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This article details the development, delivery, and evaluation of a six-session nutrition course entitled "Eating Today for a Healthier Tomorrow." The course addressed nutrition practices associated with the reduction of risk for coronary heart disease, cancer, osteoporosis, and obesity. Teaching teams, consisting of an extension agent and a registered dietitian, were used in course delivery. A wide variety of printed and audiovisual teaching aids helped participants learn through discussion, goal setting, games, and food tasting. Evaluation components of the course included demographic and pre- and post-course food frequency information as well as an overall evaluation by each participant. Post-course evaluation data were collected at a reunion session held 2 months after course completion. One hundred forty-two of 195 participants (73%) completed the course and the evaluation. Three-fourths of the participants had a family history of at least one of the life-style diseases addressed by the course. The food frequency results indicated that participants made some significant changes in their food practices. They decreased the number of times they selected high-fat cheese, regular red meats, foods from the saturated fatty acid group, desserts, sodium-rich products, and tea/coffee (p less than .05), and they increased selection of low-fat dairy products (p less than .05). Further study is recommended to determine whether individuals maintain the dietary changes and how those changes affect others in the person's immediate environment.
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PMID:A risk-reduction nutrition course for adults. 168 28

The disposition of many drugs in obesity is altered, although little is known of the effect of obesity on the pharmacokinetics of anti-cancer drugs. In this report the authors describe the pharmacokinetics of high-dose methotrexate in an obese woman (184% ideal body weight) with osteosarcoma. For this patient, both the volume of distribution at steady-state (0.398 l/kg) and systemic clearance (0.0956 l/h/kg) of methotrexate were increased compared with values observed in adult patients with osteosarcoma. The terminal elimination half-life (9.29 hours) of methotrexate was similar to other reported values in adult patients, thus indicating that increases in methotrexate volume of distribution and clearance may offset each other in obesity. Based on the experience gained from this patient, the authors suggest that renal function and methotrexate serum concentrations should be monitored in obese patients receiving high-dose methotrexate with leucovorin rescue.
Cancer 1991 Sep 15
PMID:Disposition of high-dose methotrexate in an obese cancer patient. 171 90

To evaluate the hypothesis that endocrine profiles change with aging independently of specific disease states, we examined the age trends of 17 major sex hormones, metabolites, and related serum proteins in 2 large groups of adult males drawn from the Massachusetts Male Aging Study, a population-based cross-sectional survey of men aged 39-70 yr conducted in 1986-89. Group 1 consisted of 415 men who were free of obesity, alcoholism, all prescription medication, prostate problems, and chronic illness (cancer, coronary heart disease, hypertension, diabetes, and ulcer). Group 2 consisted of 1294 men who reported 1 or more of the above conditions. Each age trend was satisfactorily described by a constant percent change per yr between ages 39-70 yr. Free testosterone declined by 1.2%/yr, and albumin-bound testosterone by 1.0%/yr. Sex hormone-binding globulin (SHBG), the major serum carrier of testosterone, increased by 1.2%/yr, with the net effect that total serum testosterone declined more slowly (0.4%/yr) than the free or albumin-bound pools alone. Among the major androgens and metabolites, androstane-3 alpha,17 beta-diol (androstanediol; 0.8%/yr) and androstanediol glucuronide (0.6%/yr) declined less rapidly than free testosterone, while 5 alpha-dihydrotestosterone remained essentially constant between ages 39-70 yr. Androstenedione declined at 1.3%/yr, a rate comparable to that of free testosterone, while the adrenal androgen dehydroepiandrosterone (3.1%/yr) and its sulfate (2.2%/yr) declined 2-3 times more rapidly. The levels of testosterone, SHBG, and several androgen metabolites followed a parallel course in groups 1 and 2, remaining consistently 10-15% lower in group 2 across the age range of the study. Subgroup analyses suggested that obese subjects might be responsible for much of the group difference in androgen level. Serum concentrations of estrogens and cortisol did not change significantly with age or differ between groups. Of the pituitary gonadotropins, FSH increased at 1.9%/yr, LH increased at 1.3%/yr, and PRL declined at 0.4%/yr, with no significant difference between groups 1 and 2.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Age, disease, and changing sex hormone levels in middle-aged men: results of the Massachusetts Male Aging Study. 171 16

To determine risk factors for carcinoma of the breast, the authors compared women with cancer on screening and diagnostic mammography with those in whom cancer was not detected. For 39 months, medical histories were collected by mammography technologists on 3492 women having routine screenings or diagnostic mammograms at their institution. Potential risk factors for women with biopsy-proven breast cancer were compared with those in women who had normal findings on mammograms or negative biopsy results (controls). Of the 3492 women, 49 had biopsy-proven breast cancer. There were 3361 patients in the control group, including those women with normal findings on mammograms (3294) and those with negative biopsy results (67). 82 women had incomplete questionnaires or were lost to follow up. Nearly all of those with breast cancer were postmenopausal compared with 68% of the controls. The mean length of lactation for breast cancer patients was significantly less than for the controls; 5.6 vs 7.5 weeks (p=.015). This was also true for the postmenopausal patients; 8.1 vs 6.1 weeks (p=.041). Postmenopausal breast cancer patients had menstruated significantly more years (p=.016) than postmenopausal control subjects: 34 vs 31 years, although the mean age at menarche was not different. When corrected for age, there was no significant difference in the total duration of menstruation in the postmenopausal cancer patients compared with the postmenopausal controls. Postmenopausal breast cancer patients had a significantly greater (p=.021) average body weight than postmenopausal control subjects: 71.7 vs 66.7 kg, although body weight was the same when all patients were considered. similar results were found when Quetelet's index for obesity (weight in kg/height in cm2 (p=.004) was calculated for postmenopausal patients: 28 for cancer patients and 26 for controls. There was no significant difference in height between cancer patients and controls when all subjects or just those who were postmenopausal were considered. History of oral contraceptive (OC) use was significantly less common among postmenopausal breast cancer patients than among postmenopausal controls: 9% vs 20%. Patients with breast cancer had lower parity than the controls. In this series of patients, women in whom breast cancer was detected on mammography lactated less, showed no significant difference in years of menstruation when corrected for age, had a greater average body weight, used OCs less often, and had fewer children than women in whom no cancer was detected on mammography.
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PMID:Risk factors for breast cancer in women undergoing mammography. 172 80

Emphasis has been placed on the understanding of the regulation of food intake in the hope of aiding the battle against obesity and of helping to ameliorate the anorexia of cancer and eating disorders. Available data suggest that the regulatory system is multifaceted and complex. This review focuses on current research on the regulation of appetite and satiety by carbohydrates, fats, and proteins as well as by artificial sweeteners. Some methodological problems and potential mechanisms of action at the biochemical level are discussed. Evidence suggests that organisms are more successful in defending against calorie dilution than in adjusting to increases in calories. The implications of that defense relative to the use of ersatz nutrients are explored.
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PMID:The influence of food on food intake: methodological problems and mechanisms of action. 174 52

High-frequency jet ventilation has been reported as an effective method of ventilation during laryngoscopy, but may expose the patient to the risks of barotrauma or alveolar hypoventilation. The aim of the study was to evaluate the determining factors of pulmonary complications under high-frequency jet ventilation in 83 patients undergoing laryngoscopy for upper airway cancer. Pulmonary distention was mainly influenced by upper airway obstruction score (p = .0001), while patients with chronic obstructive pulmonary disease (COPD) did not suffer from gas trapping. Impaired gas exchange was predicted by increased weight (p = .0001), smaller injector diameter (p = .02), and lower airway obstruction (p = .001). Hypercapnia occurred in both upper and lower airway obstruction, while hypoxemia was principally observed in COPD patients. Emphasis is placed on monitoring by pulse oximetry, end-expiratory pressure, and PCO2 measurement, especially in patients with obesity, COPD, or upper airway obstruction.
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PMID:Airway obstruction and high-frequency jet ventilation during laryngoscopy. 174 28

In order to test the sensitivity of leucocyte zinc determination in the assessment of zinc status, an isolation procedure of mononuclear (MNC) and polymorphonuclear (PMNC) cell fractions was developed. Zinc concentrations in cells from healthy subjects were (mean +/- SD, in mumol/10(10) cells): 0.81 +/- 0.24 in MNC and 0.55 +/- 0.06 in PMNC. In patients suffering from several diseases known to be associated with a marginal impairment in zinc status (cirrhosis, cancer, obesity, endocrine and rheumatic diseases), these concentrations did not differ from those in controls except in rheumatic patients in whom MNC zinc was increased (1.05 +/- 0.42 mumol/10(10) cells) and correlated with erythrocyte sedimentation rate (r = 0.41, P less than 0.01). This relation was also significant in the whole study population (r = 0.39, P less than 0.01). Leucocyte zinc therefore appears to have a limited value in the assessment of marginally impaired zinc status, except in inflammatory states.
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PMID:Interest of zinc determination in leucocyte fractions for the assessment of marginal zinc status. 176 19

Congestive heart failure (CHF) is a major cause of mortality and morbidity, and has a prognosis similar to that of several malignancies. There are increasing trends in both prevalence and incidence rates of CHF which points towards CHF becoming a major community health problem. Early detection of CHF is dependent upon criteria to define the initial stages of a condition which progresses slowly over many years. In western countries the dominant causes of CHF are hypertension and coronary heart disease, which account for more than 75% of the cases. Other precursors are diabetes and rheumatic heart disease. Independent risk factors for CHF are hypertension, smoking, obesity, and psychological stress. Early detection of CHF through identification of early symptoms such as dyspnea on exertion, treatment of known heart diseases, and treatment of risk factors may prevent its progress. Epidemiological data indicate that primary preventive efforts should be directed against hypertension, smoking and obesity. A multiple risk factor interventional approach seems to yield the best result since these risk factors act synergistically.
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PMID:Epidemiology and prognosis of heart failure. 179 25

Female hormonal contraceptives, introduced commercially in 1959, contained 10 mg of norethynodrel and .15 mg of mestranol. The estrogen and progesterone doses were progressively reduced over time. In 1989, approximately 60 million couples used oral contraceptives (OCs) ranging from 1% in Japan to 40% in the Netherlands. The monophasic pill contains .01 - .04 mg of ethinyl estradiol (EE), and the biphasic pill contains increasing doses of progesterone and estroprogesterone in the course of the menstrual cycle. Triphasic combined pills contain an initially dominant estrogen dose. In oral sequential pills, estrogen is given on days 14-16 followed by a estroprogesterone for 5-7 days. Micropills with progesterone, injectables with medroxyprogesterone, and 3rd-generation OCs such as gestoden with a low progesterone dose of .04 mg/day and reduced androgenic activity are among other OCs. The OCs are administered in 21-22 day packets. Absolute contraindications include history of venous thrombosis, atherogenic lipid profile, hormone-dependent cancer, and allergy. Relative contraindications include arterial ailments, smoking, hypertension, older age, obesity, and familial history of cardiovascular and cerebrovascular accidents. Interactions with antibiotics (ampicillin and tetracycline) occur as the modified intestinal flora reduces the level of deconjugated EE. Most frequent side effects are depression, modification of libido, ocular disorders, headache, and urinary infection. Benefits include favorable modification of menstrual cycle, and reduction of endometriosis and endometrial and ovarian cancer. Systemic risks such as cardiovascular and blood coagulation effects occur mainly with high-dose OCs. Further topics addressed are the cancer risk and protective effect of OCs, postcoital OCs, traditional contraception, the IUD, RU-486, implants, vaccination with the human antigonadotropine, and the vaginal ring.
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PMID:[Family planning with different contraceptive methods]. 182 14

In Australia the most important preventable causes of cancer, in order of importance, are tobacco smoking, diet, obesity, sunlight exposure, alcohol consumption and occupational exposure to carcinogens. We review and discuss these causes and their potential preventability and discuss three broad strategies in cancer prevention: public health policy and legislation, screening, and education and behavior change. In each of these broad areas, current research evidence and relevant approaches to research and development are considered. Six areas of research and development priority for cancer prevention and education are suggested: cigarette smoking (particularly among children and adolescents); protection of the skin from exposure to strong sunlight; screening; dietary choices; occupational exposures; and the social and environmental context of cancer prevention. All of these strategies and concerns will not apply to every country in the Asia-Pacific region but may be useful as guidelines and as a stimulus for determining particular local priorities.
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PMID:The research and development agenda for cancer prevention and education in Australia. 182 10


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