Rodney G. Bowden

Fish oil supplementation lowers C-reactive protein levels independent of triglyceride reduction in patients with end-stage renal disease.

BACKGROUND Inflammation has been identified as a marker for cardiovascular disease. The purpose of this study is to examine the effects of fish oil fatty acid supplementation on C-reactive protein (CRP) levels. METHODS The study uses a double-blind, permuted-randomized, and placebo-controlled experimental protocol. Patients are randomly placed into a fish oil group or a control group. Thirty-three patients in the experimental and control groups ingest 2 soft-gel pills (1 g each) of fish oil supplements containing eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) or placebo at each meal. Patients follow the supplementation protocol for 6 months. Analysis of variance (ANOVA) is used to measure pretest and posttest differences in the variable of interest. A Kolmogorov-Smirnov test for normality is used to test whether CRP levels are normally distributed. RESULTS The Kolmogorov-Smirnov test for CRP finds a P value of .273 (KS = .997), revealing that the distribution is normal. ANOVA reveals no statistically significant difference between groups at baseline for CRP (F = 4.118, P = .053). ANOVA reveals a significant main effect (F = 4.29, P = .048) for CRP, with the EPA/DHA group having a significant change in values from pretest (16 mg/dL, standard deviation [SD] = 13.80) to posttest (10.22 mg/dL, SD = 7.87). The placebo groups CRP levels do not change significantly from pretest (13.37, standard deviation [SD] = 7.94) to posttest (13.67, SD = 7.07). An observed power calculation using Cohens D with a computed alpha of .05 is .588. CONCLUSIONS The study demonstrates that consuming 960 mg/d of EPA and 600 mg/d of DHA can lower CRP.

Effects of Coleus Forskohlii Supplementation on Body Composition and Hematological Profiles in Mildly Overweight Women

PurposeThis study investigated the effects of Coleus Forskohlii (CF) on body composition, and determined the safety and efficacy of supplementation.MethodsIn a double blind and randomized manner, 23 females supplemented their diet with ForsLean™ (250 mg of 10% CF extract, (n = 7) or a placebo [P] (n = 12) two times per day for 12-wks. Body composition (DEXA), body weight, and psychometric instruments were obtained at 0, 4, 8 & 12 weeks of supplementation. Fasting blood samples and dietary records (4-d) were obtained at 0 and 12-wks. Side effects were recorded on a weekly basis. Data were analyzed by repeated measures ANOVA and are presented as mean changes from baseline for the CF and placebo groups, respectively.ResultsNo significant differences were observed in caloric or macronutrient intake. CF tended to mitigate gains in body mass (-0.7 ± 1.8, 1.0 ± 2.5 kg, p = 0.10) and scanned mass (-0.2 ± 1.3, 1.7 ± 2.9 kg, p = 0.08) with no significant differences in fat mass (-0.2 ± 0.7, 1.1 ± 2.3 kg, p = 0.16), fat free mass (-0.1 ± 1.3, 0.6 ± 1.2 kg, p = 0.21), or body fat (-0.2 ± 1.0, 0.4 ± 1.4%, p = 0.40). Subjects in the CF group tended to report less fatigue (p = 0.07), hunger (p = 0.02), and fullness (p = 0.04). No clinically significant interactions were seen in metabolic markers, blood lipids, muscle and liver enzymes, electrolytes, red cells, white cells, hormones (insulin, TSH, T3, and T4), heart rate, blood pressure, or weekly reports of side effects.ConclusionResults suggest that CF does not appear to promote weight loss but may help mitigate weight gain in overweight females with apparently no clinically significant side effects.

A Review of Weight Control Strategies and Their Effects on the Regulation of Hormonal Balance

The estimated prevalence of obesity in the USA is 72.5 million adults with costs attributed to obesity more than 147 billion dollars per year. Though caloric restriction has been used extensively in weight control studies, short-term success has been difficult to achieve, with long-term success of weight control being even more elusive. Therefore, novel approaches are needed to control the rates of obesity that are occurring globally. The purpose of this paper is to provide a synopsis of how exercise, sleep, psychological stress, and meal frequency and composition affect levels of ghrelin, cortisol, insulin GLP-1, and leptin and weight control. We will provide information regarding how hormones respond to various lifestyle factors which may affect appetite control, hunger, satiety, and weight control.

Omega-3 fatty acid supplementation and total homocysteine levels in end-stage renal disease patients.

Aim:  Elevated total homocysteine (tHcy) levels are commonplace among end‐stage renal disease (ESRD) patients increasing risk for poor cardiovascular outcomes. Specifically, when plasma levels become significantly elevated, tHcy levels appear to contribute to vascular damage and premature atherosclerosis. The purpose of this study was to examine the effect of an over‐the‐counter omega‐3 (n‐3) fatty acid supplementation on tHcy levels in ESRD patients undergoing chronic haemodialysis.

High-cost analysis : a closer look at the case for work-site health promotion

Studies linking medical costs to behavioral risk and risk-lowering often use means for comparisons, although claims data are highly skewed. The result overestimates and obscures the case for work-site health promotion. In this study, high-cost analysis is illustrated in a sample of university employees. Five risk factors were examined: cholesterol, blood pressure, cardiovascular fitness, body fat, and smoking status. Screened employees who released their claims (n = 367) were examined against a random sample of employees (n = 587). Linear regression was used to determine the risk of having high claims costs within four gender-specific age groups. A formula was then applied to determine that more than 43% of the cost of medical claims was associated with elevated risk. High-cost analysis accounts for the skewness in claims data and presents a clear case for work-site health promotion.

Effects of omega-3 fatty acid supplementation on lipid levels in endstage renal disease patients.

OBJECTIVE Our purpose was to determine if over-the-counter fish oil improves the cardiovascular-disease risk profile of endstage renal disease patients. DESIGN This study used a double-blind, permuted-block, randomized, placebo-controlled design. The experimental intervention consisted of fish-oil concentrate supplementation, whereas corn-oil capsules were used as a control. Compliance follow-ups were performed 3 times per week. SETTING Patients of Central Texas Nephrology Associates clinics were eligible for this study. PATIENTS Exclusion criteria comprised a life-expectancy of less than 6 months, pregnancy, a history of hemodialysis or medication noncompliance, or age below 18 years. The final sample size was 87 patients. The attrition rate was 9%. INTERVENTION Participants in the experimental group consumed six 1-g soft-gel capsules of fish-oil concentrate each day for 6 months. The control group consumed corn-oil capsules, following the same protocol. Venous blood samples were acquired before and after the intervention. MAIN OUTCOME MEASURE We assessed a number of serum lipid indicators. RESULTS There were significant supplement/time interactions in low-density lipoprotein cholesterol (LDL) levels (P = .0001) and LDL particle number (P = .0001). Repeated-measures analysis of variance revealed significant time trends in high-density lipoprotein cholesterol (P = .012) and LDL (P = .001). High-density lipoprotein cholesterol levels significantly decreased in the control group, and increased in the fish-oil group, at 6 months, and LDL levels increased significantly in both groups. CONCLUSIONS The analysis indicates mixed results with respect to cardiovascular disease risk. Further research is needed to assess the benefits of an over-the-counter fish-oil supplement in the renal population.

The use of an anti-inflammatory supplement in patients with chronic kidney disease.

Abstract Chronic kidney disease (CKD) is characterized by a continuous reduction in kidney function, increased inflammation, and reduced antioxidant capacity. The objective of this study was to assess the effects of a herbal supplement on systemic inflammation and antioxidant status in non-dialysis CKD patients. Sixteen patients with CKD (56.0±16.0 yrs, 171.4±11.9 cm, 99.3±20.2 kg) were randomly chosen to receive a herbal supplement composed of Curcuma longa and Boswellia serrata, or placebo. Plasma levels of interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), glutathione peroxidase (GPx), and serum C-reactive protein (CRP) were measured at baseline and 8 weeks. Baseline data demonstrated elevated inflammation and low antioxidant levels. A significant time effect (p=0.03) and time x compliance interaction effect (p=0.04) were observed for IL-6. No significant differences were observed for any other variables. This study demonstrates that mild and moderate CKD is associated with chronic inflammation and low antioxidant activity. Systemic inflammation and impaired antioxidant status may be greater in CKD populations with multiple comorbidities. Curcumin and Boswellia serrata are safe and tolerable and helped to improve the levels of an inflammatory cytokine.

Reverse Epidemiology of Lipid-Death Associations in a Cohort of End-Stage Renal Disease Patients

Background and Aims: Cardiovascular disease is the leading cause of death among end-stage renal disease (ESRD) patients with hypercholesterolemia as a major cause. A few studies have demonstrated counter-intuitive findings known as reverse epidemiology where normal levels of cholesterol are associated with higher levels of mortality. The purpose of this study was to determine if there are reverse epidemiological associations between lipid risk factors and mortality in ESRD patients. Methods: ESRD (n = 438) patients were recruited from 4 outpatient dialysis units. Patients were tracked for 36 months until study completion or death with mortality status as the outcome measure. Results: Analysis of covariance revealed significant differences at posttest and reverse epidemiological effects for total cholesterol (p = 0.0001), low-density lipoprotein cholesterol (LDL) (p = 0.023), LDL particle number (p = 0.0001), LDL size (p = 0.009), triglycerides (p = 0.0001), and very low-density lipoprotein cholesterol (p = 0.036). A step-wise linear regression revealed weak, but significant predictors of mortality with total cholesterol (β = 0.263, p = 0.017) and LDL (β = –0.177, p = 0.045). A Cox death hazard ratio revealed LDL size as a significant predictor of mortality in this study. Conclusions: Our study discovered reverse epidemiology in a number of lipid variables. Additionally regression revealed that LDL and total cholesterol were predictors of mortality with lower levels being more predictive of death.

Relationships among self-esteem, stress, and physical activity in college students.

The purpose of this study was to identify population and sex-specific relationships between perceived stress, self-esteem, and physical activity in college students. 90 students, ages 18 and older and enrolled in five sections of a health and human behavior class during the spring 2010 semester, were contacted for this study with 74 consenting to serve as study participants. Each participant completed three surveys: the Rosenberg Self-Esteem Scale, the Perceived Stress Scale, and the International Physical Activity Questionnaire. Significant correlations were observed between perceived stress and self-esteem in men, and in women. Physical activity was not significantly correlated with perceived stress or self-esteem.

Rhabdomyolysis and acute renal failure in a sickle cell trait athlete: a case study.

This case study reports the clinical details and pathologic mechanisms of a nonfatal case of rhabdomyolysis secondary to heat exhaustion and sickle cell trait (SCT) resulting in acute renal failure. A 19-year-old African American male college football player collapsed after running 5 intervals of 300 m during a preseason conditioning test. After 17 days of treatment, the athlete was released from the hospital to a short-term noncritical care facility for further treatment and dialysis. Scientific literature reports that at least 15 college football players with SCT have died as a result of a sickling crisis after intense physical exertion. This case study presents the clinical importance of prompt medical treatment and sustained low-efficiency dialysis in treating rhabdomyolysis and its sequelae after collapse in an SCT athlete.