolerance, and DHA and ARA status of healthy term infants receiving formula with two different ARA concentrations: Double-blind, randomized, controlled trial.

Circulating docosahexaenoic acid (DHA) and arachidonic acid (ARA) in total red blood cells (RBC) are considered indicators of fatty acid status. In this study, healthy term infants received study formula through 120 days of age. All study formulas had 17 mg DHA/100 kcal. Investigational formulas had 1) 25 g ARA/100 kcal and no added prebiotic blend (ARA-25; n = 29) or 2) 34 mg ARA/100 kcal and a prebiotic blend (1:1 ratio; 4 g/L) of polydextrose and galactooligosaccharides (PDX/GOS; n = 20). The control formula had 34 mg ARA/100 kcal and no added prebiotic blend (Control: n = 31). Fatty acids in total RBCs and plasma phospholipids (PPLs) at 120 days and buccal epithelial PLs at 14 and 120 days of age were assessed by capillary column gas chromatography. The calculated 90% confidence interval (CI) of each investigational formula relative to the Control for total RBC ARA (ARA-25: 93-105%; PDX/GOS: 96-110%) and total RBC DHA (ARA-25: 95-113%; PDX/GOS: 94-113%) fell within the pre-specified equivalence limit (85-118%), establishing study formula equivalence with respect to ARA and DHA. At day 120, total RBC and buccal epithelia PL ARA (µg/ml) were not significantly correlated (r = 0.041; p = 0.732); correlation in total RBC and buccal epithelia PL DHA was low, albeit significant (r = 0.324; p = 0.006). Consequently, buccal epithelial may not provide a suitable substitute for RBC when assessing fatty acid status and availability. The present RBC data suggest availability of DHA for central nervous system development and function is equivalent among infants receiving formulas that had 34 or 25 mg/100 kcal ARA and 17 mg/100 kcal DHA.

EPA and DHA--protein, not fat is "where it's at"?

Guidelines and recommendations for the dietary intake of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are topics of debate. Recently, EPA and DHA intakes have been demonstrated to be associated with dietary protein intakes and not dietary fat intakes that are distinct from α-linolenic acid. We presently confirm these observations in a secondary analysis of baseline dietary intake data for the validation of a food frequency questionnaire (n=99). DHA intakes measured by both 3 d dietary record and food frequency questionnaire and EPA intakes measured by food frequency questionnaire were positively correlated with protein intakes. EPA and DHA were not associated with fat intakes in either assessment, while ?-linolenic acid was positively correlated with fat intakes. Future recommendations regarding the intake of omega-3 polyunsaturated fatty acids, and EPA and DHA specifically, should consider these associations that provide insight on dietary sources of EPA and DHA in the food supply.

Assessment of blood measures of n-3 polyunsaturated fatty acids with acute fish oil supplementation and washout in men and women.

Changes in n-3 highly unsaturated fatty acids (HUFA, > or =20 carbons and > or =3 carbon-carbon double bonds) at baseline, during fish oil supplementation (4 weeks) and during washout (8 weeks) were compared in venous plasma, erythrocytes, whole blood and fingertip prick blood (weeks 0, 4, 8 and 12) with additional weekly fingertip prick samples. Correlations between the various blood fractions were slightly stronger when n-3 HUFA status was expressed as the percentage of n-3 HUFA in total HUFA as compared with the sum of EPA and DHA. Increases and decreases in n-3 HUFA were more dramatic in plasma, and EPA responded rapidly (within 1 week) with fish oil supplementation and cessation. Sex differences in the proportions of n-3 HUFA in blood were also apparent at baseline with females (n=7) having a tendency for higher docosahexaenoic acid (DHA, 22:6n-3) relative to eicosapentaenoic acid (EPA, 20:5n-3) and n-3 docosapentaenoic acid (DPAn-3, 22:5n-3) as compared with males (n=9). Further n-3 biomarker research in larger populations is required.

Thyroid cancer in South Africa--an indicator of regional iodine deficiency.

OBJECTIVE: Because follicular thyroid cancers predominate in iodine deficient and papillary cancers predominate in iodine-replete populations, we have analysed national and regional (former Transvaal) incidences of these cancer types as a surrogate measure of the population iodine nutritional status in South Africa. DESIGN: Statistical analysis, by race and sex, of differentiated thyroid cancers reported to the South African National Cancer Registry (1988), and of the computerised histology records of the Department of Anatomical Pathology, SAIMR (January 1990 to June 1994; Transvaal data). MAIN OUTCOME MEASURES: Relative frequencies of the two cancer types nationally and geographically in the Transvaal region. MAIN RESULTS: Thyroid cancer was underdiagnosed in populations other than white. Nationally, follicular histology accounted for 55% of all differentiated primary thyroid cancers, and predominated especially in black women. Follicular morphology predominated in blacks resident in the rural regions of the former Transvaal (58%), while papillary histology predominated in urban areas (of present-day Gauteng), irrespective of race (78%; P = 0.003). CONCLUSION: The national predominance of follicular thyroid cancer indicates that significant iodine deficiency exists in the country as a whole. The observed urban-rural differences in prevalences of follicular and papillary cancer types suggest regional differences in the severity of iodine deficiency. There is a need for a formal survey of the population iodine nutritional status in South Africa.

Update on treatment of rheumatoid arthritis.

Treatment of rheumatoid arthritis consists of use of drugs, physical measures, social work interventions, education and reconstructive surgery. The physician plays a co-ordinating role, since most patients with significant rheumatoid arthritis will require treatment by more than one member of the health-care team. Our drug armamentarium, including anti-inflammatory agents, disease suppressants, analgesics, rarely steroids, and even more rarely immunosuppressants, can be used to good effect in suppressing the synovitis of rheumatoid arthritis and in relieving pain. Physiotherapy, occupational therapy, nursing and social work interventions will help the patient to maintain function and to maintain their optimal level of fitness, including exercise tolerance, joint range, muscle strength and psycho-social function. Coping abilities can be greatly enhanced by a positive approach from the physician, and this, together with the very real benefits of the foregoing treatments, can produce a highly rewarding result for physician and patient alike, in terms of improved quality of life for the rheumatoid arthritis patient.

Pustulotic arthroosteitis.

We describe the case of a white male with chronic inflammation of one knee, the sternoclavicular area and the dorsal spine, who also had pustulosis palmaris et plantaris. Radiological changes were suggestive of pustulotic arthroosteitis. Our patient had prominent peripheral joint changes not previously emphasized.

Systemic lupus erythematosus during penicillamine therapy for rheumatoid arthritis.

Six patients with rheumatoid arthritis developed a syndrome resembling lupus erythematosus while being treated with penicillamine. All patients had previous mucocutaneous reactions to chrysotherapy. Manifestations included pleurisy in five of six patients, rashes in three, nephritis in two, and neurologic disturbances in two; lupus erythematosus cells were found in five patients, antinuclear antibodies in all six, antideoxyribonucleic acid in three, positive Coombs' test results for three patients, and low C4 complement in five of the six. Symptoms were slow to resolve after penicillamine treatment was discontinued, and four of the patients needed corticosteroid therapy. A higher frequency than expected of HLA A 11 in three patients and B 15 in five patients was seen.

Adverse effects of D-penicillamine in rheumatoid arthritis.

Adverse effects to D-penicillamine were studied prospectively over 3 years in 259 patients with rheumatoid arthritis. Ninety-five percent had had gold therapy previously, yet 70% benefited from D-penicillamine therapy. Of the 275 courses given, 160 (58%) were complicated by at least one reaction, including rashes (44%), dysgeusia (20%), gastrointestinal upset (18%), stomatitis (10%), proteinuria (7%), thrombocytopenia (3%), and leukopenia (2%). Their occurrences peaked in the first 6 months of treatment, except for proteinuria and thrombocytopenia, which peaked in the second 6 months. Reactions were commoner at daily doses above 250 mg; mean daily doses for proteinuria, thrombocytopenia, and leukopenia were higher (approximately 600 mg/d) than for the others (approximately 500 mg/d). Of 114 discontinued courses, 73 (27%) were due to adverse reactions. The remaining reactions were controlled by altering dosages and symptomatic treatment. Only obliterative bronchiolitis (two cases) was irreversible; it resulted in the only death in our series, possibly attributable to penicillamine.

Osteoarthritis of the trapezioscaphoid joint.

Isolated osteoarthritis (OA) of the trapezioscaphoid (TS) joint is little recognized. Nine cases that were examined clinically and radiologically are described. Of these 4 had isolated TS OA, 3 also had generalized OA, and 2 also had rheumatoid arthritis. Symptoms and signs, including pain in the wrist and thumb base, radial and volar swelling, and tenderness over the scaphoid, allowed distinction from other causes of pain at the thumb base. A wrist-working splint was beneficial in relieving pain.