The role of nutritional status in the prognosis of subjects with severe chronic obstructive pulmonary disease was studied in a cohort of Canadian men and women followed for 3 to 5 yr. A total of 348 subjects who were recruited for a study of negative pressure ventilation were evaluated for lung function and body weight, and a subset who entered hospital for the study (n=184) had baseline measures of diffusing capacity, maximal inspiratory and expiratory mouth pressure (PImax and PEmax), and blood gases. Predictors of survival were analyzed using Cox regression models. In the total cohort, low body mass index (BMI) and use of home oxygen were independently associated with reduced survival. In the hospitalized group, predictors of respiratory mortality were elevated PaCO2 and low BMI, PImax, and diffusing capacity. PaO2 (measured on oxygen therapy), FEV1, PEmax, age, smoking behavior, and gender were not associated with survival. The predictors of total mortality were similar, except that BMI was no longer significant. In conclusion, low body weight, a potentially modifiable factor, was associated with respiratory mortality, but whether it has a casual effect or is a marker of declining health can only be resolved through an intervention trial.

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OBJECTIVES. The aim of this study was to describe dietary intake and identify predictors of energy and protein intake in a group of high-risk elderly people. METHODS. All elderly persons receiving publicly financed home care services in the area of Sherbrooke, Quebec, Canada, were eligible. Subjects (n = 145) 60 to 94 years of age from three home care programs were interviewed to measure sociodemographic, health, and food-related behavior variables. Three nonconsecutive 24-hour recalls were used to describe usual dietary intake. Independent predictors of energy and protein intake were derived from multiple regression analyses. RESULTS. Very low mean energy intakes were observed in this functionally dependent population. More than 50% of the study subjects did not meet the recommended levels of daily protein intake (0.8 g/kg body weight). Significant independent determinants of intake were burden of disease, stress, poor appetite, and vision. CONCLUSIONS. Results suggest that community-living elderly people with loss of autonomy may have more nutritional problems than healthy elderly individuals. Surveillance of predictors of dietary intake may enable early detection and prevention of nutritional deficits.

ResearchM ilk is an important source of vitamin D, calcium, riboflavin, protein and energy during pregnancy, yet many women choose or are advised to avoid drinking milk for a variety of reasons, including the prevention of allergies in their children.1 Limiting milk intake compromises the quality of the maternal diet; 2-5 women who avoid milk may not obtain adequate levels of vitamin D, calcium, protein or riboflavin. Milk restriction is a risk factor for pregnancy-associated hypertension.6 Low vitamin D intake is associated with neonatal rickets 7 and decreased birth weight. 8Inadequate consumption of riboflavin is associated with decreases in weight, 9 length and head circumference of babies at birth. 10Although most nutrients in milk may be replaced from other foods or with supplements, vitamin D is found in few commonly consumed foods except for milk fortified with the vitamin.11 Dermal conversion of the precursor cholecalciferol to activated vitamin D is a seasonally unreliable source, particularly when the exposure of skin to sunlight is limited, 12and may not compensate for low nutritional intake. Under optimal conditions, 15 minutes of daily exposure of the hands and face to sun is required to produce adequate vitamin D, 13 but this conversion is reduced by the prolonged winter season at more polar latitudes, 14,15 by use of sunscreens with a sun protection factor (SPF) above 8, 16 and by ozone air pollution. 13People whose skin pigmentation is dark are more vulnerable than others to insufficient vitamin D conversion. 16In this study we compared the birth weight, crown-heel length and head circumference of newborns whose mothers restricted their intake of milk during pregnancy with the babies of those who did not. MethodsBetween May 1997 and June 1999 we screened 2091 women who attended prenatal classes at 3 hospitals in Calgary, Alberta. The study was approved by the Institutional Review Board of McGill University as well as by the Calgary Health Region Ethics Board.Women were given an anonymous questionnaire that asked whether they would be willing to participate in an indepth study on dietary intake and pregnancy outcomes, and if they restricted dairy products for any reason. For consenting participants, a second questionnaire asked for demographic data, lifestyle characteristics (e.g., smoking habits, highest level of education achieved) and if they had certain metabolic conditions (e.g., diabetes, hypertension) or a multiple pregnancy. Only healthy mothers with singleton pregnancies were Association of low intake of milk and vitamin D during pregnancy with decreased birth weightB Ba ac ck kg gr ro ou un nd d: : Some pregnant women may be advised or choose to restrict milk consumption and may not take appropriate supplements. We hypothesized that maternal milk restriction during pregnancy, which can reduce intakes of protein, calcium, riboflavin and vitamin D, might represent a health risk by lowering infant birth weight. M Me et th ho od ds s: : We screened women between the ages of 19 and 45 years...

Although chronic pain is a frequent cause of suffering and disability and is costly to society, there continues to be limited access to specialty pain clinic services. Hence, there is a need for cost-effective, accessible interventions that will help people find ways to better manage this difficult problem. This randomized controlled trial examined the effect of a low-cost, community-based, nurse-delivered, group psychoeducation program entitled the Chronic Pain Self-Management Program (CPSMP). It has a standard protocol that was modified from the successful Arthritis Self-Management Program (ASMP). One hundred and ten individuals with mixed idiopathic chronic pain conditions were enrolled in the study (75% female; mean age 40 years; mean chronicity 6 years) and were randomly assigned to one of two conditions: the 12-h (CPSMP) intervention group, or the 3-month wait-list control group. Self-report measures of pain-related and other quality of life variables as well as two hypothesized mediating variables were collected pre-treatment and 3 months later by assessors blind to group allocation. One hundred and two subjects completed the study. Results of intention-to-treat analysis indicated that the treatment group made significant short-term improvements in pain, dependency, vitality, aspects of role functioning, life satisfaction and in self-efficacy and resourcefulness as compared to the wait-list control group. Because it has a standard protocol, this intervention has the potential to be reliably delivered at low cost in varied urban and rural community settings and hence be more widely accessible to a greater number of people suffering from chronic pain than is currently the case with more specialized pain clinic services. Based on the results of this study, further research evaluating the long-term impact and potential cost savings to the individual and to the health care system is warranted.

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Our results suggest that greater protein intakes and a more even distribution across meals are modifiable factors associated with higher muscle mass in older adults but not with losses over 2 y. Interventional studies should determine longer-term effects on preserving LM with aging.