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Chronic treatment with either dexfenfluramine or sibutramine in diet-switched diet-induced obese mice.

Dexfenfluramine (DEX) and sibutramine (SIB) are effective antiobesity agents. Their effects on weight control and hormone profile have not been previously studied in diet-switched diet-induced obese (DIO) mice, in which treatment is initiated upon cessation of a low-fat diet and resumption of a high-fat diet. Furthermore, their effects on circulating ghrelin in obese humans or in animal models of obesity have not yet been reported. Male C57Bl/6J DIO mice after 16 wk on a high-fat diet (HF, 60 kcal% fat) were switched to a low-fat diet (LF, 10 kcal% fat) for 50 d. HF diet resumed concurrently with treatment for 28 d with DEX 3 and 10 mg/kg, twice a day (BID); SIB 5 mg/kg BID; or vehicle. Rapid weight regain ensued in vehicle-treated DIO mice. DEX or SIB treatment significantly blunted the body weight gain. Caloric intake was decreased acutely by DEX or SIB vs vehicle during the first 2 d treatment, but returned to control after 5 d. At the end of study, epididymal fat weight and whole body fat mass determined by DEXA scan were decreased by DEX 10 mg/kg, and whole body lean mass decreased with DEX 3 mg/kg treatment. Circulating ghrelin on d 28 was increased with either DEX 3 or 10 mg/kg treatment, while growth hormone and insulin were decreased. Leptin was also decreased in the DEX 10 mg/kg group. SIB did not significantly affect fat mass, ghrelin, growth hormone, insulin, or leptin. Mice chronically fed LF diet maintained a lower caloric intake, gained less weight and fat mass than diet-switched mice, and had higher ghrelin and lower insulin and leptin. In summary, weight regain in diet-switched DIO mice is delayed with either DEX or SIB treatment. DEX treatment of diet-switched DIO mice decreased growth hormone, insulin, leptin, fat mass, lean mass, and increased ghrelin, while SIB only decreased body weight.

Animals↗

Body fat accretion: a rat model.

A rat model for studying causes of body fat accretion was developed. Employing this model, it was possible to produce a 108 g difference in carcass fat content between two groups of rats simply by selecting the seven fattest and the seven leanest animals from a group of 100. The results of this study provide evidence that the gastrointestinal tract was not a site of caloric wastage, that total energy excreted in feces and urine was directly proportional to caloric intake, that differences in brown adipose tissue thermogenesis were not responsible for the twofold difference in adiposity between the lean and fat rats, and that a family of hepatic lipogenic enzymes was not up-regulated even though the habitual consumption of a diet rich in carbohydrate was greater in the fat vs lean rats. The fat rats also had a greater lean body mass. Therefore, the additional calories consumed by the fat rats could have contributed to their greater adiposity and/or could have been channeled to sustain more active tissue. Finally, evidence was presented to show that the experimental selection process is an important consideration when determining the relationship between caloric intake and body fat content.

Adipose Tissue, Brown↗

Acute high-fat diet paradigms link galanin to triglycerides and their transport and metabolism in muscle.

To compare the effects of acute exposure to dietary fat to those of chronic exposure, Sprague-Dawley rats were given a high-fat diet (50% fat) or moderate-fat diet (25% fat) for 1 day, 2 h or 3 weeks. With measurements of various parameters, the high-fat diet for 21 days produced the expected changes of: (1) a significant increase in total caloric intake and dissected fat pad weights; (2) a rise in leptin and the metabolites, triglycerides (TG), non-esterified fatty acids and glucose; (3) an increase in muscle beta-hydroxyacyl-CoA dehydrogenase (HADH) and adipose lipoprotein lipase (aLPL) activity, along with a decrease in LPL activity in muscle (mLPL); and (4) elevated galanin (GAL) expression and peptide levels in the anterior region of the paraventricular nucleus (PVN), with no change in the arcuate nucleus. The acute 1-day or 2-h high-fat diet similarly increased circulating lipids, HADH activity and PVN GAL mRNA but stimulated rather than suppressed mLPL activity. These effects occurred in the absence of a change in total caloric intake, fat pad weights, and adipose-related measures, suggesting that they resulted more from the rise in dietary fat from 25% to 50% than from increased adiposity or hyperphagia. Moreover, PVN GAL mRNA in the different groups was consistently and positively correlated with the specific measures of TG levels and both HADH and mLPL activity, linking it to metabolic processes related to the transport and capacity for oxidation of TG in muscle, rather than adipose tissue.

3-Hydroxyacyl CoA Dehydrogenases↗

Health behaviors associated with better quality of life for older bereaved persons.

BACKGROUND: Bereavement is a risk factor for declines in health, adverse health behaviors, increased physician visits, and mortality, and occurs with greatest frequency in later life. Little is known about health behaviors that are associated with better quality of life among recently bereaved older persons. OBJECTIVE: The objective of this community-based longitudinal, observational study was to examine the influence of health behaviors on the quality of life of 200 elderly bereaved persons. DESIGN AND MEASUREMENTS: Health behaviors (i.e., exercise, monitoring caloric intake, sleep, daily vitamin intake, annual health check-ups) were examined at approximately 6 months postloss (baseline) and 11 months postloss (Wave 2). Quality of life was assessed at approximately 11 months postloss and 19 months postloss (Wave 3), using the RAND 36-Item Health Survey, which measures 8 domains of health and functioning, plus a single item assessing change in health. RESULTS: Consistently exercising 1 or more days per week at Waves 1 and 2 significantly (p < .05) predicted better self-rated health, physical functioning, fewer physical role limitations, and greater energy at Wave 3 in models that adjusted for age, gender, prior psychiatric disorder, baseline reports of functional disabilities and chronic conditions. Consistently monitoring caloric intake at Waves 1 and 2 predicted better self-rated health (p < .05), greater energy (p < .01), and positive change in health (p < .05) at Wave 3 in models that adjusted for the above set of control variables. Sleeping 6.5-9 hours per night at baseline alone predicted better social functioning (p < .001), fewer emotional role limitations (p < .01), better emotional health (p < .001), and greater energy (p < .01). CONCLUSIONS: Should future research confirm these results, clinicians would be advised to recommend the identified preventive and protective health behaviors to recently bereaved older patients.

Aged↗

Effects of low-protein diet on carbohydrate metabolism and energy expenditure.

Low-protein diets (LPD), which are prescribed for uremic patients to slow the progression of chronic renal failure, theoretically may exacerbate disorders of carbohydrate metabolism that are frequently observed in these patients because increased carbohydrate rations are required to maintain a sufficient caloric intake. No such exacerbation actually occurs. Glucose tolerance has been shown to improve after 3 months of a diet affording .3 g protein/kg body weight supplemented with essential amino acids and ketoanalogs with carbohydrates accounting for 67% of the total energy intake. Hyperinsulinemic euglycemic clamp studies show that this amelioration is linked with an increase in insulin sensitivity, which is also observed in uremic diabetic patients on this diet. The improvement in glucose tolerance involves the insulin sensitivity of endogenous glucose production, glucose oxidative disposal, and its nonoxidative disposal. Besides these effects, LPD increases the metabolic clearance rate of insulin and causes blood insulin levels to decrease. LPD's low acid load and phosphorus content, the reduced synthesis of uremic toxins derived from alimentary protein, or both may explain these effects, which are indirectly protective against atherosclerosis. However, the significant increase in resting energy production after 3 months on LPD justifies strict monitoring of nutritional status and caloric intake.

Basal Metabolism↗

Increased caffeine and nicotine consumption in community-dwelling patients with schizophrenia.

INTRODUCTION: It is known that people with schizophrenia make poor dietary choices and smoke at alarmingly high rates. There is also anecdotal evidence that they may ingest large amounts of caffeine. However, while smoking habits in this population have been examined, no recent study has quantified caffeine consumption taking into account various dietary caffeine sources unrelated to coffee including convenience foods such as candy bars, chocolate or soft drinks, and compared results to US population data. METHODS: We employed 24-h diet recalls to assess dietary habits in a sample of outpatients suffering from schizophrenia or schizoaffective disorder. Caloric intake and caffeine consumption were quantified and the relationship to various sociodemographic variables including body mass index (BMI) and dietary quality was examined. RESULTS: 146 patients were recruited. Mean BMI in the sample was 32.7+/-7.9. Patients ingested 3,057+/-1,132 cal on average. Patients smoked at higher rates (59.6% vs. 23.4%, p< or =0.001), higher numbers of cigarettes/day (24+/-14.4 vs. 13.5+/-11.3, t=8.549, p<0.001) and ingested more caffeine (471.6+/-584.6 mg vs. 254.2+/-384.9 mg, t=6.664, p<0.001) than US population comparisons. Caffeine consumption was correlated to the number of cigarettes smoked daily (r=0.299, p< or =0.001), but not to BMI (r=0.134, p=0.107) or dietary parameters such as caloric intake (r=0.105, p=0.207). CONCLUSION: Community-dwelling schizophrenia patients consume significantly more caffeine and nicotine than US population comparisons. Clinicians should be aware that while a significant proportion of patients are overweight and have poor dietary quality - which merits lifestyle counseling on its own - there is a lack of correlation between those factors and smoking and caffeine intake. Thus, lifestyle modification counseling in all patients should address smoking and caffeine intake concurrently.

Adult↗

Symptoms potentially influencing weight loss in a cancer population. Correlations with primary site, nutritional status, and chemotherapy administration.

A nutritional assessment including determination of symptoms potentially influencing weight loss was prospectively performed on 254 consecutive cancer patients with favorable performance scores (Eastern Cooperative Oncology Group [ECOG] level 0 to 2). Primary cancer sites included the following: non-small cell lung (n = 93), colon (n = 50), prostate (n = 23), oropharyngeal (n = 18), breast (n = 15), gastrointestinal (n = 13), and other (n = 42). Thirty-nine percent of patients had received no prior chemotherapy or radiation therapy. Common symptoms in the population were abdominal fullness (61%), taste change (46%), constipation (41%), mouth dryness (40%), nausea (39%), and vomiting (27%). Current caloric intake was surprisingly similar in 170 patients with weight loss (percent usual body weight [PUBW], less than or equal to 95%) compared with 84 without weight loss (PUBW, greater than 95%; 31.4 +/- 1.5 versus 30.5 +/- 2.1 kcal/kg/d, respectively). Symptoms identified by multivariate analysis as occurring significantly more frequently in populations with weight loss included abdominal fullness (P less than 0.001), taste change (P less than 0.002), vomiting (P less than 0.005), and mouth dryness (P less than 0.02). There was no difference in frequency of symptoms between patients with or without prior chemotherapy. These results indicate that gastrointestinal/oral symptoms potentially influencing weight loss are prevalent early in the course of cancer patients with unresectable disease, regardless of current nutritional status, caloric intake, or prior therapy experience.

Adult↗

Exploration of the contribution of biobehavioral variables to the energy expenditure of preterm infants.

Variation in energy expended by preterm infants may be due to infant maturity and history of resolved acute lung disease (respiratory distress syndrome [RDS]) as well as growth, caloric intake, and activity. Indirect calorimetry was used in this exploratory, short-term longitudinal study to estimate energy expenditure (EE) from measures of inspired and expired O2 and CO2. The sample included 35 assessments for 10 preterm infants (5 with and 5 without RDS history). Lung disease history (resolved RDS, no RDS diagnosis), weight gain (g/d) from the day on which birth weight had been regained to the study day, mean activity level, the number of the assessment (1-6), and the interaction of lung disease history and time were included in a linear mixed model for repeated measures. Time was an index of postconceptional and postnatal age; all 3 were highly correlated. Because of high correlation with weight gain, caloric intake was not included in the analytic model. Lung disease history, mean activity level, and time were significant contributors to EE. A more precise measure of medical status than absence or presence of lung disease history, evenly spaced repetitions of EE assessment, and exploration of contexts in which the infants exhibit a higher activity level are needed in a replication study with a larger sample.

Acute Disease↗

Neonatal indirect hyperbilirubinaemia in twins.

Neonatal indirect hyperbilirubinaemia in 21 pairs of twins was compared and studied during the first postnatal week. Peak bilirubin concentration and the persistence of icterus was similar in the two sets of twins, but considerable individual inter-twin differences could be obeserved. Various postnatal parameters and inter-twin differences in these parameters were correlated with differences in hyperbilirubinaemia. It has been concluded that physiologic or idiopathic hyperbilirubinaeamia is closely similar in twins, probably due to the similar functional maturity of bilirubin clearance mechanisms. Individual variations were related to differences in caloric intake: the higher the caloric supply the lower was the maximum bilirubin concentration.

Bilirubin↗

Increase of circulating insulin-like growth factor-I in chronic renal failure is reduced by low-protein diet.

We performed a nutritional trial to assess the variations of circulating insulin-like growth factor-I (IGF-I) in chronic renal failure (CRF). Eight patients suffering from mild renal failure (SCr = 374 +/- 52 mumol/l) were prescribed a standard diet for 1 month followed by 1 month of protein restriction. Mean protein intake was 0.77 and 0.46 g/kg BW/day, mean caloric intake 25 and 24.7 kcal/kg BW/day for the first and the second month, respectively. After each period of diet, nitrogen balances were negative (-1.2 +/- 1.6 and -1.6 +/- 0.9 g/N/day). Despite these low-caloric conditions, mean serum IGF-I level was at the upper level of normal (358 +/- 136 ng/ml) after 1 month of standard protein intake, and statistically reduced (289 +/- 122 ng/ml, p < 0.002) by the low-protein diet. No correlation was observed between serum IGF-I levels and protein, caloric intake, and nitrogen balances for the two periods. Estimation of the IGF-I binding by the ratio of extracted to nonextracted IGF-I value suggested abnormal binding in CRF. This binding was modified by reduced protein intake. In conclusion, larger studies are needed in CRF to assess the significance of IGF-I variations and the IGF-I binding proteins which modulate the bioactivity of this growth factor.

Adult↗

The effect of high-calorie diet on nutritional parameters of children with beta-thalassaemia major.

BACKGROUND: Impaired growth accompanying thalassaemia major poses diagnostic and therapeutic problems. AIM: To test the hypothesis that impaired growth of children with thalassaemia major might be corrected, partially or totally, by increasing their caloric intake. PATIENTS AND METHODS: In a prospective controlled study, thirty selected children with thalassaemia major and 30 normal age and sex-matched controls were recruited. The dietary intake of both groups was evaluated. Nutritional status was assessed by measuring the weight, body mass index (BMI), mid-arm circumference (MAC), triceps skin fold thickness (SFT) and serum albumin and insulin-like growth factor-I (IGF-I) concentrations. The thalassaemic group was then, randomly divided into two equal groups. One group was given 8 weeks of high-caloric diet (130-150% of the caloric recommendation for age and sex) and the other was given the normal caloric requirement. RESULTS: Initially the BMI, triceps SFT and MAC of children with thalassaemia were significantly decreased compared to those for the normal control group. IGF-I and albumin concentrations of thalassemic children before nutritional supplementation (69 +/- 20.5 ng/m and 3.65 +/- 0.67 g/dl, respectively) were significantly lower than those for normal age and sex-matched children (162.5 +/- 24 ng/ml and 4.29 +/- 0.66 g/dl, respectively). After nutritional supplementation for 8 weeks the MAC, SFT and BMI, IGF-I (88.4 +/- 27.3 ng/ml) and albumin concentrations (3.85 +/- 0.85 g/dl) increased significantly (P < 0.05) in the thalassaemic children given the supplementation compared to those without supplementation, however, they were still lower than normal children. CONCLUSIONS: Increased caloric dietary intake increased significantly IGF-I levels in thalassaemic children. This was accompanied with increased BMI, mid-arm circumference and skin fold thickness. Growth impairment of children with thalassaemia major, without endocrinopathy and/or cardiomyopathy, can be partially corrected by increasing caloric intake.

Anthropometry↗

Foods and techniques for managing obesity in companion animals.

Management of obesity should initially involve assessment of the pet to rule out other possible medical problems and provide an accurate dietary history. It is essential to obtain a good estimate of the existing caloric intake, including calories from table scraps, pet treats, or other sources. Assessing the owner's willingness to make a commitment to a major lifestyle change for their pet is also an important part of any successful weight-reduction program. In some instances, this motivation can be linked to a recent, expensive bill for orthopedic or other procedures performed on their pet. Once a candidate has entered a program, calculated restriction of energy while maintaining protein, vitamin, and mineral intake should be recommended. It may be surprising to find out that the calculated amounts of food may be more than the amount a pet is currently being fed. In these animals, it is imperative to use a high-protein, obesity-management diet and not a low-protein, "light," or senior type of diet containing high fiber. If possible, treats should be restricted altogether and begging actively discouraged. Any snacks should be placed in the pet's feeding bowl so that an association between eating and the bowel become established. Of equal importance is use of a realistic exercise program that owners will encourage their pet to follow. Various products for weight reduction are available. Use of these specially formulated products to restrict caloric intake, while maintaining essential nutrient intake and increasing energy expenditure by playing and other activities, are the hallmarks of successful weight loss programs.

Animal Feed↗

Limited nutritional energy supply differentially impairs growth and bone mineralization of the developing lumbar vertebrae in minipigs.

Bone development during puberty and adolescence may influence the later risk of osteoporosis. The aim of this study was to investigate whether the three-dimensional development of the lumbar vertebrae is impaired in terms of bone mineral density and temporal control during the pubertal growth spurt when caloric intake is limited. Two groups of prepubertal female Gottingen minipigs (each n = 6) were fed either ad libitum (free fed) or with reduced food intake (controlled fed) for 12 months using a standard diet. Apparent volumetric bone mineral densities (vBMD) and size of the 4th vertebra were measured by quantitative CT in monthly intervals. The weight of free-fed animals was 29.5 +/- 0.9 kg compared to 25.9 +/- 3.5 kg in the controlled-fed group at the end of the observation period (mean +/- SD; p < 0.05). The maximal cross-sectional area of the 4th vertebra was 148.2 +/- 3.4 mm(2) in free-fed animals compared to 143.1 +/- 6.3 mm(2) in controlled-fed animals (P < 0.05) as both, the cortical and the medullary area were greater in the free-fed group. In contrast, cancellous and cortical bone mineral densities were not different between the two groups; however, maximal densities were reached earlier in the free-fed group. As regards the height of the vertebra, no difference was observed between the groups after 12 months (25.46 +/- 0.54 mm in controlled fed vs. 25.56 +/- 0.45 mm in free fed), although the peak height was reached earlier in the free-fed group. In both groups, the maximal growth rate in the cross-sectional direction was reached earlier compared to the longitudinal direction (both P < 0.05). Growth in the longitudinal direction that occurs in the primary and secondary epiphysis does not appear to depend on caloric intake contrary to the periosteal and endocortical bone generation in the cross-sectional direction. When limited energy is available, the organism seems to preserve the development of normal body height, while accepting reduced strength of the vertebra.

Age Factors↗

Cardiovascular effects of intermittent drinking: assessment of a novel animal model of human alcoholism.

The development of a novel model of human alcoholism has involved the presentation of a 30% alcohol solution to Sprague-Dawley rats via a syringe-feeding needle apparatus. With twice daily intermittent drinking, rats consumed an equivalent of 7-8 g/kg body weight of alcohol, which represented 25% of total daily caloric intake. Alcohol was absorbed rapidly, as significant circulating concentrations were observed within 15 min of gavage, eventually peaking at approximately 200 mg% 1 h later. Hemodynamic recordings in the conscious state after a 10-week drinking program indicated a normotensive blood pressure at peak blood alcohol levels, yet a hypertensive response 24 h after the final drink at a time when blood alcohol was not detected. Alcoholic rats continued to gain weight in parallel with controls fed ad libitum throughout the study, and changes in cardiac size and indices of contractility were not affected by 10 weeks of intermittent drinking. Additionally, no histological evidence of cardiac muscle damage was observed in alcoholic animals. Our animal model closely resembles the clinical situation in terms of the pattern of alcohol consumption, circulating concentrations of alcohol and the percentage of caloric intake in the form of alcohol. The hemodynamic changes observed support the hypothesis that alcoholic hypertension may be a manifestation of withdrawal, as opposed to any direct pressor effect of alcohol itself.

Alcohol Drinking↗

Consumption of a fat-rich diet activates a proinflammatory response and induces insulin resistance in the hypothalamus.

Obesity has reached epidemic proportions in several regions of the world. General changes in lifestyle, including consumption of fat-rich food, are among the most important factors leading to an unprecedented increase in the prevalence of this disease. Weight gain results from an imbalance between caloric intake and energy expenditure. Both of these parameters are under the tight control of specialized neurons of the hypothalamus that respond to peripheral anorexigenic and adipostatic signals carried by leptin and insulin. Here we show, by macroarray analysis, that high-fat feeding [hyperlipidic diet (HL)] induces the expression of several proinflammatory cytokines and inflammatory responsive proteins in hypothalamus. This phenomenon is accompanied by increased activation of c-Jun N-terminal kinase and nuclear factor-kappaB. In addition, HL feeding leads to impaired functional and molecular activation of the insulin-signaling pathway, which is paralleled by increased serine phosphorylation of the insulin receptor and insulin receptor substrate-2. Intracerebroventricular treatment of HL rats with a specific inhibitor of c-Jun N-terminal kinase (SP600125) restores insulin signaling and leads to a reduced caloric intake and weight loss. We conclude that HL feeding induces a local proinflammatory status in the hypothalamus, which results in impaired anorexigenic insulin signaling.

Adipose Tissue↗

Daylength and body mass affect diet self-selection by Siberian hamsters.

Siberian hamsters exhibit a decrease in peak body mass/fat and caloric intake when they are exposed to short winter-like days (SDs) compared with hamsters exposed to long summer-like days (LDs). We hypothesize that the photoperiod may directly or indirectly mediate alterations in gustatory processing that may account for shifts in the preferences for specific food types and/or macronutrients. Two experiments lasting 14 days each were conducted to: 1) identify photoperiod-related differences in diet selection, and; 2) determine whether these differences were a primary effect of SD exposure or a secondary effect due to SD-induced decreases in body fat/mass. In Experiment 1, two groups of hamsters were exposed to either LDs or SDs and given access to three complex food types [sunflower seeds (SF); rabbit chow (RC); millet seeds (M)]. In addition to their photoperiod-induced decreased body and fat pad mass, and caloric intake, SD-housed hamsters exhibited significant differences in their patterns of diet selection and relative amounts of fat, carbohydrate (COH), and protein eaten compared with LD-housed hamsters. By the end of the experiment, SD-housed hamsters selected a diet higher in COH and protein and lower in fat than that selected by LD-housed hamsters. Because SD-housed hamsters decrease their body mass/fat, this may reflect an adaptive strategy to maintain a leaner body mass. A second experiment was conducted to test whether the diet selection pattern of SD-housed hamsters was due to the SD-induced decrease in body mass/fat. LD-housed hamsters were allowed to feed ad lib (AL group), or were food restricted (FR group) to simulate a SD-induced decrease in body mass. Both groups were then released into the diet self-selection paradigm. FR hamsters reversed their food restriction-induced decrease in body mass and showed concurrent alterations in diet self-selection patterns that were distinct from the SD-induced patterns seen in Experiment 1. Specifically, they showed a persistent hyperphagia and selected a larger proportion of their total calories as M (high COH) and less as SF (high fat) than did AL hamsters during their return to LD body mass levels. However, once LD body mass levels were achieved, they increased their SF intake, and thus fat consumption. Despite these dynamic daily changes, the average selection patterns of both the diet types and macronutrients were not different by the end of the experiment. Therefore, it appears that the SD-induced changes in the selection of food sources (and ultimately, the macronutrient composition of the diet) cannot be solely attributable to the SD-induced decreases in body mass.

Adipose Tissue↗

[Effect of rhDNase on the respiratory function and nutritional status of children and adolescents with mucoviscidosis].

BACKGROUND: In 1994 we started recombinant human deoxyribonuclease (rhDNase) in every cystic fibrosis (CF) patient whatever his (her) clinical condition, provided they were aged more than 5 years and forced vital capacity (FVC) was > or = 40%. POPULATION AND METHODS: We reviewed retrospectively the effects of rhDNase in 69 CF children and adolescents during a 2-year follow-up. Patients (35 boys, 34 girls) received 2.5 mg of rhDNase once daily from a mean age of 8.5 years (range 5-16.4). Baseline spirometric values (% predicted) and nutritional status were as followed: FVC = 84.8 +/- 21.7; forced expiratory volume in 1 second (FEV1) = 80.8 +/- 22.2; peak flow = 89.7 +/- 34.2, forced expiratory fraction 25-75% (FEF 25-75) = 71.8 +/- 32.8; Z score weight/height = -0.41 +/- 1.14; Z score weight/age = -0.48 +/- 1.25, body mass index = 15.4 +/- 1.8; caloric intake = 107 +/- 25% of recommended dietary allowances (RDA). Patients had a Shwachman-Kulczycki's score of 87 +/- 9. Spirometric and nutritional data were analysed after 1, 3, 6, 12, 18 and 24 months of treatment and compared to baseline values (changes evaluated as percent change from mean baseline for spirometric data). Shwachman-Kulczycki's score was calculated after 24 months of rhDNase. RESULTS: An improvement of FVC (+10.7%, P < 0.001) and FEV1 (+12%, P < 0.01) was noted after one month of treatment and was maintained throughout the following 2 years around 8.7% (6.4-11.4) for FVC and 8.2% (7.3-9.1) for FEV1, P < or = 0.01. This was particularly observed in children aged 5 to 10 years, in boys and in patients with a baseline FVC under 70% predicted. There was no significant change in FEF 25-75. We observed an improvement of daily caloric intake from the third month (P < 0.05) and of body mass index from the sixth month (P = 0.02). This was particularly noted in girls. Z score weight/age was improved only during the first 3 months of treatment while Z score weight/height increased only after a 2 year follow-up. There was no significant change in Shwachman-Kulczycki's score after 24 months of rhDNase. CONCLUSION: rhDNase in CF children in effective on lung function as well as on nutritional status and the response to this treatment can be evaluated after the first 3 months.

Adolescent↗

Comparison of total parenteral nutrition and an oral, semielemental diet on body composition, physical function, and nutrition-related costs in patients with malabsorption due to acquired immunodeficiency syndrome.

BACKGROUND: The nutrition management of patients with malabsorption syndromes due to acquired immunodeficiency syndrome (AIDS) is problematic. The aim of this study was to compare the effects of total parenteral nutrition (TPN) and an oral, semielemental diet (SED) on body weight, body composition, quality of life, survival, and medical costs in AIDS patients with malabsorption. METHODS: This was a prospective, randomized, open-label study performed in outpatients. Twenty-three AIDS subjects (TPN group, 12; SED group, 11) with cryptosporidiosis, microsporidiosis, or malabsorption of unknown cause were randomized and followed. Subjects were prescribed equivalent amounts of formulas of similar composition for 3 months. Monthly estimations of caloric intake, body weight, body composition by bioimpedance analysis, and quality of life were recorded. Nutritional variables were analyzed by repeated-measures analysis of covariance, with the baseline measure as the covariate. Nutrition-related medical costs, survival, and indices of absorptive and immune function were compared, RESULTS: Subjects had lost an average of 1.5 and 1.0 kg body wt/mo for TPN and SED during the 6 months before study entry (p < not significant). The TPN group consumed more total calories than the SED group (p < .05). Weight change during therapy was significantly different from pretreatment in both groups (p < .01 for TPN, p = .023 for SED). The TPN group gained more weight than the SED group (p = .057) and significantly more fat (p = .02), but the changes in body cell mass were similar in the two groups. Changes in weight and body composition correlated with caloric intake but not the mode of feeding. The SED group scored significantly better than the TPN group on a physical functioning subscale of quality of life (p < .01). Survival was similar in the two groups. TPN therapy cost almost four times more than SED. Peripheral blood CD4+ lymphocyte numbers were unaffected by either therapy. Intestinal function was not affected by either therapy. CONCLUSIONS: An oral SED may reverse weight loss and wasting in AIDS patients with malabsorption.

Acquired Immunodeficiency Syndrome↗