Diet, lipoproteins, and coronary heart disease

Current dietary recommendations to decrease coronary heart disease (CHD) risk in the general population include reduction of total fat intake to less than or equal to 30% of energy, saturated fat to less than 10% of energy, and dietary cholesterol to less than 300 mg/day. Further restrictions in saturated fat to less than 7% of energy and in dietary cholesterol to less than 200 mg/day are indicated for those individuals with elevated low-density lipoprotein (LDL) cholesterol concentrations. Under controlled conditions, such diets reduce LDL cholesterol by 15% to 20%. However, in the out-patient setting, only 5% to 10% reductions in LDL cholesterol have been achieved, and large variability in dietary response is observed due to differences in compliance, as well as to genetic heterogeneity. This article reviews epidemiologic studies and dietary intervention trials that support a direct relationship between diet, lipoproteins, and CHD risk, with the ultimate goal of providing a framework for dietary management of the hyperlipidemic patient.     

Diet and disease

In this era of evidence based medicine information about diet and diseases is less certain than information about drugs and diseases. Drug treatment is less complex. Dietary change can't usually be incorporated in a double blind trial. There is much more funding for pharmaceutical trials than for dietary trials. The following notes concentrate on newer, developing concepts.     

Diet, lipids, and coronary heart disease.

Contends that R. M. Kaplan (see record 1985-12441-001) presented a one-sided debate on the diet/heart controversy. It is suggested, based on studies cited, that preventive efforts recognizing dietary cholesterol's primary contribution to death and disability must be implemented. Answers to 5 questions about cholesterol presented to a National Institutes of Health panel are appended. (18 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dr. B. C. Dasgupta Memorial Oration. Priorities, issues, inter-state variations and challenges

India spends only 1.5% of GDP on health as against the recommended 5% by W.H.O. for equity and universal coverage. States have a high share (89%) of funding their health care activities as against 9% by centre and 2.8% by U. T.'s. Increasing proportion of health expenditure on salaries (60-90%) and a markedly reduced (29%-5%) proportion on non-salary components is reflected in low-level of utilization of health services. Committed involvement by others in selected crucial areas is lacking. Health financing seems to be directed towards the urban sector with maximum outlays to curative care. There are high inter-state variations in health expenditure and health status. Higher share of SDF on public health does not guarantee a better health status. Health services sector urgently & legitimately needs additional resources. There is need to set up technical committee and research cells to sensitise policy makers, academicians and others and to steer and guide research. Health Financing and Management must be considered together to address issues of equity, efficiency and effectiveness in health care services.     

Diet and arthritis

Choice of diet is one way in which an individual can influence his/her own health, and it is to be expected that patients will seek their physician's expert opinion regarding dietary matters. Respect for the legitimacy of these enquiries and balanced informed discussion, which includes general advice for a prudent diet, as well as disease-specific recommendations when indicated, can be the key to a productive relationship between patients and physician. The issue of dietary advice has an impact on the management of most forms of arthritis including osteoarthritis (obesity/energy balance), gout (dietary purines, energy balance, alcohol, fluid intake) and rheumatoid arthritis (n-3 fatty acids). Food hypersensitivity appears to be a rare cause of polyarthritis, and elimination diets and fasting have little or no place in routine practice. Strategies under investigation include oral tolerization, the utility of which remains to be established.     

Diet and dyslipidemia

In this article recommendations for dyslipidemias are illustrated by practical dietary recommendations for an individual patient with combined hyperlipidemia. Recommendations in hypercholesterolemia above all consist in the replacement of saturated by unsaturated forty acids thus reducing automatically cholesterol, too. In hypertriglyceridemias reduction of body weight should often be combined with quantitative control of alcohol and simple carbohydrates. A list of foods to be chosen or to be avoided is provided.     

Diet and breast cancer

A 78 year old women developed acute fingertip necrosis just a few days after starting dihydroergotamine. The lesions healed in 3 weeks after the medication was stopped. The patient had suffered from Raynaud syndrome for 5 years and limited systemic sclerosis was diagnosed during the necrotic episode. Advanced age and microangiopathies are contraindications to the use of ergot-containing preparations.     

Diet, physical activity, and gallstones--a population-based, case-control study in southern Italy

The recent demonstration of a protein disulfide isomerase (PDI) on the surface of and secreted from blood platelets raises the possibility that proteins involved in hemostasis and wound healing are also substrates of this enzyme. In this study purified preparations of platelet PDI, thrombospondin-1 (TSP), alpha-thrombin, and antithrombin III (AT) were used to demonstrate that PDI catalyzes formation of a TSP-thrombin-AT complex consistent with previous results with supernatant platelet activation. Concentrations of 1.25 microg/ml of PDI were sufficient to convert almost 50% of thrombin to TSP-thrombin-AT complex. Complex formation requires low concentrations of a reduced thiol and the reaction can be prevented by N-ethymaleimide. The complex is dissociated by reducing agents such as mercaptoethanol. Absence of Ca2+ and the addition of EDTA increased the rate of complex formation, indicating that TSP in the Ca2+-free form is most effective. In the absence of AT a small amount of TSP-thrombin complex formed which was only 0-13% of maximal complex formation in the presence of AT. This result, in combination with kinetic studies showing rapid formation of thrombin-AT complex followed by conversion to ternary complex, suggests that the thrombin-AT complex is an obligatory intermediate in the reaction. Under optimal conditions over 70% of the thrombin is incorporated into the complex in 60 min. Heparin accelerated the reaction largely by enhancing formation of thrombin-AT complexes and had little effect on TSP. PDI coprecipitated with TSP from the supernatant solution of activated platelets, suggesting an association between PDI and its substrate. In summary, these data are consistent with a role for PDI-catalyzed formation of disulfide-linked complexes of TSP with other proteins.     

Diet diversity and gastric cancer

PURPOSE: To document a case of acute retinal necrosis syndrome in an immunocompetent patient who was successfully treated with famciclovir after unsuccessful treatment with acyclovir. METHODS: After diagnosing acute retinal necrosis syndrome in the patient's left eye, we treated him with 13 mg/kg/24 hours of intravenous acyclovir in three daily doses for 14 days, followed by 800 mg of acyclovir five times per day orally. New areas of retinitis developed within the posterior pole despite treatment with the maximum dosage of acyclovir; thus, we used a new antiviral agent, famciclovir. RESULTS: When we administered 500 mg of famciclovir orally every 8 hours for 3 months, the retinitis regressed within 1 month, leaving atrophic granular pigmented scars. CONCLUSION: Famciclovir can effectively treat acute retinal necrosis syndrome in immunocompetent patients.