P. G. Ackermann

Serum cholesterol, phospholipid and lipoprotein levels in elderly male subjects.

Summary The cholesterol, phospholipid and Sf 12-20 levels in the blood serum were determined in a number of elderly subjects all over the age of 52. In these age groups there was a slight decrease in Sf level with age and a good correlation between the Sf level and the cholesterol level. The phospholipid level was found to vary linearly with the cholesterol level.

NUTRITIONAL DEFICIENCY DUE TO AGE AND PHYSIOLOGIC STRESS; ITS CONTROL BY FOOD AND HORMONES†

The problem of health is of primary concern with older people. Our studies (1) have emphasized that body nutrition is a major factor in the control of their health. The initial change from the normal physiology which leads to different disease entities may be of a similar character, but the primary variations that occur depend upon what tissues are affected to the greatest degree. Thus kidney disease, coronary heart disease, cerebral sclerosis or mental disease may be dependent upon the same basic body nutritional change, and result in arteriosclerosis-general or focal. The location of the more advanced changes in an organ may be the factor which gives rise to a particular disease. As we know it today, the problem of geriatric medicine is not only to recognize and treat diseases that are associated with age but to understand the mechanism or mechanisms involved in the occurrence of disease and thereby control health past mid-life. Such an approach provokes the necessity of considering the mechanisms concerned in the development of a disease phenomenon and especially the loss of properly balanced nutritional status of the older person. We and others (2) have shown that the reaction of the body as it ages increasingly resembles that of an organism under stress as far as body nutrition is concerned. It is known that stress is accompanied to a greater or less degree by a disturbance of the nitrogen balance with a loss of protein from the body and changes in the lipoprotein pattern. There is often an increased diabetic tendency. Our findings and those of others have indicated that such phenomena may be observed at different ages, but are particularly important in the older person. In the elderly, the management of disturbed nutrition, such as the replacement of protein and the maintenance of nitrogen balance, is a greater problem than in other age groups (3-5) and in states of debilitation. Factors such as infection, emotional states, surgery, accidents, endocrine disturbance, or poor nutrition (6) can cause a considerable loss of protein and a negative nitrogen balance in older people for relatively long periods of time. It may be difficult for them to recover from this state, even though there is a return to nitrogen equilibrium. Since it has been established that the administration of hormones may help control nitrogen loss, at least partial relief, from a nutritional standpoint (3) might be expected to result from a better understanding of their action. An understanding of the body needs must be emphasized. As an example, we might point to the relationships involved in the administration of a hormone, such as thyroid. In a state of hypothyroidism, adequate doses of thyroid gland substance enable the organism to retain protein. On the other hand, in euthyroid, or , especially, in hyperthyroid individuals,

THE EFFECT OF ADDED CARBOHYDRATE AND FAT ON THE NITROGEN BALANCE IN THE ELDERLY

In our earlier studies on nitrogen balance in elderly individuals (1-4) the caloric intake was kept constant as the nitrogen intake was varied from 0.35 to as much as 2.5 grams of protein per kilogram of body weight per day. It is known that in younger individuals variations in the caloric intake will influence the nitrogen balance (5, 6) and that the effect is greater in protein-depleted subjects (7, 8). In our earlier work we wished to study the effect of changes in the protein intake alone and kept the caloric intake constant at approximately 35 to 40 calories per kilogram of body weight per day. Before completing the nitrogen balance studies on a group of subjects, we thought it desirable to determine to what extent changes in the caloric intake would influence the nitrogen balance.

Effect of some hormones on calcium balance in elderly subjects.

Our earlier studies on calcium and phosphorus balance in elderly subjects have shown that calcium requirements are higher for such subjects than other workers found for young adults, with little change in phosphorus requirements (1,2). We later noted that addition of Vit. D to a supposedly adequate diet increased calcium retention in these subjects (3). Increased calcium requirements in the aged make it more likely that such subjects will be in negative calcium balance on an ordinary diet. The increase in incidence of osteoporosis in the aged has been noted by many workers(4). We have been studying the effects of various hormones on nitrogen balance in elderly subjects for some time. Some cause an increase in nitrogen retention and definite clinical improvement(5,6). Use of these hormones has found a definite place in treatment of debilitated elderly subjects(7). In view of the precarious state of calcium equilibrium in such individuals, we felt it advisable to make further studies on the effect of these hormones on calcium balance, as any effect in decreasing calcium retention would be undesirable. We present results on effect of thyroid, insulin, cortisone and ACTH on calcium balance. We also give a revised summary of some earlier work on the effect of sex hormones(8) and Vit. D(3) so that the data may be compared. Material and methods. The subjects had been used in our earlier studies on calcium balance(1). All were free of acute or infectious diseases. Their ages were: DE—88 years, OS—70 years, KO—69 years, KI—72 years, and MC—76 years. Details of clinical status and general procedure of calcium balance determinations have been given(1). Details of diets, adjustment of intake and collection of specimens were the same as in our earlier work on nitrogen balance(9). The diet was similar to Diet No. 3 of this reference.

Alpha-2 lipoprotein in man and its relation to myocardial infarction.

Summary and Conclusion Data are presented which indicate that an abnormal type of cholesterol lipoprotein curve is associated with a history of recovery from a previous myocardial infarction. The type of curve obtained from a given individual is relatively constant over years. As yet we are unable to say whether the abnormal type of curve develops prior to, or after, initial infarction, or whether degree of abnormality is of any prognostic value. The relationship which exists suggests the need for further studies as to diagnostic and prognostic value of this method in the study of myocardial infarction.