Percent Ideal Body Weight Research Articles

Cystic fibrosis patients with and without central nervous system complications following lung transplantation.

Central nervous system (CNS) complications occur more frequently in cystic fibrosis (CF) patients than other lung transplant recipients. The purpose of this study was to compare CF patients with and without CNS complications following lung transplantation, to identify risk factors for CNS events. Records of 21 patients with CF who underwent lung transplant between 1991-1996 were reviewed. Data were collected on multiple variables, including: age at transplant; gender; cytomegalovirus (CMV) status; cholesterol and triglyceride levels; sinusitis; percent ideal body weight (IBW); body mass index (BMI); augmented immunosuppression, acute lung rejection episodes (ALR); cyclosporine doses; electrolytes; magnesium, blood urea nitrogen (BUN), and creatinine levels; and 6-month survival. CNS complications identified were seizures, severe headaches (HA), strokes, or confusional episodes. Eleven of 21 patients (52%) with CF had CNS events: eight had seizures, five HA, three strokes, and one confusional episode. There was no difference in age at transplant, pretransplant percent IBW or BMI, cholesterol and triglyceride levels, or number of ALR. CMV mismatch and clinical sinusitis had no effect. Cyclosporine doses did not differ between groups at 30 days, or 3 or 6 months posttransplant. Both BUN and creatinine concentrations showed a rise over time that did not differ between groups. Potassium levels were within normal limits for both groups. While sodium levels did not differ between groups pretransplant, or at 30 days or 6 months posttransplant, a decrease in sodium values was seen at the time of CNS events. There was no difference in 6-month survival. We could not identify any pre- or posttransplant risk factors that predicted CNS events. It is likely that cyclosporine toxicity is the major cause of CNS complications. Despite the high rate of CNS events, the overall prognosis was good, and 6-month survival was not affected.

The Effects of a Nutrition Intervention on Body Weight and Body Composition of HIV-Infected Individuals at Risk of Wasting Syndrome

Wasting syndrome is an opportunistic disease associated with HIV infection, and is characterized by a loss of lean body mass. The purpose of this study was to employ a non-experimental nutrition intervention in order to stop or reverse the wasting process. Thirteen free-living individuals were examined in a community setting, and all subjects were screened to be at risk for wasting syndrome based on parameters of nutritional and economic risk. The intervention consisted of individualized nutrition counseling and access to a food pantry with groceries and nutritional supplements. Body composition was measured with bioelectncal impedance analysis (BIA). Measurements at baseline indicated that many (54% to 62%) of the subjects were malnourished based on standards for percent of ideal body weight (%IBW), body mass index (BMI), percent of ideal body cell mass (%1BCM), and phase angle. Results showed that most (64% to 85%) of the subjects increased in total weight, %IBW, BMI, %IBCM, phase angle, and body fat mass. The mean difference for all thirteen subjects was an increase of 5.5 pounds of total weight, 3.8% of %IBW, 0.28 degrees of phase angle; and 0.84kg/m2 of BMI (p<.05). Subjects improved mean body cell mass by 2.3% of %IBCM and had a 2.9 pound increase in body fat mass which approached significance. The number of days spent in the study varied for each subject; however, being in the study for a longer time was not significantly correlated with a greater increase in the variables measured. Subjects malnourished at baseline displayed a pattern of greater increase compared to those in average standard categories of nutritional status. These findings illustrate the positive outcomes of nutrition therapy on body weight and body composition and support the need for nutrition intervention for free-living individuals infected with HIV who are at risk for wasting syndrome.

Psychosocial self-efficacy and personal characteristics of veterans attending a diabetes education program.

The purpose of this descriptive correlational study was to describe the perceived psychosocial self-efficacy, attitude toward having diabetes, baseline glucose level, and personal characteristics of male veterans with type 2 diabetes. The Diabetes Empowerment Scale (DES) was mailed to participants and collected on the day of the program. Percent ideal body weight and glycosylated hemoglobin were measured. Comparisons were made by educational level, racial origin, and type of medication regimen on the DES and its subscales. Participants on oral medication versus insulin had higher scores in the categories of Motivation to Change and Ability to Cope with Feelings. Participants with less education had greater scores in Ability to Cope with Feelings and Obtain Support. No racial differences were seen on the measured scores; a significant difference was seen between Caucasians and non-Caucasians in baseline glycemic control. Targeting intervention strategies early in the course of disease progression may positively affect outcome. Longitudinal studies are needed to demonstrate the impact of self-management training on psychosocial self-efficacy and clinical outcomes.

The Influence of Nutrition Education on the Dietary Intake and Percent Ideal Body Weight of College Students

Sixty-one students, enrolled in an introductory nutrition course maintained a two-day food record at the start and then again at the end of a semester. Change in nutrient intake for each student was calculated using the NutriQuest diet analysis program. As explanatory variables, student data was also collected on age. gender, height (self-reported), weight (self-reported), self perceived assessment of own diet at start of course, weekly dollars spent on food, and place of residence. The grade that the student received in the course was also recorded. Using change in nutrient intake, change in weight, and progress towards ideal body weight as dependent variables, multiple regression analysis was used to determine if grade received in the course (holding all other explanatory variables constant) significantly influenced the different dependent variables. Of most interest is the significant finding (p < 0.03) that a one-unit increase in grade received in the course (i.e., from a 3.0 to a 4.0), holding other explanatory variables constant, resulted in 1.5 percent improvement towards ideal body weight. Other significant findings (p < 0.10) related to student achievement was that among identical students in respect to the other explanatory variables, the ones who received higher grades increased their intake of iron and decreased their intake of vitamin C and calcium. Grade had no other significant effects on the other dependent variables considered. These results provide evidence that students with a stronger mastery of the nutritional knowledge provided in a college introductory course are more likely to move toward their ideal body weight in the short duration of a semester. Further improvements towards ideal body weight after the semester ended were not measured, but may be more likely for students who did better in the course. Though with the exception of iron consumption, there is little evidence that performance in such an introductory course exerts an influence on nutrient intake.

Are preoperative obesity and cachexia risk factors for post heart transplant morbidity and mortality: a multi-institutional study of preoperative weight-height indices

Background: The relationship between pre-transplant body weight and post-transplant outcome has only recently been identified using a single, indirect measure of weight (percent ideal body weight [PIBW]). The literature is equivocal regarding which index is the better indicator of body weight. The purpose of this study was to determine (1) if pre-heart transplant body weight, measured by body mass index (BMI) and PIBW, is associated with post-heart transplant morbidity and mortality and (2) if patient gender, age, and etiology of heart disease affect this association. Methods The sample included 4,515 patients who received a heart transplant from January 1, 1990–December 31, 1995 at 38 institutions participating in the Cardiac Transplant Research Database (CTRD). Patients were divided into groups according to their BMI and PIBW. Data were described using frequencies, measures of central tendency, Pearson correlation coefficients, stratified actuarial analyses and log rank tests for comparisons, and a multivariable risk factor analysis in the hazard domain. Results For all patients ( n = 4,515), being <80% or >140% of IBW before heart transplant was a risk factor for increased mortality after heart transplant. The association between pre-heart transplant PIBW and post-heart transplant survival was affected by gender, age, and etiology of heart disease. In males, a higher PIBW was a significant risk factor for death early after transplant ( p = .0003). Although not significant, there was a trend for a higher PIBW being a risk factor for death in females throughout the post transplant period ( p = .07). No differences in cause of death were found for PIBW and BMI. In male and female recipients <55 years, being overweight pre-heart transplant was a risk factor for infection. In patients with pre-transplant ischemic heart disease, the greatest risk for infection was found in patients who were >140% of IBW. Pre-heart transplant BMI and PIBW were not associated with acute rejection or cardiac allograft arteriopathy after transplant. Conclusions In conclusion, being cachectic or obese preoperatively is associated with decreased survival in all patients after heart transplantation. Being obese preoperatively is associated with increased infection after heart transplant in males and females <55 years and in patients with ischemic heart disease. Of the 2 indices of body weight used in this study, percent ideal body weight appears to be the better predictor of future morbidity and mortality following heart transplantation.

Lymphocyte Glutathione Levels in Children With Cystic Fibrosis

Lung disease in cystic fibrosis (CF) is characterized by a neutrophilic inflammatory response. This can lead to the production of oxidants, and to oxidative stress in the lungs. Glutathione (GSH) represents the primary intracellular antioxidant, and provides an important defense in the epithelial lining fluid. Evidence suggests that lymphocyte GSH reflects lung GSH concentrations, and so could potentially serve as a peripheral marker of lung inflammation. We assessed peripheral blood lymphocyte GSH concentrations in 20 children (13 boys) with CF who were in stable condition at the time of evaluation. Values were compared with nutritional status and lung function parameters. Patients were 11.7+/-3.03 years old (mean +/- SD). Their percentage of ideal body weight was 101.8+/-17.92%; FEV1, 79.5+/-19.22% predicted; FEV1/FVC, 75.0+/-10.08%; and residual volume (RV)/total lung capacity (TLC), 31.3+/-10.47%. For the group, the GSH concentration was 1.31+/-0.52 micromol/10(6) lymphocytes, which was not different from laboratory control values. GSH values were correlated with nutritional status (percentage of ideal body weight: r = 0.49, p < 0.03) and the degree of gas trapping (RV/TLC: r = 0.50, p < 0.03), and were correlated inversely with airflow limitation (FEV1, percent predicted: r = -0.45, p < 0.05; FEV1/FVC: r = -0.48, p < 0.04), but not with age, height, or weight (p > 0.1). We interpret the inverse correlation between lymphocyte GSH concentration and lung function as a reflection of upregulation of GSH production by lung epithelial tissue in response to oxidative stress. We interpret the correlation between lymphocyte GSH concentration and nutritional status as a reflection of the role of cysteine in hepatic glutamine metabolism. Peripheral blood lymphocyte GSH concentration may potentially serve as a convenient marker of lung inflammation. Furthermore, the increased demand for GSH production in the face of ongoing inflammation suggests a potential role for supplementation with cysteine donors.

A cross-sectional study comparing the nutritional status of peritoneal dialysis and hemodialysis patients in Korea

Objective: This study was performed to compare the nutritional status of peritoneal dialysis (PD) and hemodialysis (HD) patients in Korea and to validate the nutritional assessment method. Design: For nutritional assessment, we used five nutrition-related indicators, including percentage unplanned weight loss, percentage ideal body weight (IBW), serum albumin, appetite and intake, and any gastrointestinal symptoms affecting intake. A 1-month food frequency interview was conducted by clinical dietitians using food models to estimate energy and protein intake. The validity of the nutritional assessment method was tested by objective measures. Patients/Setting: A cross-sectional study was conducted in our center for 51 PD patients and 169 HD patients who met the study criteria. In the study, HD patients typically underwent dialysis three times per week, and most PD patients performed four 2-L dialysis exchanges every day. Results: Our data showed a higher incidence of malnutrition in PD patients than in HD patients (33% v 18%) and in diabetics than in nondiabetics. Age, height, and dietary energy intake of the two groups were comparable. In PD patients, however, duration of dialysis treatment (23.9 ± 19.1 months v 41.8 ± 31.7 months, P < 0.001) and serum albumin (35.2 ± 5.0 g/L v 39.7 ± 3.4 g/L, P < 0.0001) were significantly lower, whereas percentage IBW (108.1% ± 12.4% v 96.2% ± 11.6%, P < 0.0001) and dietary protein intake (1.12 ± 0.34 g/kg IBW v 0.98 ± 0.31 g/kg IBW, P < 0.05) were significantly higher than in HD patients. In malnourished PD and HD patients, percentage IBW, serum albumin, dietary energy, and protein intake were significantly lower than in well-nourished counterparts. Conclusion: A higher incidence of malnutrition was observed in PD patients than in HD patients. Nutritional profile of PD patients was different from that of HD patients. Higher body weight and lower serum albumin in PD patients did not seem to be related to dietary energy and protein intake. The five nutritional indicators can be used as a simple inexpensive and reliable method for the early detection of malnutrition in dialysis patients.

Inclusion of resistance exercise in a multidisciplinary outpatient treatment program for preadolescent obese children.

Safe and effective exercise programs are needed to prevent and treat chronic diseases in childhood. In particular, preadolescent obese children should participate in activities that are specific to their special needs. We included a moderate intensity, progressive resistance training program in a multidisciplinary weight management program for obese preadolescent children. The program included diet, behavior modification, and aerobic and flexibility exercises. The subjects reported no accidents or injuries and 100% compliance with the minimum required exercise prescription. Weight, percent ideal body weight, body mass index, and percent fat were reduced significantly at 10 weeks and did not increase significantly at 1 year follow-up. Height and lean body mass increased significantly at 1 year. A resistance training program may be safely included in a multidisciplinary weight management program for obese preadolescent children.

TO WHAT EXTENT GYMNASTS COULD SHOW A STATUS OF MALNUTRITION SIMILAR TO ANOREXIA NERVOSA.

1470 Goal to evaluate the extent to which elite gymnasts can show a status of malnutrition, even similar to patients suffering from anorexia nervosa (AN). The nutritional status of 3 groups of females (13-17yr) was tested: 1) 10 AN in-patients (ANP), 2) 10 elite, gymnasts (G) (48 hr/wk of physical exercise) and 3) 50 students (2 hr/wk), as a control group (C) by assessing anthropometric and immunological parameters. All the subjects were matched by sex, age and socio-cultural level. Anthropometric measurements weight, body mass index, ideal body weight percentage, skinfold thickness (triceps, suprailiac), arm muscle and fat areas were tested. Immunocompetence was assessed by determining CD2 and CD56 lymphocyte subset counting, and by a delayed hypersensitivity skin test. All the anthropometric parameters were similar in G and in ANP and in both cases they were significantly lower than in C, 30% of ANP and 10% of G showing emaciation CD2 lymphocyte subset was lower in both in comparison with C. However, ANP reached the lowest CD56 levels whereas G maintained the same CD56 levels than C. The response to the delayed hypersensitivity skin test was lower in G than in C, however, ANP showed anergy with a null response to the test. CONCLUSION: According to the parameters tested, both ANP and G may suffer from a situation of malnutrition, although immunological parameters may show a slightly better nutritional status in gymnasts than in ANP. This outcome should be kept into account to prevent subclinical situations of malnutrition in elite sportswomen. Supported by Nutricia España, Nestlé Research Foundation and Nutrition Research Education Foundation (Canada).

Clinical indicators associated with poor oral intake of patients with chronic renal failure

Objective: The purpose of this study was twofold: (1) to determine the incidence of patients with chronic renal failure (CRF) who consume less than 75% of their estimated nutritional needs, and (2) to identify factors associated with an oral intake less than 75% of the estimated nutritional needs of patients with CRF. Design: Prospective, descriptive, correlational study of data obtained from patients with a diagnosis of CRF. Setting: BryanLGH Medical Center East Campus, Lincoln, NE. Patients: Sixty-six patients included on this study met the following criteria: (1) a primary or secondary underlying diagnosis of CRF and (2) not receiving parenteral or enteral (tube feeding) nutritional support on admission. Intervention: Admission data (age, sex, percentage of ideal body weight, weight loss/time, type of dialysis, gastrointestinal history, blood urea nitrogen and creatinine levels, and diet) were collected from the patients' medical records and 2-day kilocalorie (kcal)/protein counts were conducted on consecutive patients admitted to the hospital. The kcal/protein counts were initiated within 24 hours of admission and consisted of six meals and all snacks the patient received. Main outcome measure: Only 15% of the patients met 75% or greater of their estimated kcal needs, and 12% met 75% or greater of their estimated protein needs. The mean kcal/kg intake was 11 kcal/kg, with a range of 0 to 27 kcal/kg, and the mean protein/kg intake was 0.42 g of protein/kg, with a range of 0 to 10 g of protein/kg. Of the variables studied for associations with decreased nutrient intake, only emesis mildly correlated with kcal intake. Conclusion: Less than one quarter of the patients on this study met 75% or greater of their kcal and protein needs. The average kcal and protein intakes found in this study were far less than current recommendations for hemodialysis, continuous ambulatory peritoneal dialysis, and predialysis patients. However, the results of this study could lead to earlier and more aggressive interventions in patients with CRF at risk for poor oral intake.

A PRELIMINARY STUDY OF CARDIOVASCULAR RISK BEHAVIORS IN ADOLESCENT TRANSPLANT PATIENTS

690 After transplantation, many adolescents experience significant weight gain coupled with poor physical activity. These changes are generally believed to be related to the improved feeling of well being, increased appetite, and altered metabolism associated with immunosuppressive drugs and transplantation. Since renal transplant recipients' life expectancies are increasing, long term risk factors for cardiovascular disease must be addressed. To deter risk factors and help encourage compliance, an educational program including diet, medication, and risk behaviors was instituted at the time of transplantation and twice yearly thereafter. The primary purpose of this study was to determine the effectiveness of the current education program. Patients (24) receiving care at the University of Alabama at Birmingham were enrolled: median 17 months post-transplant (range 1-152), 75% male/25% female, 58% white/42% black, median age 17 years (range 13-23). Anthropo-metric data demonstrated 67% of subjects with moderate to severe growth retardation, 72% were overweight to morbidly obese (based on percent ideal body weight and body mass index), triceps skinfolds showed that 82% were obese with mildly to severely increased fat stores, mid-arm muscle circumferences indicated that 88% had mild to severe muscle wasting and protein depletion. Other data related to cardiovascular risk factors (blood pressure, lipid levels) were evaluated: 86% of subjects had significantly elevated BP, 50% had elevated cholesterol, 40% had elevated triglycerides, and 40% had elevated LDL-C and VLDL-C. Significant correlations were noted between cyclosporine levels and total cholesterol and LDL-C. To determine patient behaviors, subjects completed the Youth Risk Behavior Survey and were found to be significantly less physically active than the reference YRBSS students. To determine dietary intake, subjects completed a 3 day diet diary and 24 hour diet recall. In spite of diet education, 28% of the subjects responded that they were on no special diet, and only 5.6% described the prescribed diet regimen. Though approximately 72% were considered to be obese, 78% were below Recommended Dietary Allowances for calories. This suggests the diet records were not reliable predictors of actual intake. These data suggest that the majority of these patients are obese with a high percentage of their body composition as fat, have significantly elevated lipid levels, poorly controlled hypertension, and decreased physical activity. All of these have been demonstrated to increase their risk for cardiovascular disease. Clearly new approaches to patient care and education are needed.

Does hoarseness of voice from recurrent nerve paralysis after esophagectomy for carcinoma influence patient quality of life?

Background: Recurrent laryngeal nerve injury caused by esophageal cancer surgery is worrisome but often temporary; it is unclear when and how the paralysis is resolved. Hoarseness of voice from vocal cord paralysis (VCP) can have detrimental effects on postoperative patients. The aims of this study were to clarify the progress of nerve paralysis related to difficulty in talking after surgery and to assess whether hoarseness influences patient quality of life. Study Design: Between 1985 and 1996, 141 esophageal cancer patients undergoing a resection by the Akiyama procedure were cancer free 1 year after surgery. Among them, 51 patients with VCP on discharge from the hospital were retrospectively reviewed. Their VCPs, body weights, and pulmonary functions were examined yearly. They were given a questionnaire relating to the difficulty in talking 1 year after surgery. Results: VCP on discharge spontaneously healed within 1 year of surgery in 21 patients (41.2%), with the mean duration of difficulty in talking 5.7 months. The remaining 30 patients had persistent VCP 1 year after surgery; 4 VCPs spontaneously healed approximately 2 years after surgery. Eleven of the 30 patients with persistent VCP, who complained of severe hoarseness at 1 year postoperatively from inability to close the glottis during exertion, showed debilitation in performance status, abilities to go up stairs, and swallowing. In the group of patients with severe hoarseness, the percentage of ideal body weight (90.6% ± 11.0%) preoperatively and pulmonary functions at 3 years postoperatively were deteriorated, resulting in 3 patients with repeated aspiration pneumonia. Conclusions: The inability to compensate for aspiration, presenting as severe hoarseness, may be dependent on the preoperative nutritional state of patients along with degree of vocal cord atrophy and a decrease in pulmonary support. Persistent nerve paralysis deteriorates quality of life until it is adequately treated.

Timing of Referral for Lung Transplantation for Cystic Fibrosis: Overemphasis on FEV1 May Adversely Affect Overall Survival

(1) Report our experience with referral for lung transplantation. (2) Review survival in cvstic fibrosis (CF) patients without lung transplantation after FEV1 remains < 30% predicted for 1 years. Retrospective review. A university hospital CF center. (1) Forty-five patients referred for lung transplantation evaluation, and (2) 178 patients without Burkholderia sp infection, with the above FEVl criterion. Survival. (1) One- and 2-year survival after transplantation was 55% and 45%, respectively. However, among patients without transplants with FEVl < 30% predicted, median survival, 1986 to 1990, ie, before the transplant era, was 4.6 years with 25% living > 9 years (before 1986, 25% lived > 6 vears). (2) Survival after transplantation was not correlated to any of the following: age, sex, genotype, FEVI percent predicted, insulin-dependent diabetes mellitus, or with waiting time before transplantation, and did not seem to be correlated to serum bicarbonate or percent ideal body weight. Four of five patients already infected with Burkholderia species died within 5 months of transplantation; the fifth died at 17 months. All five died of pulmonary or extrapulmonarv infection with Burkholderia species Use of FEV! < 30% predicted to automatically establish transplantation eligibility could lead to decreased overall survival for CF patients. Referral for evaluation and transplantation should also be based on oxygen requirement, rate of deterioration, respiratory microbiology, quality of life, frequency of IV antibiotic therapy, and other considerations. If pulmonary status has unexpectedly improved when the patient is at or near the top of the waiting list, total survival may be improved by "inactivating the patient" until progression is again evident.

Body Composition Analysis by Dual Energy X-ray Absorptiometry and Exercise Performance in Underweight Patients With COPD

The aim of this study was to examine the effect of body composition on maximal exercise performance in patients with COPD. The study was carried out on 27 patients with COPD and was confirmed by pulmonary function testing. Body composition was measured by dual energy x-ray absorptiometry (DXA). Exercise performance was conducted on a cycle ergometer and was measured as maximal work rate (WRmax) and maximal oxygen uptake (VO2max). Bone mineral content (BMC), lean mass (LEAN), and fat mass (FAT) were assessed by DXA and were expressed as a percentage of ideal body weight, BMC, LEAN, and FAT. LEAN% correlated significantly with VO2max (r = 0.66, p = 0.0002) and WRmax (r = 0.70, p < 0.0001). No significant correlation was found between FAT% and exercise performance. By stepwise regression analysis, variables significantly contributing to WRmax and VO2max were LEAN% and the maximal voluntary ventilation. Total variance explained in these models was 81% for WRmax aid 82% for VO2max. Lean mass was an important determinant of maximal exercise performance in patients with COPD.

Growth and weight gain in children with vesicoureteral reflux receiving medical versus surgical treatment: 10‐year results of a prospective, randomized study

In children with vesicoureteral reflux (VUR) and urinary tract infection, retardation of growth and weight gain at the time of diagnosis and catch‐up growth during follow‐up, mostly after operating for VUR, have been reported. A controlled trial comparing the effect on growth of surgical treatment and long‐term prophylactic antibiotic treatment has not been reported previously. Between 1980 and 1985, 306 children younger than 11 y with non‐obstructive grade III or IV VUR, with a history of symptomatic urinary tract infection, were randomly allocated to surgical or medical treatment. Of these, 236 were followed for 10 y, 118 randomized to surgical treatment (mean age at entry 3.5 ± 2.3 y) and 118 to medical treatment (mean age at entry 3.8 ± 2.5 y). All children had renal function and blood pressure in the normal range. Body height, measured at start and after 1, 5 and 10 y, was transformed to standard deviation score of height for chronological age (SDSH‐CA) and body weight to percentage of ideal body weight for height (%IBW). The evolution of SDSH‐CA and %IBW was similar in both treatment groups (SDSH‐CA: surgical: start, 0.23 ± 1.4; 10 y, 0.40 ± 1.0; medical: start, 0.14 ± 1.2; 10 y, 0.44 ± 1.2; %IBW: surgical: start, 99 ± 9%; 10 y, 107 ± 14%; medical: start, 98 ± 10%; 10 y, 105 ± 16%). While children starting the study below the age of 3 y (SDSH‐CA 0.55 ± 1.34) started significantly taller than those older than 3 y (SDSH‐CA −0.1 ± 1.39), the young ones demonstrated a significant drop in SDSH‐CA during the 1st year (SDSH‐CA 0.19 ± 1.23), which was regained up to the 10th year (SDSH‐CA 0.6 ± 1.13), and the older ones steadily gained height up to an SDSH‐CA of 0.28 ± 1.05 at 10 y. During all of the study period, treatment protocol, grade of VUR, renal parenchymal scars at entrance and urinary tract infections did not influence growth and weight gain. Age at entry and gender were the only significant correlates with growth and weight gain.

Impaired splenic function and tuftsin deficiency in patients with intestinal failure on long term intravenous nutrition

Background—Reticuloendothelial system function is impaired in humans receiving lipid regimens.Aims—To evaluate the effects of long term administration of long chain triglyceride emulsions on reticuloendothelial system function.Methods—Splenic function and tuftsin activity...

Effects of androgen administration on the growth hormone-insulin-like growth factor I axis in men with acquired immunodeficiency syndrome wasting.

It is unknown whether hypogonadism contributes to decreased insulin-like growth factor I (IGF-I) production and/or how testosterone administration may effect the GH-IGF-I axis in human immunodeficiency virus (HIV)-infected men with the acquired immunodeficiency syndrome (AIDS) wasting syndrome (AWS). In this study, we investigate the GH-IGF-I axis in men with the AWS and determine the effects of testosterone on GH secretory dynamics, pulse characteristics determined from overnight frequent sampling, arginine stimulation, and total and free IGF-I levels. Baseline GH-IGF-I parameters in hypogonadal men with AWS (n=51) were compared before testosterone administration (300 mg, im, every 3 weeks vs. placebo for 6 months) with cross-sectional data obtained in two age-matched control groups: eugonadal men with AIDS wasting (n=10) and healthy age-matched normal men (n=15). The changes in GH-IGF-I parameters were then compared prospectively in testosterone- and placebo-treated patients. Mean overnight GH levels [1.8+/-0.3 and 2.4+/-0.3 vs. 0.90+/-0.1 microg/L (P=0.04 and P=0.003 vs. healthy controls)] and pulse frequency [0.35+/-0.06 and 0.37+/-0.02 vs. 0.22+/-0.03 pulses/h (P=0.06 and P=0.002 vs. healthy controls)] were comparably elevated in the eugonadal and hypogonadal HIV-positive groups, respectively, compared to those in the healthy control group. No significant differences in pulse amplitude, interpulse interval, or maximal GH stimulation to arginine administration (0.5 g/kg, i.v.) were seen between either the eugonadal and hypogonadal HIV-positive or healthy control patients. In contrast, IGF-I levels were comparably decreased in both HIV-positive groups compared to the healthy control group [143+/-16 and 165+/-14 vs. 216+/-14 microg/L (P=0.004 and P=0.02 vs. healthy controls)]. At baseline, before treatment with testosterone, overnight GH levels were inversely correlated with IGF-I (r=-0.42; P=0.003), percent ideal body weight (r=-0.36; P=0.012), albumin (r=-0.37; P=0.012), and fat mass (r=-0.52; P=0.0002), whereas IGF-I levels correlated with free testosterone (r=0.35; P=0.011) and caloric intake (r=0.32; P= 0.023) in the hypogonadal HIV-positive men. In a stepwise regression model, albumin (P=0.003) and testosterone (P=0.011) were the only significant predictors of GH [mean GH (microg/L)=-1.82 x albumin (g/dL) + 0.003 x total testosterone (microg/L) + 6.5], accounting for 49% of the variation in GH. Mean overnight GH levels decreased significantly in the testosterone-treated patients compared to those in the placebo-treated hypogonadal patients (0.9+/-0.3 vs. 0.2+/-0.4 microg/L; P=0.020). In contrast, no differences in IGF-I or free IGF-I were observed in response to testosterone administration. The decrement in mean overnight GH in response to testosterone treatment was inversely associated with increased fat-free mass (r=-0.49; P= 0.024), which was the only significant variable in a stepwise regression model for change in GH [change in mean GH (microg/L)=-0.197 x kg fat-free mass - 0.53] and accounted for 27% of the variation in the change in GH. In this study, we demonstrate increased basal GH secretion and pulse frequency in association with reduced IGF-I concentrations, consistent with GH resistance, among both hypogonadal and eugonadal men with AIDS wasting. Testosterone administration decreases GH in hypogonadal men with AIDS wasting. The change in GH is best predicted by and is inversely related to the magnitude of the change in lean body mass in response to testosterone administration. These data demonstrate that among hypogonadal men with the AWS, testosterone administration has a significant effect on the GH axis.

Impaired exercise capacity late after cardiac transplantation: Influence of chronotropic incompetence, hypertension, and calcium channel blockers

Background and Methods Patients undergoing orthotopic cardiac transplantation manifest reduced exercise capacity during the first postoperative year, which is related primarily to chronotropic incompetence of the denervated heart. To determine whether exercise capacity improves during the long term after transplantation, we prospectively studied 45 patients from 1 month to 6 years after cardiac transplantation by use of maximal treadmill exercise testing for measurement of exercise duration, peak heart rate, and peak V o 2. All had normal left ventricular ejection fractions. Patients were categorized according to length of time since transplant and compared to 14 untrained normal subjects. Results Peak exercise heart rate and exercise duration were progressively higher as time after transplantation increased. However, patients who had undergone transplantation more than 2 years earlier continued to manifest a significant reduction in peak exercise heart rate (157 ± 3 beats/min vs 178 ± 14 beats/min) and reduced exercise duration (8.6 ± 0.5 minutes vs 13.2 ± 2.0 minutes) compared with controls. In contrast, peak V o 2 was similar at all times after transplant and remained markedly reduced in patients who underwent transplantation more than 2 years earlier as compared with controls (22.1 ± 0.7 mL/kg/min vs 42.1 ± 9.1 mL/kg/min). The potential effects of 14 clinical variables on exercise performance were evaluated by regression modeling. Patients with poorly controlled hypertension had a shorter median exercise duration (7.4 minutes vs 9.7 minutes) and a lower median peak V o 2 (20.3 mL/kg/min vs 23.2 mL/kg/min) compared with patients with normal or well-controlled blood pressure. Patients treated with calcium channel blockers for hypertension had greater chronotropic incompetence during exercise (peak heart rate 139 beats/min vs 158 beats/min). There was no relation between exercise capacity and recipient age, donor age, recipient sex, donor ischemic time, pretransplant diagnosis, length of peritransplant hospitalization, percentage of ideal body weight, left ventricular ejection fraction, frequency or severity of allograft rejection, or long-term use of oral prednisone therapy. Conclusions Exercise capacity, as measured by treadmill exercise time and peak heart rate, improves in the first 2 years after transplantation, but does not reach normal values in patients up to 6 years after transplant. Peak V o 2 remains significantly reduced at all times after transplantation despite the presence of normal resting left ventricular systolic function. (Am Heart J 1998;136:465-73.)

Flexible Tape is an Appropriate Tool for Knee Height Measurements and Stature Estimations of Developmentally Disabled Adults

Reliability/validity study with statistical analysis of repeated measures was performed. Using a Mediform caliper and flexible tape, two knee height measures were taken by two observers in 56 non-ambulatory developmentally disabled adults. The mean of the measurements for each instrument was used to calculate stature. Ideal Body Weight (IBW) and percent IBW (%IBW) were calculated. Subjects were 56 non-ambulatory developmentally disabled residents of an intermediate care facility with diagnoses of spastic quadriplegia. Two independent observers obtained two consecutive knee height measurements with Mediform caliper or flexible tape. Both observers performed measurements with each tool by protocol for Mediform Caliper. Mean and standard deviation of net differences for observers’ Caliper Knee height (CKH) measurements and Tape Knee Height (TKH) measurements, stature by CKH and TKH, and %IBW was determined and evaluated by t-test and Bonferroni adjusted t. Mean absolute differences for knee height measures and derived stature were examined. Technical Error of Measurement (TEM) for tools and observers was calculated. Influence of confounding variables was examined by Analysis of Variance (ANOVA). Differences in derived stature and IBW were displayed graphically by cumulative frequency distribution. Mean TKH was consistently and significantly larger than CKH. However, the TKH and CKH measurements were highly correlated (r=0.943) as were Caliper Stature (CS) and Tape Stature (TS) (r=.928). Range of mean absolute differences for cs versus TS was 0 to 13.21 cm. Interobserver TEM was small for CKH measurements and greater for inexperienced observer (Obs 2) than experienced observer (Obs 1) for both tools. TEM of Obs 1 for TKH was 0.43 cm. and of Obs 2 was 0.53 cm. TEM of Obs 1 for CKH was 0.27 cm. and of Obs 2 was 0.42 cm. In a comparison of caliper and tape, interobserver TEM was 0.41 cm. In assessment of developmentally disabled adults, accurate, efficient and practical data collection strategies are needed. Flexible tape is an appropriate tool to substitute for caliper in knee height measurements of certain developmentally disabled adults in the study population. The study supports that maximum reliability in the study population is achieved when measurements are taken by a single experienced clinician.

Effect of Reduced Body Weight on Muscle Aerobic Capacity in Patients With COPD

Reduced muscle aerobic capacity in COPD patients has been demonstrated in several laboratories by phosphorus magnetic resonance spectroscopy and by analysis of oxygen uptake (VO2) kinetics. COPD patients are usually elderly, hypoxemic, poorly active with muscle atrophy, and often malnourished. Under these conditions there is usually reduction of O2 delivery to the tissues (bulk O2 flow), redistribution of fiber type within the muscle, capillary rarefaction, and decreased mitochondrial function, alterations all capable of reducing muscle aerobic capacity. In COPD, the effect of reduced body mass on muscle aerobic capacity has not been investigated (to our knowledge). We studied 24 patients with stable COPD with moderate-to-severe airway obstruction (68+/-5 [SD] years; FEV1, 39+/-12% predicted; PaO2, 66+/-8 mm Hg; PaCO2, 41+/-3 mm Hg) with poor to normal nutritional status, as indicated by a low-normal percent of ideal body weight (IBW). Each subject first underwent 1-min maximal incremental cycle ergometer exercise for determination of VO2 peak and lactate threshold (LT). Subsequently, they performed a 10-min moderate (80% of LT-VO2) constant load exercise for determination of oxygen deficit (O2DEF) and mean response time VO2 (MRT). VO2, CO2 output (VCO2), and minute ventilation were measured breath by breath. Patients displayed low VO2 peak (1,094+/-47 [SE] mL/min), LT-VO2 (35+/-3% predicted O2 max), and higher MRT-VO2 (67+/-4 s). Univariate regression analysis showed that percent of IBW correlated with indexes of maximal and submaximal aerobic capacity: vs VO2 peak, R=0.53 (p<0.01); vs MRT R=-0.77 (p<0.001). Using stepwise regression analysis, MRT correlated (R2=-0.70) with percent of IBW (p<0.01) and with PaO2 (p<0.05). Reduced body mass has an independent negative effect on muscle aerobic capacity in COPD patients: this effect may explain the variability in exercise tolerance among patients with comparable ventilatory limitation.