The purpose of this study was to begin to fill the void regarding nutriologic status in patients with Congestive Heart Failure (CHF) and or Chronic Obstructive Pulmonary Disease (COPD) receiving palliative care, and to bring the quality of palliative care to a more appropriate level as related to nutritional injury. Objectives: The objectives were: 1) to determine the prevalence of patients with a stage of nutritional injury at or above the clinical horizon; 2) to determine the response, specifically changes in biochemical parameters and physical manifestations of nutrient based lesions, after micronutrient intervention; 3) to determine if there is a relationship between micronutrient intervention and macronutrient intake; 4) to determine if there is a positive relationship between micronutrient intervention and stage of nutritional injury regardless of the percent of estimated non-protein calorie and protein needs consumed and 5) to ascertain what characteristics identify patients without resiliency / response to treatment. Design: The design was a prospective theory-based effectiveness trial exploring nutriologic status and response to micronutrient intervention utilizing a quasi-experimental design. Twenty-six Veterans with CHF / COPD admitted to the Nursing Home Care Unit for palliative care or designated as Advanced Disease were enrolled; nineteen completed the study. Subjects were recruited consecutively and comparisons were made between baseline and post-treatment values. Methods: A Minimum Data Set structured nine-step nutritional care process including evidence, diagnoses, etiologies, goals / predicted outcomes, interventions and actual outcomes was utilized. Results: All subjects presented at or above the clinical horizon of nutritional injury at baseline representing acquired nutritional loss; 84% had lesions suggestive of nutrient imbalance. Prevalence of pyridoxine, thiamin and zinc deficits were 63%, 11% and 21% respectively. Pyridoxine status following treatment improved significantly, p = .000. Fifty-three percent of subjects had improved outcomes indicating nutritional resiliency, and change within stage of injury. Factors observed in suboptimal nutritional resiliency included drug-nutrient interactions and acute infection. Conclusions: The nutritional cost from lack of responsible nutrition therapy is likely to be significant in veterans with CHF/COPD receiving palliative care. Drug-nutrient interactions and acute infections are most likely the offending factors interacting with the resiliency state.

The prevalence of type 2 diabetes among Native American populations is escalating, particularly in children and adolescents. Dietary factors appear to influence the development of diabetes, and therefore, are modifiable risk factors for primary prevention. Studies evaluating the dietary habits of Native American adolescents are sparse. Furthermore, studies examining the relationship between insulin and dietary factors have been limited to adult populations. The objective of this study was to describe dietary intake and food consumption patterns and examine dietary factors associated with fasting and 30-minute postprandial insulin levels among adolescents from the Zuni Pueblo, New Mexico. Dietary intake and plasma insulin concentration data were collected from Zuni male and female adolescents, 15--20 years of age, participating in the Zuni Diabetes Prevention Project (ZDPP). The ZDPP, a 4-year, cross-sectional, school-based intervention study was designed to reduced risk factors of type 2 diabetes among Zuni adolescents. Using 24-hr dietary recalls to estimate dietary intake, dietary data was collected during 1993-1994 (baseline) and spring of 1997 (3 years of intervention exposure). Modified glucose tolerance tests were conducted to measure plasma insulin concentrations. Baseline dietary data was adjusted to remove day-to-day variation and compared to national dietary guidelines. Logistic regression was conducted to examine associations between nutrient intake and insulin concentrations. Estimated daily fat intakes of Zuni adolescents exceeded recommendations, whereas, dietary fiber intakes did not achieve guidelines. Less than half of Zuni females met or exceeded dietary recommendations for most micronutrients. Less than 50% of Zuni males consumed recommended levels of vitamin A, folate, vitamin E, calcium, and magnesium. Zuni adolescents reported a diet low in nutrient-dense vegetables, high-fiber grains, and fruits. Sugared-beverages were a significant source of energy and total carbohydrate. Among Zuni males, dietary fat and protein intakes were significantly inversely associated with insulin levels. A negative association between dietary fat and insulin levels was not evident among females. Positive associations were observed for total carbohydrate intake in the unadjusted models. Our results suggest that diets higher in fat or protein compared to high-glycemic carbohydrates may be less deleterious in individuals with minimal hyperinsulinemia.

There is a large decrease in endogenous estrogen production with menopause associated with increases in severity of risk factors for coronary heart disease (CHD), including lower high density lipoprotein cholesterol (HDL-C) concentrations. Exogenous estrogen is administered to decrease the risk of CHD. This project was designed to examine the influence of hormone replacement therapy (HRT), ethnicity, and body composition on cholesterol ester transfer protein (CETP) and lecithin:cholesterol acyltransferase (LCAT) activities, two enzymes involved in HDL metabolism. 205 women participated, 32% of Hispanic origin and 52% not presently undergoing HRT (58% Anglo, 39% Hispanic). CETP and LCAT activities were quantified by a mass transfer method and body composition variables were measured by dual energy x-ray absorptiometry and anthropometry. There were no significant differences in plasma lipids and lipoproteins among HRT groups (non-users, unopposed estrogen, combined therapy). Hispanic women had lower HDL-C concentrations and total plasma cholesterol to HDL-C ratio, and higher triglyceride concentrations and greater susceptibility of low density lipoprotein particles to oxidation. CETP activity was elevated in Hispanic women when compared to Anglo women. The ethnic difference in CETP activity was eliminated once IAAT or measures of trunk fat, but not total body fatness, were controlled. No differences in CETP or LCAT activities were found among HRT groups. Women not undergoing HRT tended to have greater abdominal fat compared to women undergoing either hormone therapy, however differences were not significant. Hispanic women had significantly greater amounts of abdominal fat than did Anglo women, even after adjusting for total body fat. CETP and LCAT activities were positively related to plasma lipids, lipoproteins (exception: negative association with HDL-C), and body composition. Correlations were higher with regional fat measures than with total body fat measures. In conclusion, HRT did not affect CETP or LCAT activities. Results suggest that associations between HRT use and decreased risk of CHD involve other mechanisms. Hispanic women had higher CETP activities and greater distribution of abdominal body fat suggesting that they are at greater risk for CHD compared to Anglo women.

The purpose of this study was to validate the proposed Metaparadigm of Clinical Dietetics. The proposed Metaparadigm of Clinical Dietetics is the most abstract level of the profession's body of knowledge and is a statement of seven domains of concern. The seven domains are Reference Person, Human Condition, Practitioner Actions/Attitudes, Practitioner Environment, Client Actions/Attitudes, Client Environment and Nutraceuticals and are characterized by ninety-four knowledge topics. A further purpose was to determine comparative relevance of these ninety-four knowledge topics to other health professionals and nutritional scientists. A descriptive-correlational-factor-analytical design was used for this study. An expert panel of clinical dietetic practitioners and an extensive literature review were used to develop the mailed survey instrument. A random sample of five hundred clinical dietitians was selected from members of thirteen clinical Dietetic Practice Groups of The American Dietetic Association. One hundred thirty-six surveys were returned for a response rate of twenty-seven percent.

Although cell and animal studies support an association between nonmelanoma skin cancer and dietary fat, few studies have assessed this relationship among humans. This study assessed the relationship among participants in a five-year chemoprevention trial completed at the Arizona Cancer Center. This design allowed efficient investigation into the association of dietary fat with development of skin basal (BCC) and squamous cell carcinoma (SCC) among high risk individuals. Three manuscripts were written to examine the dietary characteristics of the study population, factors associated with basal and squamous cell skin cancer occurrence, and the association of dietary fat and other dietary components with skin cancer incidence. The hypothesis was that dietary fat, and linoleic acid in particular, would increase the risk of SCC occurrence. Using a semi-quantitative food frequency questionnaire, usual dietary intake of the volunteers, aged 51 to 85 years, was generally consistent with intakes reported by other studies. However, more than half of the participants consumed less than the recommended levels of vitamin D, folate, calcium, and dairy and grain foods. Among participants randomly assigned to the control intervention with no prior history of skin cancer, the incidence of BCC and SCC was 3629 and 2671 per 100,000 person-years, respectively. Only age independently predicted BCC incidence, while male gender, naturally red hair color, years of residency in Arizona as an adult, and age predicted SCC incidence. Dietary fat was not associated with the development of BCC among these high risk individuals. Estimated daily intake of total fat and oleic acid were weakly associated with SCC occurrence (p = 0.09 and p = 0.06) and linoleic acid was not associated. Neither total dietary fat nor any specific fatty acid were associated with reduction in time to first occurrence or total number of skin cancers. Dietary vitamin C and vitamin E, antioxidants that could potentially reduce cellular protein damage from the oxidative compounds formed by ultraviolet penetration, were also not associated with BCC or SCC development.

The present study was designed to test the hypotheses that there would be physical, affective, and cognitive function decline from baseline at 3 months and 6 months for the total group and within age groups and that decline would be predicted by nutritional status. Serum concentrations of albumin, cholesterol, hemoglobin, and percent lymphocytes and white blood cells (to calculate total lymphocyte count) were measured; fat reserves and somatic protein were estimated from anthropometry; and physical signs of malnutrition and a composite of nutritional status indicators were assessed. The participants in the 6-month longitudinal study were females and males aged 75-96 years (N = 132). Physical function was measured by the Physical Self Maintenance Tool (PSMT), the Instrumental Activities of Daily Living (IADL) scale, and the Tinetti Balance and Gait Evaluation to assess decline. Affective function was measured by the Geriatric Depression Scale (GDS). Cognitive function was measured by the California Verbal Learning Test (CVLT). Where decline was significant (p ≤ .05), nutritional parameters were used to predict (p ≤ .10) decline in this exploratory research. Logistic regression revealed physical decline in balance and gait which was predicted by high or low total lymphocyte counts and low fat reserves. Aspects of cognitive decline were predicted by low fat reserves; by combined low fat reserves, low albumin, low cholesterol, and low Mini Nutritional Assessment scores; and by combined high fat reserves and high cholesterol.

Forty-five obese postmenopausal Caucasian women were treated with phentermine hydrochloride (Fastin®) and a 1200 kcal diet for weight reduction. Total and regional body composition changes were measured by dual-energy X-ray absorptiometry (DXA) and by anthropometry at 3-mo intervals over 9 mo. Plasma lipids, and serum insulin and leptin were measured. After 3 mo, Fastin® therapy produced a 6.8 kg weight loss (P < 0.01), and DXA-assessed fat and lean mass losses (P < 0.01) of 11.9 and 3.0%. respectively. DXA-estimated regional composition revealed respective fat mass losses of 14.1 and 11.9%. From abdomen and thighs, suggesting primarily subcutaneous and central fat depot losses. DXA reliability was assessed by same-day duplicate measurements (n = 10) calculated using old (version 8.1a) and new (version 8.21) analysis software. A 1.5% between-duplicate difference in lean mass was obtained with the old software; the new software yielded 1.1, 1.4 and 1.6% differences between duplicates for fat, lean and leg lean masses, respectively. CVs ranged from 1.7% for bone mineral content to 12.0% for arm fat mass for both versions. The new software produced higher values for all variables, except arm fat and lean masses than the old software. Except for a 1.9% trunk fat loss detected with the old software, magnitude of body composition changes over 3 mo in 21 weight-stable subjects was the same. The new software estimated total weight more accurately and with less variability than the old software. Fastin®-treated women lost (P < 0.01) 10% of their baseline body weight over 9 mo which correlated with a 20% reduction (P < 0.01) in serum leptin concentration. Plasma HDL-cholesterol concentration increased (P < 0.01) by 15% over 9 mo while total- and LDL-cholesterol and triglycerides decreased 14.2 (P < 0.01), 25.4 (P < 0.01) and 12.2% (P < 0.05), respectively. Serum insulin was unaffected by weight reduction. These data suggest that FastinRTM therapy was effective in reducing weight, and in producing a healthier body fat distribution and plasma lipid profile, thereby lowering cardiovascular disease risk in obese postmenopausal women. The DXA instrument (Holologic QDR-4500A. Hologic Inc. Waltham, MA) gave reproducible estimates of composition change in this population regardless of the software version used.

In this series of studies, three issues were addressed. First, the prevalence of undiagnosed diabetes (high fasting blood glucose with no prior diagnosis of diabetes) and how different they are from the diagnosed diabetes in risk factors. Second, the prevalence and risk factors of overweight and obesity were described in the general population. Finally, an evaluation of the relationship between obesity and type 2 diabetes were made in Saudi adult men and women. Our study population came from a national cross sectional survey which included 3271 males and females, age 30-70 years old. All participants completed a specifically designed questionnaire, and a comprehensive physical examination which included blood pressure and anthropometric measurements. Fasting serum samples were analyzed for glucose and blood lipids. A number of compelling findings have resulted from this research. First, the prevalence of diabetes is high with 30% of men and 25% of women diabetics. Undiagnosed diabetes presents a substantial problem; they constitute 41% of the total diabetic population and 11% of the total population. Undiagnosed diabetics are however, similar to diagnosed diabetes with uncontrolled fasting blood glucose level and many of the associated risk factors. Second, the prevalence of obesity is also high with 49.15% in women and 29.94% in men identified as obese and an additional 31.55% of females and 41.91% of males identified as overweight. Third, in this study population, 12% are obese diabetics and in the diabetic population 43% are obese diabetics. Diabetes appears to have a harmful effect on blood lipids, which seem to worsen when diabetes is combined with obesity. Based on these findings, obesity and diabetes appear to have created very serious complications and prevalent health problems in adult Saudi population between the age of 30-70 years old. Because about half of the population are under 18 years old, there is a very good chance for the government to successfully implement education and health programs to prevent and control these two conditions from becoming an epidemic in future generations.

Cardiovascular complications are prevalent in patients with AIDS. Cardiovascular complications, particularly ischemia-reperfusion injury, may be severe in AIDS patients. The pathology underlying cardiovascular complications in AIDS patients is unclear. Perhaps interplay of several pathologic factors amplifies the response to ischemia. Murine retrovirus (LP-BM5) induced murine AIDS is the best model of human AIDS research because LP-BM5 causes similar immune changes. Ethanol consumption has the advantage and disadvantage to health. The aim of this study was to determine if chronic ethanol consumption influences pathological changes caused by murine AIDS, specifically in cardiovascular complications, and if vitamin E supplementation could attenuate cardiovascular injury by murine AIDS. In our present study, we found that retrovirus infection enhanced neutrophil CD11b expression and ROS production, increased platelet CD62p and platelet microparticle formation, exaggerated coronary permeability to macromolecules and caused a severe myocardial ischemia-reperfusion injury. Chronic ethanol consumption down-regulated neutrophil CD11b expression, but neutrophil ROS production, platelet CD62p expression and platelet microparticle formation were enhanced. Chronic moderate ethanol consumption improved coronary microcirculation and attenuated ischemia-reperfusion injury. Our results indicate that neutrophil and platelet adhesion molecule expression increases in murine AIDS. Neutrophil and platelet-mediated severe ischemia-reperfusion injury may contribute to increased incidence of cardiomyopathy in AIDS. The cardiovascular protective effects of moderate ethanol consumption may be related to modulation of neutrophil CD11b expression and improve coronary microcirculation. However, chronic ethanol consumption did not preserve myocardial damage by retrovirus infection. In this study, we also demonstrated that vitamin E attenuated AIDS-induced myocardial injury. Vitamin E may be a therapeutic adjuvant agent for preventing and treatment AIDS-induced cardiovascular diseases.

Considerable changes in the practice of chemotherapy have occurred which include the shift of the majority of therapy to an outpatient setting and the availability of more effective antiemetic agents to treat nausea and vomiting. The outpatient delivery of chemotherapy is also characterized by limited nutrition intervention. Data are not available that define the impact of these changes in chemotherapy practice on the nutritional status of outpatients receiving chemotherapy. Consequently, this study was designed to address four primary aims. The first aim was to observe the change in degree of common side effects, or symptom distress, and in nutritional and functional status measures over 3 months in outpatient chemotherapy patients. The second aim was to test the utility of two versions of a nutrition risk scoring tool. Version A includes weight change and subjective appetite ratings. Version B incorporates change in fat-free mass (FFM) measures by bioelectrical impedance analysis (BIA) and energy and protein intakes. The third purpose was to examine the relationship of the nutritional and other factors studied with response to chemotherapy. Finally, comparisons were made among the body composition results from skinfold thickness measures and BIA using instrument manufacturer-supplied and population-specific equations. A key finding from this study was that Nutrition Risk Score A detected nutritional change over time and lower scores were correlated with positive chemotherapy response. Unanticipated findings from this study were the significant gender differences in nutritional and clinical factors and their relationships to chemotherapy response. Male subjects experienced weight loss and an overall decrease in nutritional status as demonstrated by an increase in Nutritional Risk Score A, while female subjects did not have weight loss and had a trend towards improved Nutritional Risk Score A. The Kushner et al (1992) BIA equation produced the closest estimates of body fat mass to those obtained using the Durnin and Womersley (1974) skinfold method. The population-based BIA equations were not interchangeable with each other or with the manufacturer's equation. Except for female breast cancer patients, the population-based BIA equations were interchangeable with each other for estimating FFM, but not with the manufacturer's equation.