Liquid Protein Diet Research Articles

Bariatric endoscopic antral myotomy: first-in-human proof of concept of a novel therapeutic method to delay gastric emptying and induce weight loss

Bariatric endoscopic antral myotomy: first-in-human proof of concept of a novel therapeutic method to delay gastric emptying and induce weight loss

Bariatric Nutrition: Right Amount at Right Time

Sometimes Diet and exercise is not much effective for people with extreme and excessive obesity. Bariatric surgery helps such individuals to reduce their weight. Bariatric procedures cause weight loss by restricting the amount of food the stomach can hold, causing malabsorption of nutrients, or by a combination of both gastric restriction and malabsorption. After bariatric surgery eating patterns of patient changes. Initially after surgery the main goal is to meet fluid and protein needs from a liquid protein diet. As the diet progresses to variety of foods which are low in sugar and fat, it will meet the nutrition needs better for long term health. It is vital to follow diet progression to maximize healing and minimize risk for complications. This review recapitulates the present protocol for nutrition care in bariatric patients to escalate safe practice in preoperative and long-term postoperative periods.

Torsade de pointes as a reperfusion arrhythmia following intravenous thrombolytic therapy

Many types of cardiac arrhythmias have been noted following acute myocardial infarction. Polymorphic ventricular arrhythmias (polymorphic ventricular tachycardia and ventricular fibrillation) related to an acute myocardial infarction generally strike during the hyperacute phase, are clearly related to ischaemia and are not associated with a long QT interval time.Pause-dependent Torsade de pointes has been reported following acute myocardial infarction and this arrhythmia generally occurs 3–11 days after the onset of acute myocardial infarction and none has been reported during the hyperacute phase. Torsade de pointes – a specific ventricular tachycardia with specific characteristics has been described in hypokalemia, hypomagnesaemia, during Quinidine therapy, and while using phenothiazines and tricyclic antidepressants. It is reported following liquid protein diet, brady-arrhythmias [especially III° AV Block], sick-sinus syndromes.Torsade de pointes either pause-dependent or pause-independent occurring directly as a reperfusion arrhythmia during intravenous thrombolytic therapy has not been reported in the literature to the best of the authors knowledge.Here, an episode of Torsade de pointes as a direct consequence of reperfusion following thrombolytic therapy in a patient of acute myocardial infarction is described.

Feasibility of a Supervised Inpatient Low-Calorie Diet Program for Massive Weight Loss Prior to RYGB in Superobese Patients

This study was undertaken to determine the feasibility of an inpatient low-calorie program for a substantial decrease of preoperative weight (>10 points in BMI) in superobese patients. Five patients were hospitalized for an average of 11 weeks and were placed on a low-calorie liquid diet (<900 kcal/day) and an exercise program. Following a drop of ten points in BMI, they underwent a Roux-en-Y gastric bypass (RYGB). Hemoglobin A1c and lipid profiles were obtained at the beginning of the diet, prior to surgery and at the last follow-up appointment. Our results were compared to the National Surgical Quality Improvement Program (NSQIP) database, which included 1,046 bariatric operations performed at VA centers between October 1999 and August 2007. All five patients were massively obese men (body mass index (BMI) = 64.3 +/- 2.1 kg/m(2); 54.7 +/- 2.6 years old; four of five were white) with multiple comorbid conditions, which placed them in a substantially higher risk for bariatric surgery. Of the four diabetic patients, two were insulin dependent. There was an average decrease in BMI by 12.7 points (85.8 +/- 6.0 lb) during the preoperative diet period (11 weeks). All patients underwent RYGB without complications. This cohort of patients further decreased their BMI by 10.6 points (88.4 +/- 29.4 lb) following surgical intervention. The total combined preoperative and postoperative excess body weight loss was 89% (10.6-month average follow-up). Sleep apnea resolved following gastric bypass but did not improve during the preoperative weight loss period. Hypertension, osteoarthritis, and dyslipidemia all improved following surgical intervention. Hemoglobin A1c decreased by 1.9% during diet-induced weight loss with no further improvement being noted after surgery. The two insulin-dependent diabetic patients discontinued insulin therapy following surgery. The NSQIP database contained 77 patients with similar characteristics to our cohort of patients. The 30-day mortality for this cohort of patients was 3.9% with a complication rate of 33.8%. Massive preoperative weight loss is possible to achieve with a liquid protein diet in superobese patients greatly facilitating gastric bypass surgery in an otherwise high-risk patient population.

Feeding essential oils and 2-heptanone in sugar syrup and liquid protein diets to honey bees (Apis mellifera L.) as potential Varroa mite (Varroa destructor) controls

SummaryEssential oils were fed to honey bees to determine whether the components were absorbed into bee larvae. The oils were added in either sucrose syrup (origanum and 2-heptanone) or in a liquid protein diet (origanum oil, cinnamon oil, thymol, and 2-heptanone), because sugar and protein sources are differentially utilized in food fed to larvae of different ages. The volatiles emitted by isolated larvae from oil-supplemented colonies were sampled at three different ages (Day 4, Day 6 and Day 9) by Solid Phase Micro-Extraction (SPME) and analyzed by Gas Chromatography-Mass Spectrometry (GC-MS). The only oil volatiles recovered in larvae were the origanum oil components carvacrol and thymol; neither 2-heptanone nor the cinnamon oil components were detected in any larvae. For larvae from colonies fed oil- supplemented sugar syrup, carvacrol volatiles were emitted at higher amounts in younger larvae (Day 4) than in older larvae (Day 9). In contrast, carvacrol and thymol volatiles were detected only in older larvae (Day 6 and Day 9) in colonies reared on oil-supplemented liquid protein diet. Carvacrol was also detected in the cocoons of Day 9 larvae from colonies fed oil-supplemented liquid protein diet, but not oil-supplemented sugar syrup diet. We believe that the age-related differences in oil incorporation by bee larvae reflect the relative importance of supplemental sugars and protein as food sources for bee larvae of these ages. Supplementation in a liquid protein diet represents a more efficacious route for the incorporation of origanum oils in fifth instar bee larvae targeted for invasion by Varroa destructor mites.

Body Image, Eating Disorders, and Obesity in Youth: Assessment, Prevention, and Treatment

J. KEVIN THOMPSON AND LINDA SMOLAK (Eos.): Body Image, Eating Disorders, and Obesity in Youth: Assessment, Prevention, and 'Treatment. American Psychological Association, Washington, DC, 2001, 403 pp., $39.95, ISBN 1-55798-758-0. Body Image, Eating Disorders, and Obesity in Youth is one of the first edited books on children and adolescents that deals with body image, obesity, and eating disorders, and as such, it is a groundbreaker. The editors distill and summarize the findings of examination of risk factors, prevention programs, assessment strategies, and treatment options for 6- to 17-year-olds into a manageable review for beginning clinicians, graduate students, and seasoned researchers. The impetus for the text is that obesity, eating disorders, and body-image disturbances affect a significant number of children today. The volume consists of 14 chapters and an introduction by the editors. The chapters are divided into four sections: Foundations; Risk Factors; Assessment and Prevention; and Treatment. Section I lays the groundwork for the discussion of eating-related problems among children and adolescents. Authors Jennifer O. Fisher and Leann L. Birch lead the section by exploring in utero possibilities of developing a dietary taste. They also discuss formula versus breastfeeding. The view of the etiology of eating problems originating from children's earliest experiences with food and eating is in tune with the more psychodynamic literature. This vantage point marks the scope of the problem. Linda Smolak and Michael P. Levine address the important DSM differential diagnostic question: Are there body image disturbances among children, or body image problems? They examine genetic influences to body-image disturbances. Their studies concede that there are no conclusions, just suppositions. Jennifer Zoler Dounchis, Helen A. Hayden, and Denise E. Wilfrey give an excellent appendix of the summary of body-image and eating-disorder studies within ethnically diverse child and adolescent populations. section II, a strong section, reviews the research of risk factors thought to connect to eating disorders. Catherine M. Shisslak and Marjorie Crago give us a thoughtful and provoking chapter that tries to separate eating disorders from a generalized psychiatric diagnosis. Ari B. Steinberg and Vicky Phares examine parental influences on body-image and weight concerns. They cite a number of studies that conclude that family therapy is an effective treatment strategy since the relationship between parents' attitudes and beliefs concerning weight, eating, and body shape and the development of body-image concerns and eating disturbances has been well established. Mary E. Connors tries to throw light on the connection of the relationship of sexual abuse among children (CSA) to body-image and eating disorders. There is a decent review of the literature. She also raises an interesting question: Does CSA increase psychic distress, which gives rise to tension-reducing activities so that survivors of CSA may use self-mutilation, as well as binge eating, as temporary relief? section III is the best section. Kelley Hill and Claire Pomeroy present a new and different view of body-image disturbances from the other chapters. They clearly state that many adolescents are preoccupied with and critical of their appearance, however, only a small percentage of adolescents go on to develop a true eating disorder. The typical adolescent struggles with control and body image are magnified. They address obesity and offer a warning about total liquid protein diets, medications, and surgery for children and adolescents. …

The effect of psychiatric disorders on weight loss in obesity clinic patients.

Research on psychiatric disorders in obesity has indicated that obese people are not psychiatrically different from nonobese people. Few studies, however, have addressed the potential impact of psychopathology on weight control. In the present study, a consecutive sample of 37 patients presenting to a major metropolitan weight control unit were given structured diagnostic interviews (Structured Clinical Interviews for Diagnosis I and II). These patients completed one of two 12-week diet programs involving either behavior modification or liquid protein diets. After 12 weeks of a liquid protein formula diet, patients with no personality disorder lost significantly more weight than personality disordered patients; personality disordered patients on a behavioral diet tended (p < .15) to lose more weight during a 12-week diet than the patients without personality disorders. These data suggest that there are differential responses to liquid protein and behavioral diets, depending on the presence or absence of a personality disorder.

Variability of the QT measurement in healthy men, with implications for selection of an abnormal QT value to predict drug toxicity and proarrhythmia

Torsades de pointes is the form of polymorphic ventricular tachycardia associated with prolongation of the QT interval that can occur as a proarrhythmic adverse response to a variety of drug treatments. 1,2 However, the degree of QT prolongation at rest 3,4 or during exercise 5 is not necessarily a good predictor of the occurrence of torsades de pointes. Prolongation of the QT interval duration is seen during therapy with many different types of drugs including class IA antiarrhythmic agents as well as ketanserin, amiodarone, bepridil, sotalol, antidepressants, phenothiazines, erythromycin, antihistamines and liquid protein diets. Quinidine is the drug most frequently implicated in this syndrome with a calculated incidence of 1 to 8%. 4 However, plasma drug level, absolute QT interval prolongation and the absolute QT C have not been found to be very good predictors of the development of torsades de pointes. 3,4 Data on the spontaneous variability of the QT interval over time in normal subjects have not been established. Thus, we determined the magnitude of spontaneous QT interval variability over just 1 day using ambulatory long-term electrocardiographic (Holter) monitoring. Knowledge of normal variability of the QT interval is important in that prolongation of the QT interval during drug therapy is considered to be a risk factor for the development of a potential proarrhythmic effect. However, knowledge of the daily spontaneous variability of the QT interval makes it possible to determine the magnitude of QT interval prolongation, which is clinically important with respect to its potential as a marker for risk of proarrhythmia.

Responsible and Irresponsible Use of Very-Low-Calorie Diets in the Treatment of Obesity

AMERICA'S most celebrated weight loss was announced on November 15,1988, when Oprah Winfrey disclosed to her 18 million television viewers that she had lost 30.5 kg (67 lb) in 4 months by consuming a medically supervised very-low-calorie diet ( New York Times . November 24,1988:B17). Ms Winfrey's announcement sparked a frenzy of interest among the nation's dieters, reminiscent of that which greeted the appearance of the liquid protein diets in 1976 and 1977 1 and the Cambridge Diet in the early 1980s. 2 Sadly, consumption of these diets was inadequately supervised; at least 58 deaths were reported among users of liquid protein products 1,3 and 6 deaths in persons who consumed the Cambridge Diet. 2 Current very-low-calorie diets that provide essential nutrients and high-quality proteins are unquestionably safer than their liquid protein predecessors, as noted in a timely report prepared by the American Medical Association's Council on Scientific Affairs. 4 But the

The PVS patient and the forgoing/withdrawing of medical nutrition and hydration.

O THE LAST several decades modern medicine has progressed at a rate that has astonished even its practitioners. Developments in drugs, vaccines, and various technologies have given physicians an incredible amount of success over disease and morbidity, as well as allowing them to make dramatic interventions into the body to repair or replace a problematic system or organ. Yet there are limits we are coming to recognize slowly and only reluctantly. For even many of our best technologies are only halfway technologies, i.e. the technology or intervention compensates for a function but cannot cure the underlying pathology or correct the damaged organ. The respirator is probably the most frequently encountered example of this phenomenon. Another intervention is our capacity to provide nutrition and hydration to those in a persistent vegetative state (PVS). For long-term feeding of such individuals, a gastrostomy tube is inserted directly into the stomach and the liquid protein diet is delivered in a controlled fashion by a pump. If the individual is reasonably healthy and other reflexes are intact, the life expectancy may be several decades. The PVS will not be cured, and the liquid protein serves to maintain the status quo. The question of how to treat these patients medically is now heavily debated nationally and internationally. In this essay we will examine the issue in several ways: (1) report on a survey of the U.S. hierarchy on bioethics committees in general and on forgoing or withdrawing nutrition and hydration in particular; (2) propose a structured argument which includes a reconceptualization of quality

Low-Energy Diets and Prolonged QT Intervals-Reply

In Reply.— The letter by Frank et al is appreciated. It highlights a somewhat unsettled area regarding the complex relationship between obesity, rapid-weight-reduction diets, QT-interval prolongation, and unexpected sudden death. Several articles have been published that have documented the occurrence of sudden cardiac death in obese persons on very-low-energy liquid protein diets. 1-4 In ten of the 17 deaths reported, electrocardiograms were recorded during the period of dieting. Nine (90%) of these ten patients had unequivocal QT prolongation, with a QT c of greater than 0.45 s. In the population study referenced by Frank et al, 5 a QT c of greater than 0.45 s occurred in only 1.7% of their obese patients. The available scientific data indicate that very-low-energy diets can be deadly, especially in a subset of patients who develop QT prolongation during rapid weight loss. The hypothesis that rapid weight loss results in acquired QT prolongation with

TRH and cyclo (His-Pro) concentrations in the young rat brain are altered by a liquid protein diet

Effects of liquid protein diet (LPD), that is known to be poor in protein quality, on brain TRH and cyclo (His-Pro) concentrations were explored in young male rats. At day 23 of weaning, the animals were fed either a 20% casein diet ad libitum or a 20% LPD, or were pair-fed with a 20% casein diet. They were decapitated at day 35 or day 48. The body weight of those in the LPD group decreased significantly, and the loss was sustained in comparison with those in the pair-fed and ad libitum groups. The extrahypothalamic cyclo (His-Pro) concentrations were significantly greater in the LPD group than in the pair-fed and ad libitum groups throughout the experimental period, whereas these concentrations were similar in the pair-fed and ad libitum groups. At day 48, TRH concentrations in the hypothalamus and extrahypothalamus also increased in the LPD group in comparison with the concentrations in ad libitum group. These data indicate that quality of the protein component in the diet has a potential effect on alteration in the neuropeptides, TRH and cyclo (His-Pro), in the young rat brain.

QT interval prolongation

The QT interval is a function of ventricular repolarization time and is measured from the onset of the QRS complex to the end of the T wave. The length of this interval is inversely related to heart rate. A prolonged QT interval is most often secondary to the use of Type I antidysrhythmic medications (quinidine, procainamide). It is also associated with phenothiazines, organophosphates, hypocalcemia, liquid protein diets and the congenital long QT syndromes. QT prolongation is associated with a variety of ventricular dysrhythmias, most characteristically Torsades des pointes. Treatment consists of correction of the underlying metabolic disorder or discontinuation of the offending medication.

Need for Medical Supervision With Very-Low-Calorie Diets

To the Editor. —I was very pleased to read the article by Kreitzman et al. 1 Management of obesity and its complications using the newer very-low-calorie diets (VLCDs) should receive more attention in the literature. Experience with these formulas is distinctly different from that with the predecessor liquid protein diets that have been discussed so extensively. My interest in VLCDs, like Dr Kreitzman's (oral communication, June 1983), began with a personal experience. Using the same formula, I managed an 18-kg net weight loss that I have maintained for 1½ years. Subsequent extensive use of the formula in my practice has resulted in several observations that I must share. Though proper use of this type of formula is deemed safe, the overwhelming majority of persons using it do not do so under medical supervision. Frequent, often avoidable problems do arise. Persons seeking medical attention after long periods of unsupervised use may

Alteration in skin composition of young rats fed liquid protein diet

The effects of liquid protein diet (LPD) on the collagen metabolism of developing skin tissue was examined in young rats fed a 20% liquid protein diet starting at day 23 after birth. Other rats were pair-fed, but with a 20% casein diet, and another group of rats were fed a 20% casein diet ad libitum. The LPD rats rapidly lost their hair, and they were smaller and weighed less than the pair-fed and ad libitum rats. None of the LPD-fed rats survived beyond day 53 of the study. Collagen contents of the skin continuously increased in all age groups, while hexosamine content decreased from day 23 to 35. From day 23 to 35, noncollagenous protein content in the ad libitum group decreased about 40% and in the LPD and pair-fed groups, about 50%; from day 35 to 48, the decrease was about 35% in the ad libitum group and only about 14% in both the LPD and pair-fed groups. The ratio of Type III to I collagen in the LPD group at days 35 and 48 was greater than that of the ad libitum group. Current observations suggest that LPD alters biochemical composition of the skin on young, growing rats.

Normal Cardiac Rhythm During Hypocaloric Diets of Varying Carbohydrate Content

Cardiac arrhythmias have been implicated in the deaths of 17 morbidly obese individuals subsisting on a collagen hydrolysate preparation ("liquid protein") during a modified fasting regimen for weight loss. Serious cardiac arrhythmias have been noted in three of six subjects studied prospectively within 28 days of starting a similar regimen, which used an inadequate protein source and was nearly devoid of all essential minerals. A comparative study of three 28-day weight loss diets of varying carbohydrate, protein, and energy content (450 to 820 kcal/day) but employing protein of good quality and adequate in micronutrients did not disclose substantial diet-related arrhythmias in five subjects on each of the three diets. The incidence of arrhythmia seen with liquid protein diets is not likely to be related to the absolute energy or carbohydrate content of the modified fasting regimen itself.

The Cambridge Diet

READERS of both Time (March 14, 1983, pp 91-93) and Newsweek (Feb 28, 1983, pp 75-77) learned recently of "a new scientific breakthrough that works faster and is more effective than you ever thought possible." This "breakthrough," heralded in three-page advertisements, is the Cambridge Diet. Since "more than three million overweight Americans have already discovered the Cambridge Diet Plan," and millions are likely to as a result of these ads, the medical community would be well advised to familiarize itself with the diet and the controversy surrounding it. The Cambridge Diet is one of several very-low-calorie diets (300 to 600 kcal/day) currently available in this country. The goal of these diets is to induce the largest, most rapid weight loss possible, while preserving lean body mass by the provision of varying amounts of high-quality protein and carbohydrate. This was the same goal of the liquid protein diets of 1976 and

Cataract formation in newborn rats from feeding a liquid protein diet during gestation

Liquid protein diets have been widely used in the United States to control weight gain. Pregnant rats were fed a standard casein diet in which liquid protein was substituted for the protein portion; all other necessary nutrients were supplied. The average incidence of cataracts in the offspring from mothers fed liquid protein was 25%. Offspring born with cataracts were successfully raised. The results suggest that nutrition may play an important role in cataract formation in newborns, and that the use of liquid protein during pregnancy may be related to ocular abnormalities in the offspring.

Vigorous supplementation of a hypocaloric diet prevents cardiac arrhythmias and mineral depletion

We have previously demonstrated that a hypocaloric, nutritionally deficient, liquid protein diet is associated with potentially lifethreatening cardiac arrhythmias, which increased in frequency and complexity over the duration of the study. The present investigation was designed to evaluate the metabolic and cardiac changes associated with a hypocaloric, but otherwise nutritionally complete, diet. Six healthy, obese females from 154 to 182 percent of ideal body weight were evaluated in a metabolic ward for 48 days. The subjects ingested a weight maintenance diet during an eight-day period, which was followed by 40 days of an experimental diet containing 472 kcal of a mixture of protein (60 percent of calories), carbohydrate (25 percent), and fat (15 percent). This diet equaled or exceeded the recommended daily allowances for minerals, trace elements, vitamins, and essential fatty acids. The subjects were monitored for balances of nitrogen and minerals, as well as for the appearance of cardiac arrhythmias by 24-hour electrocardiographic recordings. Nitrogen balance was positive, and the previously demonstrated negative balances for potassium, sodium, calcium, magnesium, and phosphorus were either reversed or markedly decreased. In contrast to our previous study, no arrhythmias were observed in subjects ingesting the present experimental diet, and no significant change in cardiac rhythm was found in 13 obese, but otherwise healthy, outpatients. The data, based on a limited number of subjects, suggest that a hypocaloric diet vigorously supplemented with essential elements, micronutrients, and vitamins appears to be safer than the once popular, incomplete liquid protein preparation.

Brain TRH and cyclo (his-pro) and brain protein in the newborn rat are altered by maternal liquid protein feeding

Liquid protein diet (LPD) has been shown previously to produce maternal and fetal weight loss and fetal congenital anomalies, including cataracts and craniofacial malformations. Therefore, to examine the effects of LPD in pregnancy upon the central nervous system of pups, pregnant dams were fed either a 20% casein diet ad libitum, a 20% LPD, or pair-fed with a 20% casein diet. LPD was associated with significant maternal weight loss, and pups had significantly lower birth weights (5.14 ± 0.64) than pups from the pair-fed controls (5.70 ± 0.46, p < 0.05). Total brain protein content was reduced significantly in pups of both sexes from pregnant fed LPD. Moreover, the concentrations of two brain peptides neurotransmitters, thyrotropin-releasing hormone (TRH), and its biologically active metabolite, histidyl-proline diketopiperazine Cyclo (His-Pro), were elevated in the pups from LPD-fed mothers. In contrast, there was no significant difference in brain protein or brain peptides in pups from pair-fed mothers vs. pups from mothers fed ad libitum. These data suggest that qualitative alterations of the protein component in maternal dietary composition have deleterious effects upon the ontogeny of the rat fetal CNS, as reflected by reduced total protein and elevated concentrations of TRH and Cyclo (His-Pro).