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Aim. This paper reports a study examining the interrater and intrarater reliability of classifying pressure ulcers according to the European Pressure Ulcer Advisory Panel classification system when using photographs of pressure ulcers and incontinence lesions. Background. Pressure ulcer classification is an essential tool for assessing ulcers and their severity and determining which preventive or therapeutic action is needed. Many classification systems are described in the literature. There are only a limited number of studies that evaluate the interrater reliability of pressure ulcer grading scales. The intrarater reliability is seldom studied. Methods. The study consisted of two phases. In the first phase 56 photographs, together with a random selection of nine photographs from the same set, were presented to 473 nurses. In the second phase, the 56 photographs were presented twice to 86 other nurses with an interval of one month and in a different order. All the nurses were familiar with the European Pressure Ulcer Advisory Panel classification. They did not receive any additional training on classification, and were asked to classify the lesions as normal skin, blanchable erythema, pressure ulcers (four grades, European Pressure Ulcer Advisory Panel classification) or incontinence lesions. Results. In the first phase, the multirater-Kappa for the 473 participating nurses was 0.37 (P < 0.001). Non-blanchable erythema was often confused with blanchable erythema and incontinence lesions. Also incontinence lesions were frequently not correctly classified. The intrarater agreement was low (kappa = 0.38). In the second phase, the interrater agreement was not significantly different in both sessions. The intrarater agreement was 0.52. Conclusion. Both the interrater and intrarater reliability of the European Pressure Ulcer Advisory Panel classification of lesion photographs by nurses was very low. Differentiation between pressure ulcers and incontinence lesions seems to be difficult. [ABSTRACT FROM AUTHOR]

Tomatoes are the main dietary source of lycopene, and the bioavailability of lycopene from tomato paste is higher than that from fresh tomatoes. We investigated systematically the effect of mechanical homogenization and heating on the bioavailability of carotenoids from canned tomatoes. Further, we compared the carotenoid response in triglyceride-rich lipoproteins (TRL) after single consumption with the change in fasting plasma carotenoid concentrations after 4 d of daily consumption. In a split plot design, 17 men and women consumed tomatoes which had received minimal additional heating and 16 others consumed extensively additionally heated tomatoes (1 h at 100 degrees C). These tomatoes were not, mildly or severely homogenized. The tomato products were consumed daily (ca. 22 mg/d lycopene) for 4 d. Eleven participants provided postprandial blood samples on the d 1 and all gave fasting blood samples on d 1 and 4. Homogenization enhanced the lycopene response significantly (P<0.05) both in TRL [mean areas under the curves: 54.9, 72.0 and 88.7 nmol. h/L (SE 11.0) for not, mildly and severely homogenized tomatoes, respectively] and in plasma [mean changes: 0.19, 0.22 and 0.23 micromol/L (SE 0.009), respectively]. Additional heating also tended to enhance the lycopene responses in TRL (P = 0.14) and plasma (P = 0.17). Similar effects to those for lycopene were found for beta-carotene. We conclude that the intactness of the cellular matrix of tomatoes determines the bioavailability of carotenoids and that matrix disruption by mechanical homogenization and/or heat treatment enhances the bioavailability. The carotenoid response in plasma after 4 d intervention can be used to compare the bioavailability of carotenoids from different foods. [ABSTRACT FROM AUTHOR]

Carotenoids are thought to contribute to the beneficial effects of increased vegetable consumption. Various dietary factors have an effect on the bioavailability of carotenoids. The type of food matrix in which carotenoids are located is a major factor. The bioavailability of beta-carotene from vegetables in particular has been shown to be low (14% from mixed vegetables) compared with that of purified beta-carotene added to a simple matrix (e.g., salad dressing), whereas for lutein, the difference is much smaller (relative bioavailability of 67% from mixed vegetables). Processing, such as mechanical homogenization or heat treatment, has the potential to enhance the bioavailability of carotenoids from vegetables (from 18% to a sixfold increase). The amount of dietary fat required to ensure carotenoid absorption seems low (approximately 3-5 g per meal), although it depends on the physicochemical characteristics of the carotenoids ingested. Unabsorbable, fat-soluble compounds reduce carotenoid absorption, and interaction among carotenoids may also result in a reduced carotenoid bioavailability. Research into the functional benefits of carotenoids should consider the fact that the bioavailability of beta-carotene in particular is one order of magnitude higher when provided as a pure compound added to foods than when it is present naturally in foods. [ABSTRACT FROM AUTHOR]

Objective: To investigate the dose-response relationship between cholesterol lowering and three different, relatively low intake levels of plant sterols (0.83, 1.61, 3.24 g/d) from spreads. To investigate the effects on lipid-soluble (pro)vitamins.Design: A randomized double-blind placebo controlled balanced incomplete Latin square design using five spreads and four periods. The five study spreads included butter, a commercially available spread and three experimental spreads fortified with three different concentrations of plant sterols.Subjects: One hundred apparently healthy normocholesterolaemic and mildly hypercholesterolaemic volunteers participated.Interventions: Each subject consumed four spreads, each for a period of 3.5 week.Results: Compared to the control spread, total cholesterol decreased by 0.26 (CI: 0.15-0.36), 0.31 (CI: 0.20-0.41) and 0.35 (CI: 0.25-0.46) mmol/L, for daily consumption of 0.83, 1.61 and 3.24 g plant sterols, respectively. For LDL-cholesterol these decreases were 0.20 (CI: 0.10-0.31), 0.26 (CI: 0.15-0.36) and 0.30 (CI: 0.20-0.41). Decreases in the LDL/HDL ratio were 0.13 (CI: 0.04-0.22), 0.16 (CI: 0.07-0.24) and 0.16 (CI: 0.07-0.24) units, respectively. Differences in cholesterol reductions between the plant sterol doses consumed were not statistically significant. Plasma vitamin K1 and 25-OH-vitamin D and lipid standardized plasma lycopene and alpha-tocopherol were not affected by consumption of plant sterol enriched spreads, but lipid standardized plasma (alpha + beta)-carotene concentrations were decreased by about 11 and 19% by daily consumption of 0.83 and 3.24 g plant sterols in spread, respectively.Conclusions: The three relatively low dosages of plant sterols had a significant cholesterol lowering effect ranging from 4.9-6.8%, 6.7-9.9% and 6.5-7.9%, for total, LDL-cholesterol and the LDL/HDL cholesterol ratio, respectively, without substantially affecting lipid soluble (pro)vitamins. No significant differences in cholesterol lowering effect between the three dosages of plant sterols could be detected. This study would support that consumption of about 1.6 g of plant sterols per day will beneficially affect plasma cholesterol concentrations without seriously affecting plasma carotenoid concentrations. [ABSTRACT FROM AUTHOR]

Objectives: To compare the effects of free access to reduced fat products or their full fat equivalents on fat and energy intake, body weight, plasma lipids and fat-soluble antioxidants concentrations and haemostasis variables.Design: A multicentre open randomised controlled trial in which intervention and control groups were followed in parallel for six months. Volunteers had free access to 44 different foods either in reduced fat or full fat version, covering between 30 and 40% of energy intake. The remainder of energy intake was covered by foods bought in regular shops.Setting: Zeist, Wageningen and Maastricht, The Netherlands.Subjects: Two hundred and forty-one non-obese healthy volunteers who had no intention to lose weight.Main Outcome Measures: Food intake, body weight, plasma lipid, vitamin E, beta-carotene, lycopene and fibrinogen concentrations, plasma factor VII clotting activity, and plasminogen-activator-inhibitor-I antigen level.Results: One hundred and three volunteers in the full fat group and 117 volunteers in the reduced fat group completed the study. Energy and fat intake from the free access products was lower in the reduced fat group, but no difference in energy and fat intake of other products occurred. Body weight, energy-, fat- and vitamin E intake and percentage of energy derived from fat decreased in the reduced fat group. No other statistical significant intervention effects were observed. Blood lipid concentrations, factor VII activity and plasminogen-inhibitor-activator-1 level were reduced after consumption of reduced fat products.Conclusions: When subjects without intention to lose weight limit fat intake by switching from ad libitum consumption of full fat products to reduced fat products body weight gain is prevented, and fat and energy intake are reduced. Such a switch may have beneficial effects on biochemical cardiovascular risk factors. We concluded that reduced fat products will help in a population strategy aimed at preventing overweight and obesity, they will also be effective in maintaining a lower body weight after slimming. Ad libitum consumption of reduced fat products will be ineffective for those individuals that want to reduce body weight because they are currently overweight or obese. [ABSTRACT FROM AUTHOR]

Objectives: To compare effects on plasma total-, LDL-, and HDL-cholesterol concentrations of margarines enriched with different vegetable oil sterols or sitostanol-ester.Design: A randomized double-blind placebo-controlled balanced incomplete Latin square design with five treatments and four periods of 3.5 weeks. Margarines enriched with sterols from soybean, sheanut or ricebran oil or with sitostanol-ester were compared to a non-enriched control margarine. Sterol intake was between 1.5-3.3 g/d. Two thirds of the soybean oil sterols were esterified to fatty acids.Setting: Unilever Research Laboratory, Vlaardingen, The Netherlands.Subjects: One hundred healthy non-obese normocholesterolaemic and mildly hypercholesterolaemic volunteers aged 45+/-12.8 y, with plasma total cholesterol levels below 8 mmol/L at entry.Main Outcome Measures: Plasma lipid, carotenoid and sterol concentrations, blood clinical chemistry and haematology, fatty acid composition of plasma cholesterylesters and food intake.Results: Ninety-five volunteers completed the study. None of the margarines induced adverse changes in blood clinical chemistry, serum total bile acids or haematology. Plasma total- and LDL-cholesterol concentrations were significantly reduced by 8-13% (0.37-0.44 mmol/L) compared to control for margarines enriched in soybean oil sterol-esters or sitostanol-ester. No effect on HDL-cholesterol concentrations occurred. The LDL- to HDL-cholesterol ratio was reduced by 0.37 and 0.33 units for these margarines, respectively. Effects on blood lipids did not differ between normocholesterolaemic and mildly hypercholesterolaemic subjects. Plasma sitosterol and campesterol levels were significantly higher for the soybean oil sterol margarine and significantly lower for the sitostanol-ester margarine compared to control. Dietary intake was very similar across treatments. The fatty acid composition of plasma cholesterylesters confirmed the good compliance to the treatment. All sterol enriched margarines reduced lipid-standardized plasma alpha- plus beta-carotene levels. Plasma lycopene levels were also reduced but this effect was not significant for all products.Conclusions: A margarine with sterol-esters from soybean oil, mainly esters from sitosterol, campesterol and stigmasterol, is as effective as a margarine with sitostanol-ester in lowering blood total- and LDL-cholesterol levels without affecting HDL-cholesterol concentrations. Incorporation in edible fat containing products of such substances may substantially reduce the risk of cardiovascular disease in the population. [ABSTRACT FROM AUTHOR]

Objectives: In 60 healthy humans, a blend of commonly used edible vegetable fats was compared with the same fat blend after random chemical interesterification, for their effects in terms of nutritional safety on blood lipids, blood enzymes and hemostasis parameters.Design: Both fat blends were supplied double-blind at two energy levels (4 and 8% of energy) in margarine according to a parallel design. At either energy level, the two fat blends were consumed according to a cross-over design for two periods of three weeks, without an intermediate wash-out period.Results: The 30 parameters studied revealed no statistically significant differences between the two fat blends, except for slightly (approximately 10%) lower D-dimers concentrations after consumption of the interesterified fat blend.Conclusions: Increased levels of the fibrin-degradation products D-dimers are positively associated with risk for coronary heart disease. Thus, it was concluded that the inclusion of a chemically interesterified vegetable fat blend in the diet of healthy people does not influence fasting blood lipids, blood enzymes and/or hemostasis parameters in an adverse way, when compared with a non-interesterified fat blend with the same fatty acid composition. [ABSTRACT FROM AUTHOR]

In this study the effect of the positional distribution of stearic acid (18:0) and oleic acid (18:1) in a triacylglycerol on absorption of fat, energy and nutrients was investigated in young rats. In addition the effect of dietary calcium on these variables was studied. Forty rats were fed purified diets containing either a fat blend high in 2-oleoyl-distearate or a fat blend high in 1-oleoyl-distearate. Both diets were given at low (0.3 g/100 g) and high (1.0 g/100 g) dietary calcium concentrations. Total fat absorption, expressed as the percentage of fat intake, was significantly lower in rats fed 2-oleoyl-distearate compared with 1-oleoyl-distearate at both dietary calcium concentrations. When expressed as absolute figures, the lower fat absorption in rats fed 2-oleoyl-distearate compared with 1-oleoyl-distearate only reached statistical significance at the high dietary calcium concentration. The reduced absorption of total fat was mainly caused by the lower absorption of stearic acid. The percentage of, but not absolute, absorption of oleic acid and energy were lower in rats fed 2-oleoyl-distearate. Absolute and percentage of calcium absorption were lower in rats fed 2-oleoyl-distearate compared with 1-oleoyl-distearate. Absolute and percentage of magnesium absorption were not significantly affected by the positional distribution of stearic acid and oleic acid in the triacylglycerol, but were decreased at a high dietary calcium concentration. We concluded that the lowered stearic acid absorption from 2-oleoyl-distearate compared with 1-oleoyl-distearate might have been due to the greater formation of insoluble calcium and magnesium soaps in the intestine. [ABSTRACT FROM AUTHOR]