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Biomedical subjects

M E Lean

Publications and source records attributed to M E Lean.

At least 91 records · Page 5Linked to original sources
PubMed1994

Predicting resting energy expenditure in patients with musculoskeletal deformities.

UNLABELLED: The aim of this study was to assess the validity of the commonly used equations (Harris-Benedict (HB), Schofield (S) and equations based on midarm circumference (MAC) and midarm muscle circumference (MAMC) in predicting resting energy expenditure (REE) in a population of patients with musculoskeletal deformities. 20 kyphoscoliotic patients (15 female (F); 5 male (M); mean age 59.6 years) and 10 controls (7 F; 3M; 59.8 years) were studied. REE measured by indirect calorimetry (IC) with a ventilated canopy system (Deltatrac metabolic monitor) was not significantly different between patients and controls (Mean (SD) REE (MJ/24 h): PATIENTS: 5.48 (1.1); controls: 5.28(0.8)). In patients with deformities the Schofield equation gave values which were closest to measured REE (mean difference and limits of agreement IC vs S: 0.098 MJ/24 h; -0.822 and 1.018). The Harris-Benedict equation using height (Ht) and armspan (AS) in lieu of height also gave acceptable results (IC vs HB (Ht): 0.34; -0.638 and 1.318; IC vs HB (AS): 0.255; -0.683 and 1.253). Equations based on MAC and MAMC compared poorly (IC vs MAC equation: 0.398; -1.530 and 2.326; IC vs MAMC equation 0.687; -0.911 and 2.285). On regression analysis the equation REE = 0.295 (MAMC) + 0.0483 (AS) -0.0324 (age) -6.25 predicted REE best in the patient population (r(2) = 0.861).

Journal Article↗
PubMed1994

Resting energy expenditure and nutritional state of patients with increased oxygen cost of breathing due to emphysema, scoliosis and thoracoplasty.

BACKGROUND: Weight loss is a well recognised feature of patients with emphysematous chronic obstructive pulmonary disease (COPD). It has been suggested that this weight loss could be due to a hypermetabolic state resulting from the increased oxygen cost of breathing (OCB). To clarify the relation between resting energy expenditure (REE), nutritional state, and OCB these indices were measured in patients with respiratory impairment and an increased OCB due to COPD, scoliosis, and thoracoplasty. METHODS: Eighteen patients (six COPD, six scoliosis, six thoracoplasty) of mean (SD) age 59.9 (8.6) years (8M, 10F) and six controls (45.5 (9.9) years; 2M, 4F) were studied. OCB was estimated by the addition of dead space to the breathing circuit and REE was measured by indirect calorimetry using a ventilated canopy system. Height, arm span, weight, triceps skin fold thickness (TSF), mid-arm muscle circumference (MAMC), forced expiratory volume in one second (FEV1), and vital capacity (VC) were measured in all study subjects. RESULTS: OCB was elevated in all patient groups (mean 7.0 ml/l) compared with controls (1.9 ml/l). All patients with COPD, four with scoliosis, three with thoracoplasty, and none of the controls were < 90% ideal body weight. Mean (SD) measured REE as % predicted (Harris-Benedict equation) was 103.8 (7.6) in patients with COPD, 105.5 (10.9) in those with scoliosis, 106.3 (6.9) in the thoracoplasty patients, and 103.3 (3.4) in controls. One patient with COPD, two with scoliosis, two with thoracoplasty, but no controls were hypermetabolic (REE > 110% predicted). In all groups there was a negative relation between OCB and lung function (OCB v FEV1 r = -0.83 in COPD, -0.62 in scoliosis, -0.67 in thoracoplasty, and -0.76 in controls). There was no correlation between REE and OCB or MAMC. CONCLUSIONS: In patients with respiratory disease OCB (augmented ventilation) is related to lung function but not to REE. This is evidence against the hypothesis that hypermetabolism due to increased oxygen cost of breathing at rest is the sole or major cause of malnutrition in patients with lung disease.

Aged↗
PubMed1994

An out-patient nutritional supplementation programme in COPD patients.

Studies that have assessed the role of nutritional supplementation in patients with emphysematous chronic obstructive pulmonary disease (COPD) have shown conflicting results. Improved respiratory muscle strength and exercise capacity have been demonstrated following intensive and costly nutritional support programmes under controlled conditions. We have evaluated a simple programme of out-patient nutritional support in a clinical setting. Twelve malnourished COPD patients (9 male and 3 female; mean age 66 yrs; < 90% ideal body weight) were studied. Forced vital capacity (FVC), forced expiratory volume in one second (FEV1), estimation of maximal oxygen uptake (VO2max) during exercise, respiratory muscle strength (PImax and PEmax), and measurement of body weight, height, triceps skinfold thickness, and mid-arm muscle circumference were performed before and after a 4 month period of out-patient nutritional support. Patients were advised by a dietician on increasing their daily caloric intake by a minimum of 50% above estimated daily energy expenditure. Three patients withdrew from the study. The mean increase in body weight in the nine remaining patients after 4 months of supplementation was 0.3 kg. There was no significant improvement in the anthropometric measures, lung function, respiratory muscle strength or VO2max for the group as a whole. Three patients who gained more than 1 kg weight were from a higher socioeconomic background compared with those who failed to do so. We conclude that achieving weight gain and improving lung function by means of simple out-patient nutritional programmes in a clinical setting is difficult.

Aged↗
PubMed1994

Bone loss associated with a high fibre weight reduction diet in postmenopausal women.

OBJECTIVE: To examine the effect of high fibre weight reduction on bone density in postmenopausal women. DESIGN: Case-control study. SETTING: Hospital outpatient dietetic clinic and Osteoporosis Screening Unit. SUBJECTS AND INTERVENTIONS: Sixteen overweight volunteers who followed a high fibre reducing diet for 6 months, to lose 20% of excess body weight (above body mass index 25 kg/m2), and returned to their starting weight by the end of a further 6 months. Forty-six non-dieting controls, matched for age and years postmenopause, selected from screening unit volunteer register. RESULTS: Annual percentage changes in lumbar spine bone mineral density, measured by dual energy X-ray absorptiometry were: controls -2.5% (SE 0.5), dieters -4.8% (0.9), 95% confidence interval of difference between groups -0.2 to -4.3% (P = 0.03); femoral neck bone density controls -2.5% (0.5), dieters -2.1% (0.9), 95% confidence interval of difference -1.7 to 2.5% (P = 0.69). CONCLUSIONS: High fibre weight reduction in postmenopausal women significantly increased annual bone loss from the lumbar spine. This loss was not reversed by weight regain in the second 6 months. Repeated cycles of high fibre weight loss and weight gain may increase the risk of spinal osteoporosis.

Absorptiometry, Photon↗
PubMed1990

Insulin management during labour and delivery in mothers with diabetes.

A standardized intravenous regimen has been assessed, in 25 insulin-treated diabetic women, for insulin and dextrose therapy in labour and delivery. Adjustments to insulin infusion rate are determined by trends in blood glucose as well as by absolute concentration, in order to approach normoglycaemia. Blood glucose was 5.0 (SD 1.7) mmol l-1 on arrival in labour (or at 0800 h before planned delivery) and was maintained at 6.0 (SD 1.8) mmol l-1 with insulin 0-5 U h-1 for up to 29 h before delivery, when it was 6.3 (SD 2.1, range 3.0-9.0) mmol l-1 with insulin infusion rate 0-4 U h-1. Neonatal blood glucose (less than 2.0 mmol l-1 in 11 babies) correlated with both maternal HbA1c (rs = -0.47, p less than 0.02) and maternal blood glucose at delivery (rs = -0.58, p less than 0.01). During 12 months observation on the intravenous regimen, 339 measurements of blood glucose were made; 10 were less than 3.0 mmol l-1, 242 were 3.0-8.0 mmol l-1, and 81 were greater than 8.0 mmol l-1 (mean 6.5, range 2.7-13.5 mmol l-1). Insulin infusion rate ranged from 0 to 5 U h-1, with 139 rate adjustments. Only one mild clinical hypoglycaemic episode, responding to increased dextrose infusion, was recorded. This simple flexible regimen proved clinically reliable for both midwifery and medical staff.

Cesarean Section↗
PubMed1990

A comparison between the diets of pregnant diabetic women and pregnant non-diabetic women.

In order to assess the effect of dietary advice for pregnant diabetic women, the habitual dietary intake of 8 pregnant diabetic women was assessed by 7-day weighed food records. These results were compared with records from 8 non-diabetic women, matched for age and gestation. Despite intense personalized dietetic advice to the diabetic women, there were no statistically significant differences in macro-nutrient intake between the two groups. The diabetic women were encouraged to increase their carbohydrate intake slightly, but failed to achieve current British Diabetic Association dietary recommendations with respect to percent energy from carbohydrate (41 +/- 5 (+/- SE)(range 29-47)%, BDA recommendation greater than 50%) and percentage from fat 43 +/- 6 (33-51)%, BDA recommendation less than 30%). Intake of bread and cereals was increased in the diabetic women, but increases in complex carbohydrates were insufficient to compensate for a reduced intake of high-sugar foods. Intakes of energy from simple sugars were significantly lower (p less than 0.05) in the diabetic group (12 +/- 2 (5-20)%) than in the non-diabetic group (21 +/- 2 (12-28)%). There was no detectable difference in sources of fats in the diet between the two groups.

Adult↗
PubMed1989

Brown adipose tissue activity in pyrexial cases of cot death.

Brown adipose tissue was investigated in two cases of cot death in which core temperatures were above 40 degrees C on arrival at the mortuary. Evidence was obtained from mitochondrial (8-3H) guanosine diphosphate (GDP) binding and oxygen uptake of active thermogenesis with uncoupled mitochondrial respiration which was recoupled by GDP. Thermogenic capacity of brown adipose tissue, estimated by radioimmunoassay of the specific mitochondrial membrane "uncoupling protein" responsible for heat production, was similar to that measured in other infants or in experimental animals acclimated to moderately warm conditions (23 degrees C). Brown adipose tissue thermogenesis, occurring inappropriately in a warm, well insulated infant, could be a cause of some cases of cot death.

Adipose Tissue, Brown↗
PubMed1988

Metabolic and thyroidal responses to mild cold are abnormal in obese diabetic women.

Mild cold exposure (22 degrees C, with reference to 28 degrees C, thermoneutral) was studied by overnight whole-body indirect calorimetry in euthyroid women. Basal, sleeping, energy expenditure (EE) was significantly increased (+3.8%, P less than 0.05) in six normal weight women but reduced (-3.5%, P less than 0.05) in five obese type II diabetic women. Mixed responses were found in five women with simple obesity. Biochemical measurements were made on fasting blood samples taken at 0900 h after 12 h exposure to the two temperatures. Serum T4, free T3 and TSH were within the normal reference range in all subjects. Serum T4 did not show any differences between the groups, nor any effect from temperature. There was a significant increase in free T3 (P less than 0.05) at 22 degrees C in the control subjects, but no differences in the obese diabetic women. Serum thyroglobulin fell significantly in the diabetic group. Both TSH and free T3 responses to mild cold were significantly different between the groups, but both correlated positively (P less than 0.05) with the changes in sleeping energy expenditure at 22 degrees C with reference to 28 degrees C. Changes in TSH and free T3 were themselves significantly correlated within individuals (P less than 0.01). The normal physiological non-shivering thermogenesis of adult humans on exposure to a cool environment may thus be mediated by a pituitary-thyroid mechanism. The abnormal response of obese diabetic women was associated with impaired TSH and thyroid hormone responses, and may be a factor contributing to weight gain.

Adult↗
PubMed1988

Catering for health in a Scottish Health Board.

This paper describes the first steps taken in Grampian Health Board to change hospital staff menus in order to provide meals higher in starchy carbohydrate and dietary fibre but lower in fat and sugar, as recommended in several recent reports. These changes are discussed with reference to the alterations made by the catering department. A nutrition education programme was used to promote these changes and the methods used for this are also described. An overall evaluation was carried out by means of a dietary intake questionnaire administered before and after the programme and the results of this show a significant decrease in fat intake and increases in carbohydrate and dietary fibre intakes.

Food Service, Hospital↗
PubMed1988

Metabolic effects of isoenergetic nutrient exchange over 24 hours in relation to obesity in women.

Twenty-four hour whole body indirect calorimetry has been used to study the effects of feeding, during a sedentary test day, isoenergetic diets which varied in fat (3 or 40 per cent of total energy) and carbohydrate (82 or 45 per cent) content. Three groups of women were studied: lean, obese and 'post-obese' after slimming. Energy expenditure was greater in absolute terms in the obese women. Twenty-four hour energy expenditure was lower by only 3-7 per cent when fasting compared to that when fed to achieve energy balance. There were no large differences in energy expenditure between the two diets or between the groups but the thermogenic effect of the high carbohydrate diet was significantly greater than that of the high fat diet (5.8 vs 3.5 per cent of energy expenditure: P less than 0.01). The post-obese tended to have lower energy expenditure per kg FFM than controls when fasting and when high-fat fed, but this pattern was not shown by the obese. Sleeping energy expenditure was particularly low in the post-obese group when high-fat fed. Dirunal variations in RQ appear to show more marked rise in morning RQ from the nocturnal minimum in the obese and post-obese, which might be evidence for an energy-saving mechanism through greater availability of stored dietary carbohydrate.

Adult↗
PubMed1988

Towards NACNE: improving eating habits in a Scottish health board.

A low-cost locally based nutrition education programme was designed around the employment of a part-time dietitian with the aim of improving the nutritional intakes of Grampian Health Board staff. Its effectiveness was evaluated by assessment of habitual dietary intakes of staff, using a previously validated questionnaire administered to random samples before and after the intervention programme. The results indicated significant changes towards lower fat and higher carbohydrate intakes (both P less than 0.05) and improvements appeared to be distributed throughout the sexes, and age and socioeconomic groups. Mean fat intakes of staff fell by 2.7 per cent of total energy (P less than 0.01). Current long-term nutritional goals were achieved by 6 per cent of staff before the intervention programme and by 13 per cent afterwards (P less than 0.05). The example set in the staff dining rooms by the introduction of modified recipes and low-fat/high-carbohydrate replacements for some of the less healthy traditional dishes was well received and led to no increase in catering costs.

Adolescent↗
PubMed1986

Prescription of diabetic diets in the 1980s.

A method is described to aid the prescription of diabetic diets, derived from newly available data for computation of metabolic rates of individuals. Absolute daily amounts of the main nutrients required to formulate a patient's diet are obtained from simple nomograms based on the patient's height and activity level. This system is more accurate and more flexible than currently accepted methods of dietary assessment and should lead to improved use of dietetic resources.

Adolescent↗
PubMed1986

Brown adipose tissue uncoupling protein content in human infants, children and adults.

A solid-phase radioimmunoassay is described for the estimation of the uncoupling protein content of human brown adipose tissue mitochondria, as an index of thermogenic capacity. The concentration of inner mitochondrial membrane uncoupling protein was measured in brown adipose tissue samples from 48 individuals who died suddenly. The uncoupling protein content of axillary adipose tissue was greater than that of perirenal adipose tissue. Variations in brown adipose tissue uncoupling protein content, which would be consistent with changing thermogenic requirements and capacity, were observed in different groups of subjects. Significantly lower concentrations were found in adults and in pre-term and stillborn infants than in older infants and children.

Adipose Tissue, Brown↗
PubMed1986

Brown adipose tissue in patients with phaeochromocytoma.

Intra-abdominal adipose tissue was obtained at laparotomy from three subjects with high circulating noradrenaline concentrations in the presence of phaeochromocytoma. Light and electron microscopy confirmed typical brown adipose tissue, both adjacent to, and in one case distant from, the tumour. Biochemically, in terms of high cytochrome-C oxidase activity, mitochondrial GDP-binding, GDP-inhibitable uncoupled mitochondrial respiration, and specific concentration of uncoupling protein (mean 31 +/- 7 micrograms/mg mitochondrial protein) the tissue possessed all the unique features of thermogenically active brown adipose tissue. These findings are contrasted with low results obtained from a case with Cushing's disease, and the significantly lower results (mean 2.5 +/- 1.8 micrograms/mg) in a group of control adults (P less than 0.02). In the presence of high circulating noradrenaline concentrations, the intra-abdominal fat of human adults, including the omental fat, which is brown adipose tissue in infancy, becomes reactivated and may be contributing to the weight loss which is typically seen with phaeochromocytoma. Human adult brown adipose tissue thus has the biochemical potential for the thermogenic activity required in order to contribute to the regulation of energy balance and body weight.

Adipose Tissue, Brown↗