Median Weight Change Research Articles

Weight gain after lung transplantation

Background Weight gain is frequently observed after lung transplantation, but the magnitude, predictors and implications of weight gain after lung transplant are unknown. Methods This retrospective cohort study included 826 lung transplant recipients randomly selected from 12 international transplant centers. We included adult patients with available weight data at baseline and 1 year post-transplant. We examined demographic and clinical predictors of first year weight gain using a multiple linear regression model ( n = 579) with percent weight change as the dependent variable. To study the association between first year weight gain and subsequent survival, we performed a Cox proportional hazards analysis. p < 0.05 was considered statistically significant. Results The median weight change was 10% (range −32% to 84%). On multi-variate analysis, increasing age and prolonged mechanical ventilation were inversely associated with weight gain; obstructive disease, interstitial disease and increasing ischemic time were positively associated with weight gain. Increasing baseline weight was negatively associated with weight gain in patients with obstructive and interstitial disease. The model accounted for 14% of the variance in weight gain. Patients with weight gain above the median had better subsequent survival (adjusted hazard ratio 0.61, 95% confidence interval 0.41 to 0.90). Infection was a more common cause of death in these patients, whereas malignant deaths were more frequent in patients with below-median weight gain. Conclusions Substantial weight gain occurs in the first year after lung transplantation. The predictors of weight gain may be used to target high-risk patients for early intervention. Higher weight gain is associated with better subsequent survival.

Fluid balance during and after an ironman triathlon.

To record weight changes, fluid intake and changes in serum sodium concentration in ultradistance triathletes. Descriptive research. Ironman triathlon (3.8 km swim, 180 km cycle, 42.2 km run). Air temperature at 1200 h was 21 degrees C, (relative humidity 91%). Water temperature was 20.7 degrees C. 18 triathletes. None. Subjects were weighed and had blood drawn for serum sodium concentration [Na], hemoglobin, and hematocrit, pre-race, post-race, and at 0800 h on the morning following the race ("recovery"); subjects were also weighed at transitions. Fluid intake during the race was estimated by athlete recall. Median weight change during the race = -2.5 kg (p < 0.0006). Subjects lost weight during recovery (median = -1.0 kg) (p < 0.03). Median hourly fluid intake = 716 ml/h (range 421-970). Fluid intakes were higher on the bike than on the run (median 889 versus 632 ml/h, p = 0.03). Median calculated fluid losses cycling were 808 ml/h and running were 1,021 ml/h. No significant difference existed between pre-race and post-race [Na] (median 140 versus 138 mmol/L) or between post-race and recovery [Na] (median 138 versus 137 mmol/L). Plasma volume increased during the race, median + 10.8% (p = 0.0005). There was an inverse relationship between change in [Na] pre-race to post-race and relative weight change (r = -0.68, p = 0.0029). Five subjects developed hyponatremia ([Na] 128-133 mmol/L). Athletes lose 2.5 kg of weight during an ultradistance triathlon. most likely from sources other than fluid loss. Fluid intakes during this event are more modest than that recommended for shorter duration exercise. Plasma volume increases during the ultradistance triathlon. Subjects who developed hyponatremia had evidence of fluid overload despite modest fluid intakes.

Nutrition After Cardiac Surgery for Infants With Congenital Heart Disease

Inadequate nutrition support in the post‐operative period in infants recovering from cardiac surgery can impact morbidity and growth. We sought to determine postoperative nutrition support patterns and identify factors associated with rate of weight gain in infants &lt;1 year. Data were collected from the medical records of 24 infants. The median age at surgery was 2.7 months (range, 1 day to 9 months). The median overall daily weight change during the postoperative ward stay was ‐11 g/d (range, ‐145 to +84 g/d), with a net positive gain in 8 (36%), net loss in 14 (64%) and unknown in 2 infants. The rate of weight change by hospital discharge was related to feeding practice: bottle fed infants gained a median of 20 g/d (range, ‐100 to +73 g/d); breast fed infants who were supplemented with bottle feeds gained a median of 5 g/d (range, ‐83 to +43 g/d); and exclusively breast fed infants lost a median of 49 g/d (range, ‐80 to ‐23 g/d)(p = .04). Patients who were meeting a greater percentage of their energy requirements by the time of hospital discharge had higher rates of weight gain (r = .78; p = .003). Rate of weight gain was not related to cardiac lesion or hospital length of stay. We conclude that weight gain after cardiac surgery in infants is sub‐optimal and is related to feeding practices. Greater attention to achieving energy requirements during postoperative recovery is necessary, especially in breast fed infants.

Weight change in women treated with adjuvant therapy or observed following mastectomy for node-positive breast cancer.

Six hundred forty-six women with node-positive breast cancer from two prospective, randomized, adjuvant breast cancer trials were evaluated for changes in weight during and after receiving 60 weeks of chemotherapy, chemohormonal therapy, or observation. The median weight change in the 545 patients remaining on protocol at 60 weeks for observed postmenopausal patients was +1.8 kg, for treated postmenopausal patients +3.6 kg, and for treated premenopausal patients +5.9 kg (P less than .001). After a median follow-up of 6.6 years, premenopausal women who gained more than the median weight at 60 weeks had a risk of relapse 1.5 times greater (covariate P = .17) and a risk of death 1.6 times greater (covariate P = .04) than premenopausal women who had gained less than the median weight. In the postmenopausal patients, the trend for inferior relapse-free and overall survival in those who gained more than the median weight at 60 weeks was not significant (P = .05). We conclude that, relative to observation, adjuvant chemotherapy is associated with greater weight gain in node-positive, postmenopausal breast cancer patients; the amount of weight gain appears greater for premenopausal than postmenopausal women, and in premenopausal women, excessive weight gain may be associated with an increase in relapse and cancer-related deaths in the selected patients who show no evidence of recurrence during 60 weeks of adjuvant chemotherapy. This last point must be interpreted with caution because of the exploratory nature of the analyses.

Biological and Clinical Effects of Interferon-βserat Two Doses

To assess biological response, therapeutic activity, and side effects, a randomized, double-blind trial of two doses of interferon-beta ser (IFN-beta ser), differing by 20-fold 4.5 and 90 x 10(6) units), was undertaken in 64 patients with metastatic renal carcinoma. Patients were treated intravenously with injections daily for 10 days with an 11-day rest before treatment was reinitiated. The trial confirmed the relatively good toleration of IFN-beta ser; in the first cycle only 4/63 patients had anorexia of moderate or greater severity. Median weight change over the duration on study was -1.5 kg; in the first cycle only 7% of patients had performance status decline greater than 1 level. Statistically significant changes (p less than 0.05) occurred in granulocytes, lymphocytes, calcium, cholesterol, alkaline phosphatase, and aspartate transferase (AST); however, except for AST, overall clinical differences in the two doses were not great. Of 60 patients evaluated, 1 developed neutralizing antibody. When assessed 24 h after IFN-beta ser at 4.5 x 10(6) units, significant (p less than 0.05) augmentation had occurred in beta 2-microglobulin, HLA-DR, and HLA-DQ expression on monocytes, 2',5'-oligoadenylate (2-5A) synthetase in peripheral mononuclear cells, and natural killer (NK) and K cells functional activity. Although the 90 x 10(6) unit dose also resulted in stimulation of these responses, little additional augmentation of biological response occurred at the higher dose. Except for a decline in monocyte HLA-DR expression, biological responses remained increased at both doses over the 10-day period of treatment. However, no objective regressions of metastatic disease occurred. In view of objective responses in metastatic renal carcinoma in other trials with IFN-beta ser, consideration should be given to alternative schedules.

Prevention of Adriamycin Cardiotoxicity by Niacin, Isocitrate or N-acetyl-cysteine in Mice: A Morphological Study

Adriamycin is known to produce treatment limiting cardiotoxicity. We studied the effect of niacin, isocitrate, and N-acetyl-cysteine on cumulative adriamycin-induced cardiotoxicity in NMRI mice. Pathologic grading of the hearts indicated a significant reduction in myocardial injury. In addition, according to median survival and weight changes there was a significant decrease in toxicity. As demonstrated in Ehrlich ascites tumor, coadministration of N-acetyl-cysteine may interfere with the antitumor activity of adriamycin. In contrast, niacin and isocitrate did not show significant inhibition of antineoplastic activity. Our experiments suggest a promising role of niacin and isocitrate as potential cardioprotectors in the course of chemotherapy with adriamycin.

1538 GROWTH FAILURE DURING DEXAMETHASONE THERAPY IN PRETERM NEONATES

Recent reports suggest that steroid treatment may improve lung function in infants with chronic lung failure. Glucocorticoid therapy has many potential toxicities, including growth failure. Growth retarding effects have been reported with 200 mg/kg of cortisol. Suggested mechanisms include inhibition of cell mitosis, loss of thymic growth factor, and increased consumption of amino acids by liver. We have noted that growth cruves of ventilator dependent infants were flat during dexamethasone (D) therapy; we retrospectively evaluated 13 such infants 27±2 wks GA, 1057±251 gms b.wt. with chronic lung failure. Parenteral D was started at mean age of 6±2 wks at a dose of 1 mg/kg/day for 4 days and 0.5 mg/kg/day for 6 days. The mean weight of the infants the week prior to treatment was 1346 gms ± 474 and 1420 gm ± 464 at the time D was started. The median daily weight change (gms) prior to and during D therapy are plotted below. This pattern was not related to differences in mean fluid intake or output for the 2 periods. These preliminary data suggest that growth during D may be impaired. Further research is needed to determine if this is a transient or long term effect.