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Malnutrition, as evidenced by low weight for height, low triceps skinfold thickness and low midarm muscle circumference, is prevalent among COPD patients. A stepped decline in nutritional status has been postulated as a mechanism for malnutrition wherein patients progressively suffer weight loss with each COPD exacerbation. A randomized clinical trial of continuous enteral nutrition could not successfully address whether or not the stepped decline in weight can be prevented. Despite this, sixteen patients admitted for a COPD exacerbation, participated in an observational prospective study wherein anthropometric, biochemical, dynamometric, respiratory, general well-being and energy consumption measures were obtained. Twelve patients had body weights below 90% of ideal weight. The mean energy intake was 107% $ pm$ 30 of estimated resting energy expenditure. Measures were repeated to assess changes during hospitalization. Weight change was a poor indicator of nutritional status. Midarm muscle circumference and handgrip strength appear to be useful as nutritional status indicators among unstable hospitalized COPD patients. Changes in handgrip strength and midarm muscle circumference were closely linked (r =.78, p $<$ 0.0005) and tended to decrease over the course of hospitalization despite clinical improvement. In the absence of adequate nutrition, COPD patients have at least as much risk of developing iatrogenic malnutrition as are other hospitalized medical patients.

Since glucose is the principal substrate used during exercise and is also the main metabolic fuel for the developing embryo and fetus, exercising during pregnancy could induce a competition for fuel between fetus and exercising muscles, perturbing glucose homeostasis. To determine if exercise during pregnancy would predispose the fetus to increased risk, pregnant rats were randomly assigned to a low (4%), moderate (12%) or high (60%) carbohydrate diet, and either rested or exercised on a rodent treadmill at a moderate (15.5 m/min) or high (24.3 m/min) intensity from day 16-21 of gestation. When food intake was controlled for in the statistical model as a covariate, the level of maternal dietary carbohydrate significantly influenced maternal liver weight, heart glycogen, insulin, amniotic fluid glucose and lactate, but not maternal plasma glucose, liver or skeletal muscle glycogens. In contrast, a restricted level of maternal dietary carbohydrate, lowered fetal weight as well as fetal plasma glucose, insulin and liver glycogen. Exercise intensity significantly altered only maternal lactate levels. The results indicate that acute exercise during pregnancy can have detrimental effects on fetal development only if carbohydrate energy is restricted. Otherwise, adequate carbohydrate in the maternal diet appears to protect the fetus.

Exercise and dietary carbohydrate restriction during pregnancy independently reduce maternal weight gain and offspring survival. It was hypothesized that the combined stress of exercise and dietary carbohydrate restriction would decrease offspring survival more than the independent effects. Within the exercise and sedentary groups pregnant rats were randomly assigned to be fed either 60%, 40%, or 20% dietary carbohydrate ad libitum. No statistical interactions were found between exercise and diet. Main effects were found for litter weight, maternal feed intake and weight gain, but not for litter size, pup birthweight, or pup survival in the first two days postpartum. Exercised rats gained less weight and ate more on a per gram body weight basis than sedentary rats. Rats fed carbohydrate restricted diets ate less and gained less weight than the rats fed 60% carbohydrate. These results demonstrate that the neonatal rat is not vulnerable to the effects of moderate maternal exercise and carbohydrate restriction during pregnancy.

The objective of this study was to determine if teaching the new sugar guidelines, which now permit up to 10% of energy from added sugars, would modify dietary habits, metabolic control and perceived quality of life in free-living subjects with type 2 diabetes. In an eight month randomized controlled trial, 48 subjects with type 2 diabetes were taught, by a trained dietitian, either a conventional diabetic meal plan: conventional group (C) or one in which they could integrate the new sugar guidelines: sugar group (S). Patients were seen at the clinic every 2 months (total of 5 visits) by the dietitian and the endocrinologist. During the pre-randomization period (0 to 4 months) all subjects were taught the conventional diabetic diet and advised to avoid concentrated sugars. Randomization to the C or the S group took place at the 4 month visit (4 to 8 month period = post-randomization). The S group were taught how to use and integrate the Canadian Diabetes Association's new sugar choices (e.g. added sugar: honey, regular jam, white sugar, etc) into their daily diabetic meal plan. (Abstract shortened by UMI.)

An imbalance of the oxidant-antioxidant equilibrium has been associated with disease progression in HIV-seropositive individuals. In vitro and in vivo studies have demonstrated the efficacy of antioxidant supplementation in reducing the concentrations of oxidative stress markers. The objectives of the present cross-sectional study were to evaluate the dietary intake and nutritional supplementation practices of 24 HIV-seropositive persons in Montreal and explore the relationship between dietary intakes of antioxidant micronutrients (ascorbic acid, vitamin E, $ beta$-carotene, zinc, selenium), oxidative stress (plasma malondialdehyde (MDA), leukocyte glutathione (GSH)) and immunological indices (absolute CD4+ counts, polymorphonuclear leukocytes (PMN)). Unexpectedly, and paradoxically, a tendency to higher MDA concentrations in subjects with higher CD4+ counts was observed (r = 0.39, p $<$ 0.10). Moreover, supplementation with vitamin E was associated with significantly higher MDA concentrations (p $<$ 0.05). Ascorbic acid intake, even at levels in excess of the tissue saturation (200 mg/d) did not significantly lower MDA concentrations. Neither GSH concentrations nor CD4+ counts were significantly different between supplement users and non-users. In general, the small sample size of this study may have been in part responsible for the failure to detect statistical significance in some associations, however, trends were noted. These included the observation that vitamin supplement users were more likely to have a history of a clinical event associated with HIV infection (opportunistic infection, neoplasm, unintentional weight loss), have a longer duration of IV-seropositivity and have significantly higher MDA concentrations (p $<$ 0.05). In this study, it appears that antioxidants, and vitamin E in particular, were ineffective in reducing the elevated levels of reactive oxygen species (ROS) associated with HIV infection.