Albert I. Mendeloff

Trends in incidence rates of ulcerative colitis and Crohn's disease

Between 1960 and 1979, three studies were conducted in the Baltimore Standard Metropolitan Statistical Area to ascertain the incidence rates of first hospitalizations for ulcerative colitis and Crohns disease. The age-adjusted rates per 100,000 population for the 1977–1979 survey for ulcerative colitis in white and nonwhite males and females were 2.92, 1.79, 1.29, and 2.90, respectively; the Crohns disease rates were 3.39, 3.54, 1.29, and 4.08, respectively. In Baltimore the age-adjusted rate for Crohns disease has increased to exceed the ulcerative colitis rate for whites of both sexes and nonwhite females. The ulcerative colitis and Crohns disease rates for nonwhite males are similar. The rate for white males exceeds that for nonwhite males for both ulcerative colitis and Crohns disease, but the converse is true for females. Females have higher rates than males for Crohns disease in both color groups and for ulcerative colitis among nonwhites. White ulcerative colitis rates are higher for males than for females. From the first to the second surveys, the white male and female rates for ulcerative colitis converge with increasing male and decreasing female rates, but then both decline from the second to the third surveys. For Crohns disease, the age-adjusted rates increased for whites of both sexes and nonwhite females from the first to second surveys. The Crohns disease rates appeared to stabilize for whites of both sexes between the second and present surveys, but they increased for nonwhites of both sexes. Trends in age-adjusted rates for other areas are also discussed.

Upper gastrointestinal bleeding: Nature and magnitude of the problem in the U.S.

This study examines the frequency of upper GI bleeding in the United States population, and the use of diagnostic endoscopy in its evaluation. Data from the National Hospital Discharge Survey and National Ambulatory Medical Care Survey are used, as well as limited data from the Veterans Administration and State of Wisconsin. There were almost 1.1 million discharges from U.S. hospitals in 1978 with diagnoses related to UGI bleeding. Using an indirect method of estimation based on cases of peptic ulcer specified as bleeding, we estimate the rate of hospitalization with UGI bleeding as 150 per 100,000 population per year. About one-sixth of these patients underwent gastroscopy and/or esophagoscopy in 1978, approximately a three-fold increase over five years previously. National mortality from UGI bleeding decreased approximately 40 percent between 1968 and 1977, but data are inadequate to infer a relationship to increased use of endoscopy. Suggestions for further research are specified.

Incidence rates of liver cirrhosis and related diseases in Baltimore and selected areas of the United States

Abstract Incident hospitalized cases of Laennecs cirrhosis, alcoholic hepatitis, and fatty liver were ascertained by abstracting hospital records from all nonfederal short-term general hospitals in the Baltimore Standard Metropolitan Statistical Area (SMSA) and in 15 other defined geographic areas located in all nine census divisions of the U.S. All cases were classified as definite or highly probable; probable; possible; or not supported by the evidence obtained. Census data were used for population estimates. Annual age-adjusted Baltimore City first hospitalization rates, considered as incidence rates, for total cases (definite or highly probable, probable and possible) in males/100,000 population were as follows: Laennecs cirrhosis, whites, 44.9, non whites, 50.1; alcoholic hepatitis, whites, 11.6, nonwhites, 33.2; fatty liver, whites, 11.6, nonwhites, 12.0. Annual age-adjusted incidence rates in males for the aggregate of the 15 other defined geographic areas were as follows: Laennecs cirrhosis, whites, 36.0, nonwhites, 32.9; alcoholic hepatitis, whites, 24.8, nonwhites, 76.0; fatty liver, whites, 8.0, nonwhites, 10.6. Incidence rates for females were considerably lower both in Baltimore City and the 15 other areas. The most dramatic finding was the great difference in incidence rates of alcoholic hepatitis between white males and nonwhite males. In Baltimore City, the male nonwhite white ratio was 2.86; in the 15 other areas it was 3.06. In Baltimore City, the peak incidence rate of alcoholic hepatitis in nonwhite males occurred at ages 30–39, which is about 10 yr earlier than the corresponding peak in white males. The peak incidence rate of Laennecs cirrhosis in nonwhite males occurred at ages 40–49, about 20 yr earlier than the corresponding peak in white males. The uses of these findings for further epidemiologtcal studies are discussed.

Long-term effects of guar gum on blood lipids

While guar gum has been shown to lower total cholesterol and low density lipoprotein cholesterol (LDL-C) in diabetic patients over the short-term, the long-term effects are less well studied and may be unpredictable. Granola bars with and without 6.6 g guar gum were developed and fed to 16 adult volunteers with Type II diabetes mellitus who had been randomized in a double-blind fashion into guar and placebo groups of equal size. Four to six bars were consumed daily with an ad lib diet over a 6-month period. Total cholesterol, total high density lipoprotein cholesterol (HDL-C), subfractions HDL2-C and HDL3-C, LDL-C, and beta-apoprotein were measured at 0 and 6 months. Although LDL-C was lower and triglycerides higher at 6 months than at baseline, these changes were of equal magnitude and direction in both guar and placebo groups. Using each subject as his own control, only the change in triglycerides was statistically significant (P less than 0.025). When male subjects alone were analyzed, the guar group showed a statistically significant decrease in LDL, while the placebo group did not. Other lipid parameters were not significantly changed during the study, despite a positive effect on carbohydrate metabolism from the guar bars. The data suggest either that the hypolipemic effects of guar gum in patients with Type II diabetes mellitus are not sustained for 6 months, or the effects occur only in men.

Flattening Postprandial Blood Glucose Responses with Guar Gum: Acute Effects

It has been proposed that high-carbohydrate, high-fiber (HCF) diets might serve as useful therapeutic modality in non-insulin-dependent diabetes mellitus (NIDDM). One problem in evaluating clinical trials of this therapy is that, by their very nature, the trials cannot be double blinded. We have developed HCF and placebo granola-type bars using complex absorbable carbohydrate and guar gum fiber to circumvent this methodologic problem. The HCF bars, when consumed with an ad lib. diet, assure an HCF intake without imposing other dietary restrictions. To test the short-term efficacy of the bars, 9 normal adult volunteers, 2 women with impaired glucose tolerance, and 20 patients with NIDDM consumed the bars alone or with meals. Blood glucose responses when HCF bars were consumed alone were blunted when compared with the placebo response (P < 0.0005 to P < 0.002), with the most marked suppression occurring in the early postprandial period. In contrast, when the bars were consumed along with breakfast, HCF and placebo responses were virtually identical in the early postprandial period, but showed a progressively greater difference from 90 to 240 min (P < 0.02 to P < 0.0005). When consumed with lunch as well as breakfast, the HCF bars caused flattening of blood glucose responses during the late postprandial period after breakfast and maintained flattened responses during the early and late postprandial periods after lunch (P < 0.05 to P < 0.005). It is concluded that these HCF bars can be used to blunt postprandial blood glucose responses, in subjects with either normal or abnormal carbohydrate metabolism.

Effect of Guar Gum on Mineral Balances in NIDDM Adults

The self-selected diet of 16 subjects with noninsulin- dependent diabetes mellitus (NIDDM) was supplemented for 6 mo with either a granolalike bar containing 35.5 g carbohydrate and 6.6 g guar gum/bar or a placebo bar containing carbohydrate but no guar gum. Subjects consumed a mean of 4.8 bars/day. Average guar gum consumption at the end of the study was 31.7 g/day. One week before and at the end of the study, subjects were admitted to a metabolic ward and fed a controlled diet similar to their self-selected diet. Food, feces, and urine were composited for analysis of iron, zinc, copper, calcium, magnesium, and manganese. Eight subjects consuming the guar gum supplement and 6 subjects consuming the placebo bar completed collections for mineral balance. Neither consumption of guar gum nor placebo bar significantly changed apparent mineral balance for iron, copper, zinc, calcium, manganese, or magnesium from prestudy levels to 6-mo levels, and no significant differences were observed between the two groups. With the exception of copper, men consumed significantly more minerals than women. We conclude that consumption of guar gum by patients with NIDDM does not adversely affect apparent mineral balance.

Nutritional Risk of High-Carbohydrate, Guar Gum Dietary Supplementation in Non-Insulin-Dependent Diabetes Mellitus

Dietary supplementation with high-carbohydrate, guar gum fiber (HCF) is effective in acutely blunting postprandial blood glucose levels. We report the effect of such supplementation on the diet and nutritional status of a group of 16 subjects with non-insulin-dependent diabetes mellitus (NIDDM) who incorporated either HCF bars (35.7 g carbohydrate and 6.6 g guar gum/bar) or placebo bars (identical except for the absence of guar gum) into the diet for 6 mo as part of a double-blind, randomized clinical trial. The HCF subjects achieved mean daily intake of 4.8 ± 0.4 bars, constituting 51.2 ± 3.1% of total calories and providing 29.7 ± 2.6 g guar gum daily. Energy intakes and body weight did not change significantly in either group. Food consumption patterns and nutrient intakes did change, although not enough to impair the nutritional integrity of the diet because the bars themselves served as a source of nutrients. The bars were rich in thiamin, B6, folacin, phosphorus, iron, zinc, and copper, adequately replacing any decrease in nutrient intake as a result of foods being dropped from the diet. In fact, daily intakes of B6, folacin, and copper actually increased due to contributions from the bars. Nutrients in which the bars were poor (vitamins A, C and B12) resulted in suboptimal intakes (<66% RDA). Although no significant change in nutritional status of the HCF group occurred as determined by arm muscle area, arm fat area, hemoglobin, hematocrit, or serum albumin, transferrin, iron, ferritin, calcium, phosphate, B12, and magnesium levels, these indicators of nutritional status are rather insensitive. To ensure adequate nutrient intake and thus nutritional status with HCF diets, vitamin and mineral supplementation is probably advisable over the long term.

PAS full coverage areas: A resource for epidemiologic research

Abstract A new resource is described for (1) examining time trends in disease frequency and (2) calculating incidence rates of hospitalization for geographic areas, defined on the basis of patient origin studies, in which all short-term hospitals participate in the PAS system. This resource will be especially useful for diseases where long- and short-term time trends cannot at present be examined because mortality data are not useful and population-based registries do not exist.

Alteration of electrical and motor activity of human and dog rectum by diphenylhydantoin

The present in vitro study on isolated colon strips in humans and dogs indicates that diphenylhydantoin acts both on neuromuscular junctions and directly on smooth muscle. Diphenylhydantoin (DPH) opposes the action of acetylcholine (ACH) and 5-hydroxytryptamine (5-HT) on neuromuscular junctions and exerts its relaxing effect on postganglionic or nonadrenergic adrenergic receptor sites, since its effects are not influenced byα− orβ− adrenergic blocking agents or by ganglionic blockade with hexamethonium. Diphenylhydantoin acts directly on smooth muscle, inhibiting spontaneous contraction, possibly by altering myogenic electrical activity. It also inhihits contraction of smooth muscle induced by neuromuscular agonists and by electrical stimulation. These results indicate that DPH has a peripheral as well as a central effect and provide a theoretic basis for its use in patients with “spastic colon” syndrome.

Diet and colorectal cancer

Data on the relationship of dietary intakes to the risk of colorectal cancer is controversial. The identification of any single causal feature in human diet for colorectal cancer is an improbable outcome because of the complexity of neoplasia, interaction of dietary factors and carcinogens, and the varied forms of colorectal cancer. The same general dietary program advocated for reduced cardiovascular risk is probably suitable for cancer reduction as well.