admission. This proportion could already be greater in some parts of the country and may increase if referrals of cases of self-poisoning increase faster than the facilities for their assessment and management. The provision of social work and psychiatric expertise in casualty departments may be one means of preventing unnecessary medical admissions without risk to the patients. Dr Blake's and Dr Bramble's figures do not demonstrate, however, that any advantage would attach to medical teams taking over assessment from psychiatrists except that, by implication, assessments would be completed sooner by staff working on the ward full time. What the figures actually suggest is that if assessment of overdoses were left to house doctors there would be an increase in admissions to psychiatric units (by 19°U), outpatients (by 5O°'), and referrals to social services (by 140o). So for house doctors to assess overdoses would provide no economy for the psychiatric or social services. The study does not tell us what the consequences would have been for the six patients who the psychiatrists would have admitted but to whom the house doctors would have offered outpatient appointments. E J SALTER

Vitamin D deficiency.

BACKGROUND\nIncreased physical activity is related to reduced risk of cardiovascular disease, possibly because it leads to improvement in the lipoprotein profile. However, the amount of exercise training required for optimal benefit is unknown. In a prospective, randomized study, we investigated the effects of the amount and intensity of exercise on lipoproteins.\n\n\nMETHODS\nA total of 111 sedentary, overweight men and women with mild-to-moderate dyslipidemia were randomly assigned to participate for six months in a control group or for approximately eight months in one of three exercise groups: high-amount-high-intensity exercise, the caloric equivalent of jogging 20 mi (32.0 km) per week at 65 to 80 percent of peak oxygen consumption; low-amount-high-intensity exercise, the equivalent of jogging 12 mi (19.2 km) per week at 65 to 80 percent of peak oxygen consumption; or low-amount-moderate-intensity exercise, the equivalent of walking 12 mi per week at 40 to 55 percent of peak oxygen consumption. Subjects were encouraged to maintain their base-line body weight. The 84 subjects who complied with these guidelines served as the basis for the main analysis. Detailed lipoprotein profiling was performed by nuclear magnetic resonance spectroscopy with verification by measurement of cholesterol in lipoprotein subfractions.\n\n\nRESULTS\nThere was a beneficial effect of exercise on a variety of lipid and lipoprotein variables, seen most clearly with the high amount of high-intensity exercise. The high amount of exercise resulted in greater improvements than did the lower amounts of exercise (in 10 of 11 lipoprotein variables) and was always superior to the control condition (11 of 11 variables). Both lower-amount exercise groups always had better responses than the control group (22 of 22 comparisons).\n\n\nCONCLUSIONS\nThe highest amount of weekly exercise, with minimal weight change, had widespread beneficial effects on the lipoprotein profile. The improvements were related to the amount of activity and not to the intensity of exercise or improvement in fitness.

Effects of the amount and intensity of exercise on plasma lipoproteins: Editor's comments

Obesity is a chronic disease of multifactorial origin and can be defined as an increase in the accumulation of body fat. Adipose tissue is not only a triglyceride storage organ, but studies have shown the role of white adipose tissue as a producer of certain bioactive substances called adipokines. Among adipokines, we find some inflammatory functions, such as Interleukin-6 (IL-6); other adipokines entail the functions of regulating food intake, therefore exerting a direct effect on weight control. This is the case of leptin, which acts on the limbic system by stimulating dopamine uptake, creating a feeling of fullness. However, these adipokines induce the production of reactive oxygen species (ROS), generating a process known as oxidative stress (OS). Because adipose tissue is the organ that secretes adipokines and these in turn generate ROS, adipose tissue is considered an independent factor for the generation of systemic OS. There are several mechanisms by which obesity produces OS. The first of these is the mitochondrial and peroxisomal oxidation of fatty acids, which can produce ROS in oxidation reactions, while another mechanism is over-consumption of oxygen, which generates free radicals in the mitochondrial respiratory chain that is found coupled with oxidative phosphorylation in mitochondria. Lipid-rich diets are also capable of generating ROS because they can alter oxygen metabolism. Upon the increase of adipose tissue, the activity of antioxidant enzymes such as superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx), was found to be significantly diminished. Finally, high ROS production and the decrease in antioxidant capacity leads to various abnormalities, among which we find endothelial dysfunction, which is characterized by a reduction in the bioavailability of vasodilators, particularly nitric oxide (NO), and an increase in endothelium-derived contractile factors, favoring atherosclerotic disease.

/pdf/inflammation-oxidative-stress-and-obesity-1qbfra0rim.pdf

Inflammation, Oxidative Stress, and Obesity

This 11th edition of the book Modern Nutrition in Health and Disease, featuring the work of more than 190 expert authors and divided into five parts, fully explains and encapsulates the fundamentals of nutrition and its role in contemporary society, from mastering the basic science of nutrient metabolism and function to applying nutritional concepts to combat human disease. Part I comprehensively covers specific dietary components, including major dietary constituents, minerals, vitamins and other Other CABI sites 

Modern Nutrition in Health and Disease

The interplay between free radicals, antioxidants, and co-factors is important in maintaining health, aging and age-related diseases. Free radicals induce oxidative stress, which is balanced by the body’s endogenous antioxidant systems with an input from co-factors, and by the ingestion of exogenous antioxidants. If the generation of free radicals exceeds the protective effects of antioxidants, and some co-factors, this can cause oxidative damage which accumulates during the life cycle, and has been implicated in aging, and age dependent diseases such as cardiovascular disease, cancer, neurodegenerative disorders, and other chronic conditions. The life expectancy of the world population is increasing, and it is estimated that by 2025, 29% of the world population will be aged ≥60 years, and this will lead to an increase in the number of older people acquiring age-related chronic diseases. This will place greater financial burden on health services and high social cost for individuals and society. In order to acheive healthy aging the older people should be encouraged to acquire healthy life styles which should include diets rich in antioxidants. The aim of this review is to highlight the main themes from studies on free radicals, antioxidants and co-factors, and to propose an evidence-based strategy for healthy aging.

Studies on free radicals, antioxidants, and co-factors.

Background: Atopic dermatitis is a chronically relapsing, highly pruritic and inflammatory skin disease. This study was done to assess the effects of vitamins D and E supplementation on the clinica...

Randomized controlled trial using vitamins E and D supplementation in atopic dermatitis

OBJECTIVE —The present study was designed to assess the effect of magnesium plus zinc, vitamins C plus E, and a combination of these micronutrients on nephropathy indexes in type 2 diabetic patients. RESEARCH DESIGN AND METHODS —In a randomized, double-blind, placebo-controlled clinical trial, 69 type 2 diabetic patients were randomly divided into four groups, each group receiving one of the following daily supplement for 3 months: group M ( n = 16), 200 mg Mg and 30 mg Zn; group V ( n = 18), 200 mg vitamin C and 100 IU vitamin E; group MV ( n = 17), minerals plus vitamins; and group P ( n = 18), placebo. Urinary albumin excretion and N -acetyl-β-d-glucosaminidase activity (NAG) in urine were determined at the beginning and at the end of the trial. Treatment effects were analyzed by general linear modeling. RESULTS —Results indicate that after 3 months of supplementation, levels of urinary albumin excretion decreased in the V and MV groups ( P = 0.034 and P = 0.005, respectively). Urinary NAG activity did not significantly change in any treatment groups. Levels of systolic, diastolic, and mean blood pressure significantly decreased in the MV group ( P = 0.008, P = 0.017, and P = 0.009, respectively). Also, combination of vitamin and mineral supplementation had significant effects in decreasing fasting serum glucose ( P = 0.035) and malondialdehyde concentrations ( P = 0.004) and in increasing HDL cholesterol and apolipoprotein A1 levels ( P = 0.019). There was no significant change in the levels of these parameters in the other three groups. CONCLUSIONS —In conclusion, the results of the present study provide evidence for the effects of vitamins C and E and also combination of magnesium, zinc, and vitamins C and E supplementation on improvement of glomerular but not tubular renal function in type 2 diabetic patients.

https://care.diabetesjournals.org/content/diacare/28/10/2458.full.pdf

Comparison of the Effects of Vitamins and/or Mineral Supplementation on Glomerular and Tubular Dysfunction in Type 2 Diabetes

Diet and its relationship to sarcopenia in community dwelling Iranian elderly: a cross sectional study.

INTRODUCTION: The role of obesity in diabetes mellitus, hyperlipidemia, colon cancer, sudden death and other cardiovascular diseases has been confirmed by many studies. In this study, it was hypothesized that obesity is an independent risk factor for lipid peroxidation and decreased activity of cytoprotective enzymes in humans. METHODS: To test the study hypothesis, we assessed lipid peroxidation by measuring the concentrations of plasma malondialdehyde (MDA) and the activity of erythrocyte copper-zinc superoxide dismutase (CuZn-SOD), glutathione peroxidase (GPX) and catalase (CAT) in 25 obese women (BMI=30-40 Kg/m 2 ) and 25 women with healthy BMI (19-25Kg/m2). RESULTS: The concentration of plasma MDA was significantly higher (P<0.001) in obese women (3.4± 0.7 µmol/L) compared to women with healthy BMI (1.4± 0.3 µmol/L). Furthermore, there was a significantly positive correlation (r =0.75, P<0.0001) between BMI and plasma MDA. On the other hand, women with healthy BMI had significantly higher (P<0.001) erythrocyte CuZn-SOD (873± 52 U/g Hb) and GPX (64.7± 14.2 U/g Hb) activity than obese women (660± 39 U/g Hb) and (48.5± 13.1 U/g Hb), respectively. Furthermore, erythrocyte CuZn-SOD and GPX activity were negatively correlated with BMI (r =-0.52, P<0.0001 and r =-0.42, P<0.001), respectively. No significant difference was observed between two groups in erythrocyte CAT activity. CONCLUSIONS: From these observations, it is concluded that obesity even in the absence of smoking, diabetes, renal or liver disease can decrease the activities of body’s protective antioxidants, and can enhance the systemic oxidative stress.

Is obesity associated with increased plasma lipid peroxidation and oxidative stress in women

We surveyed 4315 2–5 year olds in Iran. Prevalence of obesity (BMI >95th centile, Iranian reference data) was compared with the recent “IOTF” approach. Prevalence was significantly higher than expected, and increased with age, but contradictory trends were obtained from the two approaches. Monitoring of childhood obesity using the BMI in developing countries is indicated, but differences associated with obesity definition should be considered.

https://adc.bmj.com/content/archdischild/87/5/388.full.pdf

Fereydoun Siassi

Papers

Randomized controlled trial using vitamins E and D supplementation in atopic dermatitis

Comparison of the Effects of Vitamins and/or Mineral Supplementation on Glomerular and Tubular Dysfunction in Type 2 Diabetes

Diet and its relationship to sarcopenia in community dwelling Iranian elderly: a cross sectional study.

Is obesity associated with increased plasma lipid peroxidation and oxidative stress in women

Obesity in Iranian children