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Age-related cataract is a condition characterized by multiple mechanisms and multiple risk factors. The mechanisms that bring about a loss in transparency include oxidation, osmotic stress, and chemical adduct formation. Risk factors for cataract include diabetes, radiation (ultraviolet B, x-ray), certain pharmaceutical substances, certain nutritional states, and possibly acute episodes of dehydration. Interaction occurs between and among mechanistic factors and risk factors. Thus nutrition must be considered as one part of a tapestry of intertwined events and responses. Certain experimental models for nutritional cataract have been useful for study of the cataractogenic process but are probably not important factors in the human disease. Little current evidence supports significant roles in human senile cataract for imbalances of tryptophan or other amino acids, deficiencies of calcium or selenium, or excessive intake of selenium. Overconsumption of galactose is likely to be hazardous only in subjects with genetic inability to metabolize this sugar. Vitamins with antioxidant potential (riboflavin, vitamin E, vitamin C, carotenoids) deserve further research scrutiny to ascertain their significance in cataract etiology. Excessive caloric intake needs to receive added emphasis as a factor contributing to cataract. Diabetes increases the likelihood of cataract three- to four-fold. Obesity, defined as more than 20% overweight, is considered a major risk factor for non-insulin-dependent, or type II, diabetes (69, 73). Weight control can be recommended as a prudent, safe, economic, and effective means of lowering risk probability for diabetes and the associated complication of cataract.
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PMID:Nutritional factors in cataract. 220 Apr 64

The effect of orlistat, a nonabsorbed inhibitor of gastric and pancreatic lipases, was examined in patients with primary hyperlipidaemia (serum cholesterol > or = 6.2 mmol.l-1 and triglycerides < or = 5.0 mmol.l-1) not responsive to dietary change alone. In a multicentre, randomised, double-blind study, 103 men and 70 women received 30, 90, 180, or 360 mg or orlistat or placebo for 8 weeks. Total and low-density lipoprotein cholesterol levels were reduced by 4% and 5% with 30 mg orlistat, by 7% and 8% with 90 mg orlistat, by 7% and 7% with 180 mg orlistat and by 11% and 10% with 360 mg orlistat compared to placebo. High density lipoprotein cholesterol levels significantly decreased in the 360 mg orlistat group. Triglyceride levels significantly increased in the placebo group but not in the drug groups. Body weight decreased by 1.2 kg with 360 mg orlistat, despite a weight maintenance diet. Decreases in vitamin E and D levels occurred, although both vitamins remained within the normal range. Adverse effects from the gastrointestinal tract were frequent, but led to discontinuation of therapy in only seven patients. Orlistat is a new therapeutic drug for the treatment of hyperlipidaemia that may be particularly useful among overweight patients. Its potential place in therapy will await long-term studies. Vitamin supplementation should be considered during treatment.
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PMID:The effect of the gastrointestinal lipase inhibitor, orlistat, on serum lipids and lipoproteins in patients with primary hyperlipidaemia. 795 33

A study was made of the dietary habits and intake of energy and nutrients of 127 elderly people aged between 65 and 95 (60 men and 67 women). The method employed involved the recording of food consumption over a period of five days. Subjects were divided into two groups according to body mass index: those who were overweight or obese (0) (BMI > or = 25 Kg/m2), who made up 60% of the experimental population, and those with normal bodyweight (NW) (BMI < 25 Kg/m2) (40%). The percentage of subjects who took no breakfast was somewhat higher amongst members of group 0 (5.6% compared to 3.9% of NW subjects). Further, the breakfast of 0 subjects was less varied, smaller and contributed less to daily energy intake and the covering of theoretical energy expenditure than did the breakfasts of NW subjects. 0 subjects also took less time over their breakfasts. More than half (58.8%) of NW subjects took what might be considered a satisfactory breakfast, i.e. this meal provided more than 20% of the total energy intake. Only 29.6% of 0 subjects took breakfasts of similar energetic value. NW subjects consumed greater quantities of sugars and fruits at breakfasts and also more carbohydrates, fibre, vitamin E and iron than did 0 subjects. The shorter length of time spent at breakfast by 0 subjects, their consumption of smaller and less varied breakfasts and the composition of the same, could indicate the existence of less healthy breakfast habits amongst the overweight and obese. This could be the reflection of inadequate food habits all round, or be a conditioning factor prompting 0 subjects to make poorer food choices for the rest of the day. Though some people omit breakfast in an attempt to control their weight, this is probably an inadvisable practice. The control of bodyweight might be more efficiently accomplished by taking an adequate breakfast and better distributing total calorie intake across the day, avoiding its concentration into one or two meals.
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PMID:[Food, energy and nutrient intake at breakfast in a group of elderly persons. Most common problems and differences related to body mass index]. 942 6

Dietary antioxidant vitamins and retinol have been proposed to be protective against breast cancer on the basis of their ability to reduce oxidative DNA damage and their role in cell differentiation. Epidemiologic studies have not been convincing in supporting this hypothesis, but women with high exposure to free radicals and oxidative processes have not been specifically considered. We explored these issues in the Swedish Mammography Screening Cohort, a large population-based prospective cohort study in Sweden that comprised 59,036 women, 40-76 years of age, who were free of cancer at baseline and who had answered a validated 67-item food frequency questionnaire. During 508,267 person-years of follow-up, 1,271 cases of invasive breast cancer were diagnosed. Cox proportional hazards models were used to obtain hazard ratios (HRs) and 95% confidence intervals (CIs). There was no overall association between intake of ascorbic acid, beta-carotene, retinol or vitamin E and breast cancer incidence. High intake of ascorbic acid was inversely related to breast cancer incidence among overweight women (HR=0.61; 95% CI 0.45-0.82, for highest quintile of intake among women with body mass index>25 kg/m(2)) and women with high consumption of linoleic acid (HR=0.72; 95% CI 0.52-1.02, for highest quintile of ascorbic acid intake and average consumption of more than 6 grams of linoleic acid per day). Among women with a body mass index of 25 or below, the hazard ratio for breast cancer incidence was 1.27 (95% CI 0.99-1.63), comparing the highest to the lowest quintile of ascorbic acid intake. Consumption of foods high in ascorbic acid may convey protection from breast cancer among women who are overweight and/or have a high intake of linoleic acid.
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PMID:Dietary antioxidant vitamins, retinol, and breast cancer incidence in a cohort of Swedish women. 1125 82

The dietary patterns of indigenous Fijians are changing rapidly. Dietary relationships in regard to the prevalence of diabetes are poorly studied in Fiji. A survey was conducted to show the relationship of dietary patterns and other lifestyle factors for the development of diabetes among urban indigenous women in Fiji. A sample of 200 Fijian women aged 30-39 who agreed to participate were interviewed by the use of semiquantitative food frequency, 3 day-24 h recall study. Physical activity and ceremonial dietary customs were also taken into consideration. Anthropometry included measurements of height, weight, waist and hip. Total percentage bodyfat measurements and glycosuria tests were also conducted. The results showed high rates of obesity manifested in high percentage bodyfat, high body mass index (BMI) and high waist and hip ratio (WHR). The mean 24 h dietary intake exhibited a moderate intake of protein, high intake of fat and a low intake of carbohydrate. The carbohydrate reduction was a result from the decline in consumption of traditional staples. Consumption of cereals and related products favored the high intake of butter and margarine and also encouraged the use of cooking oil in frying varieties of flour products. The daily intake of anti-oxidant vitamins of beta-carotene and vitamin E were low, however there was a high intake of vitamin C. The food frequency study revealed cassava, bread and sugar were consumed daily as the main carbohydrate foods. Fish and meat were the most frequently consumed protein foods. The main beverage was sweet tea with whole-cream milk. Butter, margarine, coconut cream, cheap lamb flaps and cooking oil provided the main sources of fat. Levels of physical activity included high sedentary lifestyles with a high rate of subjects being overweight and obese. Ceremonial dietary customs showed a high consumption of meat and fish. Fruits were rarely consumed. Glycosuria existed among the age group under study. The impact of dietary transition, coupled with dietary excesses and physical inactivity, seem to be potential risk factors of diabetes among the indigenous women in the urban area.
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PMID:Dietary patterns and risk factors of diabetes mellitus among urban indigenous women in Fiji. 1170 6

Aggressive treatment of atherosclerotic risk factors can substantially reduce stroke risk in patients with a history of stroke or transient ischemic attack. Data from several recent large clinical trials provide convincing evidence of benefit for a number of specific therapies directed at this population. The authors recommend treatment with ramipril alone or perindopril plus indapamide regardless of blood pressure, provided there is no contraindication. For patients already taking a different angiotensin- converting enzyme (ACE) inhibitor, the authors do not routinely switch agents. The authors recommend use of simvastatin 40 mg per day in patients with a total cholesterol level of 135 mg/dL or greater, provided no contraindication exists. The authors also recommend consideration of gemfibrozil in patients with isolated low high- density lipoprotein levels. In patients with diabetes mellitus, tight glycemic control has not been shown to reduce macrovascular complications such as stroke, but does reduce microvascular complications. However, diabetics should receive especially aggressive treatment of other vascular risk factors. There is no role for post-menopausal hormone replacement therapy in prevention of stroke. Weight loss for overweight patients, regular exercise, and a diet rich in fruits, vegetables, cereals, and fish, as well as low in fat and cholesterol, should be a standard recommendation for this group of patients. Treatment with folic acid, B(6), and B(12) for patients with elevated homocysteine appears rational, though this is unproven. However, there is no benefit to vitamin E, vitamin C, or beta-carotene supplementation. Smokers should stop. For every 43 smokers who quit, one stroke is prevented. Moderate consumption of alcohol (one to two drinks a day) may be beneficial, but heavy alcohol use (more than five drinks a day) increases stroke risk.
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PMID:Atherosclerotic Risk Factors in Patients with Ischemic Cerebrovascular Disease. 1235 71

There are no recent assessments of nutritional intake in alcohol misusers in the United Kingdom. The purpose of this study was to measure nutritional intake in alcoholics attending an Alcohol Misuse outpatient clinic in an inner city general hospital in the United Kingdom and relating this to various measures of alcohol dependence. All patients (n = 30; 27 male, 3 female) consumed at least 100 g ethanol per day (mean 162 g/day) for at least 5 years and completed questionnaires on socio-demographics, alcohol dependency and psychosocial problems and had assays of biochemical and haematological indices. The data were analysed first with respect to the entire patient population and then according to the degree of alcohol dependency (mild, moderate or severe). The results showed that with respect to the entire patient group, one-third were below normal body weights, but one-quarter was overweight. The total energy intake (kJ/day) including alcohol was apparently adequate with respect to recommended levels in most patients. On average, approx. 60% of energy intake came from alcohol. The whole patient population had a low intake of one or more macro- and micro-nutrient compared to the dietary reference requirements. All patients had intakes of vitamin E and folate below UK recommended standards, while 85 - 95% of patients had low intakes of selenium and Vitamin D. Between 50 and 85% of all patents had intakes below UK recommended standards in calcium and zinc and Vitamins A, B(1), B(2), B(6) and C. There were significant correlations between calorie intake (when alcohol was excluded) and vitamins B(1), B(2), B(6) and C, and Ca, Mg, Fe and Zn intake. There were no correlations between alcohol intake with any of the nutritional and anthropometric variables or between the three subgroups with respect to daily energy, micro- and macro-nutrient intakes. In conclusion, malnutrition was common in this patient group: all subjects had intakes below UK recommended standards in one or more micro- or macro-nutrient. However, there was no difference in the degree of malnutrition between the harmful drinkers (mild dependency) and heavily dependent subgroups.
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PMID:Nutritional intake of hazardous drinkers and dependent alcoholics in the UK. 1285 Jul 79

Kidney cancer incidence rates in the United States have been increasing and are not fully accounted for by better diagnostic techniques. Risk factors in women are incompletely described. A total of 34,637 Iowan women initially free of cancer completed a mailed questionnaire in 1986. Kidney cancer incidence was identified over 15 years of follow-up (n = 124) through linkage to a statewide cancer registry. Adjusted for age and other risk factors, kidney cancer was associated positively with maximum adult weight (p for trend = 0.02) and current waist-to-hip ratio (p for trend = 0.002). Compared to nondrinkers, consumers of alcohol of 3.0 or more grams per day had a relative risk (RR) of 0.52 (95% CI = 0.29-0.92). Total vitamin C intake was associated positively with risk of kidney cancer (p for trend = 0.04), whereas total vitamin E intake was associated negatively with risk (p for trend = 0.002). The few women who used copper supplements had a 6.52-fold increase in risk of kidney cancer (95% CI = 1.95-21.8). Compared to never users, women who were former users of estrogen had an increased risk of kidney cancer (RR = 1.62; 95% CI = 1.11-2.36), but current users of estrogen were not at a higher risk. Women who were nulliparous or had more than 2 live births were also at increased risk of kidney cancer compared with women who had 1 or 2 live births. In conclusion, in these postmenopausal women, overweight, particularly central adiposity, was an important risk factor for kidney cancer. Potential risk factors that warrant further exploration were low intake of alcohol and vitamin E, higher intake of vitamin C, nulli- or multiparity and use of copper supplements.
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PMID:Evaluation of dietary, medical and lifestyle risk factors for incident kidney cancer in postmenopausal women. 1461 25

The purpose of the study was a more thorough assessment of the nutrition state of patients admitted to hospitals in Poland. The study was carried out in four hospitals at teaching centre level, in four hospitals at province level, and in four county hospitals. The patients for the study were selected randomly from 3310 adult patients (every 10th patient admitted to these hospitals). For the study 210 patients (122 women and 88 men) were qualified. Their mean age was 54 +/- 16 years (range 15-82 years). The patients were subjected to various biochemical tests including determination of antioxidant vitamins (vitamins A, E and C), vitamin B12, folic acid, ferritin, and homocysteine and blood lipids. Vitamin deficiency accepted as vitamin malnutrition was found in the case of vitamin C in 51.8% of the patients, folic acid in 32%, vitamin E in 10%, vitamin B12 in 6.8%, vitamin A in 1.4%. Vitamin deficiency was equally frequent in patients with malnutrition, overweight or with obesity. Lipid profile disturbances were found in 51% and high homocysteine level in 63% of the studied patients.
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PMID:[Nutritional status of patients in hospitals in Poland. More thorough assessment of nutritional status of adult patients]. 1464 80

Obesity has emerged as a significant new health problem in the pediatric population. Non-alcoholic steatohepatitis (NASH) is an entity in the spectrum of non-alcoholic fatty liver disease (NAFLD) ranges from fat in the liver -- simple steatosis, NASH/ steatohepatitis -- fat with inflammation and/or fibrosis to advanced fibrosis and cirrhosis when fat may no longer be present. NASH is associated with obesity, diabetes, insulin resistance (IR), and hypertriglyceridemia. While majority of individuals with risk factors like obesity and IR have steatosis only a minority develop steatohepatitis, possible mechanisms have been discussed. Clinical experience with pediatric NASH is limited. Children generally present in the prepubertal age group, have a male predominance with a higher incidence in children of Hispanic origin. Body mass index (BMI) of 25-29.9 is considered to be overweight and that > or =30 obese. Acanthosis nigricans as a marker of IR should be looked for. As NASH is a diagnosis of exclusion, other causes of chronic liver disease must be excluded. Increased echogenicity in the liver is noted on ultrasound. Liver biopsy is considered the gold standard in establishing the diagnosis. Histopathological lesions thought to be necessary for diagnosis of NASH include steatosis (macrovesicular > microvesicular), mixed mild lobular inflammation and hepatocyte ballooning. A system of grading depending on degree of steatosis and/or inflammation and staging depending on the extent of fibrosis has also been proposed. Although there is no consensus for the treatment for NASH, effort needs to be made to prevent development of fibrosis, which results in cirrhosis and portal hypertension. Slow, consistent weight loss has been shown to be effective in childhood NAFLD, based on improvement of serum aminotransferases or liver sonogram. A low glycemic index diet has been shown to be more effective than a low fat diet in lowering BMI. Family based behavioral intervention may also enhance success with diet. Several pharmacological agents have been used including ursodeoxycholic acid, vitamin E, betaine, n-acetyl cysteine, and insulin sensitizing agents like metformin, rosiglitazone, and pioglitazone. Transplantation for overt NASH is rare, accounting for < 1% of liver transplantations in the USA. The disease can recur after liver transplantation. A strong association exists between the presence of steatosis in a donor liver and poor graft function. As a result, cadaveric donor livers with macrovesicular steatosis >40% are not used routinely. Prognosis in NASH is dependent not only on severity and number of risk factors but also on the degree of histological damage. Clinical trials are needed to identify an effective treatment that halts the progression of NAFLD to NASH in both pretransplantation and post-transplantation patients.
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PMID:Non-alcoholic steatohepatitis in children. 1559 36


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