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The Mediterranean Diet and Risk of CVD

Over time, the diet of Crete has changed remarkably and is now characterized by higher intake of saturated fat and cholesterol, and reduced intake of monoun-saturated fats.5 At the same time, total fat consumption has fallen. These trends have been accompanied by a steady rise in CHD risk during 25 years of follow-up of the Cretan cohort.16 Today, the Cretan diet increasingly resembles a western diet there has been a concurrent rise in CHD risk. Hence, the reference Mediterranean diet should be anchored to its original description and characterization.

Observational Study Results

Unsaturated fat Unsaturated fat Table 2.2 Dietary features characteristic of the traditional Mediterranean diet29 High intake of vegetables, legumes, fruits, nuts, and whole-grain non-refined cereals High intake of olive oil Low intake of saturated fats Moderately high intake of fish

Indo Mediterranean Diet Heart Study

A recently completed trial conducted in India, the Indo-Mediterranean Diet Heart Study,25 complements findings from the Lyon Diet Heart Study. The study population consisted primarily of men ( 90 ) who were at high-risk for either a first myocardial infarction or a recurrence approximately 60 had a history of myocardial infarction at baseline, and 35 had a recent (

Clinical Feeding Study Results

The Lyon Diet Heart study and the Indo-Mediterranean diet trial relied on behavior modification strategies to promote adoption of the Mediterranean diet plans to participants. Compliance with dietary recommendations was hard to assess and effects of on-traditional CVD risk factors hard to ascertain. In fact, in the Lyon Diet Heart study, end-of study assessment of the traditional CVD risk factors including blood pressure and lipids, were not different between groups.8 This finding was unexpected as emphasis on unsaturated fatty acids rather than saturated or trans-fatty acids would be expected to beneficially affect serum lipid levels.23 Likewise, dietary patterns emphasizing fruits and vegetables have been shown to substantially lower blood pressure and are discussed next.2 Hence determining the effects of the Mediterranean diet on traditional CVD risk factors, including blood pressure and lipids, and on markers of oxidative stress, may be best determined in a different setting...

Adipocyte Dysfunction And Insulin Resistance

Our understanding of fat and carbohydrate metabolism and their interaction. In particular, a large body of evidence has accumulated suggesting that PPARy is a master regulator in the formation of fat cells and their ability to function normally in the adult21,22. PPARy is induced during adipocyte differentiation and ectopic expression of PPARy in non-adipogenic cells effectively converts them into mature adipocytes23,24. Thus, the discovery and study of the PPARs have contributed greatly to the evidence supporting the role of the adipocyte as having a major effect on skeletal muscle glucose uptake. First, there is evidence that activation of PPARy in adipose tissue improves its ability to store lipids, thereby reducing 'ectopic' fat storage in liver and muscle21. If this metabolic pathway is activated, lipid repartitioning on a whole-body level will occur increasing the triglyceride content of adipose tissue, lowering free fatty acids and triglycerides in the circulation, liver and...

Metabolism or storage

Weight and body fat, and could improve insulin sensitivity and blood lipids31,36. It also appeared that rimonabant could favorably alter the metabolic profile beyond what could be explained by weight loss32. The explanation put forth to explain the putative weight-independent effect of the drug appeared to be related to the discovery of the presence of CB1 receptors on other tissues and organs among which there is adipose tissue32,42. It has been suggested that the stimulation of CB1 receptors in fat cells would promote lipogene-sis leading to fat cell hypertrophy32. This in turn would reduce production of adiponectin by enlarged adipose cells.

The Spongy Bone And Medullary Cavity

''Okay, so what's all this marrow cavity stuff, about '' the involved reader may ask at this point. The medullary cavity is alternately called the marrow cavity, because it is filled with yellow marrow. Named for its yellowish color, the yellow marrow chiefly consists of thousands of adipocytes. Your memory may serve to remind you (Chapter 6) that adipocytes are ''fat cells'' that make up adipose connective tissue. Therefore, the yellow marrow has an energy-storing physiology for the long bone.

Response to Starvation

Fat cell volume and the number of fat cells in the marrow remain essentially unchanged in the rabbit subjected to acute starvation, despite drastic weight loss and depletion of peripheral white fat stores (29). BM adipose cells exhibit no ultrastructural change during short-term starvation when fat is mobilized from extramedullary adipose tissue (30). In prolonged induced starvation or in patients with severe anorexia nervosa, BM fat atrophies and an accumulation of gelatinous extracellular mucopolysaccharide-type matrix is observed (31,32).

Balance With Erythropoiesis

A reciprocal relationship exists between adipogenesis and erythropoiesis (23). When rabbits are treated chronically with phenylhydrazine to induce hemolysis or are subjected to chronic bleeding, erythropoiesis is stimulated. In such situations, the mean volume of marrow fat falls, whereas that of nonmedullary fat pads is unchanged. BM adipocyte shrinking is accompanied by preferential release of unsaturated fatty acids (4). This specific loss of unsaturated fatty acids suggests that increased hematopoiesis stimulates lipolysis of BM adipocytes (33,34). However, the ultimate fate of these unsaturated fats is currently unknown.

Morphological and functional characterization of bm adipocytes

In the rabbit, palmitate turnover per gram triglyceride is fivefold greater in BM adipose tissue than in subcutaneous or perinephric adipose tissues however, when expressed on the basis of individual cells, incorporation of the free fatty acid in marrow and in nonmedullary fat cells appears similar (55). Gas chromatography reveals that marrow fat contains a higher concentration of unsaturated fatty acids. As a whole, these studies and those performed during stimulation of erythropoiesis indicate that there is greater lipolysis and lesser storage in BM fat than in nonmedullary fat pads (55). Our opinion is that, contrary to white adipose tissues, fat storage and energy conservation are probably a secondary function of marrow fat.

Preadipocyte Stromal Cell Lines

BM-derived stromal cells have been cloned from mice and rats (1). Most of the cells that support myelopoiesis and or lymphopoiesis in long-term culture systems are preadipocytes. They secrete many cytokines and growth factors known to regulate proliferation or differentiation of hematopoietic progenitors. They also provide extracellular matrix components required for intracellular adhesion or cell recognition (1). However, when these stromal cells develop into adipocytes, spontaneously or in response to adipogenic agents such as glucocorticoids, the expression of extracellular matrix and cytokines is frequently altered and this affects hematopoiesis. In that respect, it has been shown that fully differentiated fat cells from an adult-derived cell line produce less colony stimulating factor-1 than their precursors (139) and that expression of stem cell factor IL-6 and leukemia inhibitory factor declined with terminal adipocyte differentiation of an embryo-derived stromal line (196). It...

Leptin and Glucose Metabolism

A number of epidemiological studies have examined circulating leptin level in diabetic and nondiabetic subjects with discrepant results 52, 90, 91 . It is still debated whether different degrees of glucose tolerance may affect plasma leptin level. In elderly overweight patients, plasma leptin did not differ between diabetic and nondiabetic men and women after accounting for age and fat mass 90 . Among US Pima Indians, subjects with type 2 diabetes had lower leptin concentration than nondiabetic subjects independent of body fat percentage 91 . resistance, evaluated by homeostasis model assessment of insulin resistance (HOMA), even after adjusting for age and fat mass 92 . In this study leptin, waist size, and age as a group accounted for up to 31-33 of insulin level and HOMA total variance, respectively 92 . In contrast, about 22 of insulin level and HOMA were accounted for by leptin alone 92 . An independent association between leptin and insulin concentration after adjustment for BMI...

What are isoflavones Are they effective for treating osteoporosis

Some people choose to eat soy instead of taking soy isoflavone supplements. The FDA has approved product labeling that says, Diets low in saturated fat and cholesterol that include 25 grams of soy protein a day may reduce the risk of heart disease. One serving of soy protein burger (for example) provides 9 grams of soy protein. In order to use this claim on labeling, a soy product must be low in fat, cholesterol, and sodium and contain at least 6.25 grams of soy protein. But it's not clear how many milligrams of isoflavones are in each gram of soy protein. The degree to which you absorb isoflavones from soy will depend on the food product and the bacteria in your intestines. An 8-ounce glass of soy milk, when converted in your intestines, can provide 20 to 45 mg of isoflavones. There's no firm evidence at this time that eating soy or taking soy

Cigarette Smoking And Cardiovascular Disease

In addition, cigarette smoking is associated with unhealthy eating patterns, including increased intakes of alcohol, total fat, cholesterol, saturated fat, a lower consumption of foods with fibers such as fruits and vegetables that may lower cholesterol levels, as well as deficiencies of vitamin C, E and beta-carotene 11,12 , These factors make smokers and heavy alcohol users more predisposed to cardiovascular disease.

Maximising the bioavailability of carotenoids

Cooking and mechanical comminution are the most common method of increasing availability, but other methods, e.g. co-processing with lipid as in prepared recipes, or enzyme treatments which cause cell separation or disruption (juice production) may be used. During digestion, any disease state that compromises fat absorption will reduce the absorption of lipid-soluble micronutrients. The consumption of fat replacers, e.g. Olestra , or cholesterol absorption inhibitors, e.g. plant phytosterols, will also have a negative impact on the absorption of carotenoids51'52 and perhaps of other lipid-soluble micronutrients.

Diet Pharmacological and Behavioral Treatment

The Atkins and Protein Power diets are very high in total and saturated fat compared with current dietary guidelines. Long-term use of these diets for weight maintenance is likely to significantly increase serum cholesterol and risk for coronary heart disease. The Sugar Busters and Zone diets would lower serum cholesterol concentrations and likely reduce risk for coronary heart disease. High-carbohydrate, high-fiber, and low-fat diets would have the greatest effect in decreasing serum cholesterol concentrations and,

The Influence of Dietary Fats on Blood Cholesterol Levels and Distribution of Fatty Acids

Blood cholesterol levels and risk of cardiovascular disease are influenced by dietary intakes of fats. The intake of red meats and saturated fats are a primary cause of elevated blood cholesterol levels.25 Monounsaturated fats generally have a neutral effect on cholesterol, whereas polyunsaturated fats decrease cholesterol levels.26 Dietary cholesterol can increase blood cholesterol levels, but contributes less to blood cholesterol levels than saturated fats.13 Specific fatty acids within each major class, saturated, monounsaturated, and polyunsaturated, often have unique effects on blood cholesterol levels and should be considered on an individual basis. Palmitic acid, a 16-carbon saturated fatty acid, is a major contributor of saturated fat intake in the United States diet, accounting for greater than 60 of the saturated fat intake. It is associated with an elevation in LDL levels27 and may cause these elevated levels by inhibiting the expression of LDL receptors on cell surfaces.28...

Adipokines and Steatosis

Furthermore, leptin dramatically suppresses the expression of the hepatic stearoyl-CoA desaturase (SCD)-1, the rate-limiting enzyme in the biosynthesis of monounsatu-rated fats (74). SCD-1 suppression, in turn, supports resistance to both hepatic steatosis and obesity owing to a marked increase in energy expenditure. Two proposed mechanisms for these leptin effects include blocking TG synthesis and exporting VLDL (74,75). These mechanisms lead to a concomitant increase in the pool of saturated fatty acyl CoAs, which allosterically inhibits ACC and reduces the amount of malonyl CoA. Inhibition of the mitochondrial carnityl palmitoyl shuttle system is relieved as a consequence, stimulating the import and oxidation of FA in mitochondria. Thus, leptin administration de-represses FA oxidation, leading to increased fat burning (74). Other proposed mechanisms of antisteatotic effects of the leptin involve increases in a peroxisome proliferator-activated receptor (PPAR) a signaling (76) or...

Lifestyle Modification in the Infertile Patient With PCOS

In obese women with PCOS, weight loss through lifestyle modification should be considered a primary intervention for the treatment of oligo-ovulatory infertility. The optimal means to achieve and maintain weight loss and the most reliable predictors of response to lifestyle modification have yet to be determined, although an improvement in insulin sensitivity and a reduction in circulating insulin levels appears to be important. Although some investigators have suggested that calorie restriction with a diet low in saturated fat and high in fiber from predominantly low glycemic-index carbohydrate foods be recommended (17), the optimum type of diet for PCOS patients remains to be determined prospectively. Similarly, the relative impact of exercise regimen, behavior modification, and drug therapy on weight reduction in obese PCOS patients has yet to be defined.

Developmental Effects Physical Activity and Diet

Another dietary factor worth greater attention is the omega-3 fatty acids, for which emerging data suggest a protective effect on asthma development in childhood (41,44, 45,48). Unfortunately, most of the work on diet and its effect on asthma has been done in adults or in children after the diagnosis of asthma has already been made. The ideal time in the lifecycle to assess the effects of diet is in the pregnant mother, in whom the effects of total caloric intake and dietary constituents can be measured and their effects on birthweight, obesity, and asthma can be assessed. Barker et al. (49) have proposed that many chronic diseases arise from adaptations the fetus makes when it is undernourished. The prototypical example of the relationship of fetal development to both asthma and obesity is the Dutch winter famine of 1944-1945. Women exposed during early and mid-pregnancy to the severe nutritional limitations imposed by the famine had offspring

Fat Processing for Injection

The ideal processing technique should provide viable adipose tissue, with less subsequent absorption of the injected fat, and should be simple, fast and cheap. Cotton towel processing utilizes a sterile operating room cotton towel as an absorption surface, separating fat cells from fluids, oil and debris. When compared with the closed centrifugation technique, operating field drape technique provided equal or better fat quality (less fibrosis), while there was no difference in fat uptake between the methods 18 . Fig. 64.11. Processing utilizes a sterile operating room cotton towel as an absorption surface, separating fat cells from fluids, oil and debris Fig. 64.11. Processing utilizes a sterile operating room cotton towel as an absorption surface, separating fat cells from fluids, oil and debris

Body Fat Distribution

Figure 3.4 There is strong evidence suggesting adipose tissue has a central role in contributing to insulin resistance. New evidence suggests that insulin resistance is partly the result of the inability of the adipose organ to expand to accommodate excess calories. Increased fat cell size may represent the failure of the adipose tissue mass to expand, i.e. proliferate and differentiate, resulting in a reduced ability to accommodate an increased energy influx. When combined with reduced fat oxidation in adipose tissue, these pathophysiologic changes will contribute to a decrease in fat storage in adipocytes and an increase peripheral deposition of lipids in tissues, i.e. increased 'ectopic fat'. Individuals who have a low capacity for proliferation and or differentiation of precursors into mature fat-storing adipocytes are susceptible to hypertrophy of the existing adipocytes under conditions of energy excess. Thus, adipocyte hypertrophy (i.e. large fat cells) is indicative of a...

Goodand Bad Cholesterol

Functional Groups Cholesterol

There is only one kind of cholesterol, and it does far more good than harm. When the popular press refers to good and bad cholesterol, it is actually referring to droplets in the blood called lipoproteins, which are a complex of cholesterol, fat, phospholipids, and protein. So-called bad cholesterol refers to low-density lipoprotein (LDL), which has a high ratio of lipid to protein and contributes to cardiovascular disease. So-called good cholesterol refers to high-density lipoprotein (HDL), which has a lower ratio of lipid to protein and may help to prevent cardiovascular disease. Even when food products are advertised as cholesterol-free, they may be high in saturated fat, which stimulates the body to produce more cholesterol. Palmitic acid seems to be the greatest culprit in stimulating elevated cholesterol levels, while linoleic acid has a cholesterol-lowering effect. Both are shown in figure 2.19. Cardiovascular disease is further discussed at the end of chapter 19, and LDLs and...

Adipose Tissue Hypertrophy and Inflammation

Hypertrophy of the mesentery and omentum eventually leads to swelling of the abdomen and to high waist hip ratios in humans (93). Thick waists are common among people of average body mass who smoke heavily, which continually exposes them to toxins and irritants in tobacco (94), or who are frequently exposed to a wide variety of parasites and pathogens (95). The link between hypertrophy of intra-abdominal adipose tissue and susceptibility to type 2 diabetes is long established (96). More recently, chronic inflammation has been implicated in the progress of long-standing obesity to insulin resistance (97) and diabetes (98). Obesity is accompanied by changes in blood cytokines, at least some of which may come from non-fat cells found in human adipose tissue (99).

The Relationships Between Lipid Profile Levels Depression and Suicide Attempts

Epidemiological and clinical studies have described an association between lower serum cholesterol concentrations and increased suicide risk that is not entirely attributable to depression-related malnutrition and weight loss. Recent epidemiological studies with greater samples and longer follow-up periods, however, have even shown a positive correlation between cholesterol concentrations and suicide risk after controlling for potential confounding variables 97, 98 . A meta-analysis of earlier intervention trials indicated that cholesterol lowering could cause or worsen depressive symptoms and increase the risk of suicide. However, some large trials of statins (simvastatin, lovastatin, and pravastatin) did not show an increase of suicide mortality 98, 99 . Recently, it was hypothesized that a decreased consumption of polyunsaturated fatty acids, especially omega-3 fatty acids, may be a risk factor for depression and suicide 98 .

Dietary Lipids And Fatty Acid Patterns

The human and laboratory evidence is most convincing for a stimulatory effect of dietary lipid concentration, particularly a diet rich in saturated fats, on cancers of the colon and rectum (6,7,21). Less certain, but supported by many studies, are the positive relationships between diets rich in fat and cancers of the prostate, breast, lung, ovary, and endometrium (6,7,21). The possibility that diets rich in omega-3 fatty acids from marine sources have inhibitor properties for cancers has been postulated, and is currently an area of active investigation (6,7,21,109-114). Dietary lipid intake is primarily in the form of triacylglycerols (triglycerides), with one molecule of glycerol bound to three fatty acids. Dietary fatty acids vary in chain length (typically even numbered, 4-22 carbon atoms in length) and the degree of saturation, which is relevant to biological functions in vivo. Most fatty acids are in a cis configuration in nature, but current...

What are the reported benefits and adverse effects of fish oil

Fish oils are used primarily in the treatment of hyperlipidemia, hypertension, and chronic inflammatory states such as rheumatoid arthritis and autoimmune disease. Fish oils contain two long-chain omega-3 fatty acids that compete with arachidonic acid in the cyclooxygenase and lipoxygenase pathways and have antiinflammatory effects, likely caused by the inhibition of leukotriene synthesis. Fish oils decrease blood viscosity and increase red blood cell deformability. The antithrombotic activity offish oils results from prostacyclin inhibition, vasodilation, reduction in platelet count and adhesiveness, and prolongation of bleeding time. Concomitant use of fish oils and anticoagulant and antiplatelet drugs previously mentioned may increase the risk of bleeding.

Molecular Basis of Insulin Action and Insulin Resistance in Peripheral Tissues

To understand the molecular basis of insulin resistance (whether primary or secondary) in muscle and fat cells, it is imperative to gain knowledge of the normal mechanisms of insulin action. In these tissues, insulin stimulates glucose uptake by rapidly mobilizing preexisting glucose transporters (primarily the GLUT4 isoform) from an intracellular storage organelle (or vesicle) to the plasma membrane (5,6). This is achieved by a series of signals elicited from the receptor, which are detected in an unknown fashion by the intracellular organelle. The latter is then free to find and interact with docking sites on the plasma membrane (7) that will ultimately enable fusion of the two membranes to provide functional glucose transporters. Detailed knowledge has emerged on the signals emanating from the receptor that are essential for GLUT4 translocation and the nature of the proteins engaged in vesicle docking and fusion with the plasma membrane.

The Lyon Diet Heart Study

The Lyon Diet Heart Study was designed to evaluate the impact of a Mediterranean diet on the risk of cardiovascular mortality in persons at high risk for CHD.8 The diet was based on the 1960 Cretan diet as defined by the Seven Countries Study, but the intervention also included supplementation with margarine rich in alpha-linolenic acid (ALA). Participants were advised to eat more bread, root vegetables, green vegetables, fish, and fruit. In addition, participants were asked to reduce their intake of red meat and pork. Finally, participants were asked to replace butter and cream with the supplemental margarine rich in ALA that was provided by the study. Estimated energy intake ( kcal) from fats was 30.5 from total fat, 8.3 from saturated fats, 0.8 from n-3 fatty acids, and 3.6 from n-6 fatty acids. Mean cholesterol intake was 217 mg day. After a mean follow-up of 27 months, there was a 70 reduction in total mortality (20 deaths in control group vs. 8 deaths in experimental group) and...

Hormonal Lifting

The administration of somatotropine can biochemically decelerate the processes of ageing fat cells are reduced and muscle cells are stimulated. Such cures can cost a fortune, however j 10,000-15,000 (US 12,000-18,000) per year. Sex hormones are glorified as true beauty elixirs . Oestrogen promotes hydronic acid, collagen, and elastine fibres and combats free radicals, osteoporosis, and hair loss. Testosterone tightens the epidermis and the connective tissue.

Interleukin6

Adipocytes themselves secrete IL-6, with approx 30 of total circulating IL-6 concentrations originating from adipose tissue in obese states (8,31). However, other cell types within the adipose tissue mass also contribute to the high release of IL-6. Interestingly, adipocytes isolated from the omental depot secrete more IL-6 than fat cells from the subcutaneous site (31). Modulators of IL-6 expression in fat depots include TNF-a, glucocorticoids, and catecholamines (4,31). Although TNF-a, noradrenaline, isoprenaline, and -adrenergic receptor activation stimulate IL-6 gene expression and protein secretion, dexamethasone markedly suppresses its production (4,8).

The Dash Trials

The Dietary Approaches to Stop Hypertension (DASH) and DASH-sodium trials2,24 tested the effects of a carbohydrate-rich diet that emphasizes fruits, vegetables, and low-fat dairy products and that is reduced in saturated fat, total fat, and cholesterol on blood pressure, total cholesterol, and LDL cholesterol. This diet is rich in potassium, magnesium, calcium, and fiber, and is reduced in total fat, saturated fat, and cholesterol it is also slightly increased in protein. Effects of this diet were compared against a group randomized to a control diet which had a nutrient composition that is typical of that consumed by many Americans (Table 2.2). Its potassium, magnesium, and calcium levels were comparatively low, while its macronutrient profile and fiber content corresponded to average US consumption. A fruits and vegetables diet tested in the original DASH trial was rich in potassium, magnesium, and fiber but otherwise similar to the control diet. All three diets contain similar...

Hunger

Bodily control of eating occurs both in the central nervous system and the peripheral nervous system. There are centres in the hypothalamus that determine the starting and finishing of eating. However, there are also peripheral mechanisms involved. The glucostatic theory suggests that the level of blood sugar is important and the lipostatic theory suggests that the amount of fat in the body is crucial. Set-point theory has it that the number of fat cells in the body is set either genetically or very early in life and remains constant. So, a person with a higher set point has more fat cells and will tend to eat more than a person with a lower set point. This person will find it relatively hard to diet or to lose weight.

Conclusions

Effect of cis-unsaturated fatty acids on cellular oxidant stress in macrophage tumor (AK-5) cells in vitro. Cancer Lett 1996 109 63-75. Das UN. Arachidonic acid as a mediator of some of the actions of phorbolmyristate acetate, a tumor promotor and inducer of differentiation. Prostaglandins Leukot Essen Fatty Acids 1991 42 241-244. Das UN, Padma M, Sangeetha P, et al. Stimulation of free radical generation in human leukocytes by various stimulants including tumor necrosis factor is a calmodulin dependent process. Biochem Biophys Res Commun 1990 167 1030-1036. Serhan CN, Hong S, Gronert K, et al. Resolvins A family of bioactive products of omega-3 fatty acid transformation circuits initiated by aspirin treatment that counter proinflammatory signals. J Exp Med 2002 196 1025-1037. 32 Serhan CN, Clish CB, Brannon J, Colgan SP, Chiang N, Gronert K. Novel functional sets of lipid-derived mediators with anti-inflammatory actions generated from omega-3 fatty acids via...

Insulin Resistance

In skeletal muscle of humans with type 2 diabetes, the plasma membrane does not show a reduction and in fact may show a small increase in the amount of GLUT4 transporters. Yet the stimulation of glucose uptake by insulin is totally blunted. Zierath et al. (28) showed that the membranes of these muscles display a diminished gain in glucose transporters in response to an insulin clamp. A similar observation was also made in two animal models of diabetes (24,29). Defective GLUT4 translocation is also seen in fat cells from these animals (30) and in fat cells from humans with type 2 diabetes (20). As a result, several explanations have been put forward to account for this reduced translocation

Diet and nutrition

Diets balanced with protein or unsaturated fats, such as those in the Optimal Macronutrient Intake Trial for Heart Health (OMNIHEART)2, also demonstrated the ability to modify factors such as blood pres sure and low-density lipoprotein (LDL). One hundred and sixty-four participants in either intervention arm (protein modified or unsaturated fat modified), versus those in the standard carbohydrate diet group, exhibited a greater decrease in systolic blood pressure and LDL despite there being no difference in weight loss among the three groups. Figure 8.2 shows the food guide pyramid for a balanced diet3. In 2005, Dansinger et al. compared four 'fad' diets, the Atkins, Ornish, Weight Watchers, and Zone diets, in a randomized trial of 160 participants4. They found that each had a similar, mild effect on weight, as well as other cardiometabolic risk factors such as LDL high-density lipoprotein (HDL) ratio and C-reactive protein (CRP) (tied to the weight loss effects). This attenuated...

Lifestyle

A diet high in saturated fat and low in fiber and a low level of physical activity are associated with an increased risk of developing type 2 diabetes mellitus (26,27). Modifications of these factors are known to improve metabolic control and insulin sensitivity (56) but should be also expected to reduce oxidative stress. Experimental data suggest that exercise training can improve insulin resistance in parallel with a better antioxidant defense (45). One explanation

Lupus panniculitis

Lobular Panniculitis

Patients with lupus erythematosus may rarely present with prominent involvement of the subcutaneous tissues, a condition that has been termed lupus panniculitis or lupus profundus. Lupus panniculitis reveals subcutaneous plaques and indurations, mostly located on the extremities, which can simulate clinically and histopathologically those observed in subcutaneous T-cell lymphoma (see Chapter 5) (Fig. 20.20) 57 . Antinuclear antibodies and other criteria for the diagnosis of systemic lupus erythematosus may be absent in some cases. Histology shows a predominantly lobular pan-niculitis, often with concomitant presence of broadened fibrotic septa. A useful feature for the differentiation of subcutaneous T-cell lymphoma from lupus panniculitis is the presence in the former of so-called 'rimming' of fat cells by pleomorphic atypical T lymphocytes that are positive for proliferation markers. It must be remembered that rimming of fat lobuli by lymphocytes is not a diagnostic feature per se,...

OMNI Heart Trial

The OMNI-Heart trial, the third in the series of clinical feeding studies, tested whether partial replacement of carbohydrate with either unsaturated fat or protein can improve blood pressure and lipid risk factors.3 The OMNI-Heart trial was a randomized, 3 periods, crossover, feeding trial designed to determine the effects on blood pressure and serum lipids of three healthful diets. Each feeding period lasted 6 weeks and body weight was held constant. Each diet was reduced in saturated fat. The three diets (characterized in Table 2.2) include a carbohydrate-rich diet, similar to the DASH diet (CARB diet) a diet rich in proteins (PROT), approximately half from plant sources and a diet rich in unsaturated fat (UNSAT), predominantly monounsaturated fat. The UNSAT diet not only had all the DASH diet similarities previously described, but also was higher in fat (37 ), predominantly monounsaturated fat (21 ) primarily from olive and canola oils, approaching levels characteristic of the...

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