Weeks Of Refeeding Research Articles

Changes in mRNA expression of grouper ( Epinephelus coioides) growth hormone and insulin-like growth factor I in response to nutritional status

Growth hormone (GH) and insulin-like growth factor-I (IGF-I) are key links to nutritional condition and growth regulation in teleost. To understand the endocrine mechanism of growth regulation in grouper, we cloned the cDNAs for grouper GH and IGF-I and examined their mRNA expression during different nutritional status. Grouper GH cDNA is 936 base pairs (bp) long excluding the poly-A tail. It contained untranslated regions of 85 and 231 bp in the 5′- and 3′-ends, respectively. It has an open reading frame of 612 bp coding for a signal peptide of 17 amino acids (aa) and a mature hormone of 187 aa residues. Based on the aa sequence of the mature hormone, grouper GH shows higher sequence identity (>76%) to GHs of perciforms than to GHs of cyprinids and salmonids (53–69%). Grouper preproIGF-I cDNA consisted of 558 bp, which codes for 186 aa. This is composed of 44 aa for the signal peptide, 68 aa for the mature peptide comprising B, C, A, and D domains, and 74 aa for the E domain. Mature grouper IGF-I shows very high sequence identity to IGF-I of teleost fishes (84–97%) compared to advanced groups of vertebrates such as chicken, pig, and human (⩽80%). Using DNA primers specific for grouper GH and IGF-I, the changes in mRNA levels of pituitary GH and hepatic IGF-I in response to starvation and refeeding were examined by a semi-quantitative RT-PCR. Significant elevation of GH mRNA level was observed after 2 weeks of food deprivation, and increased further after 3 and 4 weeks of starvation. GH mRNA level in fed-controls did not change significantly during the same period. Hepatic IGF-I mRNA level decreased significantly starting after 1 week of starvation until the 4th week. There was no significant change in IGF-I mRNA levels in fed-controls. One week of refeeding can restore the GH and IGF-I mRNA back to its normal levels. Deprivation of food for 1–4 weeks also resulted in cessation of growth and decrease in condition factor.

Compensatory growth in the Chinese longsnout catfish, Leiocassis longirostris following feed deprivation: Temporal patterns in growth, nutrient deposition, feed intake and body composition

To investigate the compensatory growth responses of the carnivorous Chinese longsnout catfish a 7-week study was performed at 28 °C. Juvenile longsnout catfish weighing a mean of 13.14 g were starved for 0 (control), 1 (S1) or 2 (S2) weeks and then re-fed to satiation for 4 weeks. Weekly changes in specific growth rate, feed intake and body composition were monitored during re-feeding. No significant difference was found in final body weight among the three groups, indicating complete compensation in the starved fish. The deprived groups caught up in body weight with that of the control within 2 weeks of re-feeding. Body concentrations of protein, lipid and energy were restored to control levels within 1 week of re-feeding. In the first week of re-feeding, specific growth rates of body weight, lipid, protein and energy contents were significantly higher in the deprived fish than in the control. In the second week of re-feeding, the specific growth rate of protein content of the S2 group was still higher than in the control. In the third week of re-feeding, the growth rates for lipid and energy content of the deprived fish dropped below that of the control, but were elevated again during the last week of the experiment. Feed intake was higher than the control level in the first week of re-feeding in the S2 group, but no significant difference was found between the S1 group and control. Growth efficiency in the S2 group was significantly higher than in the controls for the first week of re-feeding. The results were compatible with the hypothesis that compensatory growth restores the ratio of fat to lean body mass ratio in the deprived fish.

The refeeding syndrome and hypophosphataemia in the elderly

The refeeding syndrome and hypophosphataemia in the elderly

Improvement of Nutritional Status as Assessed by Multifrequency BIA During 15 Weeks of Refeeding in Adolescent Girls with Anorexia Nervosa

In patients with anorexia nervosa (AN), an assessment of changes in body composition and nutritional status is crucial for adequate nutritional management during refeeding therapies. Phase-sensitive multifrequency bioelectrical impedance analysis (BIA) is an inexpensive and noninvasive technique with which to determine nutritional status and body composition. We investigated 21 female adolescents with AN (initial BMI 15.5 +/- 1.1 kg/m(2)) 4 times between wk 3 and 15 of inpatient refeeding and 19 normal-weight, age-matched female controls. From wk 3 to 15, BMI, fat mass, body cell mass (BCM), total body water (TBW), intracellular water (ICW) but not extracellular mass (ECM), and extracellular water (ECW) increased significantly. Reactance (Xc), phase angle (PhA), and the ECM/BCM index as parameters of nutritional status improved significantly in patients and no longer differed from controls in wk 15, although the BMI of patients was significantly lower than those of controls. Changes in the ECM/BCM index were due to accretion of BCM, which was associated with an increase of ICW. Multifrequency phase-sensitive BIA seems to be a promising tool for the assessment of changes in nutritional status and body composition in patients with AN. An individually determined and controlled hyperenergetic diet as part of a multidimensional, interdisciplinary treatment program for eating disorders seems to quickly improve the nutritional status of AN patients.

Hypomagnesemia during refeeding in anorexia nervosa

Magnesium deficiency can cause weakness, constipation, seizures and arrhythmias. We frequently observe hypomagnesemia during refeeding in AN. To determine the incidence and time of onset of hypomagnesemia during refeeding in anorexia nervosa (AN). Observational cohort study. University teaching hospital in Vancouver, Canada. Patients with AN (DSM-IV criteria) admitted for refeeding. All patients were admitted for supervised refeeding by meal support, in conjunction with our standard medical and psychological treatment. Serum magnesium was measured daily for 5 days and then 3 times a week. Fifty patients were admitted for an average of 24 days. Sixty percent (30/50) had low serum magnesium during their admission. Hypomagnesemia was present on admission in 16% but as late as the third week of refeeding in others. Serum magnesium should be measured on admission and rechecked weekly for the first 3 weeks of refeeding as a minimum.

Effect of feeding malnourished patients for 1 mo on mitochondrial complex I activity and nutritional assessment measurements

We showed previously that the activity of complex I (the first enzyme of the electron transport chain) in peripheral blood mononuclear cells decreases with malnutrition and increases to a subnormal value after 1 wk of refeeding, but the traditional markers of nutritional status do not do so. The aim of this study was to ascertain whether a period of nutritional intervention longer than 1 wk would normalize complex I activity and traditional markers of nutritional status. Fifteen malnourished patients (7 women and 8 men) with > or =10% body weight loss over the previous 6 mo were studied on the day of their admission to hospital and 7, 14 and 30 d after the beginning of nutritional support. Complex I activity in peripheral blood mononuclear cells, weight, height, body composition, body water compartments, dietary intake, and serum albumin concentrations were measured on each occasion. The results before and during nutritional intervention were compared with values obtained in 30 healthy volunteers (17 women and 13 men). Complex I activity increased significantly after the first week of refeeding (P < 0.001) and reached a normal value after 1 mo of nutritional supplementation. Among the classic markers of nutritional status, only the ratio of extracellular water to intracellular water tended to decrease over the refeeding period. Complex I activity increases rapidly and is normalized by refeeding at a time when other markers of nutritional status do not change significantly.

Effect of food shortage and temperature on oxygen consumption in the lesser mealworm, Alphitobius diaperinus (Panzer) (Coleoptera: Tenebrionidae)

Abstract. Temperature and food availability are limiting factors for the establishment of tropical insects in temperate countries. In the alien pest beetle, Alphitobius diaperinus (Panzer) (Coleoptera: Tenebrionidae), starvation and temperature have a significant impact on metabolic rate with oxygen consumption ranging from 0.5 µmol/g fresh mass (FM)/h at 12 °C to 3.4 µmol/g FM/h at 24 °C. At 12 °C, oxygen consumption decreased continuously during an entire period of starvation. However, at 16, 20 and 24 °C, beetles display a marked hyperactivity that leads to an increase in the oxygen consumption level during the first week of starvation, followed by a steep decrease until the end of the starvation period. Oxygen consumption either does not decline in fed beetles (observed at higher temperatures) or declines at a much shallower rate than in starved beetles (observed at cooler temperatures). During the first week of refeeding, Oxygen consumption rose steeply at 16, 20 and 24 °C before levelling off to the initial value (t0). At 12 °C, no compensation process was observed during recovery. This study reveals that an important threshold in the biology of A. diaperinus lies between 12 and 16 °C, leading to the onset of reduced locomotor activity and the promotion of survival to the detriment of reproduction. This ‘sit and wait’ behaviour is proposed as an adaptive strategy (i.e. inactivity and lower oxygen consumption coupled with low energetic requirements and high recovery abilities). Such behaviour and the observed hyperactivity were rarely described in insects before the present study. Together, the previous and present results suggest that A. diaperinus populations are likely maintained in temperate regions by immigration from warmer situations.

A single phase of food deprivation provoked compensatory growth in barramundi Lates calcarifer

Compensatory growth of juvenile barramundi, Lates calcarifer (Bloch) was investigated at 28 °C for 8 weeks. Fish were divided into four feeding groups including one group with continuous feeding (C) and three other groups with food deprivation for 1 week (S1), 2 weeks (S2) and 3 weeks (S3), respectively. All starved fish resumed feeding in week 4. Changes in body weight, specific growth rate, feeding rate, food conversion efficiency and apparent digestion rate were examined weekly during the re-feeding period. Chemical compositions of fish were separately determined at the end of week 3 and week 8. Fish starved for 1 week reached the same weight as the control fish after re-feeding for 3 weeks, indicating that complete compensatory growth occurred. Although the specific growth rate in S2 or S3 fish was greater than that in the control fish after re-feeding, neither S2 nor S3 fish reached the same body weight of the control fish at the end. The feeding rates of S1, S2 and S3 fish were greater than those of control fish for a period of 2, 3 and 4 weeks, respectively. No significant differences in feeding rates were found among S1, S2 and S3 fish in the second week of re-feeding. Neither food conversion efficiency nor apparent digestion rate was significantly different among all treatments except that conversion efficiencies of S1 and the control fish were greater than those of S2 and S3 fish in week 7. At the end of food deprivation, the ratio of lipid to lean body mass (LBM) and the concentration of lipid, energy and moisture in S1, S2 and S3 fish were significantly less than those in the control fish, but the protein concentration in the control fish was greater than that in S2 or S3 fish. After re-feeding for 5 weeks, no difference in the concentrations of protein, ash, energy and moisture were detected among all treatments; however, the lipid concentration in S2 and S3 fish was less than that in the control fish. All fish deprived of food displayed a lower ratio of lipid to lean body weight than that in the control fish. Our results indicate that compensatory growth occurred in barramundi and the magnitude and duration of compensatory growth depended on the length of food deprivation.

Relationship between metabolism and peripheral blood mononuclear cell mitochondrial complex I activity before and after a short-term refeeding in weight-losing cancer patients

Background and aims: Previous investigations showed that mitochondrial complex I activity seems to be a specific marker of dietary malnutrition in human. Since cancer has a more complex etiology than simple calorie deficiency, the aim of this study was to investigate the relationship between mitochondrial complex I activity and cancer. Methods: Nine cancer patients (CaPs) with weight loss and 14 age-matched healthy volunteers (HVs) were recruited. Body mass index (BMI), body composition as well as resting energy expenditure (REE) and RQ were measured. Mitochondrial complex I activity was measured as described previously in isolated peripheral blood mononuclear cells. Six patients were investigated again after 7 days of refeeding. Results: Weight loss in CaPs was mainly due to a loss of fat mass (FM), while fat-free mass (FFM) was preserved. The RQ was significantly lower in CaPs compared to HVs ( P<0.001) and peripheral blood mononuclear cell complex I activity was significantly correlated with the %FM and RQ in CaPs. Furthermore, complex I activity increased significantly after 1 week of refeeding. Conclusions: Our study showed that mitochondrial complex I activity was inversely correlated to parameters of increased fat oxidation and reduced FM, which are indices of dietary insufficiency rather than loss of lean body mass, which is an index of increased catabolism in cancer.

The effect of therapeutically induced weight gain on plasma leptin levels in patients with anorexia nervosa

Previously it was shown that hyperleptinemia ensues from the therapeutically induced weight gain in patients with anorexia nervosa (AN). However, not all studies have been able to confirm this finding. To further investigate leptin secretion during weight gain in AN and potential functional implications serum leptin levels, body mass index (BMI),% body fat, fT3, fT4 and TSH of 18 adolescent AN patients (BMI at admission: 14.4±1.2) were examined four times during 11 weeks of re-feeding and compared to 18 weight stable controls. Additionally, serum leptin levels, BMI and % body fat were determined in patients reaching target weight after 11–20 weeks (mean 14.3±3) of inpatient re-feeding. At admission patients showed lower lg10 leptin levels ( P=0.000) and BMI ( P=0.000) than controls. At target weight patients still had significantly lower BMI ( P=0.000) and% body fat ( P=0.000) than controls but lg10 leptin levels of patients were higher than those of controls when adjusted for BMI and% body fat (ANCOVA, group P=0.038). In patients, correlation coefficients between lg10 leptin levels and BMI increments increased during the 11 weeks of re-feeding. BMI,% body fat and fT3 levels were not significantly correlated to lg10 leptin levels in week 11, however, 53% of the variance of leptin levels (corrected R 2=0.53, P=0.001) was explained by BMI increments between weeks 7 and 11 ( P=0.001) and lg10 leptin level at admission ( P=0.002). In conclusion, we confirmed weight gain induced hyperleptinemia in AN. Further research is required to assess if this phenomenon contributes to renewed weight loss.

Hypophosphatemia during nutritional rehabilitation in anorexia nervosa: implications for refeeding and monitoring

Purpose To determine the incidence of hypophosphatemia in adolescents with anorexia nervosa (AN) hospitalized for nutritional rehabilitation and to examine factors predisposing to its development. Methods A retrospective chart review of 69 patients (66 female, 3 male) with AN consecutively admitted to an inpatient adolescent medical unit between July 1, 1998 and June 30, 2000. Mean age was 15.5 ± 2.4 (range 8 to 22) years and mean % ideal body weight (IBW) was 72.7 ± 7%. Serum phosphorus was measured daily for 1 week and then biweekly to weekly. Patients were started on 1200–1400 kcal/day and calories were increased by 200 kcal every 24–48 hours. Results Four (5.8%) patients developed moderate hypophosphatemia (<2.5 and ≥ 1.0 mg/dl) and 15 (21.7%) had mild hypophosphatemia (<3.0 and ≥ 2.5 mg/dl). Patients who developed moderate hypophosphatemia were significantly more malnourished than those who did not ( p = 0.02). Phosphorus nadirs were directly proportional to % IBW (r = 0.3, p = 0.01). Over three-quarters of the patients (81%) reached their phosphorus nadir within the first week of hospitalization. The patient with the lowest phosphorus level experienced short runs of ventricular tachycardia. No other severe complications were seen. Overall, 19 (27.5%) patients required phosphorus supplementation. Conclusions Phosphorus drops to its nadir during the first week of refeeding. We recommend daily monitoring of serum phosphorus with supplementation as needed during the first week of hospitalization, especially in those who are severely malnourished.

Effect of water temperature and short-term fasting on macronutrient self-selection by common carp (Cyprinus carpio)

Abstract The influence of water temperature (17 and 25 °C) and a period of fasting on the self-selection of macronutrients were examined in common carp held on a 12:12-h light/dark cycle. Eight replicate groups of juvenile carp (ca. 15 g body weight at 17 °C and 25 g at 25 °C) were fed with three test diets [high-protein (HP), high-fat (HF) and high-carbohydrate (HC) diets] by individual self-feeders for 3 weeks, followed by a 2-week period of fasting and then 3 weeks of refeeding. At 17 °C, the carp initially selected the HP and HF diets [HP/HF/HC (%)=38:40:22], whereas at 25 °C, the carp selected the HP diet over the others (55:21:24). After fasting, the carp tended to increase their demand for the HF diet at 17 °C and for the HC diet at 25 °C, but the overall self-selection of the test diets did not differ markedly from that prior to fasting. Carp held at 17 °C had higher relative whole body fat content and plasma triglyceride concentration; the latter decreased markedly during fasting. These results suggest that water temperature influences the macronutrient selection by carp: a relatively high demand for both protein and fat at 17 °C and for protein at 25 °C. Two weeks of fasting, however, did not markedly alter their macronutrient selection.

Compensatory growth in the gibel carp following feed deprivation: temporal patterns in growth, nutrient deposition, feed intake and body composition

To investigate the nature of compenstory growth in fish, an 8 week study at 28°C was performed on juvenile gibel carp Carassius auratus gibelio weighing 6·6 g. Fish were starved for 0 (control), 1 (S1) or 2 (S2) weeks and then re‐fed to satiation for 5 weeks. Weekly changes in weight gain, feed intake and body composition were monitored during re‐feeding. No significant difference was found in final body weight between the three groups, indicating complete compensation in the deprived fish. The deprived groups caught up in body weight with that of the control after 2 weeks of re‐feeding. Body fat: lean body mass ratio was restored to the control level within 1 week of re‐feeding. In the re‐feeding period, weekly gains in body weight, protein, lipid, ash and energy in the S1 group were significantly higher than in the controls for 1 week. For the S2 group, weekly gains in body weight, lipid, ash and energy were higher than in the controls for 2 weeks, and gain in protein was higher than in the controls for 3 weeks, though gain in body energy became elevated again during the last 2 weeks of the experiment. Feed intake remained higher than the control level for 3 weeks in the S1 group and 4 weeks in the S2 group. Growth efficiency was not significantly different among the three groups in any of the weeks during re‐feeding. Compensatory responses in growth and especially feed intake tended to last longer than the recovery of body composition.

Conjugated linoleic acid does not impair fat regain but alters IGF-1 levels in weight-reduced rats

It has been previously reported that in rats undergoing repeated weight gain/loss cycles, more fat is regained than that was lost. Conjugated linoleic acid (CLA), a collective name for a mixture of positional and geometrical isomers of linoleic acid, is known to regulate body composition by decreasing body fat. The present study was designed to examine the effects of CLA on body fat regain in weight-reduced obese rats. Female Wistar rats (n=52), 6 mo old, were divided into 4 groups: 1) HFRF rats (n=10) were fed a high fat diet (40% w w ) diet for 9 weeks to an obese state and were then food restricted (50% ad-lib) with a modified high fat diet for 3 weeks to induce a 20% body weight loss. They were then refed the high fat diet ad-lib for 8 weeks; 2) HFCL rats (n=22) were treated in the same manner as rats in HFRF except were refed a high fat diet with 1% CLA ( w w ); 3) LFCN rats (n=10) were fed regular rodent diet ad-lib; 4) HFCN rats (n=10) were fed a high fat diet ad-lib. Ten HFCL rats were sacrificed after 4 weeks of refeeding while body composition and plasma glucose and insulin assessed for the other groups as a comparison. All remaining rats were sacrificed after 8 weeks of refeeding. After 4 weeks of refeeding, HFCL rats were similar in both body weight and body fat %. At the end of the study, HFCL rats weighed the same as high fat fed rats while HFRF rats weighed the same as rats of the other groups. All high fat fed groups had significantly higher % body fat than low fat fed rats but were not different from each other (HFCL: 22 ± 2%; HFRF: 23 ± 2%; HFCN: 27 ± 2%; LFCN: 15 ± 2%). HFCL and HFCN rats had significantly higher retroperitoneal lipoprotein lipase activity levels than that of HFRF rats (p<0.05). HFRF and HFCL rats had similar plasma insulin, leptin, and estradiol levels at sacrifice. HFCL rats had significantly lower IGF-1 levels (p<0.05) than that of HFRF and HFCN rats, while LFCN rats had levels similar to all groups (nmol/L, HFCL: 10 ± 0.7; HFRF: 13 ± 0.8; HFCN: 13 ± 0.8; LFCN: 11 ± 1.7). We conclude that a 40% high fat diet with 1% CLA fed to weight-reduced obese rats did not prevent the fat regain during the refeeding phase. The previously reported anticarcinogenic effect of CLA reported by other investigators may be partially due to lowered IGF-1 levels without the alteration of other hormone levels.

The effect of food deprivation and refeeding on the liver, thyroid hormones and transthyretin in sea bream

There was a significant reduction in body weight of sea bream Sparus aurata and the hepatosomatic index after 3 weeks food deprivation. Liver biochemical indices and morphology were altered by food deprivation, there was a loss of eosin staining in hepatocyte cytoplasm and the appearance of large depleted vacuoles. Cell and nuclear area were significantly reduced (P&lt;0·001) and did not return to control values after 1 week of refeeding. The water, lipid, glycogen and protein content of the liver was significantly reduced by 3 weeks fasting but recovered rapidly after 1 week refeeding. Food restriction also had a marked effect on circulating thyroid hormones and the concentration of plasma T3 (33·98±12·47 ng ml‐1) and T4 (16·54±9·5 ng ml‐1) was significantly (P 0·001) lower than the control (66·52±13·4 and 56·83±7·3, respectively). Refeeding for 1 week restored circulating T3 (P&lt; 0·05) close to control levels but did not significantly affect the concentration of T4. Northern blotting with an homologous probe for transthyretin (TTR) demonstrated clearly the expression of a single mRNA transcript of 0·7 kb for this protein in the liver. The level of TTR message was substantially reduced below control levels in the liver of fasted fish and 1 week refeeding failed to restore expression.

Resting energy expenditure and plasma leptin levels in anorexia nervosa during acute refeeding

To examine changes in plasma leptin levels and resting energy expenditure (REE) during short-term refeeding of patients with anorexia nervosa (AN). This was a longitudinal study of 21 women meeting the DSM-IV criteria for AN who were admitted to the hospital for renutrition. Height, weight, percent body fat (assessed by skin fold thickness), REE (measured by indirect calorimetry), and circulating plasma leptin concentration were assessed at the time of admission and 7 days later. Over the course of 1 week of refeeding, body mass index (BMI) increased 0.75 +/- 0.15 kg/m(2) (p <.0001), body fat increased 0.9 +/- 0.2% (p <.0001), and REE increased 107 +/- 33 kcal/24 hr (p =.0037). The change in mean leptin levels was not statistically significant (0.45 +/- 0.44 ng/ml; p =.32). Leptin is unlikely responsible for the increase in REE observed with short-term refeeding.

Cardiac arrest and delirium: Presentations of the refeeding syndrome in severely malnourished adolescents with anorexia nervosa

To describe the clinical presentation of the refeeding syndrome and highlight the dangers of performing nutritional rehabilitation too rapidly in a severely malnourished patient. Retrospective case review of adolescents admitted with anorexia nervosa who developed the refeeding syndrome. Between July 1993 and July 1994, 3 of 48 adolescent females developed the refeeding syndrome. While the cardiac complications occurred in the first week of refeeding, the delirium characteristic of this syndrome occurred later and was more variably related to hypophosphatemia. Refeeding malnourished patients with anorexia nervosa can be associated with hypophosphatemia, cardiac arrhythmia and delirium. Refeeding patients with anorexia nervosa who are < 70% of ideal body weight should proceed with caution, and the caloric prescription should be increased gradually. Supplemental phosphorus should be commenced early and serum levels maintained above 3.0 mg/dL. Cardiac and neurologic events associated with refeeding are most likely to occur within the first weeks, justifying close monitoring of electrolyte and cardiac status.

Use of Indirect Calorimetry in Nutritional Rehabilitation of Adolescents With Anorexia Nervosa

LEARNING OUTCOME: To describe how indirect calorimetry can be used to assess the energy needs and monitor the progress of nutritional rehabilitation in adolescents with anorexia nervosa. Predictive equations are not useful in assessing energy needs of malnourished patients with anorexia nervosa. They are often admitted with significant weight loss and reduced resting energy expenditure (REE) in response to semistarvation. During the first few weeks of refeeding and rapid weight gain, REE is significantly increased and remains higher than predicted values until the patients are weight recovered. In order to prescribe energy intake required for weight gain accurately, it is necessary to actually measure REE levels during nutritional rehabilitation. In our institution, all admitted adolescents with anorexia nervosa have their REE assessed by indirect calorimetry within the first three days of admission and every two weeks thereafter until they are completely nutritionally rehabilitated. Preliminary results showed that at admission, mean REE value (n=10, 11–15 years old) was 79±11% (range 61–97%) of predicted values using Schofields formulas. After refeeding REE rose to peak ranging from 120 to 156% of predicted values. The rate of increase in REE varied among patients and could only be explained partially by weight gain. It took about 6–8 weeks before the REE values returned to normal. Patients were generally completely rehabilitated (as measured by acceptable weight and body cell mass) when their REE values were within 100±10% of the predicted values. Both lower and higher than predicted normal REE values can thus be used as an indicator for incomplete nutritional rehabilitation. This results confirmed that at different stages of nutritional rehabilitation, patients had different energy needs for weight gain and weight maintenance, and energy requirements should be based on individual REE measurements.

Anorexia nervosa: Refeeding and hypophosphatemia

A case of anorexia nervosa (AN) is reported where heart failure occurred secondary to severe hypophosphatemia despite oral phosphate supplementation. We recommend starting patients with AN on oral phosphate when refeeding is begun, monitoring serum phosphate every 1 to 2 days for at least the first week of refeeding, and discontinuation of refeeding during phosphate supplementation should severe hypophosphatemia develop.

Reversible Effects on B and T Cells of the Gut-Associated Lymphoid Tissues in Rats Malnourished during Suckling: Impaired Induction of the Immune Response to Intra-Peyer Patches Immunization with Cholera Toxin

To define the alterations provoked by malnutrition during suckling (20 pups/dam) in the gut-associated lymphoid tissues of rats, Peyer patch (PP) and mesenteric lymph node (MLN) cells were studied by flow cytometry. After weaning (21 days of age), rats malnourished during suckling (MNR) showed an increase in the CD4+CD45RC+subset together with a decrease in the CD4+CD45RC−subset (P< 0.01). These alterations remained even after 3 weeks of refeeding with stock diet. The CD4+CD8+subset was not increased in the MNR, indicating that a release of cortical thymocytes did not occur. At weaning the percentage of CD4+Thy1+cells was decreased in the MNR, indicating a low number of cells released from the thymus. When the B cell lineage was studied, we found a decreased percentage of precursors in the bone marrow and a decreased percentage of mature B cells in the periphery. When the MNR were inmunized intra-PP with cholera toxin (CT) after 1 week of refeeding, the specific IgG and IgA and IgM antibody-forming cells (measured by ELISPOT) were diminished in the PP, MLN, and spleen when compared to the age-matched controls (P< 0.001). These results were coincident with the ELISA titers obtained in the sera and in the intestinal fluids. When CT was administered after 2 weeks of refeeding, the number of IgM anti-toxin AFC approached control values, but the number of IgA and IgG AFC continued to be low. When 3 weeks of refeeding was allowed before the CT delivery, the immune response in the MNR aproached control values. These results indicate that malnutrition during suckling provokes alterations in B and T lymphocytes and produces a lack in the induction of the primary and secondary immune responses in the GALT which reversed after 3 weeks of refeeding.