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The short-term effects of a low-protein diet in stable renal transplant recipients.

The short-term effects of a low-protein diet were assessed in eight stable renal transplant recipients on maintenance immunosuppression 38 +/- 7 months following transplantation. Two-week baseline protein and caloric intakes derived from daily food records were 0.97 +/- 0.08 g/kg.d and 25.3 +/- 1.6 kcal/kg.d. A diet containing 0.6 g protein/kg.d and greater than or equal to 30 kcal/kg.d was then prescribed. Nitrogen balance was assessed for 3 weeks and final measurements were taken at 4 weeks. Body weight decreased from 76.4 +/- 3.8 to 74.8 +/- 3.5 kg (P = 0.028). Baseline inulin clearance was 40.9 +/- 6.2 mL/min.1.73 m2 and did not change following the dietary modification. There were no significant changes in plasma proteins, lipids, or in white blood cell counts. During the low-protein diet, mean protein intake was 0.62 +/- 0.02 g/kg.d (P less than 0.001 v baseline) and the mean caloric intake decreased to 20.8 +/- 1.2 kcal/kg.d (P = 0.036 v baseline). Mean baseline nitrogen balance was -62.8 +/- 81.4 mmol/d (-0.88 +/- 1.14 g/d) and remained negative, -113.5 +/- 35.7 mmol/d (-1.59 +/- 0.50 g/d), after 3 weeks of the protein-restricted diet. A positive correlation between caloric intake and nitrogen balance combining all periods was seen (r = 0.61, P less than 0.01, n = 32) with predicted neutral nitrogen balance occurring at a caloric intake of 28 kcal/kg.d. There was also a weak correlation (r = 0.42, P less than 0.05, n = 32) between protein intake and nitrogen balance.(ABSTRACT TRUNCATED AT 250 WORDS)

Dietary Proteins↗

Weight gain and nutritional efficacy in anorexia nervosa.

To evaluate the usefulness of interval weight change in assessing nutritional support efficacy, we studied four anorexia nervosa patients (52% ideal body weight) requiring long-term total parenteral nutrition (TPN) for 63 +/- 18 days. Fluid and electrolyte deficits were corrected before the initiation of nutritional support. Resting energy expenditure was measured before the initiation of TPN and weekly thereafter, using indirect calorimetry. Daily caloric expenditure was estimated at 1.1 X resting energy expenditure, based on previous studies of continuous heart rate monitoring in this patient population. Daily excess calories were calculated as caloric intake minus caloric expenditure. Each patient was weighed daily and linear regression analysis (excess calories versus weight change) was performed for individual patients and the group over intervals of varying length. There was no individual or group correlation between excess calories and weight gain on a daily or weekly interval basis. Cumulative weight changes over the long-term course of TPN correlated significantly with cumulative excess calories for each patient and the whole group (r = +0.82, p less than 0.01). The excess calories required to gain a kilogram body weight ranged from 5569 to 15619 kcal/kg with a mean of 9768. Cumulative long-term weight changes during nutritional repletion in anorexia nervosa are meaningful indicators of caloric balance, but short interval weight changes (daily, weekly) are not. The caloric cost of weight gain is variable in this population.

Adolescent↗

Type 2 diabetes and the metabolic syndrome in children and adolescents.

The prevalence rates of obesity, metabolic syndrome, and type 2 diabetes in children are increasing at an alarming rate. The potential impact of these conditions on the individual, the family, and society, especially in regard to the costs and utilization of health care resources, are very serious. Strategies aimed at reducing caloric intake, increasing caloric expenditure through regular exercise, and treating cardiovascular risk factors and type 2 diabetes early and aggressively are necessary to meet the challenges they impose.

Adolescent↗

Dietary intakes of young children with cystic fibrosis: is there a difference?

Caloric intakes of preadolescent and adolescent girls and boys with cystic fibrosis (CF) were compared in order to evaluate the possibility that poor caloric intake contributes to poor nutritional status and high mortality among girls with CF. Fifty-six CF patients (26 girls and 30 boys), 10-15 years old, completed a 3-day food record, answered a short questionnaire, and underwent anthropometric and pulmonary function assessment. The mean ages of the girls and boys were similar, but the height and weight percentiles of the girls were lower than those of the boys (p = 0.02). Mean caloric intakes were no different (116% and 112% of the recommended nutrient intake in the girls and boys, respectively). Nutritional status, as determined by weight as a percentage of ideal weight for height, mean triceps skinfold thickness, and midarm muscle circumference, was normal and similar in both sexes. Most girls and boys with CF in this study had an appropriate perception of their body weight. Pulmonary function tests suggested mild lung disease with no significant difference between girls and boys (forced expiratory volume in 1 s of 82.2% and 79.8% of predicted values, respectively). The similar nutritional and pulmonary status of the girls and boys with CF in this age group is in contrast to previous reports. This finding may be the result of our policy, introduced > 15 years ago, of expecting normal growth, by paying close attention to enzyme therapy and encouraging high energy intake from the time of diagnosis. It remains to be seen whether boys and girls continue to maintain similar nutritional and pulmonary status at a later age and whether both sexes experience a similar mortality rate as they age.

Adolescent↗

Mice lacking the syndecan-3 gene are resistant to diet-induced obesity.

The accurate matching of caloric intake to caloric expenditure involves a complex system of peripheral signals and numerous CNS neurotransmitter systems. Syndecans are a family of membrane-bound heparan sulfate proteoglycans that modulate ligand-receptor interactions. Syndecan-3 is heavily expressed in several areas of the brain, including hypothalamic nuclei, which are known to regulate energy balance. In particular, syndecans have been implicated in modulation of the activity of the melanocortin system, which potently regulates energy intake, energy expenditure, and peripheral glucose metabolism. Our data demonstrate that syndecan-3-null mice have reduced adipose content compared with wild-type mice. On a high-fat diet, syndecan-3-null male and female mice exhibited a partial resistance to obesity due to reduced food intake in males and increased energy expenditure in females relative to that of wild-type mice. As a result, syndecan-3-null mice on a high-fat diet accumulated less adipose mass and showed improved glucose tolerance compared with wild-type controls. The data implicate syndecan-3 in the regulation of body weight and suggest that inhibition of syndecan-3 may provide a therapeutic approach for the treatment of obesity resulting from exposure to high-fat diets.

Animals↗

Four-year study of university athletes' dietary intake.

Baseline dietary intake data were collected for four years on 10 men's and 6 women's university athletic teams. Caloric intake means for specific teams were higher than those stated in nutrition textbooks (5,270 kcal for football, with a 14,000 kcal per day maximum). Athletes' caloric intakes cannot be grouped, as some athletes (wrestlers and gymnasts) have low intakes (400 kcal per day). Protein intake of all athletes except wrestlers and gymnasts is high (in many cases more than twice any recommendation). The diets of teams with high caloric intakes had a high (more than 50%) fat content. The fat content of the diets of other athletes ranged from 30% to 40%. The wrestling team had more members with poor nutrient intake (less than two-thirds of recommendations) than any other team. Poor vitamin A intakes were noted for all athletic teams studied. Low potassium intakes also were common. Members of women's teams had low iron intakes even though their protein and caloric intakes were high.

Computers↗

[Nutritional principles for the pregnant diabetic].

After a short account on alimentation in pregnant women, the authors examine in detail the correct alimentation in pregnant women affected by different types of diabetes. As general lines for a correct nutritional approach, a total caloric intake of 2200-2500 kcal daily (9196-10450 Kj) (which enclose 35-40 kcal/pro/kg ideal weight and a caloric surplus for pregnancy) is recommended. In over-weight women the caloric intake will be reduced till 1500 kcal (6270 Kj) checking constantly metabolic situation (increase of weight should be for the first ten weeks of 100 g weekly, than of 300 g weekly). Altogether weight increase should be from 9 to 12 kg. 15-20% of caloric intake should be represented for proteins, very important for pregnancy and good growth of fetus. Carbohydrate intake should be 55-60% of caloric intake represented for 75-80% by complex glucides and for 20-25% simple glucides to support a suitable amount of dietary fibres (25-30%). The lipid intake recommended should be 25-30% of the daily calories with a third of monounsaturated fat acids, a third of polyunsaturated fat acids and a third of saturated fat acids, with a cholesterol amount under 300 mg/die. In additional the nutritional plan should consist of a adequate amount of "non energetic nutrients" (minerals and vitamins), particularly the calcium intake must be 1200 mg/die and 18 mg/die that of iron and folic acid, vitamin A, D and B intake must be increased. Finally, the authors advise against alcoholic beverages and recommend a regular subdivision of the meals.(ABSTRACT TRUNCATED AT 250 WORDS)

Diet, Diabetic↗

Exercise regulation of triiodothyronine metabolism.

Negative caloric balance reduces triiodothyronine (T3) production in both humans and rodents. The effects of chronic voluntary exercise and various levels of caloric intake and balance on T3 metabolism were studied in adult male C57/BL6 mice to determine if exercise had any direct effects on T3 production in vivo and in vitro. Chronic voluntary exercise was induced by the addition of running wheels to cages for 28 days. Ad libitum-fed exercising mice ingested 20% greater calories (P less than 0.02), maintained body weight, and increased T3 production (53.1 +/- 5.3 vs. 42.3 +/- 3.4 ng.h-1.100 mg body wt-1; P less than 0.01). Exercising animals pair fed to sedentary ad libitum-fed controls decreased their body mass to an equivalent degree as underfed sedentary animals (caloric intake 75% of ad libitum-fed controls) but had increased T3 clearance compared with weight-matched underfed sedentary control (P less than 0.05). Animals that were underfed and exercised decreased their body weight to a greater extent (P less than 0.01) compared with the sedentary underfed group, but T3 production rates were equal. Activity of liver 5'-deiodinase activity was decreased almost 50% (P less than 0.01) during both exercise plus pair feeding and exercise plus caloric restriction but decreased only 28% during caloric restriction alone (P less than 0.01). T3 metabolic clearance and production rates in vivo were correlated to caloric intake (r = 0.73, P less than 0.01), but an interaction between exercise and caloric balance was observed. Chronic voluntary exercise modulates T3 metabolism via several mechanisms. Exercise has an apparent stimulatory effect independent of caloric intake, but also there are regulatory effects dependent on the absolute level of caloric intake and relative caloric balance.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

The critical role of the melanocortin system in the control of energy balance.

Animals have developed highly adaptive and redundant mechanisms to maintain energy balance by matching caloric intake to caloric expenditure. Recent evidence has pointed to a variety of peripheral signals that inform specific central nervous system (CNS) circuits about the status of peripheral energy stores as critical to the maintenance of energy balance. A critical component of these CNS circuits is the melanocortin system. Regulation of signaling by melanocortin 3 and melanocortin 4 receptors in the CNS is controlled via neuronal cell bodies in the arcuate nucleus of the hypothalamus that synthesize melanocortin receptor agonists such as alpha-melanocyte-stimulating hormone (alpha-MSH) or antagonists such as agouti-related protein (AgRP). The activity of these two populations of neurons is reciprocally regulated by a number of peripheral and central systems that influence energy balance. Further, increased melanocortin signaling via pharmacological or genetic means in the CNS causes potent reductions in food intake and weight loss. Decreased melanocortin signaling via pharmacological or genetic means results in increased food intake and weight gain. Reviewed here is the wide range of evidence that points to the melanocortin system as a critical node in the diverse neurocircuitry that regulates food intake and body weight.

Animals↗

Theoretical aspects of weight loss in patients with cancer. Possible importance of pyruvate dehydrogenase.

In the analysis of weight loss in cancer patients, consideration must be given to decreased caloric intake, increased caloric expenditure and abnormal losses of calories. When these factors do not adequately explain the degree of weight loss, this may be due to a specific loss of lean body mass, as the caloric density of muscle is much less than that of fat. The key enzyme for the protection of lean body mass in hypocaloric states is pyruvate dehydrogenase (PDH). During fasting, fast oxidation in host tissues leads to inactivation of PDH, preventing irreversible loss of pyruvate precursors which would have to be replaced by protein breakdown. A tumor in which PDH activity remains high in the fasting state would cause loss of lean body mass in the host. This report suggests that this phenomenon may be important in certain patients with cancer cachexia.

Amino Acids↗

The effect of nutritional supplements on food intake in patients undergoing radiotherapy.

PURPOSE/OBJECTIVES: To describe the effect of nutritional supplements on food intake in patients undergoing radiotherapy. DESIGN: Experimental prospective. SAMPLE: 40 newly diagnosed patients with cancer beginning external beam radiation therapy. METHODS: Weekly dietary counseling and recording of total daily dietary intake for three days a week for four weeks. One half of the subjects were randomly assigned to ingest a liquid nutritional supplement between meals and at bedtime. MAIN RESEARCH VARIABLES: Total daily protein and caloric intake, food-derived protein and caloric intake, and supplement-derived protein and caloric intake. FINDINGS: Subjects ingesting nutritional supplements between meals significantly increased their total caloric and protein intake above that of controls and did not reduce their food-derived caloric or protein intake compared to controls. CONCLUSIONS: Nutritional supplements can be used to increase total caloric and protein intake without causing a significant reduction in food intake. IMPLICATIONS FOR NURSING PRACTICE: In this patient sample, supplements were not substituted for food intake. Further research is needed to determine the effects of supplements on appetite in patients with advanced cancer.

Adult↗

Comparison of high-calorie, low-nutrient-dense food consumption among obese and non-obese adolescents.

OBJECTIVE: The purpose of this study was to determine whether obese adolescents eat more high-calorie low-nutrient-dense foods than non-obese adolescents. RESEARCH METHODS AND PROCEDURES: Using a cross-sectional design, 22 non-obese and 21 obese adolescents kept 14-day food records. Records provided estimates of total daily energy intake and caloric intake from five categories of high-calorie, low-nutrient-dense (HC) foods: candy, chips, soda, baked goods, and ice cream. Body composition was determined by 18O dilution and daily energy expenditure by doubly labeled water. Percentage of energy intake reported (%report) was calculated as the ratio of reported energy intake to measured energy expenditure (x 100%). RESULTS: Both groups underreported energy intake, but the percentage reported was significantly greater in the non-obese group (78.2+/-20.5% non-obese vs. 55.5+/-21.8% obese, p<0.001). Consumption of calories from chips and soda was similar among non-obese and obese adolescents. However, total energy intake from all HC foods was higher in the non-obese group than among the obese (617+/-356 kcal/day vs. 362+/-223 kcal/day; p<0.01) and represented 27.2+/-10.5% and 19.9+/-9.6% of reported energy intake in the non-obese and obese groups, respectively. After adjustment for under-reporting, the percentage of calories provided by each of the HC foods was similar in the obese and non-obese groups except for ice cream, which remained significantly greater in the non-obese group (p<0.05). DISCUSSION: Our findings suggest that both non-obese and obese adolescents consume a substantial portion of reported calories from HC foods and that obese adolescents do not consume more calories from these foods than non-obese adolescents. These data offer no evidence to support the widespread notion that obese adolescents eat more "junk food" than non-obese adolescents. Health professionals who treat obese adolescents must be aware that the excess calories in their diets may come from a variety of food sources and not solely from high-calorie snack foods.

Adipose Tissue↗

Fruit and vegetable intake and incidence of bladder cancer in a male prospective cohort.

BACKGROUND: Previous epidemiologic studies of fruit and vegetable intake and bladder cancer risk have yielded inconsistent results, especially with regard to the types of fruits and vegetables consumed. We examined total fruit and vegetable intake, as well as intakes of subtypes of fruits and vegetables, in relation to bladder cancer risk in a large male prospective cohort study. METHODS: Two hundred fifty-two cases of incident bladder cancer were diagnosed from 1986 through January 31, 1996, among 47,909 men enrolled in the Health Professionals Follow-up Study. Each participant in this cohort completed a 131-item food-frequency questionnaire in 1986 and subsequently in 1990 and 1994. We used logistic regression analyses to examine fruit and vegetable intake in relation to bladder cancer risk, after adjusting for age, history of cigarette smoking, current smoking status, geographic region, total fluid intake, and caloric intake. RESULTS: We observed a weak, inverse association that was not statistically significant between total fruit and vegetable intake and bladder cancer risk. Intake of cruciferous vegetables was inversely associated with risk (relative risk = 0.49; 95% confidence interval = 0.32-0.75, for the highest category of cruciferous vegetable intake compared with the lowest), but intakes of yellow or green leafy vegetables or carotenoid-rich vegetables were not associated with risk. Individual cruciferous vegetables, except for coleslaw, were all inversely related to bladder cancer risk, but only the associations for broccoli and cabbage were statistically significant. CONCLUSIONS: Data from this study indicate that high cruciferous vegetable consumption may reduce bladder cancer risk, but other vegetables and fruits may not confer appreciable benefits against this cancer.

Adult↗

Hyperosmolality and intraventricular haemorrhage in premature babies.

Serial investigations of electrolytes, osmolality and nutritional status were undertaken in 28 babies less than 33 weeks gestation. 6 died with intraventricular haemorrhage, 9 died without intraventricular haemorrhage, and 13 survived. Significant hypersomality was detected in the babies who died with intraventricular haemorrhage, whereas babies who died without intraventricular haemorrhage and survivors had values within normal limits. No relation was found between hyperosmolality and sodium concentrations. Total fluid intake and caloric intake were comparable in the three groups, but protein intake was much reduced in babies with intraventricular haemorrhage due to a lower milk intake. The hyperosmolality could have resulted from tissue breakdown following protein starvation and may be a factor in the occurrence of intraventricular haemorrhage. In premature babies an osmolality of over 320 mOsm/l carried a grave prognostic implication.

Birth Weight↗

Diet and its relation to coronary heart disease and death in three populations.

Baseline 24-hour dietary recalls from 16,349 men ages 45-64 years who had no evidence of coronary heart disease (CHD) were obtained in three prospective studies: the Framingham Study (859 men), the Honolulu Heart Study (7272 men) and the Puerto Rico Heart Health Program (8218 men). These men were followed for up to 6 years for the first appearance of CHD or death. Men who had a greater caloric intake or a greater caloric intake per kilogram of body weight were less likely to develop CHD manifest as myocardial infarction (MI) or CHD death, even though men of greater weight were more likely to develop CHD. This may reflect the benefit of greater physical activity. Men who consumed more alcohol were less likely to develop CHD, but more likely to die of causes other than CHD, particularly in the Honolulu study. In the Honolulu and Puerto Rico studies, but not in the Framingham study, men who consumed more starch were less likely to develop MI or CHD death. There was an inverse relation between starch intake and serum cholesterol, but it was too weak to explain fully the inverse starch-CHD association. There was also no evidence that the inverse relation between starch intake and incidence of CHD in the Honolulu and Puerto Rico studies was an indirect result of differences in fat intake. While the findings suggest additional areas for research, none of them would lead to an alteration of currently recommended preventive diets that emphasize lowering fat intake, because in isocaloric diets the logical way to balance a decreased fat intake is to increase the consumption of foods containing starch.

Adult↗

Managing nutrition problems in transplant patients.

Patients who undergo organ transplantation receive immunosuppressive drugs in the posttrans-plant period. All of these drugs influence host metabolic response or alter nutrient intake. One of the most prominent aspects of the posttransplant period is the occurrence of hyperlipidemia, which may require dietary or pharmacologic control. Dietary recommendations for this patient population include limiting carbohydrate intake, restricting caloric intake to maintain ideal body weight, and maintaining a low cholesterol/saturated fat diet.

Energy Intake↗

Cellular, metabolic, and clinical consequences of adipose mass enlargement in obesity.

When adipose tissue enlarges in obesity, as the result of an imbalance between caloric intake and caloric expenditure, many changes occur in the cellular components of the adipose mass. A combination of increased cell size and number underlies the accretion of the adipose mass, however, only a reduction in cell size is possible with weight loss. Several metabolic abnormalities accompany obesity--most important--hyperinsulinemia, hyperlipidemia, insulin resistance, and carbohydrate intolerance. Clinical consequences of obesity include hypertension, venous insufficiency, gallbladder disease, osteoarthritis, pulmonary and cardiovascular insufficiency, diabetes, and atherosclerotic cardiovascular disease, and all are dependent on the severity and duration of the obesity. Once established, obesity is difficult to correct because of the development of many adaptive mechanisms by which obesity defends itself.

Adipose Tissue↗

[Enteral feeding of hospitalized neurologic patients: analysis of complications and nutritional results].

Patients with severe neurologic diseases submitted to enteral tube feeding were analyzed for four weeks. Initial and weekly assessment was done by laboratory and anthropometric data. Caloric requirements were calculated by the Harris-Benedict equation corrected for stress factors. The diet used provided 151 calories per gram of nitrogen, consisting of egg albumin, soy protein, maltodextrin, soy oil, medium-chain triglycerides, vitamin supplement, and mineral salts. Starting on the second week, there was a statistically significant correlation between caloric intake and caloric needs. In the same period, maintenance of lab parameters, worsening of the arm muscle circumference, and a trend to a positive nitrogen balance were observed. Diarrhea occurred in 14.5% of the patients. Enteral nutrition support for neurologic patients can be considered effective in the maintenance of the nutritional status. Careful daily monitoring is mandatory.

Adult↗