33 Topping DL, Weller RA, Nader CJ, et al. Adaptive effects of dietary ethanol in the pig: changes in plasma high-density lipoproteins and fecal steroid excretion and mutagenicity. Am 7 Clin Nutr 1982;36: 245-50. " Yoshida T, McCormick WC, Swell L, Vlahcevic ZR. Bile acid metabolism in cirrhosis. IV. Characterization of the abnormality in deoxycholic acid metabolism. Gastroenterology 1975 ;68 :335-41. si Williams CN, Scallion SM, McCarthy SC. A diet containing highly refined carbohydrate will adversely change bile lipid composition to that seen in cholesterol gallstone disease. Ann R Coll Phys Surg Canada 1979 ;12 :44. 36 Thornton JR, Emmett PM, Heaton KW. Diet and gall stones: effects of refined and unrefined carbohydrate diets on bile cholesterol saturation and bile acid metabolism. Gtut 1983;24:2-6. " Dam H, Christensen F. Alimentary production of gallstones in hamsters. Acta Pathol Microbiol Scand 1952;30:236-41. 38 Swan DC, Davidson P, Albrink MJ. Effect of simple and complex carbohydrates on plasma non-esterified fatty acids, plasma sugar, and plasma insulin during oral carbohydrate tolerance tests. Lancet 1966; i:60-3. Wahlqvist ML, Wilmshurst EG, Murton CR, Richardson EN. The effect of chain length on glucose absorption and the related metabolic response.

Ten of the original 24 factories from the United Kingdom Heart Disease Prevention Project were resurveyed in 1983 to assess the long-term (12-year) effects of an education program on diet, smoking, and exercise. These 10 factories had previously been grouped into five pairs matched for size, location, and nature of industry, with one of each pair randomly chosen for intervention. Men in intervention factories were given advice on reduction of cholesterol in diet, stopping smoking, weight reduction, and regular exercise. High-risk workers (13%) received personal counseling in addition to the factory-wide education program. A total of 1,204 workers randomly selected from those still employed in 1978 were surveyed. There were significant differences observed in cigarette consumption, butter use, and several other dietary behaviors; however, the differences were small and insignificant for the proportion smoking and leisure-time exercise. The largest effects were in the high-risk group who had received personal counseling. This education program appears to have some lasting effects on behavior associated with coronary disease risk factors. Similarly designed programs may serve as models for community-wide coronary disease prevention programs.

33 Topping DL, Weller RA, Nader CJ, et al. Adaptive effects of dietary ethanol in the pig: changes in plasma high-density lipoproteins and fecal steroid excretion and mutagenicity. Am 7 Clin Nutr 1982;36: 245-50. " Yoshida T, McCormick WC, Swell L, Vlahcevic ZR. Bile acid metabolism in cirrhosis. IV. Characterization of the abnormality in deoxycholic acid metabolism. Gastroenterology 1975 ;68 :335-41. si Williams CN, Scallion SM, McCarthy SC. A diet containing highly refined carbohydrate will adversely change bile lipid composition to that seen in cholesterol gallstone disease. Ann R Coll Phys Surg Canada 1979 ;12 :44. 36 Thornton JR, Emmett PM, Heaton KW. Diet and gall stones: effects of refined and unrefined carbohydrate diets on bile cholesterol saturation and bile acid metabolism. Gtut 1983;24:2-6. " Dam H, Christensen F. Alimentary production of gallstones in hamsters. Acta Pathol Microbiol Scand 1952;30:236-41. 38 Swan DC, Davidson P, Albrink MJ. Effect of simple and complex carbohydrates on plasma non-esterified fatty acids, plasma sugar, and plasma insulin during oral carbohydrate tolerance tests. Lancet 1966; i:60-3. Wahlqvist ML, Wilmshurst EG, Murton CR, Richardson EN. The effect of chain length on glucose absorption and the related metabolic response.

The randomised controlled trial in

Diabetic nephropathy, a rarely listed cause of end-stage renal failure (ESRF) among patients starting renal replacement therapy (RRT) in the early seventies, has progressively gained in importance and become one of the major reasons for the continuous growth of the patient population on RRT in most European countries. Amongst new patients commencing RRT in 1985, the acceptance rate varied between 3 and 12 per million population for type I diabetes mellitus and between one and four per million population for type II diabetes mellitus. Nordic countries, particularly Sweden and Finland, had the highest acceptance rate of young patients with type I diabetes mellitus whose median ages were 38-42 years. In most central and southern European countries the median age of patients with type I diabetes mellitus varied between 50 and 58 years. The high number of young patients with type I diabetes mellitus and ESRF in Nordic countries point to a different natural history of this disease. It cannot be excluded, however, that the higher median age in other countries might result from doctors mistakenly diagnosing type I disease in patients with type II disease who need insulin treatment. Patients with type II diabetes mellitus had a similar age distribution at start of RRT throughout Europe and their median ages clustered around 60 years in most countries. The contribution of haemodialysis, peritoneal dialysis and renal transplantation was analysed for diabetic compared to non-diabetic ESRF. Despite large geographical differences in the proportional use of methods of treatment, a general trend to apply CAPD more frequently in diabetic as compared to non-diabetic patients was observed, and this was true for countries with both predominant haemodialysis and predominant transplant programmes. Transplantation without prior dialysis was performed in 17% of Swedish and 30% of Norwegian patients with type I diabetes mellitus. In order to better explain the mortality of patients with diabetic ESRF, the proportional distribution of causes of death was analysed. Myocardial ischaemia and infarction was confirmed to be the leading cause of death in patients with diabetes mellitus on RRT. The coronary death rate was estimated to be 10 times greater in young patients with type I diabetes mellitus as compared to their non-diabetic counterparts. Other cardiovascular as well as infectious causes were recorded in a similar proportion of deaths in diabetics as in non-diabetics. Cancer deaths, however, appeared to be definitely less frequent in patients on RRT due to diabetic nephropathy.