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We investigated geophagia in the black population of rural Holmes County, Mississippi. Twenty-five sources of geophagical clays were located and most of the sources are associated with rural settlements throughout the county. Clays are taken from subsurface soil horizons, and all but one of the sources come from the upland portion of the county. Geophagia occurs among 57% of women and 16% of children of both sexes, but it is not found among adult males or adolescents. Average daily comsumption of clay is 50 g. Our data indicate geophagia is not correlated with hunger, anemia, or helminthic problems, but it may contribute to the common problem of hypertension. Geophagia has been suggested as one of the factors leading to hyperkalemia, but our data do not support this notion.
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PMID:Geophagia in rural Mississippi: environmental and cultural contexts and nutritional implications. 48 31

Very fat people die earlier than people of normal weight because hypertension, diabetes and coronary disease are more frequent among the markedly obese. Most obese subjects, however, are only slightly overweight and their mortality is not elevated. Reasons for dieting are more often psychological than somatic. 2. Reducing diets are ineffective because the obese rarely follow them. Total fasting and intestinal bypass may provide better results, but are more dangerous. 3. Atkins' diet eliminates carbohydrates from food without restricting protein and fat intake. Deprived of carbohydrates, the body uses fat for fuel. A small part of metabolized fat is eliminated in the urine as ketone bodies, and this is why such diets are called "ketogenic". They have been known at least since 1863. 4. Caloric loss due to ketonuria does not exceed 100 Cal/day in the non-diabetic. It is maximal during total fasting and cannot be increased by a ketogenic diet. 5. In the short run, such diets produce rapid weight loss due to polyuria. On the other hand, refeeding carbohydrates causes water retention and weight gain. 6. The diet decreases appetite: patients eat less without feeling severe hunger and without measuring their food intake. 7. Orthostatic hypotension, fatigue, and nausea are frequent, despite what Dr. ATKINS claims. 8. The diet increases plasma cholesterol and uric acid. It may be dangerous in diabetes (anorexia, acidosis) and in heart or kidney failure (hypokalemia). 9. The diet, though far from good, is better than the book. ATKINS' theories are at best half-truths, and the results he claims lack credibility. The obese subject's disappointment with traditional reducing diets and the book's hard-sell style account for ATKINS' success.
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PMID:[Dr. Atkins' dietetic revolution: a critique]. 89 45

A 300 kcal (1.25 MJ) diet of conventional food is described, which has been studied under in-patient conditions for four to six weeks. It contained 22.6 g protein, 34 g CHO and 6.9 g fat but not the full RDA of vitamins and minerals since this is impossible without supplementation. Hunger disappeared after the third day. Patients developed ketonuria and hyperuricemia; serum lipids were normalised and hypertension disappeared. The diet offers advantages in that it induces better nutritional knowledge and habits.
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PMID:A 300 kcal (1.2 MJ) diet using conventional food. 727 57

Close relationships exist between patterns of intra-uterine growth and the risk of ischaemic heart disease, hypertension, diabetes, insulin-resistance syndrome, obesity and some cancers later in life. Earlier studies placed emphasis on low birth weight and reduced growth, but it is now clear that disproportions in early growth are of great importance. Disproportion may be identified as disproportions of fetal and placental growth (and the risk of high blood pressure), or in head circumference, length and weight. It is hypothesized that the availability of nutrients at different times during gestation, by interacting with the maternal and fetal hormonal profile, predisposes to different patterns of growth. The same interaction programmes critical metabolic functions and determines the metabolic capacity at all later ages. People who were exposed to severe undernutrition during the Dutch hunger winter showed increased adiposity if the exposure was during early pregnancy, but decreased adiposity if the exposure was during late pregnancy. In men born in the UK, those with evidence of retarded fetal growth had significantly greater waist/hip circumference ratios for any given body mass index (the ratio fell with increasing weight at one year of age). In Mexican-Americans and non-Hispanic Caucasian Americans, people in the lowest third of birth weight had more truncal fat than those in the highest third. Offspring of rats exposed to marginally reduced protein intakes during pregnancy manifest a similar pattern of growth and metabolic change to that seen in humans, with perturbations of appetite and body fat patterning. Studies in rats suggest that programming of the hypothalamus, especially the hypothalamic-pituitary-adrenal axis might be the mechanism through which these changes are brought about.
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PMID:Nutritional influences in early life upon obesity and body proportions. 901 78

Patients with neuromuscular disease may suffer from nocturnal respiratory failure despite normal daytime respiratory function. The physiological reduction in muscle tone during sleep may be life-threatening in a patient with impaired muscle strength. Nocturnal respiratory failure may occur in patients with the postpolio syndrome, amyotrophic lateral sclerosis, myasthenia gravis, myotonic dystrophy, and muscular dystrophy. Diagnosis of obstructive, central and mixed apneas, hypopneas, and hypoventilation is best made using polysomnography. Therapeutic options include noninvasive ventilation such as continuous positive airway pressure, bilevel positive airway pressure, intermittent positive pressure ventilation and, rarely, tracheostomy, oxygen, or protriptyline. Evaluation by a sleep specialist should be initiated in any neuromuscular patient with nocturnal symptoms such as air hunger, intermittent snoring or breathing, orthopnea, cyanosis, restlessness, and insomnia. Daytime symptoms may include morning drowsiness, headaches and excessive daytime sleepiness. Polycythemia, hypertension, and signs of heart failure may also be seen. Effective treatment is available, and may improve the quality of life, and possibly increase survival.
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PMID:Nocturnal respiratory failure as an indication of noninvasive ventilation in the patient with neuromuscular disease. 967 Mar 10

Chewing of Qat leaves which contain amphetamine alkaloids is a traditional drug practice in the horn of Africa. Cathine and cathinone are responsible for the desired psychogenic (suppression of hunger, mind stimulation, euphoria) and sympathicomimetic effects. In this study, we monitored seven volunteers during a traditional qat ritual. An increase in systolic and diastolic pressure was observed in three patients including one presenting predisposing chronic arterial hypertension. Peak pressure was observed approximately seven hours after beginning the ritual. The three patients presenting pressure changes were not significantly different from the four unaffected patients with regard to age or duration of qat use. These findings suggest that qat use by untreated hypertensive patients who react strongly to vasoconstrictive effects can lead to hypertension and resulting cardiovascular complications.
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PMID:[Hypertensive effects of qat]. 1008 4

The Leningrad Siege Study investigated the relationship between decreased maternal food intake and risk factors for coronary heart disease in adult life. The study screened 169 subjects exposed to intrauterine starvation during the Siege of Leningrad (now St. Petersburg) 1941-4, 192 subjects born in Leningrad before the siege and 188 subjects born concurrently with these two groups but outside the area of the siege. No difference was found between the subjects exposed to starvation in utero and during infancy in glucose tolerance [in utero: 5.2 mmol/l (95% confidence interval 5.1 to 5.3; infancy: 5.3 (5.1 to 5.5), p = 0.94], insulin concentration, blood pressure, lipid concentration or coagulation factors. The intrauterine exposed group had evidence of endothelial dysfunction by higher concentrations of von Willebrand factor and a stronger interaction between adult obesity and blood pressure. Non-systematic differences in subscapular to triceps skinfold ratio, diastolic blood pressure and clotting factors were demonstrated compared to the non-exposed groups. In conclusion, this study did not find an association between intrauterine starvation and glucose intolerance, dyslipidaemia, hypertension or cardiovascular disease in adult life. These findings differ from studies of subjects exposed to maternal starvation during the Dutch Hunger Winter. However, the dissimilar effects of exposure to the two famines may contribute to our understanding of the mechanisms of the thrifty phenotype and support the importance of catch-up growth during early childhood, a situation that occurred in the Netherlands by not in Leningrad.
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PMID:Fetal programming and the Leningrad Siege study. 1191 63

Weight loss ameliorates arterial hypertension and glucose metabolism in obese patients, but the dietary approach is unsatisfactory because obesity relapses. Durable reduction of body weight, obtained through major nonreversible surgical procedures, such as jejunal and gastric bypass, allows improvement of glucose metabolism and arterial blood pressure in morbid (grade 3) obesity. Laparoscopic adjustable gastric banding (LAGB) is a minimally invasive and reversible surgical procedure that yields a significant reduction of gastric volume and hunger sensation. In this study, 143 patients with grade 3 obesity [27 men and 116 women; age, 42.9 +/- 0.83 yr; body mass index (BMI), 44.9 +/- 0.53 kg/m(2); normal glucose tolerance (NGT; n = 77); impaired glucose tolerance (IGT; n = 47); type 2 diabetes mellitus (T2DM; n = 19)] underwent LAGB and a 3-yr follow-up for clinical (BMI, waist circumference, waist to hip ratio, and arterial blood pressure) and metabolic variables (glycosylated hemoglobin, fasting insulin and glucose, insulin and glucose response to oral glucose tolerance test, homeostasis model assessment index, total and high-density lipoprotein cholesterol, triglycerides, uric acid, and transaminases). At baseline and 1 yr after LAGB, patients underwent computerized tomography and ultrasound evaluation of visceral and sc adipose tissue. One-year metabolic results were compared with 120 obese patients (51 men and 69 women; age, 42.9 +/- 1.11 yr; BMI, 43.6 +/- 0.46 kg/m(2); NGT, n = 66; IGT, n = 8; T2DM, n = 46) receiving standard dietary treatment. LAGB induced a significant and persistent weight loss and decrease of blood pressure. Greater metabolic effects were observed in T2DM patients than in NGT and IGT patients, so that at 3 yr glycosylated hemoglobin was no longer different in NGT and T2DM subjects. Clinical and metabolic improvements were proportional to the amount of weight loss. LAGB induced a greater reduction of visceral fat than sc fat. At 1-yr evaluation, weight loss and metabolic improvements were greater in LAGB-treated than diet-treated patients. We conclude that LAGB is an effective treatment of grade 3 obesity in inducing long-lasting reduction of body weight and arterial blood pressure, modifying body fat distribution, and improving glucose and lipid metabolism, especially in T2DM.
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PMID:Laparoscopic adjustable gastric banding for the treatment of morbid (grade 3) obesity and its metabolic complications: a three-year study. 1216 74

There is evidence in Australia that 1st generation Greek Australians (GA), despite their high prevalence of cardiovascular disease (CVD) risk factors (e.g. obesity, diabetes, hyperlipidaemia, smoking, hypertension, sedentary lifestyles) continue to display more than 35% lower mortality from CVD and overall mortality compared with the Australian-born after at least 30 years in Australia. This has been called a 'morbidity mortality paradox' or 'Greek-migrant paradox'. Retrospective data from elderly Greek migrants participating in the International Union of Nutrition Sciences Food Habits in Later Life (FHILL) study suggests that diets changed on migration due to the: (i) lack of familiar foods in the new environment; (ii) abundant and cheap animal foods (iii) memories of hunger before migration; and (iv) status ascribed to energy dense foods (animal foods, white bread and sweets) and 'plumpness' as a sign of affluence and plant foods (legumes, vegetable dishes, grainy bread) and 'thinness' as a sign of poverty. This apparently resulted in traditional foods (e.g. olive oil) being replaced with 'new' foods (e.g. butter), 'traditional' plant dishes being made more energy dense, larger serves of animal foods, sweets and fats being consumed, and increased frequency of celebratory feasts. This shift in food pattern contributed to significant weight gain in GA. Despite these potentially adverse changes, data from Greece in the 1960s (seven countries study) and from Australia in the 1990s (FHILL study) has shown that Greek migrants have continued to eat large serves of putatively protective foods (leafy vegetables, onions, garlic, tomatoes, capsicum, lemon juice, herbs, legumes, fish) prepared according to Greek cuisine (e.g. vegetables stewed in oil). Furthermore, GA were found to return to the traditional Greek food pattern with advancing years. We suspect that these factors may explain why GA have recently been found to have over double the circulating concentrations of antioxidant carotenoids, especially lutein, compared with Australians of Anglo-Celtic ancestry. This in turn may have helped to make the CVD risk factors 'benign' and reduce the risk of death. This raises the question whether specific dietary guidelines need to be developed for recent migrants to Australia, encouraging them to retain the best of their traditional cultures and include the best of the mainstream culture.
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PMID:Morbidity mortality paradox of 1st generation Greek Australians. 1249 49

The purpose of the research was to study influence of diets with a various ratio of carbohydrates and fatty components on modification of metabolic risk factors due to decrease of weight and abdominal adiposity, and also on quality of life of the patient. 49 males were included in the study the age 30-65 years with metabolic syndrome X. All patients had increased body mass or obesity. Hypertension of I and II stages was observed in 49.0% of cases. The estimation of results was carried out in three months after assignment of one of investigated diets. Effective reduction of body mass parameters was achieved at use of all diets within three months. Nutritional counseling was based on dietary preferences and habits of the patient to improve quality of life at observance of a diet. Common negative feature of investigated diets was occurrence of feeling of hunger that caused infringement of accuracy of observance of recommendations.
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PMID:[Effect of different diets on quality of life in patients with metabolic syndrome]. 1292 4


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