Search

Exclusive enteral nutrition is established as an initial therapy to induce remission in active Crohn’s disease (CD), especially in children, but the mechanisms of action of this therapy are yet to be fully defined. CEACAM6 protein is an adhesion molecule that is up-regulated in active CD and implicated in the attachment of adherent-invasive Escherichia coli (AIEC) to the gut epithelium. Using the Caco-2 human adenocarcinoma cell line, this study showed that the incubation of human cells with a polymeric formula (PF) resulted in a dose-dependent increase in the expression of CEACAM6, and that this effect was most noticeable on the cell surface. Further investigation revealed that PF doubled the release of CEACAM6 protein by Caco-2 cells exposed to PF, and that an increase in release of soluble CEACAM6 inversely correlated with the ability of AIEC to associate with the intestinal epithelial cells. Our findings suggest that the secretion of cell surface-associated proteins acting as releasable decoys may be an aspect of the gut’s innate immune response to pathogenic bacteria that is strengthened by PF in the setting of CD.

We examined whether four patient characteristics (age, ethnicity, sex and appearance) influenced five physician behaviors with the patient (interviewing, nonverbal attention, courtesy, information giving and empathy). Ten physician-patient interactions were observed through a one-way mirror for each of 15 physicians. Physicians were rated higher on information giving (p = 0.002) and empathic skills (p = 0.02) when they were with female patients; on interviewing (p = 0.02) and empathy (p = 0.0007) with Anglo-American compared with Spanish-American patients; on interviewing (p = 0.01), nonverbal attention (p = 0.001) and courtesy (p = 0.02) when with the best groomed patients; and on courtesy (p = 0.03) with elderly patients. In addition, there were fewer physician-initiated interruptions with female patients (p = 0.03) and with well-groomed patients (p = 0.02). Each of the four patient characteristics studied acted independently in influencing physician behavior. The recognition that patient characteristics influence physician behavior should stimulate physicians to examine their reactions in order to insure that all types of patients receive thorough, courteous and empathic care.

The association between diet and degree of concern about dietary cholesterol was examined in a group of 244 healthy elderly persons. Specifically, it was thought that a concern about cholesterol might result in diets that exclude essential nutrients, such as calcium and vitamin D, that are found in foods that also contain cholesterol. 70% of this group indicated a concern about dietary cholesterol; 18% were “very concerned”. Over half of these elderly thought that dietary cholesterol contributed to heart disease, atherosclerosis and high blood pressure. Many indicated that they were restricting their intake of certain foods because of cholesterol. This response was strongly associated with degree of concern about cholesterol. It was found that those who were concerned about cholesterol had lower intakes of cholesterol, total fat, saturated fat and total calories, and greater intakes of vitamin D. However, no other significant associations with diet were found.

An investigation into social relationships and their connection to health was integrated into a 5-year prospective study of nutrition and immunobiology in 300 healthy elderly persons. The data were collected from a subsample of 40 individuals by interview, using the Interview Schedule for Social Interaction (ISSI), the Rotter I-E Locus of Control Scale, and the Multidimensional Health Locus of Control Scale (MHLC). This group did not differ from the general population in terms of their social relationships. The mean locus of control expectancy score was 6.5 +/- 3.3, indicating an internal group. There was a statistically significant relationship between internality and availability of social integration, but no differences based upon sex or age for the ISSI or Rotter's I-E Locus of Control Scale.

Two hundred thirty full-term infants entered a feeding-growth study at birth. Human milk or infant formula provided essentially all calories consumed during the first 6 months of life, after which partially skimmed milk or a reduced fat formula and solid foods were consumed. Both sex and feeding had significant effect on gain in length and weight during the first 9 months. The NCHS reference data may not be entirely appropriate for evaluation of growth of infants fed according to current recommendations.

This study examined how high-density lipoprotein-cholesterol (HDL-C) correlated with a 3-day food record of fat, protein, carbohydrate, and alcohol consumption in a group of 270 healthy subjects over age 60. HDL-C concentrations correlated with alcohol consumption (expressed as grams/day) (r = + .25, P less than .001), and inversely with total carbohydrate (r = - .18, P less than .01) and refined carbohydrate (r = - .17, P less than .01) ingestion (expressed as a percent of total caloric intake). Subjects consuming diets low in either total carbohydrate or refined carbohydrate had 10 to 20% higher HDL-C levels than did those consuming diets high in these food substances. The relationships between HDL-C levels and alcohol and carbohydrate ingestion were independent of other variables which correlated with HDL-C levels. Dietary fat (total fat, saturated fat, unsaturated fat, and cholesterol) did not correlate with HDL-C. LDL-cholesterol and triglyceride levels did not correlate with any dietary variable measured.

The behavior of 15 internal medicine residents, each with 10 patients, was observed through a one-way mirror. Ratings by the patients of satisfaction with their physicians were also obtained. Patient satisfaction correlated strongly with ratings for physician courtesy and information-giving, Nonverbal behaviors such as eye contact, bodily positioning, and physical contact did not correlate with patient satisfaction. The correlations between physician behavior and patient satisfaction did not hold for the four women physicians studied.The behavior of 15 internal medicine residents at the University of New Mexico Hospital, each with 10 patients, was observed through a 1-way mirror and the 150 patients rated their satisfaction with their physician. The mean ratings of patient satisfaction were between 6 and 7 on a 7-point scale. Satisfaction ratings did not vary significantly between male or female patients or between Hispanics and Anglos, although patients under 40 years of age tended to provide lower ratings than those over this age. Patient satisfaction correlated highly with physician courtesy (formal greeting and formal closure of the interview) and with information giving. Listening behavior also correlated with patient satisfaction. Physician empathy correlated only weakly with patient satisfaction, while physical attention (eye contact and body positioning) did not correlate at all with this factor. Additional factors that were not significant determinants of patient satisfaction in this study included the physical appearance of the physician, the total time of physician-patient interaction, and the amount of physical contact between patient and physician. There were no significant differences between male and female physicians in the mean ratings of caring behaviors or satisfaction. The satisfaction scores of male patients with female physicians were the same as patients of either sex with male physicians; however, female patients expressed greater satisfaction with their female physicians than did male patients with female physicians or female patients with male physicians. This study confirms the findings of earlier investigators that patient satisfaction is beneficially influenced by friendliness and information provision on the part of the physician.

Dietary and supplemental intakes were assessed from 3-day food records collected from 270 free-living, middle income and healthy men and women over 60 yr of age residing in the Albuquerque, NM vicinity. The 1980 Recommended Dietary Allowances (RDA) were used to assess adequacy of intake. Energy intake, as percentage of the RDA, was 90 +/- 23 (mean +/- SD) for men (n = 125) and 87 +/- 22 for women (n = 145). Mean daily protein intake was 83 g for men and 67 g for women and only 11% of men and 14% of women failed to receive at least 100% of the RDA for protein. Frequency and amount of vitamin and mineral supplementation was substantial. Approximately 60% of both men and women ingested one or more supplements; vitamins C and E were the most popular. In general, dietary intakes in this population appear to be adequate with the possible exception of vitamin D and calcium intakes in women.

Excerpt To the editor: The provocative editorial by Platt (1) properly emphasizes the importance of the medical interview and the need for further research. As Platt points out, patients incessantl...

This study was designed to obtain information on normal dietary intake and serum levels of choline in a healthy elderly population and to observe the relationship between blood levels of choline and cognitive function. Two hundred fifty-eight healthy volunteers with a mean age of 72 years were recruited, and blood samples and dietary histories were obtained. All subjects were ambulatory, living at home, free of serious medical illnesses, and taking no prescription medications. Cognitive abilities were assessed by the Halstead Category Test, a nonverbal test measuring abstract thinking, and the Wechsler Memory Scale, using the multiple scoring method, which measures both long- and short-term memory. The mean value for serum choline was 13.16 micron with a standard deviation of 3.31. Serum choline levels were found to increase with age, but no difference was found between serum choline levels for men and women. There was no association between dietary intake and serum choline levels, nor could a relationship be found between serum choline levels and cognitive function.

or nonspecific "digestive problems," may in fact be caused by mild dumping. We believe that transient dumping may occur more frequently than is recognized. By wrapping less fundus around the esophagus and preserving the lesser omentum, inadvertent vagotomy can be avoided with the same good antireflux result and without producing the complication of dumping. Awareness of this possibility in the pediatric patient who has postprandial gastrointestinal symptoms, sweating, and tachycardia associated with glycosuria should arouse suspicion of the syndrome, and may allow for early diagnosis and successful control of this troublesome symptom complex.

This prospectively designed study was done to evaluate growth of 133 healthy full-term infants who received breast milk (B) or infant formula (F) as essentially the only source of calories during the first 6 months of life and who were followed through age 9 months. By analysis of variance, both sex and feeding had significant effect on gains in length and weight (p< 0.01). Weight-for-age centiles (WAC) and length-for-age centiles (LAC) were computed using NCHS reference data and are summarized for B and F infants by age (mos): NCHS reference data, based principally on formula-fed infants who received solid foods in the early weeks of life, may not be entirely appropriate to evaluate growth of today's infants breast-fed according to current recommendations.

A high frequency of donations by some blood donors has prompted concern about iron depletion. Five hundred sixteen female and 505 male donors were examined by measurements of hemoglobin, hematocrit, plasma iron, total iron-binding capacity, and ferritin values and detailed histories of iron ingestion, pregnancy and menstrual status, and past blood donations. Hemoglobin, hematocrit, and serum iron studies, unlike ferritin values, were not sensitive indicators of body iron depletion. Reduced iron stores were found in 8% of male and 23% of female donors. Menstruation significantly lowered iron stores in women. The total number of lifetime donations was not as predictive of decreased iron stores as frequency of donations per year. Even casual iron supplementation reduced the impact of donations on iron stores. Administration of iron to donors, especially menstruating women, should be studied by blood programs. ( JAMA 1981;245:2038-2043)