The Effect of Nonoperative Management of Chronic Anal Fissure and Hemorrhoid Disease on Bowel Function Patient-Reported Outcomes.

BACKGROUND: Nonoperative management has been reported to decrease symptoms from common anorectal conditions such as chronic anal fissures and hemorrhoids. The effects of these interventions on bowel function are unknown. OBJECTIVE: This study aims to perform a prospective evaluation of patient-reported outcomes of bowel function on nonoperative management for chronic anal fissures and hemorrhoid disease. DESIGN: This is a prospective, observational study. SETTINGS: Patient-reported outcome measures were collected from the clinical practice of the division of colon and rectal surgery at a tertiary colon and rectal surgery referral center. INTERVENTION: All patients received standardized dietary counseling including fiber supplementation as well as toileting strategies. Those with chronic anal fissures were also prescribed topical calcium channel blockers. The Colorectal Functional Outcome questionnaire was administered at baseline and at first follow-up visit. MAIN OUTCOME MEASURES: The primary outcomes measured were the mean change in patient-reported bowel function scores after nonoperative management for each disease and in aggregate. RESULTS: A cohort of 64 patients was included, 37 patients (58%) with chronic anal fissure and 27 patients with hemorrhoid disease. Incontinence, social impact, stool-related aspects, and the global score were observed to have statistically significant improvement in the aggregate group. When analyzed by diagnosis, hemorrhoid disease demonstrated a statistically significant improvement in incontinence and stool-related aspects, whereas chronic anal fissure was associated with a statistically significant change in social impact, stool-related aspects, and the global score. LIMITATIONS: This study was limited by the small cohort size and unclear patient adherence to medical management. CONCLUSIONS: Nonoperative management of chronic anal fissures and hemorrhoid disease is associated with significant improvement in patient-reported outcome scores in several domains, suggesting that dietary counseling and medical therapy should be the first-line outpatient therapy for these diseases. See Video Abstract at http://links.lww.com/DCR/A726.

Appraising nutrient availability of household food supplies using Block Dietary Screeners for individuals.

BACKGROUND/OBJECTIVE: The growing interest in environmental influences on obesity risk has spawned the development of tools for appraising home food availability. These tools reveal good reliability but tend to be limited in scope and burdensome to use. This cross-sectional study investigated the feasibility of using food categories and scoring algorithms from valid food frequency questionnaires for individuals (that is, Block Dietary Fat and Fruit-Vegetable-Fiber Screeners) to estimate nutrient availability in household food supplies. SUBJECTS/METHODS: Screeners were compared with household food inventories from 100 two-parent families with ⩾1 children ⩽12 years of age. Inventoried foods were coded to match Screener food groups, and amounts available were converted to total adult daily equivalent servings to express the greatest possible frequency at which each food group could be eaten/day/household. Scoring algorithms were converted to express all scores on a per-day basis. For the most conservative assessment, the highest point was used for day ranges for the Fruit-Vegetable-Fiber Screener and the lowest range point was used for the Fat Screener. RESULTS: Spearman's rank-order correlations (r⩾0.76) showed that the Fruit-Vegetable-Fiber Screener ranked households well for fruit/vegetable servings, vitamin C and dietary fiber. The Fat Screener and household inventory were positively correlated (r⩾0.58) for total fat, saturated fat and cholesterol. Concordance of household inventories and the Fruit-Vegetable-Fiber Screener, as determined by kappa with quadratic weighting, were strong and significant. Fat Screener concordance was moderate. CONCLUSIONS: Results indicate that it is feasible to use the efficient, valid Block Dietary Screeners for individuals to appraise household food supplies.

Soluble and insoluble dietary fibre intake and risk factors for metabolic syndrome and cardiovascular disease in middle-aged adults: the AWHS cohort / Ingesta de fibra soluble e insoluble y factores de riesgo de síndrome metabólico y enfermedad cardiovascular en adultos de mediana edad: la cohorte AWHS

Introduction: The Westernization of the Mediterranean lifestyle has led to a modification of certain dietary habits such as a decrease in the consumption of dietary fibre-rich foods. The impact of these changes on cardiovascular diseases (CVD) has been studied over the last few years and the effect of the different sources of fibre on cardiovascular risk parameters and coronary heart disease (CHD) continues to create controversy. Objective: To evaluate the association between the source of dietary fibre and the prevalence of metabolic syndrome (MetS) and other cardiovascular risk factors in a Spanish working population. Subjects and methods: The study was carried out in a sample of 1592 Spanish workers free of CVD (40-55 years old) within the Aragon Workers' Health Study (AWHS) cohort. Sociodemographic, anthropometric, clinical and biochemical data were collected. Fibre intake was assessed by means of a validated 136-items semiquantitative food-frequency questionnaire. MetS was defined by using the modified National Cholesterol Education Programme - Adult Treatment Panel III (NCEP- ATP III) definition. Results: After adjusting for possible confounding factors, we found an inverse association between insoluble fibre intake and systolic and diastolic blood pressure, total cholesterol, triglycerides, apolipoprotein B100 and ratio TG/HDL. Soluble fibre was inversely associated with triglycerides and apolipoprotein B100. Furthermore, prevalence of MetS was found to be lower (OR 0.62, 95% CI: 0.40-0.96) in those participants in the highest quartile of insoluble fibre intake. Conclusion: A higher intake of insoluble fibre could play an important role in the control and management of hypertension, lipid profile and MetS (AU)

Introducción: La occidentalización del estilo de vida mediterráneo ha dado lugar a una modificación de ciertos hábitos dietéticos, tales como una disminución en el consumo de alimentos ricos en fibra dietética. El impacto de estos cambios sobre las enfermedades cardiovasculares (ECV) se ha estudiado en los últimos años y el efecto de las diferentes fuentes de fibra en los parámetros de riesgo cardiovascular y en la enfermedad coronaria sigue creando controversia. Objetivo: Evaluar la asociación entre la fuente de fibra dietética y la prevalencia de síndrome metabólico (SM) y otros factores de riesgo cardiovascular en una población laboral española. Sujetos y métodos: El estudio se llevó a cabo en una muestra de 1592 trabajadores españoles libres de ECV (40-55 años) pertenecientes a la cohorte del Estudio de la Salud de los Trabajadores de Aragón (AWHS). Se recogieron datos sociodemográficos, antropométricos, clínicos y bioquímicos. La ingesta de fibra se evaluó por medio de un cuestionario semicuantitativo de frecuencia de consumo de alimentos de 136-items previamente validado. Para la definición de SM se siguieron los criterios del Programa Nacional de Educación del Colesterol en el marco del III Panel de Tratamiento de Adultos (NCEPATP III). Resultados: Se encontró una asociación inversa entre el consumo de fibra insoluble y la presión arterial sistólica y diastólica, colesterol total, triglicéridos, apolipoproteína B100 y la relación TG/HDL, tras ajustar por posibles factores de confusión. Así mismo, la fibra soluble se asoció inversamente con triglicéridos y apolipoproteína B100. Además, se encontró una menor prevalencia de SM (OR 0.62, IC del 95%: 0.40 a 0.96) en aquellos participantes en el cuartil más alto de consumo de fibra insoluble. Conclusión: Una mayor ingesta de fibra insoluble puede desempeñar un papel importante en el control y manejo de la hipertensión, el perfil lipídico y el SM (AU)

Plant cell wall engineering: applications in biofuel production and improved human health.

Plant cell walls consist largely of cellulose, non-cellulosic polysaccharides and lignin. Concerted attempts are underway to convert wall polysaccharides from crop plant residues into renewable transport fuels and other valuable products, and to exploit the dietary benefits of cereal grain wall polysaccharides in human health. Attempts to improve plant performance for these applications have involved the manipulation of the levels and structures of wall components. Some successes in altering non-cellulosic polysaccharides has been achieved, but it would appear that drastic changes in cellulose are more difficult to engineer. Nevertheless, future prospects for both genetically modified (GM) and non-GM technologies to modify plant cell wall composition and structure remain bright, and will undoubtedly find applications beyond the current focus on human health and biofuel production.

A nutritional analysis of New Zealand military food rations at Gallipoli in 1915: likely contribution to scurvy and other nutrient deficiency disorders.

BACKGROUND: Amongst New Zealand soldiers in Gallipoli in 1915 there were reports of poor food quality and cases of scurvy. But no modern analysis of the military food rations has ever been conducted to better understand potential nutritional problems in this group. METHODS: We analysed the foods in the military rations for 1915 using food composition data on the closest equivalents for modern foods. We compared these results with other plausible diets and various optimised ones using linear programming. RESULTS: Historical accounts provide evidence for poor food quality supplied to these soldiers. The nutrient analysis suggested that the military rations were below modern requirements for vitamins A, C and E; potassium; selenium; and dietary fibre. If military planners had used modest amounts of the canned vegetables and fruit available in 1915, this would probably have eliminated four of these six deficits. The results from the uncertainty analyses for vitamin C (e.g., 95% uncertainty interval [UI]: 5.5 to 6.7 mg per day), was compatible with the range known to cause scurvy, but the UI for vitamin A intake was only partly in the range for causing night blindness. To indicate the gap with the ideal, an optimised diet (using foods available in 1915), could have achieved all nutrient requirements for under half the estimated purchase cost of the 1915 military rations. CONCLUSIONS: There is now both historical and analytic evidence that the military rations provided to these soldiers were nutritionally inadequate in vitamin C, and probably other nutrients such as vitamin A. These deficits are likely to have caused cases of scurvy and may have contributed to the high rates of other illnesses experienced at Gallipoli. Such problems could have been readily prevented by providing rations that included some canned fruit or vegetables (e.g., as manufactured by New Zealand at the time).

Dieta y prevención de enfermedad coronaria / Diet and prevention of coronary heart disease

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Evidence-based dietary recommendations for patients with type 2 diabetes mellitus.

We review the scientific evidence behind current dietary recommendations for patients with type 2 diabetes and examine the effects of various dietary interventions on glycemic control, serum lipids, and inflammation in individuals with diabetes. Attention is focused on dietary fiber, glycemic index, dietary protein, omega-3 fatty acids, chromium, magnesium, and vitamin E. Practical dietary recommendations for patients with type 2 diabetes are highlighted.

The New Zealand food supply and diet--trends 1961-95 and comparison with other OECD countries. Organisatioin for Economic Co-operation and Development.

AIMS: To compare the New Zealand food supply and trends from 1961 to 1995 with other Organisation for Economic Co-operation and Development (OECD) countries, with an emphasis on foods linked with coronary heart disease (CHD). METHOD: Food and Agricultural Organization per capita food supply statistics for 24 OECD countries were converted to nutritional supply values and adjusted for edible portion. RESULTS: In 1995, New Zealand had the highest supply per capita of butter and meat fats among OECD countries, ranking its food supply highest for thrombogenicity and third for atherogenicity. Seafood and alcohol supply were average and vitamin E supply was high compared with other OECD countries. Beneficial trends have occurred with increases in fruit consumption, vegetable consumption and fibre intake between 1961 and 1995. While total fat intake has not changed appreciably, the fatty acid profile has shifted and is now less likely to promote CHD. CONCLUSIONS: The New Zealand diet's tendency to promote CHD has decreased, particularly since 1985. The diet's fatty acid profile, however, remains highly atherogenic and thrombogenic, predisposing to CHD, and the fat content of the food supply remains high, predisposing to obesity. Continued efforts are needed to improve the diet of New Zealanders and to maintain food supply data collection for long term monitoring of these changes.

Estudos do potencial ibero-americano de fibra alimentar: produtos, alimentos e resíduos / Study of Ibero-American dietary fiber potential: products, foods and residues

A reduzida ingestäo de fibra alimentar (FA) tem sido relacionada com o aumento de doenças crônico-degenerativas. Nos países ibero-americanos muitos pesquisadores, já vêm caracterizando a FA em alimentos e em resíduos industriais, buscando tecnologia para produzir concentrados, além de desenvolver e testar produtos enriquecidos a partir de alimentos regionais. Estes estudos foram reunidos, descritos e analisados a fim de avaliar o potencial de alimentos e formulaçöes ricas em FA em nove países ibero-americanos. Muitos alimentos regionais contêm quantidades significativas de FA, o mesmo acontece com frutas e hortaliças, porém as leguminosas e cereais merecem destaque. Resíduos industriais säo fontes concentradas de FA (por centagem na base seca) que podem ser utilizadas no enriquecimento de alimentos, como a casca do abacaxi (85 por cento), resíduo de beterraba (58 por cento) e farelo de trigo (32 por cento). Alimentos enriquecidos vêm sendo testados, como biscoitos com torta de milho na Colômbia (16,8 por cento) e macarräo com fibra de tremoço no Chile (11,2 por cento), e no mercado cubano já se encontram produtos como päo de trigo integral (12 por cento), produtos para fins especiais como comprimidos de fibra de cítricos (55 por cento) e alimentos para dieta enteral (1-1,9por cento). Há um grande potencial de FA nos países ibero-americanos em resíduos industriais, que já vem sendo utilizados como fontes concentradas, que podem ser explorados näo apenas por profissionais de saúde e indústria, mas também pela populaçäo

Monounsaturated fatty acid (avocado) rich diet for mild hypercholesterolemia

To assess the effect of a high monoinsaturated fatty acids (MFA) diet on serum lipids, 30 healthy adultt normolipidemic volunteers and 37 adult patients with mild hypercholesterolemia (5.4 - 9.3 mmol/l), 15 of them also with hypertriglyceridemia (2.3 - 4.8 mmol/l), were studied. Fifteen healthy and 30 hypercholesterolemic subjects (15 of them with associated type 2 diabetes mellitus) received an avocado enriched diet (2000 Kcal, lipids 53 percent MFA 49 g saturated/unsaturated ratio 0.54), and seven non-diabetic hypercholesterolemic individuals received an isocaloric control diet (MFA 34 g, saturated/unsaturated ratio 0.7). Serum total cholesterol, LDL-cholesterol, HDL-cholesterol and triglyceride concentrations were measured before and after a 7-day diet period. In healthy individuals a 16 percent decrease of serum total cholesterol level followed the high MFA diet, while it rose after the control diet (p<0.001 between diets). In hypercholesterolemic subjects a significant (p<0.01) decrease of serum total cholesterol (17 percent), LDL-cholesterol (22 percent) and triglycerides (22 percent), and increase of HDL-cholesterol (11 percent) levels occurred with the avocado diet, while no significant changes were noticed with the control diet. High lipid, high MFA-avocado enriched diet can improve lipid profile in healty and especially in mild hypercholesterolemic patients, even if hypertriglyceridemia (combined hyperlipidemia) is present