A diet based on multiple functional concepts improves cardiometabolic risk parameters in healthy subjects

Background: Different foods can modulate cardiometabolic risk factors in persons already affected by metabolic alterations. The objective of this study was to assess, in healthy overweight individuals, the impact of a diet combining multiple functional concepts on risk markers associated with cardiometabolic diseases (CMD). Methods: Fourty-four healthy women and men (50-73 y.o, BMI 25-33, fasting glycemia <= 6.1 mmol/L) participated in a randomized crossover intervention comparing a multifunctional (active) diet (AD) with a control diet (CD) devoid of the "active" components. Each diet was consumed during 4 wk with a 4 wk washout period. AD included the following functional concepts: low glycemic impact meals, antioxidant-rich foods, oily fish as source of long-chain omega-3 fatty acids, viscous dietary fibers, soybean and whole barley kernel products, almonds, stanols and a probiotic strain (Lactobacillus plantarum Heal19/DSM15313). Results: Although the aim was to improve metabolic markers without promoting body weight loss, minor weight reductions were observed with both diets (0.9-1.8 +/- 0.2%; P < 0.05). CD did not modify the metabolic variables measured. AD promoted significant changes in total serum cholesterol (-26 +/- 1% vs baseline; P < 0.0001), LDL-cholesterol (-34 +/- 1%; P < 0.0001), triglycerides (-19 +/- 3%; P = 0.0056), LDL/HDL (-27 +/- 2%; P < 0.0001), apoB/apoA1 (-10 +/- 2%; P < 0.0001), HbA1c (-2 +/- 0.4%; P = 0.0013), hs-CRP (-29 +/- 9%; P = 0.0497) and systolic blood pressure (-8 +/- 1%, P = 0.0123). The differences remained significant after adjustment for weight change. After AD, the Framingham cardiovascular risk estimate was 30 +/- 4% (P < 0.0001) lower and the Reynolds cardiovascular risk score, which considers CRP values, decreased by 35 +/- 3% (P < 0.0001). Conclusion: The improved biomarker levels recorded in healthy individuals following the multifunctional regime suggest preventive potential of this dietary approach against CMD

Study protocol: a multi-professional team intervention of physical activity referrals in primary care patients with cardiovascular risk factors-the Dalby lifestyle intervention cohort (DALICO) study

Background: The present study protocol describes the trial design of a primary care intervention cohort study, which examines whether an extended, multi-professional physical activity referral (PAR) intervention is more effective in enhancing and maintaining self-reported physical activity than physical activity prescription in usual care. The study targets patients with newly diagnosed hypertension and/or type 2 diabetes. Secondary outcomes include: need of pharmacological therapy; blood pressure/plasma glucose; physical fitness and anthropometric variables; mental health; health related quality of life; and cost-effectiveness. Methods/Design: The study is designed as a long term intervention. Three primary care centres are involved in the study, each constituting one of three treatment groups: 1) Intervention group (IG): multi-professional team intervention with PAR, 2) Control group A (CA): physical activity prescription in usual care and 3) Control group B: treatment as usual (retrospective data collection). The intervention is based on self-determination theory and follows the principles of motivational interviewing. The primary outcome, physical activity, is measured with the International Physical Activity Questionnaire (IPAQ) and expressed as metabolic equivalent of task (MET)-minutes per week. Physical fitness is estimated with the 6-minute walk test in IG only. Variables such as health behaviours; health-related quality of life; motivation to change; mental health; demographics and socioeconomic characteristics are assessed with an electronic study questionnaire that submits all data to a patient database, which automatically provides feed-back to the health-care providers on the patients' health status. Cost-effectiveness of the intervention is evaluated continuously and the intermediate outcomes of the intervention are extrapolated by economic modelling. Discussions: By helping patients to overcome practical, social and cultural obstacles and increase their internal motivation for physical activity we aim to improve their physical health in a long- term perspective. The targeted patients belong to a patient category that is supposed to benefit from increased physical activity in terms of improved physiological values, mental status and quality of life, decreased risk of complications and maybe a decreased need of medication

Helicobacter pylori and Chlamydia pneumoniae in primary care- cardiovascular and gastrointestinal aspects

Helicobacter pylori and Chlamydia pneumoniae are common infectious agents in the Swedish population, causing gastritis ulcers and respiratory infections. The metabolic syndrome is characterised by overweight, insulin resistance, hypertension, diabetes and dyslipidaemia. Sera from a patient cohort (n=531) originally examined in 1987-89 were investigated for previous infection of H. pylori and C. pneumoniae in order to find possible associations with the metabolic syndrome. When comparing patients who have suffered infections (n=245) from both agents combined with those without infection (n=57) a significant increase in fasting insulin was observed indicating that the double infection may influence peripheral insulin resistance, which in turn could influence manifest disease. In a gastroscopy patients cohort (n=166), we compared the ELISA and immunoblot (IB) serology for H. pylori, with the histological features of the gastric mucosa. The presence of metaplasia and atrophy in the antrum were associated with a more specific immunoblot pattern and immunoblot analysis had a better sensitivity for gastric mucosal changes than ELISA-H. pylori serology. In all patients with chronic gastritis (n=90) significant correlation was seen to the 59 and 65 kDa protein band and in the corpus of the stomach also to a 33 kD protein. Atrophic gastritis and metaplasia in the antrum were significantly correlated with immunoreactivity to the 62 kDa protein (p<0.001 vs. p<0.002). Atrial fibrillation, with largely unknown origin, is the most common form of cardiac arrythmia demanding treatment. In comparing a population with this condition at a cardiology clinic (n=54) with a matched control population (n=54) from the same geographical area we found a significant independent association between atrial fibrillation and seropositivity for the combination of H. pylori and C. pneumoniae infection. Anti-Secretory Factor (ASF) is a protein with potent anti-inflammatory and anti-secretory properties. The pathophysiology of IBS, a common disorder often impairing quality of life, is unknown but a disturbance of motility, sensitivity and secretory processes has been observed. In order to improve the general condition, half of a group of patients (n=82) with IBS were given special processed cereals for eight weeks and the remaining half were randomly given placebo diet. Both groups significantly improved in their general well-being after eight weeks of treatment but no difference was seen between the groups. Patients with H. pylori infection (n=11) showed a tendency towards benefiting from the active treatment (p=0.08). In a sub-group of patients with loose stools (n=14) the ASF level increased in the active diet group. In the individual patients there was also a significant correlation between the improvement of symptoms and the change of the ASF plasma levels (p<0.05). In conclusion, we have shown that chronic infections with H. pylori and C. pneumoniae may affect the biological processes in several organ systems. The common pathophysiological pathway is probably a chronic inflammation where either the histological changes or the agents mediating the inflammation are of greatest importance, e.g. cytokines

Lack of adherence to hypertension treatment guidelines among GPs in southern Sweden-A case report-based survey

Background: General practitioners (GPs) often fail to correctly adhere to guidelines for the treatment of hypertension. The reasons for this are unclear, but could be related to lack of knowledge in assessing individual patients' cardiovascular disease risk. Our aim was to investigate how GPs in southern Sweden adhere to clinical guidelines for the treatment of hypertension when major cardiovascular risk factors are taken into consideration. Method: A questionnaire with five genuine cases of hypertension with different cardiovascular risk profiles was sent to a random sample of GPs in southern Sweden (n = 109) in order to investigate the attitude towards blood pressure (BP) treatment when major cardiovascular risk factors were present. Results: In general, GPs who responded tended to focus on the absolute target BP rather than assessing the entire cardiovascular risk factor profile. Thus, cases with the highest risk of cardiovascular disease were not treated accordingly. However, there was also a tendency to overtreat the lowest risk individuals. Furthermore, the BP levels for initiating pharmacological treatment varied widely (systolic BP 140-210 mmHg). ACE inhibitors (70%) were the most common first choice of pharmacological treatment. Conclusion: In this study, GPs in Southern Sweden were suggesting, for different cases, either under- or overtreatment in relation to current guidelines for treatment of hypertension. On reason may be that they failed to correctly assess individual cardiovascular risk factor profiles. Key points: Despite international and national clinical guidelines on the treatment of hypertension, general practitioners often fail to correctly assess the cardiovascular risk for patients in a clinical setting. Most GPs use target blood pressure levels but do not consider other cardiovascular risk factors. Both under- and overtreatment of high and low cardiovascular risk groups were seen in this study

Effects of anti-secretory factor (ASF) on irritable bowel syndrome (IBS)

Objective. To evaluate the role of the endogenous protein anti-secretory factor (ASF) on the symptoms, especially loose stools, in irritable bowel ayndrome (IBS). Design. A diet with specially processed cereals (SPC) known to induce ASF production was used in patients with IBS, in an eight-week randomized, placebo-controlled study. Subjects. Eighty-two patients with IBS were randomized to a diet with either SPC or placebo. Main outcome measures. The overall clinical condition and the quality of life were measured by VAS and SF-36 questionnaire, respectively. The plasma levels of ASF were determined in 14 patients with dominating loose stools before and after diet. Results. All patients significantly (p < 0.001) improved in IBS-related symptoms irrespective of active or placebo diet. In an active-diet sub-group with diarrhoea (n = 11) there was a significant (p < 0.05) correlation between the increase of plasma ASF level and the improvement on the VAS. Conclusion. Both study groups improved significantly on the VAS but no additive effect was seen for the active treatment. In the sub-group with loose stools, the SPC diet induced ASF plasma levels in IBS patients and was correlated to significant symptom improvement in the individual patient

Well-being and dietary adherence in patients with coeliac disease depending on follow-up

Objective It is not clear how follow-up of coeliac disease should be optimally organised. In Malmo, Sweden, patients are followed up by general practitioners (GP), but in Linkoping by gastroenterologists (GE). The aim of this study was to investigate if there were any differences in well-being and dietary adherence depending on type of follow-up. Methods All adult patients with newly diagnosed biopsy-verified coeliac disease in the cities between 2010 and 2014 were offered to participate. Data was retrieved comprising demography, laboratory analyses, questionnaires (Gastrointestinal Symptoms Rating Scale, Short Health Scale, Multidimensional Fatigue Inventory, Psychological General Well-being Index and Short Form 36) and follow-up. Results In the GP cohort 39/73 patients and in the GE cohort 58/121 agreed to participate (mean age 43 and 44 years, 69 and 60% women, respectively). A follow-up to a dietician was carried out in 31% and 93% of patients, respectively (p &amp;lt; .001). In the GP group 28% had eaten gluten-containing food during the last 4 weeks compared to 9% in the GE group (p = .01). Despite this, no differences could be seen in vitamin or mineral levels. The questionnaires did not indicate any major discrepancies in subjective health. Conclusion Irrespective of the design of the follow-up physical and mental well-being were comparable. Dietary adherence was not quite as good in the GP group but follow-up in a primary care setting can still be a suitable and equivalent alternative. However, it is crucial that the dietary counselling is structured in a way that ensures dietary adherence

Celecoxib 200 mg q.d. is efficacious in the management of osteoarthritis of the knee or hip regardless of the time of dosing

Objectives. The primary objective was to demonstrate equivalence between a.m. and p.m. dosing of celecoxib 200 mg q.d. An equivalence assessment of q.d. vs b.i.d. dosing was a secondary objective. Methods. In this randomized, double-blind study, patients with symptomatic osteoarthritis of the knee or hip were randomized to receive celecoxib 200 mg q.d. a.m., celecoxib 200 mg q.d. p.m. or celecoxib 100 mg b.i.d. The primary outcome variable, measured at week 12 on a 0- to 10-point integrated scale, was patient satisfaction-assessment (pain relief, walking/bending, and willingness to continue medication). Equivalence was declared if the 95% confidence interval (CI) of the difference (a.m. q.d. vs p.m. q.d., b.i.d. vs q.d.) fell within the interval of -2 to +2. Results. A total of 697 patients were enrolled in this trial. For the a.m. vs p.m. comparison, the 95% CIs were within the prespecified equivalence criteria for all three measures of patient satisfaction: pain relief, mean -0.2, 95% CI -0.53 to 0.68; ability to walk and bend, mean -0.2, 95% CI -0.54 to 0.64; willingness to continue medication, mean -0.7, 95% CI -0.98 to 0.49. The 95% CIs for the q.d. vs b.i.d. comparison were also within the -2 to +2 interval. Conclusion. Regardless of the time of day at which celecoxib 200 mg q.d. is administered, patients are equally satisfied with the pain relief, ability to walk and bend, and willingness to continue medication

Lack of adherence to hypertension treatment guidelines among GPs in southern Sweden-A case report-based survey

Abstract Background General practitioners (GPs) often fail to correctly adhere to guidelines for the treatment of hypertension. The reasons for this are unclear, but could be related to lack of knowledge in assessing individual patients' cardiovascular disease risk. Our aim was to investigate how GPs in southern Sweden adhere to clinical guidelines for the treatment of hypertension when major cardiovascular risk factors are taken into consideration. Method A questionnaire with five genuine cases of hypertension with different cardiovascular risk profiles was sent to a random sample of GPs in southern Sweden (n = 109) in order to investigate the attitude towards blood pressure (BP) treatment when major cardiovascular risk factors were present. Results In general, GPs who responded tended to focus on the absolute target BP rather than assessing the entire cardiovascular risk factor profile. Thus, cases with the highest risk of cardiovascular disease were not treated accordingly. However, there was also a tendency to overtreat the lowest risk individuals. Furthermore, the BP levels for initiating pharmacological treatment varied widely (systolic BP 140-210 mmHg). ACE inhibitors (70%) were the most common first choice of pharmacological treatment. Conclusion In this study, GPs in Southern Sweden were suggesting, for different cases, either under- or overtreatment in relation to current guidelines for treatment of hypertension. On reason may be that they failed to correctly assess individual cardiovascular risk factor profiles.</p