Caloric Intake on the Sabbath: A Pilot Study of Contributing Factors to Obesity in the Orthodox Jewish Community.

The American Orthodox Jewish community has specific cultural factors that may contribute to overweight and obesity. This study aimed to look at caloric intake on the Sabbath and its contribution to overweight and obesity. Twelve married or previously married women who identify themselves as Orthodox Jews were recruited to do 24-h food recalls over the phone. The participants were divided into three weight groups (normal, overweight, and obese) based on their BMI. The overweight and obese participants' data were combined into one group for the purposes of statistical testing. Paired t tests looking at the data for all participants showed significantly great caloric intake during an average Sabbath day than an average weekday [t(4) = 7.58, p < 0.001]. A repeated-measures ANOVA showed significantly greater energy intake on the Sabbath for the overweight-obese women compared to the normal weight women [F(1) = 7.83, p = 0.02]. No statistical difference was seen between the weekday energy intake of the normal weight women as compared to the combined group of overweight-obese women [F(1) = 0.501, p = 0.499]. These results support the hypotheses that all groups eat significantly more on the Sabbath than on weekdays, and overweight and obese individuals eat significantly more on the Sabbath than normal weight individuals. This supports the theory that caloric intake on the Sabbath is a contributing factor to overweight and obesity within the American Orthodox Jewish community.

Validation and reliability for the updated REAP-S dietary screener, (Rapid Eating Assessment of Participants, Short Version, v.2).

BACKGROUND: The American Heart Association (AHA) chose the REAP-S dietary screener in 2020 as one of three US dietary screeners recommended for integrating dietary assessment into clinical care. The REAP-S v.2 is an updated version that is aligned with the 2020-2025 US Dietary Guidelines and is easily incorporated into electronic medical records and taught to medical students. METHODS: The University of New England, Institutional Review Board, approved the study protocol. We evaluated the reliability and validity of the REAP-S v.2 scale by having first-year medical students (n = 167) complete both the REAP-S v.2 and a three-day food record and then analyzing their data with the following statistical techniques: Internal consistency was measured using Cronbach's alpha. Construct validity was assessed with exploratory factor analysis. Criterion validity was evaluated using analysis of variance (ANOVA) that explored the associations between REAP-S v.2 scale item responses and selected nutrient estimates from the food record analyses. The hierarchical cluster analysis classified healthy and unhealthy diet grouping under each subscale. Further using these groupings, cut points for "good" and "bad" diets for each of the three main REAP-S v.2 subscales (Food Sufficiency/Food Insufficiency; Healthy Eating Pattern and Low Nutrient Density Foods) were calculated using receiver operating characteristics (ROC) analysis. Students analyzed their three-day food intake records using an online USDA application called SuperTracker. RESULTS: The Cronbach's alpha measuring internal consistency was acceptable for the overall scale at 0.71. The exploratory factor analysis extracted three factors that roughly paralleled the three main subscales, suggesting construct validity. Most selected food record-derived nutrient values were significantly associated with scale items confirming criterion validity. The score cut points suggest that dietary counseling might be needed at ≤ 8, ≤ 10, and ≤ 16 for the above subscales. CONCLUSION: The REAP-S v.2 is intended for clinicians to use as a brief dietary screener with their patients. Tested in a population of first-year medical students, the REAP-S v.2 brief dietary screener showed acceptable internal consistency, criterion, and construct validity. It is easily scored and incorporated into the electronic medical record.

Triggers of Lapse and Relapse of Diet and Exercise in Behavioral Weight Loss.

OBJECTIVE: This study aimed to (1) develop instruments to evaluate situations that lead to lapse and relapse in diet and exercise and (2) prospectively investigate when and which psychosocial situations predict failure to lose weight in a clinical trial of intentional weight loss. METHODS: Participants were 469 individuals with overweight or obesity participating in a behavioral weight loss program (age: mean = 53.6 years, SD = 11.4; BMI: mean = 35.7 kg/m2 , SD = 6.5). RESULTS: The Cronbach alphas for the Diet Lapse and Relapse Triggers Scale and the Exercise Lapse and Relapse Triggers Scale were 0.93 and 0.91, respectively. Subscale alphas ranged from 0.60 to 0.96. Lapse and relapse were assessed at 3 and 9 months for associations with weight loss at 12 months. At 9 months, diet triggers were negative emotional states (beta = 0.11, P = 0.02) and urges (beta = 0.14, P = 0.01). Predicted social situations showed the opposite (beta = -0.09, P = 0.02). Exercise subscales were all nonsignificant. CONCLUSIONS: Findings suggest the ongoing importance of addressing negative emotional states and the contributing influence of urges. The novel finding that participants whose difficulties arise in social situations may do better over time requires further study.

Quantitative Contribution of rs75017182 to Dihydropyrimidine Dehydrogenase mRNA Splicing and Enzyme Activity.

Dihydropyrimidine dehydrogenase (DPD; DPYD gene) variants have emerged as reliable predictors of adverse toxicity to the chemotherapy agent 5-fluorouracil (5-FU). The intronic DPYD variant rs75017182 has been recently suggested to promote alternative splicing of DPYD. However, both the extent of alternative splicing and the true contribution of rs75017182 to DPD function remain unclear. In the present study we quantified alternative splicing and DPD enzyme activity in rs75017182 carriers utilizing healthy volunteer specimens from the Mayo Clinic Biobank. Although the alternatively spliced transcript was uniquely detected in rs75017182 carriers, canonically spliced DPYD levels were only reduced by 30% (P = 2.8 × 10-6 ) relative to controls. Similarly, DPD enzyme function was reduced by 35% (P = 0.025). Carriers of the well-studied toxicity-associated variant rs67376798 displayed similar reductions in DPD activity (31% reduction). The modest effects on splicing and function suggest that rs75017182 may have clinical utility as a predictor of 5-FU toxicity similar to rs67376798.

Stimulation of insulin secretion from isolated rat islets by SaRI 59-801. Relation to cAMP concentration and Ca2+ uptake.

The mechanism of stimulation of insulin release from isolated rat islets by 0.3 mM SaRI 59-801 (DL-alpha-dimethylaminomethyl-2-[ 3-ethyl-5-methyl-4-isoxazoyl]-1H-indole-3-methanol) was investigated, considering cAMP concentration and Ca2+ uptake. Ten millimolar theophylline or 1 mM 1-methyl-3-isobutylxanthine, which inhibit cAMP phosphodiesterase, each greatly increased the stimulation of insulin release by 59-801. Forskolin (0.1 mM), an activator of adenylate cyclase, or 1 mM dibutyryl cAMP also potentiated 59-801, suggesting that 59-801 does not elevate islet cAMP but is potentiated by other compounds that do. Measurement of cAMP in islets by radioimmunoassay confirmed that it was not significantly elevated by 59-801 but was increased sevenfold by forskolin or 1-methyl-3-isobutylxanthine. SaRI 59-801 was not effective in the absence of Ca2+ and presence of 1 mM EGTA. Agents that block entry of Ca2+ into beta-cells, verapamil, nifedipine, or CoCl2, inhibited the release of insulin in response to 59-801. Studies of 45Ca2+ uptake by isolated islets revealed an increased uptake in the presence of 59-801 and blockage of this effect by 50 microM verapamil. Thus, the stimulation of insulin secretion by 59-801 appears to involve a stimulation of Ca2+ uptake rather than an increase of cAMP concentration. The mechanism of stimulation of Ca2+ uptake by 59-801 requires further investigation.

Stimulation of insulin secretion from isolated rat islets by SaRI 59-801.

Oral administration of SaRI 59-801 (DL-alpha-[dimethylaminomethyl]-2-[3-ethyl-5-methyl-4-isoxazolyl]-1H- indole-3-methanol) has been reported to decrease blood glucose in several species and to elevate plasma insulin in rats and mice. In studies with isolated rat pancreatic islets incubated 1 h with 3 mM glucose, 0.05 mM 59-801 produced a significant increase in insulin secretion, and 0.3 mM produced maximum release. 59-801 (0.3 mM) stimulated insulin release 4-5-fold from islets incubated with 0, 3, or 5 mM glucose but had little effect on the high rates of release obtained at 10 or 20 mM glucose. Ten millimolar mannoheptulose, which inhibits phosphorylation of glucose and blocks glucose-stimulated insulin release, had little effect on the stimulation of insulin release by 0.3 mM 59-801 from islets incubated with 3 mM glucose. Stimulation of insulin release in the absence of glucose or in the presence of 3 mM glucose plus 10 mM mannoheptulose suggests that glucose metabolism is not required for the action of 59-801. The rate of conversion of 5 mM [5(-3)H]-glucose to 3H2O by islets, a measure of the rate of glycolysis, was not affected by 59-801. The potency, dependency on glucose concentration, lack of inhibition by mannoheptulose, and lack of effect on glycolysis of 59-801 were similar to that of tolbutamide. However, proinsulin synthesis by islets incubated with 5.55 mM glucose was not affected by 0.5 mM 59-801, but was inhibited 72% and 67% by 0.5 mM tolbutamide and 0.1 mM glibenclamide, respectively.

The change of the staple diet of black South Africans from sorghum to maize (corn) is the cause of the epidemic of squamous carcinoma of the oesophagus.

The change of the staple diet of Black South Africans from sorghum to maize (corn) is the cause of the epidemic of squamous carcinoma of the oesophagus. For many years sorghum was the staple diet of Black South Africans. From approximately the early part of the twentieth century, maize gradually replaced sorghum. Squamous carcinoma of the oesophagus was infrequent in the first half of the twentieth century, rising slowly to current epidemic proportions. Fusarium fungi grow freely on maize, producing fumonisins, which reduce nitrates to nitrites and synthesise cancer-producing nitrosamines. Nitrosamines are the presumed carcinogens. Fusarium fungi do not grow well on sorghum, the production of fumonisin from sorghum being two orders of magnitude lower than maize. The higher incidence of oesophageal cancer in Black males is ascribed to their greater consumption of traditional beer, which is produced by fermenting maize. Patients with oesophageal cancer consume more beer than controls. Countries in Africa, in which the staple food is sorghum, have a low incidence of squamous carcinoma of the oesophagus. Crops from various parts of the country should be examined for Fusarium fungi and nitrosamines. The nitrosamine content of traditional beer should be assessed. If nitrosamines are detected, their carcinogenic potential should be studied experimentally. Should these tests prove positive, it would be vital to break the Fusarium-nitrosamine-cancer chain.

Keeping those telomeres short! an innovative intratumoral long-term drug delivery system.

BACKGROUND: Telomerase activation and an alternative lengthening of telomeres (ALT) mechanism are two telomere-lengthening cancer cell survival mechanisms elicited by both chemo- and/or radiotherapy. Telomere lengthening interferes with cell lethality and results in the immortalization of cancer cells. To counteract these mechanisms, we developed a drug delivery system (DDS) consisting of a polymeric implant that is inserted directly into tumors. The DDS releases, continuously and gradually, a cationic porphyrin (PdTMPyP4) for >30 days after a single application, and inhibits telomerase activation. METHODS: The PdTMPyP4 porphyrin is incorporated into a poly(co-glycolic lactic)acid (PLGA) polymer, solidified and cut into small rods. PdTMPyP4 release from the rods was measured spectrophotometrically over time. Uptake of Pd in the DNA of in L428 Hodgkins lymphoma cells was measured by ICP-MS, and telomerase activation by the TRAP assay. The rods were placed into the growth medium of cells whose growth rate was measured for 11 and 19 days. The cylinders were also inserted directly into KHJJ murine mammary tumors borne on the thighs of BALB/c mice and the tumor growth rate measured. RESULTS: In vitro, >10(9)Pd atoms were measured in the DNA of each L428 cell and telomerase activity was reduced by ~15% within 24 h. A one-time application of the rod in the cell medium induced a factor of >5 greater lethality compared to a blank rod or untreated controls. In vivo, a one-time insertion of the rod into tumors resulted in the retardation of the growth rate by factors of 3-5 compared to untreated controls. Systemic uptake after intratumoral insertion of the rod was negligible. CONCLUSION: The results suggest that the direct intratumoral insertion of a PdTMPyP4-containing polymeric rod would be of benefit as an adjuvant treatment for patients undergoing chemo- or radiotherapy. By preventing the lengthening of telomeres and therefore the unrestricted growth of cancer cells, our DDS will provide a significant therapeutic advantage to these treatments without affecting normal tissues.

Changing patterns of dietary iron overload in black South Africans.

Over the last 17 years there has been a significant reduction in the prevalence and severity of dietary iron overload in urban blacks of Johannesburg. This is attributed to a decrease in the consumption of traditionally brewed beer of high iron content over this period. A 40% reduction was found in hepatic iron concentrations measured in necropsy specimens from 248 male patients who died in 1976 as compared with 220 who died in 1959 and 1960. While hepatic iron concentrations rose with age in both groups there was no evidence of iron accumulation during the period between the two studies. Hepatic iron concentrations measured in 345 female subjects were many fold less than those of males and the 1976 group did not differ significantly from the 1959 to 1960 group. A paradoxical increase in the prevalence of portal fibrosis and cirrhosis was seen and may be due to the effects of increased ingestion of spirits and fortified wine in recent years. Iron overload was significantly greater in males with carcinoma of the esophagus and in those with idiopathic heart failure when compared to subjects who died of other causes. This suggests excessive exposure of these subjects to traditionally brewed beverages and the adulterants present in them.

Transfemoral removal of a chronically implanted pacemaker lead: report of a case.

A transfemoral angiographic technique was used to remove a chronically implanted, infected pacemaker wire that could not be withdrawn by using direct traction. The case and a description of the technique are detailed, and the principles of nonsurgical extraction of chronically implanted pacemaker wires are discussed.

Loxoscelism in the Transvaal, South Africa.

Bites by spiders of the genus Loxosceles have been implicated as a cause of necrotic arachnidism in the Transvaal. The identification and natural history of three species of Loxosceles common in the Transvaal, L. spinulosa, L. speluncarum and L. parrami, are discussed, the clinical symptoms of envenomation as observed both in human patients and in experimental animals are presented, and the histopathological appearance of the lesion, at different stages of its development, is described.

Computerized weight loss intervention optimizes staff time: the clinical and cost results of a controlled clinical trial conducted in a managed care setting.

OBJECTIVE: To evaluate the costs and effects of incremental components of a weight-loss program. DESIGN: A 3-arm, 12-month randomized controlled clinical trial to evaluate 3 incremental levels of intervention intensity. SUBJECTS/SETTING: The study included 588 individuals (BMI > 25 kg/m2) in a freestanding health maintenance organizalion and achieved an 81% completion rate. INTERVENTION: Using a cognitive behavioral approach for tailoring lifestyle modification goals, the incremental levels of intervention included a) a workbook alone, b) the addition of computerized tailoring using onsite computer kiosks with touch screen monitors, and c) the addition of both computers and staff consultation. MAIN OUTCOME MEASURES: Endpoints included weight parameters, lipid profile, plasma glucose, blood pressure, intervention costs, dietary intake, and physical activity. STATISTICAL ANALYSIS PERFORMED: Study endpoints were analyzed using analysis of variance for normally distributed variables and analysis of covariance to control for any baseline differences. Regression and correlation analysis assessed the relationship between weight loss and other variables. RESULTS: For the increasing levels of intervention intensity, the mean 12-month weight losses were 2.2, 4.7, and 7.4 pounds, with the respective cost per participant being $12.33, $41.99, and $133.74. The decreases in mean BMIs for these respective intervelation levels were 0.4, 0.9 and 1.2. All groups reported a decrease in energy and fat intake and an increase in blocks walked (P<.01). Intervention variables that correlated with weight loss included more computer log-ons, achieving computer-selected goals, more self-monitoring, increased walking, and decreased energy and fat intake, as well as higher attendance in staff consultation group sessions for that treatment condition. Weight loss correlated with decreases in fasting glucose and blood pressure. APPLICATIONS/CONCLUSIONS: In a weight-loss program, computers can facilitate selecting behavioral change goals. More frequent usage resulted in greater weight loss. Staff counseling to augment the computer intervention achieved the most weight loss.

Primary choriocarcinoma of the fallopian tube. Report of a case with survival and postoperative delivery. Review of the literature.

A patient is presented with primary choriocarcinoma of the fallopian tube arising from a tubal pregnancy. Treatment consisted of an initial operation including adnexectomy and resection of bilateral ovarian thecalutein cysts, followed by chemotherapy. The patient delivered a healthy infant 2 years later, and is alive and well 5 years after the event.

Synovial iron deposits in black subjects with iron overload.

The traditional alcoholic beverages drunk by many South African blacks are prepared in iron drums, and, as a result, iron overload is common in this population. The typical pattern of iron distribution in such persons with severe iron overload is one in which the major deposits are in hepatocytes and the reticuloendothelial system. However, when cirrhosis is present, significant epithelial deposits are found in a number of organs. In the present study, the synovium of the knee joint was examined in 41 black subjects and synovial iron deposits, when present, were correlated with those in other organs. Significant amounts of iron in the synovial-lining cells were not found in any subject in whom the hepatic iron concentration was less than 1% dry weight. Heavy deposits, which were found in six of 19 subjects with concentrations above this figure, only occurred in those exhibiting cirrhosis and significant levels of histological iron in a number of epithelial tissues. Insofar as iron uptake is concerned, these findings suggest that there are cells within the synovium that have the functional characteristics of epithelial cells.

The pathology of hypertension in a tropical environment.

Hypertension is very common in blacks and occurs at a younger age than in whites. It behaves in an explosive manner with death occurring frequently from cerebral hemorrhage, uremia or congestive heart failure. Pathologically the majority have essential hypertension. The development of hypertension is related to urbanization and Westernization, as the incidence in rural blacks is low. Despite the high incidence of hypertension, myocardial infarction remains infrequent.

Structural determinants of food insufficiency, low dietary diversity and BMI: a cross-sectional study of HIV-infected and HIV-negative Rwandan women.

OBJECTIVES: In Sub-Saharan Africa, the overlapping epidemics of undernutrition and HIV infection affect over 200 and 23 million people, respectively, and little is known about the combined prevalence and nutritional effects. The authors sought to determine which structural factors are associated with food insufficiency, low dietary diversity and low body mass index (BMI) in HIV-negative and HIV-infected Sub-Saharan women. STUDY DESIGN: Cross-sectional analysis of a longitudinal cohort. SETTING: Community-based women's organisations. PARTICIPANTS: 161 HIV-negative and 514 HIV-infected Rwandan women. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcomes included food insufficiency (reporting 'usually not' or 'never' to 'Do you have enough food?'), low household dietary diversity (Household Dietary Diversity Score ≤3) and BMI <18.5 (kg/m(2)). The authors also measured structural and behavioural factors including: income, household size, literacy and alcohol use. RESULTS: Food insufficiency was prevalent (46%) as was low dietary diversity (43%) and low BMI (15%). Food insufficiency and dietary diversity were associated with low income (adjusted odds ratio (aOR)=2.14 (95% CI 1.30 to 3.52) p<0.01), (aOR=6.51 (95% CI 3.66 to 11.57) p<0.001), respectfully and illiteracy (aOR=2.00 (95% CI 1.31 to 3.04) p<0.01), (aOR=2.10 (95% CI 1.37 to 3.23) p<0.001), respectfully and were not associated with HIV infection. Alcohol use was strongly associated with food insufficiency (aOR=3.23 (95% CI 1.99 to 5.24) p<0.001). Low BMI was inversely associated with HIV infection (aOR≈0.5) and was not correlated with food insufficiency or dietary diversity. CONCLUSIONS: Rwandan women experienced high rates of food insufficiency and low dietary diversity. Extreme poverty, illiteracy and alcohol use, not HIV infection alone, may contribute to food insufficiency in Rwandan women. Food insufficiency, dietary diversity and low BMI do not correlate with one another; therefore, low BMI may not be an adequate screening tool for food insufficiency. Further studies are needed to understand the health effects of not having enough food, low food diversity and low weight in both HIV-negative and HIV-infected women.

Targeting insulin inhibition as a metabolic therapy in advanced cancer: a pilot safety and feasibility dietary trial in 10 patients.

OBJECTIVE: Most aggressive cancers demonstrate a positive positron emission tomographic (PET) result using ¹8F-2-fluoro-2-deoxyglucose (FDG), reflecting a glycolytic phenotype. Inhibiting insulin secretion provides a method, consistent with published mechanisms, for limiting cancer growth. METHODS: Eligible patients with advanced incurable cancers had a positive PET result, an Eastern Cooperative Oncology Group performance status of 0 to 2, normal organ function without diabetes or recent weight loss, and a body mass index of at least 20 kg/m². Insulin inhibition, effected by a supervised carbohydrate dietary restriction (5% of total kilocalories), was monitored for macronutrient intake, body weight, serum electrolytes, ß-hydroxybutyrate, insulin, and insulin-like growth factors-1 and -2. An FDG-PET scan was obtained at study entry and exit. RESULTS: Ten subjects completed 26 to 28 d of the study diet without associated unsafe adverse effects. Mean caloric intake decreased 35 ± 6% versus baseline, and weight decreased by a median of 4% (range 0.0-6.1%). In nine patients with prior rapid disease progression, five with stable disease or partial remission on PET scan after the diet exhibited a three-fold higher dietary ketosis than those with continued progressive disease (n = 4, P = 0.018). Caloric intake (P = 0.65) and weight loss (P = 0.45) did not differ in those with stable disease or partial remission versus progressive disease. Ketosis was associated inversely with serum insulin levels (P = 0.03). CONCLUSION: Preliminary data demonstrate that an insulin-inhibiting diet is safe and feasible in selected patients with advanced cancer. The extent of ketosis, but not calorie deficit or weight loss, correlated with stable disease or partial remission. Further study is needed to assess insulin inhibition as complementary to standard cytotoxic and endocrine therapies.

Validation of a food frequency questionnaire to assess intake of n-3 polyunsaturated fatty acids in subjects with and without major depressive disorder.

The role of n-3 polyunsaturated fatty acids (PUFAs) in psychiatric illness is a topic of public health importance. This report describes development and biomarker validation of a 21-item, self-report food frequency questionnaire (FFQ) intended for use in psychiatric research to assess intake of α-linolenic acid (18:3n-3 [ALA]), docosahexaenoic acid (22:6n-3 [DHA]), and eicosapentaenoic acid (20:5n-3 [EPA]). In a cross-sectional study conducted from September 2006 to September 2008, sixty-one ethnically diverse adult participants with (n=34) and without (n=27) major depressive disorder completed this n-3 PUFA FFQ and provided a plasma sample. Plasma levels of n-3 PUFAs EPA and DHA, and n-6 PUFA arachidonic acid (20:4n-6 [AA]) were quantified by gas chromatography. Using Spearman's ρ, FFQ-estimated intake correlated with plasma levels of DHA (r=0.50; P<0.0001) and EPA (r=0.38; P=0.002), but not with ALA levels (r=0.22; P=0.086). Participants were classified into quartiles by FFQ-estimated intake and plasma PUFA concentrations. Efficacy of the FFQ to rank individuals into same or adjacent plasma quartiles was 83% for DHA, 78.1% for EPA, and 70.6% for ALA; misclassification into extreme quartiles was 4.9% for DHA, 6.5% for EPA, and 8.2% for ALA. FFQ-estimated EPA intake and plasma EPA were superior to plasma AA levels as predictors of the plasma AA to EPA ratio. This brief FFQ can provide researchers and clinicians with valuable information concerning dietary intake of DHA and EPA.