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Noncompliance with therapeutic diets remains a major obstacle to achieving improvements in cardiovascular disease (CVD) morbidity and mortality. This study compared dietary compliance and CVD risk factor response to two dietary interventions designed to treat hypertension, dyslipidemia, and diabetes mellitus. In a multicenter trial, 560 adults were randomly assigned to either a self-selected, mixed-food plan (n = 277), or a nutrient-fortified prepared meal plan (n = 283); each was designed to provide 15-20% of energy from fat, 55-60% from carbohydrate, and 15-20% from protein. Nutrient intake was estimated from 3-d food records collected biweekly throughout the 10-wk intervention. Compliance was determined by evaluating the participants' ability to meet specific criteria for energy intake [+ or -] 420 kJ (100 kcal) from the midpoint of the prescribed energy range], fat intake (< 20%, < 25%, or < 30% of energy from total fat), and the National Cholesterol Education Program/American Heart Association Step 1 and 2 diet recommendations. Compliance with energy, fat, and Step 1 and 2 criteria was better in participants who followed the prepared meal plan than in those who followed the self-selected diet (P < 0.0001). Compliant participants in both groups achieved greater reductions in body weight, systolic and diastolic blood pressure, and total and low-density-lipoprotein cholesterol than noncompliant participants (P < 0.05). In general, better endpoint responses were observed with lower fat intakes regardless of group assignment. The prepared meal plan is a simple and effective strategy for meeting the many nutrient recommendations for CVD risk reduction and improving dietary compliance and CVD endpoints. Am J Clin Nutr 1997;66:373-85.

Current dietary recommendations for cardiovascular disease risk reduction and recommended dietary allowances (RDAs) were used to develop a nutritionally complete prepackaged prepared meal plan specifically designed to reduce the risk of cardiovascular disease. In the current study we tested patient acceptance of the diet as defined by measures of quality of life. In a randomized, parallel-design, multicenter clinical trial, 77 persons with hypertension, diabetes mellitus, dyslipidemia, or a combination of two or more of these conditions were recruited and randomly assigned to either a prepared meal plan (n = 39) or a comparable self-selected diet (n = 38) for 10 wk. The prepared meal plan met both the RDAs for all essential micronutrients and the dietary recommendations of national health organizations for macronutrients, cholesterol, sodium, and fiber. The prescribed self-selected diet was matched for macronutrients. Quality of life, as measured by a battery of instruments, was the major endpoint. Individuals consuming the prepared meal plan had significant improvements in mental health (P < 0.01), general perceived health (P < 0.005), daily activities (P < 0.05), work performance (P < 0.005), affect (P < 0.01), and nutritional health perceptions (P < 0.001), and reductions in nutrition hassles based on a standardized questionnaire (P < 0.001). The self-selected-diet group had significant improvements in nutritional health perceptions (P < 0.001) and affect (P < 0.001). There were significant improvements in weight (P < 0.001), blood pressure (P < 0.001), cholesterol (P < 0.002), low-density lipoproteins (P < 0.001), glucose (P < 0.014), and glycated hemoglobin (Hb [A.sub.1c]) (P < 0.004) that were comparable in both groups. In summary, this study shows that a nutritionally complete diet, whether prepackaged or self-selected, improves multiple risk factors for cardiovascular disease. The prepackaged prepared meal plan had the added benefit of a greater improvement in quality of life.

Gestational diabetes appears to associated with decreased free magnesium within cells. This may explain why gestational diabetics are more prone to hypertension because magnesium depletion can adversely affect several factors relating to blood pressure. Blood samples were taken from 13 women with diet-treated gestational diabetes, 20 healthy women, and 26 nonpregnant women. Free magnesium within red blood cells and ionized magnesium in blood plasma were measured. Pregnant women had reduced total amounts of magnesium and plasma ionized magnesium compared with nonpregnant women. Gestional diabetics had slightly reduced levels of cellular free magnesium compared with normal pregnant women and non-pregnant women.

Magnesium can be used to treat or prevent many cardiac arrhythmias and may improve post-M outcome. It could also pay a role in treating diabetes and hypertension and preventing atherogenesis. [...]

Magnesium is an electrolyte necessary for several crucial physiologic functions, including cellular processes. A person who lacks adequate magnesium can suffer a variety of systemic problems. Diagnostic methods are discussed. Therapeutic use of magnesium may resolve these problems., Clinicians are just beginning to appreciate the role magnesium plays in a vast array of acute and chronic diseases. This article, first or two, tells when to look for magnesium [...]

We have investigated the cellular basis for the clinical and epidemiologic linkage of hypertension, left ventricular hypertrophy (LVH), obesity, and non-insulin-dependent diabetes mellitus (NIDDM) and have studied cytosolic free calcium and free magnesium levels in these syndromes. Specifically, intracellular free calcium is elevated and free magnesium is deficient in hypertension, and both are related (directly and inversely, respectively) to the ambient level of blood pressure, to LV mass index (and thus to the degree of cardiac hypertrophy), and to the hyperinsulinemia and insulin resistance of essential hypertension. Dynamically, the ability of dietary salt loading to elevate blood pressure corresponds to its ability to elevate cytosolic free calcium and reciprocally to suppress free magnesium levels. Conversely, the ability of calcium channel blockade to reverse salt-induced hypertension is related to its ability to prevent these transmembrane ionic effects. Higher steady-state free calcium or lower free magnesium, or both, are also observed in clinical states linked to hypertension, such as obesity and NIDDM. Oral glucose loading in normal subjects itself elevates free calcium and suppresses free magnesium levels, as does hyperglycemia in vitro. These data suggest an ionic hypothesis of cardiovascular and metabolic disease, in which a generalized defect in cell ion handling is present in all tissues, resulting in higher steady-state free calcium and lower free magnesium levels. In pancreatic [Beta] cells, this would produce hyperinsulinemia; in fat and skeletal muscle, cause peripheral insulin resistance; and in renal tissue, increase proximal sodium resorption and increase urinary calcium excretion--all features of essential hypertension. In vascular smooth muscle, high cytosolic free calcium would increase smooth muscle tone and cause vasoconstriction, and in heart muscle, independent of blood pressure, would increase contractility and predispose to LVH. Therefore, what may appear clinically to be the separate syndromes of hypertension, obesity, and NIDDM may pathophysiologically be different manifestations of the same underlying cellular defect, thus explaining their frequent clinical coexistence. Therapeutically, reversal of this excess free calcium accumulation and/or free magnesium deficit with ion-specific agents, such as calcium channel blocking drugs, may thus ameliorate not only the elevated blood pressure of hypertension but also the concurrent excess morbidity and mortality of the concurrent cardiac, vascular, and metabolic aspects of the hypertensive state.

We previously reported that preeclampsia is associated with hypocalciuria (N Engl J Med 1987;316:715). The purpose of this study was to determine whether alterations in calcium regulatory hormones are present in preeclampsia and, if so, whether they are responsible for hypocalciuria. Thirty-two pregnant women were studied in the second and third trimesters of pregnancy (11 women with preeclampsia, nine with chronic hypertension, and 12 normotensive women. 1,25-Dihydroxyvitamin D, C-terminal parathyroid hormone, ionized calcium, and urinary calcium excretion were measured. 1,25-Dihydroxyvitamin D was significantly lower in the women with preeclampsia in the third trimester when the disease developed (37.8 [+ or -] pg/ml) than in women with chronic hypertension (75 [+ or -] pg/ml, p < 0.05) and normal women (65 [+ or -] 10 pg/ml, p < 0.05). Parathyroid hormone was higher, but not significantly, in those with preeclampsia. lonized calcium was not significantly different among the three groups. Urinary calcium excretion was abnormally low for pregnancy (

Background: Elevated blood homocysteine is a risk factor for cardiovascular disease. A 5-[micro]mol/L increase is associated with an [approximately equals] 70% increase in relative risk of cardiovascular disease in adults. For patients with established risk factors, this risk is likely even greater. Objective: Effects of increased dietary folate and recommended intakes of vitamins B-12 and B-6 on serum total homocysteine (tHcy) were assessed in individuals at high risk of cardiovascular disease. Design: This trial was conducted at 10 medical research centers in the United States and Canada and included 491 adults with hypertension, dyslipidemia, type 2 diabetes, or a combination thereof. Participants were randomly assigned to follow a prepared meal plan (PMP; n = 244) or a self-selected diet (SSD: n = 247) for 10 wk, which were matched for macronutrient content. The PMP was fortified to provide [is greater than or equal to] 100% of the recommended dietary allowances for 23 micronutrients, including folate. Results: Mean folate intakes at 10 wk were 601 [+ or -] 143 [micro]g/d with the PMP and 270 [+ or -] 107 [micro]g/d with the SSD. With the PMP, serum tHcy concentrations fell from 10.8 [+ or -] 5.8 to 9.3 [+ or -] 4.9 [micro]mol/L (P [is less than] 0.0001) between weeks 0 and 10 and the change was associated with increased intakes of folate, vitamin B-12, and vitamin B-6 and with increased serum and red blood cell folate and serum vitamin B-12 concentrations, tHcy concentrations did not change significantly with the SSD. Conclusions: The PMP resulted in increased intakes and serum concentrations of folate and vitamin B-12. These changes were associated with reduced serum tHcy concentrations in persons at high risk of cardiovascular disease. Am J Clin Nutr 1999:70:881-7. KEY WORDS Homocysteine, dietary folate, vitamin B-12, vitamin B-6, cardiovascular disease, randomized clinical trial, humans

High blood pressure has been associated with abnormal sugar metabolism. Diabetic patients have generally higher blood pressures than patients with normal glucose control. The hormone insulin is essential for the transport of glucose, a simple sugar, into cells. Patients with diabetes mellitus either have deficient insulin metabolism or become resistant to insulin, and it is thus unclear whether increased blood insulin or resistance to insulin is the cause or the effect of high blood pressure. Calcium and magnesium are elements involved in the transport across cell membranes. Alterations in calcium metabolism may affect the metabolism of glucose. In addition, insulin may increase the amount of available free calcium. Magnesium was found to increase after patients were given a load of glucose. There is a connection between defects in calcium and magnesium metabolism and high blood pressure and diabetes. Although abnormal sugar tolerance, increased insulin in the blood, insulin resistance and high blood pressure are all clinically different, the underlying cause may stem from altered calcium and magnesium metabolism.

A slight excess of acid may be present within red blood cells during pregnancy, and this may aid the transfer of oxygen from mother to fetus across the placenta. Researchers analyzed blood samples from 22 pregnant women in their third trimester and from 33 women who were not pregnant. The pH inside the red blood cells was significantly lower in blood samples from pregnant women. This finding remained true despite differences in age, body size, and race. The lower pH inside red blood cells may explain why hyperventilation of pregnancy occurs.