Bernhard Schellenberg

Blood pressure and adipose tissue linoleic acid.

SummaryIn a natural, “free-living population” of 650 men, surveyed with the purpose of health assessment within an epidemiological design, a strongly significant negative correlation between the relative linoleic acid composition of adipose tissue and blood pressures was found (P<0.001). This correlation remained significant when age and weight were statistically controlled for. Thus, dietary, lipid-lowering linoleic acid seems to effect blood pressures as well in a favorable way.

Serum lipids and anticonvulsants

The serum lipid levels of 200 epileptics (aged 20 to 40 years) undergoing long‐term treatment with anticonvulsants were measured and compared with the levels of a normal population of the same age. The epileptics had higher serum lipid levels (especially of apolipoprotein B and HDL‐cholesterol) but no higher incidence of hyperlipemias. A correlation between LDL‐cholesterol and vitamin E has been found in epileptics, but it was not as significant as in normals. In male epileptics, positive correlations between the average daily dose of anticonvulsants (especially of those with a well‐known enzyme‐inducing effect) and triglycerides, cholesterol and LDL‐cholesterol were found; in females there were no significant correlations.

Antiepileptic drugs reduce serum uric acid

Uric acid examination in 554 epileptic out-patients under long-term anticonvulsant medication revealed significantly lower serum concentrations compared to a group of normal controls. In patients taking enzyme-inducing drugs, uric acid levels were found to be lower than in those under valproate sodium. In addition, uric acid concentrations showed a negative correlation with duration of therapy in epileptic males. At this time, we can only speculate on the mechanism involved in the reduction of uric acid by enzyme-inducing anticonvulsants as well as on the possible implication of this finding in the treatment of hyperuricemia.

Tagesprofile von Plasmalipiden und Lipoproteinen bei Patienten mit endogener Hypertriglyzeridämie (Typ IV-Hyperlipoproteinämie)

Acute and chronic effects of three isocaloric diets on plasma lipids and plasma lipoproteins were studied in 10 patients with primary endogenous hypertriglyceridemia (type IV-hyperlipoproteinemia). The diets used contained 20% protein, 50, 37 and 1% fat and 30, 43 and 79% carbohydrates respectively. Cholesterol levels were similar with all diets. Fasting values of plasma triglycerides were lower with the fat-containing diets compared to the high-carbohydrate diet. Diurnal patterns, however, were significantly higher with the former diets in 8 of the 10 patients. Postprandial lipoprotein patterns on fat-containing diets are characterized by chylomicronemia and marked changes of concentration and composition of other lipoprotein classes. If, analogous to diabetic therapy, control of hypertriglyceridemia is meant to imply low all-day levels rather than low fasting levels, a rather low-fat, high-carbohydrate diet seems to be superior in most patients with endogenous hypertriglyceridemia to diets containing more than 35 calorie per cent of fat.SummaryAcute and chronic effects of three isocaloric diets on plasma lipids and plasma lipoproteins were studied in 10 patients with primary endogenous hypertriglyceridemia (type IV-hyperlipoproteinemia). The diets used contained 20% protein, 50, 37 and 1% fat and 30, 43 and 79% carbohydrates respectively. Cholesterol levels were similar with all diets. Fasting values of plasma triglycerides were lower with the fat-containing diets compared to the high-carbohydrate diet. Diurnal patterns, however, were significantly higher with the former diets in 8 of the 10 patients. Postprandial lipoprotein patterns on fat-containing diets are characterized by chylomicronemia and marked changes of concentration and composition of other lipoprotein classes.If, analogous to diabetic therapy, control of hypertriglyceridemia is meant to imply low all-day levels rather than low fasting levels, a rather low-fat, high-carbohydrate diet seems to be superior in most patients with endogenous hypertriglyceridemia to diets containing more than 35 calorie per cent of fat.ZusammenfassungBei 10 Patienten mit primärer endogener Hypertriglyzeridämie (Typ IV-Hyperlipoproteinämie) wurden akute (Tagesprofile) und chronische Wirkungen von 2 fetthaltigen (50 und 37 kcal%) und einer fettfreien, kohlenhydratreichen, isokalorischen Diät auf Plasmalipide und Lipoproteine untersucht. Die zwei fetthaltigen Kostformen mit identischem P/S Quotient und die fettfreie Kostform führten zu ähnlichen Cholesterinspiegeln. Bei den Plasmatriglyzeriden lagen die Nüchternwerte nach den fetthaltigen Kostformen zwar niedriger als nach der kohlenhydratreichen Diätperiode, Tagesprofile zeigten jedoch bei 8 der 10 Patienten eine „schlechtere“ Einstellung. Postprandial kommt es nach fetthaltigen Kostformen neben einer Chylomikronämie auch zu ausgeprägten Veränderungen von Konzentration und Zusammensetzung anderer Lipoproteinklassen.Wenn in Analogie zur Diabetestherapie als Einstellungskriterium der Hypertriglyzeridämie Lipidtagesprofile herangezogen werden, scheint bei der Mehrzahl von Patienten mit endogenen Hypertriglyzeridämien eine relativ kohlenhydratreiche, fettarme Diät fettreicheren Kostformen überlegen zu sein.

Abnormal low density lipoproteins in children with familial hypercholesterolemia--effect of polyanion exchange resins.

ZusammenfassungBei 20 Kindern mit familiärer Hyperlipoproteinämie Typ IIa wurden die Serumlipide und -Lipoproteine vor und während einer lipidsenkenden Behandlung mit Anionenaustauscher-Kunstharzen untersucht. Die Zusammensetzung der low density Lipoproteine (LDL) wurde mit derjenigen der gesunden Geschwister der Patienten verglichen. Nach einer diätetischen Vorbehandlung von mindestens 12 Monaten Dauer erhielten die Patienten während je 8 Wochen Colestipol (0,5 g/kg Körpergewicht) und Colestyramin (0,6 g/kg Körpergewicht) in cross-over-Anordnung. Die Behandlung mußte bei 6 Kindern wegen Nebenwirkungen (Obstipation, Oberbauchbeschwerden) vorzeitig abgebrochen werden.Neben zahlreichen Laborroutineparametern wurden Cholesterin, Triglyzeride und Phospholipide im Vollserum sowie Cholesterin, Triglyzeride und Apolipoprotein-B (Apo B) in isolierten Lipoproteinfraktionen nach Ultrazentrifugation gemessen. Apo B wurde mittels radialer Immunodiffusion bestimmt.Die LDL der Patienten mit familiärer Hypercholesterinämie zeigten im Vergleich mit denen ihrer gesunden Geschwister eine Reduktion des Triglyzeridanteils um gegen 50%. Das Verhältnis Apo B: LDL-Cholesterin war dagegen bei Patienten und gesunden Kindern annähernd gleich. Diese abnorme LDL-Zusammensetzung wurde durch die Therapie mit Anionenaustauscher-Kunstharzen nicht verändert. Der HDL-Cholesterinspiegel war bei den Patienten mit familiärer Hypercholesterinämie signifikant niedriger als bei den gesunden Kindern — er blieb unter der lipidsenkenden Behandlung unverändert tief.Das mit Colestyramin und Colestipol erzielte Behandlungsergebnis war sehr ähnlich, Gesamt- und LDL-Cholesterin wurden durch beide Substanzen um etwa 25% gesenkt. Die Triglyzerid- und Phospholipidspiegel wurden dagegen praktisch nicht beeinflußt.SummaryIn 20 children and adolescents with familial Type IIa hyperlipoproteinemia, serum lipids and lipoproteins were examined before and during treatment with polyanion exchange resins. The composition of LDL was compared to that of healthy siblings. The patients were given Colestyramine (0.6 g/kg body weight) and Colestipol (0.5 g/kg body weight) in a cross-over study for 8 weeks each, after they had been under dietary treatment for at least 12 months. In 6 children, drug treatment had to be stopped due to side-effects. The most common complaints were gastrointestinal discomfort and constipation.Cholesterol, triglycerides and phopholipids were measured in whole serum and cholesterol, triglycerides and Apolipoprotein-B in isolated lipoprotein fractions after ultracentrifugation. Apo-B was determined by radial immunodiffusion.The Apo-B: cholesterol ratio in whole serum and in the LDL fraction was identical in the patients and in the controls. The LDL triglyceride: Apo-B ratio, however, was about 50% lower in the patients. This abnormal LDL composition was not altered by therapy with polyanion exchange resins. HDL cholesterol levels were significantly lower in the patients than in healthy children, and remained low during therapy.The decrease of total and LDL cholesterol (25%) and Apo-B (20%) was similar under both Colestipol and Colestyramine. Triglycerides and phospholipids showed no significant changes in therapy.

Urinary sodium excretion in renal stone formers

ZusammenfassungIn der vorliegenden Untersuchung wurden 238 randomisiert ausgewählte männliche Individuen der Normalbevölkerung (Alter: 19–41 Jahre) und 42 altersgleiche Patienten mit rezidivierender Calcium-Oxalat- und/oder Calcium-Phosphat-Nephrolithiasis verglichen. Die Untersuchungen fanden unter ambulanten Bedingungen ohne diätetische Restriktionen statt. Die Urin-Natriumausscheidung betrug 207 ± 82 mmol/24 h (Bereich 55–570) bei Kontrollen und 208 ± 100 mmol/24 h (Bereich 75–574) bei Stein-Patienten. Sowohl bei Kontrollen (r=0,36,p < 0,01) und Patienten (r=0,4,p < 0,01) bestand eine signifikante Beziehung zwischen der Natrium- und Calcium-Ausscheidungsrate. Weder bei normotensiven noch bei hypertensiven Individuen konnte eine Beziehung zwischen Urin-Natrium-Ausscheidung zu systolischem oder diastolischem Blutdruck gefunden werden. Das Urin-Natrium als Index der Nahrungsaufnahme war signifikant korreliert mit verschiedenen coronaren Risikofaktoren, z.B. Glukose, Cholesterin und Übergewicht. Es konnte eine signifikante inverse Relation zwischen Urin-Natrium und Plasma-Phosphat gefunden werden, es bestand jedoch keine Beziehung zwischen Plasma-Phosphat und iPTH oder Urin-cAMP. Dieser Befund deutet darauf hin, daß die Natrium-Ausscheidung eine Determinante des Plasma-Phosphates darstellt.SummaryIn the present investigation 238 randomly selected male individuals of the general population (age 19–41 years) and 42 age-matched male patients with recurrent renal stone formation (calcium oxalate and/or calcium phosphate) were studied under outpatient conditions without dietary restrictions. Urinary Na excretion was 207 ± 82 mmol/24 h (range 55–570) in controls and 208 ± 100 (range 76–575) in recurrent renal stone formers. Both in controls (r=0.36;p < 0.01) and in stone formers (r=0.4;p < 0.01) a significant correlation was observed between urinary excretion of sodium and calcium.Urinary sodium excretion was unrelated to systolic or diastolic blood pressure in normotensive or hypertensive individuals. This finding indicates that factors other than sodium are involved in the maintenance of hypertension. Urinary sodium, presumably an index of intake of nutrients, was significantly correlated to several coronary risk factors, e.g. fasting glucose, cholesterol and overweight. There existed a significant inverse relationship between fasting plasma phosphate and urinary sodium, but not between fasting plasma phosphate and serum iPTH or urinary cAMP. This finding points to some function of sodium excretion as one determinant of plasma phosphate.

Lipoprotein Metabolism in Man

In the majority of us middle-aged males in the postprandial state, right now pancreatic and plasma lipases are working to dispose of the fatty parts of our breakfast aided by carbohydrate stimulated insulin incretion. At the vascular endothelium the rising VLDL and IDL compete for binding sites with LDL and the HDL as “guards” may be fighting adverse effects of tobacco smoke, hopefully assisted by yesterday evenings glass of beer. This would, in shorthand, describe “human lipoprotein metabolism, 1977.”

Dietary management of familial type II-hyperlipoproteinemia in children and adolescents-a feasibility study.

Studies in the USA (Glueck et al, 1971), South Africa (Stein et al, 1974) and Germany (Greten et al, 1974) suggest 0.9 to 3 % familial type II hyperlipoproteinemia in the newborn. According to Slack (1969) more than 50 % of the heterozygous subjects will have clinically manifest coronary heart disease by the age of 50. Homozygous children rarely reach the age of 20. Thus, early identification and treatment of this disorder appears to be mandatory.