Percent Ideal Weight Research Articles

The association of a nucleobindin 2 gene (NUCB2) variant with childhood adiposity

Nucleobindin 2 (NUCB2) is a precursor of nesfatin-1, a hypothalamic anorectic neuropeptide. The association between variants of the NUCB2 gene and adiposity was examined. 142 severely obese Chinese children in Singapore, and 384 normal weight Chinese children from a longitudinal cohort from Da Qing, China, were studied. NUCB2 was screened using PCR and direct sequencing in 29 severely obese children and 24 non-obese children, then screened for a variant c.1012C>G (Q338E, or rs757081) in the rest of the cohort using TaqMan probe. Five variants, including c.1012C>G (Q338E) were found. Genotyping for c.1012C>G found that the GG genotype was significantly less frequent in the obese group; odds ratio for obese subjects carrying the CC and CG genotypes was 2.29 (95% CI 1.17–4.49) in the dominant model, CC genotype 2.86 (95% CI 1.41–5.81) in the additive model, and C allele 1.57 (95% CI 1.17–2.1). The findings were replicated in an independent cohort of 372 obese and 390 normal weight Chinese children, where the odds ratio of obese subjects with CC and CG genotypes was 1.69 (95% CI 1.12–2.55). Within the Da Qing cohort, subjects with the GG genotype had significantly lower BMI and percentage ideal weight for height (WFH) at 5 and 8years of age. Subjects with lower birth weights also had more pronounced difference in WFH and BMI at 5 and 10years of age between GG subjects versus CC/CG subjects. We postulate that GG genotype is protective against excessive weight gain, and factors which predispose to excessive weight gain such as higher birth weights may ameliorate the effect.

Quantitative Ultrasound in Spanish Children and Young Adults With Cystic Fibrosis

We studied the relationship between bone density and cystic fibrosis in Spanish children and young adults. We measured the phalangeal bone amplitude-dependent speed of sound (Ad-SoS) in 35 patients with cystic fibrosis and in 30 healthy controls matched for gender, age, and body mass index (BMI). Participants were subjects with normal levels of 25(OH) Vitamin D. We found no difference in Ad-SoS between patients and controls. The only difference between the groups was that the patients had a significantly higher daily caloric intake than the controls (p < .05) as a result of the patient group's greater intake of fats (p < .05). There was a positive correlation between Ad-SoS and weight (p < .0001), but after adjusting for potential confounding factors such as age, the correlation was lost. The percentage of ideal weight did not differ between the two groups. We conclude that well-nourished CF patients had similar Ad-SoS to controls.

Oral Mucositis Measured by the Oral Mucositis Assessment Scale (OMAS), but Not by the World Health Organization (WHO) Scoring System, Correlates with Nutritional Changes after Autologous Peripheral Blood Stem Cell Transplantation.

Objective: There is limited information regarding the relationship between oral mucositis (OM) and the nutritional status of autologous peripheral stem cell transplantation (APSCT) recipients. The objective of this study was to determine the relationship between OM, measured by two different instruments, and the nutritional status change of patients undergoing APSCT for lymphoid malignancies.Design: Eighty-two APSCT recipients were prospectively evaluated for OM by a physician or dentist not directly taking care of the patient. Oral examinations were performed 1–2 days before the administration of the conditioning regimen, the day of the transplant and 3 times weekly until resolution of mucositis. The presence of OM was assessed utilizing the objective portion of the OMAS which takes into account the degree of erythema and ulceration; and the WHO scoring system which combines both objective mucosal changes with functional outcomes such as the ability to eat. A registered dietician assessed the nutritional status (NS) of the patients before conditioning and at day 14 after transplantation, utilizing the Nutritional Status Classification Scheme (NSCS). The NSCS is a validated instrument developed by the Department of Veterans Affairs that stratifies patients in 4 categories or levels based on 7 indicators including nutrition history, unintentional weight loss, percent of ideal weight, diet, diagnosis, albumin, and total lymphocyte count. Defined levels range from patients with normal NS (level 1) to patients with severely compromised NS (level 4).Results: The mean age of study subjects was 56 (19–74) years, of these patients 76 (93%) were males. Of the 82 patients, 60 (73%) had multiple myeloma (MM), 17 (21%) had non-Hodgkin's lymphoma (NHL), and 5 (6%) had Hodgkin's lymphoma (HL). Conditioning regimens consisted of melphalan in 60 (73%), the combination of cyclophosphamide, etoposide and BCNU (CBV) in 19 (23%), and 3 (4%) received BCNU, etoposide, cytarabine, and melphalan (BEAM). Only 18% of the patients had a normal NS (level 1) before transplant. Most patients (73%) had mildly compromised NS (level 2) before transplant and the rest (9%) had moderately compromised NS (level 3). There was a statistically significant decrement in the NS 14 days after transplantation: 62% of the patients had moderate NS (level 3) and 5% has severely compromised NS (level 4) (p=0.002).Some degree of OM developed in 74 (90%) patients using the OMAS and 71 (87%) patients using the WHO scoring system. The NS change was associated with the OMAS (p=0.003) score but not with the WHO scoring system (p=0.094). There were no statistically significant correlation between change in NS and type of disease (0.496), conditioning regimen (0.496) and diarrhea (0.8849). There was a statistically significant correlation between change in NS and pain on swallowing (P=0.022), days with fever (P=0.036), neutrophil (P=0.01) and platelet (P=0.045) engraftment and length of hospital stay (P=0.004).Conclusions: Oral mucositis measured by the OMAS, but not by the WHO scoring system, correlates with nutritional changes after APSCT in patients with lymphoid malignancies. Decrement of the nutritional level in the NSCS correlated with adverse clinical outcome.

Timing and Driving Components of the Breathing Strategy in Children with Cystic Fibrosis During Exercise

The aim of this study was twofold: first, to determine the breathing strategies of children with cystic fibrosis (CF) during exercise, and secondly, to see if there was a correlation with lung function parameters. We determined the tension-time index of the inspiratory muscles (T(T0.1)) during exercise in nine children with CF, who were compared with nine healthy children with a similar age distribution. T(T0.1) was determined as followed T(T0.1) = P0.1/PImax . T(I)/T(TOT), where P0.1 is mouth occlusion pressure, PImax is maximal inspiratory pressure, and T(I)/T(TOT) is the duty cycle. CF children showed a significant decrease of their forced expiratory volume in 1 sec (FEV1), forced vital capacity (FCV), and FEV1/FVC, whereas the residual volume to total lung capacity ratio (RV/TLC) ratio and functional residual capacity (FRC) were significantly increased (P < 0.001). Children with CF showed mild malnutrition assessed by actual weight expressed by percentage of ideal weight for height, age, and gender (weight/height ratio; 82.3 +/- 3.6%). Children with CF showed a significant reduction in their PImax (69.3 +/- 4.2 vs. 93.8 +/- 7 cmH2O). We found a negative linear correlation between PImax and weight/height only in children with CF (r = 0.9, P < 0.001). During exercise, P(0.1), P0.1/PImax, and T(T0.1) were significantly higher, for a same percent maximal oxygen uptake in children with CF. On the contrary, T(I)/T(TOT) ratio was significantly lower in children with CF compared with healthy children. At maximal exercise, children with CF showed a T(T0.1) = 0.16 vs. 0.14 in healthy children (P < 0.001). We observed at maximal exercise that P0.1/PImax increased as FEV1/FVC decreased (r = -0.90, P < 0.001), and increased as RV/TLC increased (r = 0.92, P < 0.001) only in children with CF. Inversely, T(I)/T(TOT) decreased as FEV1/FVC decreased (r = 0.89, P < 0.001), and T(I)/T(TOT) decreased as RV/TLC increased (r = -0.94, P < 0.001). These results suggest that children with CF adopted a breathing strategy during exercise in limiting the increase of the duty cycle. Two determinants of this strategy were degrees of airway obstruction and hyperinflation.

Anthropometric measures, cytokines and survival in haemodialysis patients.

Lower serum albumin concentration (sAlb) and higher levels of pro-inflammatory cytokines have been reported to predict death in patients treated with haemodialysis (HD). SAlb, along with anthropometric measures, has been used as a surrogate marker for nutritional status in patients with chronic disease. Though adequate nutrition has been considered an important factor for patients treated with HD, it has not been established if any nutritional markers other than lower serum albumin and lower body mass index (BMI) predict death. Furthermore, it has not been shown whether anthropometric measures other than BMI are associated with predictors of mortality. At the outset of the study, patients were assessed using demographic and anthropometric indices including arm fat area (AFA), arm muscle area (AMA), BMI, per cent ideal weight (PIW), pre-dialysis sAlb, and circulating levels of tumour necrosis factor-alpha (TNF-alpha), IL-1 and IL-6. A severity index, previously demonstrated to be a mortality marker, was used to grade medical co-morbidity. Two-hundred and forty patients entered the study. The mean age was 55.1+/-14.3 years, mean sAlb 3.76+/-0.60 mg/dl, mean AFA 1742+/-1225 mm(2), mean AMA 5464+/-1817 mm(2), mean PIW 101.0+/-21.3% and mean BMI 24.9+/-5.6 kg/m(2). PIW, BMI, AFA and AMA were, as expected, all highly correlated with one another. SAlb correlated with serum transferrin; however, neither sAlb nor serum transferrin concentration correlated with circulating cytokine levels. Circulating cytokines and sAlb did not correlate with PIW, BMI, AFA or AMA. In Cox regression analyses using multiple control variables, IL-6 predicted survival, while the anthropometric measures did not. Pro-inflammatory cytokines and sAlb are robust predictors of death in patients treated with HD. PIW and BMI correlate well with other anthropometric measures in patients treated with HD, but these measures do not correlate with markers of inflammation. Anthropometric measures are poor predictors of survival compared with measures linked to the acute-phase response.

Cardiovascular Risk Factors and Ambulatory Blood Pressure Monitoring after Kawasaki Disease

Controversy persists as to whether patients who have had Kawasaki disease (KD) are at increased risk for premature atherosclerosis. Previous reports have suggested an increased tendency towards the metabolic syndrome and abnormal endothelial function. Purpose: We sought to determine cardiovascular risk factors in patients after KD. Methods: Complete cardiovascular risk assessment was performed in 43 patients (mean age 15.4±2.3 years; 60% males) at a mean of 9.5±3.2 years after typical KD, including 11% with persistent and 33% with regressed aneurysms, and 56% with ectasia or no coronary artery involvement. Results were related to a concurrent normal control group of 30 adolescents (mean age 15.9±2.5 years; 53% males). Results: There were no significant differences between cases vs. controls regarding body mass index, percent ideal weight for height or percentile of triceps skin fold thickness. There were no significant differences regarding amount of time spent in active and sedentary pursuits, family history of risk factors or cardiovascular disease, or smoking or smoke exposure. There were no significant differences regarding serum electrolytes, creatinine, fasting lipid profile, plasma free fatty acids, insulin and C-peptide levels, apolipoproteins, Lp(a), or urinary microalbumen clearance. From 24-hour ambulatory blood pressure monitoring, cases did not differ significantly from controls regarding mean total, daytime or nighttime systolic or diastolic blood pressure values, except cases had a tendency towards lower mean daytime systolic pressure (113±10 mmHg vs. 118±9 mmHg; p=0.06). However, cases had significantly lesser night-time fall (dipping) in both mean systolic (mean -5.1% vs. -8.4%; p=0.01) and diastolic (-9.6% vs. -12.8%; p=0.05) pressure. This difference dinimished (cases vs. control p=0.086 for systolic and p=0.13 for diastolic dipping) after adjustment for age, gender, BMI and mean daytime pressure measurements. Conclusion: Abnormalities of blood pressure regulation may represent an increased predisposition to hypertension in patients after KD

Obesity surgery: discouraging long term results with Mason's vertical banded gastroplasty.

To evaluate the long term results of Mason's vertical banded gastroplasty (VBG) using accepted criteria, and to find out which factors predicted success. Retrospective survey of a cohort of 40 severely obese patients (mean initial body mass index (BMI in kg/m2): 43, range 34-62). General teaching hospital, The Netherlands. Success according to three definitions: weight loss of more than 25%; percentage of excess weight 50% or less; and BMI < 30. Mean follow-up was 7.4 years (range 0.5-10) or 85%. The distribution over MacLean and Reinhold criteria shows a shift towards unfavourable categories. The consecutive percentages of success at five years were 35%, 62%, and 35%. Logistic regression analysis of success at 5 years shows that the following factors significantly predicted success: Definition I: age odds ratio (95% confidence interval): 0.88 (0.78 to 0.99). Definition II: age: 0.84 (0.69-1.01), outlet > or = 5 cm: 176 (2.4 to 12774), percentage of ideal weight > or = 100%: 0.03 (0.002 to 0.48). Definition III: age: 0.86 (0.75 to 0.99), pouch size > or = 15 ml: 10.64 (1.48 to 76.6). The long term results of VBG are disappointing when assessed by the standard criteria.

168. Is percentage ideal weight for height a reliable measure of nutritional status in children with cystic fibrosis?

168. Is percentage ideal weight for height a reliable measure of nutritional status in children with cystic fibrosis?

Comparison of growth status of patients with cystic fibrosis between the United States and Canada

Differences in growth status of patients with cystic fibrosis (CF) between the United States and Canada were reported in the 1980s based on analysis of data from 2 regional CF centers. We evaluated the current growth status of the entire CF population in the United States and Canada in view of recent advances in the treatment of CF. Growth data from the 1992-1994 CF Patient Registries were analyzed. Mean height and weight were at approximately the 30th percentile for children with CF in the United States. Mean height and weight were 4-5 percentiles higher in children with CF in Canada than in those in the United States (P < 0.01), but percentages of ideal weight (104%) were similar in both populations. In adults with CF, mean height was similar at the 37th percentile; however, weight (26th compared with the 21st percentiles) and percentage of ideal weight (93% compared with 90%) were significantly higher in Canada than in the United States. Differences related to sex and age were similar in both countries for all indexes, which showed a high prevalence of underweight in infants and in older patients, but little sex discrepancy. We observed substantially smaller differences in the growth indexes of CF patients between the United States and Canada compared with results from the 1980s. These findings reflect significant improvements in the nutritional status of US patients in recent years. However, caution is required in the direct comparison of mean percentiles from reports using different growth standards because there are systematic differences in growth standards, which affect, in particular, the comparison of growth in males and females.

APNEIC DESATURATION TIME IN PATIENTS WITH MILD-T0-MODERATE OBESITY

S411 INTRODUCTION: This study was undertaken to define the effects of mild to moderate obesity on the time required for arterial desaturation during anesthetic-induced apnea. METHODS: A cross-section observational study was conducted in 60 ASA I-II adult patients scheduled for elective surgery under general anaesthesia. The principal study variable was Tm_DESAT, the time required for a 5 percentage point decrease in arterial oxygen saturation during apnea. The apneic state was induced with intravenous Thiopental and Succinylcholine following three minutes of preoxygenation with 100% O2. Arterial saturation (SpO2) was measured noninvasively at the right index finger with a Nellcor pulse-oximeter. Tm_DESAT was recorded in seconds and analysed for correlation with measured body weight and several derived morphometric indices which correct body weight for the effects of height. These included: (1) weight as a percent of ideal weight; (1) weight as a percent of frame-adjusted ideal weight; and (3) body mass index (BMI). Obesity was graded according to BMI on the scale of Garrow1, where BMI <or=to 24.9 is grade 0 (non-obese), BMI 25-29.9 is grade I (mild), and BMI 30-40 is grade II (moderate). RESULTS: Tm_DESAT varied over a 22-fold range and was inversely related to each of the measures of body mass studied (Figure 1A). Correlation coefficients for the relation to Tm_DESAT were similar for all derived morphometric indicies, and none correlated significantly better than uncorrected body weight (Tm_DESAT=638-5.23*WT; R=0.73; P< 0.01). Tm_DESAT was shorter in moderately obese (grade II) and mildly obese (grade I) patients than in non-obese subjects (Figure 1B; P<0.01 and P<0.02 respectively). Moderately obese subjects also desaturated more quickly than those with mild obesity. (P<0.01)Figure 1CONCLUSION: Mild-to-moderate obesity has a significant negative impact on the time course arterial desaturation during anesthetic induced apnea. Desaturation time is inversely related to body mass for patients in this weight range.

Nutritional Effects of Long-Term Gastrostomy Feedings in Children With Cystic Fibrosis

Objective To analyze the long-term nutritional effects of supplemental gastrostomy feedings in undernourished patients with cystic fibrosis. Design Longitudinal, retrospective assessment of anthropo-metric measures before and for up to 4 years after gastrostomy. Subjects/setting All patients at a large cystic fibrosis care center who underwent gastrostomy between 1980 and 1993 when they were at least 1 year old and were followed up for a minimum of 1 year after gastrostomy. Statistical analyses performed The Mann-Whitney U test was used to compare anthropometric values measured during 4 postgastrostomy time intervals with values measured during the year preceding gastrostomy. Results The 21 patients ranged in age from 1.1 to 20.8 years (median age=7.4 years). They had mild to moderate malnutrition at the time of gastrostomy. Patients were followed up for a mean of 39 months after gastrostomy. Supplemental feedings were associated with significant improvements in weight and height percentiles for age, and in weight as a percentage of ideal weight. Improvement in weight occurred earlier than improvement in height. Among subjects followed up for at least 18 months after gastrostomy, median weight percentile for age increased from 2% for the year before gastrostomy to 12% for the period 6 to 18 months after gastrostomy ( P<.001) and 19% for the period 30 to 48 months after gastrostomy ( P=.002 compared with before gastrostomy). Other nutritional parameters followed similar, although less dramatic patterns. Gastrostomy feedings were well tolerated and associated with only minor complications. Conclusions Long-term gastrostomy feedings appear to be a safe and effective means of improving nutrition in malnourished patients with cystic fibrosis. Clinical dietitians should function as care managers for patients with cystic fibrosis who are receiving supplemental gastrostomy feedings. J Am Diet Assoc. 1999;99:191–194.

Vertical banded gastroplasty-gastric bypass in Mexican patients with severe obesity: 1 year experience.

Different surgical alternatives for the treatment of severe obesity have been described. The two most common surgical procedures are the Vertical Banded Gastroplasty (VBG) and the Roux-en-Y Gastric Bypass (GBP). This work describes the results seen during the first 12 months after a surgical technique named Vertical Banded Gastroplasty-Gastric Bypass on 221 Mexican patients with severe obesity operated on between March 1993 and August 1996. 73.3% of the patients were female with an average age of 33.4 years with a standard deviation (SD) of 10 years. The initial mean overweight was 62.2 kg (SD = 26.5 kg). The percentage of ideal weight was 202.3% (SD = 39.4%). The initial body mass index (BMI) was 44.9 kg/m2 (SD = 9.1). The average of excess weight loss in a year was 81.2% (SD = 15.6%) and the BMI was lowered to 26.7 kg/m2 (SD = 5.9). An interesting finding was that the greater the initial overweight, the lesser the resulting weight loss (r = 0.57, P < 0.001). The procedure was fairly easy to perform. The results were excellent in terms of weight loss and postoperative complications. It is an early experience and the long-term results are still inconclusive; regular check-ups should indicate the procedure's long-term effectiveness.

Hormonal changes and catabolic/anabolic imbalance in chronic heart failure and their importance for cardiac cachexia.

The role of hormonal and cytokine abnormalities in the development of cardiac cachexia remains obscure. Healthy control subjects (n=16) and patients with chronic heart failure (CHF), classified clinically as cachectic (8% to 35% weight loss over > or = 6 months before study, n=16) or noncachectic (n=37), were assessed for markers of disease severity (maximal oxygen consumption, left ventricular ejection fraction, NYHA functional class). These markers were compared with plasma concentrations of potentially important anabolic and catabolic factors. The degree of neurohormonal activation and catabolic/anabolic imbalance was closely related to wasting but not to conventional measures of the severity of heart failure. Compared with control subjects and noncachectic patients, cachectic patients had reduced plasma sodium and increased norepinephrine, epinephrine (all P<.0001), cortisol, tumor necrosis factor (TNF)-alpha (both P<.002), and human growth hormone (P<.05). Insulin-like growth factor-1, testosterone, and estrogen were similar in all groups. Insulin was increased only in the noncachectic patients (P<.005 versus control subjects). Dehydroepiandrosterone was reduced in the cachectic patients (P<.02 versus control subjects). Insulin, cortisol, TNF-alpha, and norepinephrine correlated independently with wasting in CHF (P<.05; multiple regression of these four factors versus percent ideal weight, R2=.50, P<.0001). Cachexia is more closely associated with hormonal changes in CHF than conventional measures of the severity of CHF. This study suggests that the syndrome of heart failure progresses to cardiac cachexia if the normal metabolic balance between catabolism and anabolism is altered.

Relationship of Malnutrition and Length of Stay in the Hospital

LEARNING OUTCOME: To examine the relationship between malnutrition, average length of stay, and hospital costs.Recent studies have suggested that malnutrition may increase average length of stay (ALOS) and thereby increase medical costs. A retrospective chart review of 150 randomly selected cardiac patients was performed to assess this possible relationship and to investigate if early nutrition intervention can eliminate/reduce hospital costs. Subjects were classified into levels of malnutrition by utilizing albumin, total lymphocyte count, percent ideal weight, and percent weight loss. Results indicated a 67% prevalence of malnutrition. Severely malnourished subjects had a five day longer ALOS than adequately nourished subjects, however, across all groups this was not statistically significant, F(2,138)=2.267, (p>.05). In terms of nutrition intervention, subjects who received early nutrition intervention (⩽4 days) had a five day shorter ALOS compared to those who received late nutrition intervention (⩾5 days), however, this was not statistically significant, F(2,138)=12.61, (p>.05). The five day difference in ALOS was substantial in increasing medical costs. A potential patient day savings of 5179,028 for the total sample could have been captured if malnutrition was treated in the hospital stay and nutrition intervention initiated early. Overall, malnutrition still exists in hospitals and costs may be reduced by improving nutrition practices to identify and treat malnutrition early in the stay.

A prospective analysis of factors influencing outcome after fundoplication

Fundoplication remains a common operation in the braindamaged pediatric patient, but recent reports suggest a poor outcome in these patients. The factors that might be associated with complications or recurrence after fundoplication have not been extensively examined. Fifty-six brain-damaged children, aged 6 months to 12 years, with documented gastroesophageal (GE) reflux underwent preoperative nutritional evaluations (percentage of ideal weight, albumin, nutrition risk index [NRI]) and documentation of medications (dexamethasone for bronchopulmonary dysplasia) before standard Nissen fundoplication. Hospital stay, intensive care unit (ICU) stay, and time on ventilator, as well as major postoperative complications (wound infection/dehiscence, pneumonia) were prospectively analyzed. Survival and recurrence rates 1 to 3 years postoperatively were also assessed. Eighty-two percent of patients were <90% ideal weight, and 50% had NRI < 90 (normal = 100) and 29% had albumin < 3.5 g/dL. Albumin < 3.5 was significantly ( P < .01) associated with prolonged hospitaliaation (26.8 + 2.2 versus 15.1 + 1.1 days) and ICU stay (13.8 + 1.0 versus 4.4 + .5 days) and time on ventilator (8.0 + 1.0 versus 1.8 + .4 days). NRI < 90 showed similar significant differences ( P < .01). Ideal body weight < 90% was not significant. Major complications developed in 54% of patients; only two or more preoperative nutritional deficiencies, or a nutritional deficiency plus dexamethasone were significantly associated ( P < .01). Recurrence occurred in 21% of patients and was significantly and especially when dexamethasone plus a nutritional deficit were present (low albumin, P < .001; low NRI, P < .005). No factor correlated with survival. These data show that preoperative nutritional status greatly affects short- and long-term results after fundoplication, especially when steroids are also administrred, suggesting that preoperative nutritional support might benefit these patients.

Influence of nutritional and haemoglobin status on malaria infection in children

Anaemia and malnutrition have been suggested to confer some degree of protection against malaria infection. Therefore, the influence of nutritional status as assessed anthropometrically and that of haemoglobin level on the incidence of malaria and the degree of parasitaemia was studied in 330 children in the age range of 1-9 years in Bisra block near Rourkela in Orissa state. Moderate to severe malnutrition as assessed from percentage of ideal weight was found in 48.8% (161/330) of children but only 8.8% (29/330) of children had some degree of malnutrition when assessed as weight for height indicating presence of chronic malnutrition. Similarly, 197 children (59.7%) had various grades of anaemia as estimated by haemoglobin level prevalence of malaria on initial examination was 27.6% (91/330), while incidence of clinical malaria in children during the year of study was 250/1000. There was no statistical difference in the Prevalence/incidence of malaria or severity of P. falciparum parasitaemia at different haemoglobin or nutritional levels (p > 0.05). No child died or developed severe complications requiring hospitalization. Therefore, anaemia or malnutrition do not appear to provide any protection against malaria or degree of parasitaemia in the children around Rourkela.

Weight gain as an indicator of response to chemotherapy for oesophageal carcinoma.

Patients with oesophageal carcinoma commonly present with dysphagia and weight loss, which may be related to the tumour burden and/or the physical obstruction to the passage of food. In this study we have examined the relationship between weight change and response to chemotherapy in 28 patients undergoing neo-adjuvant chemotherapy for squamous or anaplastic carcinoma. Two pulses of mitomycin, ifosfamide and cisplatin were given 3 weeks apart. Body weights were measured prior to the first pulse and 3 weeks after the second. Patients underwent oesophageal dilatation routinely at diagnostic endoscopy prior to chemotherapy, in order to permit oral nutrition. No dietary modifications were made. Tumour response was assessed on a barium swallow. Patients had a normal spread of weights on presentation. In the non-responding group (n = 9), eight patients lost weight and one gained weight. Of the partial responders (> 50% tumour shrinkage; n = 11), five gained weight, five lost weight and one remained constant. In the complete response group (n = 8), six gained weight and two lost weight. Statistical analysis showed a significant difference (F = 4.61; P = 0.02) between change in weight expressed as a percentage of ideal weight in nonresponders (mean -5.3%) versus partial responders (mean +2.4%), and in non-responders versus complete responders (mean +1.1%). Weight gain during chemotherapy is a good indication of response, although its absence does not preclude a response. In the majority of patients who respond to chemotherapy there will be an increase in weight with improvement in their general condition prior to operation.

Reduction in long-term antihypertensive medication requirements. Effects of weight reduction by dietary intervention in overweight persons with mild hypertension

Increasing concern over long-term drug treatment of mild hypertension has stimulated several studies of weight reduction. Phase I of the Trial of Antihypertensive Interventions and Management demonstrated a short-term effect of weight loss on blood pressure control in overweight persons with mild hypertension, who were either taking placebo or taking low-dose monotherapy. Phase II investigates the long-term benefit of weight loss on the ability to maintain blood pressure control. From 10148 community-based screenees, 587 persons (5.8%), aged 21 to 65 years, entered a multicenter, randomized drug (double-blind, placebo-controlled) and diet trial. Participants had a diastolic blood pressure between 90 and 100 mm Hg and were at 110% to 160% of their ideal weight. They were randomized to a usual diet (n = 296) or to a weight loss diet (n = 291) and within each diet group to placebo, chlorthalidone, 25 mg/d, or atenolol, 50 mg/d. Treatment failure was defined as using additional antihypertensive medications if diastolic blood pressure rose above 90 mm Hg according to protocol-specified criteria. At baseline, mean diastolic blood pressure was 93 mm Hg; systolic blood pressure, 143 mm Hg; weight, 88 kg; percent ideal weight, 137%; age, 48 years; 56% were men; and 33% were black. Mean follow-up was 4.5 years. There was a net loss of 2 to 3 kg with weight loss diet compared with usual diet over most of the follow-up period. The 5-year incidence of treatment failure was 56.7 per 100 participants with usual diet and 49.8 per 100 with weight loss. Long-term weight loss decreased failure of blood pressure control for those receiving placebo or low-dose diuretic or beta-blocker by 23%. The results were similar in direction in each drug group. The Trial of Antihypertensive Interventions and Management demonstrated that weight reduction is an effective long-term therapy for maintaining blood pressure in the normal range when used as monotherapy or in combination with either thiazide diuretics or beta-blockers. Consequently, weight loss should be recommended for the management of obese individuals with mild hypertension.

Effectiveness of programme for reducing cardiovascular risk for men in one general practice.

To assess the effectiveness of a programme for reducing cardiovascular risk in men in terms of clinical measurements and perceptions of patients. Collection of paired data on men attending well person clinics over three to five years. Questionnaire to determine changes in risk related habits. Well person clinics in rural general practice with five partners in mid-Wales. The first 687 men seen in the clinic: analysable data obtained on 520. Initial age range 28-60 years. Analysis of serum cholesterol concentration (mmol/l) and blood pressure (mm Hg). Changes in diet, exercise, smoking, and drinking. Mean (SD) cholesterol concentration for all subjects increased from 5.8 (1.0) to 6.0 (1.0), p < 0.001. Overall percentage of ideal weight and mean systolic blood pressure also increased. Mean diastolic blood pressure was unchanged at 84 mm Hg. Professed dietary change, age, and number of visits all had significant effects on final cholesterol concentration. Those seen more often showed a significant decrease in cholesterol concentrations (in those seen more than twice mean (SD) initial value 6.7 (0.9) mmol/l v final value 6.5 (1.0) mmol/l, p < 0.001). Those over 45 years at start of study showed a significant decrease in diastolic blood pressure (mean (SD) initial value 89 (9) mm Hg v final value 86 (7) mm Hg, p < 0.001). These clinics are not effective in achieving a reduction in mean cholesterol concentration or blood pressure, despite evidence that the message of reduction in risk had been successfully transmitted. Success was achieved in older patients and those in whom a definite problem was identified. Identification of high risk groups and clinical case finding with appropriate long term follow up may be more cost effective in reducing cardiovascular risk than non-specific screening of the whole population.

Heart-lung transplantation for cystic fibrosis. 1: Assessment.

Forty five patients with cystic fibrosis (age 5-15 years) were assessed for heart-lung transplantation between September 1987 and March 1990. The two main conditions for acceptance were (i) life expectancy less than 2 years and (ii) a severely impaired quality of life. Patients were accepted onto an active waiting list (n = 26), a provisional waiting list (n = 15), or not accepted (n = 4). Selection was made on clinical grounds with objective measurements used as an aid in assessment. As expected, the mean values for objective measures were significantly different between patients on the active waiting list compared with the provisional waiting list/not accepted group for resting heart rate (118/minute v 101/minute), percentage of ideal weight (83.2% v 93.1%), forced expiratory volume at one second as percent of predicted normal (27.3% v 47.6%), Shwachman-Kulczycki score (33.6 v 52.5), Chrispin-Norman x ray score (25.8 v 22.1), 12 minute walk (540 m v 854 m), and minimal oxygen saturation (81.5% v 92%). Psychological evaluation demonstrated a 55% incidence of individual and a 50% incidence of family morbidity. Of the 26 patients accepted onto the active waiting list, 11 have been transplanted (mean waiting time 3.3 months), 10 have died within a mean of 3.7 months of acceptance, and five remain on the active list (mean 5.6 months).