Daphne A. Roe

Drug-induced nutritional deficiencies

Drugs can cause impairment in nutritional status when they produce one or more of the following effects: 1 Anorexia with depression of food intake 2 Malabsorption 3 Vitamin antagonism 4 Mineral depletion 5 Catabolic stress with loss of lean body mass.

Estimation of sulfur in biological materials by atomic absorption spectrometry.

Abstract Atomic absorption spectrometry has been applied to the estimation of barium and thus indirectly of sulfate in the low concentration in which this may be found in biological materials. Preliminary oxidation procedures for conversion of organic sulfur to the inorganic form included Benedicts method and the Schoniger oxygen flask technique. Standard determinations and recovery experiments demonstrated the precision of the analyses. The method is simple and rapid and therefore it has been concluded that it could be applied to both medical and biological research where multiple sulfur estimations are indicated.

Effect of UV exposure and β-carotene supplementation on delayed-type hypersensitivity response in healthy older men

OBJECTIVES The aims of this study were to determine if ultraviolet light (UV) is immunosuppressive in healthy older males, if beta-carotene (betaC) supplementation could prevent any observed UV-induced immunosuppression, and to compare these effects with those observed previously in younger men. METHODS The study was a placebo-controlled, randomized trial that employed a 2 x 2 factorial design. Healthy older men (mean age 65.5 years) received 30 mg betaC or placebo daily throughout the 47-day trial, while on a low carotenoid diet. After 28 days, half of each group received 12 suberythemic exposures to UV over a 16-day period. Delayed-type hypersensitivity (DTH) tests and plasma carotenoid assays were performed at baseline, pre-UV and post-UV time points, with DTH testing performed on an area of skin protected from UV exposure. RESULTS UV exposure resulted in significantly suppressed DTH response in the placebo group but not in the betaC-UV group. While there was no significant interaction between betaC supplementation and UV on DTH response, there was a significant inverse relationship between final plasma betaC concentration and extent of UV-induced suppression of DTH response. A similar correlation existed among subjects not exposed to UV. CONCLUSIONS Suberythemic UV exposure was immunosuppressive, as measured by DTH response, in healthy older men as in younger men. Higher plasma betaC was significantly associated with maintenance of DTH response, although the extent of protective effect of betaC appeared less than previously observed in younger subjects. The attenuated effect of betaC in the older UV-exposed subjects may have resulted in part from muted plasma betaC responses to betaC supplementation and/or higher plasma vitamin E levels than those of younger men. The finding that stronger DTH responses were associated with higher plasma betaC concentrations in both UV and non-UV subjects further supports a role for this nutrient in immunomodulation.

Drug-Nutrient Interactions in the Elderly

Drug-nutrient interactions include physicochemical, physiological, and pathophysiological events that are inherent to drug usage (Roe, 1985a). These events, which are summarized in Table I, may affect the disposition of drugs and nutrients.

In-Home Nutritional Assessment of Inner-City Elderly

Aims of this research have been to obtain aggregate data on reported problems in food access that are experienced by homebound, inner-city elderly; to disaggregate the data to show which subgroups of elderly are at highest risk for these types of food insecurity; and to assess whether these elderly differ socioeconomically, medically, or nutritionally from homebound elderly who report that they eat regularly. Instruments were designed to measure population-based food insecurity and to ask respondents to provide information about their socioeconomic status and disabilities as well as the extent to which they have formal or informal assistance in obtaining food. The need to collect this information has been linked to a state-wide effort to target city nutritionally needy elderly for home-delivered meals. Findings have been that food insecurity in the inner-city homebound is linked to loss of mobility as well as to poverty and lack of in-home food assistance. Minority elderly whose questionnaire responses indicate food insecurity include diabetics whose disease control is adversely affected by irregular eating. When methods of home assessment have been used to examine the extent to which a home-delivered meals program meets the nutritional needs of recipients, it has been possible to demonstrate that meals recipients show less food insecurity than a comparison group on waiting lists to receive meals.

Drug-nutrient interactions in three long-term-care facilities

OBJECTIVE To assess the risk of drug-nutrient interactions (DNIs) in three long-term-care facilities. DESIGN Retrospective audit of charts. SETTING Three long-term-care facilities in central New York State. SUBJECTS Fifty-three patients selected randomly from each facility. MEASUREMENT Data were collected from the medical record of each patient for a period of 6 months. A computerized algorithm was used to assess the risk for DNIs. Mean drug use, most frequently consumed drugs, incidence of potential DNIs, and the most commonly observed potential DNIs are reported. RESULTS In facilities A, B, and C, respectively, patients consumed a mean of 4.86, 4.04, and 5.27 drugs per patient per month and were at risk for a mean of 1.43, 2.69, and 1.43 potential DNIs per patient per month. The most commonly observed potential DNIs were gastrointestinal interactions affecting drug bioavailability and interactions affecting electrolyte status. CONCLUSIONS Patients in long-term-care facilities, who are primarily elderly and chronically ill and who consume multiple medications, are at notable risk for certain DNIs. Efforts need to be made to ensure appropriate pharmacologic and nutrition therapies as well as adequate and timely monitoring of patients in these facilities. Dietitians can play an important role in training other health professionals and in designing policies to prevent DNIs.

Home-delivered meals benefit the diabetic elderly

he importance of a regular meal pattern is commonly stressed to elderly diabetic persons and to their caretakers. This recommendation takes forgranted that there are no physical or financial barriers to buying or preparing food. The diabetic elderly who fail to comply with their diets are assumed to lack motivation, intelligence, or both (1-3). By removing these barriers, home-delivered meals (HDMs) may improve the eating patterns of the diabetic elderly and in turn improve control of their diabetes. Because of the increasing incidence of diabetes in the aging population, the number of people who could be helped by HDMs is considerable. For example, in a recent study of HDMs in New York State, 20% of recipients reported that they had diabetes (4). The study reported here, undertaken by the New York State Nutritional Surveillance program, examined the effects of an HDM program on food insecurity, dietary practices, and control of diabetes in an elderly diabetic population.

Effects of drugs on nutrition.

Abstract Drugs can increase nutrient requirements through various mechanisms and if these requirements are not met by dietary modification or provision of nutrient supplements, deficiency disease will result. Commoner nutritional effects of drugs consist in the insidious development of hypovitaminoses; other serious nutritional consequences of drug intake include growth impairment and, in the case of vitamin antagonists, poisoning through interference with metabolic processes dependent on the activity of vitamins or coenzymes. Interactions may exist between pharmacologic agents and nutrients with respect to their absorption, transport, metabolism and excretion. Single drugs can cause nutrient depletion by more than one mechanism and multiple drug regimens can deplete nutrient stores by a synergistic effect. Risks of drug-induced malnutrition with drugs increase with dose and duration of intake, marginal diets and co-existence of disease which increases requirements for the same nutrients that are affected by the drug.

Tissue Folacin Stores in Rats Measured by Radioassay

Summary Serum and liver folacin levels determined by competitive protein binding assay fell rapidly after the administration of folacin-depleting diets to female rats and returned to normal after dietary repletion with folic acid. Values of liver folacin measured by radioassays were comparable to values concurrently-determined by assay with Lactobacillus casei. Liver, serum, and kidney folacin levels were similar to those previously determined in this laboratory and to published values for total folacin determined by L. casei. Incubation of liver homogenates for 3-5 hr at 37° led to a threefold increase in folacin concentration when measured by L. casei, but did not alter values determined by radioassay. The results suggest that competitive protein binding offers a feasible and conventional technique for measuring total folacin content of rat tissues.

Effect of oral contraceptives on blood folate levels in pregnancy.

An investigation was carried out to assess residual effects of oral contraceptives on the folate status of pregnant women who had discontinued intake of these drugs within six months of conception. The sample population of middle class women consisted of users and nonusers of oral contraceptives of similar age groups. Subgroups were those studied initially during the summer (May to July) or winter (October to January). Red blood cell folate values showed seasonal variability and were lower in the winter months. Oral contraceptive users had lower plasma and red blood cell folate values than did the respective control subjects. Red blood cell folate values were more affected by previous drug use in the winter group than in the summer group. Dietary folate was found to have a significant effect on plasma and red cell folate; such for any one level of intake, blood folate values were significantly lower in oral contraceptive users.