There are increasing numbers of adults living in the community who require enteral tube feeding. While there is significant evidence of the importance of this treatment, there are side effects which can cause difficulties for patients, their carer tabers and health professionals. Gastrointestinal complications are the most common side effects with feed formula being cited as the main culprit, often without investigating other potential causes. Many patients requiring aggressive nutrition support also require concurrent drug therapy to manage underlying disease. Drugs are often given via tubes in liquid form. These elixirs often contain large quantities of sorbitol, which will increase the osmolar concentration. There is a lack of awareness from primary health-care professionals about the difficulties that can arise when giving medications to patients receiving enteral feeding which may affect patient care and the nutritional outcomes.
Previous studies have suggested that oral or intravenous glucose enhances salt and water retention following a saline load. To test this, we studied the effects of an oral glucose load on urinary sodium and water excretion and serum biochemistry in response to a 2l intravenous infusion of 0.9% saline in normal subjects.
A crossover study was conducted on six male volunteers. On one occasion, they received 2l 0.9% saline intravenously over 1h. A week later, they were given 100ml 50% dextrose orally prior to the same infusion. Subjects passed urine before start of the infusion. Body weight, haematocrit and serum biochemistry were recorded preinfusion and hourly for 6h. Urine was collected for 6h postinfusion and analysed for sodium, potassium and osmolality.
The six subjects had a mean (SE) age of 20.9 (0.4) years and BMI of 22.7 (0.2). Median (IQR) water balance over 6h was 1462 (1005-1650)ml after saline and 1203 (989-1735)ml after glucose and saline (NS). Urinary sodium and potassium excretion on the two occasions over 6h were 76 (69-111) vs 74 (92-174)mmol and 31 (29-40) vs 30 (20-36)mmol, respectively (NS). Using repeated measures testing, there was no significant difference in body weight, haematocrit, serum albumin, sodium, potassium, chloride, osmolality and blood glucose measured at hourly intervals on the two occasions.
In contrast to previous literature, in normal subjects, an additional oral glucose load does not appear to have an effect on urinary sodium excretion or serum biochemistry after a rapid 2l infusion of 0.9% saline. This does not preclude an effect under conditions of prior starvation or injury.
We aimed to trace the historical origins of 0.9% saline, how it came to be used so commonly today, and to consider whether its continued use can be justified.
We searched the Medline, Science Citation Index, ScienceDirect and Google databases using the key words saline, physiological, salt solution, sodium chloride, 0.9%, intravenous, injection, fluid, cholera, resuscitation, parenteral, history, historical and origins.
The use of 0.9% saline is believed to have originated during the cholera pandemic that swept across Europe in 1831. However, an examination of the composition of the fluids used by the pioneering physicians of that era reveals solutions that bear no resemblance to 0.9% or so-called 'normal' saline which appears to have very little scientific or historical basis for its routine use, except for Hamburger's in vitro studies of red cell lysis.
The currently used 0.9% saline solution is without convincing historical basis. Given that the composition of 0.9% sodium chloride is dissimilar to most solutions used in the past, and is in no way 'normal' or 'physiological', our current practice may be based on historical fallacy and misconception.
The aim of this study was to investigate whether the consumption of Lactobacillus gasseri PA 16/8, Bifidobacterium longum SP 07/3, B. bifidum MF 20/5 (5 x 10(7) cfu/tablet) during at least 3 months influences the severity of symptoms and the incidence and duration of the common cold.
A randomized, double-blind, placebo-controlled intervention study was performed over at least 3 months during two winter/spring periods. Four hundred and seventy nine healthy adults (aged 18-67) were supplemented daily with vitamins and minerals with or without the probiotic bacteria. Cellular immune parameters were evaluated in a randomly drawn subgroup of 122 volunteers before and after 14 days of supplementation. During common cold episodes, the participants recorded symptoms daily. Stool samples were collected before and after 14 days of probiotic supplementation to quantify fecal Lactobacilli and Bifidobacteria using qRT-PCR.
The total symptom score, the duration of common cold episodes, and days with fever during an episode were lower in the probiotic-treated group than in the control group: 79.3+/-7.4 vs. 102.5+/-12.2 points (P = 0.056), 7.0+/-0.5 vs. 8.9+/-1.0 days (P = 0.045), 0.24+/-0.1 vs. 1.0+/-0.3 days (P = 0.017). A significantly higher enhancement of cytotoxic plus T suppressor cells (CD8+) and a higher enhancement of T helper cells (CD4+) was observed in the probiotic-treated group. Fecal lactobacilli and bifidobacteria increased significantly after probiotic supplementation.
The intake of probiotic bacteria during at least 3 months significantly shortened common cold episodes by almost 2 days and reduced the severity of symptoms.
Numerous studies suggest that immune function may be compromised by lipid emulsions rich in polyunsaturated fatty acids, especially linoleic acid. In our study, we compared the effect of a new olive oil-based lipid emulsion (ClinOleic(R)) containing 18% linoleic acid, and an emulsion based on soybean oil (Ivelip(R); 52% linoleic acid) on lymphocyte functions. Weaning Wistar rats (n= 24) were fed for 4 weeks on an oral diet that contained 12% of total energy as lipids from soybean oil. Then they received, during 6 days, a total parenteral nutrition (260 kcal/kg/d) in which 12% of total energy was brought by one of the two lipid emulsions. The fatty acid profile of spleen lymphocyte phospholipids reflected lipid intakes, with a higher content of oleic acid in ClinOleic(R) group and linoleic acid in Ivelip(R) group. A greater proportion of cells expressed the interleukin-2 receptor a-chain (CD25) after administration of ClinOleic(R) when compared to Ivelip(R) (55.43 +/- 3.47 vs 45.48 +/- 3.26%, P< 0.05). Moreover, the CD25 expression was positively correlated with oleic acid content of spleen lymphocyte phospholipids (r= 0.500, P< 0.018). These results show that ClinOleic(R) is able to induce, in vivo, a greater proportion of cells expressing CD25, and suggest that oleic acid could have a role in the observed effects.
Structured lipids (1,3-specific triglycerides) are new chemical entities made by enzymatic transesterification of the fatty acids in the 1,3-positions of the triglyceride. The purpose of this study was to investigate the in vitro interaction of fat emulsions based on either structured lipids or vegetable oils with human plasma proteins employing two-dimensional polyacrylamide gel electrophoresis (2-D PAGE). The structured lipids are triglycerides of the SLS and MLM types, where S is short-chain fatty acids (C4), M is medium-chain fatty acids (C8-10) and L is long-chain fatty acids (C16-18). The vegetable oil-based fat emulsions were the commercially available product, Intralipid, and a soybean oil (LLL) emulsion made de novo identically as the emulsions containing structured lipids. The SLS emulsion was found to adsorb a different protein pattern than the MLM and LLL emulsions. The protein pattern of the SLS emulsion was similar to the protein pattern of Intralipid. These findings might explain the in vivo difference in elimination found in another study, where the emulsion based on structured lipids with short-chain fatty acids in the 1,3-positions was removed more slowly from the general blood circulation compared to emulsions based on lipids with long-chain fatty acids in the 1,3-positions (LLL).
This study investigates time-dependent aroma changes in human milk after intake of an odorant-containing pharmaceutical preparation by correlating sensory evaluation with quantitative results.
Human milk donors ingested 100 mg of encapsulated 1,8-cineole. 21 milk samples from 12 participants underwent sensory analysis, of which 14 samples were quantified by stable isotope dilution assay (SIDA) analysis. Furthermore, several consecutive breast milk and exhaled breath gas samples from one volunteer after intake of 1,8-cineole were analysed by proton-transfer-reaction mass spectrometry (PTR-MS) and sensory evaluation on three separate days.
The emergence of the characteristic eucalyptus-like odour of 1,8-cineole in exhaled breath after capsule ingestion coincided with its transfer into milk; its presence in breath was therefore used to indicate the time at which milk should be expressed for gathering samples. Odorant transfer could not be confirmed by sensory analysis in 7 of the 21 milk samples, most likely due to disadvantageous timing of milk expression. The other 14 samples exhibited a distinct eucalyptus-like odour. Quantitative results matched these observations with <20 μg/kg 1,8-cineole in the odourless samples and 70 to an estimated 2090 μg/kg 1,8-cineole in the other samples.
Transfer of 1,8-cineole into human milk after oral intake is time dependent and exhibits large inter and intra-individual differences.
Microbial safety is essential during enteral nutrition (EN) as it can be the origin of gastrointestinal symptoms, but can also lead to systemic infections. The use of large-volume diet reservoirs could limit the risk of contamination and reduce nursing time, due to fewer repeated manipulations. The aim of the study was to evaluate in vivo the microbial safety of a new 1.5l enteral feeding diet reservoir system.
After validation of the study settings under standard laboratory conditions, 86 EN lines with sealed fittings were connected to 1.5l diet reservoirs under hospital/patient conditions. Microbial identification and quantification at different sampling times and points were performed.
No microbial contamination was observed in the diet reservoirs and in the nutrition lines above the drip chamber, demonstrating the microbial safety of this system. Retrograde contamination of the distal nutrition line end at completion of EN was observed and may be affected by the cumulative time of use of the tube. The contaminating microbial species were essentially bacteria of normal oral and digestive flora.
The mechanisms linking dietary calcium and vitamin D to body weight regulation require confirmation.
Eleven subjects, aged (mean ± SEM) 54 ± 1.2 y and BMI 31 ± 2.4 kg/m(2), participated in a randomised within-subject, sequential meal protocol comparing a low calcium trial (LCT) to an isoenergetic high calcium trial (HCT). Diet induced thermogenesis (DIT), fat oxidation rates (FOR), serum leptin, subjective feelings of hunger/satiety were measured at fasting and hourly over 8 h. Spontaneous food intake at a buffet and over the following 30 h was recorded. Postprandial responses, calculated as change (Δ) from baseline for each meal, were analysed by paired t-tests and 2 × 2 repeated measures ANOVA.
HCT resulted in lesser suppression of ΔFOR (p = 0.02) and a significantly greater DIT (p = 0.01). Further, the buffet to dinner interval was prolonged (p = 0. 083) and reported 24 h energy intake following this trial was significantly reduced (p = 0.017). ∆leptin following HCT but not LCT was negatively related to 24 h fat intake (r = -0.81, p = 0.016).
Higher calcium and vitamin D intake at a breakfast meal acutely increased postprandial FOR and DIT over two successive meals, and reduced spontaneous energy intake in the subsequent 24 h period. Australian New Zealand Clinical Trials Registry (ANZCTR) number: ACTRN12609000418279.
The purpose of this study is to report the frequency of central venous catheter (CVC) complications and to analyze the potential risk factors for complications requiring CVC removal in home parenteral nutrition (HPN) patients.
A questionnaire developed by the ESPEN HAN WORKING GROUP was distributed to 12 European centers to investigate the complications occurring during the period between January 1995 and December 2000 when HPN patients used their first CVC. The questionnaire collected informations related to the Home Parenteral Nutrition technique and the underlying disease. Factors affecting the time of CVC removal were jointly investigated using Cox's multivariable regression models.
The study was performed on 447 patients for a total of 110869 CVC-days. Complications occurred in about 1/4 of patients, approximately half were infections and about half required Central Venous Catheter removal. The Cox analysis showed that using the CVC 7 times/week and implanted ports were associated with a hazard ratio of 3 and 2.8, respectively. A reduced risk of removal (of about 40%) was associated with using CVC also for non-nutritional purposes (P = 0.0016).
Within the limits of this retrospective investigation, the type of CVC, the type of administration of HPN and the type of training are important factors associated with occurrence of complications or with CVC removal. However, in our opinion, proper care of the CVC, of preparation and administration of the nutritive admixture seem to be paramount for a safe management of HPN.
Long-term survival of patients with intestinal failure requiring home parenteral nutrition (HPN) has not been clearly shown. The authors describe the survival of these patients and explore the prognostic factors. A total of 217 non-cancer non-AIDS adult patients presenting with chronic intestinal failure enrolled from January 1980 to December 1989 in approved HPN programs in Belgium and France. Data were updated in March 1991; not one of the patients was lost for follow up. The prognosis factors for survival are explored using multivariate analysis. During the survey 73 patients died, and the mortality rate related to HPN complications accounted for 11% of deaths. Probabilities of survival at 1, 3 and 5 years were 91%, 70%, and 62% respectively. Three independent variables were associated with a decreased risk of death: age of patients younger than 40 years, start of HPN after 1987, and absence of chronic intestinal obstruction. In patients younger than 60 years, included after 1983 and with a very short bowel (< or = 50 cm), (who could represent suitable candidates for small bowel transplantation) the 2-year survival rate was 90%, a prognosis that compares favourably with recent reports on survival after small bowel transplantation. In conclusion, HPN prognosis compares favourably with recent reports of survival after small bowel transplantation.
Concerns have been raised about potential neurological injury related to exogenous glutamate. In cardiac surgery glutamate has been administered as a putative cardioprotective agent by cardioplegia or intravenous infusion. In the GLUTAMICS trial, in addition to surveillance of clinical neurological injuries, a prespecified subgroup was analyzed with regard to postoperative S-100B levels to detect potential subclinical neurological injury related to glutamate infusion.
Sixty-nine patients operated on for unstable coronary syndrome were randomized to intravenous infusion of glutamate (n=35) or saline (n=34) perioperatively. Plasma levels of S-100B were obtained on the third postoperative day.
S-100B in the glutamate group and the control group were 0.079+/-0.034microg/L and 0.090+/-0.042microg/L respectively (p=0.245). There were no patients with stroke or mortality. Three patients in the control group and two in the glutamate group had postoperative confusion. These patients had significantly elevated S-100B compared with those without confusion (0.132+/-0.047vs 0.081+/-0.036microg/L; p=0.003). Overall, 21 patients had S-100B above reference level (> or =0.10microg/L) and these patients had significantly more calcifications in the ascending aorta on epiaortic scanning.
Intravenous glutamate infusion during surgery for unstable coronary artery disease did not initiate a sustained elevation of plasma S-100B. Thus, no evidence for subclinical neurological injury related to glutamate infusion was found. In contrast, postoperative elevation of plasma S-100B was linked to calcification of the ascending aorta and postoperative confusion.
Background & aims:
The abundance of specific microbes might be associated with plasma lipopolysaccharide and insulin levels. The aims were to quantify the abundance of specific microbes and plasma LPS in females and assess their association with anthropometric, body composition and biochemical measurements.
Methods:
Seventeen lean (BMI 19-24.99 kg/m(2)) and fifteen obese females (BMI > 30 kg/m(2)) participated. Anthropometry, body composition, food intake and biochemical analyses were assessed. Bacterial groups in faeces were analysed by qPCR method.
Results:
Lactobacillus plantarum prevalence was higher (p = 0.005) and its counts tended to be higher in lean vs. obese group (p = 0.06). Bifidobacterium genus, Bifidobacterium longum, Clostridium coccoides and Clostridium leptum counts were higher in lean women (p < 0.05); prevalence and counts of Akkermansia muciniphila tended to be higher in lean group (p = 0.09, p = 0.06, respectively). Plasma LPS levels were similar between the study groups (p > 0.05). No association was found between LPS and bacterial levels or insulin. Bifidobacteria and C. coccoides counts were inversely associated with insulin and HOMA index.
Conclusions:
Abundance of specific microbes is distinct between obese and lean women, but is not associated with LPS level. Bifidobacterial and C. coccoides levels are associated with insulin sensitivity. These bacterial groups may be capable of modulating insulin action.
The efficacy of enteral nutrition as primary therapy of active Crohn's disease is controversial. The aim of the study was to compare by meta-analysis the likelihood of clinical response to liquid diet therapy vs. corticosteroids and to assess the importance of formula composition to efficacy.
Randomised controlled trials comparing exclusive enteral nutrition with corticosteroids and elemental with non-elemental formulas were identified through a combination of computerised and hand-searching techniques. Rates of clinical remission of active Crohn's disease, based on the intention to treat principle, were extracted from the studies by two independent reviewers. Odds ratios for the likelihood of clinical response were calculated.
In eight trials comprising 413 patients, enteral nutrition was inferior to corticosteroids (pooled odds ratio 0.35; 95% confidence interval 0.23-0.53). In five trials comprising 134 patients, there was no difference in the efficacy of elemental versus non-elemental formulas (pooled odds ratio 0.87; 95% confidence interval 0.41-1.83).
Corticosteroids are more effective than enteral nutrition in the treatment of active Crohn's disease. Limited sample size precludes definite conclusions about the importance of formula composition in the efficacy of enteral nutrition; however, data analysed in this study do not support an advantage to elemental feedings compared with a polymeric formulation.
To assess and compare the rates of malnutrition in Hammersmith Hospital NHS Trust over a 5-year period following changes in hospital nutrition care strategies.
Design: Three consecutive cross-sectional studies carried out in 1998, 2000 and 2003.
Inpatients at Hammersmith Hospital NHS Trust.
A total of 2283 inpatients aged over 16 years old, 686 in 1998, 780 in 2000, 817 in 2003. Inpatients excluded: ventilated patients, ante/post-natal women and people aged <16.
Improvements in the catering service and nutrition education provision in 2000, and the implementation of a nutrition screening tool and 'Better Hospital Food' in 2003.
Prevalence of malnutrition.
There was a reduction in the prevalence of malnutrition in 2000 and 2003 from baseline data in 1998 (1998: 23.5%, 161/686; 2000: 20.4%, 159/780; 2003: 19.1%, 156/817; P<0.001). The odds ratio of being either at risk of malnutrition or malnourished was reduced in both 2000 and 2003 by approximately 33% (P=0.001). Indicators of good nutritional practice also improved: Weighing patients on admission increased from 37.5% (257/686) in 1998, to 42.9% (335/780) in 2000, and 59.6% (487/817) in 2003 (P0.001). Dietetic referrals also increased from 31.5% (216/686) in 1998 to 41.6% (340/817) in 2003 (P<0.001)(no change in 2000, 31%, 242/780). Appropriate referrals also improved, results showing that the proportion of malnourished patients who were referred showed a dramatic increase in 2003 (1998: 91/161, 56.5%; 2000: 85/159, 53.5%; 2003: 111/156, 71.2%; P=0.003).
The prevalence of malnutrition in hospital can be influenced by the implementation of a variety of nutrition care strategies, which target identification of malnutrition and its treatment.
Iodine fortification is widespread. Systematic monitoring of iodine fortification programs should be carried out to secure an optimal fortification level. Our aim was to investigate the effectiveness of the Danish iodine fortification program by comparing iodine excretion at baseline and at 11-year follow-up, and to study determinants for any change in iodine intake including dietary habits, education, life style factors and health parameters.
A follow-up study based on the Danish DanThyr cohort examined in 1997-1998 just before iodine fortification was introduced, and reexamined in 2008-2010. In total, 2465 (59.1%) adult participants were reexamined.
Median (IQR) iodine concentration in urine had increased by 19 (-25-68) μg/L to 83 (47-133) μg/L. Estimated 24-h iodine excretion had increased by 36 (-21-95) μg/24-h to 134 (93-206), and calculated total iodine intake (diet plus supplements) had increased by 16 (-18-48) μg/day. Iodine excretion had increased significantly in all age and gender groups, but was still below the recommended amount at follow-up. The increase in iodine excretion was positively associated with changes in milk intake, with changes in the use of iodine supplements, and with bread intake at follow-up. Salt intake, education, self-rated health, smoking, alcohol intake and physical activity were not associated with the increase in iodine excretion.
The strategy to combat iodine deficiency in Denmark seems to be working because the fortification led to increased urinary iodine excretion in (almost) all participants. However, the level of iodine fortification of salt is too low.
Children's food choices are guided by their preferences. It is established, however, that repeated exposure to a novel food increases children's acceptance. This study investigated how acceptance of an initially liked and disliked snack bar develops in 9-11 year-old children.
315 children were randomised into three groups: A control group (n = 111) and two groups exposed to an initially liked kamut bar (n = 94) and an initially disliked sea buckthorn bar (n = 110). Acceptance of both bars was tested before and after the exposure period, and on the 9th exposure.
Intake of both bars increased significantly in the exposure groups. There was no difference in the control groups' intake or liking of the bars between pre and post-testing. Liking rose significantly for children exposed to the disliked sea buckthorn bar, while this was not observed in children exposed to the liked kamut bar. In a post-test children exposed to kamut bars had higher intake of that bar than non-exposed children. This was also observed for the sea buckthorn bar that was also given significantly higher liking scores by the exposure group.
The majority of children exposed to an initially disliked bar increase acceptance after nine exposures to the same level as an initially liked bar. Children repeatedly exposed to a liked bar show stable acceptance.
We report our experience of paediatric home enteral nutrition, as there is little detailed evidence published.
All patients younger than 18 years commencing treatment between January 1990 and December 2000 were included in this retrospective study.
The study covered 416 children and adolescents, corresponding to a total of 243,844 days of home enteral nutrition (HEN). The mean (+/-SD) age of patients commencing treatment was 5.4+/-5.3 years (range 0.1-17.8). Indications were digestive disorders in 35% of patients, neurological and muscular disorders in 35%, malignancy in 11%, failure to thrive in 8%, and miscellaneous ailments in 9%. Enteral feeding comprised commercially available paediatric industrial diets in 36%, adult-type diet in 35% and infant formulas in 29%. Children received enteral feeding by nasogastric tube (53%), or gastrostomy (41%). A mechanical pump was used in 98% of the patients. The mean duration of treatment was 595+/-719 days.
HEN can be used while treating a large group of chronic diseases of children. It can be started very early in life and is often prolonged over several years.
Elderly long-term care patients (n = 501) were randomly allocated to receive dietary supplementation (400 kcal/day) in addition to a normal hospital diet, or normal hospital diet only, for 26 weeks. The patients' functional condition was assessed by a modified Norton scale comprising mental condition, activity, mobility, food intake, fluid intake, incontinence and general physical state. Nutritional status was assessed by anthropometry, serum protein analysis and delayed hypersensitivity skin tests. Improvements during the first 8 weeks were seen in activity and general physical condition in the supplemented group, and in mobility and general physical condition in the control group. After 8 weeks the supplemented group showed a significantly higher level of activity (p < 0.05) compared to the control group. We conclude that in long-term geriatric care nutritional supplements help to maintain and improve the patients function.
This paper describes a case-report of a 21-year-old woman who sustained an isolated traumatic brain injury following a road traffic accident. After a 3-day period of parenteral nutrition including fat (Intralipid 20%) she developed hypertriglyceridaemia and 'creaming plasma', with a rash, high fever, hypertension, raised inracranial pressure, hepatic and renal failure, haemolysis, marked thrombocytopenia, and leucopenia, coagulation disorder and pulmonary failure, suggestive of hyperactivation of the monocyte-macrophage system. Treatment involved cessation of the lipid emulsion infusion and steroids. 6 months after the accident, the patient was well recovered with only minor neurological sequelae.
It is essential that children on prolonged parenteral nutrition for anatomical or functional loss of small bowel should enjoy a quality of life which is as normal as possible. Their return home is a major factor in this. Over the past 8 years, 112 children were able to remain at home on cyclic parenteral nutrition. Forty-nine of them are no longer on home parenteral nutrition (HPN), 45 are still on HPN, and 18 have died. Growth and quality of life were good in most cases. Most of the complications were from infection, 1 septicaemia per 594 days on HPN. In the light of these results, HPN seems to be the best option for children requiring prolonged parenteral nutrition, although it can only be considered within the framework of a specialized centre, which ensures patient follow-up, and provides the logistical support required for this high-technology treatment.
The aim of our study was to detect differences in weigth loss with a hypocaloric diet in obese patients depending on their glycaemic status.
A population of 76 obesity outpatients was analysed in a prospective way. The following variables were specifically recorded at basal time and after 3 months of hypocaloric diet (1200 kcal/day): weight, blood pressure, body mass index (BMI), waist circumference, and waist-hip ratio. Basal glucose, insulin, fibrinogen, cortisol, c-reactive protein, total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides blood levels were measured. HOMA was calculated. An indirect calorimetry, tetrapolar electrical bioimpedance and a serial assessment of nutritional intake with 3 days written food records were performed.
The mean age was 46.9 +/- 17.1 years and the mean BMI 34.6 +/- 5.3. All subjects were weight stable during the 2 weeks period preceding the study (body weight change, 0.3 +/- 0.1 kg). Anthropometric measurements showed an average waist circumference (108.7 +/- 15.7 cm), waist-to-hip ratio (0.93 +/- 0.11), and average weight (88.7 +/- 16.9 kg). Bipolar body electrical bioimpedance showed a fat mass of 37 +/- 12.3 kg. Indirect calorimetry showed a resting metabolic rate (RMR) (1674.3 +/- 392 kcal/day). Patients were divided in to two groups by glycaemic status (group I: normal glycaemic metabolism, fasting glucose levels <109 mg/dl; n = 50) and (group II: impaired glycaemic metabolism, fasting glucose levels >110 mg/dl, n = 26). Waist circumference (I: 108 +/- 17.1cm vs. 104.6 +/- 16.7 cm; P < 0.05) and (II: 113.6 +/- 9.8 cm vs. 110.9 +/- 8.9 cm; P < 0.05), weight (I: 90.6 +/- 19.2 kg vs. 86.3 +/- 18.6 kg:P < 0.05) and (II: 89.2 +/- 11.3 kg vs. 86.4 +/- 11.6 kg: P < 0.05) and BMI (I: 34.2 +/- 5.6 vs. 33.7 +/- 5.5; P < 0.05) and (II: 34.8 +/- 4.2 vs. 34.2 +/- 4.6; P < 0.05) improved in both groups with hypocaloric diet. Blood systolic pressure, total cholesterol and LDL cholesterol improved in both groups, without statistical differences. In group II improved glucose levels and HOMA index, too. Patients of group II had higher systolic blood pressure, glucose, total cholesterol, LDL cholesterol, triglycerides, lipoprotein (a), RCP levels and HOMA index than patients in group I. ANOVA analysis did not show differences among weight loss in tertiles of HOMA and glucose.
Ability to lose weight on a hypocaloric diet over a 3-month time period does not vary in obese patients as a function of glycaemic status. Improvement in cardiovascular risk factors is not related with glycaemic status, too.
To study the 1-yr follow-up of 118 bulimia nervosa (BN) patients after a 3-month at-home tube feeding (TF) in a prospective study.
At-home TF lasted 3 months, including one month of exclusive TF (no food). All patients fulfilled 4 questionnaires (score of binge/purging episodes (BP), eating disorder inventory, anxiety, depression), before, at the 3-month TF point, and 6 and 12 months latter.
The score of BP episodes dramatically decreased from 28.8 ± 15 (before TF) to 7.3 ± 5.4 at 3 months, as well as at 1 yr (15.1 ± 6.2). We also obtained a 50% decrease in Beck score (depression) and Hamilton score (anxiety). Curiously, there was no difference between the BP scores of the patients following psychotherapy and those who did not, despite lower scores for anxiety and depression.
In conclusion, in bulimia nervosa patients having normal BMI and purging behavior, home-TF allow to obtain total withdrawal from bingeing/purging in at least 75% of the cases at short term (3 months) and in 25% of the patients at one year, whatever the patients have or have not psychotherapy.
The effect of arginine on lymphocyte proliferation in vitro was studied in patients with advanced gastric cancer. Patients who were ambulatory, normally nourished and consuming a normal diet, received a daily supplement of 30 g arginine for 7 days. There was no change in total lymphocyte count, T B cell ratio in peripheral blood, or an enhancement of lymphocyte proliferation in response to mitogen stimulation. Arginine ingestion did not impair liver function and had no detectable side effects except transient nausea in one patient. An in vitro study on the effect of arginine on phytohaemagglutination-stimulated lymphocyte proliferation showed that lymphocytes from gastric cancer patients had poorer responses than obtained from normal subjects despite the supplement in the culture medium with normal serum, patient serum, or fetal bovine serum. These results indicate that dietary arginine supplementation appears safe but does not stimulate lymphocyte function in these advanced gastric cancer patients. The suppressed immune function may be the results of their intrinsic lymphocyte defect.
