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Background: Obesity is associated with elevated levels of inflammation and metabolic abnormalities, with increased risk of developing insulin resistance, type 2 diabetes, stroke and CVD. Nutrients that can assist in weight loss may also reduce the risk of obesity related co-morbidities., Aim: The aim of this study was to investigate whether LCn-3PUFA, combined with a reduced energy diet, facilitated weight loss and improvements in blood lipids and inflammatory mediators., Design: A double blind randomised controlled trial with two parallel groups. Both groups followed a low energy diet for 12 weeks, one group consumed 6 × 1 g capsules/d monounsaturated oil (Placebo) (n = 18), the other 6 × 1 g capsules/d LCn-3PUFA (fish oil) (n = 17). Fasting blood samples, anthropometric measurements and 3-day food diaries were collected at baseline and post intervention., Results: There was a two-fold increase in plasma levels of EPA and DHA in the fish oil group (p < 0.001). There were no significant difference within and between the placebo and the fish oil groups for weight reduction (3.37% and 4.35% respectively), fat mass reduction (8.95% and 9.76% respectively), or changes in inflammatory biomarkers and blood lipids apart from triglycerides, reduced by 27% in fish oil group (p < 0.05). For fish oil group there were significant correlations between leptin and weight loss (p = 0.01) and leptin and EPA and DHA (p < 0.05 for both)., Conclusion: Dietary LCn-3PUFA supplementation during a weight loss program does not appear to assist weight loss. Poor dietary compliance may be a contributing factor in accurate assessment of the role of these fatty acids in weight loss., (Crown Copyright © 2011 Published by Elsevier Ltd on behalf of Asian Oceanian Association for the Study of Obesity. All rights reserved.)

Obesity has been linked with low levels of ω-3 fatty acids. Generally, intervention studies have failed to establish benefits of supplementation with ω-3PUFA in reducing body weight or fat mass in humans. The aim of this study was to investigate whether supplementation with LCω-3PUFA alone, then consumed concomitantly with a very low energy diet (VLED), facilitated weight loss, improvements in blood lipids and positive changes to inflammatory mediators. This was a double blind randomised controlled trial with two parallel groups. For 4 weeks of prior supplementation, one group consumed 6 × 1 g capsules per day monounsaturated oil (placebo), the other group consumed 6 × 1 g capsules per day LCω-3PUFA (fish oil) each comprising 70 mg EPA and 270 mg DHA, while consuming their usual diet. Each group continued with their supplements for another 4 weeks while both groups followed a VLED regimen (n = 19 placebo, n = 20 fish oil). Fasting blood samples, anthropometric measurements and 3-day food diaries were collected at baseline, at 4 weeks and at 8 weeks. At 4 weeks levels of EPA and DHA increased two-fold in the fish oil group (P < 0.001), with no significant changes to anthropometric measurements for either group. At 8 weeks a significant 3-way interaction between time, group and gender was observed for percentage reduction in weight, F(1,35) = 5.55, P = 0.024, and BMI, F(1,35) = 5.3, P = 0.027 with a greater percentage decrease for females in FO compared to PB for weight (-7.21% vs.-5.82%) and BMI (-7.43% vs.-5.91%) respectively (P < 0.05 for both). It would appear that supplementation with LCω-3PUFA had a time dependent effect on weight loss in females.

Obesity is associated with elevated levels of inflammation and metabolic abnormalities which are linked to CVD. The aim of the present study was to investigate whether long-chain n-3 PUFA (LCn-3PUFA), combined with a very-low-energy diet (VLED), facilitated weight loss and weight maintenance, and improvements in blood lipids and inflammatory mediators. This was a double-blind, randomised, controlled trial with two parallel groups. For 14 weeks, one group consumed 6 × 1 g capsules/d of monounsaturated oil (placebo group, PB), and the other group consumed 6 × 1 g capsules/d of LCn-3PUFA (fish oil group, FO), each comprising 70 mg EPA and 270 mg DHA. Both groups were on VLED for 4 weeks (n 14 PB, n 18 FO), which was then followed by 10 weeks of weight maintenance (n 12 PB, n 17 FO). Fasting blood samples, anthropometric measurements and 3 d food diaries were collected at baseline, at 4 and 14 weeks. A greater-than-2-fold increase occurred in plasma levels of EPA and DHA in the FO group (P < 0·001). At 4 weeks, the mean weight loss was -6·54 (SD 2·08) kg (-6·9%) for PB and -6·87 (SD 1·83) kg (-7·7%) for FO. At week 14, after the maintenance phase, there was a further mean decrease in weight, -1·57 (SD 3·7) kg (1·85%) for PB and -1·69 (SD 2·32) kg (-1·9%) for FO. Both groups experienced improved metabolic profiles and there was a significant reduction in fat mass for the FO group at week 14 but not for PB. However, it would appear that supplementation with LCn-3PUFA had no significant effect on weight loss or weight maintenance over the 14 weeks.

Intentional weight loss with a reduction in adipose tissue is associated with an improvement in medical complications linked to obesity. The aim of this study was to compare the effect of two different weight loss diets on obese individuals (BMI 30-40 kg m(-2)) for improvements in anthropometric measurements and blood biomarkers. Study 1 comprised a low energy diet (LED) of 5000-6000 kJ d(-1) for a slow but steady weight loss over 12 weeks. Study 2 comprised a very low energy diet (VLED) of 3000 kJ d(-1) using meal replacements for rapid weight loss over a shorter period of 4 weeks followed by 10 weeks of weight stabilisation to prevent rebound after rapid weight loss. Nutrition information sessions were given to both groups. Fasting blood samples, anthropometric measurements and 3-day food diaries were collected at baseline and again at completion of weight loss, at 12 weeks for LED group and 4 weeks for VLED group. Mean weight loss in the LED group (n = 18) was -3.17 kg (-3.7%) compared to a -6.54 kg (-7%) loss in the VLED group (n = 14) (p < 0.001). The VLED group experienced significantly greater reductions in fat mass, -13.9% compared to -8.9% for the LED group (p < 0.05). Significantly greater reductions in blood glucose (p < 0.05), cholesterol and LDL-C (p < 0.01 for both), and waist circumference (p≤ 0.05) were noted in VLED compared to those for LED diet. Short-term, rapid weight loss produced the desired ≥5% weight loss suggested to substantially reduce metabolic abnormalities associated with obesity, and to reduce health risks.

High sensitivity C-reactive protein (hs-CRP) is a marker of low-grade sustained inflammation. Omega-3 (n-3) fatty acids have anti-inflammatory properties and are associated with reduced cardiovascular disease (CVD) risk. The aim of this study was to investigate whether plasma n-3 fatty acid concentration is related to hs-CRP concentration. A total of 124 free-living adults, were divided into tertiles of plasma hs-CRP (<1.0, 1.0-3.0 and >3.0 mg/l). Body composition and anthropometric measurements were recorded. Hs-CRP was analysed using immunoassays and fatty acids were measured by gas chromatography. Plasma hs-CRP concentration was negatively correlated with total n-3 fatty acids (P=0.05), eicosapentaenoic acid (EPA; P=0.002) and docosapentaenoic acid (DPA; P=0.01). The highest hs-CRP tertile (>3.0 mg/l) had significantly lower concentrations of total n-3 fatty acids, EPA and DPA, when compared with the other tertiles (P<0.05). This study provides evidence that in healthy individuals, plasma n-3 fatty acid concentration is inversely related to hs-CRP concentration, a surrogate marker of CVD risk.

Objective: Recent developments in micro-emulsification technology have allowed the fortification of foods with long-chain n-3 polyunsaturated fatty acid (PUFA) without the undesirable fish odour/taste and with reasonable shelf life. The effects of supplementing the diets of people with diabetes type II with a hummus-based dip enriched with long-chain n-3PUFA on plasma fatty acid composition and lipid levels were examined., Design: A pre- and post-intervention study., Setting: This study was conducted at the University of Newcastle, Australia., Subjects: Participants were recruited via advertisements on the University of Newcastle notice boards and in the local newspapers. Following initial response to study advertisements, information statements were mailed out to 29 potential participants. Thirteen participants were eligible and consented to participate in the trial. There were no dropouts as all the 13 participants completed 6-week intervention trial., Methods: Free-living male and female subjects with diabetes type II (n=13) consumed the n-3PUFA-enriched dip for a period of 6 weeks. Fasting blood samples were collected pre- and post-intervention for analyses of fatty acids and plasma lipids., Results: Following 6 weeks of consuming the enriched dip, all the long-chain n-3PUFA (20:5n-3, 22:5n-3 and 22:6n-3) were significantly (P<0.05) elevated in the plasma lipids. This represented an increase in 20:5n-3 content by 117%, an increase in 22:5n-3 content by 15% and an increase in 22:6n-3 content by 80% over the baseline values before dip consumption. A significant reduction (P<0.05) in the plasma triglyceride levels from 1.93 (1.08-2.09) mmol/l at baseline to 1.27 (0.93-2.22) mmol/l after 6 weeks was also apparent following the consumption of the n-3PUFA-enriched dip. Plasma cholesterol was unchanged; however, low-density lipoprotein (LDL)-cholesterol (2.46+/-0.21 versus 2.72+/-0.22 mmol/l, P<0.034) and high-density lipoprotein (HDL)-cholesterol (1.16+/-0.09 versus 1.22+/-0.09 mmol/l, P<0.042) were significantly increased following the dietary intervention., Conclusions: These results demonstrate that n-3PUFA are readily bioavailable from the fortified dip matrix and alter the plasma lipid profile.

Background: The Medtronic Intact porcine bioprosthesis was further evaluated to determine the influence of zero-pressure glutaraldehyde fixation on structural valve deterioration (SVD)., Methods: From 1986 through 1996, at three Canadian centers, 1,272 patients had 1,296 procedures: 836 aortic valve replacement (AVR), 332 mitral valve replacement (MVR), 14 tricuspid valve replacement, 3 pulmonary valve replacement, and 111 multiple valve replacements. The mean age of the patient population was 67 years (range 9 to 91 years). The total follow-up was 8,011 patient-years (mean 6.2 years)., Results: The late mortality (overall) was 4.8% and 6.7% per patient-year for AVR with or without concomitant procedures, respectively; and 4.7% and 10.4% per patient-year for MVR, respectively. There were 51 cases of SVD (AVR 22 of 836; MVR 23 of 332; pulmonary valve replacement 1 of 3; and multiple valve replacement 5 of 111). The actuarial freedom from SVD at 12 years for AVR was 94.3%+/-3.3% for patients aged 61 to 70 years and 97.7%+/-1.1% for those more than 70 years; for MVR actuarial freedom from SVD at 12 years was 93.7%+/-3.9% for patients more than 70 years. The actual freedom at 12 years from SVD for AVR was 92.4%+/-3.1% for patients aged 51 to 60 years, 96.1%+/-2.1% for those 61 to 70 years, and 98.4%+/-0.7% for those older than 70 years; for MVR actual freedom from SVD at 12 years was 89.6%+/-3.2% for patients 61 to 70 years and 96.6%+/-3.4% for those more than 70 years., Conclusions: The Medtronic Intact porcine bioprosthesis, formulated with tissue preservation at zero-pressure fixation, has encouraging freedom from structural failure.

Twelve patients with chronic airways obstruction took part in a bioavailability study of a sustained-release preparation of theophylline (Nuelin SR). Each patient took a Nuelin SR (250 mg) tablet after an overnight fast and, next day, after a light breakfast. On the third day, six patients took two halves of a 250 mg Nuelin SR tablet after breakfast; six subjects took one-half of a 500 mg Nuelin SR tablet after an overnight fast. There were marked interindividual variations in the plasma theophylline concentrations on all study days. The effect of food was equally variable, and appeared to delay the peak plasma concentration in four subjects; in another four, the peak plasma theophylline concentration occurred earlier, and no change was observed in the remaining four. Overall, no significant differences either in the amount of theophylline absorbed, or in its bioavailability were observed. We suggest that patients should be instructed to take theophylline at the same time every day in relation to food intake; however, theophylline assay is essential for the appropriate use of the drug.

Forty-eight critically ill patients in an intensive care unit were enrolled in a prospective study of stress ulcer prophylaxis. The H2-receptor antagonists cimetidine and ranitidine were used, patients being randomized on hospital number. Response was assessed by measuring gastric pH every 2 hours. The drugs were administered by intravenous infusion, and up to three dosage increments fo each of the drugs were titrated against the pH of the aspirated gastric juice. If one drug, in maximum dose, failed to maintain the pH above 4, the other drug was administered at maximum dose. If both drugs failed to achieve control of gastric pH, antacids were administered in an endeavor to ensure patient safety. Cimetidine was successful in maintaining the intragastric pH above 4, for the duration of the intensive care admission, in five of 28 patients. Ranitidine was successful in 10 of 20 patients. The difference between these two groups was statistically significant (p = 0.04). In patients in whom cimetidine therapy failed, ranitidine provided adequate control of pH in four of 13. Cimetidine controlled one of six patients who had failed to improve with ranitidine therapy. Plasma concentrations of both drugs were well above established acid inhibitory concentrations. However, even with much lower plasma concentrations of ranitidine, similar amounts of both drugs were present in the gastric juice, suggesting a possible explanation for the greater efficacy of ranitidine. We conclude that, although ranitidine is more effective than cimetidine, neither of these drugs is adequate for stress ulcer prophylaxis. If they ae used for this purpose in the critically ill patient, regular monitoring of gastric pH is essential to allow detection of therapeutic failures.

The peripheral and central nervous, cardiovascular and respiratory effects of midazolam 0.15 mg/kg, administered intravenously, were studied in 57 patients. Midazolam induced anaesthesia satisfactorily in 78% of the patients, the remainder required either further doses of midazolam, or alternative induction agents. There was no pain on injection. No evidence of thrombophlebitis was apparent up to 72 hours after injection. Mean systolic arterial pressure decreased from 128 mm Hg to 114 mm Hg and mean diastolic pressure decreased from 75 mm Hg to 67 mm Hg (P less than 0.005) four minutes after injection. Mean Apnoea occurred in 14 patients, with a mean onset time of 82 sec and a mean duration of 30 sec. Patients showed a decrease in mean respiratory rate from 13.7 breaths/min to 12.8 breaths/min two minutes after injection of midazolam. A larger dose than used in this study would be necessary for satisfactory use of midazolam as an induction agent for general anaesthesia.