Near normalisation of lumbar spine bone density in young women with osteopenia recovered from adolescent onset anorexia nervosa: a longitudinal study

To investigate the effect of the progression of adolescent onset anorexia nervosa (AN) on bone parameters we followed two cohorts (Disease cohort and recovered cohort) of adolescents for a total of 5.2 years. In the 'Disease' cohort (n = 18), lumbar spine bone density (BMD) was reduced by 0.6 SD after 0.8 years of disease and was reduced a further 1.0 SD after a total 2.5 years of disease (p < 0.001). At the third lumbar vertebra there was bone loss (-3.7%, p < 0.05) resulting in reduced volumetric BMD (-5.1%, p < 0.08). In the 'recovered' cohort, lumbar spine BMD was reduced by 1.9 SD after 1.7 years of disease, and increased by 1.5 SD after 2.7 years of recovery (p < 0.001). At the third lumbar vertebra there was an increase in bone mass (20.5%, p < 0.001) and bone volume (14.1%, p < 0.001), resulting in increased volumetric BMD (6.3%, p < 0.08). Normalisation of lumbar spine BMD may be achieved in patients with adolescent onset AN when the successful recovery of body weight is combined with the return of regular menses.

The effect of exercise and nutrition on the mechanostat

In this review, we discuss the effect of increased and decreased loading and nutrition deficiency on muscle and bone mass and strength (and bone length and architecture) independently and combined. Both exercise and nutrition are integral components of the mechanostat model but both have distinctly different roles. Mechanical strain imparted by muscle action is responsible for the development of the external size and shape of the bone and subsequently the bone strength. In contrast, immobilization during growth results in reduced growth in bone length and a loss of bone strength due to large losses in bone mass (a result of endosteal resorption in cortical bone and trabecular thinning) and changes in geometry (bone shafts do not develop their characteristic shape but rather develop a rounded default shape). The use of surrogate measures for peak muscle forces acting on bone (muscle strength, size, or mass) limits our ability to confirm a cause-and-effect relationship between peak muscle force acting on bone and changes in bone strength. However, the examples presented in this review support the notion that under adequate nutrition, exercise has the potential to increase peak muscle forces acting on bone and thus can lead to a proportional increase in bone strength. In contrast, nutrition alone does not influence muscle or bone in a dose-dependent manner. Muscle and bone are only influenced when there is nutritional deficiency – and in this case the effect is profound. Similar to immobilization, the immediate effect of malnutrition is a reduction in longitudinal growth. More specifically, protein and energy malnutrition results in massive bone loss due to endosteal resorption in cortical bone and trabecular thinning. Unlike loading however, there is indirect evidence that severe malnutrition when associated with menstrual dysfunction can shift the mechanostat set point upward, thus leading to less bone accrual for a given amount of bone strain.

Snacking behaviours of adolescents and their association with skipping meals

Background: Snacking is likely to play an important role in the development of overweight and obesity, yet little is known about the contexts of snacking in adolescents or how snacking may influence other dietary habits, like meal skipping. This study examines the contexts in which adolescents snack and whether these contexts are associated with demographic characteristics of adolescents and with meal skipping.
Methods: A cross-sectional, self-reported online food habits survey was administered to 3,250 secondary students in years seven and nine. The students were drawn from 37 secondary schools in Victoria, Australia during 2004–2005. Frequencies of meal skipping, and snacking in eight contexts, were compared across gender, year level and region of residence. Logistic regressions were performed to examine associations between snacking contexts and meal skipping adjusting for gender and region.
Results: The most common contexts for snacking among adolescents were after school (4.6 times per week), while watching TV (3.5 times per week) and while hanging out with friends (2.4 times per week). Adolescents were least likely to snack all day long (0.8 times per week) or in the middle of the night (0.4 times per week). Snacking contexts were variously associated with gender, year level and region. In contrast, meal skipping was associated with gender and region of residence but not year level. Adolescents who reported more frequent snacking on the run, on the way to or from school, all day long, or in the middle of the night were more likely to skip meals.
Conclusion: These data suggest adolescents snack frequently, especially in their leisure time. In addition, adolescents who snack on the run, on the way to or from school, all day long or in the middle of the night are more likely to skip meals than are adolescents who don't snack at these times. Understanding the contexts in which adolescents snack, and their associations with skipping meals, may assist those involved in the promotion of healthy food habits among adolescents.

Anthropometric and biochemical markers for nutritional risk among residents within an Australian residential care facility

The risk of malnutrition is high among elderly population, yet few studies have measured indicators of nutritional status among Australian aged-care residents. To determine the relationship between nutritional status and bone density, hand grip strength, and the timed-up and go test, in a group of Australian aged-care residents. Anthropometric and biochemical analysis measured in subjects recruited to be part of a six month multivitamin supplementation study. One hundred and fifteen subjects participated (68% female). The mean (SD) age and body weight was 80.2(10.6) years, and 66.5(15.0) kg, respectively. Eleven percent were underweight (body mass index, BMI, <or =20.0 kg/m(2)), and 20% were obese BMI >or =30 kg/m(2)). Low serum 25-hydroxy-vitamin D (25(OH)D, <or =50 nmol/L) concentrations were found among 79% of subjects. After adjustment for body weight, there was an association between serum 25(OH)D and bone density (heel ultrasound) (r=.204, p=.027). Low serum zinc <or =10.7 micromol/L) concentrations were found among 46% of subjects; this group had a slower timed up and go time compared with those with higher zinc concentrations (n=19, 44.6 +/- 5.6 seconds vs. n=27, 30.0 +/- 3.3 seconds, p=.020). There were no associations between nutritional markers and hand grip strength. In this group, more than (3/4) of subjects had low serum 25(OH)D, and 46% had low zinc concentrations. Serum 25(OH)D was associated a lower bone density and zinc with a slower walking time. This indicates that the elderly in long term residential care facilities are at high risk for poor nutritional status, potentially increasing morbidity and mortality.

The cognitive contexts of beliefs about the healthiness of meat

Objective: The overall aim of this study was to examine a variety of belief and demographic factors that are associated with the perception that meat is intrinsically unhealthy.

Design: State-wide survey (written questionnaire) that included questions on meat and nutrition beliefs, perceived barriers and benefits of vegetarian diets, personal values, number of vegetarian friends and family members, and use and trust of health/nutrition/food information sources.

Setting: South Australia.

Subjects: Six hundred and one randomly selected South Australians and 106 non-randomly selected vegetarians and semi-vegetarians.

Results: For all respondents considered as a group, the most important predictors of the belief that meat is intrinsically unhealthy were the perceived benefits of vegetarian diets (all positive predictors). These included: (1) the perceived links between vegetarianism, peace and increased contentment; (2) animal welfare and environmental benefits; and (3) health benefits. There were differences between different dietary groups however. For non-vegetarians, social concerns about vegetarianism (positive) were most important, followed by health and non-health benefits (positive) of vegetarianism. Red meat appreciation was the strongest (positive) predictor for vegetarians, with health benefits of vegetarianism (positive) and education (negative predictor) also important.

Conclusions: The implications of the findings for health and other issues are discussed. Judgements about the healthiness of meat are likely to be related to moral and environmental beliefs and, for non-vegetarians, to social concerns about vegetarianism, in addition to health beliefs. These need to be considered if any attempts are made to influence meat consumption.

Meat consumption among 18-month-old children participating in the Childhood Asthma Prevention Study

Objective: To document meat consumption among 18-month-old children, for use in refining population dietary assessment methods and dietary guidance for young children.

Design: A secondary analysis of data collected in 1998-2000 from the 18 months follow up of the Childhood Asthma Prevention Study: an intervention trial of omega-3 oil supplementation and house-dust mite reduction, from birth to five years.

Subjects and setting: Pregnant women whose unborn children had an atopic family history were recruited from antenatal clinics of six hospitals in western Sydney. Carers of 429 18-month-old children (80% response) satisfactorily completed three-day weighed food records.

Main outcome measures: Mean and median intakes per day and portion sizes of various meats and meat products.

Statistical analyses: T-tests for comparing gender differences; Pearson correlation and one-way analysis of variance for relationships between meat and nutrient intake.

Results: During the recording period 94% of the children ate meat. McDonald's Chicken McNuggets^TM, beef mince, and beef sausages were the most frequently consumed meats. Median portion sizes ranged from 20-50 g, and were considerably smaller than 'usual' portions specified on food frequency questionnaires in common use. Higher meat diets in this age group were not associated with higher intakes of iron or zinc per MJ.

Conclusion: The marginally low intakes of iron and zinc in this age group could be improved by greater use of cuts of red meat appropriately prepared for toddlers.

Determination of astaxanthin steroisomers and colour attributes in flesh of rainbow trout (Oncorhynchus mykiss) as a tool to distinguish the dietary pigmentation source

The presence of carotenoids in animal tissue reflects their sources along the food chain. Astaxanthin, the main carotenoid used for salmonid pigmentation, is usually included in the feed as a synthetic product. However, other dietary sources of astaxanthin such as shrimp or krill wastes, algae meal or yeasts are also available on the market. Astaxanthin possesses two identical asymmetric atoms at C-3 and C-3' making possible three optical isomers with all-trans configuration of the chain: 3S,3'S, 3R,3'S, and 3R,3'R. The distribution of the isomers in natural astaxanthin differs from that of the synthetic product. This latter is a racemic mixture, with a typical ratio of 1:2:1 (3S,3'S:3R,3'S:3R,3'R), while astaxanthin from natural sources has a variable distribution of the isomers deriving from the different biological organism that synthesized it. The high-performance liquid chromatographic (HPLC) analysis of all-trans isomers of astaxanthin was performed in different pigment sources, such as red yeast Phaffia rhodozyma, alga meal Haematococcus pluvialis, krill meal and oil, and shrimp meal. With the aim to investigate astaxanthin isomer ratios in flesh of fish fed different carotenoid sources, three groups of rainbow trout were fed for 60 days diets containing astaxanthin from synthetic source, H. pluvialis algae meal and P. rhodozyma red yeast. Moreover, the distribution of optical isomers of astaxanthin in trout purchased on the Italian market was investigated. A characteristic distribution of astaxanthin stereoisomers was detected for each pigment sources and such distribution was reproduced in the flesh of trout fed with that source. Colour values measured in different sites of fillet of rainbow trout fed with different pigment sources showed no significant differences. Similarly, different sources of pigment (natural or synthetic) produced colour values of fresh fillet with no relevant or significant differences. The coefficient of distance computed amongst the feed ingredient and the trout fillet astaxanthin stereoisomers was a useful tool to identify the origin of the pigment used on farm.

Dietary intakes and food sources of Omega-6 and Omega-3 polyunsaturated fatty acids.

Both n−6 and n−3 polyunsaturated fatty acids (PUFA) are recognized as essential nutrients in the human diet, yet reliable data on population intakes are limited. The aim of the present study was to ascertain the dietary intakes and food sources of individual n−6 and n−3 PUFA in the Australian population. An existing database with fatty acid composition data on 1690 foods was updated with newly validated data on 150 foods to estimate the fatty acid content of foods recorded as eaten by 10,851 adults in the 1995 Australian National Nutrition Survey. Average daily intakes of linoleic (LA), arachidonic (AA), α-linolenic (LNA), eicosapentaenoic (EPA), docosapentaenoic (DPA), and docosahexaenoic (DHA) acids were 10.8, 0.052, 1.17, 0.056, 0.026, and 0.106 g, respectively, with longchain (LC) n−3 PUFA (addition of FPA, DPA, and DHA) totaling 0.189 g; median intakes were considerably lower (9.0 g LA, 0.024 g AA, 0.95 g LNA, 0.008 g EPA, 0.006 g DPA, 0.015 g DHA, and 0.029 g LC n−3 PUFA). Fats and oils, meat and poultry, cereal-based products and cereals, vegetables, and nuts and seeds were important sources of n−6 PUFA, while cereal-based products, fats and oils, meat and poultry, cereals, milk products, and vegetable products were sources of LNA. As expected, seafood was the main source of LC n−3 PUFA, contributing 71%, while meat and eggs contributed 20 and 6%, respectively. The results indicate that the majority of Australians are failing to meet intake recommendations for LC n−3 PUFA (>0.2 g per day) and emphasize the need for strategies, to increase the availability and consumption of n−3-containing foods.

Fatty acid composition of habitual omnivore and vegetarian diets

High-fat diets are implicated in the onset of cardiovascular disease (CVD), cancer, and obesity. Large intakes of saturated and trans FA, together with low levels of PUFA, particularly long-chain (LC) omega-3 (n−3) PUFA, appear to have the greatest impact on the development of CVD. A high n−6∶n−3 PUFA ratio is also considered a marker of elevated risk of CVD, though little accurate data on dietary intake is available. A new Australian food  composition database that reports FA in foods to two decimal places was used to assess intakes of FA in four habitual dietary groups. Analysis using the database found correlations between the dietary intakes of LC n−3 PUFA and the plasma phospholipid LC n−3 PUFA concentrations of omnivore and vegetarian subjects. High meat-eaters (HME), who consumed large  amounts of food generally, had significantly higher LC n−3 PUFA intakes (0.29 g/d) than moderate meat-eaters (MME) (0.14 g/d), whose intakes in turn were significantly higher than those of ovolacto-vegetarians or vegans (both 0.01 g/d). The saturated FA intake of MME subjects (typical of adult male Australians) was not different from ovolacto-vegetarian intakes, whereas n−6∶n−3 intake ratios in vegetarians were significantly higher than in omnivores. Thus, accurate dietary and plasma FA analyses suggest that regular moderate consumption of meat and fish maintains a plasma FA profile possibly more conducive to good health.

An index of diet and eating patterns is a valid measure of diet quality in an Australian population

Diet indices represent an integrated approach to assessing eating patterns and behaviors. The aim of this study was to develop a comprehensive food-based dietary index to reflect adherence to healthy eating recommendations, evaluate the construct validity of the index using nutrient intakes, and evaluate this index in relation to sociodemographic factors, health behaviors, risk factors, and self-assessed health status. Data were analyzed from adult participants of the Australian National Nutrition Survey who completed a 108-item FFQ and a food habits questionnaire (n = 8220). The dietary guideline index (DGI) consisted of 15 items reflecting the dietary guidelines, including dietary indicators of vegetables and legumes, fruit, total cereals, meat and alternatives, total dairy, beverages, sodium, saturated fat, alcoholic beverages, and added sugars. Diet quality was incorporated using indicators relating to whole-grain cereals, lean meat, reduced/low fat dairy, and dietary variety. We investigated associations between the DGI score, sociodemographic factors, health behaviors, chronic disease risk factors, and nutrient intakes. We found associations between the DGI scores and sex, age, income, area-level socioeconomic disadvantage, smoking, physical activity, waist:hip ratio, systolic blood pressure (males only), and self-assessed health status (females only) (all P < 0.05). Higher DGI scores were associated with lower intakes of energy, total fat, and saturated fat and higher intakes of fiber, β-carotene, vitamin C, folate, calcium, and iron (P < 0.05). This food-based dietary index is able to discriminate across a variety of sociodemographic factors, health behaviors, and self-assessed health and reflects intakes of key nutrients.

In vitro bioactivity evaluation of titanium and niobium metals with different surface morphologies

Current orthopaedic biomaterials research mainly focuses on designing implants that could induce controlled, guided and rapid healing. In the present study, the surface morphologies of titanium (Ti) and niobium (Nb) metals were tailored to form nanoporous, nanoplate and nanofibre-like structures through adjustment of the temperature in the alkali-heat treatment. The in vitro bioactivity of these structures was then evaluated by soaking the treated samples in simulated body fluid (SBF). It was found that the morphology of the modified surface significantly influenced the apatite-inducing ability. The Ti surface with a nanofibre-like structure showed better apatite-inducing ability than the nanoporous or nanoplate surface structures. A thick dense apatite layer formed on the Ti surface with nanofibre-like structure after 1 week of soaking in SBF. It is expected that the nanofibre-like surface could achieve good apatite formation in vivo and subsequently enhance osteoblast cell adhesion and bone formation.

Overweight children have poor bone strength relative to body weight, placing them at greater risk for forearm fractures

Introduction: Obesity is thought to be a protective factor for bones in adults but not in children based on the evidence of the greater incidence of forearm fractures in obese children. Our objective was to investigate the effect of adiposity on bone strength in relation to the mechanical challenge placed onto the forearm bones in case of a fall.

Methods: Cross sectional areas (CSA) were obtained at the mid- and distal radius by peripheral quantitative computed tomography in 486 children (241 boys), mean age 8.3 years (range 6.9–9.7), participating in the LOOK Project. The following parameters were measured: bone mass and bone CSA (both sites), and muscle and fat CSA (mid-forearm only). Bone strength indices combining bone size and total volumetric density were calculated at each site.

Results/Discussion: Overweight children (BMI > percentile equivalent to 25 kg/m² in adults) have higher bone parameters than normal-weight peers (Z-scores +0.6 to +0.9SD, p < 0.0001). These differences disappear after adjustment for muscle CSA. Adiposity (fat CSA/muscle CSA) was negatively correlated with bone mass, size and strength at the distal radius only (r = −0.1, p < 0.05). After adjustment for body weight (estimate of the load during a fall), the negative correlations were stronger and observed at both the mid- and distal radius (r = −0.37 to −0.55, p < 0.0001).

Conclusion. Overweight children have stronger bones due to greater muscle size. However, children with high fat mass relative to muscle mass (increased adiposity) have poorer bone strength, independent of weight, which may contribute to the increased risk of fracture in obese children.

Tissue donation and the attitudes of health care professionals

Since the first corneal transplant in 1905, improved surgical techniques and the development of immunosuppressive drugs have led to excellent success rates for organ and tissue transplantation procedures. This Chapter ,"'ill focus on the cadaveric donation of tissue and the attitudes towards it of health professionals, because they are key players in the donation- transplantation process.

The chapter begins with an overview of cadaveric tissue donation, including what can currently be transplanted. It will then present what is known about health professionals' attitudes to and knowledge of tissue donation and the impact that these have on donation rates. Attitudes, their components and their effect upon behaviour are explored using theories arising from social psychology to explain how these influence actual or intended behaviours associated with the discussion of donation wishes with relatives of the potential donor. Since some tissues, such as blood and bone marrow, can only normally be donated during life, these will be excluded since the behaviours associated with blood donation differ significantly from those associated with cadaveric tissue donation.

Takeaway food consumption and its associations with diet quality and abdominal obesity : a cross-sectional study of young adults

Background : Few studies have investigated the associations of takeaway food consumption with overall diet quality and abdominal obesity. Young adults are high consumers of takeaway food so we aimed to examine these associations in a national study of young Australian adults.

Methods : A national sample of 1,277 men and 1,585 women aged 26–36 completed a self-administered questionnaire on demographic and lifestyle factors, a 127 item food frequency questionnaire, usual daily frequency of fruit and vegetable consumption and usual weekly frequency of takeaway food consumption. Dietary intake was compared with the dietary recommendations from the Australian Guide to Healthy Eating. Waist circumference was measured for 1,065 men and 1,129 women. Moderate abdominal obesity was defined as ≥ 94 cm for men and ≥ 80 cm for women. Prevalence ratios (PR) were calculated using log binomial regression. Takeaway food consumption was dichotomised, with once a week or less as the reference group.

Results : Consumption of takeaway food twice a week or more was reported by more men (37.9%) than women (17.7%, P < 0.001). Compared with those eating takeaway once a week or less, men eating takeaway twice a week or more were significantly more likely to be single, younger, current smokers and spend more time watching TV and sitting, whereas women were more likely to be in the workforce and spend more time watching TV and sitting. Participants eating takeaway food at least twice a week were less likely (P < 0.05) to meet the dietary recommendation for vegetables, fruit, dairy, extra foods, breads and cereals (men only), lean meat and alternatives (women only) and overall met significantly fewer dietary recommendations (P < 0.001). After adjusting for confounding variables (age, leisure time physical activity, TV viewing and employment status), consuming takeaway food twice a week or more was associated with a 31% higher prevalence of moderate abdominal obesity in men (PR: 1.31; 95% CI: 1.07, 1.61) and a 25% higher prevalence in women (PR: 1.25; 95% CI: 1.04, 1.50).

Conclusion : Eating takeaway food twice a week or more was associated with poorer diet quality and a higher prevalence of moderate abdominal obesity in young men and women.

Age does not influence the bone response to treadmill exercise in female rats

Purpose: Because it is believed that bone may respond to exercise differently at different ages, we compared bone responses in immature and mature rats after 12 wk of treadmill running.

Methods: Twenty-two immature (5-wk-old) and 21 mature (17-wk-old) female Sprague Dawley rats were randomized into a running (trained, N = 10 immature, 9 mature) or a control group (controls, N = 12 immature, 12 mature) before sacrifice 12 wk later. Rats ran on a treadmill five times per week for 60-70 min at speeds up to 26 m[middle dot]min-1. Both at baseline and after intervention, we measured total body, lumbar spine, and proximal femoral bone mineral, as well as total body soft tissue composition using dual-energy x-ray absorptiometry (DXA) in vivo. After sacrificing the animals, we measured dynamic and static histomorphometry and three-point bending strength of the tibia.

Results: Running training was associated with greater differences in tibial subperiosteal area, cortical cross-sectional area, peak load, stiffness, and moment of inertia in immature and mature rats (P < 0.05). The trained rats had greater periosteal bone formation rates (P < 0.01) than controls, but there was no difference in tibial trabecular bone histomorphometry. Similar running-related gains were seen in DXA lumbar spine area (P = 0.04) and bone mineral content (BMC;P = 0.03) at both ages. For total body bone area and BMC, the immature trained group increased significantly compared with controls (P < 0.05), whereas the mature trained group gained less than did controls (P < 0.01).

Conclusion: In this in vivo model, where a similar physical training program was performed by immature and mature female rats, we demonstrated that both age groups were sensitive to loading and that bone strength gains appeared to result more from changes in bone geometry than from improved material properties.