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The proposition that lifestyle is a major determinant of community health is explored by contrasting the features of a rural subsistence community in the highlands of Papua New Guinea and the features of the community in urbanized, industrialized Australia. Reference is made to differences in physical environment, housing, work, social situation, human relationships, patterns of disease, population statistics, diet, growth, obesity, physical fitness, blood lipid concentrations, blood pressure, salt intake and the occurrence of hypertension, diabetes, cardiovascular disease and signs of degenerative changes in various tissues. The Papua New Guinea community is seen as a self-reliant, self-contained, socially cohesive subsistence society whose members are well adapted to their physical and social environment, free from major degenerative cardiovascular diseases, with little overt psychiatric illness, but with a heavy burden of infectious disease, with marginal nutritional levels of degenerative disease and disease from psychological stress. It is clear that health, in its fullest sense, is not the prerogative of any one type of society.
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PMID:Lifestyle, health and disease: a comparison between Papua New Guinea and Australia. 73 10

The immune system plays a key role in the body's ability to fight infection and reduce the risk of developing tumors, autoimmune and degenerative disease. Nutritional deficiencies and excesses influence various components of the immune system. Early studies investigating the association between nutrition and immunity focused on generalized protein-energy malnutrition, particularly in children in developing countries. The extent of immunological impairment depends not only on the severity of malnutrition but on the presence of infection and on the age of onset of nutritional deprivation, among other factors. In industrialized nations, immune function has been shown to be compromised in many malnourished hospitalized patients, small-for-gestational age infants, and the elderly. Obesity also may adversely influence immune function. Imbalances of single nutrients are relatively uncommon in humans, and investigations of protein and amino acids and specific vitamins, minerals, and trace elements generally are carried out in experimental animals. Deficiencies of protein and some amino acids, as well as vitamins A, E, B6 and folate, are associated with reduced immunocompetence. In contrast, excessive intake of fat, in particular polyunsaturated fatty acids (e.g. linoleic and arachidonic acids), iron, and vitamin E are immunosuppressive. Trace elements modulate immune responses through their critical role in enzyme activity. Both deficiency and excess of trace elements have been recognized. Although dietary requirements of most of these elements are met by a balanced diet, there are certain population groups and specific disease states which are likely to be associated with deficiency of one or more of these essential elements. The role of trace elements in maintenance of immune function and their causal role in secondary immunodeficiency is increasingly being recognized. There is growing research concerning the role of zinc, copper, selenium, and other elements in immunity and the mechanisms that underlie such roles. The problem of interaction of trace elements and immunity is a complex one because of the frequently associated other nutritional deficiencies, the presence of clinical or subclinical infections which in themselves have a significant effect on immunity, and finally the altered metabolism due to the underlying disease. There are many practical applications of our recently acquired knowledge regarding nutritional regulation of immunity.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Nutrition, immune response, and outcome. 309 56

For many years knee arthrodesis has been recommended for patients with severe degenerative disease complicated by obesity, venous insufficiency or old sepsis. Recently, failed total knee arthroplasties are being treated by arthrodesis, but these new indications entail new and difficult circumstances. A biplane fixation frame, more rigid than the Charnley clamp, and the instrumentation for producing absolutely flat opposing surfaces are important. The frame provides the advantages of good access to the wound and permits early ambulation. Pin tract loosening and infection are potential disadvantages, but in this small series were not significant.
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PMID:The biplane frame: modified compression arthrodesis of the knee. 728 20

In adults the distribution of body fat towards the central region seems a good predictor of disease and mortality. Central fat deposition tends to increase with age; sex and obesity further influence this trend. In children the distribution of adiposity to the central region is not well known. Recently, using circumferences of waist and thigh, we computed the percentile curves of the waist to thigh circumference ratio (WTR) from 2858 subjects (1440 males, 1418 females), 6-14-years-old (Zannolli, R., Chiarelli, F., and Morgese, G., 1993, International Journal of Obesity, 17 (Supplement 2), 60). In the present study, using the same sample of data, we showed that in lean, average or fat subjects, WTR is only weakly (< 5% of variance) explained by age, sex and body-mass index (in spite of the 'statistical significance' of sex and body-mass index in some groups). Hence, some subjects, among the lean, average and fat groups, could have a high (i.e. > 2 SD over the mean) WTR, independent of age, sex or weight. We therefore propose that the values of WTR should be checked against appropriate standards. Those with a WTR value greater than 2 SD from the mean, independent of age, sex or weight, should be studied more carefully, using anthropometry, so as to give early warning of those who are more prone to degenerative disease.
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PMID:Influence of age, sex, and BMI on waist-to-thigh circumference ratio in children. 761 53

Ad libitum (AL) overfeeding is the most significant, uncontrolled variable affecting the outcome of the current rodent bioassay. There is a highly significant correlation between AL food consumption, the resultant obesity and body weight, and low 2-yr survival in rodents. AL feeding of diets with lowered protein, metabolizable energy (ME), and increased fiber does not improve survival. Only dietary restriction (DR) of all diets tested significantly improves survival and delays the onset of spontaneous degenerative disease (i.e., nephropathy and cardiomyopathy) and diet-related tumors. Moderate DR results in an incidence of spontaneous tumors similar to AL-fed rats, but the tumors are found incidentally and do not cause early mortality. There is a decreased age-adjusted incidence of pituitary and mammary gland tumors in moderate DR-fed rats, but tumor growth time is similar between AL and DR rats with only a delay in tumor onset time seen in DR-fed groups. Moderate DR does not significantly alter drug-metabolizing enzyme activities nor the toxicologic response to 5 pharmaceuticals tested at maximum tolerated doses (MTDs). However, moderate DR-fed rats did require much higher doses of 4 additional pharmaceutical compounds before classical MTDs were produced. Toxicokinetic studies of 2 of these compounds demonstrated equal or higher steady-state systemic exposures to parent drug and metabolites in moderate DR-fed rats. Markers of oxidative stress (lipid peroxidation, protein oxidation) are decreased and cytoprotective anti-oxidant markers are preserved in moderate DR-fed rats. But moderate DR does not delay reproductive senescence in female rats. Only marked DR delays reproductive senescence compared to AL and moderate DR-fed female rats. These and other data indicate that moderate DR is the most appropriate method of dietary control for the rodent bioassay when used to assess pharmaceuticals for human safety and compounds for risk assessment.
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PMID:The effects of diet, ad libitum overfeeding, and moderate dietary restriction on the rodent bioassay: the uncontrolled variable in safety assessment. 899 7

The conditions under which laboratory animals are maintained can powerfully influence the results of toxicological studies utilized for risk assessment. Nutrition is of importance in toxicological bioassays and research, because diet composition and the conditions under which it is fed can affect the metabolism and activity of xenobiotic test substances and alter the results and reproducibility of long-term studies. It is known that ad libitum (AL) overfed sedentary laboratory rodents suffer from an early onset of degenerative disease and diet-related tumors that lead to poor survival in chronic bioassays. AL-fed animals are not well-controlled subjects for any experimental studies. Examination of study-to-study variability in food consumption, body weight, and survival in carcinogenicity studies for the same strain or stock of rodents shows tremendous laboratory-to-laboratory variability. However, a significant correlation between average food (calorie) consumption, adult body weight, and survival has been clearly established. The use of moderate dietary restriction (DR) results in a better controlled rodent model with a lower incidence or delayed onset of spontaneous diseases and tumors. Operationally simple, moderate DR significantly improves survival, controls adult body weight and obesity, reduces age-related renal, endocrine, and cardiac diseases, increases exposure time, and increases the statistical sensitivity of these expensive, chronic bioassays to detect a true treatment effect. A moderate DR regimen of 70-75% of the maximum unrestricted AL food intake is recommended as a nutritionally intelligent, well-established method in conducting well-controlled toxicology and carcinogenicity studies.
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PMID:Need for dietary control by caloric restriction in rodent toxicology and carcinogenicity studies. 965 May 34

The rapid shift in the stage of nutrition towards a pattern of degenerative disease is accelerating in the developing world. Data from China, as shown by the China Health and Nutrition Survey, between 1989 and 1993, are illustrative of these shifts. For example, an increase from 22.8 to 66.6% in the proportion of adults consuming a higher-fat diet, rapid shifts in the structure of diet as income changes, and important price relationships are examples that are presented. There appears to reflect a basic shift in eating preferences, induced mainly by shifts in income, prices and food availability, but also by the modern food industry and the mass media. Furthermore, the remarkable shift in the occupations structure in lower-income countries from agricultural labour towards employment in manufacturing and services implies a reduction in energy expenditure. One consequence of the nutrition transition has been a decline in undernutrition accompanied by a rapid increase in obesity. There are marked differences between urban and rural eating patterns, particularly regarding the consumption of food prepared away from home. Other issues considered are the fetal origins hypothesis, whereby the metabolic efficiencies that served well in conditions of fetal undernutrition become maladaptive with overnutrition, leading to the development of abnormal lipid profiles, altered glucose and insulin metabolism and obesity. Furthermore, obesity and activity are closely linked with adult-onset diabetes. The shift towards a diet higher in fat and meat and lower in carbohydrates and fibre, together with the shift towards less onerous physical activity, carries unwanted nutritional and health effects. It is also clear that the causes of obesity must be viewed as environmental rather than personal or genetic.
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PMID:Nutrition in transition: the changing global nutrition challenge. 1170 76

Obesity, cardiovascular disease, and type 2 diabetes mellitus are now prevalent among adults living in developing countries; these chronic diseases affect socioeconomically disadvantaged adults living in impoverished families with undernourished children. This review summarizes data from Brazil--a developing country undergoing the nutrition transition--suggesting an association between childhood undernutrition and obesity and chronic degenerative disease. Potential mechanisms for the association include long-term effects of childhood undernutrition on energy expenditure, fat oxidation, regulation of food intake, susceptibility to the effects of high-fat diets, and altered insulin sensitivity. The combination of childhood undernutrition and adult chronic degenerative disease results in enormous social and economic burdens for developing countries. Further research is urgently needed to examine the effect of childhood undernutrition on risk of obesity and chronic degenerative diseases; one goal of such research would be to determine and provide low-cost methods for prevention and treatment.
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PMID:The link between childhood undernutrition and risk of chronic diseases in adulthood: a case study of Brazil. 1282 5

Our advances in knowledge of the epidemiology of cancer and of the nutritional and genetic effects on this disease have not yet been translated into successful treatment. This is due in part to our tendency toward reductionist thinking, dating to the days when one drug killed one bug. We could learn something by trying to reconcile the differences. Cancer is a degenerative disease that develops over a long time and goes through many stages. Perhaps different nutritional approaches are needed at each stage. The same dietary treatment may not exert the same effects during all stages of tumor development. Obesity is one risk factor that is generally agreed upon. Energy (caloric) restriction has been shown to inhibit experimental carcinogenesis, and energy expenditure affects human carcinogenesis. It would be interesting to combine energy restriction with nutritional treatment. One neglected area of inquiry is that of interactions among nutrients. Substitution of nutrient A for nutrient B can precipitate a series of interactions between nutrient B and the rest of the diet. If more experimental work were done with spontaneous tumors, it would eliminate possible effects of carcinogen metabolism in carcinogenesis and might provide a more accurate reflection of human carcinogenesis. Focusing on one specific dietary component or class of components belies the complexity of the problem.
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PMID:Diet and cancer: what's next? 1460 21

Osteoarthritis (OA) is a common degenerative disease of joints. The major clinical features are pain and stiffness, leading to a decline in physical function, which may ultimately require joint replacement surgery. As no cure exists, current medical intervention focuses on symptomatic relief. Moreover, as no cure is imminent, preventable risk factors for the onset and progression of the disease are of great interest. Obesity is the main preventable risk factor that has been identified. Given that obesity is modifiable by conservative treatment such as weight loss, its potential importance in reducing the incidence of OA cannot be underestimated.
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PMID:Obesity: a preventable risk factor for large joint osteoarthritis which may act through biomechanical factors. 1561 30


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