The aetiology of rickets-like lower limb deformities in Malawian children

Summary: Debilitating rickets-like lower limb deformities are common in children throughout the world, particularly in Malawi, Africa where the causes are unknown. We have identified that Blount disease and calcium deficiency rickets are the likely causes of these deformities and propose calcium supplementation as a potential treatment of Malawian rickets. Introduction: Surgical correction of rickets-like lower limb deformities is the most common paediatric operation performed at Beit Cure Orthopaedic Hospital, Malawi. The aim of this study was to investigate the aetiology of these deformities. Methods: Children with a tibio-femoral angle of deformity >20° were enrolled (n = 42, 3.0–15.0 years). Anthropometric and early life and well-being data were collected. Early morning serum and urine samples were collected on the morning of the operation for markers of calcium and phosphate homeostasis. Knee radiographs were obtained, and the children were diagnosed with either Blount (BD, n = 22) or evidence of rickets disease (RD, n = 20). As BD is a mechanical rather than metabolic disease, BD were assumed to be biochemically representative of the local population and thus used as a local reference for RD. Results: There were no differences in anthropometry or early life experiences between BD and RD. Parathyroid hormone (PTH), 1,25-dihydroxyvitamin D, total alkaline phosphatase and urinary phosphate were significantly higher and serum phosphate, 25-hydroxyvitamin D (25OHD) and tubular maximal reabsorption of phosphate significantly lower in RD than BD. There was no difference in serum calcium, fibroblast growth factor 23 or markers of iron status between groups. All children had 25OHD > 25 nmol/L. Conclusions: Vitamin D deficiency is not implicated in the aetiology of RD or BD in Malawian children. The cause of RD in Malawi is likely to be dietary calcium deficiency leading to elevated PTH resulting in increased losses of phosphate from the bone and glomerular filtrate. The causes of BD remain unclear; there was no evidence in support of previously suggested risk factors such as being overweight or starting to walk early. Prior to surgical intervention, supplementation with calcium should be considered for children with RD

Life Cycle Assessment in the Wine Sector

Currently, stakeholders\u2019 increasing attention to quality is driving the wine sector to rethink and change its own production processes. Amongst product quality dimensions, the environment is gaining ever-growing attention at various levels of policy-making and business. Given its soundness, the use of Life Cycle Assessment (LCA) has become widespread in many application contexts. Apart from applications for communication purposes, LCA has also been used in the wine sector to highlight environmental hot spots in supply chains, to compare farming practices and to detect improvement options, inter alia. Case studies whose focus is the wine industry abound in high quality publications. This Chapter has a two-fold focus: firstly, an analysis of the methodologies and standards of the Life Cycle Thinking concept, related to wine, and secondly, a critical analysis of wine LCA case studies in order to compile a list of scientificallybased environmental hot-spots and improvements. The chapter also expands the knowledge on LCA\u2019s application to the wine industry by discussing how best to contribute to: \u2022 the identification of the critical environmental issues of the wine supply-chain and the essential elements that an LCA case study in the sector should consider; \u2022 the identification of an optimal set of indicators and methodologies for the evaluation of the environmental impacts of wine; \u2022 the comparability of results; \u2022 the improvement of the environmental research quality in this sector

Better wine for better health: fact or fiction?

In the first decade of the twenty-first century, the potential therapeutic effects of regular moderate wine consumption are being increasingly acknowledged. They include a reduction in the risk of, and death from, cardiovascular disease, which accounted for 40% of all Australian deaths in 2000. The reduction in risk for wine consumers is similar to that of consumers of fruits, grains and vegetables, which, together with wine, are the core components of a 'Mediterranean-style diet'. The chemical components of wine considered primarily responsible for this therapeutic effect are ethanol, and the phenolic compounds and their polyphenolic forms. Indeed, moderate wine consumption has been observed to supplement the cardioprotective effects of an already high phenolic diet, and more importantly, to counter the harmful effects of a high fat diet on blood clotting, endothelial function and lipid oxidation, which contribute to the development of cardiovascular disease. This paper explores both the viticultural and vinification factors that influence phenolic concentration in grapes and wine. The synthesis and accumulation of phenolic compounds in grapes is primarily dependent upon varietal factors, the expression of which is influenced by a combination of climatic and viticultural factors such as sunlight and temperature during ripening, as well as ripeness at harvest. While the maximum possible concentration of phenolic compounds in a wine will be determined by the content in the constituent grapes, factors which influence the extraction of the phenolic compounds from the skins and seeds primarily influence their concentration in the juice, must and wine. Once harvested, the concentration of phenolic compounds in grapes is invariate, but extraction efficiency can vary during vinification. Accordingly, this paper also explores innovative techniques and technologies that can increase the phenolic content of the resultant wine. At best, winemaking can only extract at 50% of the total phenolic compounds accumulated in the grapes. Therefore, the phenolic content of the resultant wine can only be increased by supplementation of the must during fermentation with additional sources of phenolic compounds. Alternatively, a grape seed extract could be added to wine post fermentation to supplement its phenolic content, although this same grape seed extract may also be added to other foods such as yoghurt, from which the phenolic compounds are readily absorbed. Regular and moderate consumption of wine by consumers should, however, be placed in context with the other constituents and characteristics of a healthy diet and lifestyle. Indeed, wine consumers generally have fewer risk factors for cardiovascular disease compared with beer and spirits consumers, which is reflected in an approximately 25% to 35% lower risk of cardiovascular disease for wine consumers compared to consumers of beer and spirits, respectively