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Effect of wheat bran and pectin on bile acid and cholesterol excretion in ileostomy patients buy generic malegra dxt 130mg on-line. Bouhnik Y buy discount malegra dxt 130mg line, Flourié B, Riottot M, Bisetti N, Gailing M-F, Guibert A, Bornet F, Rambaud J-C. Effects of fructo-oligosaccharides ingestion on fecal bifidobacteria and selected metabolic indexes of colon carcinogenesis in healthy humans. Short-chain fructo-oligosaccharide administra- tion dose-dependently increases fecal bifidobacteria in healthy humans. High β-glucan oat bran and oat gum reduce postprandial blood glucose and insulin in subjects with and without type 2 diabetes. Oat beta-glucan reduces blood cholesterol concentration in hyper- cholesterolemic subjects. Symptomatic response to varying levels of fructo- oligosaccharides consumed occasionally or regularly. Effect of consumption of a ready-to-eat breakfast cereal containing inulin on the intestinal milieu and blood lipids in healthy male volunteers. Iron absorption from bread in humans: Inhibiting effects of cereal fiber, phytate and inositol phosphates with different numbers of phosphate groups. Dietary supplementa- tion of neosugar alters the fecal flora and decreases activities of some reductive enzymes in human subjects. Effect of dietary fibre on stools and transit-times, and its role in the causation of disease. Sustained post-ingestive action of dietary fibre: Effects of a sugar-beet-fibre-supplemented breakfast on satiety. Assessment of the effect of increased dietary fibre intake on bowel function in patients with spinal cord injury. Relationship between the intake of high- fibre foods and energy and the risk of cancer of the large bowel and breast. The effects of grapefruit pectin on patients at risk for coronary heart disease without alter- ing diet or lifestyle. Beneficial effects of high dietary fiber intake in patients with type 2 diabetes mellitus. Effect of dietary chitosans with different viscosity on plasma lipids and lipid peroxidation in rats fed on a diet enriched with cholesterol. Comparison of diarrhea induced by ingestion of fructooligosaccharide Idolax and disaccharide lactulose (role of osmolarity versus fermentation of malabsorbed carbohydrate). Toxicological evaluation of neosugar: Genotoxicity, carcinogenicity, and chronic toxicity. Coudray C, Bellanger J, Castiglia-Delavaud C, Remesy C, Vermorel M, Rayssignuier Y. Effect of soluble or partly soluble dietary fibres supplementation on absorption and balance of calcium, magnesium, iron and zinc in healthy young men. Fermentation and the production of short-chain fatty acids in the human large intestine. Colonic responses to dietary fibre from carrot, cabbage, apple, bran, and guar gum. Fecal weight, colon cancer risk, and dietary intake of nonstarch polysaccharides (dietary fiber). Digestion and physiological properties of resistant starch in the human large bowel. A case-control study of relationships of diet and other traits to colorectal cancer in American blacks. Long-term effects of consuming foods containing psyllium seed husk on serum lipids in subjects with hypercholesterolemia. Resistant starch decreases serum total cholesterol and triacylglycerol concentrations in rats. Effects of different soluble:insoluble fibre ratios at breakfast on 24-h pattern of dietary intake and satiety. Resistant starch has little effect on appetite, food intake and insulin secretion of healthy young men. A multi-centre, general practice comparison of ispaghula husk with lactulose and other laxatives in the treatment of simple constipation.

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Patients are at risk of secondary The management of hyperlipidaemia is based on an as- infection buy malegra dxt 130 mg with visa. Management r General measures include weight loss cheap malegra dxt 130 mg with amex, lipid-lowering r Prevention of eye disease with adequate diet and diets, reduction of alcohol intake, stopping smoking supplementation in patients with disorders of fat and increasing exercise. In pregnant women, vitamin A but not r Control of hypertension is important preferably β carotene is teratogenic. Corneal transplant may be required 1 Cholesterol-lowering drugs include resins, which for irreversible corneal ulceration. Vitamin B1 (thiamine) deficiency Vitamin deficiencies See also Wernicke–Korsakoff syndrome in Chapter 7 (Nervous System; page 317) Vitamin A deficiency Definition Definition Deficiency of thiamine (vitamin B1). Deficiency of vitamin A, a fat-soluble vitamin, is a major cause of blindness in many areas of the world. Aetiology Insufficient intake of thiamine, which is present in for- Aetiology tified wheat flour (the natural thiamine is removed by Insufficient intake of carotenoids, especially β-carotene milling, so it is replaced in most countries), fortified found in carrots and dark green leafy vegetables and breakfast cereals, milk, eggs, yeast extract and fruit. Occasionally it can be seen in disorders of fat malabsorption, such as cystic fibrosis, cholestatic Pathophysiology liver disease and inflammatory bowel disease. Thiamine is an essential factor for the maintenance of the peripheral nervous system and the heart. It is also involved in glycolytic pathways, mediating carbohydrate Pathophysiology metabolism. Vitamin A is required for maintenance of mucosal sur- faces, the formation of epithelium and production of Clinical features mucus. Dry beriberi is an endemic form of polyneuritis re- Retinal function is dependent on retinol, a constituent sulting from a diet consisting of polished rice deficient of the retinal pigment rhodopsin. The neuropathy predominantly affects the 512 Chapter 13: Nutritional and metabolic disorders legs with weakness, parasthesia and loss of ankle jerks. Wet beriberi is the high output heart failure caused by thiamine deficiency resulting in Management oedema. Supplementation with nicotinic acid and treatment of other coexisting deficiencies. Erythrocyte transketolase activity and blood pyruvate Vitamin B6 (pyridoxine) deficiency are increased. Definition Deficiency of pyridoxine is rarely a primary disorder, but Management it does occur as a secondary disorder. The cardiac failure usually responds rapidly, but Aetiology neuropathies may only partially resolve if they are long- Important sources of Vitamin B6 are similar to those of standing. Deficiency may occur with malabsorp- Niacin deficiency (pellagra) tion such as coeliac disease, dietary lack in alcoholism and drug toxicity especially isoniazid. Definition Niacin (vitamin B3) has two principle forms: nicotinic Pathophysiology acid and nicotinamide. Deficiency of niacin causes pel- Pyridoxine is important in the metabolism of amino lagra. In some rare metabolic disorders, pyridoxine deficiency is as- Aetiology sociated with infantile convulsions and sideroblastic Niacin is found in plants, meat and fish. Clinical features Othercausesincludeincreasedtryptophanconsumption Marginal deficiency may cause stomatitis, glossitis, dry in the carcinoid syndrome, prolonged use of isoniazid lips, irritability and confusion. Deficiency causes men- and Hartnup disease, an autosomal recessive congenital tal confusion, glossitis, dry skin lesions and peripheral disorder with reduced absorption of tryptophan from neuropathy. Management Pathophysiology Oral replacement; however, high doses may cause Nicotinic acid is involved in energy utilisation. Vitamin B12 deficiency It is also used in maintaining skin, especially in sun- exposed areas. Vitamin C deficiency Clinical features Pellagra is due to lack of nicotinic acid, it often occurs Definition as part of a more general nutritional deficiency. Pellagra Vitamin C deficiency causes scurvy, which was first de- presents with dermatitis, diarrhoea and dementia. Chapter 13: Metabolic disorders 513 Aetiology/pathophysiology tably in the brain in Alzheimer’s disease. Genetic factors Occurs in the poor, pregnant or those on a peculiar may be involved in predisposing to the development of diet.

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They were not developed malegra dxt 130 mg for sale, for example safe malegra dxt 130 mg, to lead to weight loss in overweight individuals. However, just as is the case with other nutrients, energy expen- ditures vary from one individual to another, even though their characteris- tics may be similar. Note that this does not imply that an indi- vidual would maintain energy balance at any intake within this range; it simply indicates how variable requirements could be among those with similar characteristics. Usual energy intakes are highly correlated with expenditure when con- sidered over periods of weeks or months. This means that most people who have access to enough food will, on average, consume amounts of energy very close to the amounts that they expend, and as a result, main- tain their weight over extended periods of time. Any changes in weight that do occur usually reflect small imbalances accumulated over a long period of time. In many situations, however, the usual energy intake of an indi- vidual is not known, and the estimated energy requirement equations are useful planning tools. When the goal is to maintain body weight in an individual with specified characteristics (age, height, weight, and activity level), an initial estimate for energy intake is provided by the equation for the energy expenditure of an individual with those characteristics. By definition, the estimate would be expected to underestimate the true energy expenditure 50 percent of the time and to overestimate it 50 percent of the time, leading to corresponding changes in body weight. This indicates that monitoring of body weight would be required when implementing intakes based on the equations that predict individual energy requirements. In some situa- tions the goal of planning might be to prevent weight loss in an individual with specified characteristics. This would lead to an intake that would be expected to exceed the actual energy expenditure of all but 2 to 3 percent of the individuals with similar characteristics. Using the above example for the 33-year-old, low-active woman, one would provide 2,028 + (2 × 160) kcal, or 2,348 kcal. This intake would prevent weight loss in almost all individuals with similar characteristics. Of course, this level of intake would lead to weight gain in most of these individuals. This would lead to an intake that would be expected to fall below the actual energy requirements of all but 2. Using the above example for the 33-year-old, low-active woman, the energy requirement would be 2,028 – (2 × 160) kcal, or 1,708 kcal. Of course, this level of intake would lead to weight loss in most of these individuals. Planning for Energy for Groups As is true for individuals, the underlying objective in planning the energy intake of a group is similar to planning intakes for other nutrients— to attain an acceptably low prevalence of inadequacy and of potential excess. The approach to planning for energy, however, differs substan- tially from planning for other nutrients. In the case of energy, however, there are adverse effects for the indi- viduals in the group whose intakes are above their requirements, as weight gain is bound to occur over time. In addition, the assumptions required to apply this method, as well as for the probability approach, do not hold for energy. Most notably, the methods assume that intakes are essentially uncorrelated with requirements. In the case of energy, however, intakes are very highly correlated with requirements. There are two possible approaches: estimate energy requirements for the refer- ence person or obtain an average of estimated maintenance energy needs for group members. However, if the assumptions did not hold true, as is likely in many situations, the estimates would be incorrect. At a practical level, it is likely that the estimate obtained would be less than the true average energy expenditure of the group, since for most life stage and gender groups the reference person weighs less than the average person. The preferred approach would be to plan for an intake equal to the average energy expenditure for the group. For example, using the same group of 19- to 30-year-old men from the previous section, the energy expenditure for each individual in the group would be estimated (assum- ing access to data on height, weight, age, and activity level).

Drugs and the Law Drug laws in Ireland are complex and subject to change and schools are advised to be proactive in developing a good working relationship with local Gardaí as they will be able to clarify issues relating to drug laws malegra dxt 130mg otc. The laws that are the most relevant to the school setting include the Misuse of Drugs Acts 1977 and 1984 purchase malegra dxt 130 mg with mastercard. Offences under the Misuse of Drugs Act include: y Possession of any small amount for personal use y Possession with intent to supply to another person y Production y Supplying or intent to supply to another person y Importation or Exportation y Allowing premises you occupy to be used for the supply or production of drugs or permitting the use of drugs on premises y Growing of opium poppies, cannabis and coca plants y The printing or sale of books or magazines that encourage the use of controlled drugs or which contain advertisements for drug equipment There are other laws controlling tobacco, alcohol, solvents and medicines. Equally, drugs, their various uses and our understanding of them change over tim e. W ith this in m ind, there is a list of organisations and websites at the end of this handbook which you can consult if you encounter substances or related behaviours not included in the following section. Tobacco use also figures in cannabis smoking, where cannabis users may use tobacco along with the crumbled cannabis resin in the production of a joint or spliff (hand-rolled cannabis cigarette). Tobacco can also be administered via smokeless products such as snuff, which is sniffed, or ‘dipped’ that is, held between the lip and the gum of the mouth. Under Section 6 of the Tobacco (Health Promotion and Protection) Act 1988 the importation and distribution of these smokeless products are banned due to concerns around their adverse effects on health. However, the acute effects of nicotine dissipate within a few minutes and nicotine disappears from the body in a few hours, as it is metabolised fairly rapidly. It is the combination of the mode of administration (smoking) and nicotine’s highly addictive properties (the W orld Health Organisation ranks nicotine as being more addictive than heroin, cocaine, alcohol, cannabis and caffeine18) which impact on the number of dependent users. By inhaling, the smoker can get nicotine to the brain very rapidly with every puff. A typical smoker will take 10 puffs on a cigarette over a period of five minutes that the cigarette is lit. Thus, a person who smokes about one and a half packs (30 cigarettes) daily gets 300 ‘hits’ of nicotine to the brain each day. W ithin eight hours of stopping, oxygen in the blood increases to norm al levels and carbon m onoxide levels in the blood drop to norm al. Twenty-four hours after stopping, the risk of sudden heart attack decreases and by 48 hours, one’s sense of taste and sm ell begin to return to norm al. Long-term use will result in a staining of the teeth and possibly of the fingers and nails. Short Term Risks Although nicotine is highly toxic (like cyanide, if a sufficient amount is ingested, death can result in a few minutes from respiratory failure caused by paralysis23) there is a tendency to associate the health risks related to sm oking with long-term use. However, outside of the im m ediate im pact sm oking m ay have on a young person in term s of the sm ell of tobacco and the cost, there are short-term adverse health effects: y Increased risk of dependence – those who start smoking regularly when young tend to carry on smoking throughout their adult life, most … adults who smoke began during adolescence. Outside of these short-term health risks, adolescent tobacco use is “… often the first drug used by young people who use alcohol, marijuana and other drugs. Because your lungs You get bad breath grow at a slower rate and are three times and don’t work as more likely to be well, less oxygen gets out of breath than to your muscles. Your hands smell Your heart has to of stale cigarette work harder, it will smoke and your beat two to three fingers and nails times faster than can become stained someone who yellow. Throat Cancer, Stomach Cancer, Heart Disease and Bronchitis Long Terms Risks The increased risk of lung cancer is the risk predominantly associated with smoking. However, long-term exposure to nicotine increases the risk of: y Heart disease y Heart attack y Blood clots y Strokes y Bad circulation y Ulcers y Lung infection y Bronchitis y Emphysema y Cancers of the mouth and throat29 30 Drug Facts Equally, smoking impacts on both male and female fertility – decreased fertility is associated with women who smoke and wish to start a family and the risk of impotence is 50% higher in male smokers than in non-smokers. There is evidence of an increased risk of a prem ature birth, stillbirth and early death of the newborn baby where the m other sm okes m ore than five cigarettes a day and infants born to m others who sm oked throughout pregnancy also have a lower birth weight. For children, this increases the risks of asthm a and other respiratory illnesses and ‘glue’ or m iddle ear disease. Legal Status Health Act 2001 prohibits the sale of tobacco to young people under the age of eighteen years. Harm Reduction Approaches There are no ‘safe or safer’ tobacco products and given the adverse health effects of any tobacco product non-smoking is the only safer option. However, this over familiarity with alcohol poses in itself an enormous challenge for the promotion of healthier life-styles.

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