Hypertriglyceridemia: a potential side effect of propofol sedation in critical illness

Purpose: Hypertriglyceridemia (hyperTG) is common among intensive care unit (ICU) patients, but knowledge about hyperTG risk factors is scarce. The present study aims to identify risk factors favoring its development in patients requiring prolonged ICU treatment. Methods: Prospective observational study in the medicosurgical ICU of a university teaching hospital. All consecutive patients staying ≥4days were enrolled. Potential risk factors were recorded: pathology, energy intake, amount and type of nutritional lipids, intake of propofol, glucose intake, laboratory parameters, and drugs. Triglyceride (TG) levels were assessed three times weekly. Statistics was based on two-way analysis of variance (ANOVA) and linear regression with potential risk factors. Results: Out of 1,301 consecutive admissions, 220 patients were eligible, of whom 99 (45%) presented hyperTG (triglycerides >2mmol/L). HyperTG patients were younger, heavier, with more brain injury and multiple trauma. Intake of propofol (mg/kg/h) and lipids' propofol had the highest correlation with plasma TG (r 2=0.28 and 0.26, respectively, both p<0.001). Infection and inflammation were associated with development of hyperTG [C-reactive protein (CRP), r 2=0.19, p=0.004]. No strong association could be found with nutritional lipids or other risk factors. Outcome was similar in normo- and hyperTG patients. Conclusions: HyperTG is frequent in the ICU but is not associated with adverse outcome. Propofol and accompanying lipid emulsion are the strongest risk factors. Our results suggest that plasma TG should be monitored at least twice weekly in patients on propofol. The clinical consequences of propofol-related hyperTG should be investigated in further studie

Glucose-fructose beverages do not alter the effects of training on lactate metabolism

Glucose-fructose beverages do not alter the effects of training on lactate metabolism Rosset R., Egli L., Cros J., Schneiter P. and Tappy L. and Lecoultre V. Department of Physiology, University of Lausanne, Lausanne, Switzerland. Introduction It is generally accepted that lactate is produced by skeletal muscle during exercise, and is either used in adjacent muscle fibers (lactate shuttle) or recycled to glucose in the liver. We have shown that ingestion of fructose-containing drinks stimulates lactate production and release from the liver during exercise, and that fructose-derived lactate is subsequently used as an energy substrate by muscle. The regulation of this liver to muscle fructose-lactate shuttle remains unknown. In this study, we assessed whether consumption of fructose-containing beverages alters the effects of training on fructose and lactate metabolism. Methods Two groups of eight sedentary male subjects were endurance-trained for three weeks while ingesting 489 mL/h of either a 9.8%-glucose 6.2%-fructose beverage (GLUFRU) or water (C) during exercise training sessions. An incremental test to exhaustion and a metabolic test were performed before and after the interventions to assess training adaptations and substrate use during endurance-type exercise. Indirect calorimetry, [1-13C]lactate and [6,6-2H2]glucose were used to calculate plasma lactate appearance, clearance and oxidation and glucose kinetics. Results Anthropometrics and performance parameters were similar in both groups at baseline. Plasma glucose concentrations (+1±3 vs. +3±3 % vs. baseline values), glucose rate of appearance (+3±7 vs. +2±3 %) and metabolic clearance (+6±8 vs. +1±5 %) remained stable after both GLUFRU and C training (all p=n.s.). Overall, lactate concentrations were decreased after intervention in both GLUFRU and C, but not differently between groups (-10±5 vs. -20±4 %; p&lt;0.01 vs. baseline, p=n.s. between GLUFRU and C), as a result of an increased lactate metabolic clearance (+26.5±11.4 vs. +17.5±10.2 mL·min-1; p=0.01 vs. baseline, p=0.56 between GLUFRU and C). Lactate appearance (+10±6 vs. -4±9 %) and oxidation (+9±6 vs. - 6±9 %) remained unchanged across time and conditions (all p=n.s.). Maximal oxygen consumption (+287±53 vs. +249±104 mL·min-1) and power eliciting lactate threshold (+25±5 vs. +25±8 W) were similarly increased in GLUFRU and C (both p&lt;0.01 vs. baseline, p=n.s. between GLUFRU and C). Discussion These data corroborate our earlier observation that fructose is converted into lactate by the liver and subsequently oxidized during exercise. Endurance training did not alter liver lactate release, but increased lactate metabolic clearance. The effects of endurance training were not differently altered by the consumption of fructose during training sessions, however

Heterotwin Zn3P2 superlattice nanowires: the role of indium insertion in the superlattice formation mechanism and their optical properties

Zinc phosphide (Zn3P2) nanowires constitute prospective building blocks for next generation solar cells due to the combination of suitable optoelectronic properties and an abundance of the constituting elements in the Earth’s crust. The generation of periodic superstructures along the nanowire axis could provide an additional mechanism to tune their functional properties. Here we present the vapour–liquid–solid growth of zinc phosphide superlattices driven by periodic heterotwins. This uncommon planar defect involves the exchange of Zn by In at the twinning boundary. We find that the zigzag superlattice formation is driven by reduction of the total surface energy of the liquid droplet. The chemical variation across the heterotwin does not affect the homogeneity of the optical properties, as measured by cathodoluminescence. The basic understanding provided here brings new propsects on the use of II–V semiconductors in nanowire technology

Effects of Dietary Protein and Fat Content on Intrahepatocellular and Intramyocellular Lipids during a 6-Day Hypercaloric, High Sucrose Diet: A Randomized Controlled Trial in Normal Weight Healthy Subjects.

Sucrose overfeeding increases intrahepatocellular (IHCL) and intramyocellular (IMCL) lipid concentrations in healthy subjects. We hypothesized that these effects would be modulated by diet protein/fat content. Twelve healthy men and women were studied on two occasions in a randomized, cross-over trial. On each occasion, they received a 3-day 12% protein weight maintenance diet (WM) followed by a 6-day hypercaloric high sucrose diet (150% energy requirements). On one occasion the hypercaloric diet contained 5% protein and 25% fat (low protein-high fat, LP-HF), on the other occasion it contained 20% protein and 10% fat (high protein-low fat, HP-LF). IHCL and IMCL concentrations (magnetic resonance spectroscopy) and energy expenditure (indirect calorimetry) were measured after WM, and again after HP-LF/LP-HF. IHCL increased from 25.0 ± 3.6 after WM to 147.1 ± 26.9 mmol/kg wet weight (ww) after LP-HF and from 30.3 ± 7.7 to 57.8 ± 14.8 after HP-LF (two-way ANOVA with interaction: p &lt; 0.001 overfeeding x protein/fat content). IMCL increased from 7.1 ± 0.6 to 8.8 ± 0.7 mmol/kg ww after LP-HF and from 6.2 ± 0.6 to 6.9 ± 0.6 after HP-LF, (p &lt; 0.002). These results indicate that liver and muscle fat deposition is enhanced when sucrose overfeeding is associated with a low protein, high fat diet compared to a high protein, low fat diet

Prevalence of cardiovascular risk factors in a middle-income country and estimated cost of a treatment strategy

BACKGROUND: We assessed the prevalence of risk factors for cardiovascular disease (CVD) in a middle-income country in rapid epidemiological transition and estimated direct costs for treating all individuals at increased cardiovascular risk, i.e. following the so-called "high risk strategy". METHODS: Survey of risk factors using an age- and sex-stratified random sample of the population of Seychelles aged 25–64 in 2004. Assessment of CVD risk and treatment modalities were in line with international guidelines. Costs are expressed as US$per capita per year. RESULTS: 1255 persons took part in the survey (participation rate of 80.2$45.6, i.e. $11.2 for high blood pressure,$3.8 for diabetes, and $30.6 for dyslipidemia (using generic drugs except for hypercholesterolemia). Cost for minimal follow-up medical care and laboratory tests amounted to$22.6. CONCLUSION: High prevalence of major risk factors was found in a rapidly developing country and costs for treatment needed to reduce risk factors in all high-risk individuals exceeded resources generally available in low or middle income countries. Our findings emphasize the need for affordable cost-effective treatment strategies and the critical importance of population strategies aimed at reducing risk factors in the entire population

Tolerable upper intake level for dietary sugars

Following a request from five European Nordic countries, the EFSA Panel&nbsp;on Nutrition, Novel Foods and Food Allergens (NDA) was tasked to provide scientific advice on a tolerable upper intake level (UL) or a safe level of intake for dietary (total/added/free) sugars based on available data on chronic metabolic diseases, pregnancy-related endpoints and dental caries. Specific sugar types (fructose) and sources of sugars were also addressed. The intake of dietary sugars is a well-established hazard in relation to dental caries in humans. Based on a systematic review of the literature, prospective cohort studies do not support a positive relationship between the intake of dietary sugars, in isocaloric exchange with other macronutrients, and any of the chronic metabolic diseases or pregnancy-related endpoints assessed. Based on randomised control trials on surrogate disease endpoints, there is evidence for a positive and causal relationship between the intake of added/free sugars and risk of some chronic metabolic diseases: The level of certainty is moderate for obesity and dyslipidaemia (&gt; 50–75% probability), low for non-alcoholic fatty liver disease and type 2 diabetes (&gt; 15–50% probability) and very low for hypertension (0–15% probability). Health effects of added vs. free sugars could not be compared. A level of sugars intake at which the risk of dental caries/chronic metabolic diseases is not increased could not be identified over the range of observed intakes, and thus, a UL or a safe level of intake could not be set. Based on available data and related uncertainties, the intake of added and free sugars should be as low as possible in the context of a nutritionally adequate diet. Decreasing the intake of added and free sugars would decrease the intake of total sugars to a similar extent. This opinion can assist EU Member States in setting national goals/recommendations