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Predictors of distal and proximal forearm bone density, measured by photon absorbtiometry, were investigated in 248 premenopausal women aged 39-56 years. Only one strong predictor of lower bone density was found--history of previous fracture at any site (P less than 0.001). Two other factors showed a weaker association with density, but only at the distal site--history of diuretic use showed a positive association (P less than 0.02) whereas alkaline phosphatase level was inversely correlated with density (P less than 0.01). Other factors were not significant predictors: these included age, calcium intake, level of exercise, anthropometric measures of obesity, serum calcium level, parity, lactation history, a menopausal symptom history, use of the contraceptive pill, smoking and alcohol intake. These results contrast with the far stronger predictors found for postmenopausal women and suggest that genetic endowment rather than lifestyle may be the major determinant of bone density before the menopause.
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PMID:Determinants of forearm bone density in premenopausal women: a study in one general practice. 187 69

Hypertension has been related to both obesity and a high salt intake. Evidence for the associations of blood pressure with body weight and dietary salt intake is summarized. In both adolescents and adults correlations between blood pressure and weight are highly significant, and in longitudinal studies change in blood pressure over time is correlated with change in weight. Correlations between salt intake and blood pressure are less striking, and the results of trials of modest salt restriction demonstrate a small but significant effect on blood pressure. Individuals vary in their susceptibility to salt, and hypertensive individuals are more responsive than normotensive individuals. Dietary deficiencies of potassium and calcium may amplify the effect of a high salt intake on blood pressure. Animal models provide compelling evidence for a genetic component to salt sensitivity of blood pressure. In two hypertension prevention trials, change in blood pressure was more convincingly related to change in weight than to change in dietary salt. Avoidance of obesity, or weight reduction in overweight individuals, should be key strategies for hypertension prevention. Avoidance of salt excess is also appropriate, although currently available trial data do not justify a recommendation of rigorous salt restriction for the entire population.
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PMID:Nutrition and hypertension prevention. 188 52

This paper attempts to define the theory and practice of a modern approach to the initial workup of the patient with hypertension. The process includes a complete general medical evaluation along with special measures to enable the fullest characterization and clinical differentiation of the disease. The initial workup aims to (a) establish that the hypertension is sustained and should be treated; (b) identify all definable and curable causes for the hypertension; (c) identify the presence and degree of attendant risk factors such as smoking, alcohol use, obesity, diabetes, and abnormal lipid metabolism; (d) characterize the hypertension in terms of its pathophysiology; and (e) assess the presence and degree of target organ damage to the heart, brain, and kidneys. Because all diastolic hypertension is due to arteriolar vasoconstriction, a fundamental strategy of this process is to distinguish between renin-mediated and sodium-related vasoconstrictive forces and to evaluate which is preponderant. The chief instruments of this strategy are the renin-sodium profile and the response of plasma renin activity and blood pressure to specific antirenin system drugs. The captopril test, an important protocol in making this distinction, is primarily a powerful screening tool for confirming the possible presence or absence of curable renovascular disease or curable primary aldosteronism. That renin profiling cannot accurately discriminate between the contributions of either the renin or sodium-volume factors in that large fraction of medium-renin patients is not a viable reason for not performing the test. The test has its greatest strength for identifying sizable numbers of otherwise unrecognizable patients with very high or very low renin concentrations who might have curable disorders and who likely reflect different pathophysiologic vasoconstrictive mechanisms for which entirely different drug therapies are appropriate. However, the baseline renin test is also useful for assessing prognosis and the likelihood of a heart attack and it is valuable for deciding whether to use an anti-renin system drug (for medium and high renin concentrations) as opposed to natriuretic agents (low-renin patients) such as a diuretic or calcium antagonists as the primary step. In our present state of knowledge, the basic diagnostic biochemical workup includes the renin-sodium profile and the 24-h urinary sodium, potassium, and microalbumin excretion rates. This package is further enriched by baseline electrocardiography and echocardiography and the evaluation of glucose and lipid patterns.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Clinical evaluation and differential diagnosis of the individual hypertensive patient. 191 3

Psittacines are often classified as seed eaters despite studies that have established great diversity in food habits in the wild. While seeds are consumed, so are flowers, buds, leaves, fruits and cambium. Some psittacines consume part of greater than 80 species of grasses, forbs, shrubs and trees. In addition, insects may be important. Although there are few controlled studies of the requirements of psittacines, it is probable that most nutrient needs are comparable to those of domesticated precocial birds that have been thoroughly studied. Commercial seed mixes for psittacines commonly contain corn, sunflower, safflower, pumpkin and squash seeds, wheat, peanuts, millet, oat groats and buckwheat, although other seeds may be present. Because hulls/shells comprise 18-69% of these seeds and they are removed before swallowing, a significant proportion of typical seed mixtures is waste. Some of the seeds also are very high in fat and promote obesity. Common nutrient deficiencies of decorticated seeds include lysine, calcium, available phosphorus, sodium, manganese, zinc, iron, iodine, selenium, vitamins A, D, E and K, riboflavin, pantothenic acid, available niacin, vitamin B-12 and choline. Attempts to correct these deficiencies by incorporating pellets into seed mixes are usually thwarted by rejection of the pellets and disproportionate consumption of items that are more highly favored. An extruded diet formulated to meet the projected nutrient needs of psittacines was fed with fruits and vegetables to eight species of psittacines for 1 y. Fledging percentage was increased to 90% from the 66% observed during the previous 2 y when these psittacines were fed seeds, fruits and vegetables. Although this extruded diet was well accepted in a mixture of fruits and vegetables and met nutrient needs, analyses have shown that not all commercial formulated diets are of equal merit.
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PMID:Formulated diets versus seed mixtures for psittacines. 194 Dec 26

Renal osteodystrophy in hemodialyzed patients with DM-HD shows different features from that in non-DM,HD. Two studies were done. One was a comparison of BMD in 30 non-DM,HD patients and 30 DM-HD patients. The second was a comparison of possible factors affecting calcium metabolism in the higher and lower BMD groups (n = 20/21) in the DM-HD patients. BMD was measured by dual-energy X-ray absorptiometry (DEXA; Hologic QDR 1,000/W) in the third lumbar vertebra (L3), head, pelvis, and whole body. The BMDs of the DM-HD group were lower in these areas and whole body than that in the non-DM,HD group. A significant difference was found in the head BMD (p less than 0.05). In the second study, factors which may contribute to the differences in BMD were compared in the DM-HD patients divided into higher and lower BMD of the head. The group with higher head BMD had a value 110% of the mean value or more. Clinical and biochemical test results (age, the time since the first dialysis, body weight, the degree of obesity, height, serum calcium, serum phosphate, serum aluminum, serum c-PTH level and the dose of 1 alpha-OH-D3) were compared. The degree of obesity of the patients with higher BMD was significantly larger than that with lower BMD (p less than 0.005).
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PMID:Decreased bone mineral density in diabetic patients on hemodialysis. 195 51

Isolated systolic hypertension (ISH) is a common disorder in the elderly, carrying with it a high risk of cardiovascular morbidity and mortality. Environmental and age-related factors believed to contribute to ISH include obesity, declining physical activity, stress, and such dietary changes as increased salt intake and decreased intake of calcium and potassium. Increased rigidity of the aorta resulting in reduced compliance is an important hemodynamic feature, but factors that increase peripheral resistance also appear to play a role. Antihypertensive drugs have been shown to effectively and safely lower the systolic blood pressure elevations characteristic of ISH. To date, use of low drug doses and careful titration of dosage have avoided significant orthostatic hypotension and undue lowering of the diastolic pressure. Studies of relatively small groups of patients suggest that antihypertensive drugs can lower the risk of cardiovascular morbidity/mortality associated with ISH but the definitive answer awaits results of the ongoing large-scale Systolic Hypertension in the Elderly Program trial. In the interim, management should begin with conservative measures such as weight loss, salt restriction and, possibly, calcium supplementation. If this fails, drug therapy should be considered in patients with systolic blood pressures above 180 mm Hg and in those with systolic readings between 160 and 180 mm Hg who have concomitant cardiovascular risk factors. To date, no controlled trials of sufficient size have demonstrated that one drug class is more effective than another in treating ISH. Drug therapy should be tailored to the individual patient, starting with a low dose of a single drug and, if necessary, slowly increasing dosage until a systolic blood pressure under 160 mm Hg is attained.
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PMID:Epidemiology, pathophysiology, and management of isolated systolic hypertension in the elderly. 201 51

To investigate the cellular basis linking hypertension, non-insulin-dependent diabetes mellitus (NIDDM), and obesity, we used 31P and 19F nuclear magnetic resonance spectroscopy to measure intracellular pH (pHi), free magnesium (Mgi), and cytosolic free calcium (Cai) in erythrocytes of obese and NIDDM subjects with and without hypertension. Compared with normotensive, nondiabetic controls (Cai, 25.2 +/- 1.4 nM; Mgi, 232 +/- 8 microM), Cai was elevated in both normotensive (36.8 +/- 2.7 nM, sig = 0.005) and hypertensive (43.4 +/- 2.9 nM, sig = 0.001) NIDDM subjects, and Mgi was concomitantly suppressed (normotensive: 206 +/- 11 microM, sig = 0.05; hypertensive: 196 +/- 8 microM, sig = 0.001). Similar but less striking changes were noted in obese subjects. Values of pHi were significantly lower (sig = 0.05) in all hypertensive groups compared with their normotensive controls. Continuous relations were observed for all subjects between Cai and diastolic blood pressure (r = 0.649, p less than 0.001) and body mass index (r = 0.565, p less than 0.001), between Mgi and diastolic blood pressure (r = -0.563, p less than 0.001) and fasting blood glucose (r = -0.580, p less than 0.001), and in diabetics, between pHi and diastolic blood pressure (r = -0.680, p less than 0.001). Thus, the constellation of elevated Cai and suppressed Mgi and pHi levels is characteristic of the hypertensive state. These abnormalities of cellular ion handling in whole or in part common to hypertension, diabetes, and obesity may contribute to the pathophysiology of these syndromes and may help to explain their frequent clinical coexistence.
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PMID:Cellular ions in hypertension, diabetes, and obesity. A nuclear magnetic resonance spectroscopic study. 204 75

Diabetes mellitus and hypertension constitute two powerful independent risk factors for cardiovascular, renal and atherosclerotic disease. The frequent occurrence of the two diseases in the same individual doubles the risk of cardiovascular death, as well as substantially increasing the frequency of transient ischemic attacks, strokes, peripheral vascular disease with lower extremity amputations, as well as end-stage renal disease and blindness. Although hypertension usually occurs in IDDM in association with renal disease, in NIDDM the evolution of hypertension appears to be multifactorial and independent of renal disease. Obesity appears to be dissociable from hypertension and NIDDM with a common link between obesity, hypertension and NIDDM appearing to be hyperinsulinism and insulin resistance. It has been suggested that hyperinsulinism and insulin resistance may lead to hypertension through altered intracellular calcium metabolism, enhanced renal sodium reabsorption, or through an effect of insulin upon lipid and/or catecholamine metabolism. Further, insulin itself may have a direct effect upon the atherosclerotic process in the hypertensive diabetic patient. These considerations have been taken into account in the structuring of antihypertensive therapy in Type I and Type II Diabetes Mellitus.
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PMID:Diabetes and hypertension. 207 56

Serum osteocalcin and alkaline phosphatase levels, as indexes of bone formation, and urinary calcium and hydroxyproline excretions relative to creatinine, as indexes of bone resorption, were measured in 10 obese women before and after two months of hypocaloric diet. In basal condition, serum osteocalcin, but not alkaline phosphatase levels, were higher in obese than in controls (7 +/- 0.4 vs 5.3 +/- 0.2 ng/ml). Urinary calcium/creatinine and hydroxyproline/creatinine ratios were also significantly higher than those in normals (0.37 +/- 0.05 vs 0.2 +/- 0.01 and 0.035 +/- 0.004 vs 0.02 +/- 0.002, respectively). After weight loss, serum osteocalcin significantly increased (9.5 +/- 0.5 ng/ml), while urinary calcium/creatinine and hydroxyproline/creatinine ratios fell to the normal values (0.23 +/- 0.03 and 0.026 +/- 0.001). In conclusion, it appears that obesity, at least in young women, is associated with a high bone turnover, which seems to be reversible with weight loss.
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PMID:[Assessment of bone resorption/neoformation indexes in obese women before and after weight loss]. 209 52

Bearing in mind the reports which clearly document the constant dissociation between daily calorie intake from diet, obesity and the positive effects of the mechanical load on bone trophism, the possible correlation between total daily calorie intake of some nutrients (Ca, P and vitamin D) on the one hand, and bone mineral density (BMD) on the other was evaluated in 61 obese women. The results appear to indicate that the higher BMD in obese compared to normal weight subjects may largely depend on the presence of notoriously high estrogen levels which allow a better efficacy and use of dietary calcium.
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PMID:[Caloric intake and bone mineral content in obese and normal weight subjects]. 210 34


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