Annotated Bibliography: Nursing Care of Patient With Stroke

Annotated Bibliography: Nursing Care of Patient With Stroke This annotated bibliography will discuss three pieces of literatures, which include a Department of health policy. Demonstrating an understanding of the chosen articles with the use of additional literatures to analyse identify and explore learning and how it will influence the nursing care of patient with stroke. Furthermore, the analysis of how the literature search was performed, the database used, search term used, the inclusion and exclusion criteria, the findings and exploration of why the literature was chosen will be identified. Search Strategy Database such as CINAHL plus, British Nursing Index and Department of Health policy was utilised to acquire relevant articles and guideline relating to stroke (Achterberg, Schoonhoven Grol, 2008). This was searched using keywords such as; â€Å"self- care CVA†, â€Å"self-care management†, with the use of the Boolean operator â€Å"OR†, â€Å"AND â€Å"and â€Å"IN† which helped expand and narrow the search criteria (Petersen, 2010). To carry out the first search the keywords â€Å"self-care management† was inserted and it came up with 1878 hits, again Boolean operator â€Å"OR† was used to refine the search. However the hits were large at 40361 hits, the Boolean operator â€Å"IN† was inserted which gave less than 1657 hits. Moreover, when the search keywords â€Å"self-care stroke† was inserted to the database it came up with 1831 hits, however when the Boolean operator â€Å"AND† was added the number of hits had red uced to 51. To further narrow the search to get minimum and relevant information relating to stroke, the writer used the advance search tools by limiting the search to UK only, publications dates within 6years and excluding international. As a result of this, the first article had 30 results, second article had 500 results and the third article had 321 results. From this, the writer read 10 abstracts each from the articles that were more suitable for the research. From the ten abstract read, the writer was able to come to conclusion by choosing 1 article from each search as it contains appropriate information regarding nursing care for patient with stroke. However the policy was found using the DoH website as the database used to find the other articles were not appropriate for finding a guideline. This was search using keywords â€Å"SELF MANAGEMENT FOR STROKE†, in which gave the writer suitable information relating to stroke and how it influence nursing care (reference) Annotated Article 1 Joice, S. (2012). Self-Management following Stroke. Nursing Standard, 26 (22), 39-46 In this article the author defines the concept of self-management and describes psychological theories and emerging behaviour change techniques that nurses can use to promote positive self-care in patients who have had a stroke (McCabe Timmins, 2013). They identify the importance that nurses are in the main position to combine a wide range of behaviour change techniques that can be modify to different patients (Egan, 2009). They also identify the importance of nurses creating a therapeutic relationship through communication as it enhances the delivery of care provided (Palmer, 2000). Additionally, by providing useful communication between the nurse and patient it encourages them to take more interest in their condition and develop greater understanding and confidence in self-care management (McCabe Timmins, 2013). Many authors such as Burnard (2003), Barrett, Komaromy, Robb and Rodger (2004) and Bach and Grant (2011) agree that communication is the most important therapeutic skill compulsory for nurses. Whilst Schuster (2000) highlights that nurses must also be able to appreciate non-verbal communication, through eye contact and touch, as it is a crucial method to creating a rapport and trusting relationship with their patient before verbal communication commences. The article also identified the challenges nurses face when delivering self-management after stroke, as different policies, authors or researchers may not use same definition of self-management (Newman, Steed Mulligan 2009). Therefore, nurses have to interpret documents and apply them in different environment. Lorig Holman (2003) supports that self-management is poorly theorised, which means lack of knowledge restrict both the nurses and patients from facilitating self-care management (White, Duncan and Baumle, 2011) Although it identifies the importance of individual’s attitudes and beliefs towards recovery and response to rehabilitation, the attitudes and beliefs of the nurse also plays a role (Young and Forster, 2007). However Daniel, Grendall Wilkins (2008) states the importance of valuing people’s attitude and beliefs as it determines their motivation to participate in self- care. Therefore nurses have to be sensitive to that fact that all patients share different beliefs regarding health care issues. (Barker, 2009) The overall article highlighted the importance of nurse’s usage of different behaviour change techniques to promote positive self-management after stroke. It also identifies nurses as the main provider in promoting self-care to patients and their families in order to improve the outcome. Annotated Article 2 Rowat, A. (2011). Malnutrition and Dehydration after Stroke. Nursing Standard, 26 (14), 42-46 The aim of the article was to encourage nurses to identify the frequency and causes of malnutrition and dehydration, consider the complications it can cause and to be aware of the feeding strategies. They identify that patient presented with stroke should be assessed within the first 48 hours and swallowing should be assessed before giving any food, fluid or oral medication (NICE, 2008). They identify the video-fluoroscopy test used to observe the patient swallowing process. However the test is not practical for assessing patient with stroke as they are unable to sit independently as well as endure movement of their head (Rowe D’Antonio, 2005, Jacobsson et al, 2000). Although the video-fluoroscopy is used to detect dysphagia, it is believed to be an unreliable source as it does not identify how the patient should be fed when they return to the ward (Clayton, Jack, Ryall, Tran, Hilal Gosney 2006). The use of different trials carried out by Dennis, Lewis Warlow (2005) supports decisions about feeding patients after stroke as it illustrates the significance of enteral tube feeding reducing risks of death at 6months. The article also identifies alternative evaluation tool; Fibre optic Endoscopic Evaluation of Swallowing (FEES) has been developed as it can be used at the bedside to establish the movement of fluid and food in the larynx (Ramsey, Smithard Kalra, 2003). However it still requires a skilled operator to administer the swallowing test, therefore the person administering the tests must receive sufficient education and training in order to carry out the test accurately (Rodgers, 2005). It identifies the importance of nurses using the Malnutrition Universal Screening Tool as it is a valid and reliable nutritional screening tool used in hospital setting, as high number of patient with stroke experience malnutrition (NICE, 2008). However the tool is not specific to stroke and would not identify reasons the patient is malnourished, but it enables the nurses to identify the patients who need to refer to speech and language therapist (Hickson, 2006). The overall article informs nurses of the common complication arising from stroke and the tools used to examine. It also identifies the importance of teamwork between nurses and speech and language therapy in maintaining the nutrition and hydration status of the patient after stroke. Annotated Policy Department of Health. (2007). National Stroke Strategy. London: HMSO The strategy has been put in place as it provide a quality framework against which local services can secure improvements to stroke services and address health inequalities involving stroke within ten years, provide advice, guidance and support for commissioners, strategic health authorities, the voluntary sector and social care, in the planning, development and monitoring of services; and inform the expectations of those affected by stroke and their families, by providing a guide to high-quality health and social care services. The Department of Health (2007) established a national strategy for stroke facilities in England. According to DoH (2007), almost 110,000 people under the age of 65 in England have a stroke yearly and 20-30% of those people pass away within a month. They identified Stroke as the main cause of disability within adults and costing the NHS and economy  £7 billion yearly as suggested by (Leatherman, Sutherland Airoldi 2008). The DoH developed the strategy as a result of an evidence based practice (Keele, 2011), which suggest what needs to be done by recommending nurses to use the care pathway to deliver an effective care to patients with stroke (Barker, 2013). The policy was implemented to remodel the services provided to the patients, ensuring they receive the best care using resources available. However due to some nurses lack of knowledge, it could limit the resources being used effectively (Rodgers, 2005). Although the policy supports the involvement of patients and family with stroke by involving them in care planning (Benner, Kyriakidis Stannard, 2011). However the policy identifies that this can prove to be less effective when communicating with the patient due to either physical disability or limited communication as a result of the severity of their stroke (DoH,2007).Therefore the policy identifies how to interact effectively with the patient by maintaining their dignity (Masters, 2014). Overall the policy highlights the important of nurses being updated frequently on different tools available to use when caring for their patient. This ensures the patients receive an up-to-date care and restricts their stay in hospital. To conclude, the writer has demonstrated understanding of the articles and policy chosen, by using literatures to analyse and explore further reading concerning how it influences the nursing care of the stroke patient. This has equipped the writer on how effective high quality care should be delivered to patients effectively. References Achterberg, T.V, Schoonhoven, L Grol, R. (2008). Nursing implementation science: How evidence based nursing requires evidence- based implementation. Journal of Nursing Scholarship, 40(4), 302-310. Bach, S. Grant, A. (2011). Communication and interpersonal skills in nursing. (2nd ed). Great Britain: Short Run Press. Barker, A.M. (2009). Advanced practice nursing: Essential knowledge for the profession. USA: Jones and Bartlett Publishers. Barker, J. (2013). Evidence based practice for nurses. (2nd ed.). London:SAGE. Barret, S., Komaromy, C., Robb, M. Rodgers, A. (2004).Communication, relationship and care: A reader. USA: Routledge. Benner, P., Kyriakidis, P.H. Stannard, D. (2011). Clinical wisdom and interventions in acute and critical care: A thinking-in-action approach. (2nd ed.). New York: Springer Publishing. Burnard,P. (2003). Ordinary chat and therapeutic conversation: Phatic communication and mental health nursing. Journal of Psychiatric and Mental Nursing, 10 (6), 678-682. Clayton, J., Jack, C.I., Ryall, C., Tran, J., Hilal, E. Gosney, M. (2006). Tracheal pH monitoring and aspiration in acute stroke. Age and Ageing. 5 (1), 47-53. Daniels, R, Grendell, R Wilkins, F.R. (2008). Nursing fundamentals: caring and clinical decision making. (2nd ed). USA: Cengage Learning. Dennis, M.S., Lewis, S.C. Warlow, C. Food Trial Collaboration (2005b). Effect of timing and method of enteral tube feeling for dysphagic stroke patients (FOOD): a multicentre randomised controlled trial. The Lancet. 365, 9461, 764-772. Egan, G. (2009). The skilled helper: A problem management and opportunity-development approach to helping. (9th ed.). USA: Cengage Learning. Hickson, M. (2006). Malnutrition and ageing. Postgraduate Medical Journal. 82 (963), 2-8. Jacobsson, C., Axelsson, K., Osterlind, P.O. Norberg, A. (2000). How people with stroke and healthy older people experience the eating process. Journal of Clinical Nursing. 9 (2), 255-264. Joice, S. (2012). Self-Management following Stroke. Nursing Standard, 26 (22), 39-46 Keele, R. (2011). Nursing research and evidence based practice: Ten steps to success. USA: Jones Bartlett Learning. Lorig, K. Holman, H.R. (2003). Self-Management education: History, definition,outcomes and mechanisms. Annals of Behavioural Medicine. 26 (1), 1-7. Leatherman, S., Sutherland, K. Airold, M. (2008). Bridging the quality gap: Stroke. Retrieved March, 9, 2014 from http://www.wales.nhs.uk/documents/bridging_the_quality_gap.pdf Masters, K. (2014). Role development in professional nursing practice. (3rd ed). USA: Jones and Bartlett Publishers. McCabe, C Timmins, F. (2013). Communication skills for nursing practice. (2nd ed). UK: Palgrave Macmillian. Newman, S., Steed, L. Mulligan, K. (2009). Chronic physical illness: Self-management and behavioural intervention. England: Open University Press. Palmer, S. (2000). Introduction to counselling and psychotherapy. London: Sage Petersen, R. (2010). Ubuntu 10.04 LTS desktop handbook. USA: Surfing Turtle Press. Ramsey, D.J., Smithard, D.G. Kalra, L. (2003). Early assessments of dysphagia and aspiration risk in acute stroke patients. Stroke. 34 (5), 1252-1257. Rodger, B.L. (2005). Developing nursing knowledge: Philosophical traditions and influences. USA: Lippincott Williams and Wilkins. Rowat, A. (2011). Malnutrition and Dehydration after Stroke. Nursing Standard, 26 (14), 42-46 Rowe, M.R D’Antonoio, L.L. (2005). Velopharyngeal dysfunction: Evolving developments in evaluation. Current Opinion in Otolaryngology Head and Neck Surgery, 13 (6), 366-370. Schuster, P. (2000). Communication the key to the therapeutic relationship. Phiadelphia: F.A. Davis Company. United Kingdom. Department of Health. (2007). National Stroke Strategy. London: HMSO. United Kingdom. National Institute for Health and Clinical Excellence. (2008). Stroke: National Clinical Guidelines for the Diagnosis and Initial Management of Acute Stroke and Transient Ischaemic Attack. Clinical Guideline No.68. London: HMSO. White, L., Duncan, G Baumle, W. (2011). Foundation of basic nursing. (3rd ed). USA: Cengage Learning. Young, J Forster, A. (2007). Review of stroke rehabilitation. British Medical Journal. 334 (7584), 86-90.

Relation to the Socio-Political Essay

Comparison and Contrast of the General Tones of the Sumerian and Egyptian Hymns, in Relation to the Socio-Political and Geographic History of these Nations It is interesting to note that the Egyptian and Sumerian civilizations both sprung up beside rivers: Egypt lies in the delta of the Nile while the Sumerian civilization was on the fertile Mesopotamia along the banks of Tigris and Euphrates. It is thus expected that both civilizations revere their river, and associate them with gods, because the rivers prove to be vital to their existence and a channel of life for them. These forces of nature are considered holy and addressed by prayers. Examples of such pleas can be found in both hymns â€Å"A Sumero-Akadian Prayer to Every God† and the â€Å"Hymn to the Nile. † In these prayers, however, we find very different attitudes of the early people towards their gods. In the Sumero-Akadian prayer we will read a tone of sorrow, grief and fear by a troubled soul over his offences with the gods. The introduction fearfully desire for peace with the divinity: â€Å"May the fury of my lords heart be quieted toward me. † Throughout the text we will also find out that the gods are not named, but is rather just sanctified as an existing being that may not be offended. This apparent fear of the divinity may be attributed to the structure of the Mesopotamian civilizations, where the land was divided into different city-states believed to be owned by a deity. The Sumerian state is therefore not a solid state, but is a conglomeration of small states. Consistent fear of invasion made them turn into the divine beings for protection and blessing. As a further note, in the Sumero-Akadian civilizations, the power of government is divided into two: the lugal took care of the military powers and the even more powerful ensi was the supreme religious leader who also controlled â€Å"economic and technological expertise† (Krejci and Krejcova, p. 31). It can therefore be seen that the fear of the gods was the way of the ensi to maintain political control over his dominions. Political and social structure in Egypt proved much different from the Sumerians. The whole of Egypt was controlled by only one ruler – the Pharaohs. This unity gave the Egyptians more control over their surroundings and their country. Early on, the Egyptians had a clear sense of identity (Kemp, p. 25). This control is best exemplified by their ability to time and control the flooding of the Nile. However, geographically, the Egyptians were not as lucky as the Sumerians, as they were surrounded by deserts. This made them consider the Nile as a gift from the gods, a means by which they would live. It is therefore not surprising that the â€Å"Hymn to the Nile† is a joyous song of praise. The overall theme of the hymn is perhaps best stated in the first lines: â€Å"Hail to thee, O Nile! Who manifests thyself over this land, and comes to give life to Egypt!† References Mircea Eliade `From Primitives to Zen`: A SUMERO-AKADIAN PRAYER Ancient History Sourcebook:Hymn to the Nile, c. 2100 BCE Jaroslav Krejci, Anna Krejcova (1990). Before the European Challenge: The Great Civilizations of Asia and the Middle East. SUNY Press. Barry J. Kemp (2006). Ancient Egypt: Anatomy of a Civilization, 2nd Ed. Routledge

Underrated Questions on Current Social Issues Essay Topics That You Should Know About

Underrated Questions on Current Social Issues Essay Topics That You Should Know About Top Current Social Issues Essay Topics Choices The most significant thing in letter writing is its format so that you ought to know the appropriate format of both. While you have little time and the sum of pages, it's imperative not to bite more than you can chew. You should write just a word in every block. See the way your letter writing campaign can create a difference. For instance, today, the old-fashioned face-to-face conversation was phased out by social networking platforms which promise more connectivity irrespective of distance. You have to comprehend what issues are definitely the most important with you, and be informed. The social justice issues can be classified below a list of social policy problems and social awareness troubles. Lots of the modern day problems that have hit conventional media and social media headlines incorporate a list of social justice problems that it is possible to find at our essay writing services. You may continue to keep your argumentative essays for your upcoming job portfolio in case they're highly graded. Given such a job, make certain you understand or have a notion about a particular social issue you want to manage. Find more information about the case here. The problem of doctor-assisted suicide. To totally understand the political process an individual should have lots and tons of understanding of the way our society operates. You may observe advertisements everywhere urging you to get products which will supposedly improve your physical appearance. In addition, there are different joints which only draw in women or seem to get frequented by men only. There are a lot of problems, even on your own campus, that ought to be resolved. Apparently, it's quite apparent that we have to understand the significance of national integration in our lives and follow everything to provide a single identity of our nation. When it may boost their social life, it is exceedingly detrimental to their academic life and the majority of them may wind up failing. There have been a number of instances of communal and religious riots in our country and many innocent lives have endured because of the exact same. Conflicts between individuals of different religions. What Needs to be Done About Current Social Issues Essay Topics Before You Miss Your Chance Homelessness This 8 page paper gives an example study on deviance in regard to the homeless. Classic stories, excellent stories, original stories are always likely to get high price. Some people believe that children have zero power since they can't vote. Therefore, students who study industry and other relevant subjects may be interested in writing on a number of the next topics. The Appeal of Current Social Issues Essay Topics Therefore, it's critical to make them experience its different facets to enhance their knowledge. Strategy There are lots of distinct strategies which you can disclose in your w ork. General information Students that are new to the topic of social studies must be ready for in-depth education at their very first lessons. Learning There are many approaches and approaches to learning and grasping the very same materials. Another social effect of the dearth of education is poverty. There's no public interest exemption. This change may lead to a more dynamic learning environment or it may raise tensions and reinforce stereotypes. In the majority of communities, the financial status always defines someone's social status. Vital Pieces of Current Social Issues Essay Topics You also receive a great opportunity to dig more into research! Pay close attention to all things electronic, and you will be certain to find something debatable of what you see. This topic will need a lot of practice. When you're picking your topic, remember that it's much simpler to write about something which you presently have interest ineven in case you don't know a great deal a bout it. Current Social Issues Essay Topics Features Learning materials As people study, the appropriate assortment of articles dramatically boosts the practice. These topics are supposed to help students identify some helpful sources. Don't hesitate to use our sample topics to produce your own! Don't hesitate to browse through our sample topics to find some inspiration. The Start of Current Social Issues Essay Topics Therefore, every paper needs to be written carefully. Moral argumentative essay topics are a few of the simplest to get carried away with. Writing an intriguing essay about trendy topics is an opportunity to reveal your knowledge of earth. It is wise to pick a topic you could easily research on. Therefore, the topic ought to be debatable! Sure, you could have a particular topic assigned to you.

Health promoting effects of probiotics - Free Essay Example

Sample details Pages: 20 Words: 6060 Downloads: 1 Date added: 2017/06/26 Category Biology Essay Type Analytical essay Did you like this example? Introduction Health promoting effects of probiotics have gained increasing attention from consumers and producers over the past few decades (de Vrese and Schrezenmeir 2008). The term â€Å"probioticâ€Å" was coined in the 1950s (Kollath, 1953) and has been defined as live microorganisms that when administered in adequate amounts confer a health benefit on the host (Report of a Joint FAO/WHO Working Group, 2002). Beneficial effects of probiotic bacteria include a reduction in gut pathogenic bacteria and harmful metabolites, gastrointestinal motility normalization, and immunomodulation. Don’t waste time! Our writers will create an original "Health promoting effects of probiotics" essay for you Create order Probiotics not only affect the intestinal flora in the large intestine but also influence other organs by modulating the immune system, intestinal permeability and providing bioactives (de Vrese and Schrezenmeir, 2008). The mechanism of action of probiotic microorganisms and their efficacy depend on their interactions with specific immuno-competent cells of the intestinal mucosa. Various probiotic strains have been shown to possess a wide range of health benefits including the re-establishment of colonic and intestinal microbiotic balance. The balance in this microbiotica is attained by reducing the intestinal pH and producing bactericidal products, organic acids and hydrogen peroxide (Saikali et al., 2004; Fric, 2002; De roos and Katan 2000). The presence of probiotics in the intestine stimulates intestinal motility, increases the production of mucus, short chain fatty acids, and amino acids and strengthens the barrier function of intestinal mucosa. Increases in the number of ben eficial bacteria in the intestine results in competition with pathogenic bacteria for nutrients, and thus survival (Gill et al., 2001; Mangell et al., 2002; Jain et al., 2004). Probiotics have been shown to possess strong therapeutic effect against diarrhea and inflammatory bowel disease (De Vrese and Marteau 2007; Peran et al., 2007, 2006). In humans and animals, bacteria of the Lactobacillus (L.) strain exist as general components of the intestinal microflora (Naidu et al., 1999) and have been shown to possess bile salt hydrolase enzyme (De Smet et al., 1994), which is responsible for deconjugation of bile salt in enterohepatic circulation. Among the various probiotic strains, L. reuteri and L. fermentum have been shown with promising health benefits. L. fermentum have been demonstrated to be capable of adhering to the epithelial cells in the small intestine and colonized (Henriksson et al., 1991; Reid et al., 2001; Rojas et al., 2002). In addition, L. fermentum possess stro ng resistance to low pH as well as bile salts and also prevent adhesion of uropathogenic bacteria by producing surface-active components (Heinemann et al., 2000). In an in vitro study, L. fermentum have been shown to affect the lipid metabolism by reducing circulating cholesterol levels (Pereira et al., 2003). The mechanism of action in reducing cholesterol could be attributed to the enzymatic deconjugation of bile acids where the bile acids after deconjugation become more insoluble and not effectively reabsorbed from the intestine. As a result, the excretion of bile acids in feces increases significantly (Usman and Hosono 1999; De Smet et al., 1994). Hence, deconjugation of bile acids by L. fermentum reduces serum cholesterol in two ways which are (a) reducing the cholesterol absorption in the intestine and; (b) inducing the demand of cholesterol for bile acid synthesis. Similarly, previous research outcomes showed a significant decrease in serum cholesterol levels after adminis tration of L. reuteri; however, this hypocholesterolemic effect persisted only during the probiotic administration. Once treatment was terminated, the cholesterol levels were found to be reversed back to their original levels before treatment (Grunewald, 1982; Massey, 1984). In contrast, Taranto et al., (2000) demonstrated the prophylactic effect of L. reuteri in the prevention of hypercholesterolemia. The authors also claimed that L. reuteri remain in the gut permanently after administration. Hence, the current study investigated the effects on consumption of two probiotic bacterial strains either L. fermentum or L. reuteri, compared to control, on plasma lipid concentrations and their kinetics, fecal bile acid clearance, body composition, as well as microbial distribution in the gastrointestinal microflora in hyperlipidemic, but otherwise healthy, individuals. Experimental design Study population Subjects were recruited from the local Winnipeg area via newspaper and radio advertisements. Potential subjects were initially screened on the phone using a questionnaire where some brief questions regarding personal health information were asked. If subjects were determined to be potentially eligible after telephone screening, they underwent a blood screening where 10 ml fasting blood samples were taken in order to test for general lipid profile including total cholesterol (T-C), high density lipoprotein-cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C) and triglycerides (TG). If the potential volunteer qualified, they were invited back for a subsequent screening at which time 25 ml of blood was obtained for measurement of a complete blood count and routine biochemistry test. In addition, volunteers underwent a complete medical history and physical examination. During the physical examination, the physician measured vital signs, examined the norm ality of body systems and reviewed the individuals medical history. The inclusion criteria included baseline LDL-C between 130-260 mg/dL (3.4-6.8 mmol/L), TG below 400 mg/dL (4.5 mmol/L), a body mass index (BMI) between 22 and 32 kg/m2 and aged 18-60yr. Subjects were excluded if they took medications known to affect lipid metabolism. Subjects who were diagnosed to have diabetes mellitus, heart disease, liver disease, kidney disease, lactose intolerance or had recently undergone major surgery were also excluded from the study. Experimental protocol The study was a controlled diet, cross-over clinical investigation using a Latin square sequence. The study consisted of three 43 day phases separated by a six week wash out interval. Subjects were randomized to one of three treatment arms: a) control yogurt; b) yogurt containing 1013 CFU of microencapsulated bile salt hydrolase promoter L. ruteri bacteria; c) yogurt containing 1013 CFU microencapsulated ferulic acid esterase promote r L. fermentum bacteria. During each treatment period, subjects were provided with a diet containing 35% of energy as fat, 50% carbohydrate and 15% protein. All meals were prepared at the metabolic kitchen located at the Richardson Centre for Functional Foods and Nutraceuticals (RCFFN) using a three-day rotation menu. Individual basal energy requirements were determined using Mifflin equation (Mifflin et al., 1990) and were multiplied by a physical activity factor of 1.7. The control and two treatment yogurts comprised a part of the meals at supper and were consumed simultaneously with 4g of wheat bran. Subjects were instructed to consume their supper meal in conjunction with one treatment or control under supervision on a daily basis to monitor compliance. The remaining meals were packed for take-out. Subjects were instructed to return the empty containers to ensure that the diet was properly consumed. Blood collection protocol Twelve-hour fasting blood samples were collected on days 1, 2, 28, 29, 39, 40, 41, 42 and 43 of each of the three phases of the trial. Blood samples obtained on days 1 and 2 were used to measure baseline values for different study measurements, whereas blood samples obtained on the days 28 and 29 were used to measure midpoint values; samples collected on days 42 and 43 were used to measure endpoint values. Blood samples were collected using vacutainer tubes and centrifuged for 20 min at 3000 rpm and the separated aliquots were frozen until analysis. Stable isotope administration For the purposes of measurement of cholesterol absorption, 70 mg of 13C-labelled cholesterol was provided orally on day 39, with blood samples collected just before dosing this tracer and on the mornings of days 40, 41, 42 and 43 to follow the appearance of the isotope into the blood compartment. For purpose of measuring cholesterol synthesis, approximately 25 g deuterium water (D2O) was provided orally just after the collection of blood on day 42. Synthesis was assessed as the increase in D within blood cholesterol between day 42 and day 43. Stool sample collection protocol Two stool samples were collected from each individual at the end of each period. Subjects were provided with a â€Å"stool collection kit†. This kit consisted of two fecal collection vials, a pair of gloves, and a commode attachment (inverted hat). The commode was placed onto the toilet seat, and urine was voided so as not to contaminate the fecal sample. Once the stool had been voided into the collection device stool was scooped up and placed into the fecal collection vial (50 ml container). The vial was brought into the laboratory and frozen at -80 °C as soon as possible. Stool collections were conducted twice in the final week of each feeding period. Body composition assessment Body composition was analyzed using dual-energy X-ray absorptiometry (DEXA), a method that can accurately and rapidly assess body fat analysis. DEXA scan ser ies was conducted using General Electrics Lunar Digital Prodigy Advance at the beginning and end of each phase in order to assess body composition including overall body fat and lean mass. Analyses Blood lipid analysis Plasma T-C, TG, and HDL-C were analysed using a VITROS 350 autoanalyser. Plasma LDL-C concentrations were calculated using the Friedewald equation as described below: LDL-C (mmol/L) =T-C-HDL-C-(TG/2.2) (Friedewald et al., 1972) (1) Total apolipoprotein B (apoB-48 and apoB-100) was measured by the human apoB EIA kit (Cayman Chemical). This assay is based on the quantitative sandwich enzyme immunoassay technique. In summary, each well is pre-coated with a monoclonal antibody specific to apoB. Any apoB from serum introduced to the kit binds to this antibody. Serum samples were diluted 5000x using the sample diluent buffer provided. To each well 100 ml of standard or sample was added and the plate was incubated at room temperature on an orbital shaker for 2 hrs to allow binding. The plate was then rinsed 4 times with the provided wash buffer and 100 ml of goat polyclonal apoB antibody was added. The plate was incubated at room temperature and shaken for another hour to detect the captured apoB. Following this, the plate was washed once again (4 times) and 100 ml of donkey anti-goat IgG/HRP-conjugated antibody was added to allow for ‘sandwich recognition. After a third incubation on an orbital shaker for 1 hr at room temperature, the plate was washed for the final time (4 times) and 100 ml of chromogenic substrate TMB was added. The apoB concentration of the samples was determined by the enzymatic activity of the HRP. After 25 minutes, the plate was stopped with the 100 ml of the provided acidic stop solution, which changes the well colour from blue to yellow. This colour was then measured spectrophotometrically at 450 nm, using a microplate reader. The intensity of the colour is proportional to concentration of apoB in the wells (Absorbance ? [donkey a-goat HRP] ? [apoB]). The absorbance of the plate blanks was subtracted from the absorbance of the standards and samples. The standards were plotted using linear regression and the samples concentrati on were determined by: apoB (ng/mL) in sample = [A450- (Y-intercept)/Slope] x Dilution (2) Concentrations were then multiplied by the dilution factor (5000x) and expressed as g/L. Cholesterol fractional synthesis rate analysis The rate of deuterium from body water incorporated into RBC membrane free cholesterol over day 42 to day 43 of each phase was taken as an indicator of cholesterol fractional synthesis rate (FSR). Therefore, deuterium enrichments were measured in both RBCs and plasma water. The deuterium enrichment of free cholesterol extracted from RBCs was analyzed in samples obtained at day 42 and day 43 of each phase utilizing a gas chromatography/pyrolysis/isotope ratio mass spectrometry (GC/P/IRMS) approach. Free cholesterol samples were extracted from RBCs through the following procedures; methanol was added to RBCs and samples were heated at 55oC in a shaking water bath for 15 min, before addition of hexane: chloroform (4:1, by volume) and double-distilled water. Thereafter, samples were centrifuged for 15 min at 1500 rpm at 4oC. Supernatants of the samples were dried down under nitrogen and re-dissolved with hexanes and subsequently transferred in injection vials. Samples were injected i nto an Agilent 6890N gas chromatograph (GC). The GC was connected to a Delta V Plus isotope ratio mass spectrometer (IRMS) through a pyrolysis furnace (alumina tubing, reactor temperature at 1450oC). A 30 m capillary column (SAC-5; Supelco, Bellefonte, CA) was installed in the GC which was programmed with the starting temperature at 60oC and isothermal for 1 min and increasing by 25oC/min to 275oC; increasing by 4oC/min to 290oC and isothermal for 3 min; increasing by 25oC/min to 308oC and isothermal for 3 min. Under these conditions, the organic hydrogen from free cholesterol was converted to H2 gas. The enrichment of this H2 gas was then detected by the Delta V Plus IRMS system. Isotopic ratios were expressed as d 2H/1H in per mil against V-SMOW (Vienna Standard Mean Ocean Water). The deuterium enrichment of plasma water was analyzed by temperature conversion elemental analyzer (TC/EA)-IRMS. After correction for free cholesterol pool, FSR was taken as the indicator of the fraction of the cholesterol pool that is synthesized over days 42 and 43 was calculated as: FSR (%) = ? Deuterium / (? Plasma water * 0.478) *100 (3) Cholesterol absorption analysis The enrichment of 13C-cholesterol detected from free cholesterol extracted from RBCs was used to determine absorption (ABS) using gas chromatography/combustion/isotope ratio mass spectrometry (GC/C/IRMS). The free cholesterol was extracted from RBCs by the procedure as mentioned above. Samples were injected into an Agilent 6890 N gas chromatograph (GC). The GC was connected to a Delta V Plus isotope ratio mass spectrometer (IRMS) through a combustion furnace (alumina tubing, reactor temperature at 940oC). A 30-m capillary column (SAC-5; Supelco, Bellefonte, CA) was installed in the GC which was programmed with the starting temperature at 60oC and isothermal for 1 min and increasing by 25oC/min to 275oC; increasing by 4oC/min to 290oC and isothermal for 3 min; increasing by 25oC/min to 308oC and isothermal for 3 min. Under these conditions, the small portion of free cholesterol was converted to CO2. The 13C content of CO2 was measured by the Delta V Plus IRMS system. Enrichments were then expressed as ? 13C/12C in per mil relative to PeeDee Belemnite (PDB) limestone. The absorption is then calculated with the area under the curve from the graph plotted with ? 13C/12C per mil relative to (PDB) over time. Body composition analysis The General Electric Prodigy Body Composition software program, EnCore 2005, was used to analyze scans and generate body composition data. Analysis of fecal bile acids All samples were dried at -66 °C on a freeze dryer until 2 consecutive weights were obtained using 2 decimal places. Lyophilized samples were stored at -80 °C until further analysis. Approximately 100 mg of lyophilized fecal sample was pulverized, added to 15 ml Pyrex glass screw top test tubes and suspended in 1 ml of ethylene glycol-KOH. Teflon lined lids were used to seal the tubes, which were then heated on a dry heat bath for 2 hrs at 115 °C. Once cooled, 1 ml of aqueous NaCl was added to the tube and vortexed for 10 sec. From here 200 ml of concentrated HCL was added and samples were vortexed for another 10 sec. Tubes were allowed to cool after acidification and 6 ml of diethyl ether was added and samples vortexed for 1 min. All samples were centrifuged at 2000 g for 4 min at 4 °C. The diethyl ether phase was aspirated and placed into a new tube. This extraction was repeated twice more with 6 ml of diethyl ether added each time. All extracts were poo led together and evaporated under nitrogen gas in a water bath set at 45 °C. The remaining residue was suspended in 3.0 ml of methanol, capped and stored at -20 °C until used for analysis. All reagents were brought to room temperature before analyses. To a 96-well co-star plate, 150 ml of reconstituted R3 (diaphorase, NAD+, NBT, oxamic acid) and 20 ml of sample or standard were added to the wells. Methanol was run as the blank. The plate was then incubated at 37 °C for 4 min. After this incubation, 30 ml of R2 (3 µHSD, tris buffer) was added and the plate was read immediately at 540 nm and this value was A1. After 5 min incubation the plate was read again at 540 nm to calculate A2. The absorbance of the standard and sample was calculated by subtracting A1 from A2. The concentration of the total fecal bile acid was calculated using the formula: Fecal bile acid concentrations (mmol/L) = ? A540sample/? A540standard standard (35 mmole/L) (4) Values obta ined from equation (4) were then converted to mmol/g of dry feces. Fecal microbial composition analysis DNA extraction Stool samples were thawed at 32 °C for 15 min and resuspended in phosphate buffered saline (PBS) in new sterile tubes. Then, approximately 150 mg of wet mass was washed in 1 ml of PBS and centrifuged at 10,000 ÃÆ'? g for 2 min. The washing step was repeated twice. DNA was extracted from the pellets by using ZR Fecal DNA Kit (D6010, Zymo Research Corp., Orange, CA), which included a bead-beating step for the mechanical lysis of the microbial cells. We followed the manufactures instruction except that we increased the bead-beating step to 3 min. DNA concentration and purity were determined spectrophotometrically by measuring the OD and A260/280 (Beckman DU/800, Beckman Coulter Inc., Fullerton, CA). Primers and Real-time PCR. Primers were assembled from the literature or newly designed and tested for specificity in silico. Those primers that did not meet our selection criteria for specificity and performance were redesigned from sequence alignments. The oligonucleotides were synthesized by University Core DNA Services (University of Calgary, Calgary, AB). Real-time PCR was carried out using an AB 7300 system (Applied Biosystems, Foster City, CA) and sequence detection software (Version 1.3; Applied Biosystems, Foster City, CA). Each reaction was run in triplicate in a volume of 25  µl in optical reaction plates (Applied Biosystems, Foster City, CA) sealed with optical adhesive film (Applied Biosystems, Foster City, CA). Amplification reactions were carried out with Power SYBR Green PCR Master Mix (Applied Biosystems, Foster City, CA) mixed with the selected primer set at a concentration of 0.5  µM for each primer, and 2  µl (~12 ng) of genomic DNA. To evaluate the efficiency (E) of the amplification of each primer set, DNA templates were pooled (50 ng/reaction) and serially diluted 8 fold. Amplification efficiency was calculated from the slope of the standard curve generated from plotting the threshold cycle (CT) versus logarithmic values of different DNA concentrations using the following equation (Denman and McSweeney, 2005): E=10-1/slope (5) Relative quantification was accomplished using following mathematical model (Pfaffl, 2001): Ri = [(Etarget)?CTtarget (Controli SARAi)]/[(Eref)?CTref (Controli SARAi)] (6) Where target is the 16S rDNA gene of interest, ref is Eubacteria, ?CT is the CT deviation of the control vs treatment, i is the period, and Ri is the relative expression ratio of a target gene compared to a reference gene at a specific time point. Statistical analysis All data were expressed as mean+/- SE. Statistical significance was set at P0.05 for all analyses. Log transformation was preformed when data were determined to be not normally distributed. Differences between treatments at baseline, midpoint and endpoint for lipids, cholesterol absorption and synthesis rates, fecal bile acid concentrations, body composition were compared by using the analysis of variance (ANOVA) model for determination of diet effects. When diet effects were found to be significant, Least Squares Means was used to identify differences between diet effects. Students paired- t test was used to compare baseline and midpoint as well as baseline and endpoint within each diet. Differences of percent changes at endpoint relative to control between L. fermentum and L. reuteri treatments were also analyzed using Students paired-t test. The LSD multiple comparison test was conducted to detect significant differences among treatment groups in analyzing gut microbial compo sition parameters. Data were analyzed with the use of SAS software (version 8.0; SAS Institute Inc, Cary, NC, USA). Results Two hundred and thirty seven subjects underwent blood screening sessions. Forty-eight subjects were initially recruited and thirty subjects (11 males and 19 females) completed the entire trial. Eighteen subjects dropped out due to difficulties with consuming study diets and/or with accommodating the setting of the study (n=2, dropped out on the first day), relocation to another city (n=1), problems with daily centre visiting (n=7), personal reasons (n=4), and difficulties with re-starting the study (n=4). Blood lipids in response to treatments There were no significant differences at baseline in any of the lipid parameters assessed across treatments. Yogurt containing L. fermentum resulted in lowered (P=0.0226) T-C levels compared to L. reuteri-enriched yogurt at midpoint (T-C=5.36  ± 0.15 and 5.65  ± 0.20 mmol/L for L. fermentum and L. reuteri treatments, respectively). Although no statistical difference was noted between L. fermentum and control yogurt, there was a strong tendency (P=0.058, compared by Least Squares Means) towards T-C reduction with L. fermentum treatment compared to control. Lower (P=0.0288) circulatory LDL-C levels were observed with L. fermentum treatment compared to L. reuteri containing yogurt at midpoint (LDL-C=3.37  ± 0.13 and 3.61  ± 0.15 mmol/L for L. fermentum and L. reuteri treatments, respectively). Furthermore, L. fermentum treatment tended to result in (P=0.0634, compared by Least Squares Means) lower circulatory LDL-C levels, compared to control, at midpoint. Plasma TG, HDL-C and apo B did not differ across treatments at the midpoint contrast. Although T-C and LDL-C levels were determined to be lower at midpoint as a result of L. fermentum treatment supplementation, compared to L. reuteri treatment, endpoint T-C and LDL-C levels were not statistically affec ted across three treatments. Furthermore, no treatment effect was noted in TG, HDL-C and apo B levels at endpoint. Lipids were further analyzed as percent change over time between baseline and midpoint. All three treatments resulted in T-C reductions at midpoint (P0.0001 for L. fermentum treatment; P=0.0014 for L. reuteri treatment; P=0.0061 for control). Plasma LDL-C levels were decreased (P=0.0032) by 7% from baseline in response to L. fermentum treatment. However, LDL-C levels did not appear to be decreased at midpoint in response to L. reuteri and control treatments. Circulating HDL-C levels were decreased (P0.0001 for L. fermentum treatment; P=0.0005 for L. reuteri treatment; and P=0.0008 for control) in response to all three treatments from baseline to midpoint. Plasma TG levels were reduced (P=0.0011) by 14% from baseline as a result of L. fermentum administration at midpoint. L. reuteri feeding also resulted in a significant (P=0.0012) 17% reduction at midpoint, compared to baseline. However, TG and apo B concentrations were not affected by control treatment at midpoint, compared to baseline. Furthermore, lipids were analyzed as percent change over time between baseline and endpoint. All three treatments resulted in T-C reductions at endpoint (P=0.0054 for L. fermentum treatment; P0.0001 for L. reuteri treatment; P=0.0025 for control). Plasma LDL-C levels were not decreased at endpoint as a result of L. fermentum treatment. In contrast, LDL-C concentrations were reduced by 5% from baseline in response to L. reuteri and control treatments (P=0.0344 and P=0.0111 for L. reuteri and control, respectively). Circulating HDL-C levels were decreased (P=0.0241 for L. fermentum treatment; P=0.0005 for L. reuteri treatment; and P=0.0006 for control) in response to all three treatments from baseline to endpoint. Plasma TG levels were reduced (P=0.0078) by 13% from baseline as a result of L. fermentum administration at endpoint. L. reuteri feeding also result ed in (P=0.0003) 21% reductions at endpoint, compared to baseline. However, TG and apo B concentrations were not affected by consumption of the control diet at endpoint, compared to baseline. Additional analysis was performed on a subset of data where values outside the range of two standard deviations were removed form the original data set. The treatment effects on each parameter at midpoint and endpoint remained unchanged using ANOVA. Cholesterol absorption and synthesis rate in response to treatments No treatment effect was observed in ABS in week 6 with and without outliers being removed from the original data set. However, slightly lower ABS levels were noted as a result of L. fermentum feeding, compared to L. reuteri treatment (ABS=379.83  ± 36.87 and 384.38  ± 32.14 per mil ÃÆ'— hr for L. fermentum and L. reuteri feeding, respectively). Furthermore, L. fermentum feeding resulted in a slightly smaller increase in ABS, compared to L. reuteri trea tment; however, the difference between L. fermentum and L. reuteri feeding in ABS relative to control, was not significant (L. fermentum=46.48  ± 23.88 % relative to control treatment; L. reuteri=55.73  ± 34.02 % relative to control treatment). There was no difference across treatments in FSR (FSR = 11.73  ± 1.80; 10.33  ± 1.85; 11.67  ± 1.75 %, for L. fermentum, L. reuteri and control treatment, respectively). However, once the outliers, which are outside the range of plus and/or minus two standard deviations, were removed, L. fermentum treatment resulted in a higher (P=0.0169) FSR value, compared to L. reuteri feeding. Although there was no difference in FSR between L. fermentum and control treatments, L. reuteri resulted in a lower FSR value, compared to control (P=0.0112, obtained by Least Squares Means). Fecal bile acid in response to treatments There were no differences noted across three treatments in fecal bile acid concentrations in week 6 (fecal bile acids= 33.28  ± 2.12; 32.26  ± 2.13; 30.93  ± 2.44  µmol/g dry feces, for L. fermentum, L. reuteri and control treatment, respectively). In addition, no treatment effect in fecal acid levels was identified when outliers were further removed from the original data set. However, a slightly greater percent increase in fecal bile acid concentrations relative to control was observed in response to L. fermentum, compared to L. reuteri treatment, although the difference between L. fermentum and L. reuteri was not significant (L. fermentum=19.15  ± 9.82 % relative to control; L. reuteri=13.77  ± 9.44 % relative to control treatment). Body weight and body compositions in response to treatments There were no differences in body weight of subjects at baseline or endpoint across the three treatments. In terms of body composition analysis, since ethics approval for conducting DEXA scans was not granted until February 4, 200 8, only 28 subjects were available to undergo whole body scans over the course of the study. As a result, endpoint scans of all three phases were obtained from a smaller subgroup of subjects (n=15). Among these 15 subjects, eleven subjects received scans at baseline and endpoint for L. fermentum treatment; twelve subjects were scanned at baseline and endpoint for L. reuteri treatment; and twelve subjects underwent scans at baseline and endpoint for control. No treatment effect was observed at endpoint in total lean mass and total fat mass. However, over the study period, total fat mass was decreased (P=0.0158) by 3% from baseline in response to L. fermentum treatment, while L. reuteri feeding reduced (P=0.0211) fat mass by 4% from baseline to endpoint. In addition, total fat mass was observed to be decreased (P=0.0127) by 1% from baseline with control. These changes occurred despite no statistically significant shift in body weights across treatments. Additional analysis was p erformed on a subset of data where values outside the range of two standard deviations were removed form the original data set. No treatment effect was observed at endpoint in total lean mass and total fat mass using ANOVA. Microbial abundance in response to treatments The sub-study for the microbial composition of human stool samples was conducted as a blinded study, in which the investigators were not knowledgeable of the order of the treatments.. The only designation that was available was O, M, or N. Once the RT-PCR data had been compiled it became fairly obvious that â€Å"O† was the control. At this point the treatments were unblinded and treatment designations were as follows: O = control M = Lactobacillus fermentum N = Lactobacillus reuteri The quantification of the RT-PCR data is provided relative to the control treatment. As discussed in the methods we typically use an internal control rather than an external control. The reason for this is that th e RT-PCR data are based on the efficiency of the PCR reaction. In gut samples, as with many environmental samples, there is always contamination of the DNA extract with food components which result in a decreased efficiency of the PCR reaction. Thus, if one does not take this inefficiency into account erroneous results can be obtained. The efficiency with an external standard is always high. There was a highly significant effect for Lactobacillus (P = 0.008), when the control (O) was compared to M and N. This was to be expected because both probiotic treatments, M and N, were Lactobacillus containing yogurts. The feeding of Lactobacillus exerted a synergistic effect (P = 0.038), directly or indirectly, on the Clostridium cluster IV group in the gut. Clostridium cluster IV contains a large number of butyrate producing bacteria (Collins et al., 1994). Butyrate formation in the gut is considered an important health indicator and dietary interventions that result in increased buty rate is beneficial (Flint et al., 2008). Many of the Clostridium cluster IV bacteria are able to ferment indigestible complex polysaccharides like inulin, oligofructose, xylooligosaccharides, and other polysaccharides that pass to the hind-gut undigested. This investigator was not provided with information as to other components of the yogurt, however, it can be speculated that either there were indigestible polysaccharides in the yogurt, or Lactobacillus directly influenced the Clostridium cluster IV cluster of bacteria. Discussion This report demonstrates the effects of L. fermentum, L. reuteri and control treatments on general lipid profile, cholesterol kinetics, fecal bile acid clearance and body composition, as well as microbial distribution in the gastrointestinal microflora, in hyperlipidemic, but otherwise healthy, individuals. Our current results suggest that over four weeks duration, L. fermentum containing yogurt exerted a more pronounced cholesterol-lowering eff ect compared to L. reuteri-enriched yogurt administered with a controlled-diet, in hypercholesterolemic subjects. In addition, the present data suggest a strong tendency towards cholesterol reductions with L. fermentum treatment, compared to control yogurt over four weeks. Furthermore, over the six week total study period, consumption of L. fermentum and L. reuteri containing yogurts was shown to lead to possible reductions in total body fat mass. Recent findings, primarily from in vitro and animal studies, have demonstrated the potential lipid lowering efficacy in response to administration of L. fermentum and L. reuteri treatments. L. fermentum have previously demonstrated to reduce cholesterol levels (Pereira et al., 2003). In addition, administration of L. reuteri to hypercholesterolemic mice for 7 days reduced the serum T-C by 38% compared to control hypercholesterolemic animals (Taranto et al., 1998). In our current study, L. fermentum-enriched yogurt resulted in lower T-C and LDL-C concentrations, compared to L. reuteri treatments, at the fourth week of the study. To date, human studies have not yet been conducted to directly compare L. fermentum and L. reuteri for lipid lowering efficacy. However, it was demonstrated in a previous animal study (Peran et al., 2007) that L. fermentum appeared to be more efficacious in improving inflammatory markers by producing glutathione compared to L. reuteri. In fact, erythrocyte glutathione levels were reported to be inversely correlated with serum cholesterol levels in a population-based study (Trevisan et al., 2001). Hence, our study results were, at certain degree, in agreement with the previous animal work where it was concluded that administration of L. fermentum could yield more promising health benefits, compared to L. reuteri supplementation (Peran et al., 2007). Although L. fermentum tended to result in lower T-C and LDL-C levels compared to control treatment, the differences in lipids between L. ferm entum and the control diet interventions at the fourth week did not reach statistical significance. The lack of significant differences between L. fermentum and control yogurt might be due to the composition of the background diet, which led to 5% reductions in T-C and LDL-C levels at study midpoint. If L. fermentum had been supplemented to a traditional North American diet, it is possible that the lowering effect of L. fermentum may have been significantly different from the impact of the background diet alone. Cholesterol reduction effects were observed by L. fermentum-containing yogurt supplementation at the fourth week of the study. As such, it was anticipated that more prominent lipid lowering effects of L. fermentum and L. reuteri treatments would be achieved at the sixth week, compared to the results obtained at the fourth week. Surprisingly, L. fermentum, L. reuteri and control yogurt supplementations did not differentially affect T-C and LDL-C levels at endpoint. These r esults support previous evidence of a clinical trial by Simons et al., (2006) demonstrating the no significant change in cholesterol levels after consumption of L. fermentum for ten weeks by humans. Although the dosage level of the probiotic was higher in their study (2 capsules a day and each capsule consisting 2 X 109 CFU), no effects on lipid levels were reported. In fact, clinical investigations with various other strains of Lactobacillus have shown highly inconsistent or absent effects on circulating cholesterol levels (Bukowska et al., 1997; Naruszewicz et al., 2002; Anderson and Gilliland 1999; Kiebling et al., 2002; de Roos and Katan 2000). Treatment with four Lactobacillus tablets per day (each tablet contains 2 X 106 cfu/tablet of L. acidophilus and L. bulgaricus cells) by human subjects for six weeks resulted in no change in serum lipoprotein concentrations (Lin et al., 1989). De Roos et al., (1999) have demonstrated that consumption of yogurt containing L. acidophilus fo r six weeks did not change any of the lipid levels in both normal and borderline hypercholesterolemic men and women. Taken together, it is possible that in investigating the effect of probiotics products on lipid metabolism in human, four weeks seems to be an appropriate study length to observe the optimal treatment effect. Four weeks being a more beneficial treatment duration may be due to the fact that subjects could closely adhere to study protocol for four weeks, but there may be a decline in compliance if the dietary phase lasts longer than four weeks. Alternatively, it is equally possible that some form of biological adaptation occurs after 4 weeks of consumption of these probiotics. In previous animal studies, it has been demonstrated that lactic acid bacteria could alter blood cholesterol levels by influencing cholesterol assimilation (Gilliland and Walker 1990; Gilliland et al., 1997). Our current results indicated higher cholesterol synthesis rates were observed in resp onse to L. fermentum, compared to L. reuteri feeding. The above mentioned result suggested that the higher cholesterol synthesis rate as a result of L. fermentum feeding may be due to the reduction of cholesterol absorption, compared to L. reuteri supplementation, in attempting to maintain cholesterol homeostatisis. Indeed, a slightly lower cholesterol absorption rate was observed in L. fermentum treatment group, compared to L. reuteri, although the difference in cholesterol absorption rate was not significant. However, the increase in synthesis was not sufficient to fully compensate the cholesterol deficit due to L. fermentum intake. Hence, the overall lower T-C and LDL-C levels were observed in response to L. fermentum, compared to L. reuteri feeding at midpoint. Our results were also in accordance with previous findings which indicated the Lactobacilli could exert hypocholesterolemic effect by inhibition of dietary cholesterol absorption in vitro (Gilliland and Walker 1990). I t has been shown that lactic acid bacteria might reduce serum cholesterol levels by influencing the deconjugation and dehydroxylation of primary bile acids within the intestinal tract (De Smet et al., 1998; Gilliland et al., 1985) and increasing bile excretion in feces via bile salt hydrolase (De Smet et al., 1994; Fukushima and Nakano 1995). Increased fecal bile acid after lactobacillus administration was observed in hypercholesterolemic rats (Fukushima and Nakano 1995). Hypercholesterolemic rats fed with lactobacilli showed a significant reduction in their blood cholesterol levels and significantly increased fecal total bile acids compared with a control group. (Usman and Hosono 2000, 2001; Fukushima and Nakano 1996). However, results of our current study do not appear to support the aforementioned findings in animal studies, although cholesterol reductions were noted at week 4 in response to L. fermentum treatment. The discrepancies between animal and current human results might be due to the following reasons. First, stool samples used for fecal bile acid analysis were collected in week 6 whereas cholesterol lowering effects were obtained at week 4. In fact, no treatment effect was identified in cholesterol levels at week 6. Second, due to biological differences, it is generally accepted that the results from animal and in vitro studies cannot be directly extrapolated to humans. Therefore, more human studies are required to elucidate the underlying cholesterol-lowering mechanism of probiotics products. It has been suggested that gut microbiota might play a role in obesity by regulating energy homeostasis and nutrient metabolism (Dibaise et al., 2008). Therefore, probiotics have been postulated to serve as a potential obesity treatment. Although treatment effects were not noted at endpoint, our results suggests that over the study period, body fat mass tended to be reduced by both L. fermentum and L. reuteri treatments. However, more studies are needed t o elucidate the underlying mechanisms responsible for such an effect of fat mass. In summary, our results demonstrate that consumption of L. fermentum-containing yogurt for four weeks, in the context of a controlled-diet, favorably modifies blood lipid profiles, compared to L. reuteri treatment supplementation, in hypercholesterolemic subjects. There was a strong tendency towards cholesterol reductions with L. fermentum-enriched yogurt feeding, compared to control at week four. The mechanism for the cholesterol lowering effect of L. fermentum treatment may be due to the inhibition of cholesterol absorption which was supported by the higher cholesterol synthesis rate in response to L. fermentum feeding, compared to L. reuteri treatment. In addition, both L. fermentum and L. reuteri-containing yogurt supplementations could possibly improve body composition by reducing total fat mass. Overall, our current results support the use of L. fermentum-containing yogurt as an effective prob iotics product in managing cholesterol levels and body composition, as compared to the choice of L. reuteri treatment, in hypercholesterolemic populations.