Cholesterol-lowering therapy with pravastatin in patients with average cholesterol levels and established ischaemic heart disease: is it cost-effective?

Objective: To measure the cost-effectiveness of cholesterol-lowering therapy with pravastatin in patients with established ischaemic heart disease and average baseline cholesterol levels. Design: Prospective economic evaluation within a double-blind randomised trial (Long-Term Intervention with Pravastatin in Ischaemic Disease [LIPID]), in which patients with a history of unstable angina or previous myocardial infarction were randomised to receive 40 mg of pravastatin daily or matching placebo. Patients and setting: 9014 patients aged 35-75 years from 85 centres in Australia and New Zealand, recruited from June 1990 to December 1992. Main outcome measures: Cost per death averted, cost per life-year gained, and cost per quality-adjusted life-year gained, calculated from measures of hospitalisations, medication use, outpatient visits, and quality of life. Results: The LIPID trial showed a 22% relative reduction in all-cause mortality (P < 0.001). Over a mean follow-up of 6 years, hospital admissions for coronary heart disease and coronary revascularisation were reduced by about 20%. Over this period, pravastatin cost $A4913 per patient, but reduced total hospitalisation costs by $A1385 per patient and other long-term medication costs by $A360 per patient. In a subsample of patients, average quality of life was 0.98 (where 0 = dead and 1 = normal good health); the treatment groups were not significantly different. The absolute reduction in all-cause mortality was 3.0% (95% CI, 1.6%-4.4%), and the incremental cost was $3246 per patient, resulting in a cost per life saved of $107730 (95% Cl, $68626-$209881) within the study period. Extrapolating long-term survival from the placebo group, the undiscounted cost per life-year saved was $7695 (and $10 938 with costs and life-years discounted at an annual rate of 5%). Conclusions: Pravastatin therapy for patients with a history of myocardial infarction or unstable angina and average cholesterol levels reduces all-cause mortality and appears cost effective compared with accepted treatments in high-income countries.

Tracing the fate of N-15-enriched feed in an intensive shrimp system

The fate of N-15-nitrogen-enriched formulated feed fed to shrimp was traced through the food web in shallow, outdoor tank systems (1000 1) stocked with shrimp. Triplicate tanks containing shrimp water with and without sediment were used to identify the role of the natural biota in the water column and sediment in processing dietary nitrogen (N). A preliminary experiment demonstrated that N-15-nitrogen-enriched feed products could be detected in the food web. Based on this, a 15-day experiment was conducted. The ammonium (NH4+) pool in the water column became rapidly enriched (within one day) with N-15-nitrogen after shrimp were fed N-15-enriched feed. By day 15, 6% of the added N-15-nitrogen was in this fraction in the 'sediment' tanks compared with 0.4% in the 'no sediment' tanks. The particulate fraction in the water column, principally autotrophic nanoflagellates, accounted for 4-5% of the N-15-nitrogen fed to shrimp after one day. This increased to 16% in the 'no sediment' treatment, and decreased to 2% in the 'sediment' treatment by day 15. It appears that dietary N was more accessible to the phytoplankton community in the absence of sediment. The difference is possibly because a proportion of the dietary N was buried in the sediment in the 'sediment' treatment, making it unavailable to the phytoplankton. Alternatively, the dietary N was retained in the NH4+ pool in the water column since phytoplankton growth, and hence, N utilization was lower in the 'sediment' treatment. The lower growth of phytoplankton in the 'sediment' treatment appeared to be related to higher turbidity, and hence, lower light availability for growth. The percentage N-15-nitrogen detected in the sediment was only 6% despite the high capacity for sedimentation of the large biomass of plankton detritus and shrimp waste. This suggests rapid remineralization of organic waste by the microbial community in the sediment resulting in diffusion of inorganic N sources into the water column. It is likely that most of the dietary N will ultimately be removed from the tank system by water discharges. Our study showed that N-15-nitrogen derived from aquaculture feed can be processed by the microbial community in outdoor aquaculture systems and provides a method for determining the effect of dietary N on ecosystems. However, a significant amount of the dietary N was not retained by the natural biota and is likely to be present in the soluble organic fraction. (C) 2002 Elsevier Science B.V. All rights reserved.

The effects of level of dietary protein on the milk production and rumen physiology of dairy cows fed a diet based on a tropical grass hay

zFour rumen-fistulated, multiparous Holstein-Friesian cows in early lactation were offered mixed diets based on rhodes grass hay (Chloris gayana) cv. Callide containing 13, 14, 15 or 16% crude protein (CP) on a dry matter basis, in a 4 x 4 latin square design. The estimated undegradable protein concentration in these diets was similar with rumen degradable protein concentration varying. Cows fed a diet containing 13% CP had lower (P = 0.07) milk yields than cows in other treatments (20.4 vs 21.9, 22.0 and 22.2 L/d for 13, 14, 15 and 16% CP, respectively). A positive linear relationship was found (P = 0.06) between organic matter intake and dietary CP%. There were negative linear relationships between dietary CP% and digestibilities of dry matter (P = 0.09), organic matter (P = 0.06) and neutral detergent fibre (P = 0.02). Feeding a diet containing 13% CP resulted in significantly lower (P = 0.001) molar proportions (%) of rumen valerate in comparison with other treatments. The molar proportions of isovalerate differed (P = 0.001) between treatments (0.66, 0.78, 0.89 and 1.04%) for 13, 14, 15 and 16% CP, respectively). Dietary protein level had no effect on rates of passage, in situ digestion of rhodes grass hay or ratios of allantoin: creatinine in urine. These data showed that increasing the dietary CP concentration of lactating cows fed diets based on rhodes grass hay increased intakes and not significantly improved at dietary CP concentrations above 14% DM.

Low-density koala (Phascolarctos cinereus) populations in the mulgalands of south-west Queensland. II. Distribution and diet

This study used faecal pellets to investigate the broadscale distribution and diet of koalas in the mulgalands biogeographic region of south-west Queensland. Koala distribution was determined by conducting faecal pellet searches within a 30-cm radius of the base of eucalypts on 149 belt transects, located using a multi-scaled stratified sampling design. Cuticular analysis of pellets collected from 22 of these sites was conducted to identify the dietary composition of koalas within the region. Our data suggest that koala distribution is concentrated in the northern and more easterly regions of the study area, and appears to be strongly linked with annual rainfall. Over 50% of our koala records were obtained from non-riverine communities, indicating that koalas in the study area are not primarily restricted to riverine communities, as has frequently been suggested. Cuticular analysis indicates that more than 90% of koala diet within the region consists of five eucalypt species. Our data highlights the importance of residual Tertiary landforms to koala conservation in the region.

Evidence for a QTL on chromosome 19 influencing LDL cholesterol levels in the general population

The genetic basis of cardiovascular disease (CVD) with its complex etiology is still largely elusive. Plasma levels of lipids and apolipoproteins are among the major quantitative risk factors for CVD and are well-established intermediate traits that may be more accessible to genetic dissection than clinical CVD end points. Chromosome 19 harbors multiple genes that have been suggested to play a role in lipid metabolism and previous studies indicated the presence of a quantitative trait locus (QTL) for cholesterol levels in genetic isolates. To establish the relevance of genetic variation at chromosome 19 for plasma levels of lipids and apolipoproteins in the general, out-bred Caucasian population, we performed a linkage study in four independent samples, including adolescent Dutch twins and adult Dutch, Swedish and Australian twins totaling 493 dizygotic twin pairs. The average spacing of short-tandem-repeat markers was 6 - 8 cM. In the three adult twin samples, we found consistent evidence for linkage of chromosome 19 with LDL cholesterol levels ( maximum LOD scores of 4.5, 1.7 and 2.1 in the Dutch, Swedish and Australian sample, respectively); no indication for linkage was observed in the adolescent Dutch twin sample. The QTL effects in the three adult samples were not significantly different and a simultaneous analysis of the samples increased the maximum LOD score to 5.7 at 60 cM pter. Bivariate analyses indicated that the putative LDL-C QTL also contributed to the variance in ApoB levels, consistent with the high genetic correlation between these phenotypes. Our study provides strong evidence for the presence of a QTL on chromosome 19 with a major effect on LDL-C plasma levels in outbred Caucasian populations.

GLUT4 recycles via a trans-Golgi network (TGN) subdomain enriched in Syntaxins 6 and 16 but not TGN38: Involvement of an acidic targeting motif

Insulin stimulates glucose transport in fat and muscle cells by triggering exocytosis of the glucose transporter GLUT4. To define the intracellular trafficking of GLUT4, we have studied the internalization of an epitope-tagged version of GLUT4 from the cell surface. GLUT4 rapidly traversed the endosomal system en route to a perinuclear location. This perinuclear GLUT4 compartment did not colocalize with endosomal markers (endosomal antigen I protein, transferrin) or TGN38, but showed significant overlap with the TGN target (t)-soluble N-ethylmaleimide-sensitive factor attachment protein receptors (SNAREs) Syntaxins 6 and 16. These results were confirmed by vesicle immunoisolation. Consistent with a role for Syntaxins 6 and 16 in GLUT4 trafficking we found that their expression was up-regulated significantly during adipocyte differentiation and insulin stimulated their movement to the cell surface. GLUT4 trafficking between endosomes and trans-Golgi network was regulated via an acidic targeting motif in the carboxy terminus of GLUT4, because a mutant lacking this motif was retained in endosomes. We conclude that GLUT4 is rapidly transported from the cell surface to a subdomain of the trans-Golgi network that is enriched in the t-SNAREs Syntaxins 6 and 16 and that an acidic targeting motif in the C-terminal tail of GLUT4 plays an important role in this process.

The trans-membrane protein p25 forms highly specialized domains that regulate membrane composition and dynamics

Trans-membrane proteins of the p24 family are abundant, oligomeric proteins predominantly found in cis-Golgi membranes. They are not easily studied in vivo and their functions are controversial. We found that p25 can be targeted to the plasma membrane after inactivation of its canonical KKXX motif (KK to SS, p25SS), and that p25SS causes the co-transport of other p24 proteins beyond the Golgi complex, indicating that wild-type p25 plays a crucial role in retaining p24 proteins in cis-Golgi membranes. We then made use of these observations to study the intrinsic properties of these proteins, when present in a different membrane context. At the cell surface, the p25SS mutant segregates away from both the transferrin receptor and markers of lipid rafts, which are enriched in cholesterol and glycosphingolipids. This suggests that p25SS localizes to, or contributes to form, specialized membrane domains, presumably corresponding to oligomers of p25SS and other p24 proteins. Once at the cell surface, p25SS is endocytosed, together with other p24 proteins, and eventually accumulates in late endosomes, where it remains confined to well-defined membrane regions visible by electron microscopy. We find that this p25SS accumulation causes a concomitant accumulation of cholesterol in late endosomes, and an inhibition of their motility - two processes that are functionally linked. Yet, the p25SS-rich regions themselves seem to-exclude not only Lamp1 but also accumulated cholesterol. One may envision that p25SS accumulation, by excluding cholesterol from oligomers, eventually overloads neighboring late endosomal membranes with cholesterol beyond their capacity (see Discussion). In any case, our data show that p25 and presumably other p24 proteins are endowed with the intrinsic capacity to form highly specialized domains that control membrane composition and dynamics. We propose that p25 and other p24 proteins control the fidelity of membrane transport by maintaining cholesterol-poor membranes in the Golgi complex.

Dietary interactions influence the effects of bovine folate-binding protein on the bioavailability of tetrahydrofolates in rats

The newborns of mammals have a high folate demand, yet obtain adequate folate nutrition solely from their mothers' milk despite its low folate content. Milk folate is entirely bound by an excess of folate-binding protein (FBP), prompting speculation that FBP may affect the bioavailability of the limited folate supply. Previous research has shown that FBP-bound folic acid is more gradually absorbed, thereby reducing the peak plasma folate concentration and preventing loss into the urine. Natural folates are reduced derivatives of folic acid, with milk predominantly containing 5-methyltetrahydrofolate, yet little research has been carried out to determine the role of FBP in the bioavailability of reduced folates. We studied the effect of FBP on folate nutrition of rats in both single-dose and 4-wk feeding experiments. The effect of FBP was influenced by the presence of other milk components. FBP increased bioavailability of dietary folate when it was consumed with other whey proteins or with soluble casein. However, in the presence of acid-precipitated casein or a whey preparation enriched in lipids, bioavailability was decreased. These results highlight the difficulties of extrapolating from experimental results obtained using purified diets alone and of studying interactions among dietary components. They suggest that the addition of FBP-rich foods to folate-rich foods could enhance the bioavailability of natural folates, but that the outcome of such a combination would depend on interactions with other components of the diet.

Racionaliza????o e manuten????o da qualidade alimentar do Servi??o de Nutri????o e Diet??tica (SND)

A crise econ??mica que atravess??vamos foi a mola propulsora para desenvolvermos o projeto Racionaliza????o/Manuten????o da Qualidade Alimentar do Servi??o de Nutri????o e Diet??tica -SND do Hospital Escola. A dificuldade era tanta que nos obrigava a "cortar"os custos de um setor (que fornece uma m??dia mensal de 7.192 refei????es para os plantonistas de servi??o e, principalmente 54.764 refei????es para os pacientes do Hospital) envolvido diretamente, na recupera????o da sa??de dos pacientes. Portanto, era de fundamental import??ncia n??o diminuir a qualidade nutritiva dos alimentos fornecidos. Ent??o, o grande desafio seria: reduzir os custos, sem prejudicar o pronto restabelecimento dos pacientes. Ap??s amplo estudo, conclu??mos que seria necess??rio: simplificar e padronizar os procedimentos operacionais do Servi??o de Nutri????o e Diet??tica (SND); criar mecanismos de controle de acesso aos refeit??rios e encontrar formas alternativas de alimenta????o. Os resultados das medidas implantadas foram surpreendentes. Conseguimos uma redu????o nos custos na ordem de 20% (anexo 1). A mensagem final que gostar??amos de deixar para os nossos colegas Funcion??rios P??blicos ?? que as adversidades s??o essenciais para podermos "mexer" e este ato s?? ocorrer?? se, de fato, precisarmos faz??-lo em nosso benef??cio ou de nossos semelhantes ( o contribuinte que paga seus impostos)

Oral rapamycin attenuates atherosclerosis without affecting the arterial responsiveness of resistance vessels in apolipoprotein E-deficient mice

The objective of the present study was to assess the effects of the immunosuppressant rapamycin (Rapamune®, Sirolimus) on both resistance vessel responsiveness and atherosclerosis in apolipoprotein E-deficient 8-week-old male mice fed a normal rodent diet. Norepinephrine (NE)-induced vasoconstriction, acetylcholine (ACh)- and sodium nitroprusside (SNP)-induced vasorelaxation of isolated mesenteric bed, and atherosclerotic lesions were evaluated. After 12 weeks of orally administered rapamycin (5 mg·kg-1·day-1, N = 9) and compared with untreated (control, N = 9) animals, rapamycin treatment did not modify either NE-induced vasoconstriction (maximal response: 114 ± 4 vs 124 ± 10 mmHg, respectively) or ACh- (maximal response: 51 ± 8 vs 53 ± 5%, respectively) and SNP-induced vasorelaxation (maximal response: 73 ± 6 vs 74 ± 6%, respectively) of the isolated vascular mesenteric bed. Despite increased total cholesterol in treated mice (982 ± 59 vs 722 ± 49 mg/dL, P < 0.01), lipid deposition on the aorta wall vessel was significantly less in rapamycin-treated animals (37 ± 12 vs 68 ± 8 µm2 x 103). These results indicate that orally administered rapamycin is effective in attenuating the progression of atherosclerotic plaque without affecting the responsiveness of resistance vessels, supporting the idea that this immunosuppressant agent might be of potential benefit against atherosclerosis in patients undergoing therapy.

Estado nutricional e estilo de vida em vegetarianos e onívoros, Grande Vitória-ES

Objetivo: Descrever e analisar o estado nutricional e aspectos do estilo de vida de vegetarianos e onívoros residentes na Grande Vitória/ES, na faixa etária de 35 a 64 anos de idade. Material E Métodos: Trata-se de estudo observacional híbrido de casos prevalentes com avaliação retrospectiva da exposição. Os grupos de expostos (134) e não expostos à dieta onívora típica ocidental (67) foram determinados no início da investigação. Foram coletados dados antropométricos, bioquímicos, de atividade física e alimentação através de questionário e 3 recordatórios de 24 horas e diagnosticados sobrepeso, Razão Cintura Quadril (RCQ) inadequada e hipercolesterolemia. Colesterol total e frações, triglicerídeos, ácido úrico, sódio e potássio urinários foram comparados entre os grupos, através do teste t de Student. Foi usado o teste qui-quadrado para comparar proporções, com =0,05. Resultados: Foram encontradas diferenças significativas em relação à ocupação. Duração da atividade física e tempo assistindo televisão e/ou utilizando computador foram maiores entre os onívoros. Os vegetarianos relataram práticas alimentares mais saudáveis e menor consumo de lipídios, proteínas e sódio. Os onívoros apresentaram maior risco de sobrepeso, RCQ inadequada e hipercolesterolemia (valores de P<0,0001). HDL-colesterol não foi diferente nos grupos. Conclusão: Os vegetarianos apresentaram perfil nutricional mais adequado e menor risco para os agravos crônicos estudados, apesar de pequena diferença no padrão de atividade física regular entre os grupos estudados.

Efeito da jabuticaba (Myrciaria caulifora), do fruto da palmeira juçara (Euterpe edulis Martius) e do jambolão (Syzugium cumini) sobre o perfil lipídico, a glicemia e a endotoxemia em camundongos submetidos à dieta de cafeteria

O excesso de gordura corporal induz a um quadro inflamatório associado à endotoxemia metabólica e aumento da resistência à insulina, bem como altera o perfil lipídico que resulta em prejuízos a função hepática e renal. Estudos sugerem que a ingestão de alimentos antioxidantes, como os polifenóis, proporcionam efeitos benéficos sobre os metabolismos glicídico e lipídico. O objetivo deste estudo foi investigar o efeito da casca de jabuticaba (Myrciaria cauliflora), da polpa do açaí juçara (Euterpe edulis Martius) e do jambolão (Syzygium cumini) sobre o perfil lipídico, a glicemia e a endotoxemia em camundongos Swiss submetidos à dieta de cafeteria. Inicialmente, os frutos foram liofilizados e submetidos à avaliação da composição centesimal. O ensaio biológico contou com 50 camundongos machos adultos da raça Swiss distribuídos em 5 grupos (n=10/grupo), a saber: grupo tratado com dieta comercial padrão (controle negativo), grupo tratado com dieta de cafeteria (controle positivo) e grupos teste que receberam por 14 semanas a dieta de cafeteria suplementada com 2% de casca de jabuticaba, ou polpa do jambolão ou polpa do açaí juçara liofilizados. Na 13ª e 14ª semana foram determinadas a tolerância à insulina e à glicose dos animais. Ao final do período experimental, avaliaram-se o ganho de peso, os parâmetros bioquímicos sanguíneos, histopatológicos e endotoxemia. Os parâmetros bioquímicos avaliados foram: colesterol total (CT) e as frações HDL-c, LDL-c, triacilgliceróis (TAG), bem como proteína C reativa (PCR), aspartato aminotransferase (AST) e alanina aminotransferase (ALT). Na histopatologia foram avaliados os efeitos da dieta hipercalórica sobre a área dos adipócitos, esteatose hepática e função renal a partir do número e área dos glomérulos. A endotoxemia foi avaliada pela concentração de lipopolissacarídeos (LPS) no soro dos animais. Aplicou-se o teste t para comparação dos resultados entre os grupos controle e ANOVA, complementada com teste de Tukey (α=5%), para comparação dos grupos suplementados com os frutos e o controle positivo. A suplementação com 2% de jambolão à dieta de cafeteria resultou em redução significativa (p<0,05) do conteúdo de CT, LDL-c, TAG, da razão CT/HDL, bem como diminuição da área dos adipócitos dos animais tratados com os frutos. A suplementação com açaí juçara também foi capaz de reduzir o conteúdo de CT, TAG e a área dos adipócitos, além de elevar a tolerância à glicose. Por outro lado, a jabuticaba não foi eficaz na melhoria dos parâmetros relacionados ao metabolismo lipídico, ao metabolismo da glicose e dos aspectos histopatológicos. A suplementação com 2% dos frutos liofilizados não promoveu efeitos positivos na redução do ganho de peso, resistência à insulina e endotoxemia provocada pela ingestão da dieta de cafeteria. Além disso, os frutos também não foram eficientes na preservação da histologia renal e infiltração lipídica no fígado. Conclui-se que a inclusão do jambolão e do açaí juçara na dieta pode apresentar efeitos positivos sobre danos causados por dietas hiperlipídicas, especialmente no que se refere à dislipidemia, à tolerância à glicose e à hipertrofia dos adipócitos.