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Showing papers in "European Journal of Clinical Nutrition in 1999"


Journal ArticleDOI
TL;DR: A reliable and valid questionnaire to provide a comprehensive measure of the nutritional knowledge of UK adults that meets psychometric criteria for reliability and construct validity and should provide a useful scale with which to reassess the relationship between knowledge and dietary behaviour is described.
Abstract: Objective: This paper describes the development of a reliable and valid questionnaire to provide a comprehensive measure of the nutritional knowledge of UK adults. The instrument will help to identify areas of weakness in people’s understanding of healthy eating and will also provide useful data for examining the relationship between nutrition knowledge and dietary behaviour which, up until now, has been far from clear. Design: Items were generated paying particular attention to content validity. The initial version of the questionnaire was piloted and assessed on psychometric criteria. Items which did not reach acceptable validity were excluded, and the final 50 item version was administered to two groups differing in nutritional expertise on two occasions to assess the construct validity and test-retest reliability. Setting: The questionnaire was developed in 1994 in the UK. Subjects: Three hundred and ninety-one members of the general public, recruited via their places of work, completed the questionnaire at the piloting stage. The final version was administered to 168 dietetics and computer science students following a university lecture. Results: The internal consistency of each section was high (Cronbach’s alpha=0.70–0.97) and the test-retest reliability was also well above the minimum requirement of 0.7. Nutrition experts scored significantly better than computer experts [F(1167)=200.5, P<0.001], suggesting good construct validity. Conclusions: The findings demonstrate that the instrument meets psychometric criteria for reliability and construct validity. It should provide a useful scale with which to reassess the relationship between knowledge and dietary behaviour. Sponsorship: The study was funded by a grant from the Biotechnology and Biological Sciences Research Council.

586 citations


Journal ArticleDOI
TL;DR: This study would support that consumption of about 1.6 g of plant sterols per day will benefically affect plasma cholesterol concentrations without seriously affecting plasma carotenoid concentrations.
Abstract: Objective: To investigate the dose-response relationship between cholesterol lowering and three different, relatively low intake levels of plant sterols (0.83, 1.61, 3.24 g/d) from spreads. To investigate the effects on lipid-soluble (pro)vitamins. Design: A randomized double-blind placebo controlled balanced incomplete Latin square design using five spreads and four periods. The five study spreads included butter, a commercially available spread and three experimental spreads fortified with three different concentrations of plant sterols. Subjects: One hundred apparently healthy normocholesterolaemic and mildly hypercholesterolaemic volunteers participated. Interventions: Each subject consumed four spreads, each for a period of 3.5 week. Results: Compared to the control spread, total cholesterol decreased by 0.26 (CI: 0.15-0.36), 0.31 (CI: 0.20-0.41) and 0.35 (CI: 0.25-0.46) mmol/L, for daily consumption of 0.83, 1.61 and 3.24 g plant sterols, respectively. For LDL-cholesterol these decreases were 0.20 (CI: 0.10-0.31), 0.26 (CI: 0.15-0.36) and 0.30 (CI: 0.20-0.41). Decreases in the LDL/HDL ratio were 0.13 (CI: 0.04-0.22), 0.16 (CI: 0.07-0.24) and 0.16 (CI: 0.07-0.24) units, respectively. Differences in cholesterol reductions between the plant sterol doses consumed were not statistically significant. Plasma vitamin K1 and 25-OH-vitamin D and lipid standardized plasma lycopene and alpha-tocopherol were not affected by consumption of plant sterol enriched spreads, but lipid standardized plasma (alpha + beta)-carotene concentrations were decreased by about 11 and 19% by daily consumption of 0.83 and 3.24 g plant sterols in spread, respectively. Conclusions: The three relatively low dosages of plant sterols had a significant cholesterol lowering effect ranging from 4.9-6.8%, 6.7-9.9% and 6.5-7.9%, for total, LDL-cholesterol and the LDL/HDL cholesterol ratio, respectively, without substantially affecting lipid soluble (pro)vitamins. No significant differences in cholesterol lowering effect between the three dosages of plant sterols could be detected. This study would support that consumption of about 1.6 g of plant sterols per day will benefically affect plasma cholesterol concentrations without seriously affecting plasma carotenoid concentrations. Sponsorship: Unilever Research Vlaardingen, NL

413 citations


Journal ArticleDOI
TL;DR: The current intake of TFA in most Western European countries does not appear to be a reason for major concern, but it would therefore be prudent to reduce intake of all cholesterol-raising fatty acids, TFA included.
Abstract: Objective: To assess the intake of trans fatty acids (TFA) and other fatty acids in 14 Western European countries. Design and subjects: A maximum of 100 foods per country were sampled and centrally analysed. Each country calculated the intake of individual trans and other fatty acids, clusters of fatty acids and total fat in adults and/or the total population using the best available national food consumption data set. Results: A wide variation was observed in the intake of total fat and (clusters) of fatty acids in absolute amounts. The variation in proportion of energy derived from total fat and from clusters of fatty acids was less. Only in Finland, Italy, Norway and Portugal total fat did provide on average less than 35% of energy intake. Saturated fatty acids (SFA) provided on average between 10% and 19% of total energy intake, with the lowest contribution in most Mediterranean countries. TFA intake ranged from 0.5% (Greece, Italy) to 2.1% (Iceland) of energy intake among men and from 0.8% (Greece) to 1.9% among women (Iceland) (1.2-6.7 g/d and 1.7-4.1 g/d, respectively). The TFA intake was lowest in Mediterranean countries (0.5 -0.8 en%) but was also below 1% of energy in Finland and Germany. Moderate intakes were seen in Belgium, The Netherlands, Norway and UK and highest intake in Iceland. Trans isomers of C(18:1) were the most TFA in the diet. Monounsaturated fatty acids contributed 9-12% of mean daily energy intake (except for Greece, nearly 18%) and polyunsaturated fatty acids 3-7%. Conclusion: The current intake of TFA in most Western European countries does not appear to be a reason for major concern. In several countries a considerable proportion of energy was derived from SFA. It would therefore be prudent to reduce intake of all cholesterol-raising fatty acids, TFA included. Sponsorship: Commission of the European Communities (AIR 2421); National Funds; European Industries supported the chemical analyses.

406 citations


Journal ArticleDOI
TL;DR: In lean women, satiety and DIT were synchronously higher with a high protein/high carbohydrate diet than with ahigh fat diet, and differences in DIT correlated with differences in satiety over 24 h.
Abstract: Objective: Assessment of a possible relationship between perception of satiety and diet-induced thermogenesis, with different macronutrient compositions, in a controlled situation over 24 h. Design: Two diets with different macronutrient compositions were offered to all subjects in randomized order. Setting: The study was executed in the respiration chambers at the department of Human Biology, Maastricht University. Subjects: Subjects were eight females, ages 23–33 y, BMI 23±3 kg/m2, recruited from University staff and students. Interventions: Subjects were fed in energy balance, with protein/carbohydrate/fat: 29/61/10 and 9/30/61 percentage of energy, with fixed meal sizes and meal intervals, and a fixed activity protocol, during 36 h experiments in a respiration chamber. The appetite profile was assessed by questionnaires during the day and during meals. Diet induced thermogenesis was determined as part of the energy expenditure. Results: Energy balance was almost complete, with non-significant deviations. Diet-Induced-Thermogenesis (DIT) was 14.6±2.9%, on the high protein/carbohydrate diet, and 10.5±3.8% on the high fat diet (P<0.01). With the high protein/high carbohydrate diet, satiety was higher during meals (P<0.001; P<0.05), as well as over 24 h (P<0.001), than with the high fat diet. Within one diet, 24 h DIT and satiety were correlated (r=0.6; P<0.05). The difference in DIT between the diets correlated with the differences in satiety (r=0.8; P<0.01). Conclusion: In lean women, satiety and DIT were synchronously higher with a high protein/high carbohydrate diet than with a high fat diet. Differences (due to the different macronutrient compositions) in DIT correlated with differences in satiety over 24 h.

369 citations


Journal ArticleDOI
TL;DR: The depression of the vitamin D-PTH system seen among smokers may represent another potential mechanism for the deleterious effects of smoking on the skeleton, and may contribute to the reported risk of osteoporosis among smokers.
Abstract: Objective: To assess the influence of smoking on serum parathyroid hormone (PTH), serum vitamin D metabolites, serum ionized calcium, serum phosphate, and biochemical markers of bone turnover in a cohort of 510 healthy Danish perimenopausal women. Design: A cross-sectional study. Setting: Copenhagen, Denmark. Subjects: Five-hundred-and-ten healthy women aged 45–58 y, included 3–24 months after last menstrual bleeding. None were using hormone replacement therapy. Methods: The women were grouped according to their current smoking status. The two groups were compared with regard to serum levels of 25-hydroxyvitamin D (25OHD) and 1,25-dihydroxyvitamin D (1,25-(OH)2D), intact PTH, ionized calcium and phosphate, osteocalcin, as well as urine pyridinolines. Bone mineral density (BMD) was measured with DEXA-scans. Multiple regression analyses were performed to detect the effect of potentially confounding lifestyle factors, such as calcium and vitamin D intakes, alcohol and coffee consumption, sunbathing, and physical exercise. Results: Fifty percent were current smokers. Smokers had significantly reduced levels of serum 25OHD (P=0.02), 1,25(OH)2D (P=0.001), and PTH (P<0.001). There was no difference in serum ionized calcium between smokers and non-smokers. We found a negative effect of smoking on serum osteocalcin (P=0.01), while urinary pyridinolines were similar in the two groups. The small differences in lifestyle between the two groups could not explain these findings. Smokers had small but significant reductions in bone mineral density. Conclusions: Smoking has a significant effect on calcium and vitamin D metabolism, which is not likely to be explained by other confounding lifestyle factors. The depression of the vitamin D-PTH system seen among smokers may represent another potential mechanism for the deleterious effects of smoking on the skeleton, and may contribute to the reported risk of osteoporosis among smokers. Sponsorship: Grants from the Karen Elise Jensens Foundation.

364 citations


Journal ArticleDOI
TL;DR: It is concluded that regular coffee may be harmful to some hypertension-prone subjects and the hemodynamic effects of chronic coffee and caffeine consumption have not been sufficiently studied.
Abstract: Objective: We review the published data relating to intake of coffee and caffeine on blood pressure in man. We also refer to studies on the possible mechanisms of actions of these effects of caffeine. Design: The MEDLINE and Current Contents databases were searched from 1966 to April 1999 using the text words ‘coffee or caffeine’ and ‘blood pressure or hypertension’. Controlled clinical and epidemiologic studies on the blood pressure effects of coffee or caffeine are reviewed. We also refer to studies on the possible mechanisms of action of these effects of caffeine. Results: Acute intake of coffee and caffeine increases blood pressure. Caffeine is probably the main active component in coffee. The pressor response is strongest in hypertensive subjects. Some studies with repeated administration of caffeine showed a persistent pressor effect, whereas in others chronic caffeine ingestion did not increase blood pressure. Epidemiologic studies have produced contradictory findings regarding the association between blood pressure and coffee consumption. During regular use tolerance to the cardiovascular responses develops in some people, and therefore no systematic elevation of blood pressure in long-term and in population studies can be shown. Conclusions: We conclude that regular coffee may be harmful to some hypertension-prone subjects. The hemodynamic effects of chronic coffee and caffeine consumption have not been sufficiently studied. The possible mechanisms of the cardiovascular effects of caffeine include the blocking of adenosine receptors and the inhibition of phosphodiesterases.

323 citations


Journal ArticleDOI
TL;DR: In vitro amylase hydrolysis of the three foods showed that high amylose content in HAWB significantly lowered starch degradation in bread without affecting Hydrolysis kinetics.
Abstract: Objective: This study investigated whether postprandial metabolic responses to bread could be lowered by substituting high amylose maize starch for a part of the flour. Design and subjects: Eight healthy subjects consumed test meals of equivalent nutritional composition based on white wheat bread, bread rich in amylose (HAWB) and spaghetti as a breakfast meal. Blood samples were collected to measure insulin and glucose concentration during two hours after consumption. The degree of starch crystallinity was investigated by X-ray diffraction and DSC analysis. Results: HAWB produced low glycaemic (60±18) and insulinaemic (57±20) indexes similar to those of spaghetti (83±46, 61±16). In vitro amylase hydrolysis of the three foods showed that high amylose content in HAWB significantly lowered starch degradation in bread without affecting hydrolysis kinetics. Addition of amylose in dough increased the resistant starch content of HAWB (14% of dry matter). The resistant starch fraction was mainly composed of crystalline amylose (B-type X-ray diffraction pattern, melting temperature 105°C) attributable to native high amylose maize starch incompletely gelatinised during bread-cooking. Conclusions: Bread produced by the substitution of high amylose maize starch for a part of wheat flour showed a low glycaemic index. Resistant starch in HAWB corresponded to native crystalline amylose not gelatinised during normal bread-processing conditions. Sponsorship: Barilla, via Montova 166, 43100, Parma, Italy.

279 citations


Journal ArticleDOI
TL;DR: Results of four studies of intermediate quality support that fish consumption is inversely associated with coronary heart disease mortality in high-risk populations only, and suggest that 40–60 g fish per day is optimal and associated with a risk reduction of 40-60%.
Abstract: Objectives: To review all prospective cohort studies examining the relationship between fish intake and coronary heart disease mortality, and to assess the strength and consistency of their findings. Design: Systematic review of studies based on individual records of fish or n-3 polyunsaturated fatty acid consumption and coronary heart disease death. Studies were given scientific quality scores and divided into categories of high, intermediate, or insufficient quality. Main outcome measure: Coronary heart disease mortality. Results: Eleven studies were identified. The cohorts counted a total of 116 764 individuals. Of four studies judged to be of high quality, the two largest (n=44 895 and 20 051) were performed in populations at low risk of coronary heart disease. They found no protective effect of fish consumption. The other two high-quality studies were relatively small (n=852 and 1822) and included individuals at higher risk. They both found an inverse relationship between fish consumption and coronary heart disease death, suggesting that 40–60 g fish per day is optimal and associated with a risk reduction of 40–60%. Results of four studies of intermediate quality support that fish consumption is inversely associated with coronary heart disease mortality in high-risk populations only. Three studies were judged to be of insufficient quality to be used for drawing conclusions. Conclusions: Fish consumption is not associated with reduced coronary heart disease mortality in low-risk populations. However, fish consumption at 40–60 g daily is associated with markedly reduced coronary heart disease mortality in high-risk populations. The underlying biochemical mechanism is not known and causal inference premature.

269 citations


Journal ArticleDOI
TL;DR: Epicatechin is absorbed from chocolate and is rapidly eliminated from plasma and the maximal concentration and area under the curve of plasma kinetics of both substrates correlated very well with the dose of chocolate.
Abstract: Objective: To evaluate the plasma kinetics in man of epicatechin from black chocolate. Design: An intervention study with 8 volunteers. Each served as his own control. Theobromine was used as control marker of the chocolate intake. Setting: Metabolic Unit, Nestle Research Center, Vers-chez-les-Blanc, Switzerland. Subjects: Eight healthy male volunteers (4 smokers and 4 non-smokers) were enrolled in this study. They abstained from foods rich in polyphenols (coffee, tea, wine, fruit juice, cocoa products) for 24 h prior to the test until its completion. Intervention: Volunteers ate 40 g and 80 g of black chocolate (Nestle Noir) together with bread with a one-week interval. Blood samples were drawn every hour during the first 4 h and a last one at 8 h after chocolate consumption. Plasma samples were analysed for epicatechin and theobromine content by HPLC. Results: Plasma concentrations of epicatechin and theobromine increased markedly after chocolate consumption (P=0.002 and P=0.001, respectively), reaching a maximum between 2 and 3 h. The maximal concentration and area under the curve of plasma kinetics of both substrates correlated very well with the dose of chocolate. Conclusions: Epicatechin is absorbed from chocolate and is rapidly eliminated from plasma. Attainable plasma values are 0.7 μmol/l from 80 g of black chocolate. Sponshorship: Nestec LTD, Vevey, Switzerland.

254 citations


Journal ArticleDOI
TL;DR: It is concluded that DNL is not the pathway of first resort for added dietary CHO, in humans, and only when CHO energy intake exceeds TEE does DNL in liver or adipose tissue contribute significantly to the whole-body energy economy.
Abstract: The enzymatic pathway for converting dietary carbohydrate (CHO) into fat, or de novo lipogenesis (DNL), is present in humans, whereas the capacity to convert fats into CHO does not exist. Here, the quantitative importance of DNL in humans is reviewed, focusing on the response to increased intake of dietary CHO. Eucaloric replacement of dietary fat by CHO does not induce hepatic DNL to any substantial degree. Similarly, addition of CHO to a mixed diet does not increase hepatic DNL to quantitatively important levels, as long as CHO energy intake remains less than total energy expenditure (TEE). Instead, dietary CHO replaces fat in the whole-body fuel mixture, even in the post-absorptive state. Body fat is thereby accrued, but the pathway of DNL is not traversed; instead, a coordinated set of metabolic adaptations, including resistance of hepatic glucose production to suppression by insulin, occurs that allows CHO oxidation to increase and match CHO intake. Only when CHO energy intake exceeds TEE does DNL in liver or adipose tissue contribute significantly to the whole-body energy economy. It is concluded that DNL is not the pathway of first resort for added dietary CHO, in humans. Under most dietary conditions, the two major macronutrient energy sources (CHO and fat) are therefore not interconvertible currencies; CHO and fat have independent, though interacting, economies and independent regulation. The metabolic mechanisms and physiologic implications of the functional block between CHO and fat in humans are discussed, but require further investigation.

229 citations


Journal ArticleDOI
TL;DR: Hypovitaminosis D is fairly common in growing Finnish girls in the wintertime, and three months of vitamin D supplementation with 10 μg/d was insufficient in preventing hypov vitaminosis D.
Abstract: Objectives: To study the prevalence of hypovitaminosis D, the effect of vitamin D supplementation on serum 25-hydroxyvitamin D [S-25(OH)D], and the intakes of vitamin D and calcium in Finnish 9− to 15-year-old athletic and nonathletic girls. Design: 1-year follow-up study (February 1997-March 1998) with three months of vitamin D supplementation (10 μg/d) from October to January. Setting: Turku University Central Hospital, Finland. Subjects: 191 female volunteers aged 9–15 y (131 athletes and 60 controls). Methods: Vitamin D and calcium intakes were estimated by a four-day food recording and a semi-quantitative food frequency questionnaire (FFQ). S-25(OH)D was followed by radioimmunoassay (RIA). Results: At baseline the mean S-25(OH)D concentration was 33.9 nmol/l among all girls. In winter severe hypovitaminosis D (S-25(OH)D<20 nmol/l) occurred in 13.4% of the participants and in 67.7% S-25(OH)D was below 37.5 nmol/l. By the next summer the mean S-25(OH)D concentration was 62.9 nmol/l and in 1.6% of the subjects it was below 37.5 nmol/l. The prevalence of severe hypovitaminosis D was not significantly reduced by three months of vitamin D (10 μg/d) supplementation. At baseline, the mean intake of vitamin D was 2.9 μg/d by food recording and 4.3 μg/d by FFQ. The mean calcium intake was 1256 mg/d and 1580 mg/d, respectively. The intakes of vitamin D and calcium remained unchanged during the follow-up period. The athletes consumed more calcium than nonathletic controls, whereas the intake of vitamin D was quite similar among both groups. The vitamin D intake by FFQ correlated with the S-25(OH)D concentration in wintertime (r=0.28, P<0.01). Conclusion: Hypovitaminosis D is fairly common in growing Finnish girls in the wintertime, and three months of vitamin D supplementation with 10 μg/d was insufficient in preventing hypovitaminosis D. The daily dietary vitamin D intake was insufficient (<5 μg/d) in the majority of participants, while the calcium intake was usually sufficient. Sponsorship: Supported by the Yrjo Jahnsson Foundation, The Turku University Foundation, and the Medical Research Foundation of the Turku University Central Hospital.

Journal ArticleDOI
TL;DR: Positive clinical and haemodynamic effects of oral Q10 supplementation have been observed in double-blind trials, especially in chronic heart failure, and these effects should be further examined.
Abstract: The literature concerning the importance of coenzyme Q10 in health and disease has been reviewed. Usual dietary intake together with normal in vivo synthesis seems to fulfil the demands for Q10 in healthy individuals. The importance of Q10 supplementation for general health has not been investigated in controlled experiments. The literature allows no firm conclusions about the significance of Q10 in physical activity. In different cardiovascular diseases, including cardiomyopathy, relatively low levels of Q10 in myocardial tissue have been reported. Positive clinical and haemodynamic effects of oral Q10 supplementation have been observed in double-blind trials, especially in chronic heart failure. These effects should be further examined. No important adverse effects have been reported from experiments using daily supplements of up to 200 mg Q10 for 6-12 months and 100 mg daily for up to 6 y.

Journal ArticleDOI
TL;DR: It was concluded that standardised food composition tables have to be developed for the nine European countries involved in EPIC in order to provide comparable nutrient intake data.
Abstract: Food composition tables were studied from nine European countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC): Denmark, France, Germany, Greece, Great Britain, Italy, The Netherlands, Spain and Sweden. They were compared from the point view of availability, definition, analytical methods, and mode of expression of the nutrients of interest for EPIC, and it was seen that most of the nutrients in the tables are analysed and expressed in a compatible way. For some nutrients, however, common methods and definitions (folate, dietary fibre), or modes of expression (energy, protein, carbohydrates, carotenes, vitamin A and E) have not yet been agreed upon, so values are not comparable. For vitamin C a wide range of values are found due to the high natural variation in foods. For compiled tables, an additional problem is the use of several sources which may mean that the nutritional values are not comparable within the same table; and these values cannot be converted if the source is not stated. In addition, some tables were compiled using food composition values produced over 20 years ago with outdated analytical methods. In view of the inconsistent values for some nutrients and due to the large amount of foods reported within EPIC, it was concluded that standardised food composition tables have to be developed for the nine European countries involved in EPIC in order to provide comparable nutrient intake data.

Journal ArticleDOI
TL;DR: A review of the sociological research regarding the gendered features of food consumption is presented, with particular reference to the issue that dietary recommendations appear to focus upon increasing the consumption of foods that are markers of femininity and decreasing the consumption in Western food culture.
Abstract: A review of the sociological research regarding the gendered features of food consumption is presented. The focus is upon differences between women and men in regard to their preferences for particular foods and types of meals, seen in relation to the cultural function of foods as symbolic markers of femininity or masculinity, assessments of the quantities of food consumed by women and men respectively, and differences between women and men in regard to concerns with food safety, health, weight reduction and fitness. Some methodological limitations of this research are discussed with particular reference to the need for interdisciplinary cooperation between sociologists and nutritionists in the design and analysis of dietary surveys. Suggestions are made in regard to future directions for sociological research in this field, with particular reference to the issue that dietary recommendations appear to focus upon increasing the consumption of foods that are markers of femininity and decreasing the consumption of foods that are markers of masculinity in Western food culture.

Journal ArticleDOI
TL;DR: The study suggests that fasting morning urine samples would underestimate iodine status in this population and the use of the I/Cr ratio in casual urine samples is a usable measure of iodine status if corrected for the age- and sex-adjusted 24-h creatinine excretion.
Abstract: Objective: To examine the day-to-day and within-day variation in urinary iodine excretion and the day-to-day variation in iodine intake. Design: Collection of consecutive 24-h urine samples and casual urine samples over 24 h. Setting: The study population consisted of highly motivated subjects from our Institute. Subjects: Study 1: Ten healthy subjects (seven females and three males) aged 30–46 y. Study 2: Twenty-two healthy subjects (9 males and 13 females) aged 30–55 y. Methods: Study 1: 24-h urine samples were collected for four consecutive days. Study 2: Each urine voided over 24 h was collected into separate containers. In both studies dietary records were kept. Main outcome measures: Twenty-four-hour urinary iodine excretion, 24-h urinary iodine excretion estimated as I/Cr*24 h Cr and as a concentration in casual urine samples. Results: Study 1: Both iodine excreted in 24-h urine and iodine intake varied from day-to-day. Iodine excretion correlated with iodine intake (r=0.46, P=0.01). Iodine intake (mean 89±6.5 μg/d) was not significantly different from iodine excretion (mean 95±5.3 μg/d). Study 2: Twenty-four hour iodine excretion estimated as I/Cr*24 h Cr from the morning urine sample was significantly lower than actual 24-h iodine excretion, whereas 24-h iodine excretion estimated as I/Cr*24 h Cr from the first sample after the morning sample and the last sample before the subjects went to bed was not significantly different from actual 24-h iodine excretion. Twenty-four-hour urine excretion estimated as a concentration was lower than actual 24-h iodine excretion in casual urine taken at any time of the day. Conclusions: For determination of iodine status in an individual, more than one 24-h urine sample must be used. The use of the I/Cr ratio in casual urine samples is a usable measure of iodine status if corrected for the age- and sex-adjusted 24-h creatinine excretion. Further, the study suggests that fasting morning urine samples would underestimate iodine status in this population. Sponsorship: The study was supported by a grant from the 1991 Farmacy Foundation (Denmark). Contributors: Lone Banke Rasmussen and Lars Ovesen contributed to design, carried out the study, and wrote the paper. Erik Christiansen made the analyses. Guarantor: Lone Banke Rasmussen.

Journal ArticleDOI
TL;DR: Inulin seems to have a lipid lowering potential in normolipidemic men possibly mediated by mechanisms related to colonic fermentation.
Abstract: Objective: To investigate the effect of a breakfast cereal containing inulin on blood lipids and colonic ecosystem in normolipidemic young men. Setting: Department of Food Science and Microbiology,University of Milan, Italy. Subjects: Twelve healthy male volunteers, age 23.3±0.5 y, body mass index (BMI) 25.7±1.2 kg/m2 (mean±s.e.m.). Interventions: Subjects consumed daily, for three periods of four weeks, 50 g of a rice-based ready-to-eat cereal (placebo) and the same cereal containing 18% inulin (test) in substitution of their habitual breakfast, then returned to the habitual diet (wash-out). They followed no other dietary restrictions. Results: No changes in body weight, dietary habits, faecal and bile acid output, faecal short-chain fatty acid (SCFA) and faecal pH, were observed at the end of each period, whereas plasma total cholesterol and triacylglycerols significantly decreased at the end of test period by 7.9±5.4 (P<0.05) and 21.2±7.8% (P<0.005) respectively. Meal glucose tolerance test (MTT) resulted in the same incremental area under the curve for both cereals (IAUC test 124±35; placebo 118±33 mmol·min/l, ns). Inulin markedly enhanced breath H2 excretion (IAUC test 280±40; placebo 78±26 ppm·h, P<0.005), as well as faecal concentration of L-lactate. Total facultative anaerobes significantly decreased after test, and bifidobacteria increased after correction for total anaerobes (P<0.05). Changes in blood lipids were negatively correlated with bifidobacteria counts and positively with secondary bile acid excretion (P<0.05). Conclusions: Inulin seems to have a lipid lowering potential in normolipidemic men possibly mediated by mechanisms related to colonic fermentation. Sponsorship: National Research Council of Italy, grant number 95.00773.PF41.

Journal ArticleDOI
TL;DR: Results appear to indicate that aerobic exercise training produced small but favourable modifications to blood lipids in previously sedentary adults, and the evidence for the effect of resistance exercise training was inconclusive.
Abstract: Objective: To determine the effectiveness of exercise training (aerobic and resistance) in modifying blood lipids, and to determine the most effective training programme with regard to duration, intensity and frequency for optimizing the blood lipid profile. Design: Trials were identified by a systematic search of Medline, Embase, Science Citation Index (SCI), published reviews and the references of relevant trials. The inclusion criteria were limited to randomized, controlled trials of aerobic and resistance exercise training which were conducted over a minimum of four weeks and involved measurement of one or more of the following: total cholesterol (TC), high density lipoprotein (HDL-C), low density lipoprotein (LDL-C) and triglycerides (TG). Subjects: A total of 31 trials (1833 hyperlipidemic and normolipidemic participants) were included. Results: Aerobic exercise training resulted in small but statistically significant decreases of 0.10 mmol/L (95% CI: 0.02, 0.18), 0.10 (95% CI: 0.02, 0.19), 0.08 mmol/L (95% CI: 0.02, 0.14), for TC, LDL-C, and TG, respectively, with an increase in HDL-C of 0.05 mmol/L (95% CI: 0.02, 0.08). Comparisons between the intensities of the aerobic exercise programmes produced inconsistent results; but more frequent exercise did not appear to result in greater improvements to the lipid profile than exercise three times per week. The evidence for the effect of resistance exercise training was inconclusive. Conclusions: Caution is required when drawing firm conclusions from this study given the significant heterogeneity with comparisons. However, the results appear to indicate that aerobic exercise training produced small but favourable modifications to blood lipids in previously sedentary adults. Sponsorship: Public Health Research and Development Project Grant, National Health and Medical Research Council, Department of Health, Housing, Local Government and Community Services, 1995.

Journal ArticleDOI
TL;DR: Results indicate that nondigestible oligosaccharides are (partly) fermented in the human colon, but in healthy young men the effects are limited, as well as on blood lipid concentrations and glucose absorption.
Abstract: Objective: To study the effect of the intake of 15 g nondigestible oligosaccharides per day on various parameters of large-bowel function, as well as on blood lipid concentrations and glucose absorption in man. Design: Latin square, randomized, double-blind, diet-controlled. Setting: Metabolic research unit. Subjects: Twelve apparently healthy men (mean age 23 years), recruited from the Institute's pool of volunteers, no drop-outs. Interventions: Four treatment periods of 3 weeks: inulin, fructo-oligosaccharides (FOS), galacto-oligosaccharides (GOS) and control; analyses of stool weight, intestinal transit, faecal pH, short-chain fatty acids, bile acids, faecal enzymes, blood lipids and glucose absorption. Results: As compared to the control treatment: higher concentration of faecal acetate (inulin and GOS, P < 0.05) and valerate (inulin, P < 0.05), significantly lower concentration of faecal deoxycholic acid (inulin and FOS, P < 0.05 and P < 0.02, respectively) and β-glucuronidase activity (inulin and GOS, P < 0.05 and P < 0.02 respectively). Other changes of faecal parameters and those of blood lipids and glucose absorption were statistically not significant. Conclusions: Results indicate that nondigestible oligosaccharides are (partly) fermented in the human colon, but in healthy young men the effects are limited. Also the consumption of 15 g nondigestible oligosaccharides does not seem to alter blood lipid concentrations and glucose absorption in our young healthy adults.

Journal ArticleDOI
TL;DR: The results of this study indicate that an active transport mechanism for the transport of Ca, Mn, Rb, and Zn from the mother to the newborn exists, whereas Cs, Li, and Sr follow concentration gradients.
Abstract: Trace element transfer from the mother to the newborn — investigations on triplets of colostrum, maternal and umbilical cord sera

Journal ArticleDOI
TL;DR: In this paper, a 25-year longitudinal study of a population aged 70 to 95 years was conducted to investigate the relationship between height and body weight in the elderly, and the results showed that the elderly were more likely to be overweight.
Abstract: Height and body weight in the elderly. I. A 25-year longitudinal study of a population aged 70 to 95 years

Journal ArticleDOI
TL;DR: With additional refinements, the air displacement plethysmography system has the potential of providing an accurate and practical method of quantifying body fat in children as it now does in adults.
Abstract: Objectives: Air displacement plethysmography (ADP) may provide a partial alternative to body density (Bd) and therefore body composition measurement compared to conventional hydrodensitometry (Hd) in children. As there are no evaluation studies of ADP in children, this study had a two-fold objective: to compare Bd estimates by ADP and Hd; and to compare fat estimates by both ADP and Hd to fat estimates by another reference method, dual energy X-ray absorptiometry (DXA). Setting: Obesity Research Center, St. Luke’s=Roosevelt Hospital, New York, USA. Subjects: One hundred and twenty subjects (66 females=54 males) who ranged in age from 6 ‐ 86 y and in body mass index (BMI, kg=m 2 ) from 14.1 ‐ 40.0 kg=m 2 met study entry criteria. Study Design: Cross-sectional study of healthy children (age 19 y) and adult group for comparison to earlier studies. Each subject completed ADP, Hd, and DXA studies on the same day. Only subjects with subjectivelyjudged successful Hd studies were entered into the study cohort. Results: There was a high correlation between Bd by ADP and Hd (Bd Hda 0.11a 0.8966Bd ADP; ra 0.93, SEEa 0.008 g=cm 3 , P 0.9, P< 0.0001) with %fat by DXA in child and adult subgroups. Bland ‐ Altman analyses revealed no significant %fat bias by either ADP or Hd vs DXA in either children or adults, although a bias trend (Pa 0.11) was detected in the child subgroup. Conclusion: With additional refinements, the air displacement plethysmography system has the potential of providing an accurate and practical method of quantifying body fat in children as it now does in adults. Sponsorship: This study was in-part supported by NIH Grants RR00645, NIDDK 42618 and NIDDK 37352. Descriptors: air displacement plethysmography; body composition; hydrodensitometry; children

Journal ArticleDOI
TL;DR: The analysis draws attention to the wide variation in reported fruit and vegetable consumption among British adults and suggests strategies to increase consumption should be targeted at groups most likely to include low consumers of fruits and vegetables.
Abstract: Objectives: Using a national representative sample to examine variation in fruit and vegetable consumption among adults in the UK, with particular reference to consumers with high and low reported intakes. Design: National representative dietary survey using 7-d weighed diet records of men and women aged 16–64 y living in private households in the UK in 1986–1987. Setting: The UK. Subjects: 1087 men and 1110 women. The sample was selected by a multi-stage random probability design. The response was 70%. Subjects with low energy intake were subsequently excluded. Main outcome measures: Food group, nutrient intake, physiological measures socio-economic, demographic and behavioural characterstics. Results: Consumption of fruit and vegetables was estimated. The sample was divided by sex into four quarter groups according to fruit and vegetable consumption. There were significant similarities between quarter groups in fruit and vegetable and other food intake, nutrient intake, physiological measures, and socia-economic, demographic and behavioural variable. The lowest consumers of fruit and vegetables had a mean intake of 738 g/week (men) and 630 g/week (women), equivalent to 1.3 and 1.1 portion/d, respectively. Conversely, the mean intake of both men women with the highest consumption was 3137 g/week (5.6 portions day). There were more than twice as many adults in the age group 16–24 located in Q1 than in Q4. The Manual social class and those in receipt of benefits were negatively associated with fruit and vegetable consumption. Smokers were significantly associated with low fruit and vegetable intake. Being married was associated with increased fruit and vegetable intake and being single or divorced/separated was associated with low fruit and vegetable intake. Eating home grown produce was associated with hogh intake. Consumers who lived in London or the South-East were associated with higher fruit and vegetable intake. Conclusions: The analysis draws attention to the wide variation in reported fruit and vegetable consumption among British adults. High consumers merit further investigation to elucidate practical strategies for increasing fruit and vegetable consumption. Strategies to increase consumption should be targeted at groups most likely to include low consumers of fruits and vegetables. Sponsorship: London School of Hygience and Tropical Medicine.

Journal ArticleDOI
TL;DR: Quercetin can be absorbed in humans from dietary sources to high enough concentrations to increase the overall antioxidant activity of the plasma, but has a strong affinity for protein and provides no direct protective effect during LDL oxidation.
Abstract: Objective To investigate the in vivo effects of quercetin following the ingestion of fried onions. Design Five healthy volunteers, three males and two females aged between 25 and 39 y, ingested 225 g of fried onions after an overnight fast and peripheral venous blood was collected 0, 2, 4, 24 and 48 h after consumption. Quercetin in the plasma, total antioxidant capacity and susceptibility of low density lipoproteins (LDL) to oxidation were measured. Results Following the onion meal, quercetin levels increased from baseline values (28.4 +/- 1.9 ng/ml) to peak after 2 h (248.4 +/- 103.9 ng/ml), decreasing to baseline again after 24 h (P > 0.05). This was accompanied by an increase in the total antioxidant activity of the plasma from baseline (1.70 +/- 0.04 mmol/l trolox equivalents) to 1.75 +/- 0.10 mmol/l trolox equivalents after 2 h and 1.76 +/- 0.08 mmol/l trolox equivalents after 4 h. There was no significant change in the susceptibility of the plasma or the isolated LDL to oxidation over the 48 h period after consumption of the fried onions. In view of these negative findings, we isolated LDL and other lipoproteins from plasma at each time point. Quercetin was not detected in either LDL or VLDL, but was present in the HDL fraction, although this fraction also contains other proteins including albumin. Conclusions Quercetin can be absorbed in humans from dietary sources to high enough concentrations to increase the overall antioxidant activity of the plasma. Quercetin, however, has a strong affinity for protein and provides no direct protective effect during LDL oxidation.

Journal ArticleDOI
TL;DR: High-mono high-GI and high- CHO, low-GI diets are superior to high-CHO, high- GI diets with respect to HDL metabolism but no effect was noted on glucose metabolism in variably controlled NIDDM subjects.
Abstract: Objective: To examine the relative effects of high and low glycemic index (GI) carbohydrates, and monounsaturated fats on blood glucose and lipid metabolism in NIDDM subjects. Subjects: Fourteen male and seven female variably controlled NIDDM subjects recruited by advertisement. Setting: Free living outpatients. Research design: A repeated measures, within-subject design was used such that each subject consumed three diets: (a) a high-GI diet (53% CHO7 21% fat, 63 GI units (glucosea 100)); (b) a low-GI diet (51% CHO 7 23% fat, 43 GI units); and (c) a high-mono high-GI diet (42% CHO735% fat, 59 GI units) in random order and cross-over fashion for four weeks. Approximately 45% energy was provided as key foods which differed in published GI values and specifically excluded legumes. Dietary fibre intake was > 30 g=d on each diet. At the end of each dietary intervention, we measured fasting plasma lipids, glucose, insulin, total glycated plasma protein, fructosamine, LDL and HDL particle size as well as 24 h urinary excretion of glucose and C-peptide. Results: HDL-cholesterol was higher on the low-GI and high-mono high-GI diets compared to the high-GI diet (P< 0.05 for overall diet effect). There were no other significant differences in metabolic control between diets, even when adjusted for BMI, glucose control or gender. Body weight and saturated fat intake remained stable between dietary interventions. Conclusion: High-mono high-GI and high-CHO, low-GI diets are superior to high-CHO, high-GI diets with respect to HDL metabolism but no effect was noted on glucose metabolism in variably controlled NIDDM subjects. Sponsorship: This study was funded by CSIRO Human Nutrition. Descriptors: non-insulin dependent diabetes diet; carbohydrates; glycemic index; monounsaturated fatty acids; plasma lipids

Journal ArticleDOI
TL;DR: Results suggest that Social Desirability and self image of body shape are associated with RA, and modifications in subject training may reduce the effect of these factors on RA.
Abstract: Objective: Assess the association between reporting bias of dietary energy intake and the behavioral and psychological profiles in women. Design: At baseline a series of questionnaires were administered to 37 women, (the Marlowe-Crowne Social Desirability Scale, Weinberger Adjustment Inventory (WAI), the Eating Disorder Inventory (EDI), the Restraint Scale and Sorensen-Stunkard’s silhouettes). Subjects received training on how to record dietary records. Subjects recorded three days of dietary records to measure energy intake (EI) during a study to determine total energy expenditure (TEE) using doubly labeled water. Reporting accuracy (RA=EI/TEE×100) was determined for each subject. Statistical analysis of the data used a mixed effects model accounting for within subject variability to determine if the psychological scores were associated with reporting accuracy. Setting and subject: Women were recruited with local advertisements in Tucson, Arizona. The women had a mean (±1 s.d.) age of 43.6±9.3 yrs, body mass index (BMI) of 28.7±8.5 kg/m2 and total body fat (%TBF) of 31.9±7.3%. Results: Age and %TBF were significantly and inversely associated with RA. Furthermore, Social Desirability was negatively associated with RA. Body dissatisfaction and associating a smaller body size than one’s own as being more healthy were also associated with a lower RA. Conclusions: These results suggest that Social Desirability and self image of body shape are associated with RA. Modifications in subject training may reduce the effect of these factors on RA. Sponsorship: This project was supported by a grant from the National Institute of Diabetes, Digestive and Kidney Diseases.

Journal ArticleDOI
TL;DR: Waist circumference showed higher values in boys than in girls, especially after 11.5 y, and waist values increase with age both in males and females, justifying the use of age and gender specific reference standards.
Abstract: Objective: To obtain reference values of the waist circumference in Spanish children, and to investigate their dependence on age and gender. Design: Cross-sectional study. Setting: General school-age population. Subjects: A representative sample of the schools in Zaragoza, Spain, was drawn from seven schools. The population selected comprised 1728 children with ages ranging from 6.0–14.9 y. Of the original sample, 368 children (21.29%) were excluded because of chronic diseases or refusal. Finally, 1360 children and adolescents: 701 boys and 659 girls, were studied. Interventions: Waist and hip circumferences were measured with an unelastic tape. Results: Waist circumference tended to be higher in males than in females and this difference was significant after 11.5 y. In general, hip circumference was higher in females than in males (statistically significant differences at 7.5, 10.5, 12.5 and 13.5 y). In general, percentile values of waist circumference were higher in males than in females, especially after 12.5 y. Difference between males and females on percentile 95 at 14.5 y was 7.6 cm. Hip was greater than waist in both sexes, and the two curves run nearly parallel in males. In females, while hip enlarges continuously, waist shows the reverse tendency between 11.5 and 14.5 y. Conclusions: Waist circumference showed higher values in boys than in girls, especially after 11.5 y, and waist values increase with age both in males and females. These findings justify the use of age and gender specific reference standards. Sponsorship: This work was supported by grant 216-02 from Universidad de Zaragoza, Zaragoza, Spain.

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TL;DR: The above data suggest that chitosan in the administered dosage, without dietary alterations, does not reduce body weight in overweight subjects, and is not incorporated as a major constituent into several over-the-counter remedies.
Abstract: Background: Overweight and obesity is a prevalent and costly threat to public health. Compelling evidence links overweight and obesity with serious disorders such as cardiovascular diseases and diabetes. Dietary regimen are notoriously burdened with poor compliance. Chitosan is promoted in the US and other countries as an oral remedy to reduce fat absorption and has now been incorporated as a major constituent into several over-the-counter remedies. The primary aim of this study is to investigate the clinical effectiveness of oral chitosan for body weight reduction. Methods: Thirty-four overweight volunteers were included in a randomized placebo-controlled double-blind trial. Subjects were assigned to receive either four capsules of chitosan or indistinguishable placebo twice daily for 28 consecutive days. Measurements were taken at baseline, after 14 and 28 d of treatment. Subjects maintained their normal diet and documented the type and amount of food consumed. Adverse effects were assessed and compliance monitored. Results: Data from 30 subjects were entered into an intention-to-treat analysis. After four weeks of treatment, body mass index, serum cholesterol, triglycerides, vitamin A, D, E and β-carotene were not significantly different in subjects receiving chitosan compared to those receiving placebo. Vitamin K was significantly increased after four weeks in the chitosan group compared with placebo (P<0.05). Compliance was 91.5% and 96.0% for chitosan and placebo groups respectively. Conclusion: The above data suggest that chitosan in the administered dosage, without dietary alterations, does not reduce body weight in overweight subjects. No serious adverse effects were reported. Sponsorship: Marshtech Ltd, London.

Journal ArticleDOI
TL;DR: Lactase deficient subjects benefit from a better lactose absorption after ingestion of yoghurt compared with milk and from milk added lactase, whereas ingestion of unfermented acidophilus milk does not seem to improve lactose absorbing.
Abstract: Objective: This review summarises the effects of lactic acid bacteria on lactose malabsorption, bacterial/viral or antibiotic associated diarrhoea, and describes the impact of lactic acid bacteria on cancer and the fermentative products in the colon. Results: Eight studies (including 78 patients) demonstrated that lactase deficient subjects absorbed lactose in yogurt better than lactose in milk, while two studies (25 patients) did not support this. Two studies (22 patients) showed that unfermented acidophilus milk was absorbed better than milk, while six studies (68 patients) found no significant differences. Addition of lactose hydrolysing enzyme, lactase, to milk improved lactose malabsorption in seven studies (131 lactose malabsorbers), while one study (10 malabsorbers) demonstrated no improvement. Lactic acid bacteria alleviated travellers’ diarrhoea in one study (94 individuals) while a study including 756 individuals was borderline statistically significant. One study (50 individuals) did not find an effect of lactic acid bacteria on travellers’ diarrhoea. Six studies (404 infants) demonstrated a significant effect of lactic acid bacteria on infant diarrhoea, while one study (40 infants) did not. Lactic acid bacteria moderated antibiotic associated diarrhoea in three studies (66 individuals), while two studies (117 individuals) were insignificant. Conclusions: Lactase deficient subjects benefit from a better lactose absorption after ingestion of yoghurt compared with milk and from milk added lactase, whereas ingestion of unfermented acidophilus milk does not seem to improve lactose absorption. The majority of studies support that lactic acid bacteria alleviate bacterial/viral induced diarrhoea, especially in infants, while the effect on antibiotic associated diarrhoea is less clear. Experimental studies indicate an effect of lactic bacteria on human cell cancer lines, but clinical evidence is lacking. A ‘stabilising’ effect of lactic acid bacteria on the colonic flora has not been documented.

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TL;DR: Findings show that energy density is a key determinant of energy intake in that cognitive, behavioral, and sensory cues related to the volume or weight of food consumed can interact with or override physiological cues associated with food intake.
Abstract: In this review, we consider two hypotheses which could explain why high-fat foods are overeaten. The first hypothesis is that fat is overeaten because it affects satiety and satiation less than carbohydrate. In several studies which have evaluated the effects of fat on satiety and satiation, fat differed little from carbohydrate when both the palatability and energy density of the test foods were matched. Therefore it is unlikely that the effects of fat on satiety or satiation provide the primary explanation for why it is overeaten. The second hypothesis is that the high energy density of fat facilitates its overconsumption. Support for this view comes from recent studies in which energy density significantly influenced intake when both the macronutrient content and palatability of the test foods were matched. For example, when individuals were fed diets varying in energy density and could eat as much food as they liked, they ate the same amount of food (by weight) so energy intake varied directly with energy density. Furthermore, when participants consumed foods of low energy density, they felt satisfied, despite reductions in energy intake. These findings show that energy density is a key determinant of energy intake in that cognitive, behavioral, and sensory cues related to the volume or weight of food consumed can interact with or override physiological cues associated with food intake.

Journal ArticleDOI
B A Stoll1
TL;DR: Nutritional and lifestyle modifications that improve insulin sensitivity may not only decrease a tendency to atherosclerosis but also reduce breast cancer risk in women.
Abstract: Objective: The incidence of breast cancer in the Western world runs parallel to that of the major components of the insulin resistance syndrome—hyperinsulinaemia, dyslipidaemia, hypertension and atherosclerosis. Evidence is reviewed that the growth of breast cancer is favoured by specific dietary fatty acids, visceral fat accumulation and inadequate physical exercise, all of which are thought to interact in favouring the development of the insulin resistance syndrome. Design: Clinical, epidemiological and experimental studies linking breast cancer risk with evidence of insulin resistance and its concomitants, were searched for in the MEDLINE database since 1985. Results: Clinical and epidemiological evidence suggests that both breast cancer and the metabolic disorders comprising the insulin resistance syndrome are polygenic and multifactorial in origin. Experimental evidence suggests that hyperinsulinaemia and its concomitants can increase the promotion of mammary carcinogenesis and the mechanism is likely to involve increased bioactivity of insulin-like growth factor 1 (IGF-1). Case-control and cohort studies have shown that higher serum levels of IGF-1 are associated with increased breast cancer risk. Pharmacological agents which lower IGF-1 concentrations are under clinical trial for breast cancer prevention. Conclusions: Nutritional and lifestyle modifications that improve insulin sensitivity may not only decrease a tendency to atherosclerosis but also reduce breast cancer risk in women. In addition to a reduced fat intake, the dietary regimen might involve a reduced n-6/n-3 ratio of polyunsaturated fatty acids and should be associated with avoidance of obesity and regular physical exercise. Interventions to decrease breast cancer risk in first-degree relatives of breast cancer patients need to begin at an early age.