Effect of changing the amount and type of fat and carbohydrate on insulin sensitivity and cardiovascular risk: the RISCK (Reading, Imperial, Surrey, Cambridge, and Kings) trial

Background: Insulin sensitivity (Si) is improved by weight loss and exercise, but the effects of the replacement of saturated fatty acids (SFAs) with monounsaturated fatty acids (MUFAs) or carbohydrates of high glycemic index (HGI) or low glycemic index (LGI) are uncertain. Objective: We conducted a dietary intervention trial to study these effects in participants at risk of developing metabolic syndrome. Design: We conducted a 5-center, parallel design, randomized controlled trial [RISCK (Reading, Imperial, Surrey, Cambridge, and Kings)]. The primary and secondary outcomes were changes in Si (measured by using an intravenous glucose tolerance test) and cardiovascular risk factors. Measurements were made after 4 wk of a high-SFA and HGI (HS/HGI) diet and after a 24-wk intervention with HS/HGI (reference), high-MUFA and HGI (HM/HGI), HM and LGI (HM/LGI), low-fat and HGI (LF/HGI), and LF and LGI (LF/LGI) diets. Results: We analyzed data for 548 of 720 participants who were randomly assigned to treatment. The median Si was 2.7 × 10−4 mL · μU−1 · min−1 (interquartile range: 2.0, 4.2 × 10−4 mL · μU−1 · min−1), and unadjusted mean percentage changes (95% CIs) after 24 wk treatment (P = 0.13) were as follows: for the HS/HGI group, −4% (−12.7%, 5.3%); for the HM/HGI group, 2.1% (−5.8%, 10.7%); for the HM/LGI group, −3.5% (−10.6%, 4.3%); for the LF/HGI group, −8.6% (−15.4%, −1.1%); and for the LF/LGI group, 9.9% (2.4%, 18.0%). Total cholesterol (TC), LDL cholesterol, and apolipoprotein B concentrations decreased with SFA reduction. Decreases in TC and LDL-cholesterol concentrations were greater with LGI. Fat reduction lowered HDL cholesterol and apolipoprotein A1 and B concentrations. Conclusions: This study did not support the hypothesis that isoenergetic replacement of SFAs with MUFAs or carbohydrates has a favorable effect on Si. Lowering GI enhanced reductions in TC and LDL-cholesterol concentrations in subjects, with tentative evidence of improvements in Si in the LF-treatment group. This trial was registered at clinicaltrials.gov as ISRCTN29111298.

Frontiers and borderlands in Imperial perspectives: exploring Rome’s Egyptian frontier

Archaeological research has addressed imperial frontiers for more than a century. Romanists, in particular, have engaged in exploring frontiers from economic, militaristic, political, and (more recently) social vantages. This article suggests that we also consider the dialogue between space and social perception to understand imperial borderland developments. In addition to formulating new theoretical approaches to frontiers, this contribution represents the first comprehensive overview of both the documentary sources and the archaeological material found in Egypt's Great Oasis during the Roman period (ca. 30 B.C.E. to the sixth century C.E.). A holistic analysis of these sources reveals that Egypt's Great Oasis, which consisted of two separate but linked oases, served as a conceptual, physical, and human buffer zone for the Roman empire. This buffer zone protected the "ordered" Nile Valley inhabitants from the "chaotic" desert nomads, who lived just beyond the oases. This conclusion suggests that nomads required specific imperial frontier policies and that these policies may have been ideological as well as economic and militaristic.

The child and imperial return: the mystery of Edwin Drood

The Mystery of Edwin Drood has often been read as an Imperial text, just as Dickens's work has repeatedly been considered in relation to its construction of childhood. Despite this, 'the child' has either been avoided in criticism of Dickens's last novel, or has actively been read as absent. In this essay, I return the ‘repressed’ child to a reading of Drood, and through this disrupt appeals to a hard-impacted Imperial structure I understand to be made within criticism of it.