Mark Corson

By N. Lares. Western New Mexico University.

In many cases buy cheap pletal 100mg, oxidative damage is to a greater degree the consequence of the tissue damage that the disease produces than a cause of the disease itself and therefore can contribute to worsening of the tissue dam age generated [3] generic 100 mg pletal. On the other hand cheap pletal 100mg otc, numerous epidemiological studies suggest that more persons could avoid the appearance of pathological processes if they consumed antioxidant-rich diets (fruits and vegetables). This has led to conducting experiments to identify the specific components responsible for the positive effects on health by the consumption of foods of plant origin. Antioxidants are synthetic or natural substances that present in low concentrations com pared with the biomolecules that they should protect. The consumption of antioxidant exogens can increase protection of the body and aid antioxidant endogens in combating diseases [5]. Fortunately, numerous foods and supplements that we ingest are rich in the antioxidants that protect against damage to the cells. Vitamin C, which is found in abundance in citrics and vegetables, is perhaps the best known antioxidant. In recent years, plant-derived natural antioxidants have been used frequently, given that they present activity that is comparable with the most frequently employed synthetic antiox idants. In the present work, the description is performed of the characteristics of the exogenous an tioxidants with regard to their employment in human health [6]. Vitamins Vitamins are organic micronutrients that possess no energetic value, are biologically active, and with diverse molecular structure, which are necessary for humans in very small quanti ties (micronutrients) and which should be supplied by the diet because humans are unable to synthesize and which are essential for maintaining health [7]. However, this synthesis is gen erally not sufficient to cover the organism s needs. The functions of the vitamins and the need of the organism for these are highly varied. The majority of vitamins have a basic function in the maintenance of health (doing honor to their name: vita means life. In addition, today we know that their nutritional role extends beyond that of the preven tion of deficiency or deficiency-associated diseases. They can also aid in preventing some of the most prevalent chronic diseases in developed societies. Vitamin C, for example, prevents scurvy and also appears to prevent certain types of cancer. Vitamin E, a potent antioxidant, is a protector factor in cardiovascular disease and folates help in preventing fetal neural tube defects [9]. These vitamins can accumulate and cause toxicity when in gested in large amounts [9]. Therefore, any problem with respect to the absorp tion of fats will be an obstacle to the absorption of liposoluble vitamins. The latter are stored in moderate amounts in the vital organs, especially in the liver [8]. Hydrosoluble vitamins: The following are vitamins of the B group: [B (thiamin); B (ribofla1 2 vin; B3 (niacin); pantothenic acid; B (pyridoxine); biotin; folic acid, and B (cyanocobala6 12 min)], and vitamin C (ascorbic acid), contained in the aqueous compartments of foods. These are water-soluble compounds that are found in foods of animal and plant origin. Dif ferent from liposoluble vitamins, water-soluble vitamins are not stored in the body; thus, they should be ingested daily with food to avoid their supply becoming exhausted [8]. The hydrosoluble vitamins participate as co-enzymes in processes linked with the metabolism of organic foods: carbohydrates; lipids, and proteins. One important difference between these two vitamin groups lies in their final destiny in the organism. An excess of water-soluble vitamins is rapidly excreted in the urine; on the other hand, liposoluble vitamins cannot be eliminated in this manner; they accumulate in tissues and organs. This characteristic is associated with a greater risk of toxicity, which means the ingestion of excessive amounts of liposoluble vitamins, especially vitamins A and E. Vita min B12 constitutes an exception because it is stored in the liver in important quantities. Action: The presence of this vitamin is required for a certain number of metabolic reactions in all animals and plants and is created internally by nearly all organisms, humans compris ing a notable exception [10]. Currently, this vitamin is the most widely employed vitamin in drugs, premedication, and nutritional supplements worldwide [11]. If these are not neutralized, so-called propagation or amplification is produced and, in the case of oxidation, the peroxides are again oxi dized into peroxyls [12]. Foods are substances or products of any nature that due to their characteristics and compo nents are utilized for human nutrition. Chemical structure: Ascorbic acid is a 6-carbon ketolactone that has a structural relationship with glucose; it is a white substance, stable in its dry form, but in solution it oxidizes easily, even more so if exposed to heat. Its chemical structure is reminiscent of that of glucose (in many mammals and plants, this vitamin is synthesized by glucose and galactose). If dihydroascorbic acid is hydrated, it is transformed into diketo gluconic acid, which is not biologically active, and with this an irreversible transformation. Deficit: It is well known that a deficiency of vitamin C causes scurvy in humans, thus the origin of the name ascorbic given to the acid [10]. Prior to the era of research on vita mins, the British Navy established the practice of supplying lemons and other citric fruits to their sailors to avoid scurvy [13]. The oxidation-reduction (redox) reaction of vitamin C, molecular forms in equilibrium.

The oxygen is provided to muscle by blood vessels including the small capillaries generic pletal 100 mg. By using the macronutrients carbohydrates (glycogen) order 50 mg pletal free shipping, proteins (amino acids) and fat (fatty acids and glycerol) energy is produced in the mitochondria in muscle cells 100 mg pletal mastercard, and the muscle will be able to contract (30). Glucocorticoids A special problem in patients with myositis that may affect nutritional status is their need for long-term (often over months to years), high-dose, glucocorticoids. Glucocorticoids are used to suppress muscle inflammation by acting on most cell types. The effects on T lymphocytes and macrophages are both direct and indirect, by influencing the mediators released by these cells (31,32). Via this mechanism, blocked gene expression of proinflammatory cytokines will occur and therefore the amount of these inflammatory molecules will decrease. As mentioned previously, it was noticed early that treatment with glucocorticoids had negative effects on muscles and may induce muscle atrophy and also a catabolic state. Glucocorticoids act in several ways to retard growth and promote muscle protein breakdown (35). Some strategies that could possibly be undertaken to counteract these negative effects of glucocorticoids are discussed later. Role of Exercise The catabolic effect of glucocorticoids on muscle tissue is likely to contribute to muscle wasting in patients with myositis who are also affected by catabolism from the muscle inflammation and from physical inactivity as well. In patients who have undergone renal transplant, the negative effect of low or moderate doses (10 12 mg per day) of glucocorticoids on muscles was reversed by physical exercise. There are numerous benefits of exercise in terms of nutritional status in healthy individuals. Although many of these effects have not been evaluated specifically in patients with myositis, they could be assumed to be attributable to these patients. In healthy individuals, the muscle protein metabolism after exercise is negative and food intake is needed in order to gain muscle mass. Because patients with myositis already experience a catabolic state owing to glucocorticoid treatment, the post-exercise meal could be even more important to prevent further muscle protein breakdown. This is best achieved by digesting a combination of carbohydrates and protein after the exercise bout (52). It seems as if early post-exercise ingestion of a nutrient supplement, as opposed to ingestion 2 hours after training, enhances the anabolic effect of whole-body protein (53,54). The fact that patients with myositis are in a catabolic state caused by inflammation and steroid use, this approach, otherwise mostly used by athletes, might be of use in these patients. Dietary Management A diet achieving energy balance with a content of approx 30% fat, 50 to 60% carbohydrates and 10 to 20% protein of total energy is recommended for healthy individuals in Nordic European countries and is likely to be appropriate for patients with myositis as well (52,55). Dietary supplements have become popular and some of these have been tested in clinical trials in patients with various chronic inflammatory diseases. There are a few reports on effects of supplements in patients with polymyositis or dermatomyositis. Gluten Celiac disease or gluten-sensitivity is a chronic intestinal disorder where the upper small intestine is damaged, leading to impaired nutrient uptake in these patients. Anti-gliadin, another antibody associated with celiac disease, has been found with increased frequency in patients with myositis. Thus, celiac disease should be considered in patients with myositis who experience intestinal problems such as diarrhea or weight loss that cannot be explained otherwise. Imple- mentation of a gluten-free diet is important in these cases to avoid malnutrition (59). Supplements In healthy individuals, it is crucial to support the body with adequate nutrients in order to optimize physical exercise and increase muscle mass or muscle endurance. Supplements have become an enormously profitable industry and the effect of most supplements on the market can be questioned. Through basic research, the safety of several different supplements for use in healthy people has been established (60). There is limited information available that is specific to patients with polymyositis and dermatomyositis; information that is available is presented further on in this chapter. A large number of studies have been published on the subject, describing the ergogenic outcome on muscle strength and size when using creatine in combination with resistance training [61 64]. This provides the ability to work out at an enhanced level and results in a greater gain in muscle mass (65). Creatine supplements have recently been evaluated in a placebo-controlled trial in patients with myositis, in combination with stable immunosuppressive treatment and/or steroids (68). The creatine-supplemented group had a significant improvement, compared with the placebo group, in the primary outcome that reflected the ability to undertake high-intensity exercise. Side effects of creatine supplements, for example, muscle cramps and heat intol- erance, have been described. These side effects may be related to an increase in water retention during the initial days of supplementation. Water retention and an increase in muscle mass may cause weight gain while supplementing with creatine (69). The use of creatine supplements with exercise among patients with myositis was without significant side effects and was considered effective and inexpensive (68,70). In animal models with arthritis, it was suggested that creatine supplementation might have an anti-inflammatory action; similar suggestions have been made based on research using cell cultures in which creatine supplementation also had an anti- inflammatory action on endothelial cells. These effects may arise from the ability of creatine-supplemented cells to inhibit endothelial permeability and expression of adhesion molecules, decreasing the traffic of proinflammatory cells and mediators from the bloodstream into the tissue (71). Regarding creatine supplementation in general, the literature is based on adults, so there is a lack of data regarding safety of creatine use in growing adolescents. Therefore, no conclusions can be drawn for patients with juvenile dermatomyositis and creatine supplementation (72). Although creatine is a common supplement, commercially marketed creatine products might not meet the same quality control standards as pharmaceuticals, and because of possible impurities or differences in dosage, caution is urged.

The unique feature of assessment in systemic lupus erythematosus is the need for very careful assessment of kidney function because the disease affects the kidneys and may eventually lead to kidney failure buy discount pletal 100 mg on line. Careful consideration of a patient s nutritional status using basic principles of assessment generic pletal 100mg otc, and addressing problem areas purchase 50 mg pletal with visa, can contribute to a patient s overall well-being. The Practical Guide: Identification, Evaluation, and Treatment of Overweight and Obesity in Adults, 2000. Prediction of stature from knee height for black and white adults and children with application to mobility-impaired or handicapped persons. A practical approach to nutrition in the patient with juvenile rheumatoid arthritis. You are what you eat: healthy food choices, nutrition, and the child with juvenile rheumatoid arthritis. The Stanford Health Assessment Questionnaire: a review of its history, issues, progress, and documentation. Measurement of health status, functional status, and quality of life in children with juvenile idiopathic arthritis: clinical science for the pediatrician. Rheumatoid cachexia: cytokine-driven hyperme- tabolism accompanying reduced body cell mass in chronic inflammation. Pain and quality of life among older people with rheumatoid arthritis and/or osteoarthritis: a literature review. Systemic review: pathophysiology and management of gastrointestinal dysmotility in systemic sclerosis (scleroderma). Measuring disease activity and functional status in patients with scleroderma and Raynaud s phenomenon. Gout Assessment Question- naire: initial results of reliability, validity and responsiveness. The content and properties of a revised and expanded arthritis impact measurement scales health status questionnaire. Bundy Summary Heterogeneity in clinical presentation and variability in disease course of rheumatic diseases pose a significant problem in describing the epidemiology of these conditions. Unlike cardiovascular disease, diabetes mellitus, and many cancers, the heterogeneity in clinical presentation and variability in disease course of rheumatic diseases pose a significant problem in describing the epidemiology of these conditions. This chapter presents an overview of some of the important issues in rheumatic disease epidemiology and it provides a summary of epidemiologic features of major rheumatic diseases. It is broadly defined as the study of the distribution and determinants of health-related events or conditions in populations (2). The goal of the epidemiologist is to identify risk factors From: Nutrition and Health: Nutrition and Rheumatic Disease Edited by: L. Primordial prevention, a relatively new concept coined by Strasser (4), includes efforts directed to the general population that prevent the emergence of disease risk factors. These can include changes in social or environmental conditions that favor the development of disease risk factors. Because many diseases share the same risk factors, primordial prevention efforts can have a wide impact on multiple diseases. Primary prevention protects health by eliminating or modifying risk factors in susceptible people. Using antibiotics to treat strep throat is an example of a primary prevention of rheumatic heart disease. Secondary prevention refers to early detection of a disease for prompt intervention and treatment to minimize disability. This type of prevention could include early detection of repetitive strain injuries to prevent further tissue damage. Finally, tertiary prevention is actions to prevent or minimize the impact of long-term complications and disability of a disease. Hip replacement to reduce pain and provide improved mobility from degenerative joint disease is an example of a tertiary prevention effort. Primary Epidemiological Study Designs In working toward the ultimate goal of preventing disease, epidemiologists use a variety of study methods to understand the frequency of disease, uncover risk factors, and design interventions to modify disease risk factors. These study designs, some of which are shown in Table 2, have various strengths and limitations. Epidemiologists Table 1 Epidemiological Definitions of Prevention Types of Prevention Definition Example Primordial Preventing the emergence and Population-wide healthy establishment of environmental, lifestyles promotion program socioeconomic, behavioral to encourage physical activity conditions known to increase the and prevent obesity risk of disease Primary Protecting health by eliminating or Using antibiotics to treat strep modifying risk factors in susceptible throat to prevent rheumatic people heart disease Secondary Detecting disease for early Early detection of repetitive intervention and treatment to strain injuries to prevent minimize disability further tissue damage Tertiary Preventing or minimizing the impact Hip replacement to reduce pain of long-term complications and and provide improved mobility disability of a disease from degenerative joint disease Adapted from refs. Epidemiological study designs are often grouped in the general categories of obser- vational studies or experimental studies. These studies describe the natural course of disease and they do not involve a planned intervention. Descriptive studies are essential for estimating the distribution of disease and associated risk factors in populations. In general, they are moderately costly but yield important data for public health planning and evaluating disease trends that could help indicate disease etiology. Often they are conducted as cross-sectional studies at one period of time and provide estimates of disease prevalence, defined as the total number of individuals with the disease in a population at a given point of time. A second cross-sectional study conducted on the same population could allow the calculation of disease incidence, defined as the number of newly developing cases of a disease occurring in a defined population over a defined period. Ecological studies, sometimes called correlational studies, use data from groups rather than individuals to identify correlations that could indicate potential risk factors (2).