Low Liver Enzymes and Risk of Dementia: The Atherosclerosis Risk in Communities (ARIC) Study

Background: Low levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in the low physiologic range, surrogate markers for reduced liver metabolic function, are associated with cerebral hypometabolism, impairment in neurotransmitter production and synaptic maintenance, and a higher prevalence of dementia. It is unknown whether a prospective association exists between low liver enzyme levels and incident dementia. Objective: To determine whether low levels of ALT and AST are associated with higher risk of incident dementia. Methods: Plasma ALT and AST were measured on 10,100 study participants (mean age 63.2 years, 55% female, 22% black) in 1996-1998. Dementia was ascertained from comprehensive neuropsychological assessments, annual contact, and medical record surveillance. Cox proportional hazards regression was used to estimate the association. Results: During a median follow-up of 18.3 years (maximum 21.9 years), 1,857 individuals developed dementia. Adjusted for demographic factors, incidence rates of dementia were higher at the lower levels of ALT and AST. Compared to the second quintile, ALT values <10th percentile were associated with a higher risk of dementia (hazard ratio [HR] 1.34, 95% CI 1.08-1.65). The corresponding HR was 1.22 (0.99-1.51) for AST. Conclusion: Plasma aminotransferases <10th percentile of the physiologic range at mid-life, particularly ALT, were associated with greater long-term risk of dementia, advocating for attention to the putative role of hepatic function in the pathogenesis of dementia

Pleiotropy among common genetic loci identified for cardiometabolic disorders and C-reactive protein.

Pleiotropic genetic variants have independent effects on different phenotypes. C-reactive protein (CRP) is associated with several cardiometabolic phenotypes. Shared genetic backgrounds may partially underlie these associations. We conducted a genome-wide analysis to identify the shared genetic background of inflammation and cardiometabolic phenotypes using published genome-wide association studies (GWAS). We also evaluated whether the pleiotropic effects of such loci were biological or mediated in nature. First, we examined whether 283 common variants identified for 10 cardiometabolic phenotypes in GWAS are associated with CRP level. Second, we tested whether 18 variants identified for serum CRP are associated with 10 cardiometabolic phenotypes. We used a Bonferroni corrected p-value of 1.1×10-04 (0.05/463) as a threshold of significance. We evaluated the independent pleiotropic effect on both phenotypes using individual level data from the Women Genome Health Study. Evaluating the genetic overlap between inflammation and cardiometabolic phenotypes, we found 13 pleiotropic regions. Additional analyses showed that 6 regions (APOC1, HNF1A, IL6R, PPP1R3B, HNF4A and IL1F10) appeared to have a pleiotropic effect on CRP independent of the effects on the cardiometabolic phenotypes. These included loci where individuals carrying the risk allele for CRP encounter higher lipid levels and risk of type 2 diabetes. In addition, 5 regions (GCKR, PABPC4, BCL7B, FTO and TMEM18) had an effect on CRP largely mediated through the cardiometabolic phenotypes. In conclusion, our results show genetic pleiotropy among inflammation and cardiometabolic phenotypes. In addition to reverse causation, our data suggests that pleiotropic genetic variants partially underlie the association between CRP and cardiometabolic phenotypes

Long-term intensive athletic training: few adverse effects on later physical health

[Long-term intensive athletic training; few adverse effects on later physical health] [Article in Dutch] Kuipers H, Keizer HA, Schep G, Hoogeveen AR. Universiteit Maastricht, vakgroep Bewegingswetenschappen, Postbus 616, 6200 MD Maastricht. [email protected] In general, physical activity benefits health. However, long-term intensive physical training may have detrimental effects on the health of some individuals. In cyclists, changes in the femoral arteries may occur leading to stenoses that are manifested in claudication type symptoms. Some endurance athletes may experience atrial fibrillations that are possibly related to long-term physical training. Older athletes only have an increased risk of osteoarthritis in joints that have suffered injuries. Menstrual disturbances and premature osteoporosis may occur in women as a consequence of intensive physical training. However, the risk for these adverse consequences of long-term physical training is smal

Financial burden of allergen free food preparation in the catering business

This study aimed to quantify costs and benefits of allergen free food (food not containing ingredients that fall under the European labelling regime) production at a catering business under two scenarios. In scenario 1 the caterer provides information to the consumer regarding the presence of allergens in the meals served, uses allergen free ingredients in preparation of allergen free meals, but does not avoid cross contamination during food preparation. Scenario 2 expands upon scenario 1 as to also include the prevention of cross contamination during preparation of allergen free foods. A stochastic partial budgeting analysis was performed to simulate the costs and benefits in both scenarios, relative to the current situation of providing neither information regarding the presence of allergens nor serving allergen free meals. Costs values were based upon the adaptations necessary to comply with the two scenarios for an on premise catering location. Fixed and variable cost items were identified via literature review, critical inspection of the catering establishment, and expert opinion. Benefit items were identified and quantified via a questionnaire about willingness to pay and willingness to buy at a catering location, according to each scenario. Given the price increase of meals in accordance to the estimated willingness to pay, and using mean values of the distributions of the costs and benefit items, an investment payback time of 8.1 and 7.7 months was estimated for scenarios 1 and 2, respectively. However, with median values of the distributions, both scenarios were not profitable, since monthly net profits were estimated at € -413 and € -636 for scenarios 1 and 2, respectively. If additional costs are not passed on to the consumer, no scenario is profitable. Catering companies can use the methodology and results in their decision making process on serving allergen free foods.</p

Financial burden of allergen free food preparation in the catering business

<p>This study aimed to quantify costs and benefits of allergen free food (food not containing ingredients that fall under the European labelling regime) production at a catering business under two scenarios. In scenario 1 the caterer provides information to the consumer regarding the presence of allergens in the meals served, uses allergen free ingredients in preparation of allergen free meals, but does not avoid cross contamination during food preparation. Scenario 2 expands upon scenario 1 as to also include the prevention of cross contamination during preparation of allergen free foods. A stochastic partial budgeting analysis was performed to simulate the costs and benefits in both scenarios, relative to the current situation of providing neither information regarding the presence of allergens nor serving allergen free meals. Costs values were based upon the adaptations necessary to comply with the two scenarios for an on premise catering location. Fixed and variable cost items were identified via literature review, critical inspection of the catering establishment, and expert opinion. Benefit items were identified and quantified via a questionnaire about willingness to pay and willingness to buy at a catering location, according to each scenario. Given the price increase of meals in accordance to the estimated willingness to pay, and using mean values of the distributions of the costs and benefit items, an investment payback time of 8.1 and 7.7 months was estimated for scenarios 1 and 2, respectively. However, with median values of the distributions, both scenarios were not profitable, since monthly net profits were estimated at € -413 and € -636 for scenarios 1 and 2, respectively. If additional costs are not passed on to the consumer, no scenario is profitable. Catering companies can use the methodology and results in their decision making process on serving allergen free foods.</p

Left atrial and ventricular dimensions in highly trained cyclists

Objectives: This study sought to investigate the development of left ventricular remodeling during active cycling. Methods: A group of 17-year-old (±0.2 years) highly trained competitive cyclists (group I, n = 66) and a group of 29-year old (± 2.6 years) professional cyclists (group II, n = 35) underwent two-dimensional (2D) echocardiography. Data from groups I and II were compared with values of normal untrained subjects based on the literature. Results: Left atrial dimensions were significantly increased in group II as compared to group I (44 ± 5 vs. 36 ± 4 mm, p <0.005). Left ventricular end diastolic diameter was significantly increased in group II as compared to group I (61 ± 5 vs. 54 ± 6 mm, p <0.005). Left ventricular mass was also significantly increased in group II as compared to group I (321 ± 77 vs. 246 ± 59 g, p <0.005). Wall stress showed a significant inverse relation: 104 ± 42 mmHg in group I vs. 83 ± 14 mmHg in group II (p <0.005). The early filling phase of the left ventricular inflow was significantly larger in both athlete groups in relation to the normal value. The E-wave in the athletes compared to the E-wave in normal subjects was 0.87 ± 0.17 vs. 0.71 ± 0.14 m/s in group I, p <0.005, 0.82 ± 0.17 vs. 0.71 ± 0.14 m/s in group II, p <0.05. Late filling phase and the ratio of the diastolic filling pattern did not show significant differences between the two groups. Conclusions: Left atrial and left ventricular remodeling starts early in the athlete's career. Athletes of 17 years of age already show significant left atrial and left ventricular dilatation compared to data of untrained subjects described in literature. The process of dilatation continues during the athlete's career. Also left ventricular mass is increased at a young age which continues for several years. More than 60% of the athletes in both groups demonstrated an intermediate form of left ventricular hypertrophy. Diastolic function of the left ventricle remains normal during a long period of athletic career performance