Improvements In Lean Body Mass Research Articles

The Effects of Italian Mediterranean Organic Diet (IMOD) on Health Status

The aim of this study was to verify the effects of Italian Mediterranean Diet (IMD), consisting of organic versus conventional foods, on body composition, and biochemical parameters in a healthy individuals and in Chronic Kidney Disease (CKD) patients, in order to decrease cardiovascular diseases (CVD) risk factor and the progression of renal diseases. After providing a written fully informed consent to the study, 150 Caucasian Italian men were recruited: 100 healthy male individuals (mean age 44,66+/-13,98 years; range 30-65 years) and 50 male CKD patients (mean age 46,25+/-5,97 years; range 42-54 years). These patients were affected by stage 2 and 3 of Chronic Renal Failure according to the K-DOQI 2003. Usual dietary intake and physical activity, during the previous 12 months were estimated by a semiquantitative food-frequency questionnaire. The following were measured at baseline and after consumption of conventional/organic 14 days IMD: Body mass index (BMI), Body composition, by Dual-X absorptiometry (DXA) scanner, total plasma homocysteine (tHcy), serum phosphorus, glycemia concentrations, lipid profile, and microalbuminuria. A significant reduction of total homocysteine (tHcy) and phosphorus blood values were observed in the studied subjects. Body composition analysis by DXA highlighted high significant differences between conventional (T(0)) and organic diet (T(1)) for fat mass parameter, expressed as kilograms and as percentage (p<0.001). Improvement of lean body mass was observed in CDK patients (p=0.004). Our study clearly demonstrates that the Italian Mediterranean Organic Diet (IMOD), according to the "Nicotera diet", was able to reduce tHcy, phosphorus, microalbuminuria levels and CVD risk in healthy individuals and in CDK patients.

Anthropometric and Metabolic Determinants of 6,000-m Rowing Ergometer Performance in Internationally Competitive Rowers

The aim of this study was to examine the anthropometric and metabolic determinants of performance during 6,000-m of rowing on an ergometer. The sample comprised 25 internationally successful male heavyweight rowers (mean +/- SD: age 22.2 +/- 4.8 years, rowing experience 8.8 +/- 4.6 years, stature 1.91 +/- 0.05 m, body mass 91.7 +/- 5.9 kg, maximal oxygen uptake 5.53 +/- 0.30 L x min(-1)). The rowers completed an incremental maximal exercise test on a rowing ergometer and, within 2 weeks of this test, also completed a 6,000-m rowing ergometer time trial (mean +/- SD: 1195.4 +/- 36.1 seconds). The strongest correlates (r > 0.5, p < 0.05) with performance were lean body mass (r = -0.767), power output at ventilatory threshold (r = -0.743), power output at maximal oxygen uptake (r = -0.732), body mass (r = -0.693), chest girth (r = -0.598), relaxed arm girth (r = -0.574), forced vital capacity (r = -0.519), and arm span (r = -0.505). Stepwise multiple linear regression procedures indicated that the model comprising a combination of anthropometric and metabolic variables is the best predictor of performance (adjusted R2 = 0.722), followed by models comprising anthropometric (adjusted R2 = 0.575) and metabolic (adjusted R2 = 0.530) variables alone. The results suggest that 6,000-m ergometer performance is determined mainly by power output at ventilatory threshold (58.7% of explained variance). Based on the obtained correlations and regression models, it can be concluded that rowers competing over a 6,000 m distance on a rowing ergometer should devote their training time to the improvement of lean body mass and to the improvement of power output corresponding to ventilatory threshold.

Anti‐obesity and anti‐atherogenesis effect of Chungkookjang supplementation in overweight/obese Korean subjects: A randomized, double‐blind, placebo‐controlled clinical trial

To investigated the effects of Chungkookjang (CKJ) supplementation on anti‐obesity and anti‐atherogenesis in overweight/obese subjects. This study was a 12‐week, randomized, double‐blind, placebo‐controlled clinical trial followed by a 3 week screening period. Overweight/obese subjects [both BMI = 23 kg/m2 and WHR = 0.90(men), WHR = 0.85(women)] who were not diagnosed with diseases were included in this study and sixty subjects (38.68 ± 1.47 years, 72.2 ± 1.47 kg) and were randomly divided to a placebo (n=30) or a supplement group (n=30, CKJ 26g/day). We measured anthropometric parameters, abdominal fat distribution by computerized tomography and blood components before and after the 12 week intervention period. Fifty‐five subjects (29 CKJ group, 26 Placebo group) finished the study. After the 12 weeks of supplementation, subjects in the CKJ supplemented group showed a significant improvement in lean body mass (p&lt;0.035) and Apo B(p&lt;0.027) compared with placebo group. Visceral fat areas (p&lt;0.013) by CT scans and fructosamine (p&lt;0.02) concentrations were significantly reduced in the CKJ group after the 12 weeks, but there was no significant differences between placebo and CKJ group. The results suggested CKJ supplementation that potential anti‐obesity and anti‐atherogenesis benefits might be more pronounced when combined with lifestyle modification.

New perspective on the nutritional approach to cancer-related anorexia/cachexia: preliminary results of a randomised phase III clinical trial with five different arms of treatment

Cancer-related anorexia/cachexia syndrome (CACS) is a multifactorial syndrome characterised by tissue wasting, particularly lean body mass (LBM), metabolic alterations, fatigue, anorexia and reduced food intake. In April 2005 we started a phase III randomised study to establish the most effective and safest treatment for CACS addressing as primary endpoints: LBM, resting energy expenditure (REE), total daily physical activity, interleukin (IL)-6 and tumour necrosis factor (TNF)-α levels, and fatigue. According to the statistical design the sample size was 475 patients (95 per arm). Eligibility criteria: histologically confirmed tumours of any site; weight loss −5% in the last 3 months and/or abnormal laboratory values; life expectancy >4 months. Patients were treated with either antineoplastic therapy or supportive care. All patients received as basic oral treatment polyphenols plus alpha lipoic acid plus carbocysteine plus vitamins A, C and E. Patients were then randomised to one of the following 5 arms: (1) medroxyprogesterone acetate (MPA)/megestrol acetate (MA); (2) pharmaconutritional support containing eicosapentaenoic acid (EPA); (3) l-carnitine; (4) thalidomide; and (5) a combination of all the above agents. Treatment duration was 4 months. Interim analyses were planned after every 100 randomised patients. In September 2008, 280 patients were randomised and 240 were evaluable: M/F 167/113, mean age 62 years (range 30-84), 96% stage IV. A first interim analysis on 125 patients showed a worsening of LBM, REE and fatigue in arm 2 in comparison to the others and therefore it was withdrawn from the study. A second interim analysis after the enrolment of 204 patients showed that arm 1 was clearly significantly less effective than the others for primary efficacy endpoints, therefore it was withdrawn from the study. Statistical analysis in September 2008 showed a significant improvement of LBM (by dual X-ray energy absorptiometry), REE and fatigue in arm 5, a decrease of IL-6 in arms 3 and 5, and a decrease of TNF-α in arms 3 and 4. As for toxicity, 1 patient discontinued MPA because of deep vein thrombosis and 1 patient discontinued L-carnitine because of severe diarrhoea. In conclusion, the interim results seem to suggest that the most effective treatment for cancer patients with CACS/oxidative stress (OS) should be the combination regimen. The study is in progress.

A Randomized Controlled Trial of Kung Fu Training for Metabolic Health in Overweight/Obese Adolescents: The "Martial Fitness" Study

Twenty overweight/obese adolescents underwent six months of Kung Fu or placebo (Tai Chi) training, 3x.wk(-1). Outcomes included fasting insulin and insulin resistance, lipids, glucose and HbA(1c), and C-reactive protein (CRP). CRP decreased significantly (p = 0.03) in both groups over time at six months. Although insulin sensitivity did not change, HbA(1c) tended to decrease over time (p = 0.09), again with no group difference (p = 0.60). Reduced CRP was related to increased upper body strength (p = 0.01). Increased lean body mass was related to reductions in HbA(1c), insulin resistance, triglycerides, and total cholesterol. Improvements in lean body mass appear to have a potential role in favorable metabolic outcomes, independent of changes in fat mass. Further research in this area is warranted before definite conclusions can be drawn about the efficacy of martial arts training for metabolic outcomes in this cohort.

Ghrelin Treatment of Chronic Kidney Disease: Improvements in Lean Body Mass and Cytokine Profile

Chronic kidney disease (CKD) is associated with an increase in inflammatory cytokines and can result in cachexia with loss of muscle and fat stores. We previously demonstrated the efficacy of treating a model of cancer cachexia with ghrelin and a ghrelin receptor agonist. Currently, we examine a surgical model of CKD in rats, resulting in uremia and decreased accrual of lean body mass. Treatment with ghrelin and two ghrelin receptor agonists (BIM-28125 and BIM-28131) resulted in increased food intake and an improvement in lean body mass accrual that was related in part to a decrease in muscle protein degradation as assessed by muscle levels of the 14-kDa actin fragment resulting from cleaved actomyosin. Additionally, there was a decrease in circulating inflammatory cytokines in nephrectomized animals treated with ghrelin relative to saline treatment. Ghrelin-treated animals also had a decrease in the expression of IL-1 receptor in the brainstem and a decrease in expression of prohormone convertase-2, an enzyme involved in the processing of proopiomelanocortin to the anorexigenic peptide alpha-MSH. We conclude that ghrelin treatment in uremia results in improved lean mass accrual in part due to suppressed muscle proteolysis and possibly related to antiinflammatory effects.

Effects of Cessation of a Structured and Supervised Exercise Conditioning Program on Lean Mass and Muscle Strength in Severely Burned Children

Suman OE, Herndon DN. Effects of cessation of a structured and supervised exercise conditioning program on lean mass and muscle strength in severely burned children. Objective To determine whether the benefits of exercise by burned children are maintained 3 months after the exercise program is concluded. Design Randomized, controlled prospective study. Setting Pediatric burn hospital. Participants Twenty severely burned children with a 40% or greater total body surface area burn, with main outcome measures completed before exercise training, immediately after 12 weeks of exercise training (intervention), and 12 weeks after training ended. Intervention Randomization into a 12-week standard rehabilitation program at home (n=9) or a 12-week standard hospital rehabilitation program supplemented with an exercise-training program beginning 6 months after burn injury (n=11). Main Outcome Measures Assessment of lean body mass (LBM) using dual-energy x-ray absorptiometry and of leg isokinetic muscle strength at a speed of 150°/s were done before, after the 12-week rehabilitation and exercise training program, and 3 months after the exercise program was completed (12mo postburn). The effects of exercise on the dependent variables were analyzed by repeated-measures analysis of variance. If we found a significant overall effect of time and/or intervention, we did a post hoc test for multiple comparison (Holm-Sidak). Results are expressed as mean ± standard error. Results The mean percentage increase in LBM and muscle strength was significantly greater in the exercise group (6.4%±1.9%, 40.7%±8.6%, respectively) than in the no-exercise group (1.9%±2.6% vs 3.4%±4.5%, respectively). Three months after cessation of the exercise program, LBM remained relatively unchanged in the no-exercise group (3.5%±1.8%). In contrast, LBM in the exercise group increased significantly (10.7%±4.8%, P=.03). In addition, muscle strength further increased by 17.9%±10.1% in the exercise group versus 7.2%±3.4% in the no-exercise group, although neither percentage increase was significant ( P=.08 for exercise vs P=.61 for no exercise). Absolute values in LBM and muscle strength for both groups at 12 months postburn continued to be below historical or concurrent age-matched, nonburned children. Conclusions Participation in an exercise program resulted in a greater improvement in LBM and muscle strength in the exercise group than in the no-exercise group. Three months after the exercise training ended, there were persistent mild-to-moderate increases in LBM and muscle strength. Absolute levels continued to be below previously reported nonburned, age-matched values, however, which underscores the need for continued exercise to improve LBM and muscle strength in severely burned children.

A phase II randomized, placebo-controlled, double-blind study of the efficacy and safety of RC-1291 (RC) for the treatment of cancer cachexia

9133 Background: Cancer cachexia is closely correlated with poor outcome and poor survival. RC is an oral ghrelin mimetic with orexigenic and anabolic activity. Methods: A phase II trial enrolled 81 patients with cancer, performance scores of 0–2, and weight loss of 5% or more within 6 months prior to enrollment at 17 sites in the US. Patients were randomized to treatment with two placebo (PL) or two 25 mg RC capsules taken once daily for 12 weeks. Outcome measures included lean body mass (LBM), total body mass (TBM) by DEXA (central reading), scale weight, handgrip strength (HS) and QOL measures. Biochemical markers included IGF-1 and IGFBP-3. In the per protocol analysis (32 RC, 28 PL) more than 20 cancer types were represented; the most common were lung (n=13) and colorectal cancer (n=15). The two treatment groups were balanced at baseline except for (RC vs PL, respectively): gender (66 % male vs 57 %), TBM (60.9 kg vs 65.3 kg), and HS (53.8 kg vs 56.6 kg). The analyses (repeated measures ANOVA without imputation) included all available data from the patients. Results: TBM and LBM (primary endpoint at 8 wks) were significantly increased vs. PL at wks 4 and 8 and at wks 4, respectively. The magnitude of the increase vs. baseline was stable from wk 4 through wk 12 during RC treatment for both TBM and LBM. HS was increased at significantly at wk 8. IGF-1 and IGFBP-3 significantly increased at wks 4, 8, and 12. No significant differences were found on the QOL or scale weight measures. RC was well tolerated. Patients having any AEs were 96% vs 87% and SAEs were 32% and 26% for RC and PL, respectively. The percent of patients and types of AEs were similar; possible exceptions included cardiac events and infections (11% vs 3% and 30% vs 42%, RC vs PL, respectively). Conclusions: In this randomized, double-blind, placebo-controlled trial, RC treatment led to improvements in LBM, TBM and HS. RC-1291 is a promising potential therapeutic agent for the treatment of cancer cachexia. No significant financial relationships to disclose.

FES Cycling Improves CNS Status and Decreases Metabolic Risk Factors in SCI Individuals

Individuals with spinal cord injury (SCI) are more likely to develop metabolic abnormalities that are linked in part to the onset of obesity due to physical inactivity and to the loss of muscle mass due to the paralysis incurred by the injury to the spinal cord. Functional electrical stimulation (FES) cycling promotes muscular contraction of paralyzed muscles and stimulates sensory pathways traveling in the central nervous system (CNS). Training with this mode of exercise is thought to strengthen CNS pathways that already exist and improve lean body mass. Improvements in lean body mass from FES exercise is likely to combat the metabolic risk factors associated with inactivity from paralyzed muscles. PURPOSE: The purpose of this study was to investigate the effect of functional electrical stimulation (FES) cycling on the CNS status and metabolic risk factors for persons with SCI. METHODS: Nine SCI individuals with clinical presentation of either paraplegia or tetraplegia performed 30 minutes of FES cycling 3 times a week for 10 weeks. Body composition, CNS status and metabolic function were assessed within 48 hours pre and post training. Body composition and bone mass were analyzed by dual X-ray absorptiomtery. The sensory and motor components of the CNS were assessed with the American Spinal Injury Association (ASIA) neurological classification of SCI. An oral glucose tolerance and insulin resistance test was performed under fasting conditions (12 hrs) to assess metabolic function. RESULTS: The participants cycled 4.6 +/− 0.5 miles/day for 29.9 +/− 1.1 days. Mean cycling power and work were approximately 5, 7 and 8 times greater during training weeks 8, 9 and 10 compared to week 1, respectively (all p<0.05). Total lean body mass increased on average by 4.0 +/− 4.7% (3.1 +/− 3.7lbs) (p<0.05). The lower extremity motor score and light touch sensory score of the ASIA test battery improved by 35.3 +/−2.8% and 7.3 +/− 3.1% (both p<0.05). Glucose tolerance improved on average 19.3 +/−13.6% (p<0.05) and resulted in a 31.4 +/− 14.4% decrease of insulin secretion (p<0.05). CONCLUSION: The 10 week FES training protocol enhanced lean body mass and CNS status; and decreased metabolic risk factors in SCI persons.

Growth hormone therapy in pediatric hypercatabolic state: a systematic review and meta-analysis

To assess the use of recombinant human growth hormone (rhGH) in pediatric patients with hypercatabolic state in the pediatric intensive care unit. We searched the databases of MedLine (1990 to 2005), LILACS (1990 to 2005), OVID (1990 to 2006) and EMBASE (1990 to 2005). Randomized controlled trials in pediatric patients using rhGH for hypercatabolic state (burns, sepsis) were selected. Intervention included rhGH therapy versus placebo. Data were extracted in duplicate and independently. Meta-analyses were performed using the software Review Manager statistic tools, with Mantel-Haenzel method for dichotomous outcomes and inverse variance method for continuous. There were evidences that rhGH in burned pediatric patients can reduce exogenous albumin requirement, with a improvement in Lean Body Mass, and accelerate site-donor wound healing, with no effects on mortality. Possibly can reduce the length of hospital stay. Hyperglycemia was the most frequently reported adverse event. This review suggests that the early application of rhGH to standard treatment in pediatric severe burned patients has the potential to improve some aspects from outcome. At this time, although the literature does not support routine rhGH for pediatric burn patients, consideration should be given to its use in this group, at least as an aim for further research. For use in septic patients, no proper statement can be done.

Effect of amino acid supplementation on insulin sensitivity in elderly

Recent reports show that increased protein intake in the context of weight loss improves glucose control. The aim of this study was to examine if supplementation of a weight-maintaining diet with essential amino acids (EAA) is effective in improving insulin sensitivity in elderly. Eight insulin-resistant elderly (66 ± 2 (SE) years, 4 females, 4 males) ingested 11 g of EAA two times a day, between meals for 16 weeks. Diet and activity were not otherwise modified. Insulin sensitivity was determined by an oral glucose tolerance test, and body composition was measured by DEXA, at baseline, and every four weeks. One-way repeated measures ANOVA was used. EAA supplementation significantly improved the Matsuda index (p = 0.019). From a baseline value of 3.8 ± 0.4, the Matsuda index increased to 4.0 ± 0.9, 5.6 ± 1.0, 6.1 ± 1.4, and 5.3 ± 0.9 at week 4, 8, 12, and 16, respectively. The effect of EAA supplementation on insulin sensitivity varied between subjects, with the changes in the Matsuda index ranging from −1.76 to 6.73. A positive correlation between the baseline value and the change in Matsuda index was found at 12 weeks (r = 0.762, p = 0.021), whereas a trend was observed after 8 weeks (r = 0.643, p = 0.071). There was also an improvement in lean body mass (p = 0.066) and leg lean mass (p = 0.049) during the study, but no correlation between changes in lean mass and Matsuda index was seen. In conclusion, supplementation of the diet with EAA improves glucose control in insulin-resistant elderly to a variable extent. (Studies performed at GCRC, UTMB, funded by M01 RR 00073 and P30 AG024832)

Mo-P1:55 Epidemiology of risk factors as lipids, hypertension, CHD, diabetes melitus, and smoke on Island Lemnos Greece population

There have been tremendous advances in diabetes technology in the last decade. Continuous glucose monitors (CGM), insulin pumps, and automated insulin delivery (AID) systems aim to improve glycemic control while simultaneously decreasing the burden of diabetes management. Although diabetes technologies have been shown to decrease both hypoglycemia and hyperglycemia and to improve health-related quality of life in individuals with type 1 diabetes, the impact of these devices in individuals with cystic fibrosis-related diabetes (CFRD) is less clear. There are unique aspects of CFRD, including the different underlying pathophysiology and unique lived health care experience and comorbidities, that likely affect the use, efficacy, and uptake of diabetes technology in this population. Small studies suggest that CGM is accurate and may be helpful in guiding insulin therapy for individuals with CFRD. Insulin pump use has been linked to improvements in lean body mass and hemoglobin A1c among adults with CFRD. A recent pilot study highlighted the promise of AID systems in this population. This article provides an overview of practical aspects of diabetes technology use and device limitations that clinicians must be aware of in caring for individuals with CF and CFRD. Cost and limited insurance coverage remain significant barriers to wider implementation of diabetes technology use among patients with CFRD. Future studies exploring strategies to improve patient and CF provider education about these devices and studies showing the effectiveness of these technologies on health and patient-reported outcomes may lead to improved insurance coverage and increased rates of uptake and sustained use of these technologies in the CFRD community.

Whole body leucine flux in HIV-infected patients treated with or without protease inhibitors

The present study was carried out to assess the effects of protease inhibitor (PI) therapy on basal whole body protein metabolism and its response to acute amino acid-glucose infusion in 14 human immunodeficiency virus (HIV)-infected patients. Patients treated with PIs (PI+, 7 patients) or without PIs (PI-, 7 patients) were studied after an overnight fast during a 180-min basal period followed by a 140-min period of amino acid-glucose infusion. Protein metabolism was investigated by a primed constant infusion of l-[1-(13)C]leucine. Dual-energy X-ray absorptiometry for determination of fat-free mass (FFM) and body fat mass measured body composition. In the postabsorptive state, whole body leucine balance was 2.5 times (P < 0.05) less negative in the PI+ than in the PI- group. In HIV-infected patients treated with PIs, the oxidative leucine disposal during an acute amino acid-glucose infusion was lower (0.58 +/- 0.09 vs. 0.81 +/- 0.07 micromol x kg FFM(-1) x min(-1) using plasma [(13)C]leucine enrichment, P = 0.06; or 0.70 +/- 0.10 vs. 0.99 +/- 0.08 micromol x kg FFM(-1) x min(-1) using plasma [(13)C]ketoisocaproic acid enrichment, P = 0.04 in PI+ and PI- groups, respectively) than in patients treated without PIs. Consequently, whole body nonoxidative leucine disposal (an index of protein synthesis) and leucine balance (0.50 +/- 0.10 vs. 0.18 +/- 0.06 micromol x kg FFM x (-1) x min(-1) in PI+ and PI- groups respectively, P < 0.05) were significantly improved during amino acid-glucose infusion in patients treated with PIs. However, whereas the response of whole body protein anabolism to an amino acid-glucose infusion was increased in HIV-infected patients treated with PIs, any improvement in lean body mass was detected.

Anabolic steroids for the treatment of weight loss in HIV-infected individuals

Individuals with HIV infection often lose weight during the course of their disease. Furthermore, low serum concentrations of testosterone are common in individuals with HIV infection, particularly those with weight loss. Treatment of weight loss with anabolic steroids in HIV-infected individuals may be beneficial. Our objectives were to assess the efficacy and safety of anabolic steroids for the treatment of weight loss in adults with HIV infection. We searched the following databases: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, AIDSLINE, AIDSearch, EMBASE, CINAHL, Current Contents, and the National Library of Medicine Gateway Abstracts for controlled trials up to April 2005. We also searched the bibliographies of the identified studies and review the articles. In addition, pharmaceutical manufacturers of anabolic steroids were contacted. Randomized controlled trials that compared the use of an anabolic steroid to placebo to treat weight loss in adults with HIV were included. Randomized controlled trials that compared the use of anabolic steroids to placebo for the treatment of weight loss in adults with HIV were selected. Change from baseline in lean body mass or in body weight was reported as on outcome measure. Two reviewers independently assessed the trials for quality of randomization, blinding, withdrawals, and adequacy of allocation concealment. For continuous data, weighted mean differences (WMD) were calculated. For dichotomous outcomes, risk differences, were calculated. Because of uncertainty as to whether consistent true effects exist in such different populations and treatments, the authors decided a priori to use random effects models for all outcomes. Thirteen trials met the inclusion criteria. Two hundred ninety-four individuals randomized to anabolic steroid therapy and 238 individuals randomized to placebo were included in the analysis of efficacy for change from baseline in lean body mass. Three hundred forty-three individuals randomized to anabolic steroid and 286 randomized to placebo were included in the analysis of efficacy for change from baseline in body weight. The mean methodologic quality of the included studies was 4.1, of a maximum 5 points. Although significant heterogeneity was present for both outcomes, the average change in lean body mass was 1.3 kg (95% CI: 0.6, 2.0), while the average change in total body weight was 1.1 kg (95% CI: 0.3, 2.0). A total of eight deaths occurred during the treatment period; four in the anabolic steroid treatment groups and four in the placebo-treatment groups (risk difference 0.00, 95% CI -0.03, 0.03). The risk difference for withdrawals or discontinuations of study medication due to adverse events was 0.00 (95% CI: -0.02, 0.03). Although the results of the trials were heterogeneous, on average, the administration of anabolic steroids appeared to result in a small increase in both lean body mass and body weight as compared with placebo. While these results suggest that anabolic steroids may be useful in the treatment of weight loss in HIV infected individuals, due to limitations, treatment recommendations cannot be made. Further information is required regarding the long-term benefit and adverse effects of anabolic steroid use, the specific populations for which anabolic steroid therapy may be most beneficial, and the optimal regime. In addition, the correlation of improvement in lean body mass with more clinically relevant endpoints, such as physical functioning and survival, needs to be determined.

Testosterone, sexuality, and erectile function in aging men.

Human aging is associated with many changes, which resemble those seen with deficiencies of sex steroids or growth hormone and with cortisol excess. Among these are decreases in lean body mass (LBM) and muscle strength, loss of bone mineral, increase in body fat, and, in men, reduced libido and erectile function. Circulating total and free testosterone (T) decrease progressively with age in men, and these decreases correlate with observed changes in body composition and function. T is implicated in maintaining both male libido and erectile function, the latter effect possibly mediated by local increases in nerve nitric oxide (NO) synthase in the corpora cavernosa. Preliminary studies of T replacement in older men suggest improvements in LBM, fat, bone, libido, and erections, but more research needs to be done to better delineate benefits and potential risks before definitive recommendations can be made regarding T replacement in older men.

The effect of prolonged euglycemic hyperinsulinemia on lean body mass after severe burn

Background. The hypermetabolic response to burn increases protein catabolism. Euglycemic hyperinsu-linemia with exogenous insulin maintains muscle protein by continued stimulation of net protein synthesis. Our aim was to determine the effect of euglycemic hyperinsulinemia over the entire hospitalization on muscle anabolism by investigating lean body mass (LBM) as the primary endpoint. Methods. Eighteen subjects between the ages of 2 and 18 with burns of more than 40% were prospectively randomized into 2 groups, a control (n = 9) and a treatment group (n = 9). The treatment group was given continuous intravenous insulin at a rate of at least 1.5 μU/kg/min to maintain serum glucose levels between 100 to 140 mg/dL. Treatment was instituted 24 to 48 hours after arrival and continued until the patient's injury was 95% healed. All patients received continuous enteral feeding. Patients underwent body composition studies by dual-energy x-ray absorptiometry (DEXA) scan on postoperative day 6 after initial burn excision and when 95% healed. Results. Nutritional intakes were not different between groups. In the control, subjects continued catabolism resulted in peripheral muscle wasting and centripetal obesity with diminished truncal LBM. The treatment group had improvement in lean body mass (P =.004) and bone mass (P =.025). The treatment group also had less peripheral muscle wasting with overall increases in upper/lower extremity LBM (P =.005). Hospital length of stay in days per percent of total body surface area burned was decreased in the insulin group (control = 1.03 ± 0.1 vs 0.7 ± 0.9 for insulin patients; P <.05). Conclusions. Euglycemic hyperinsulinemia throughout the hospital course mitigates muscle catabolism and preserves lean body mass. (Surgery 2002;132:341-7.)

THE EFFECTS OF STRENGTH TRAINING VOLUME ON RESTING METABOLIC RATE AND BODY COMPOSITION IN POSTMENOPAUSAL WOMEN

The purpose of the present study was to investigate the effects of different strength training (ST) volumes on muscular strength, resting metabolic rate (RMR), and lean body mass (LBM) in postmenopausal women (n = 35, 59 ± y yr). One-repetition maximum (1 RM) strength, RMR, and body composition were assessed before and after twelve weeks of whole body ST. Seventeen women performed one set (OS) and eighteen women performed three sets (TS) of 8–12 repetitions two days per week using 75% of the predetermined 1 RM. Muscular strength increased by 23% in the OS group and 26% in the TS group (both p < 0.01) with no significant difference between the groups. RMR increased by 4% in the OS group and 7% in the TS group (both p < 0.01) with no significant difference between the groups. Increases in LBM were observed in the OS and TS groups (both p < 0.01); however, the TS group displayed greater increases in LBM as compared to the OS group (6 kg and 7kg increases for the OS and TS groups, respectively; p < 0.05). While the changes in LBM led to reductions in percent body fat for both groups (16% and 25%, respectively; both p < 0.01), greater reductions were found in the TS group as compared to the OS group (p < 0.05). The results of this study indicate that OS of whole body ST is as effective as TS for producing increases in 1 RM strength and RMR. However, TS may elicit greater improvements in LBM and percent body fat in postmenopausal women.

Growth Hormone: A Physiological Fountain of Youth?

During childhood and early adult life, growth hormone (GH), secreted by the anterior pituitary, is involved in the growth of bones and muscles and other organs as well. Aging is characterized by a decrease in muscle mass and bone strength and an increase in adipose, similar to the effects of pathological hyposecretion of GH in the young. Aging is also accompanied by a gradual decrease in the output of GH, like the drying of an internal fountain, until in the eighth decade of life, it is secreted at less than one-fifth of the youthful level. The GH hypothesis of aging posits that with the availability of human recombinant growth hormone and human recombinant insulin-like growth factor-I, which mediates most of the effects of GH, the GH hypothesis has become testable. Initial experiments involving short term administration of GH in a group of elderly men did indeed show modest improvement in lean body mass and adipose tissue. These studies are sometimes—and incorrectly—taken as proof of the correctness of...

Effects of 3-Month Amino Acid Dialysis Compared to Dextrose Dialysis in Children on Continuous Ambulatory Peritoneal Dialysis

To compare the nutritional and biochemical effects of amino acid dialysis to dextrose dialysis in children receiving continuous ambulatory peritoneal dialysis (CAPD). Prospective randomized crossover study. Pediatric Nephrology Unit in a tertiary care, teaching hospital of the University of Toronto. Seven children aged 0.7-16.5 years receiving CAPD. All patients had poor linear growth, with 5 patients showing evidence of energy deficit. Each patient received either amino acid or dextrose dialysate for 3 months, then crossed over to the alternate regimen for a subsequent 3 months. Nutritional and biochemical data were obtained on each patient during each dialysis regimen. Analysis of the patients' nutritional data showed comparable weight gain with both regimens but no significant improvement in lean body mass with either regimen. Appetite improved in most patients during amino acid dialysis. Biochemical data during amino acid dialysis showed a tendency to higher plasma potassium and urea levels with no clinical side effects or worsening of acidosis; however, there was a reduced anion gap and increased total plasma protein, due mostly to a rise in plasma albumin and a smaller increase in immunoglobulins. With the exception of tryptophan, fasting amino acid levels at the start and end of amino acid dialysis did not show any significant change. An interesting phenomenon of early blunting of the rise in amino acid levels, following a single amino acid dialysate exchange, was noticed at the end of the amino acid dialysis period. This newly described phenomenon could have been due to tolerance or hepatic enzyme induction. Overall amino acid dialysis was comparable to dextrose dialysis with no additional proven nutritional benefit, was equally effective in ultrafiltration and creatinine clearance, and produced no adverse clinical or biochemical effects.

Nutritional therapy for alcoholic hepatitis: are we there yet?

Nutritional therapy for alcoholic hepatitis: are we there yet?