Percent Ideal Body Weight Research Articles

Decreased leptin levels in normal weight women with hypothalamic amenorrhea: the effects of body composition and nutritional intake.

Leptin is a protein encoded by the ob gene and expressed in adipocytes. A sensitive marker of nutritional status, leptin is known to correlate with fat mass and to respond to changes in caloric intake. Leptin may also be an important mediator of reproductive function, as suggested by the effects of leptin infusions to restore ovulatory function in an animal model of starvation. We hypothesized that leptin levels are decreased in women with hypothalamic amenorrhea and that leptin may be a sensitive marker of overall nutritional status in this population. We, therefore, measured leptin levels and caloric intake in 21 women with hypothalamic amenorrhea (HA) and 30 age-, weight-, and body fat-matched eumenorrheic controls. Age (24 +/- 5 vs. 24 +/- 3 yr), body mass index (20.6 +/- 1.3 vs. 21.1 +/- 1.5 kg/m2), percent ideal body weight (94.9 +/- 5% vs. 96.3 +/- 6.3%), and fat mass (14.2 +/- 3.6 vs. 15.5 +/- 2.9 kg, determined by dual energy x-ray absortiometry) did not differ between the groups. Leptin levels were significantly lower in the HA subjects compared with those in the controls (7.1 +/- 3.0 vs. 10.6 +/- 4.9 micrograms/L; P = 0.005). Total caloric intake (1768 +/- 335 vs. 2215 +/- 571 cal/day; P = 0.003), fat intake (333 +/- 144 vs. 639 +/- 261 cal/day; P < 0.0001), and insulin levels (5.6 +/- 1.2 vs. 7.4 +/- 3.2 microU/mL; P = 0.015) were lower in the women with HA than in the eumenorrheic controls. The difference in leptin levels remained significant after controlling for insulin (P = 0.023). These data are the first to demonstrate hypoleptinemia, independent of fat mass, in women with HA. The hypoleptinemia may reflect inadequate calorie intake, fat intake, and/or other subclinical nutritional disturbances in women with HA. The mechanism and reproductive consequences of low leptin in this large population of women remain unknown.

Compromised bone density 11.4 years after diagnosis of anorexia nervosa.

This investigation evaluated bone density in 36 premenopausal women (mean +/- SD age = 29.5 +/- 8.4 years) an average of 11.4 years after diagnosis for anorexia nervosa. Twenty-nine women were aged 20-45 years, and seven were aged 16-19 years. Body composition, age of menarche, length of amenorrhea, estrogen exposure, and lumbar spine and proximal femur bone density were determined. Average appendicular bone density for those > or = 20 years was found to meet World Health Organization T score criteria for osteopenia: total femur T = -1.22 and femoral neck T = -1.33. The average total lumbar Z score for all 36 participants was -0.95, which was 90% of the mean for their age, and the mean Z scores for adolescent subjects were within 91% of the mean for their age (Z = -0.84). Years of estrogen exposure were correlated with lumbar mineral content (r = 0.50, p = 0.002). A modest but significant inverse relationship was observed between length of amenorrhea and femoral and lumbar bone density. The total proximal femur and trochanteric bone densities were best predicted, using stepwise regression, by the number of years after diagnosis and years of amenorrhea, respectively (R2 = 0.23, p = 0.02 and R2 = 0.21, p = 0.04). Lumbar density was best predicted by years of amenorrhea and current percent of ideal body weight (%IBW)(R2 = 0.25, p = 0.02). Length of amenorrhea, estrogen exposure, and %IBW independently contribute to axial and appendicular bone density. Because of risk for compromised bone density, women with a history of anorexia nervosa should be followed longitudinally to maximize premenopausal bone replacement.

THE ROLE OF DEGREE OF OBESITY IN MAXIMAL PHYSIOLOGIC AND METABOLIC PARAMETERS IN OBESE YOUTH.

242 Research indicates that obese children exhibit lower maximal oxygen uptake(VO2max) and heart rate (HRmax) values than non-obese children. However, it is unclear what impact the varied levels of obesity [defined as percentage of ideal body weight (%IBW)] i.e., severe (>200%IBW), moderate(150-199%IBW) and mild (121-150%IBW) will have on maximal physiologic and metabolic parameters during treadmill walking. We examined the impact of level of obesity on VO2max, HRmax, maximal ventilation (VEmax), maximal carbon dioxide (VCO2max) and respiratory exchange ratio (RER) in nonobese (<120%IBW) compared to severely, moderately and mildly obese children. Forty-seven subjects (M=15, F=32; 11.9±1.8 yrs.) were stratified into four groups by level of obesity. Subjects performed a graded treadmill test after 30 minutes (mn) of rest. Expired gases were collected with a Sensormedics MMC 2900C, HRmax with a Polar XL monitor as follows: 10 mn of unsupported standing; walking @ 0% grade for three 5-mn stages of 2.5, 3.0& 3.5 mph, respectively, then a 2% increase in grade every 2 mn @ 3.5 mph until fatigue. The results are: (mean±S.D).TableNo significant differences were noted in, VO2max L/min., VEmax and VCO2max. VO2max mL/kg/min. was significantly greater in nonobese& mild versus (vs.) moderate & severe obese subjects (p<0.0001). HRmax was significantly lower in severe obese subjects vs. all others(p<0.0045). RER was significantly lower in mild vs. severe & nonobese and also lower in moderate vs. non-obese subjects (p<0.035). We conclude that obesity levels >150%IBW negatively impact VO2max mL/kg/min. Severe obesity negatively impacts HRmax but positively impacts RER.

Adenoid size is related to severity but not the number of episodes of obstructive apnea in children

Objective: The objective of this study was to determine the extent to which adenotonsillar hypertrophy contributes to the severity of obstructive sleep apnea (OSA) in children. Study design: Thirty-three consecutive children who were referred to a sleep disorders center for evaluation of suspected OSA had standard lateral neck roentgenography performed. Adenoid size was determined by measuring the adenoidal-nasopharyngeal (AN) ratio. Tonsil size was quantitated on physical examination. The severity of OSA was determined by full-night polysomnography in the sleep laboratory. Results: All of the patients reported snoring with trouble breathing, apneas, or both problems witnessed by a parent. The patients' respiratory disturbance index ranged from 0 to 95.3 (mean ± SD 12.5 ± 9.1). The patients' AN ratio ranged from 0.48 to 0.98 (0.76 ± 0.14); 30 (91%) of the 33 patients had AN ratios greater than published normal means, and 16 (48%) had AN ratios more than 2 standard deviations above published means. Although the AN ratio and tonsil size did not predict the number of apneas, a significant relationship was seen between the AN ratio and the duration of obstructive apneas ( r = 0.48, p < 0.01). Obesity (percent ideal body weight) was the only independent predictor for the number of respiratory events per hour of sleep ( r = 0.49, p < 0.01). Percent ideal body weight was also the major predictor of the lowest oxyhemoglobin saturation ( r = –0.58, p < 0.0001), but the AN ratio also contributed to the variance in saturation, with a correlation coefficient ( r) of 0.69 for the two factors ( p < 0.0001). Conclusion: Lymphoid hyperplasia affects the severity of apnea more than the number of obstructive apneas. The pathophysiologic characteristics of OSA in children probably involve complex interactions between pharyngeal size and mechanics. (J Pediatr 1998;132:682-6)

Age as a Factor in Long Term Program Retention and Weight Maintenance in Obese Children and Adolescents † 698

Research indicates that prevention of adult obesity may be accomplished through the treatment of prediatric obesity. However, it is unclear whether treatment should begin during the early or later childhood years. We examined the one-year program retention and weight maintenance of 139 obese children(M=63, F=76; Age=12.11±2.6 yrs.; Range=7.1-17.6 yrs.) enrolled in a multidisciplinary pediatric weight management program. The one-year program consisted of a protein-sparing modified fast diet, followed by a balanced hypocaloric diet, nutrition education, behavior modification, and a moderate-intensity (45-55% VO2max), progressive exercise program. Measures of height, weight, percent of ideal body weight (%IBW), and body mass index (BMI) were obtained at baseline, ten weeks and one year. For statistical analysis, subjects were blocked by age as follows: 7-8 yrs., 9-10 yrs., 11-12 yrs., and 13+ yrs. A repeated measures one way analysis of variance indicated the the results in the table (%IBW, mean±S.D;*Baseline to 10 weeks and baseline to 1 year. 10 weeks to 1 year = N.S.).

Nutrition in children with cerebral palsy.

Nutrition in children with cerebral palsy.

Nutrition Problems and Their Association with Patient Outcomes in a Geriatric Rehabilitation Setting

Geriatric rehabilitation patients (n = 152) assessed by the dietician were found to have significant nutrition problems. Protein-energy malnutrition (PEM) was the most common nutrition diagnosis (57%). Patient outcomes of length of stay, death and discharge location were associated with the nutrition variables of: anaemia, PEM, weight loss, percent ideal body weight, Level of Nutritional Care, swallowing assessment, feeding impairments and poor appetite. Over two-thirds of patients met their nutrition goals during admission. Patients admitted to geriatric rehabilitation have significant nutrition problems that are associated with pertinent outcome variables. These clients can benefit from the expertise of a registered dietician.

Lack of sensitivity of weight targets compared with body cell mass for determining recovery from malnutrition in adolescents with anorexia nervosa.

Using body weight targets to assess recovery from malnutrition in adolescents with anorexia nervosa (AN) may lead to premature discontinuation of refeeding programs. We examined body cell mass (BCM) to determine nutritional recovery, comparing with conventional indices based on weight. Body mass index (BMI), Z-score, percentage of ideal body weight (IBW), and BCM (by total body potassium) were studied in adolescent females with AN (n = 92). Fourteen percent had "normal" weights (> 85% of IBW), 24% had "acceptable" BMI values (> 16), and 15% had "acceptable" Z-score values (> -1) when their BCM was not fully restored. The use of percentage of IBW, Z-scores, or BMI lacks sensitivity in determining adequacy of nutritional rehabilitation. Body compartmental analysis particularly of BCM and body fat is recommended, and the use of BMI particularly should be discarded.

Long-term growth and development in children after home parenteral nutrition

Growth and development after the cessation of prolonged parenteral nutrition (PN) has not been fully evaluated. Growth, body composition, and nutritional and developmental status were documented in nine children (five boys, four girls) 2 to 6 years old (mean 4.9 ± 1.0 years) who had previously received long-term PN (mean 14.6 ± 11.4 months). PN had been discontinued in all subjects for at least 6 months (mean 3.4 ± 1.4 years); they were receiving oral feedings only. One subject had a significantly low height-for-age, and another had a low percent ideal body weight; five subjects had low total body fat. Serum vitamin A was low in six subjects. Seventy-two–hour fecal fat analysis was abnormal in two of eight subjects. Abnormal bone mineral density was present in four of nine subjects. Psychomotor development was normal in all nine subjects. Two had functional difficulties in swallowing. One or more abnormalities were present in all nine subjects. These findings suggest that children who require prolonged PN in early life are at risk for abnormalities in growth and nutritional status in later childhood; they require long-term dietary, growth, and nutritional monitoring. (J Pediatr 1998;132:461-6)

Two years of practice in adjustable silicone gastric banding (LAP-BAND): evaluation of variations of body mass index, percentage ideal body weight and percentage excess body weight.

In the treatment of morbid obesity, surgery had been the only method of obtaining a good and enduring weight loss. Although the procedure of choice is still a matter of debate, among gastric restriction procedures LAP-BAND has become our first choice. We report the results from 62 morbidly obese patients operated in the period October 1994-December 1996. Their characteristics were: mean age 35.6 years, mean body weight 130.6 kg, mean height 162.3 cm, mean body mass index (BMI) 49.9 kg/m2, mean percentage ideal body weight (%IBW) 215.7 and mean excess weight (EW) 69.57 kg. Twenty-four months after surgery we found a mean BMI of 39.3, a mean %IBW of 168.6 and a mean % EW loss of 88.5. We removed the band in two patients: one after 9 months because of stoma stenosis and pouch enlargement in a woman who had been lost at follow-up, and the other for gastric slippage occurring after 18 months due to incorrect fixation of the band. Our results led us to consider LAP-BAND as the surgical approach for severe obesity among those patients selected for gastric restriction; indeed, it was very safe as well as effective and was rarely followed by complications.

Quality of life following esophagectomy with three-field lymphadenectomy for carcinoma, focusing on its relationship to vocal cord palsy.

To clarify the quality of life of patients who underwent esophagectomy for carcinoma by right thoracotomy, laparotomy and cervical anastomosis, 116 patients who were cancer free at the time of mailing a questionnaire were analyzed. A significant decrease in vital capacity for 3 years postoperatively, as well as in the percentage of ideal body weight, between 3 and 5 years were observed in 57 patients with three-field lymphadenectomy. Patients' quality of life undergoing three-field dissection was worse than those with less radical lymphadenectomy (59 cases) in terms of the performance status and difficulty in talking at 60 months or more postoperatively. Around 20% of all patients reported severe hoarseness due to permanent recurrent nerve paralysis, resulting in poor quantity of food intake at 24 months or less postoperatively and restricted daily activity and difficulty in talking at 60 months or more after the operation. When a patient suffers from vocal cord insufficiency caused by permanent paralysis of the recurrent nerve, early treatment before discharge from the hospital should be performed to improve the quality of life of such a patient.

Gut permeability, intestinal morphology, and nutritional depletion.

Nutritional depletion increases the risk for postoperative complications. The intestinal barrier may be important in the underlying pathophysiologic mechanism. In this study, 26 patients were evaluated to determine whether nutritional depletion was related to gut integrity and intestinal morphology. Nutritional depletion was estimated by calculating percentage ideal body weight (PIB) or percentage ideal fat free mass (PIFFM). To assess gut integrity, a lactulose/mannitol (L/M) test was performed. Duodenal biopsies were taken, and villous height, crypt depth, number of IgA-producing plasma cells, intraepithelial lymphocytes (IELs), and proliferating index were determined. The L/M ratio was increased, and villous height was decreased in depleted patients. Depletion was not associated with differences in the number of immune cells or proliferating index. The number of IgA-producing plasma cells was positively correlated with the L/M ratio. This study shows that nutritional depletion is associated with increased intestinal permeability and a decrease in villous height.

重回帰分析による慢性肺気腫の％IBWと呼吸・代謝機能の関連性の検討

重回帰分析による慢性肺気腫の％IBWと呼吸・代謝機能の関連性の検討

Survivorship of Cemented Total Knee Arthroplasty

The survivorship method of analysis was used to compare the failure rate and overall success of 2629 cemented primary total knee arthroplasties during a 22-year period by the senior surgeon. There were 215 Total Condylar prostheses with a polyethylene tibia, 265 of the Posterior Stabilized type with an all polyethylene tibia, 2036 Posterior Stabilized with a metal backed tibial component, 49 Posterior Stabilized with modular augmented components, and 64 with the Constrained Condylar system. Failure was considered revision or planned revision. The Total Condylar series had an average annual failure rate of 0.46% and a 21-year success rate of 90.77%. The Posterior Stabilized prosthesis with an all polyethylene tibia had an average annual rate of failure of 0.38% and a 16-year success rate of 94.10%, and this prosthesis with a metal backed tibial component had an annual failure rate of 0.14% and a 14-year success rate of 98.10%. The Posterior Stabilized series with modular components had an average annual rate of failure of 0.59% and a 10-year success rate of 93.63%. The Constrained Condylar knee series had an average annual failure rate of 0.26% and a 7-year success rate of 98.12%. This review represents a retrospective analysis of consecutive series of cemented, total knee arthroplasties, whose annual failure and success rates were done during differing time spans. The overall success rate was not influenced by gender, age, diagnosis, or percentage of ideal body weight. Failure was considered revision or planned revision. The best and worse case scenarios were calculated for each series. Long term results of cemented, total knee arthroplasty with a relatively conforming articular surface has been shown to be a reliable procedure with excellent survivorship.

Regional variability of lung inflammation in cystic fibrosis.

Chest radiography in patients with cystic fibrosis (CF) frequently shows more severe changes in the upper lobes. We performed bronchoalveolar lavage (BAL) on 12 clinically stable, young adult patients with CF to determine whether inflammation varies significantly among geographically distinct areas of the lung. We found that absolute numbers of neutrophils were generally greater in BAL fluid from the upper lobe (25.7 +/- 7.9 x 10(5) neutrophils/ml [mean +/- SEM]) of the right lung than that obtained from the right lower lobe (6.8 +/- 2.8 x 10(5) neutrophils/ml; p < 0.01). The mean value of unopposed neutrophil elastase activity in upper-lobe BAL fluid (227 +/- 91 nmol peptide hydrolyzed/ml/min) was also significantly greater than that in lower-lobe BAL fluid (84 +/- 43 nmol/peptide hydrolyzed/ml/ min; p < 0.01), and similar differences were found for myeloperoxidase activity and DNA content. Neutrophil influx and unopposed neutrophil elastase for a given region correlated inversely with lung function or percentage of ideal body weight, and upper-versus lower-lobe differences were more pronounced in subjects with better preservation of lung function. Our findings suggest that regional variation in inflammation must be considered when utilizing BAL to study lower respiratory tract inflammation in CF or to monitor responses to therapeutic interventions that can potentially diminish lung inflammation. Our findings may also have implications for the study of the natural history of lung inflammation and infection in neonates, infants, and young children with CF.

Nutrition Support of Obese Hospitalized Patients

Obesity is a chronic disease that affects 33% of the adult population and 30% to 40% of the hospitalized adult population. Obesity can be defined with the use of percent of ideal body weight, but because of a number of problems associated with this method, body mass index has become the accepted measure. Nutrition assessment and selection of route of nutrition support are similar in the obese and normal weight patient. A variety of methods for estimating energy and protein needs in the obese patient are available but become increasingly unreliable as the degree of obesity increases. Measuring energy needs becomes appropriate as obesity becomes more severe. A strategy that uses hypocaloric nutrition support in the obese hospitalized patient is reviewed.

Insulin resistance is associated with decreased clinical status in cystic fibrosis

Patients with cystic fibrosis (CF) frequently have impaired glucose tolerance and progression to diabetes (DM) with clinical features of both insulin-dependent and non-insulin-dependent diabetes. One feature of non-insulin-dependent DM is decreased insulin sensitivity, also known as insulin resistance. The goal of this study was to determine whether patients with CF exhibit insulin resistance and to determine the potential effect of insulin resistance on clinical status. We also sought to determine whether insulin resistance is associated with a specific CF genotype. We studied 18 patients with CF (8 with normal glucose tolerance, 5 with impaired glucose tolerance, 5 with DM), and 20 lean control subjects matched for age, weight, and sex. All control subjects had normal glucose tolerance. The clinical status for each CF patient was determined according to a modified National Institutes of Health scoring system. Each subject underwent a three-step hyperinsulinemic euglycemic clamp (insulin doses of 10, 40, 120 mU/m 2 per minute). Results from the 120 mU/m 2 per minute infusion defined maximal glucose disposal rate (defined in milligrams per kilogram body weight per minute) at steady state with peripheral insulin levels 195 ± 20 mU/ml. Subjects with CF demonstrated insulin resistance (control subjects = 13.6 ± 1.1, patients with CF = 10.2 ± 1.6 mg/kg per minute; p = 0.003). When each subgroup was compared separately with control subjects, all subgroups were statistically insulin resistant (glucose disposal rate, patients with CF and normal glucose tolerance = 10.8; those with impaired glucose tolerance = 8.4; those with DM = 10.1 mg/kg per minute), and the patients with CF with impaired glucose tolerance were the most insulin resistant. When plotted versus glucose disposal rate, a striking positive correlation between worsened clinical status and insulin resistance ( r = 0.85) is demonstrated. Furthermore, there is no correlation between insulin resistance and fasting blood glucose, subject age, or percent ideal body weight (all r values not significant). In conclusion, patients with CF exhibit insulin resistance that is associated with worsened clinical status. We believe it is the combination of insulin resistance and decreased insulin secretion that is responsible for the high incidence of CF-related diabetes. (J Pediatr 1997;130:948-56)

A Random Study in a Rural Population of Diabetic Patients Comparing Diabetic Control With Depression Status

Diabetus mellitus and depression are two major medical disorders that afflict many Americans. Studies have shown that there is an increased prevalence of depression among diabetic patients.1 Research has indicated that depression has effects on a diabetic patient’s weight and glycohemoglobin (HbA1c) values.2 This study examined a population of rural diabetes patients from the Guthrie Clinic, Sayre campus. The effects of depression status on their mean percent of ideal body weight (%IBW) and mean glycohemoglobin (HbA1c) values over a three year study period were determined. The results of the study indicate a significant difference between %IBW of depressed versus non-depressed diabetic patients after only six months.

Morphologic and Histochemical Evaluation of Muscle in Patients with Chronic Pulmonary Emphysema Manifesting Generalized Emaciation

Twelve severely emaciated patients with emphysema and 4 control patients with mild emaciation were studied. Arterial blood gas analysis, pulmonary function tests, and muscle biopsy were performed. According to the percentage of ideal body weight (%IBW), patients were divided into two groups of 6 patients each; one with %IBW values greater than 70.0 (group 1) and the other with %IBW values less than 70.0 (group 2), and 4 control patients with emphysema whose %IBW values were greater than 85.5. %FEV1.0, PaO2 and Hugh-Jones scores in group 2 patients were consistent with significantly greater deterioration as compared with those in group 1 patients and controls. In the muscle fibers of 11 patients and 4 controls, nicotinamide and adenosine dinucleotide tetrazolium reductase activity was studded with spots. Nemalin rods were detected in 3 specimens in group 2 and in 1 specimen each in both group 1 and controls. These changes probably result from chronic hypoxemia. Fiber type grouping accompanied by type II dominant fiber atrophy was demonstrated in 5 patients of group 2, whereas type II fiber atrophy was shown in 2 specimens from patients of group 1. Diameters of both types I and II fibers in group 2 were smaller than those in group 1 and controls. Significant correlations were observed between fiber diameters and %IBW, %FEV1.0 and %IBW, and PaO2 and %IBW. Neurogenic and disuse muscular atrophy due to both hypoxic axonal disorder and disuse is likely to be the cause of the emaciation, and a 'vicious circle' between muscular atrophy, respiratory function and hypoxemia probably exists in group 2. Since mild or moderate emaciation was observed in controls and group 1 in spite of the lack of fiber atrophy, involvement of fat and connective tissue should also be taken into consideration to determine the cause of emaciation.

Nutrition Risk Classification: A Reproducible and Valid Tool for Nurses

Incorporating the nursing staff to assist with the screening process on admission will allow patients who are at nutritional risk to be assessed by registered dietitians earlier in their hospital stay. The goal of this study was to develop an objective, valid, reproducible nutrition screen for use by registered nurses (RNs) to allow for nutrition classifications of hospitalized patients. The current nursing admission assessment form was modified to contain questions on weight loss history, percentage of ideal body weight, and alterations in dietary intake and gastrointestinal function. Assessments were completed within 48 hours of admission. On the basis of the answers to these questions, patients were classified as "at nutritional risk" or "low nutritional risk." In phase 1, to assess reproducibility of the form, a prospective study between staff RNs and a nutritionist was undertaken on 186 consecutive adult admissions. Nutrition screening and classification was done independently by both practitioners. In phase 2 of the study, prospective validation of the form contrasting prealbumin (PAB) levels with RN nutritional risk classification (n = 56) was investigated. Interobserver agreement of nutrition classification between RN and nutritionist was 97.3% (p = .95). Twenty-nine patients were classified at low nutritional risk (27 normal PAB and 2 low PAB); 27 patients were classified as at nutritional risk (16 normal PAB and 11 low PAB) (chi 2 = 8.9, p < .003, power 0.8). The sensitivity of the tool was 84.6%. To our knowledge, this is the first nutrition screening tool designed for staff RNs that has been tested for both validity and reproducibility.