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PubMed2005

Choice of lard, but not total lard calories, damps adrenocorticotropin responses to restraint.

Although rats given the choice of eating high-density calories as concentrated sucrose solutions or lard exhibit reduced responsivity in the hypothalamo-pituitary-adrenal axis, rats fed high-fat diets have normal or augmented responses to stressors. To resolve this apparent discrepancy, we compared in adult male rats the effects of 7-d feeding with lard + chow (choice) to feeding a 50% lard-chow mixture (no-choice) and to chow only. Rats with choice composed diets with 50-60% total calories from lard. Rats were exposed to 30 min of restraint on d 7. In the choice group, there was a robust inhibition of ACTH and corticosterone responses to restraint compared with chow or no-choice groups. Total caloric intake was less with choice than no-choice. Fat depot weights and body weight gain were similar in the high-fat groups. Leptin concentrations were equal but insulin was higher in the choice group. We conclude the following: 1) choice of eating high-density calories strongly damps hypothalamo-pituitary-adrenal responses to stress; without choice, high-density diet is ineffective; and 2) insulin may signal metabolic well-being, and may act through hypothalamic sites to reduce caloric intake but through forebrain sites to damp stress responses.

Adrenal Glands↗

PubMed1985

Anorexia and weight loss: indicators of cachexia in small cell lung cancer.

A study was conducted to determine the incidence and extent to which anorexia, a decrease in spontaneous food intake, contributes to the occurrence of cancer cachexia. Data for ten male subjects with small cell carcinoma of the lung are reported for a five-month period following diagnosis. Although body weights of the subjects at the time of diagnosis averaged less than 95% of the usual weight (weight 6 months prior to diagnosis), they were greater than 109% of the mean ideal weight. At five months, the mean weight (N = 8) was 88% of the preillness weight. From the time of diagnosis, there was a mean loss of 7.2 kg (15.8 lb). The urinary creatinine excretion was below the normal range, whereas the urinary urea nitrogen values were within the normal range. At the time of diagnosis, the mean triceps skin-fold measurements were approximately 80% of the standard reference for males. During the five-month period, the mean midarm muscle circumference determinations remained greater than 90% of the reference standard. The mean serum transferrin values were 10% or more below the reported lower range of normal, whereas the great majority of the serum albumin values were 3.0 g/dl or above during the five-month period. The mean caloric intake of 2,204 kcal at the time of diagnosis was only 86% of the estimated basal energy expenditure (BEE) times a factor of 1.5 used to account for moderate activity. Four months following diagnosis, the mean caloric intake had fallen to 1,702 kcal, only 67% of the BEE X 1.5 (calculated from the weight at diagnosis). The findings provide evidence of a decline in spontaneous food intake, a small decrease in body fat, and a greater than 13% weight loss. The oral intake was less than adequate for any activity beyond the basal state. Decreased intake could account for most of the weight loss observed in the subjects.

Adult↗

PubMed1991

Functional relationship of thyroid hormone-induced lipogenesis, lipolysis, and thermogenesis in the rat.

Metabolic balance studies were carried out to determine the interrelationships of thyroid hormone-induced lipogenesis, lipolysis, and energy balance in the free-living rat. Intraperitoneal doses of 15 micrograms triiodothyronine (T3)/100 g body wt per d caused an increase in caloric intake from 26.5 +/- 1.7 (mean +/- SEM) kcal/100 g per d to 38.1 +/- 1.5 kcal/100 g per d. Food intake, however, rose only after 4-6 d of treatment and was maximal by the 8th day. In contrast, total body basal oxygen consumption rose by 24 h and reached a maximum by 4 d. Since total urinary nitrogen excretion and hepatic phosphoenolpyruvate carboxykinase mRNA did not rise, gluconeogenesis from protein sources did not supply the needed substrate for the early increase in calorigenesis. Total body fat stores fell approximately 50% by the 6th day of treatment and could account for the entire increase in caloric expenditure during the initial period of T3 treatment. Total body lipogenesis increased within 1 d and reached a plateau 4-5 d after the start of T3 treatment. 15-19% of the increased caloric intake was channeled through lipogenesis, assuming glucose to be the sole substrate for lipogenesis. The metabolic cost of the increased lipogenesis, however, accounted for only 3-4% of the T3-induced increase in calorigenesis. These results suggest that fatty acids derived from adipose tissue are the primary source of substrate for thyroid hormone-induced calorigenesis and that the early increase in lipogenesis serves simply to maintain fat stores. Since the mRNAs coding for lipogenic enzymes rise many hours before oxygen consumption and lipolysis, these results suggest that T3 acts at least in part by an early coordinate induction of the genes responsible for these processes.

Animals↗

PubMed1981

Diagnosis of Gilbert's syndrome. Reliability of the caloric restriction and phenobarbital stimulation tests.

The diagnostic role of the reduced caloric intake test and phenobarbitone treatment in Gilbert's syndrome was evaluated. During fasting the increase in unconjugated serum bilirubin concentration was significantly higher in patients with Gilbert's syndrome than in normal subjects but not when compared with the increase observed in patients with acute hepatitis, which is the clinically most relevant differential diagnosis. Phenobarbital treatment significantly reduced the level of unconjugated serum bilirubin in patients with acute hepatitis or Gilbert's syndrome, but without any difference within these two groups of patients. The reduced caloric intake test and phenobarbital treatment seem to have low diagnostic specificity in Gilbert's syndrome when the differential diagnosis is that of hepatitis. The fraction of plasma unconjugated bilirubin of total bilirubin was significantly different in all three groups examined. The clinical diagnosis of Gilbert's syndrome can be established with relative certainty if the patients have a mild hyperbilirubinemia with a high fraction of unconjugated bilirubin, normal values of liver enzymes, and no overt signs of hemolysis. Liver biopsy is not mandatory.

Acute Disease↗

PubMed2002

Effects of pair-feeding and growth hormone treatment on obese transgenic rats.

BACKGROUND: It has been shown that GH-deficient subjects tend to have fat accumulation. We have produced human GH (hGH) transgenic rats that exhibit low circulating hGH levels and hyperphagia. These rats are also characterized by severe obesity, hyperinsulinemia and hyperlipidemia. OBJECTIVE: The present study was conducted in order to elucidate how excess caloric intake and impaired GH secretion account for fat accumulation and metabolic abnormalities in the transgenic rats. DESIGN AND METHODS: The transgenic rats were subjected to either pair-feeding with non-transgenic controls or hGH treatment from 4 to 12 weeks of age, and the effects on fat accumulation and some metabolic parameters were assessed. RESULTS: At the age of 12 weeks, body weight and food intake were greater in transgenic than in control rats by 10% and 27% respectively. The ratio of epididymal white adipose tissue weight to body weight (WAT/BW) was more than three times greater in transgenic than in control rats. Although pair-feeding for 8 weeks decreased body weight, it did not affect the WAT/BW ratio. Treatment with hGH affected neither body weight nor food intake, while it reduced the WAT/BW ratio by 30%. Serum concentrations of triglyceride, free fatty acid, insulin and leptin were all significantly higher in the transgenic than in the control rats. Pair-feeding decreased serum triglyceride, insulin and leptin levels, but not serum free fatty acid levels. On the other hand, hGH treatment decreased only serum leptin concentrations. CONCLUSIONS: These results suggest that severe fat accumulation in the transgenic rats mainly resulted from the decreased lipolytic action of GH, while metabolic abnormalities mainly resulted from excess caloric intake.

Adipose Tissue↗

PubMed2004

Differences in endocrine function with varying fitness capacity in postpubertal females across the weight spectrum.

OBJECTIVE: To relate endocrine and nutritional correlates of fitness in postpubertal physically active females across the normal weight spectrum to identify markers and how these might serve as associations of exercise-related endocrine disruption. DESIGN: Cross-sectional study analyzed by repeated-measures analysis of variance for frequent blood sampling. SETTING: A general clinical research center. SUBJECTS: Twenty-two healthy postpubertal female subjects recruited 2 years or more after menarche. MAIN OUTCOME MEASURES: Maximum oxygen consumption was determined as an index of fitness and daily caloric intake was calculated from a 3-day food diary. During the follicular phase of the cycle, luteinizing hormone was sampled every 10 minutes during a 24-hour period, while follicle-stimulating hormone and cortisol were sampled hourly. RESULTS: For every 1-unit increase in maximum oxygen consumption, cortisol concentration increased by 2% (P =.005; 95% confidence interval, 1%-3%). However, there was no association between mean gonadotropin concentrations and fitness. Hormone concentrations were not significantly associated with body mass index or percentage of body fat. Higher mean caloric intake from a 3-day summary was inversely related to mean luteinizing hormone concentration, which decreased by 5.5% for every 100-kcal increase (P =.03; 95% confidence interval, 1%-10%). With every 1-year increase in age at menarche, follicle-stimulating hormone concentration decreased by 12% (P =.01; 95% confidence interval, 4%-19%) and cortisol concentration increased by 7% (P =.03; 95% confidence interval, 1%-12%). CONCLUSIONS: In active adolescents, increased cortisol concentration may represent an adaptive change to exercise that may precede gonadotropin changes seen with higher levels of fitness.

Adolescent↗

PubMed1988

Effect of environmental temperature on dietary obesity in Osborne-Mendel rats.

The effects of cold acclimation on cellularity, lipoprotein lipase (LPL) activity and lipolysis were studied in white adipose tissue of rats fed a high fat diet. Male Osborne-Mendel rats (7 weeks old) were exposed at either 28 or 5 degrees C for 10 weeks. The rats were fed a semipurified diet (normal fat (NL): 5% lard, high fat (HL): 54% lard) for the last 9 weeks. Caloric intake with NL and HL diets were comparable and cold exposure led to the same increase with both diets. At 28 degrees C, HL diet initiated both hypertrophy and hyperplasia; however, at 5 degrees C only hyperplasia was observed. Total LPL activity showed high stimulation both in 28 and 5 degrees C HL rats. In vitro lipolytic stimulation by norepinephrine was lowered at 5 degrees C and abolished at 28 degrees C in HL-fed rats. HL diet resulted in enhanced lipid deposition without an increase in caloric intake. Even in cold-adapted Osborne-Mendel rats a relative obesity could be produced by a HL diet.

Adaptation, Biological↗

PubMedDate not supplied

Suboptimal selenium status in home parenteral nutrition patients with small bowel resections.

The selenium status of 13 adult home parenteral nutrition (HPN) patients was evaluated using 12 healthy adult volunteers as controls. Patients had been maintained on HPN for a mean of 36 months and averaged 121 cm of residual small bowel. Prospective diet surveys in patients indicated a mean oral caloric intake of 902 kcal/day. The mean plasma selenium concentrations (microgram/g) were 0.044 in patients and 0.117 in controls (p less than 0.01). The erythrocyte glutathione peroxidase activities, as mumol of NADPH oxidized/g hemoglobin/min, averaged 11.01 in patients and 31.76 in controls (p less than 0.01). Four patients exhibited myalgic symptomatology suggestive of clinical selenium deficiency. No correlations could be ascertained between plasma selenium levels and glutathione peroxidase activities in either patients or controls. Additionally, in the patient group, no significant correlations could be ascertained between selenium status and oral caloric intake, residual small bowel length, symptomatology suggestive of deficiency or HPN duration. However, since sample size was not large, lack of correlations might best be considered suggestive not conclusive. The data indicate that HPN patients with small bowel resections exhibit suboptimal selenium status and may be at risk of developing clinically evident selenium deficiency. HPN patients should be prophylactically supplemented with selenium regardless of oral intake, duration of HPN, or residual length of resected small bowel.

Adult↗

PubMed1992

Suckling is a persistent stimulus to the adrenocortical system of the rat.

The present experiments investigated the hypothesis that lactation constitutes a chronic stress to the adrenocortical system. To determine whether the normal circadian control of the adrenocortical system or the ability to mount an adequate ACTH response to stress are modified during lactation, we compared morning and evening basal and stress-induced ACTH, corticosterone (B), and PRL secretion as well as pituitary ACTH content and thymus weight in virgins and lactating females on day 10 of lactation. We also compared the capacity of B to suppress ACTH secretion in adrenalectomized virgin or lactating females, both given various B pellet replacement doses (40-130% B) for 5 days. In addition, we investigated the influence of decreased litter size and increased caloric intake on basal circadian activity in the adrenocortical system. Finally, we measured suckling-induced activation of ACTH and B release and restoration of basal morning ACTH and B levels after pup separation. In all 10-d lactating females, basal PRL levels were elevated compared to virgins and the circadian rhythm observed in virgins (P less than 0.05) was absent in all lactating females. By contrast, diurnal variations in ACTH and B secretion (P less than 0.05 or 0.01) were observed in all females regardless of lactation and changes in caloric intake or litter size. Plasma ACTH and B were elevated during the trough of the diurnal rhythm in mothers, compared to virgins. The amplitude of the increase in ACTH between trough and peak was greater in mothers than virgins; however, the amplitude of the increase in plasma B was greater for virgins than mothers, probably because of the higher levels of corticosteroid binding globulin in the former. Diurnal rhythms in stress responsiveness and sensitivity of ACTH to B feedback were normal in mothers; however, the magnitude of their ACTH, B, and PRL response to ether stress was less in mothers than virgins. Attempts to normalize basal ACTH and B concentrations by increasing calorie consumption were unsuccessful. However, we found that suckling caused marked stimulation of ACTH and B secretion; moreover, within 24 h after pups removal, trough ACTH and B concentrations were restored to normal values.(ABSTRACT TRUNCATED AT 400 WORDS)

Adrenal Cortex↗

PubMed2004

Metabolic and hormonal responses to exercise in the anti-obese Lou/C rats.

OBJECTIVE: Lou/C rats are a substrain of Wistar rats that exhibit a spontaneous low caloric intake and no development of obesity with age. Recently, we reported that Lou/C rats, compared to equally food-restricted Wistar counterparts, show lower resting levels of plasma glucose, epinephrine and liver glycogen. To further explore this metabolic particularity, we used exercise (swimming 60 min) as a situation of high-energy demand, to test the ability of Lou/C rats to maintain euglycemia. DESIGN: Male Lou/C rats (14-week-old) were compared to age-matched male Wistar rats fed either ad libitum (WAL) or Wistar rats whose food was chronically restricted (WFR) to the same caloric intake as the Lou/C rats. RESULTS: In spite of low liver glycogen stores ( approximately 50% of normal values), Lou/C rats were able to maintain euglycemia during exercise even though liver glycogen breakdown was blunted. The decreased use of glycogen during exercise in Lou/C rats was associated with a reduced epinephrine response compared to WFR animals. By contrast, WFR were also able to maintain euglycemia during exercise but at the expense of a significant (P<0.01) decrease in liver and muscle glycogen content. Plasma free fatty acid and glycerol concentrations were increased (P<0.01) similarly in all three groups during exercise. In a separate experiment conducted in isolated hepatocytes from 24 h fasted Lou/C and Wistar rats, it was found that gluconeogenic flux from glycerol was found to be significantly (P<0.01) higher in Lou/C than in Wistar rats (5.4+/-0.2 vs 3.7+/-0.1 micromol/min/g dry cells). Resting and exercising plasma leptin levels were also significantly (P<0.05) lower in Lou/C than in the two other groups. CONCLUSION: It is concluded that Lou/C rats have the particularity to rely spontaneously less on their liver glycogen stores to meet their energy demands during exercise while maintaining euglycemia.

3-Hydroxybutyric Acid↗

PubMed2002

Audit of nutrition support for hematopoietic stem cell transplantation at a single institution.

OBJECTIVE: To analyze experience with total parenteral nutrition (TPN) for hematopoietic stem cell transplantation (HSCT) at our institution compared with reports in the literature. PATIENTS AND METHODS: We reviewed medical records of 100 patients (53 men and 47 women) who underwent HSCT from 1992 to 2001. Data were abstracted on demographics, primary diagnosis, type of transplantation, myeloablative regimen, length of hospital stay, time to engraftment, 1- and 5-year survival, initiation and duration of TPN, and TPN-related complications. RESULTS: Seventy-one transplantations were autologous, 27 allogeneic, and 2 syngeneic. The median age of the patients was 51 years (range, 19-71 years). We initiated TPN when patients' oral caloric intake was less than 50% of their estimated needs (4 to 7 days after the start of myeloablative therapy; median, 1.2 days after HSCT; range, 8 days before HSCT to 13 days after HSCT). We discontinued TPN when oral intake was more than 50% of estimated needs (median duration, 16 days for autologous and 24 days for allogeneic transplantations, with the shortest duration in breast cancer patients and the longest duration in those treated with cyclophosphamide). Mean weight loss was less than 2%. No differences in patient characteristics, myeloablative regimen, or diagnosis were observed between patients who required and those who did not require TPN. Infection, hospital stay, time to engraftment, and mortality were comparable to published reports. CONCLUSION: In patients undergoing HSCT, TPN should not be initiated until oral caloric intake is less than 50% of estimated needs. During the period of inadequate oral intake, TPN maintains stable body weight with longer duration of support needed for patients undergoing allogeneic than for those undergoing autologous transplantations.

Adult↗

PubMed2001

Subclinical hypothyroidism in obese patients: relation to resting energy expenditure, serum leptin, body composition, and lipid profile.

OBJECTIVE: To evaluate whether subclinical hypothyroidism (SH) affects resting energy expenditure (REE) as well as body composition, lipid profile, and serum leptin in obese patients. RESEARCH METHODS AND PROCEDURES: A total of 108 obese patients with SH defined as normal free thyroxine levels and thyroid-stimulating hormone (TSH) values of > 4.38 microU/ml (mean +/- 2 SD of the values of our reference group of obese patients with normal thyroid function) were compared with a group of 131 obese patients matched for age, sex, and body mass index (BMI) but with normal TSH levels. We assessed estimated daily caloric intake by 7-day recall, REE by indirect calorimetry, body composition by bioelectrical impedance analysis, serum leptin by radioimmunoassay, and lipid profile (i.e., total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglycerides). RESULTS: All of the variables measured were not different between the euthyroid obese patients and those with SH. In a multiple regression model with REE expressed for kilograms of fat free mass (REE/kgFFM) as a dependent variable and percentage of fat mass, BMI, waist-to-hip ratio, age, TSH, free thyroxine, serum leptin, and caloric intake as independent variables, only percentage of fat mass was significantly correlated with REE/kgFFM in both groups. In the SH group only, BMI, waist-to-hip ratio, age, and TSH were related to REE/kgFFM and explained 69.5% of its variability. After dividing the patients with SH using a cutoff TSH value of 5.7 microU/ml, which represents 3 SD above the mean of TSH levels of the group of obese patients with normal thyroid function, only REE/kgFFM was significantly different and lower in the group of more severely hypothyroid patients. DISCUSSION: In patients with obesity, SH affects energy expenditure only when TSH is clearly above the normal range; it does not change body composition and lipid profile. We suggest that, at least in obese patients, evaluation of TSH levels may be useful to rule out a possible impairment of resting energy expenditure due to a reduced peripheral effect of thyroid hormones.

Basal Metabolism↗

PubMed1991

The effect of surgical stress on the in vitro metabolism of thyroxine by rat liver, kidney, and brain.

In man, acute stress, like extensive surgery, leads to a rapid and prolonged decrease in serum T3 concentrations. The present study was carried out to investigate the mechanisms that underly the abrupt decrease in T3-neogenesis that occurs in response to acute surgical stress. Male Sprague-Dawley rats, surgically thyroidectomized, and treated with 1.2 micrograms T4/100 g BW/day, underwent wide vertical and horizontal incisions extending into the abdominal cavity while receiving light ether anesthesia. Different dietary manipulations were performed to investigate the superimposed influence of reduced carbohydrate and caloric intake on T3-neogenesis. The metabolism of 125I T4 labeled in its outer (phenolic) ring was investigated in liver, kidney, and brain homogenates of animals killed 48 h after surgery. In liver, values for the proportion of T4 degraded and the percent generation of T3 and iodide were unaffected by laparotomy. The percent T3 generation in experiments with 25 nM T4 concentration was 3.7 +/- 1.24% (mean +/- SD) in fed control animals given free access to 5% glucose, 3.4 +/- 0.67% in unoperated controls given a restricted amount of chow and 5% glucose, and 3.8 +/- 0.67% in operated animals given free access to chow and 5% glucose. As expected, T3 neogenesis in livers from unoperated animals was significantly reduced in rats fasted for 48 h and this reduction was similar in laparotomized rats fasted for 48 h after surgery. As in the liver, no effect of laparotomy on T4 metabolism in kidney and brain homogenates was observed. Finally, serum total T4 and T3 concentrations were not affected by surgery. It is concluded that acute surgical stress in thyroidectomized T4 replaced rats does not influence T4 metabolism in liver, kidney, and brain homogenates or affect the serum T4 and T3 concentrations. Since thyroid secretion of T4 (and T3) was eliminated and careful attention was paid to caloric intake in this rat model, previously reported abnormalities in serum thyroid hormone concentrations and T3-neogenesis in various states of nonthyroidal illness in man and rat, including surgery, are probably contributed to by thyroid secretion of T4 (and T3) and caloric deprivation, especially carbohydrate.

Animals↗

PubMed2003

Gastrostomy in infants with neonatal pulmonary disease.

OBJECTIVE: To report our experience of enteral feeding via gastrostomy in children with severe chronic neonatal lung disease, failure to thrive, and oral aversive behavior after initial hospitalization. POPULATION: Thirteen patients were studied. All children had chronic lung disease of neonatal onset and were severely malnourished. They received enteral nutrition via a gastrostomy at a median age of 13 months (range: 8-35). RESULTS: Z-scores for weight-for-height increased significantly, from -3.4 to -1.9 after four months of enteral nutrition. Caloric intake increased significantly from 100% to 140% of the recommended daily allowance for age. Pulmonary status remained stable for all patients and oxygenation was normal. There was an aggravation of oral aversive behavior in 7 of the 13 children, especially those children who were ventilated and hospitalized for a long time (median duration: 195 days). The median follow-up of patients after gastrostomy was 30 months (range: 8-54) and only six patients could be weaned from enteral nutrition. CONCLUSION: Enteral nutrition via gastrostomy is efficient, and provides the means to improve caloric intake and nutritional status. Gastrostomy is a safe and convenient technique that should be considered early in the course of treatment for infants presenting with malnutrition related to neonatal pulmonary disease.

Body Height↗

PubMed1984

Increased lipid fuel dependence in the critically ill septic patient.

The effect of sepsis in modifying post-surgical fuel utilization in critically ill patients was determined from 374 observations (246 septic [S] and 128 nonseptic [N] in 12 intubated ICU patients studied serially. Patients received TPN (values/24 hrs: Septic, N2, 9.1 +/- 2.2 gm; glucose, 543 +/- 211 kcal/m2, Nonseptic, N2, 8.3 +/- 3.6 gm; glucose, 550 +/- 346 kcal/m2). In some periods, intravenous lipid (L) was given to raise total caloric intake to 826 +/- 223 kcal/ 24 hr/m2. The VO2, VCO2, respiratory rate, minute volume, and blood gas levels were measured, and respiratory quotient (RQ) and metabolic rate (MR) computed. Statistics were performed by 2-way ANOVA and analysis of covariance. Without lipid, mean VCO2 for S (126 ml/min/m2) and N (128 ml/min/m2) were not significantly different, but VO2 in S (146 ml/min/m2) and N (132 ml/min/m2), and the RQ values S (0.88) and N (0.97), were different (p less than 0.0001). In 360 studies RQ was shown to be increased by the total caloric intake, but reduced in the presence of sepsis: RQ = 0.00014 (kcal/m2) - 0.09 (sepsis effect + 0.878 N = 360; r2 = 0.304; F2,357 = 78; p less than 0.0001; but both administered glucose and lipid calories contribute to the RQ in sepsis: RQ = 0.00017 (glucose kcal/m2) + 0.266 X 10(-3) (lipid kcal/m2) + 0.732 n = 114; r2 = 0.260; F2,111 = 19.5; p 0.0001. Sepsis increased VO2 with little change in VCO2, thus RQ fell, suggesting increased use of lipid fuels for oxidation. During hypercaloric lipid infusion in septic patients (SL) VO2 and VCO2 increased but VO2 was still greater, so RQ remained low (SL RQ = 0.89). As sepsis worsened VO2 remained high but VCO2 fell producing RQ less than 0.8, while plasma glucose levels were increased. These data suggest that septic patients are more dependent than nonseptics on lipid fuels for oxidative metabolism, and that IV lipids can be used to increase oxidative metabolism in sepsis at a time when glucose metabolism appears reduced.

Aged↗

PubMed1997

[Diagnosis of Gilbert's syndrome: current status of the fasting test. Review of the literature].

UNLABELLED: Gilbert's syndrome is a benign, often familial condition characterized by recurrent but asymptomatic jaundice. AIM: To describe the involvement of the reduced caloric intake test, used as a diagnostic test in Gilbert's syndrome. METHOD: 49 patients were diagnosed of Gilbert's syndrome for 6 years. 39 patients took 400 kcal/day for three days. The unconjugated bilirubinemia levels were measured at 0, 24, 48 and 72 hours. RESULTS: The 82.05% of test were diagnostics at 24 hours (p < 0.001), while it was necessary 48 hours to 100% of tests were diagnostics (p < 0.05). In any case was necessary to determinate the unconjugated bilirubinemia at 72 hours (p < 0.5). CONCLUSIONS: The best diagnostic efficiency of the reduced caloric intake test is at 48 hours, while the 24 hours determination could be considered diagnostic in a big percentage of the cases. It is not necessary the determination at 72 hours in any case.

Adolescent↗

PubMed1989

Feeding disorders and gastroesophageal reflux in infants with chronic renal failure.

Twenty-two infants (mean age 7.5 months) with chronic renal failure (CRF) were studied for their nutrition, growth, and upper gastrointestinal function. Most infants had a history of poor caloric intake and 7 had received supplemental feeding (SF) prior to the investigation. All infants were undergrown, underweight, and malnourished. The infants were characterized as having only a fair interest in food, refusing feedings, and vomiting excessively. Sixteen of 22 infants (73%) had significant gastroesophageal (GE) reflux demonstrated by 24-h esophageal pH monitoring. Gastroesophageal scintiscans were less sensitive and specific in detecting the reflux. Infants with GE reflux were significantly younger and more often required SF than those without GE reflux. There were no significant differences in the degree of renal failure, growth failure, caloric intake, protein intake, or nutritional status between the infants with and without GE reflux. From these studies we conclude that GE reflux should be considered as one of the factors contributing to the feeding problems of infants with CRF.

Energy Intake↗

PubMed1993

Energy balance in stable malnourished patients with chronic obstructive pulmonary disease.

We have measured caloric intake, energy expenditure, and the thermogenic effect of food in ten patients with stable COPD who had a history of involuntary weight loss over several years and were malnourished (< 85 percent ideal body weight). Each patient completed a 7-day food record. Indirect calorimetry was performed in the resting postabsorptive state. After placement of a nasoenteric tube, patients were randomly assigned to be refed or sham-fed (mean +/- SD, 16 +/- 3 days), following which, metabolic measurements were repeated. Indirect calorimetry was also performed before and after a large meal in each patient. Home caloric intake was 135 +/- 23 percent of resting energy expenditure. Resting energy expenditure was 94 +/- 16 percent of that predicted by the Harris-Benedict equation and did not change significantly during inpatient refeeding. Refeeding resulted in weight gain (2.4 +/- 1.9 kg, p < 0.02). A large meal caused substantial increases in energy expenditure (24 +/- 18 percent), carbon dioxide production (39 +/- 18 percent), and oxygen consumption (23 +/- 16 percent). We conclude that stable malnourished COPD patients consume adequate calories to meet average energy requirements and are not hypermetabolic. Inpatient refeeding by nocturnal nasoenteric infusion is well tolerated and results in weight gain, but the thermogenic effect of a large meal poses a considerable metabolic and ventilatory load that could precipitate acute respiratory failure.

Aged↗