[Show abstract][Hide abstract] ABSTRACT: BACKGROUND & AIMS: Aminotransferase abnormalities have been reported in malnourished patients with anorexia nervosa (AN). The aim of this study was to identify prevalence and risk factors of hyperaminotransferasemia in an adult cohort of AN patients and to describe evolution during nutritional rehabilitation with enteral nutrition for a period of 4 weeks. METHODS: Retrospective study of all consecutive malnourished (BMI <16) AN adult patients, without previous liver diseases or hepatotoxic drugs or alcohol consumption, hospitalized for enteral nutrition in a single center between 1998 and 2008. Hypertransaminasemia was defined by an increase in AST and (or) ALT >2N. RESULTS: In all, 126 AN patients (117 W, 9 M), age 30 ± 10.8 years, were included. At admission, 54 (43%) patients presented hypertransaminasemia. In univariate analysis, risk factors for hypertransaminasemia were: lower BMI (11.2 ± 2 vs. 13 ± 2, p < 0.0001) and age (28 ± 9 vs. 32 ± 12, p < 0.05), male sex (p < 0.05) and the pure restrictive form (p = 0.07). In multivariate analysis only BMI, at a threshold of 12, remained significant [OR 3.7, CI: 95% 2.24-5.2]. Normalization of aminotransferases at the end of week 4 of enteral nutrition was obtained in 96%. Only 2/54 patients (4%) presented a worsening of aminotransferases during the refeeding period, including one that died of liver failure. None of the patients without hypertransaminasemia admission presented a subsequent elevation. At the end of the 4-week refeeding period, the increase in BMI was greater in patients without hypertransaminasemia than in those with it (2.0 ± 0.8 vs. 1.5 ± 1.0, p < 0.0001). CONCLUSION: Elevated transaminases is common in severe malnourished AN patients. Four risk factors were identified: young age, low BMI (the only independent factor in multivariate analysis), the pure restrictive form of the disease and male sex. After 4 weeks of enteral nutrition the evolution is in most cases favourable, albeit with a lower increase in BMI, but can be severe. The long-term evolution remains to be determined.
[Show abstract][Hide abstract] ABSTRACT: Body weight changes do not reflect the respective changes of body compartments, namely fat-free mass (FFM) and fat mass (FM). Both bioelectrical Impedance Analysis (BIA) and the Dual X-ray absorptiometry (DXA) measure FFM and FM. This study in underweight patients with anorexia nervosa (AN) aims to compare measurements of FM and FFM done by DXA and BIA using 5 different BIA equations already validated in healthy population and to identify the most suitable BIA equation for AN patients.
Fifty female patients with AN (BMI=14.3 ± 1.49, age=19.98 ± 5.68yrs) were included in the study. Body composition was measured by DXA (Delphi W, Hologic, Bedford, MA) and by 50 kHz BIA (FORANA, Helios) using 5 different BIA equations validated in healthy population (Sun, Geneva, Kushner, Deurenberg and Roubenoff equations). Comparison between the DXA and the 5 BIA equations was done using the sum of the squares of differences and Bland-Altman plots.
The Deurenberg equation gave the best estimates of FFM when compared to the measurements by DXA (FFM(dxa)=35.80 kg versus FFM(deurenberg)=36.36 kg) and very close estimates of FM (FM(dxa)=9.16 kg and FM(deurenberg)=9.57 kg) The Kushner equation showed slightly better estimates for FM (FM(kushner)=9. 0kg) when compared to the DXA, but not for FFM. Sun equation gave the broadest differences for FM and FFM when compared with DXA.
The best available BIA equation to calculate the FFM and the FM in patients with AN is the Deurenberg equation. It takes into account the weight, height and age and is applicable in adults and adolescents AN patients with BMI of 12.8-21.0, and for ages between 13.4 and up to 36.9 years.
[Show abstract][Hide abstract] ABSTRACT: The psychiatric condition of patients suffering from anorexia nervosa (AN) is affected by their nutritional status. An optimal assessment of the nutritional status of patients is fundamental in understanding the relationship between malnutrition and the psychological symptoms. The present review evaluates some of the available methods for measuring body composition in patients with AN. We searched literature in Medline using several key terms relevant to the present review in order to identify papers. Only articles in English or French were reviewed. A brief description is provided for each body composition technique, with its applicability in AN as well as its limitation. All methods of measuring body composition are not yet validated and/or feasible in patients with AN. The present review article proposes a practical approach for selecting the most appropriate methods depending on the setting, (i.e. clinical v. research) and the goal of the assessment (initial v. follow-up) in order to have a more personalised treatment for patients suffering from AN.
Nutrition Research Reviews 03/2011; · 5.50 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Plasma citrulline is a biomarker of enterocyte mass and function in humans.
We evaluated citrulline in the reemerging context of diarrhea in HIV-infected patients receiving highly active antiretroviral therapy.
This study prospectively measured citrulline in 6 groups of HIV-1 patients (n = 115): 1) undetectable viral load without chronic diarrhea (a; n = 40) and with protease inhibitor-associated toxic chronic diarrhea (b; n = 26), 2) detectable viral load and CD4 > 200/mm(3) without (a; n = 6) and with (b; n = 11) chronic diarrhea, and 3) detectable viral load and CD4 <200/mm(3) without chronic diarrhea (a; n = 7) and with opportunistic intestinal infections or HIV enteropathy (b; n = 25). The influence of diarrhea on citrulline was assessed by comparing the a and b subgroups with healthy control subjects (n = 100).
Citrulline was slightly decreased (22-30 micromol/L) in groups 1b and 2b and was <22 micromol/L in 19 of 25 patients in group 3b. In group 3b, a citrulline concentration <10 micromol/L was associated with a clinical indication for parenteral nutrition (n = 6 of 8 compared with 2 of 17 if the citrulline concentration was >10 micromol/L; P < 0.05). Citrulline correlated positively with albumin (P < 0.01) and BMI (P < 0.05) and negatively with C-reactive protein (P < 0.01). When antiinfectious and nutritional therapies were successful (n = 18 of 25), citrulline normalized in 2-12 wk. Neither chronic hepatic or pancreatic disease nor lipodystrophy and the metabolic syndrome affected citrulline. Compared with control subjects (38 +/- 8 micromol/L), patients without chronic diarrhea (groups 1a, 2a, and 3a) had normal citrulline concentrations (36 +/- 6 micromol/L).
Plasma citrulline is a reliable biomarker of enterocyte functional mass in HIV patients. Citrulline does not allow the etiologic diagnosis of enteropathy, but it can discriminate between protease inhibitor toxic diarrhea and infectious enteropathy and quantify the functional consequences, which makes it an objective tool for indicating the need for parenteral nutrition.
American Journal of Clinical Nutrition 08/2009; 90(3):587-94. · 6.50 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To characterize intra-abdominal adipose tissue changes in HIV patients with clinical lipodystrophy using a reproducible imaging technique. Materials and methods. 89 HIV patients with clinical lipodystrophy were included. A single axial T1W image was acquired at the mid L4 vertebral level. Two radiologists measured subcutaneous (SAT) and visceral (VAT) adipose tissues using a semi-automated method. Measurements were compared to a matched population (race, sex, age and BMI).
Measurements of abdominal adipose tissue on MRI are reproducible. Three clinical types of lipodystrophy are described in males with increased visceral (VAT) and reduced subcutaneous (SAT) adipose tissues compared to control subjects. Two clinical types of lipodystrophy are described in females with increased visceral (VAT) and unchanged subcutaneous (SAT) adipose tissues.
MRI with comparison between HIV patients and normal control subjects is a reproducible method to characterize adipose tissue changes of lipodystrophy and evaluate its severity. Evaluation of a adipose tissue distribution in a large control population would be helpful to the study of metabolic disorders.
[Show abstract][Hide abstract] ABSTRACT: Introduction et but de l’étude
L’existence de perturbations des tests hépatiques au cours de l’anorexie mentale est décrite dans la littérature depuis plusieurs années.
Nous avons souhaité analyser les anomalies du bilan hépatique au cours des dénutritions graves chez des patients atteints d’anorexie mentale, et observer leur évolution au cours de la renutrition entérale
Matériel et méthodes
Étude rétrospective monocentrique de la biologie hépatique chez des patients atteints d’anorexie mentale sévèrement dénutris (37 dossiers sélectionnés au hasard parmi un collectif de 204 pris en charge entre Janvier 1998 et Octobre 2006). Critères d’exclusion : affection hépatique, prise de médicaments hépatotoxiques ou d’alcool pouvant expliquer la perturbation du bilan hépatique.
Parmi les patients inclus, 34 étaient des femmes (95 %). L’âge moyen était de 28 ans ± 11, l’IMC moyen à l’admission était de 12 ± 2,0, < 12 chez 8 patients, <10 chez 2 patients. Aucun patient ne présentait de syndrome inflammatoire biologique, la CRP était inférieure à 3 dans 100 % des cas. L’albuminémie moyenne était de 37,5 ± 7,2.
On a observé à l’admission une cytolyse hépatique chez 17 (46 %) patients. Leur IMC à l’admission était de 10,9 ± 1,4; leur âge 25,4 ± 18. Ils présentaient une augmentation moyenne des ASAT à 8N, médiane (Extrême) 84 (46-1620), et ou des ALAT à 8N, médiane (Extrême) 215 (57-2614).L’évolution du bilan hépatique à la fin de la première semaine après la mise en route d’une alimentation entérale progressive, associée à une supplémentation en vitamines, oligoéléments et phosphore était favorable chez 16 des 17 patients (94 %) avec une moyenne des ASAT à 3N, médiane (Extrême) 65 (29-225) et Des ALAT à 4N, médiane (Extrême) 137 (55-1129). La normalisation totale du bilan hépatique est observée à la 4e semaine d’hospitalisation. Une seule patiente a cependant présenté une aggravation secondaire des transaminases sous alimentation entrale après amélioration initiale avec des ASAT 10N et ALAT 8N à la 4e semaine, un retour à des valeurs normales est observé au bout de la 7e semaine ; elle avait par ailleurs présenté une hypophosphorémie majeure à l’admission et un TP à 40 %.
L’IMC moyen des patients présentant une cytolyse hépatique était de 11,7 ± 1,6 à la 4e semaine.Les patients n’ayant pas présenté de cytolyse hépatique à l’admission, étaient âgés de28 ans ± 11.Leur IMC à l’admission était de 13,4 ± 2 et à 14 ± 2à la 4e semaine de renutrition.
Le reste du bilan hépatique était peu perturbé.
Près de la moitié des patients dénutris sévères atteints d’anorexie mentale admis pour renutrition entérale présentent une augmentation systématique des transaminases, ils avaient à l’admission un IMC inférieur et étaient plus jeunes que les patients ayant un bilan hépatique normal. L’évolution est rapidement favorable dès la première semaine d’hospitalisation dans la majorité des cas. La normalisation des transaminases parallèlement à la prise de poids à concerné tous les patients au terme d’un mois d’alimentation entérale progressive associée à une supplémentation en vitamines et oligo-éléments.
Par ailleurs, une meilleure connaissance des mécanismes à l’origine des perturbations du bilan hépatique nécessiterait certainement des études prospectives plus complètes chez les patients atteints d’anorexie-mentale.
Nutrition Clinique Et Metabolisme - NUTR CLIN METAB. 01/2007; 21:64-65.
[Show abstract][Hide abstract] ABSTRACT: PurposeTo characterize intra-abdominal adipose tissue changes in HIV patients with clinical lipodystrophy using a reproducible imaging technique.Materials and methods89 HIV patients with clinical lipodystrophy were included. A single axial T1W image was acquired at the mid L4 vertebral level. Two radiologists measured subcutaneous (SAT) and visceral (VAT) adipose tissues using a semi-automated method. Measurements were compared to a matched population (race, sex, age and BMI).ResultsMeasurements of abdominal adipose tissue on MRI are reproducible. Three clinical types of lipodystrophy are described in males with increased visceral (VAT) and reduced subcutaneous (SAT) adipose tissues compared to control subjects. Two clinical types of lipodystrophy are described in females with increased visceral (VAT) and unchanged subcutaneous (SAT) adipose tissues.ConclusionMRI with comparison between HIV patients and normal control subjects is a reproducible method to characterize adipose tissue changes of lipodystrophy and evaluate its severity.Evaluation of a adipose tissue distribution in a large control population would be helpful to the study of metabolic disorders.
[Show abstract][Hide abstract] ABSTRACT: Disease-related undernutrition is significant in European hospitals but is seldom treated. In 1999 the council of Europe decided to collect information regarding Nutrition programmes in hospitals and for this purpose a network consisting of national experts from 12 of the Partial Agreement member states was established. The aim was to review the current practice in Europe regarding hospital food provision, to highlight deficiencies and guidelines to improve the nutritional care and support of hospitalised patients. Five major problems seemed to be common in this context: (1) lack of clearly defined responsibilities; (2) lack of sufficient education; (3) lack of influence of the patients; (4) lack of co-operation among all staff groups; (5) lack of involvement from the hospital management. To solve the problems highlighted, a combined “team-effort” is needed from national authorities and all staff involved in the nutritional care and support, including support managers.
Nutrition Clinique Et Metabolisme - NUTR CLIN METAB. 01/2003; 17(4):207-212.
[Show abstract][Hide abstract] ABSTRACT: Infection by the human immunodeficiency virus (HIV) is characterized by progressive destruction of the immune system, which leads to recurrent opportunistic infections and malignancies, progressive debilitation and death. Malnutrition is one major complication of HIV infection and is recognized as a significant prognostic factor in advanced disease. Malnutrition is multifactorial and poorly treated during the course of HIV. Even if a standardized approach to the management of active weight loss has not been well established, early nutritional intervention is important in HIV infected patients to maximize gain of lean body mass. From early in the era of highly active antiretroviral therapy (HAART), an initial decreased incidence of malnutrition was noted only in western countries while a variety of changes in the distribution of body fat and associated metabolic abnormalities have been recognized under the banner of lipodystrophy.
British Journal Of Nutrition 02/2002; 87 Suppl 1:S111-9. · 3.30 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In 1999 the Council of Europe decided to collect information regarding Nutrition programmes in hospitals and for this purpose a network consisting of national experts from eight of the Partial Agreement member states was established. The aim was to review the current practice in Europe regarding hospital food provision, to highlight deficiencies and to issue guidelines to improve the nutritional care and support of hospitalized patients. Five major problems seemed to be common in this context: 1) lack of clearly defined responsibilities; 2) lack of sufficient education; 3) lack of influence of the patients; 4) lack of co-operation among all staff groups; and 5) lack of involvement from the hospital management. To solve the problems highlighted, a combined 'team-effort' is needed from national authorities and all staff involved in the nutritional care and support, including hospital managers.
[Show abstract][Hide abstract] ABSTRACT: Ritonavir (RTV) is a powerful inhibitor of P450 3A4 cytochorme. When given in combination with indinavir (IDV) it increases the IDV trough concentrations (Cmin) allowing a lower IDV dosage in a twice a day regimen, independently of meals. We report tolerance data and IDV Cmin levels observed in plasma and cerebrospinal fluid (CSF) in a cohort of HIV-infected patients treated with the IDV-RTV combination at different dosages of IDV and RTV.
IDV Cmin was assayed 56 times in 40 patients (few patients had received different dosages of the IDV-RTV combination). Tolerance was recorded.
For patients given the IDV-RTV combination at the doses of 800/100 mg b.i.d., 800/200 mg b.i.d. or 400/400 mg b.i.d., the IDV Cmin was 12 times the median IDV IC95. If the Cmin/IC95 ratio was greater than 10 with the 800/100 mg b.i.d. regimen and virological success was achieved, the IDV dosage was reduced to 400 mg b.i.d. For these patients, the 400/100 mg b.i.d. IDV-RTV regimen always gave a Cmin above the IDV IC95. Median Cmin for IDV in CSF was 146 ng/ml (range 71-881 ng/ml), above the IDV IC95. It was possible to control most of the adverse effects by reducing dosage after obtaining the IDV pharmacological levels. Definitive interruption of treatment was required in only 2 cases at mean follow-up of 7.9 months.
The IDV-RTV combination should be used to improve observance of antiretroviral treatments and reduce the risk of virological failure related to low plasma levels. The IDV-RTV combination at 800/100 mg b.i.d. is a useful protocol when IDV efficacy alone is the goal. The 400/400 mg b.i.d. IDV-RTV regimen is an interesting alternative when efficacy of both inhibitors is the goal. Drug assays should be systematic to adapt individual dosages and limit the risk of adverse effects.
La Presse Médicale 05/2001; 30(15):731-5. · 0.87 Impact Factor