Despite the increasing prevalence of nonalcoholic fatty liver disease (NAFLD), the criteria used to diagnose the disorder remain poorly defined. Localized proton magnetic resonance spectroscopy (MRS) accurately measures hepatic triglyceride content (HTGC) but has been used only in small research studies. Here, MRS was used to analyze the distribution of HTGC in 2,349 participants from the Dallas Heart Study (DHS). The reproducibility of the procedure was validated by showing that duplicate HTGC measurements were high correlated (r = 0.99, P < 0.001) and that the coefficient of variation between measurements was low (8.5%). Intake of a high-fat meal did not significantly affect the measurements, and values were similar when measurements were made from the right and left hepatic lobes. To determine the "upper limit of normal" for HTGC, the distribution of HTGC was examined in the 345 subjects from the DHS who had no identifiable risk factors for hepatic steatosis (nonobese, nondiabetic subjects with minimal alcohol consumption, normal liver function tests, and no known liver disease). The 95th percentile of HTGC in these subjects was 5.56%, which corresponds to a hepatic triglyceride level of 55.6 mg/g. With this value as a cutoff, the prevalence of hepatic steatosis in Dallas County was estimated to be 33.6%. Thus MRS provides a sensitive, quantitative, noninvasive method to measure HTGC and, when applied to a large urban US population, revealed a strikingly high prevalence of hepatic steatosis.

-The primary aim of this investigation was to determine the reliability and sensitivity of 1 H magnetic resonance spectroscopy ( 1 H-MRS) as a method for quantifying myocardial triglyceride (TG) content in humans over time and in response to metabolic perturbations. Three separate experiments were designed to quantify myocardial TG content 1) over a 90-day period, 2) after a high-fat meal, and 3) after a 48-h fast. Proton spectra were collected from a 10 ϫ 20 ϫ 30-mm 3 voxel placed within the intraventricular septum, with measurements acquired at end-systole and end-expiration, using cardiac triggering and respiratory gating. Minimal variation was observed between myocardial TG content determined 90 days apart (r ϭ 0.98, CV ϭ 5%), whereas TG values were unaffected by a high-fat meal despite a significant twofold increase (P Ͻ 0.05) in serum TG. In contrast, myocardial TG content increased threefold (P Ͻ 0.05) after a 48-h fast despite a 25% reduction in serum TG. Body mass index was significantly related to myocardial TG (r ϭ 0.58, P Ͻ 0.05) and the change in myocardial TG after a 48-h fast (r 2 ϭ 0.60). 1 H-MRS is a reliable method for the determination of myocardial TG in humans and is relatively unaffected by the consumption of one high-fat meal but sensitive to changes following a prolonged fast. cardiac spectroscopy; cardiac imaging; lipotoxicity; prolonged fasting IN THE FACE OF AN OBESITY EPIDEMIC, the development of new technologies to predict the progression of obesity-related chronic disease has advanced dramatically in the past decade. Studies in animals reveal that an excessive deposition of triglyceride (TG) droplets in metabolically active tissues, such as the liver (8), skeletal muscle (10), and myocardium (3, 6, 25), impairs cellular function, predisposing animals to type 2 diabetes (9) and heart failure (3,6,25). In an effort to translate these studies into a clinical setting, researchers have relied on biopsy-derived quantification of TG or in vivo magnetic resonance spectroscopy (MRS) imaging to study the role of intracellular TG accumulation in the human liver (15, 21) and skeletal muscle (7,12,19) in the development of metabolic diseases. Impressively, results from studies using MRS of hepatic and muscle tissue mirror results obtained in animals (11,13,14,24), suggesting that intracellular TG may be a valuable biomarker for metabolic disease in humans. Unfortunately, the technology for measuring TG in the human myocardium is still not completely resolved.Until recently, the evaluation of myocardial TG in humans was limited to invasive biopsies, limiting the usefulness of intracellular TG as a biomarker for chronic disease in humans (16). We (20) and others (4, 5) have developed a proton MRS ( 1 H-MRS) technique similar to that used for skeletal muscle and hepatic tissue that quantifies intracellular TG in vivo in the beating human heart. Initial cross-sectional studies revealed that myocardial TG accumulated with increasing body mass and was related to cardiac structure and function in human...

Abstract-Barbershops constitute potential sites for community health promotion programs targeting hypertension (HTN) in black men, but such programs have not been evaluated previously. Here we conducted 2 nonrandomized feasibility studies to determine whether an enhanced intervention program of continuous blood pressure (BP) monitoring and peer-based health messaging in a barbershop lowers BP more than standard screening and health education (study 1) and can be implemented by barbers rather than research personnel (study 2). In study 1, we measured changes in HTN treatment and BP in regular barbershop customers with poorly controlled HTN assigned for 8 months to either an enhanced intervention group (nϭ36) or a contemporaneous comparison group (nϭ27). Groups were similar at baseline. BP fell by 16Ϯ3/9Ϯ2 mm Hg in the enhanced intervention group but was unchanged in the comparison group (PϽ0.0001, adjusted for age and body mass index). HTN treatment and control increased from 47% to 92% (PϽ0.001) and 19% to 58% (PϽ0.001), respectively, in the enhanced intervention group, whereas both remained unchanged in the comparison group. In study 2, barbers were trained to administer the enhanced intervention continuously for 14 months to the entire adult black male clientele (nϭ321) in 1 shop. Six barbers recorded 8953 BP checks during 11 066 haircuts, thus demonstrating a high degree of intervention fidelity. Furthermore, among 107 regular customers with HTN, treatment and control increased progressively with increasing intervention exposure (PϽ0.01). Taken together, these data suggest that black-owned barbershops can be transformed into effective HTN detection, referral, and follow-up centers. Further research is warranted. Key Words: population science Ⅲ special populations Ⅲ blood pressure measurement/monitoring Ⅲ blacks Ⅲ hypertension H ypertension (HTN) is more prevalent, more severe, and causes disproportionate numbers of premature disabilities and deaths from heart attack, stroke, and end-stage renal disease in blacks than in all other racial/ethnic groups in the United States. [1][2][3] HTN is present in 40% of blacks, with blood pressure (BP) being controlled with medication to a recommended value of Ͻ140/90 mm Hg in less than one-third of these affected high-risk individuals. 2,4 In the other two-thirds, HTN either is untreated or undertreated.Among black women, HTN treatment rates are high, and most of the uncontrolled HTN occurs under the watchful eye of the healthcare system. 2,5 Black men have less frequent contact with the healthcare system and considerably lower rates of HTN detection and treatment. 2,[5][6][7][8] The black church has been a conventional site for medical outreach and HTN screening programs. 9,10 However, regular church attendance is much less common among black men than women. 6,11 To reach a larger fraction of the at-risk male population, we approached the black-owned barbershop, a cultural institution that regularly attracts large numbers of black men and provides an open forum for dis...

Background Left ventricular (LV) rotation results from contraction of obliquely oriented myocardial fibers. The net difference between systolic apical counterclockwise rotation and basal clockwise rotation is left ventricular torsion (LVT). Although LVT is altered in various cardiac diseases, determinants of LVT are incompletely understood. Methods and Results LV end-diastolic volume (LVEDV), LV apical and basal rotation, peak systolic LVT, and peak early diastolic untwisting rate (UTR) were measured by speckle tracking echocardiography in healthy subjects (n=8) before and after infusion of a weight-based normal saline bolus (2.1±0.3 L). Saline infusion lead to a significant increase in end-diastolic LV internal diameter (45.9±3.7 versus 47.6±4.2 mm; p=0.002) and LVEDV (90.0±21.6 versus 98.3±19.6 mL; p=0.01). Stroke volume (51.3±10.9 versus 63.0±15.5 mL; p = 0.003) and cardiac output (3.4±0.8 versus 4.4±1.5 L/min; p = 0.007) increased while there was no change in heart rate and blood pressure. There was a significant increase in the magnitude of peak systolic apical rotation (7.5±2.4 versus 10.5±2.8 degrees; p < 0.001) but no change in basal rotation (-4.1±2.3 versus -4.8±3.1 degrees; p = 0.44). Accordingly, peak systolic LVT increased by 33% following saline infusion (11.2±1.3 versus 14.9±1.7 degrees; p < 0.001). This saline-induced increase in LVT was associated with a marked increase in peak early diastolic UTR (72.3±21.4 versus 136.8±30.0 degrees/s; p < 0.001). Conclusions Peak systolic LVT and peak early diastolic UTR are preload dependent. Changes in LV preload should be considered when interpreting results of future LVT studies.

In the absence of HCV coinfection, HIV infection is associated with higher CRP levels in men. HCV coinfection is associated with lower CRP levels in men and women.