Ronald L. Wilson

Effects of a popular exercise and weight loss program on weight loss, body composition, energy expenditure and health in obese women.

ObjectiveTo determine the safety and efficacy of altering the ratio of carbohydrate and protein in low-energy diets in conjunction with a popular exercise program in obese women.DesignMatched, prospective clinical intervention study to assess efficacy of varying ratios of carbohydrate and protein intake in conjunction with a regular exercise program.ParticipantsOne-hundred sixty one sedentary, obese, pre-menopausal women (38.5 ± 8.5 yrs, 164.2 ± 6.7 cm, 94.2 ± 18.8 kg, 34.9 ± 6.4 kg·m-2, 43.8 ± 4.2%) participated in this study. Participants were weight stable and not participating in additional weight loss programs.MethodsParticipants were assigned to either a no exercise + no diet control (CON), a no diet + exercise group (ND), or one of four diet + exercise groups (presented as kcals; % carbohydrate: protein: fat): 1) a high energy, high carbohydrate, low protein diet (HED) [2,600; 55:15:30%], 2) a very low carbohydrate, high protein diet (VLCHP) [1,200 kcals; 63:7:30%], 3) a low carbohydrate, moderate protein diet (LCMP) [1,200 kcals; 50:20:30%] and 4) a high carbohydrate, low protein diet (HCLP) [1,200 kcals; 55:15:30%]. Participants in exercise groups (all but CON) performed a pneumatic resistance-based, circuit training program under supervision three times per week.MeasurementsAnthropometric, body composition, resting energy expenditure (REE), fasting blood samples and muscular fitness assessments were examined at baseline and weeks 2, 10 and 14.ResultsAll groups except CON experienced significant reductions (P < 0.05 – 0.001) in waist circumference over 14 weeks. VLCHP, LCHP and LPHC participants experienced similar but significant (P < 0.05 – 0.001) reductions in body mass when compared to other groups. Delta responses indicated that fat loss after 14 weeks was significantly greatest in VLCHP (95% CI: -5.2, -3.2 kg), LCMP (-4.0, -1.9 kg) and HCLP (-3.8, -2.1 kg) when compared to other groups. Subsequent reductions in % body fat were significantly greater in VLCHP, LCMP and HCLP participants. Initial dieting decreased (P < 0.05) relative REE similarly in all groups. All exercise groups significantly (P < 0.05) improved in muscular fitness, but these improvements were not different among groups. Favorable but non-significant mean changes occurred in lipid panels, glucose and HOMA-IR. Leptin levels decreased (P < 0.05) in all groups, except for CON, after two weeks of dieting and remained lower throughout the 14 week program. Exercise participation resulted in significant improvements in quality of life and body image.ConclusionExercise alone (ND) appears to have minimal impact on measured outcomes with positive outcomes apparent when exercise is combined with a hypoenergetic diet. Greater improvements in waist circumference and body composition occurred when carbohydrate is replaced in the diet with protein. Weight loss in all diet groups (VLCHP, LCMP and HCLP) was primarily fat and stimulated improvements in markers of cardiovascular disease risk, body composition, energy expenditure and psychosocial parameters.

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 arachidonic acid supplementation on training adaptations in resistance-trained males

BackgroundTo determine the impact of AA supplementation during resistance training on body composition, training adaptations, and markers of muscle hypertrophy in resistance-trained males.MethodsIn a randomized and double blind manner, 31 resistance-trained male subjects (22.1 ± 5.0 years, 180 ± 0.1 cm, 86.1 ± 13.0 kg, 18.1 ± 6.4% body fat) ingested either a placebo (PLA: 1 g·day-1 corn oil, n = 16) or AA (AA: 1 g·day-1 AA, n = 15) while participating in a standardized 4 day·week-1 resistance training regimen. Fasting blood samples, body composition, bench press one-repetition maximum (1RM), leg press 1RM and Wingate anaerobic capacity sprint tests were completed after 0, 25, and 50 days of supplementation. Percutaneous muscle biopsies were taken from the vastus lateralis on days 0 and 50.ResultsWingate relative peak power was significantly greater after 50 days of supplementation while the inflammatory cytokine IL-6 was significantly lower after 25 days of supplementation in the AA group. PGE2 levels tended to be greater in the AA group. However, no statistically significant differences were observed between groups in body composition, strength, anabolic and catabolic hormones, or markers of muscle hypertrophy (i.e. total protein content or MHC type I, IIa, and IIx protein content) and other intramuscular markers (i.e. FP and EP3 receptor density or MHC type I, IIa, and IIx mRNA expression).ConclusionAA supplementation during resistance-training may enhance anaerobic capacity and lessen the inflammatory response to training. However, AA supplementation did not promote statistically greater gains in strength, muscle mass, or influence markers of muscle hypertrophy.

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.

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.

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.

Effect of over-the-counter fish-oil administration on plasma Lp(a) levels in an end-stage renal disease population.

OBJECTIVE This study sought to examine the effect of n-3 supplementation on lipoprotein(a) (Lp(a)) levels in end-stage renal disease (ESRD) patients undergoing chronic hemodialysis. DESIGN The present study was conducted using a double-blind, permuted-randomized, controlled experimental protocol. SETTING This study took place at the Central Texas Nephrology Associates Dialysis Clinic (Waco, TX). PATIENTS Patients with ESRD and associated with the Central Texas Nephrology Associates who were undergoing chronic hemodialysis participated in this study. INTERVENTION Patients with ESRD were followed prospectively while receiving supplements of fish oil (treatment, eicosapentaenoic acid, 0.96g/day, and docosahexaenoic acid, 0.6g/day) or corn oil (control subjects) for 6 months. After a 12-hour fast, participants donated 12mL of blood for analysis of Lp(a) at baseline and at 6 months. MAIN OUTCOME MEASURE The comparison of Lp(a) concentration by group at 6 months was the primary outcome measure of the study. RESULTS Our study suggests that fish-oil supplementation did not decrease levels of Lp(a) (P=.66), compared with control subjects. CONCLUSION We failed to show a significant effect of 6 months of over-the-counter fish-oil supplementation on Lp(a) status in an ESRD population, although results from this study support findings from other studies suggesting that African Americans have higher Lp(a) concentrations than persons of Caucasian decent.

Homocysteine and Vascular Access Thrombosis in a Cohort of End‐Stage Renal Disease Patients

Background: Maintaining successful hemodialysis services is dependent upon an access to circulation that is reliable and stable. Complications of vascular access such as dysfunction, thrombosis, or infection are major causes of hospitalization with thrombosis being the most common reoccurring problem. Initial prospective evidence supports an independent association between total homocysteine (tHcy) levels and access thrombosis. The purpose of this study was to determine if significant associations exist between tHcy, age, gender, and vascular access thrombosis in patients with end‐stage renal disease (ESRD). Subjects and Methods: One hundred eighty‐five (N = 185) patients undergoing dialysis were selected as subjects. The retrospective sample was divided into a one or less vascular access thrombosis (VAT) (VAT) group (n = 133) and more than one (VAT II) VAT group (n = 52). The data was collected during a 16‐month period (January 2000 to April 2002). Additional subgroup analyses included gender and age. Results: The Mann–Whitney U nonparametric t‐Test for variance between groups revealed no significant difference in tHcy values between VAT groups (U = 1841.50, p = 0.284). A two‐sample t‐Test for variance between tHcy and age revealed no significant differences (F‐ratio = 0.832, p = 0.32). A chi‐square analysis revealed no significant differences in gender and VAT groups (X2 = 0.246, p = 0.62). A Kolmogorov–Smirnov test for normality was calculated for tHcy with a p‐value of 0.859 revealing insufficient evidence that the distribution is not normal. Spearman Rank Correlations were calculated, revealing low to moderate associations among variables. Conclusions: While some studies have demonstrated a relationship between tHcy and VAT, this study found that chronically high homocysteine levels in patients with ESRD were not associated with incidence of VAT. There were no significant differences in the number of VATs across additional variables of age and gender.