Abstract-The study assessed the efficacy of fish oil supplementation in counteracting the classic dyslipidemia of the atherogenic lipoprotein phenotype (ALP). In addition, the impact of the common apolipoprotein E (apoE) polymorphism on the fasting and postprandial lipid profile and on responsiveness to the dietary intervention was established. Fifty-five ALP males (aged 34 to 69 years, body mass index 22 to 35 kg/m 2 , triglyceride [TG] levels 1.5 to 4.0 mmol/L, high density lipoprotein cholesterol [HDL-C] Ͻ1.1 mmol/l, and percent low density lipoprotein [LDL]-3 Ͼ40% total LDL) completed a randomized placebo-controlled crossover trial of fish oil (3.0 g eicosapentaenoic acid/docosahexaenoic acid per day) and placebo (olive oil) capsules with the 6-week treatment arms separated by a 12-week washout period. In addition to fasting blood samples, at the end of each intervention arm, a postprandial assessment of lipid metabolism was carried out. Fish oil supplementation resulted in a reduction in fasting TG level of 35% (PϽ0.001), in postprandial TG response of 26% (TG area under the curve, PϽ0.001), and in percent LDL-3 of 26% (PϽ0.05). However, no change in HDL-C levels was evident (Pϭ0.752). ANCOVA showed that baseline HDL-C levels were significantly lower in apoE4 carriers (Pϭ0.035). The apoE genotype also had a striking impact on lipid responses to fish oil intervention. Individuals with an apoE2 allele displayed a marked reduction in postprandial incremental TG response (TG incremental area under the curve, Pϭ0.023) and a trend toward an increase in lipoprotein lipase activity relative to non-E2 carriers. In apoE4 individuals, a significant increase in total cholesterol and a trend toward a reduction in HDL-C relative to the common homozygous E3/E3 profile was evident. Our data demonstrate the efficacy of fish oil fatty acids in counteracting the proatherogenic lipid profile of the ALP but also that the apoE genotype influences responsiveness to this dietary treatment.

Fractured neck of femur occurs mostly in the older female population and is generally caused by falls. Malnutrition has been postulated as a factor that increases the tendency to suffer falls. Nutritional status of older female hospital patients admitted for emergency surgery for fractured neck of femur recruited (n 75), was compared with an age-matched independent-living group of females attending one of three local day centres (n 50). Dietary assessment was undertaken using three consecutive 24 h dietary recalls and, in the hip fracture group, completed menu cards were used as memory prompts. Data concerning key lifestyle characteristics were obtained using a face-to-face administered questionnaire. Blood samples were taken to determine levels of plasma albumin, transferrin, C-reactive protein (CRP), cholesterol, vitamin C, Se, Zn and total antioxidant status. Haemolysate samples were analysed for Se-dependent glutathione peroxidase activity. There were no significant differences in age between the two groups, but the hip fracture patients had lower mean values for body weight (59´6 v. 67´5 kg; P 0´005Y mindex (weight/demispan) (83´1 v. 94´4 kg/m; P , 0´0001Y calculated BMI (24´1 v. 27´5 kg/m 2 P , 0´0001Y mid-upper arm circumference; 27´1 v. 31´3 cm, P 0´001 and triceps skinfold thickness; 17´0 v. 18´9 mm, P 0´005 than the home-living group. The hip fracture patients had lower intakes of energy (4´3 v. 5´4 MJ, P 0´001Y fat P 0´025Y carbohydrate P 0´002Y protein P 0´006Y thiamine P 0´017Y vitamin B 6 P 0´001Y calcium P 0´01Y K P 0´001Y Mg P 0´001Y P P 0´001Y Fe P 0´007Y Se P 0´008 and NSP P 0´001X Mean intakes of both groups were below the estimated average requirement for energy and below the reference nutrient intakes for folate, Ca, vitamin D, Mg, K, Se and Zn. In a high percentage of the hip fracture group the dietary intake of particular nutrients fell below the lower reference nutrient intake for Se (73 %), Mg (54 %) and Fe (19 %). As expected, the fracture patients had reduced plasma albumin P , 0´0001 and increased CRP P , 0´001 values. They had higher plasma vitamin C levels P , 0´001 and lower cholesterol levels P 0´04 than the day centre attendees. There were no significant differences in plasma levels of Se, Zn, transferrin or haemolysate glutathione peroxidase activity between the two groups. However, there was evidence of under-nutrition in both groups as key anthropometric values were low, plasma nutrient and metabolite levels were below the standard reference ranges and many individuals had low dietary intakes for specified nutrients.

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Objective: To assess the use of the Mini-Nutritional Assessment (MNA) in elderly orthopaedic patients. Design: An observation study assessing the nutritional status of female orthopaedic patients. Setting: The orthopaedic wards of the Royal Surrey County Hospital. Subjects: Forty-nine female patients aged 60 ± 103 y; dietary records were obtained for 41 subjects and 36 subjects gave a blood sample for biochemical analysis. Major outcome methods: MNA questionnaire, anthropometry, plasma albumin, transferrin, C-reactive protein (CRP) levels and dietary analyses. Results: The group as a whole had low mean values for body weight, albumin and transferrin and high CRP levels. In addition, the group had mean energy intakes well below the estimated average requirement (EAR) and mean intakes of vitamin D, magnesium, potassium, selenium and non-starch polysaccharides (NSP) were below the lower reference nutrient intakes (LRNI). The MNA screening section categorized 69% of the patients as requiring a full assessment (scored 11 or below), but for the purposes of the study the MNA was completed on all patients. The MNA assessment categorized 16% of the group as`malnourished' (scored`17 points), 47% as at risk' (scored 17.5 ± 23.5) and 37% as`well nourished' (scored b23.5). Signi®cant differences were found between the malnourished and well nourished groups for body weight (P`0.001), body mass index (BMI) (P`0.001), demiquet (P`0.001) and mindex (P`0.001). Mean values for energy and nutrient intakes showed a clear stepwise increase across the three groups for all nutrients except sodium, with signi®cant differences for protein (P`0.05), carbohydrate (P`0.05), ribo¯avin (P`0.05) niacin (P`0.05), pyridoxine (P`0.05), folate (P`0.05), calcium (P`0.05), selenium (P`0.05), iron (P`0.05) and NSP (P`0.05) intakes. Stepwise multiple regression analysis indicated that anthropometric assessments were the most predictive factors in the total MNA score. The sensitivity and speci®city of the MNA was assessed in comparison with albumin levels, energy intake and mindex. The sensitivity of the MNA classi®cation of those scoring less than 17 points in comparison with albumin levels, energy intake and mindex varied from 27 to 57% and the speci®city was 66 ± 100%. This was compared with the sensitivity and speci®city of using a score of less than 23.5 on the MNA to predict malnourished individuals. Using this cut-off the sensitivity ranged from 75 to 100%, but the speci®city declined to between 37 and 50%. Conclusions: The results suggest that the MNA is a useful diagnostic tool in the identi®cation of elderly patients at risk from malnutrition and those who are malnourished in this hospital setting.

A length-based population model was constructed for Bristol Bay red king crab, Paralithodes camtschaticus, incorporating stochastic growth, gradual recruitment over length, and a bowl-shaped pattern for instantaneous natural mortality as a function of length. A nonlinear least squares approach was used to estimate abundance, recruitment, and natural mortality. The model was applied to abundance and catch data from 1968 to 1993. The observed population abundances fit well with the model. Natural mortality was estimated to be three to six times higher in the early 1980s than during other periods. High natural mortality coupled with high harvest rates and followed by low spawning biomass may have contributed to the collapse of the population in the early 1980s and its continued lack of recovery. The stock–recruitment data estimated from the length-based model provided a good fit to both general and autocorrelated Ricker models. The general Ricker model is supported by strong recruitment associated with intermediate levels of spawning biomass and extremely low recruitment related to low spawning stock; the autocorrelated Ricker model fit the data slightly better and is supported by the fact that extremely strong and weak recruitment occurred successively over two separate periods.

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Health care is changing towards a greater involvement of the patients in their own care. Therefore, it is important to increase understanding of the patients' perspective of chronic diseases, including migraine and CDH. The results from this study inform health care professionals of the range of their patients' needs and preferences. This knowledge can be used to shape clinical practice, to develop patient education programmes and to further research efforts into issues that are important to the headache patient.