Unintended Weight Loss Research Articles

Tu1381 - Impact of Treatments on Diabetic Control and Gastrointestinal Symptoms after Total Pancreatectomy

OBJECTIVES The aims of this study were to compare the safety, efficacy, and patients' quality of life with continuous subcutaneous insulin infusion (CSII) versus multiple daily injections (MDIs) in type 3c diabetes mellitus (T3cDM) following total pancreatectomy (TP) and pancreatic enzyme usage. METHODS Thirty-nine patients with T3cDM (18 CSII patients vs 21 MDI patients) who underwent TP between 2000 and 2016 at 3 Harvard-affiliated hospitals and the University of Minnesota returned prospectively obtained questionnaires examining quality of life and both endocrine and exocrine pancreatic functions. RESULTS Main indications for TP were as follows: chronic pancreatitis (n = 19), intraductal papillary mucinous neoplasm (n = 12), and adenocarcinoma (n = 4). Median hemoglobin A1c using MDIs was 8.1% versus 7.3% in CSII. Severe hypoglycemic events using MDIs were increased compared with CSII (P = 0.02). There were no significant differences in quality-of-life measures with CSII versus MDIs. Pancreatic enzyme dose per meal (P < 0.05) differed between the hospitals. Gastrointestinal symptoms and unintended weight loss (P < 0.01) were more common with low doses of pancreatic enzymes. CONCLUSIONS After TP, CSII therapy is safe compared with MDIs in T3cDM and not associated with an increase in severe hypoglycemic events. Pancreatic enzyme replacement therapy is highly variable with low doses associated with unintentional weight loss and gastrointestinal symptoms.

Examining the relationship between therapeutic self-care and adverse events for home care clients in Ontario, Canada: a retrospective cohort study

BackgroundIn an era of a rapidly aging population who requires home care services, clients must possess or develop therapeutic self-care ability in order to manage their health conditions safely in their homes. Therapeutic self-care is the ability to take medications as prescribed and to recognize and manage symptoms that may be experienced, such as pain. The purpose of this research study was to investigate whether therapeutic self-care ability explained variation in the frequency and types of adverse events experienced by home care clients.MethodsA retrospective cohort design was used, utilizing secondary databases available for Ontario home care clients from the years 2010 to 2012. The data were derived from (1) Health Outcomes for Better Information and Care; (2) Resident Assessment Instrument-Home Care; (3) National Ambulatory Care Reporting System; and (4) Discharge Database. Descriptive analysis was used to identify the types and prevalence of adverse events experienced by home care clients. Logistic regression analysis was used to examine the association between therapeutic self-care ability and the occurrence of adverse events in home care.ResultsThe results indicated that low therapeutic self-care ability was associated with an increase in adverse events. In particular, logistic regression results indicated that low therapeutic self-care ability was associated with an increase in clients experiencing: (1) unplanned hospital visits; (2) a decline in activities of daily living; (3) falls; (4) unintended weight loss, and (5) non-compliance with medication.ConclusionsThis study advances the understanding about the role of therapeutic self-care ability in supporting the safety of home care clients. High levels of therapeutic self-care ability can be a protective factor against the occurrence of adverse events among home care clients. A clear understanding of the nature of the relationship between therapeutic self-care ability and adverse events helps to pinpoint the areas of home care service delivery required to improve clients’ health and functioning. Such knowledge is vital for informing health care leaders about effective strategies that promote therapeutic self-care, as well as providing evidence for policy formulation in relation to risk mitigation in home care.

Frailty in patients admitted to hospital with acute decompensated heart failure

Frailty is a geriatric syndrome characterized by a progressive impairment in the subjects’ ability to respond to environmental stress. Frailty is more commonly found in heart failure (HF) patients than in general population and it is an independent predictor of rehospitalization, emergency room visits and death. To estimate the prevalence of frailty in patients with decompensated HF admitted to four hospitals in Santiago, Chile. Cross-sectional study. Subjects aged 60 or older consecutively admitted for decompensated HF to the study centers between August 2014 and March 2015 were included. Frailty was defined as the presence of three or more of the following criteria: unintended weight loss, muscular weakness, depression symptoms (exhaustion), reduced gait speed and low physical activity. Independent variables were tested for association using simple logistic regression. Variables associated with frailty (p < 0.05) were included in a multiple logistic regression model. Seventy-nine subjects were included. The prevalence of frailty was 50.6%. Frail patients were mostly female (52.6%) and older than non-frail subjects (73.7± 7.9 vs 68.2 ± 7.1; p < 0.003). Independent predictors of frailty were age (Odds raio (OR) 1.10; 95% confidence intervals (CI): 1.03-1.17), quality of life measured with the Minnesota Living with Heart Failure Questionnaire (OR 1.07; IC95%: 1.03-1.11), previous hospitalizations (OR 2.56; 95%CI: 1.02-6.43) and number of medications (OR 4.46; 95%CI: 1.11-17.32). The prevalence of frailty in patients admitted to the hospital for decompensated heart failure is high. Age, quality of life, hospitalizations and polypharmacy were factors associated with frailty in this group of participants.

P2.08-005 Treating Cachexia-Anorexia in Lung Cancer Patients: Understanding the Patient Perspective on Novel Treatment Approaches: Topic: Patient’s Voice, Patient’s Information

Cachexia-anorexia (CA) is a weight loss/appetite loss syndrome commonly affecting cancer patients. It is characterized by progressive sarcopenia (loss of muscle mass) accompanied by weight and appetite loss. These physiological changes lead to a decreased ability to perform daily activities, a reduction in the quality of life of the patient, and a decrease in the efficacy of chemotherapy and other treatments. Typically, oncologists focus on palliation of the symptoms of CA, and the reduction of distress of patients and families instead of on a cure. Recently, drugs that offer the possibility of treatment have shown promise in clinical trials. We conducted an online survey of lung cancer patients to understand:•Prevalence of CA among lung cancer patients•Extent of impairment of quality of life of lung cancer patients•How patients are managing the symptoms of CA The study was approved by Schulman IRB, Inc (IRB#201600600). Three hundred and thirty-five lung cancer patients were surveyed through different online platforms (social media and LUNGevity homepage). Of the lung cancer patients surveyed:•Six in ten report experiencing one or more of the physical changes asked about (unintended weight loss, loss of appetite, loss of muscle mass, and malnutrition)•Patients currently undergoing treatment and Stage IV patients are more likely to experience these changes and be concerned than those who are not currently undergoing treatment or have less advanced lung cancer•Unintended weight loss and other physical changes are most likely to lead to a decline in patients’ strength, energy level, and ability to engage in physical activities. Among patients who experienced a decrease in quality of life, the most important aspects they would like to improve or maintain are their energy level and their ability to remain independent.•Patients were measured in their willingness to try new treatment approaches, especially when presented with a description of the adverse events associated with treatment. Cachexia-anorexia is common in lung cancer patients, including early-stage patients. Patient attitudes towards CA differ among those whose quality of life has been impaired due to weight loss and those who are able to continue living a normal life. Maintaining a sense of independence was of primary importance to all patients. Their willingness to try new treatment options, however, is based on understanding both the benefits and risks of these treatments, suggesting that a well-informed patient is more effectively engaged in their treatment decisions.

ANNA-1 Paraneoplastic Encephalomyelitis Presenting as Rapidly Progressing Dementia in a Man With Undiagnosed Small Cell Lung Cancer

ANNA-1 Paraneoplastic Encephalomyelitis Presenting as Rapidly Progressing Dementia in a Man With Undiagnosed Small Cell Lung Cancer

Which patients with myelofibrosis should receive ruxolitinib therapy? ELN-SIE evidence-based recommendations.

Ruxolitinib is an oral Janus-activated kinase 1 (JAK1)/JAK2 inhibitor approved for the treatment of patients with myelofibrosis based on the results of two randomized clinical trials. However, discordant indications were provided by regulatory agencies and scientific societies for selecting the most appropriate candidates to this drug. The European LeukemiaNet and the Italian Society of Hematology shared the aim of building evidence-based recommendations for the use of ruxolitinib according to the GRADE methodology. Eighteen patient-intervention-comparator-outcome profiles were listed, each of them comparing ruxolitinib to other therapies with the aim of improving one of the three clinical outcomes: (a) splenomegaly, (b) disease-related symptoms, and (c) survival. Ruxolitinib was strongly recommended for improving symptomatic or severe (>15 cm below the costal margin) splenomegaly in patients with an International Prognostic Scoring System (IPSS)/dynamic IPSS risk intermediate 2 or high. Ruxolitinib was also strongly recommended for improving systemic symptoms in patients with an MPN10 score >44, refractory severe itching, unintended weight loss not attributable to other causes or unexplained fever. Because of weak evidence, the panel does not recommend ruxolitinib therapy for improving survival. Also, the recommendations given above do not necessarily apply to patients who are candidates for allogeneic stem cell transplant.

Risk Factors for Malnutrition in Seniors Aged 75+ Living in Home Environment in Selected Regions of the Czech Republic.

Nutrition is an important social determinant of health that influences the ageing process. The aim of this study was to evaluate the nutritional condition of a group of seniors and identify the bio-psycho-social factors that increase the risk of malnutrition. The research was conducted using a quantitative method. The standardised scales Mini Nutritional Assessment - Short Form (MNA-SF) and the Geriatric depression scale (GDS-5) were used to evaluate the nutritional condition and tendency towards depression of the tested group. This group consisted of seniors aged 75 and above living in home environment in the České Budějovice region. The group was comprised of 320 seniors, 115 men (35.9%) and 205 women (64.1%), which corresponds to the composition of the population in the chosen region of the Czech Republic. Statistical data analysis was conducted using SASD 1.4.10 and SPSS 15.0 programs. Pearson's chi-squared test (Χ²) and Cramér's V were chosen for statistical testing. The significance level was set at 5%. The average BMI value of the seniors was 26.2 kg/m² (overweight). This value decreased with age. More than one third of the respondents were evaluated as being at risk of malnutrition (36.3%). Unintended weight loss was determined as the strongest risk factor of malnutrition. Seniors who had lowered their food intake stated unintended weight loss 10 times more often than respondents with no noticeable reduction in food intake. Seniors who showed signs of depression indicated weight loss three and a half times more often than respondents without depression. Meanwhile acute illness increased the risk by three times. Depression was found to be the cause and also the consequence of malnutrition. Despite the high prevalence of overweight and obesity, a large proportion of the respondents were running the risk of malnutrition. It was concluded that the strongest risk factors for malnutrition in the respondents were unintended weight loss, depression and lowered food intake. Compared to biological factors, social and economic factors were less significant in causing malnutrition in seniors.

Abstract PR413

Background & Objectives: Many gastrointestinal surgeries are processed every year. To find the risk factors for delaying of the length of stay after surgery of patients undergoing elective gastrointestinal surgery. Materials & Methods: We performed a retrospective clinical study using data from January 2013 to March 2013 in West China hospital, Sichuan University. We selected the patients undergoing elective gastrointestinal surgery, and according the length of stay after surgery we divided them into two groups. Group A included the patients discharged from hospital in average days (≤ 9 days). The patients in Group B stayed in hospital more than average days (> 9 days). For the continuous variables, we used one-sample t test. For binary categorical variables, we used Chi-square test or fisher’s exact test. For ordinal categorical variables, we used Mann-Whitney u test. And logistic regression was used to identify risk factors for delaying the length of stay after surgery. All potential risk factors were analyzed through univariate logistic regression analysis. Results: Among many potential risk factors, we found that unintended weight loss (OR=2.522, CI, 1.222-5.204, p=0.012), prolonged operative time (P=0.003), urine output (P=0.006), fasting time after surgery (Exp (B) =1.628, CI, 1.412-1.879, P=0.000), and postoperative administration of advanced antibiotics (P=0.004) were risk factors which made patients stay longer in hospital after surgery. Conclusion: Length of stay after surgery is a complex outcome influenced by multiple factors. Weight loss, long operative time, less urine output, postoperative infection and fasting after surgery are risk factors for influencing recovery after surgery. Disclosure of Interest: None declared

A Rare Angiosarcomatous Transformation in a Primary Gastrointestinal Stromal Tumor: A Case Study

Gastrointestinal stromal tumor (GIST) is the most frequent mesenchymal tumor of the digestive tract, with 2/3 of cases occurring in the stomach. We report a case of GIST with rare angiosarcomatous transformation in a 59-year man who presented with a 50 lb unintended weight loss. Esophagogastroduodenoscopy demonstrated a 5 cm ulcerated mass in the body of the stomach. Morphologic diagnosis of high-grade …

Factors associated with unintended weight change in the UK Armed Forces: a cohort study.

ObjectiveTo examine factors associated with self-reported unintended weight change in (ex-) military personnel of the UK Armed Forces.DesignA cohort study whereby a self-report questionnaire was administered at baseline (2003–2005) and follow-up (2007–2009).ParticipantsA total of 6352 former and serving military personnel of the UK Armed Forces.SettingUnited Kingdom.Main outcome measuresPersonnel were asked about socio-demographic, military and (mental) health characteristics, including screening measures for common mental health disorders. Further, participants were asked to report unintended weight fluctuations (none, < or > than 10 lbs in the past month). Multinomial regression analyses were used to identify factors associated with self-reported weight change at follow-up.ResultsOut of the 6352 former and serving military personnel, 123 (2.1%) reported unintended weight loss and 577 (9.0%) reported unintended weight gain in the past month. At follow-up, multivariable analyses indicated that unintended weight loss or weight gain was more likely to be reported by those who screened positive for mental health problems and those reporting weight changes at baseline. Reported weight loss was more common among smokers than non-smokers, whereas reported weight gain at follow-up was associated with having a higher BMI at baseline.ConclusionsAt follow-up, self-reported unintended weight changes in former and serving military personnel of the UK Armed Forces were found to be associated with mental health problems, body mass index, smoking and self-reported weight changes at baseline.

Aging clinical problems: a difficult balance between age and frailty.

Frailty is a common geriatric syndrome that embodies an elevated risk of catastrophic declines in health and function among older adults. Frailty is a condition associated with ageing with associated weakness, slowing, decreased energy, lower activity, and, when severe, unintended weight loss. As a population ages, a central focus of geriatricians and public health practitioners is to understand, and then beneficially intervene on, the factors and processes that put elders at such risk, especially the increased vulnerability to stressors (e.g. extremes of heat and cold, infection, injury, or even changes in medication) that characterizes many older adults. The syndrome of geriatric frailty is hypothesized to reflect impairments in the regulation of multiple physiologic systems, embodying a lack of resilience to physiologic challenges and thus elevated risk for a range of deleterious endpoints. The empirical assessment of geriatric frailty in individuals seeks to capture this or related features.

Waxing and waning eczematous dermatitis and glossitis

Fig 2 View Large Image Figure Viewer Download Hi-res image Fig 3 View Large Image Figure Viewer Download Hi-res image A 61-year-old woman presented with a 3-year history of a recurrent, painful rash and tongue pain. She denied jaundice, fatigue, abdominal pain, or a change in bowel habits. The physical examination revealed atrophic glossitis and thin, scaly, erythematous, tender plaques and scattered erosions on her face, trunk, perineum, buttocks, gluteal cleft, and extremities (Fig 1, Fig 2, Fig 3). Her abdomen was soft, nontender, and without palpable masses. A skin biopsy obtained by a different institution revealed “eczema.” However, she experienced minimal relief with topical or systemic corticosteroids. Two years after onset of the rash, she developed nausea, vomiting, and an unintended weight loss of 10 kg, which prompted additional work-up and treatment. 1.What is the most likely diagnosis? A.Drug eruption B.Seborrheic dermatitis C.Necrolytic migratory erythema D.Tinea corporis E.Necrolytic acral erythema 2.Which of the following is the most specific test for diagnosing the underlying cause of the patient's rash? A.Serum glucagon level B.Serum zinc level C.Potassium hydroxide preparation D.Hepatitis C serologies E.Absolute eosinophil count 3.What would be an appropriate first-line treatment for the underlying cause of the patient's eruption? A.Topical steroids B.Topical antifungal medications C.Nutritional supplementation D.Surgical resection E.Antiviral medications

The Impact of Medical Comorbidities in MPN-Related Fatigue

Background:Philadelphia chromosome negative myeloproliferative neoplasms (MPN) include myelofibrosis (MF), polycythemia vera (PV), and essential thrombocythemia (ET). Pertinent to these disorders is the high persistence, prevalence, and severity of fatigue. Overall, excessive fatigue compared to age and gender matched controls occurs in greater than 95% of MPN patients (Blood. 2011;118(2):401-8). Physiologic etiologies of fatigue in these patients include cytokine dysregulation and impaired hematopoiesis, however to date no one has investigated the impact that cofounding medical illnesses have on MPN fatigue burden.Methods:A 70-item internet-based survey was developed by a team of MPN investigators, patient advocates from MPN Forum, and hosted by the Mayo Clinic Survey Research Center. The survey was promoted online via multiple MPN-related webpages including the MPN Forum, MPN Net, MPN Research Foundation, and MPN Voice during late February to March of 2014. Surveyed data included disease demographics such as splenomegaly, thrombosis, hemorrhage transfusions, medications, and phlebotomies. The MPN-SAF (including the MPN 10) was utilized including the 10-item brief fatigue inventory was used to assess disease burden (Blood. 2011 Jul 14;118(2):401-8). Comorbid conditions were assessed, including hypothyroidism, anemias, sleep disturbances, obesity, and heart and lung disorders.Data:Demographics. Overall 1788 MPN patients participated in the survey. Of these, 1676 consented to participate and provided additional data (i.e., completed at least 10 questions). Of these, 555 (33%) patients had ET, 651 (39.0%) had PV, and 417 (25.0%) had MF. Among MF patients, 44.1% had primary MF, 29.7% had post-PV MF, and 26.2% had post-ET MF. Respondents were 68% female with a mean age of 59. Overall brief fatigue inventory score had a mean of 4.4 (range 0-10). MPN-10 score average was 28.4 (range 0-83).Medical Comorbidities. Overall, many patients endorsed having comorbid medical diseases that could contribute to overall fatigue (Table1). Overall 20.2% of patients endorsed having low thyroid function, with 10% indicating they obtained this diagnosis in the last six months. Twenty three percent endorsed having a new sleep disturbance in the last six months. On average, patients tended to have an average to above average BMI (mean =26.3, median = 25.0). However, many patients also experienced a high rate of unintended weight loss (11.8% with >11lb weight loss in the last 6 months). Cytopenias were also frequently encountered, with 14.7% of participants having required previous transfusions. Among these, 46% required transfusions in the last 6 months. Thrombosis (18.3%), hemorrhage (14.7%), and anemia (48.0%) were relatively common. In the last six months, 11.1% of patients required iron supplementation and 2.2% required erythropoietin injections. Many patients also endorsed the use of medications that could contribute to overall fatigue.Correlations. Items significantly correlated with worsened fatigue score (BFI greater than or equal to four) included female gender (<0.001), age (p=0.0047), lower education level (<0.001) and lower BMI (<0.001). Current use of alcohol and tobacco was also significantly associated with greater burden of fatigue (<0.001 and 0.0025, respectively). Items not significantly associated with fatigue included DIPSS (MF only), IPSET (ET only) or PV risk scoring.ConclusionsOverall patients with MPN experience an exclusive pattern of disabling fatigue. Many fatigue-related medications and medical comorbidities may contribute to the debilitating fatigue seen among MPN patients, although no specific comorbidities could account for the high prevalence of fatigue. Rates of comorbid disease burden varied widely compared to the general population. For some diseases including diabetes, rates among MPN populations were less than the general population (National Diabetes Statistics Report, 2014), however the rates of other comorbidities, such as hypothyroidism, were higher (J Clin Endocrinol Metab 2002;87:489–99). Similar to our previous studies, females tended to suffer from a higher mean fatigue burden than males (Geyer ASH 2014). Clinical and research-related determination of fatigue should take into account cofounding comorbid medical conditions that can contribute to overall fatigue burden. [Display omitted] DisclosuresHarrison:Novartis: Consultancy, Honoraria, Research Funding, Speakers Bureau; Sanofi: Honoraria, Speakers Bureau; Shire: Speakers Bureau; CTI: Consultancy; YM Bioscience: Consultancy; Gilead: Consultancy; SBio: Consultancy. Mesa:Incyte: Research Funding; Novartis: Consultancy; Gilead: Research Funding; Genentech: Research Funding; Promedior: Research Funding; Ns Pharma: Research Funding; Celgene: Research Funding; Lilly: Research Funding; Cti: Research Funding.

Predicting risk of hospital and emergency department use for home care elderly persons through a secondary analysis of cross-national data.

BackgroundOlder adults remain the highest utilization group with unplanned visits to emergency departments and hospital admissions. Many have considered what leads to this high utilization and the answers provided have depended upon the independent measures available in the datasets used. This project was designed to further understanding of the reasons for older adult ED visits and admissions to acute care hospitals.MethodsA secondary analysis of data from a cross-national sample of community residing elderly, 60 years of age or older, and most of whom received services from a local home-care program was conducted. The assessment instrument used in this study is the interRAI HC (home care), designed for use in assessing elderly home care recipients. The model specification stage of the study identified the baseline independent variables that do and do not predict the follow-up measure of hospitalization and ED use. Stepwise logistic regression was used next to identify characteristics that best identified elders who subsequently entered a hospital or visited an ED. The items generated from the final multivariate logistic equation using the interRAI home care measures comprise the interRAI Hospital-ED Risk Index.ResultsIndependent measures in three key domains of clinical complications, disease diagnoses and specialized treatments were related to subsequent hospitalization or ED use. Among the eighteen clinical complication measures with higher, meaningful odds ratios are pneumonia, urinary tract infection, fever, chest pain, diarrhea, unintended weight loss, a variety of skin conditions, and subject self-reported poor health. Disease diagnoses with a meaningful relationship with hospital/ED use include coronary artery disease, congestive heart failure, cancer, emphysema and renal failure. Specialized treatments with the highest odds ratios were blood transfusion, IV infusion, wound treatment, radiation and dialysis. Two measures, Alzheimer’s disease and day care appear to have a protective effect for hospitalization/ED use with lower odds ratios.ConclusionsExamination into “preventable” hospitalizations and re-hospitalizations for older adults who have the highest rates of utilization are occurring beneath an umbrella of assuring the highest quality of care and controlling costs. The interRAI Hospitalization-ED Risk Index offers an effective approach to predicting hospitalization utilization among community dwelling older adults.

Predictors Of Averse Events After Total Laryngectomy: An Analysis Of The 2005-2011 NSQIP Datasets

Background: We reviewed the 2005-2011 ACS-NSQIP database to evaluate factors associated with adverse events (AE) after total laryngectomy (TL). Methods: All total laryngectomies performed from 2006 to 2011 were identified for analysis. The cohort was characterized with respect to preoperative and demographic characteristics, complications, reoperation, and mortality. Results: 493 cases were identified. Complications of any category occurred in 189 cases (38.3%). Factors that were found to confer significant risk for medical complications were increased age [Odds Ratio (OR) 1.03], prior PCI (OR 2.84), disseminated cancer (OR 2.47), chronic steroid/immunosuppresion use (OR 2.87), unintended weight loss > 10% over 6 months prior to surgery (OR 2.02), increasing work RVU total (OR 1.02), and increased anesthesia Z-score (OR 1.31). Only increased anesthesia Z-score (OR 1.27) was found to be a statistically significant risk factor for surgical complications. Chronic steroid/immunosuppression use (OR 3.16) and increased anesthesia Z-score (OR 1.29) were both found to be statistically significant risk factors of reoperation within 30 days. Conclusions: NSQIP is the only dataset that correctly discerns between minimally invasive and wide excision in laryngectomy. The use of the NSQIP dataset may be imperfect, as pertinent details of chemotherapy and radiation, and procedure-specific complications, including fistula formation, are not tracked. In spite of this, our findings suggest avenues for improvement in the care of TL patients, and suggest directions for a laryngectomy-specific outcomes database. DOI : 10.14302/issn.2379-8572.joa-14-429 Corresponding Author: Jon P Ver Halen, MD, FACS, Division of Plastic and Reconstructive Surgery, Baptist Cancer Center; Department of Surgery, St. Jude Childrens’ Research Hospital; Department of Surgical Oncology, Vanderbilt-Ingram Cancer Center, 3268 Duke Circle, Germantown, TN 38139 Email: jpverhalen@gmail.com Tel: (206) 963-8714, Fax: (901) 227-9825 Running Head: Tracking laryngectomy using NSQIP

Hypothalamic alterations in Huntington's disease patients: comparison with genetic rodent models.

Unintended weight loss, sleep and circadian disturbances and autonomic dysfunction are prevalent features of Huntington's disease (HD), an autosomal dominantly inherited neurodegenerative disorder caused by an expanded CAG repeat sequence in the HTT gene. These features form a substantial contribution to disease burden in HD patients and appear to be accompanied by a number of neuroendocrine and metabolic changes, pointing towards hypothalamic pathology as a likely underlying mechanism. Neuronal inclusion bodies of mutant huntingtin, which are hallmarks of the disease, occur throughout the hypothalamus, and indicate local mutant huntingtin expression that could interfere with hypothalamic neuropeptide production. Also, several genetic rodent models of HD show features that could be related to hypothalamic pathology, such as weight loss and circadian rhythm disturbances. In these rodents, several hypothalamic neuropeptide populations are affected. In the present review, we summarise the changes in genetic rodent models of HD for individual hypothalamic nuclei, compare these observations to the hypothalamic changes that occur in HD patients, and make an inventory of the work that still needs to be done. Surprisingly, there is only limited overlap in the hypothalamic changes reported in HD patients and genetic rodent models. At present, the only similarity between the hypothalamic alterations in HD patients and genetic rodent models is a decrease in the number of orexin-expressing neurones in the lateral hypothalamus. Possible reasons for these discrepancies, as well as potential consequences for the development of novel therapeutic strategies, are discussed.

Favourable effects of consuming a Palaeolithic-type diet on characteristics of the metabolic syndrome: a randomized controlled pilot-study.

BackgroundThe main goal of this randomized controlled single-blinded pilot study was to study whether, independent of weight loss, a Palaeolithic-type diet alters characteristics of the metabolic syndrome. Next we searched for outcome variables that might become favourably influenced by a Paleolithic-type diet and may provide new insights in the pathophysiological mechanisms underlying the metabolic syndrome. In addition, more information on feasibility and designing an innovative dietary research program on the basis of a Palaeolithic-type diet was obtained.MethodsThirty-four subjects, with at least two characteristics of the metabolic syndrome, were randomized to a two weeks Palaeolithic-type diet (n = 18) or an isoenergetic healthy reference diet, based on the guidelines of the Dutch Health Council (n = 14). Thirty-two subjects completed the study. Measures were taken to keep bodyweight stable. As primary outcomes oral glucose tolerance and characteristics of the metabolic syndrome (abdominal circumference, blood pressure, glucose, lipids) were measured. Secondary outcomes were intestinal permeability, inflammation and salivary cortisol. Data were collected at baseline and after the intervention.ResultsSubjects were 53.5 (SD9.7) year old men (n = 9) and women (n = 25) with mean BMI of 31.8 (SD5.7) kg/m2. The Palaeolithic-type diet resulted in lower systolic blood pressure (−9.1 mmHg; P = 0.015), diastolic blood pressure (−5.2 mmHg; P = 0.038), total cholesterol (−0.52 mmol/l; P = 0.037), triglycerides (−0.89 mmol/l; P = 0.001) and higher HDL-cholesterol (+0.15 mmol/l; P = 0.013), compared to reference. The number of characteristics of the metabolic syndrome decreased with 1.07 (P = 0.010) upon the Palaeolithic-type diet, compared to reference. Despite efforts to keep bodyweight stable, it decreased in the Palaeolithic group compared to reference (−1.32 kg; P = 0.012). However, favourable effects remained after post-hoc adjustments for this unintended weight loss. No changes were observed for intestinal permeability, inflammation and salivary cortisol.ConclusionsWe conclude that consuming a Palaeolithic-type diet for two weeks improved several cardiovascular risk factors compared to a healthy reference diet in subjects with the metabolic syndrome.Trial registrationNederlands Trial Register NTR3002

A Case of Superior Mesenteric Artery Syndrome

Case Report: A 31-year-old woman with celiac disease presented with onset of RUQ pain, which she had developed while on a field trip. Pain was sharp and constant with associated nausea but no vomiting. There was early satiety and unintended weight loss of 18 lbs. She was afebrile and her vitals were within normal range. There was tenderness on deep palpation in the RUQ. There was no guarding, rigidity or rebound tenderness. Laboratory evaluation revealed leukocytosis and anemia. Cross sectional imaging with contrast revealed significant narrowing of duodenum between aorta and SMA and compression of the transverse duodenum. EGD showed dilation of the duodenum. Small bowel series showed decreased flow in the duodenum across the midline. US showed the angle between duodenum and aorta to be 25 degrees. A diagnosis of SMA syndrome was made. Conservative management was successful in resolving her symptoms. She has not required surgical intervention to this point. Discussion: Superior mesenteric artery syndrome (SMAS) is an uncommon but well-recognized clinical entity. It is characterized by compression of third or transverse part of duodenum between aorta and superior mesenteric artery (SMA). The SMA usually forms an angle of 45 degrees between with the abdominal aorta and the third part of duodenum, which crosses caudal to the origin of the SMA. Any factor that narrows this angle can cause entrapment of transverse duodenum resulting in SMA syndrome. SMA syndrome may present acutely or with acute exacerbation of chronic symptoms. Symptoms can include epigastric pain, nausea, vomiting, postprandial discomfort, and early satiety. Symptoms are often aggravated when the patient is in supine position and relieved in the lateral decubitus, prone or kneechest positions. SMA syndrome may be suspected with clinical and radiographic findings suggestive of duodenal obstruction. Plain films may show dilated and fluid/gas filled stomach. Abdominal US may be helpful in measuring the angle between SMA and and aorta. Abdominal CT is also a useful diagnostic modality, providing aorta-SMA distance and evidence of duodenal distension. EGD may be required to exclude mechanical causes of duodenal obstruction. Conservative management is recommended for 4-6 weeks. This includes NG decompression, frequent small meals, and proper posturing (ie left lateral decubitus, prone, and knee chest position). Surgical intervention is indicated if these measures fail. Surgical options include bypass or derotation procedures. The outcome may be excellent with timely diagnosis and appropriate treatment.

Mealtime assistance and identification of eating difficulties prevent unintended weight loss in nursing home residents – A controlled trial

Background: The study evaluated an individualized multifactorial intervention to enhance the nutritional intake in nursing home residents. Method: The study was carried out as a controlled intervention study. Baseline data was collected during the first month and the intervention was continued for twelve months. Five units participated. Three units were conveniently selected for intervention and the two units as control units. Residents were included consecutively during the study period. In total 163 residents were available. Nutritional risk, eating difficulties and weight were obtained at baseline and every 3 months for a year. Interventions: An individual care plan was developed for each resident receiving extra mealtime assistance. Results: Rresidents who received mealtime assistance increased the average body weight significantly whereas the residents in the control units decreased their weight. Conclusion: Systematic identification of eating difficulties combined with sustained mealtime assistance is a safe and effective method to maintain body weight in nursing home residents.

B29 Two-point Magnitude Mri For Rapid Mapping Of Brown Adipose Tissue And Its Application To The R6/2 Mouse Model Of Huntingtons Disease

The recent discovery of active brown fat in human adults has led to renewed interest in the role of this key metabolic tissue in health and disease. This is particularly true for Huntington’s disease (HD), with a prominent energy deficit phenotype. HD patients show an unintended weight loss with normal or even high food intake already at early stages of the disease. Alterations in brown adipose tissue (BAT) including failure in thermogenesis are found in HD mouse models. Current methods for imaging BAT in vivo are in limited use because they are equipment-wise demanding and often prohibitively expensive. This prompted us to explore how a standard MRI set-up can be modified to visualise BAT in situ by taking advantage of its characteristic fat / water content ratio to differentiate it from surrounding white fat. We present a modified MRI protocol for use on an 11.7 T small animal MRI scanner to visualise and quantify BAT in wild-type and disease model laboratory mice. In this application study using the R6/2 transgenic mouse model of HD we demonstrate a significantly reduced BAT volume in HD mice vs. matched controls (n = 5 per group). This finding provides a plausible structural explanation for the previously described temperature phenotype of HD mice and underscores the significance of peripheral tissue pathology for the HD phenotype. On a more general level, the results demonstrate the feasibility of MR-based BAT imaging in rodents in vivo and open the path towards transferring this imaging approach to human patients. Future studies are needed to determine if this method can be used to track disease progression in HD and other disease entities associated with BAT abnormalities, including metabolic conditions such as obesity, cachexia, and diabetes. Funding EHDN seed fund 414.