BACKGROUND Lipids accumulate during the storage of red blood cells (RBCs), prime neutrophils (PMNs), and have been implicated in transfusion-related acute lung injury (TRALI). These lipids are composed of two classes: nonpolar lipids and lysophosphatidylcholines based on their retention time on separation by high-pressure liquid chromatography. Prestorage leukoreduction significantly decreases white blood cell and platelet contamination of RBCs; therefore, it is hypothesized that prestorage leukoreduction changes the classes of lipids that accumulate during storage, and these lipids prime PMNs and induce acute lung injury (ALI) as the second event in a two-event in vivo model. STUDY DESIGN AND METHODS RBC units were divided: 50% was leukoreduced (LR-RBCs), stored, and sampled on Day 1 and at the end of storage, Day 42. Priming activity was evaluated on isolated PMNs, and the purified lipids from Day 1 or Day 42 were used as the second event in the in vivo model. RESULTS The plasma and lipids from RBCs and LR-RBCs primed PMNs, and the LR-RBC activity decreased with longer storage. Unlike RBCs, nonpolar lipids comprised the PMN-priming activity from stored LR-RBCs. Mass spectroscopy identified these lipids as arachidonic acid and 5-, 12-, and 15-hydroxyeicsotetranoic acid. At concentrations from Day 42, but not Day 1, three of four of these lipids individually, and the mixture, primed PMNs. The mixture also caused ALI as the second event in a two-event model of TRALI. CONCLUSION We conclude that the nonpolar lipids that accumulate during LR-RBC storage may represent the agents responsible for antibody-negative TRALI.
BACKGROUND Models are needed for implementing weight management interventions for adolescents through readily accessible venues. This study evaluated the feasibility and efficacy of a school nurse-delivered intervention in improving diet and activity and reducing BMI among overweight and obese adolescents. METHODS Six high schools were randomized to either a 6-session school nurse-delivered counseling intervention utilizing cognitive-behavioral techniques or nurse contact with provision of information. Eighty-four overweight or obese adolescents in grades 9 through 11 completed behavioral and physiological assessments at baseline and 2- and 6-month follow-ups. RESULTS At 2 months, intervention participants ate breakfast on more days/week (difference = 1.01 days; 95% CI 0.11, 1.92), and had a lower intake of total sugar (difference = −45.79g; 95% CI −88.34, −3.24) and added sugar (difference = −51.35g; 95% CI −92.45, −10.26) compared to control participants. At 6 months, they were more likely to drink soda ≤ one time/day (OR 4.10: 95% CI 1.19, 16.93) and eat at fast food restaurants ≤ one time/week (OR 4.62: 95% CI 1.10, 23.76) compared to control participants. There were no significant differences in BMI, activity or caloric intake. CONCLUSION A brief school nurse-delivered intervention was feasible, acceptable, and improved selected obesogenic behaviors, but not BMI.
OBJECTIVE -The purpose of this study was to test the effect of high glycemic index (HGI) and low glycemic index (LGI) meals on blood glucose levels using continuous blood glucose monitoring in youths with type 1 diabetes. RESEARCH DESIGN AND METHODS-A total of 20 youths on basal-bolus regimens consumed macronutrient-matched HGI and LGI meals 1 day each in a controlled setting in varying order following consumption of a standardized evening meal. Medtronic MiniMed Continuous Glucose Monitoring Systems were used to assess blood glucose (BG) profiles.RESULTS -Participants demonstrated significantly lower daytime mean BG, BG area Ͼ180 mg/dl, and high BG index when consuming LGI meals but no differences for daytime BG area Ͻ70 mg/dl, daytime low BG index, or any nighttime values. Significantly more BG values Ͻ80 mg/dl were treated on LGI days. CONCLUSIONS -Findings indicate that consumption of anLGI diet may reduce glucose excursions, improving glycemic control. Diabetes Care 31:695-697, 2008W hile American Diabetes Association recommendations for dietary management emphasize the amount rather than the source of carbohydrate (1), research suggests that a low glycemic index (LGI) diet may improve glycemic control (2-4). However, the utility of an LGI diet remains controversial (5), and it is unknown whether it affords meaningful benefit over careful insulin-to-carbohydrate dosing or whether dietary glycemic index could affect insulin dose. Two studies using continuous glucose monitoring system (CGMS) conducted with healthy adults (6,7) and another with adults with type 2 diabetes (8) suggest that an LGI diet confers a more favorable blood glucose (BG) profile. However, insufficient research exists in type 1 diabetes, particularly with contemporary insulin regimens. The purpose of this study was to test the effect of HGI andLGI meals on BG levels using CGMS in youth with type 1 diabetes on basal-bolus regimens.RESEARCH DESIGN AND METHODS -Participants were recruited from a pediatric endocrinology practice; inclusion criteria included diagnosis of type 1 diabetes Ն1 year, insulin dose Ն0.5 units ⅐ kg Ϫ1 ⅐ day Ϫ1 , and age 7-16 years. Informed consent and assent were obtained. The study was approved by the institutional review board of the National Institutes of Health. A withinsubject crossover trial was used; participants consumed 1 day of HGI meals and 1 day of LGI meals in a controlled setting. The order of conditions was counterbalanced, with a washout day between and a standardized evening meal before each condition. Diets were matched for calories and macronutrients; mean glycemic index of the HGI diet was 64 (e.g., corn flakes, white bread, mashed potatoes) and of the LGI diet was 40 (e.g., peaches, kidney beans, brown basmati rice) (onlineonly appendix table [available at http:// dx.doi.org/10.2337/dc07-1879]). Meal timing and activity levels were consistent across conditions. The CGMS (Medtronic MiniMed, Northridge, CA) was used to assess BG profiles. Subjects were given standard BG meters, and BG checks were p...
Purpose-The purpose of this study was to explore the perceptions of healthy eating by youth with diabetes as well as facilitators of and barriers to healthy eating behavior.Methods-One hundred forty youth aged 7 to 16 years with diabetes participated in 18 focus groups. Sample race/ethnicity was 71% white, 18% African American, 6% Hispanic, and 5% other; 69% of the participants were female.Results-Healthy eating was defined primarily in terms of eating fruits and vegetables, low fat, low sugar, and eating to keep blood sugar in range. However, there were notable differences in perceptions of healthy eating versus perceptions of eating practices good for diabetes management. Specifically, "free" foods (foods high in fat but low in carbohydrate) were commonly reported as being good for diabetes management. Major barriers to healthy eating included widespread availability of unhealthy foods, preparation time, and social situations. Parental behaviors, including monitoring food choices and positive modeling, were the most commonly reported facilitators of healthy eating.Conclusion-Findings suggest that youth with diabetes have a general understanding of healthy eating and face similar barriers and facilitators to healthy eating as nondiabetic children do. However, the diabetes regimen may influence their understanding of healthy eating, sometimes negatively. Diabetes nutrition education sessions should emphasize the connection between healthy eating and both short-and long-term diabetes outcomes, and they should highlight strategies to reduce saturated fat consumption while avoiding excessive carbohydrate consumption. The diabetes educator can play an integral role in promoting healthy dietary practices by facilitating parental involvement, designing action plans for managing social situations, and increasing awareness of healthier alternatives to widely available unhealthy foods.Adolescence has been described as a time of physiological, emotional, and behavioral change. 1,2 In particular, eating behaviors transform as youth gain autonomy over their food choices.Poor eating habits initiated during adolescence can pose acute and chronic health, growth, and developmental consequences. Not only are adolescent eating habits associated with subsequent adult diet, but recent research suggests that chronic disease risk can be perpetuated during this time. 3,4 Cardiovascular disease risk factors have been seen in youth, 5 and the prevalence of type 2 diabetes has increased markedly in the adolescent population. 6Correspondence to Dr Tonja R. Nansel, The Prevention Research Branch at National Institute of Child Health and Human Development (NICHD), 6100 Executive Blvd., Room 7B13R, Bethesda, MD 20892-7510 (Nanselt@mail.nih.gov). Healthful dietary practices are of particular interest for youth with diabetes. Many children and adolescents with diabetes are unable to sustain recommended blood glucose values for optimal health. 7 The American Diabetes Association recommends that nutritional guidelines for children and ad...
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