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PubMed1977

LaTulippe--a case study of a one hundred and sixty kilometre runner.

A 55 year old runner covered 160 km within a 20 hour period. His speed averaged 8.16 km/h, at an estimated 59.1% of maximum oxygen intake. After the first four hours of running, one of five fluids was taken in rotation every twelve minutes. Volumes ingested whe heart rate for the final four hours (125/min) was not increased relative to oxygen consumption for this portion of the run. Constancy of heart rate, continued urine production and formal fluid balance calculations all indicate that hydration was well maintained over the run. Caloric intake averaged 480 kcal/h (2.01 MJH), being greatest fro the ice-creas/syrup mixture; the energy deficit (56/KA/H, 235 kJ/h) was small during that part of the run in which food was provided.

Blood Pressure↗
PubMed1984

Albumin homeostasis in the nephrotic rat: nutritional considerations.

Albumin catabolism and the relationship between plasma albumin concentration and albuminuria were studied in male Sprague-Dawley rats with Heymann nephritis. The rats were placed on isocaloric diets of 8.5, 21, or 40% protein. Serum albumin concentration correlated negatively with urinary albumin excretion for each of these dietary groups, but the correlation was dependent on dietary protein intake. The magnitude of albuminuria reflected the increase in albumin synthesis rate plus the decrease in albumin catabolic rate. Maximal urinary albumin loss was dependent on dietary protein intake. Albumin catabolism was studied in the different groups of nephrotic animals. Albumin catabolism correlated inversely with the rate of albuminuria in the 21 and 40% protein-fed rats and contributed nearly half of the albumin that was lost in these groups of animals. Albumin catabolism was independent of albuminuria in the rats fed 8.5% protein. The rats were fed 18% of their normal caloric intake, and albumin catabolism was studied in nephrotic and control animals. Albumin catabolism increased with increased albuminuria, in contrast to the well-nourished group, and there was no relationship between serum albumin concentration and urinary albumin excretion. Increased catabolism of albumin plays little or no role in albumin homeostasis in the well-nourished nephrotic rat but may be significant in protein- and calorie-malnourished animals.

Albumins↗
PubMed1987

Nutritional supplementation in ambulatory patients with chronic obstructive pulmonary disease.

We examined the effect of nutritional supplementation for 8 wk on respiratory muscle function (RMF) in 21 malnourished patients with COPD. Patients were randomized to a fed group or to a control group. Patients in the fed group were provided with an enteral formula in addition to their usual diet. Daily calorie and protein intake and weekly anthropometric measures were made. Pulmonary function tests were measured on Weeks 1, 4, and 8. Respiratory muscle strength was measured by means of maximal inspiratory and expiratory pressures (MIP), (MEP), and respiratory muscle endurance was measured by the maximal sustained ventilatory capacity (MSVC). The mean weight of the fed group increased from 52.2 +/- 6.4 to 53.3 +/- 6.9 kg (NS). The mean daily caloric intake of the fed group was significantly increased during the study (p less than 0.02). The mean calorie intake during the study of the fed group was 174 +/- 17% of the estimated basal energy expenditure. During the study period, no change was observed in anthropometric measures, pulmonary function studies, or RMF. Because patients tend to decrease their own food intake while receiving enteral formulas, it is difficult to provide sufficient calories and protein needed to effect changes in nutritional status and RMF in an outpatient COPD population. In addition, we compared RMF in 12 poorly nourished male patients (87.6 +/- 6.1% of ideal body weight) and 13 well-nourished male patients with severe COPD. Both groups had comparable degrees of air-flow limitation and hyperinflation. No difference was noted between the groups in either MIP, MEP, or MSVC.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1996

Nutritional and endocrine-metabolic aberrations in amenorrheic athletes.

Growing evidence suggests that menstrual disturbances in female athletes are related to the metabolic cost of high levels of energy expenditure without compensatory increases in dietary intake. However, the linkage(s) between nutritional deficits and reproductive impairments as a result of slowing of LH pulsatility has not been defined. This study was directed to simultaneously characterize nutritional intake, insulin sensitivity (by rapid iv glucose tolerance test), and 24-h dynamics of insulin/glucose, cortisol, somatotropic [GH/GH-binding protein (GHBP)/insulin-like growth factor I (IGF-I)/IGF-binding proteins (IGFBPs)], and LH axes in highly trained athletes with (cycling athletes; CA) and without (amenorrheic athletes; AA) menstrual cyclicity and in age- and body mass index-matched cycling sedentary controls (CS; n = 8/group). Although daily caloric intake did not differ among the three groups, athletes (CA and AA) consumed less fat and protein than CS. However, the restriction of fat was 50% greater (P < 0.01) in AA than CA and was accompanied by increased carbohydrate (P < 0.05) and fiber (P < 0.01) intake. Athletes, independent of menstrual status, had increased (P < 0.05) insulin sensitivity and reduced insulin levels during the feeding phase of the day. Hypoinsulinemia was more pronounced in AA (P < 0.05) than CA, extending throughout the day, and was accompanied by reduced glucose increments in response to meals (P < 0.05), not seen in CA. Levels of the insulin-dependent IGFBP-1 were markedly elevated (P < 0.001) throughout the diurnal pattern in AA, whereas in CA, a modest elevation (P < 0.001) of IGFBP-1 levels occurred only during the feeding portion of the day. IGFBP-1 levels for the three groups related inversely to 24-h insulin (r = -0.63) and directly to 24-h cortisol (r = 0.69) levels. A 70-80% augmentation (P < 0.001) of 24-h mean GH levels was seen in both groups of athletes, but with distinct pulsatile features. Although pulse amplitude was increased 60% in CA with no change in pulse number, AA displayed more frequent (P < 0.001) pulses, with an elevated (P < 0.01) baseline between pulses. The distorted pattern of GH pulses seen in AA was associated with a 35% decrease in GHBP levels, not seen in CA. Although levels of IGF-I and IGFBP-3 did not differ in either CA or AA, the 2- to 4-fold higher levels of IGFBP-1 in AA than in CA and CS resulted in a 3-fold reduced ratio of IGF-I/IGFBP-1 in AA, which may decrease the bioactivity and hypoglycemic effect of IGF-I. LH pulse frequency was progressively attenuated in the athletes, with a greater (P < 0.001) slowing in AA than CA, unaccompanied by alterations in pulse amplitude or 24-h levels. LH pulse frequency was related positively with insulin (r = 0.65) levels and the ratio of IGF-I/IGFBP-1 (r = 0.69), and negatively with cortisol (r = -0.70) and IGFBP-1 (r = -0.75) concentrations. Stepwise regression analysis suggested that negative influences associated with hypercortisolemia and elevated IGFBP-1 levels predominate in determining GnRH/LH pulsatile activity in these athletes. In sum, although neuroendocrine-metabolic adaptations to the energy cost of exercise training were evident in both groups of athletes, AA displayed alterations distinct from their cycling counterparts, with evidence of a hypometabolic state, including decreased basal body temperature and reduced levels of plasma glucose and serum GHBP, a decrease in the ratio of IGF-I/IGFBP-1, accelerated GH pulse frequency, and elevated interpulse GH levels. Thus, in AA, increased insulin sensitivity, decreased circulating insulin, and a reduced hypoglycemic effect of IGF-I together with elevated GH and cortisol concentrations may comprise a cascade of glucoregulatory adaptations to repartition metabolic fuels for conservation of protein. (ABSTRACT TRUNCATED)

Adolescent↗
PubMed1995

Injury severity score as a guide to nutritional management of the pediatric trauma patient.

Age, degree of injury, different metabolic rates, and growth complicate the estimation of nutritional requirements in the pediatric trauma victim. This study was designed to determine energy requirements of the injured child in relation to injury severity. Fourteen patients of 600 seen in a 5-year period met our criteria for evaluation with significant weight loss, caloric deficit recorded to the lowest weight, and details of injury. There were 10 males and four females with a mean age of 11.24 years (+/- 5.5). Mean injury scores included ISS 24.24 +/- 5.96, PTS 4.8 +/- 1.7, and TSS 11.79 +/- 2.78. The closest Theoretical Caloric Requirement (ThCR) that would have produced the Cumulative Caloric Deficit was calculated from the actual weight loss and Caloric Intake. Eighty-six per cent of the ThCR were less than or equal to the 1989 Recommended Dietary Allowances (RDA) (mean -16.43 +/- 24%). The per cent increase of the ThCR above the basal was significantly higher for lower ISS scores (P < 0.05). When compared to RDA, the per cent change of the ThCR for mild injuries were 1.8 +/- 27.9% above the RDA and were 26.5 +/- 17.2% below the RDA for the severe injuries. These findings are consistent with the child with milder injuries resuming activity and the growth process earlier than a severely injured child. We would recommend calculating caloric requirements based on the RDA for milder injuries and on 0.75 RDA for the more severely injured child (ISS > 25).

Adolescent↗
PubMed1999

Effect of age and caloric restriction on bleomycin-chelatable and nonheme iron in different tissues of C57BL/6 mice.

The objective of this study was to test the hypothesis that the widely observed age-associated increase in the amounts of macromolecular oxidative damage is due to an elevation in the availability of redox-active iron, that is believed to catalyze the scission of H2O2 to generate the highly reactive hydroxyl radical. Concentrations of bleomycin-chelatable iron and nonheme iron were measured in various tissues and different regions of the brain of mice fed on ad libitum (AL) or a calorically restricted (to 60% of AL) diet at different ages. The concentrations of these two pools of iron varied markedly as a function of tissue, age, and caloric intake. There was no consistent ratio between the amounts of nonheme and the bleomycin-chelatable iron pools across these conditions. Nonheme iron concentration increased with age in the liver, kidney, heart, striatum, hippocampus, midbrain and cerebellum of AL animals, whereas bleomycin-chelatable iron increased significantly with age only in the liver. Amounts of both nonheme and bleomycin-chelatable iron remained unaltered during aging in the cerebral cortex and hindbrain of AL mice. Caloric restriction had no effect on iron concentration in the brain or heart, but caused a marked increase in the concentration of both bleomycin-chelatable and nonheme iron in the liver and the kidney. The results do not support the hypothesis that accumulation of oxidative damage with age, or its attenuation by CR, are associated with corresponding variations in redox-active iron.

Aging↗
PubMed2001

Central leptin infusion attenuates the cardiovascular and metabolic effects of fasting in rats.

The role of reduced leptin signaling in the regulation of cardiovascular responses to negative energy balance is not known. We tested the hypothesis that central infusion of leptin would attenuate the cardiovascular and metabolic responses to fasting. Male Sprague-Dawley rats, instrumented with telemetry devices and intracerebroventricular cannulas, were housed in metabolic chambers for continuous (24 hours) measurement of dark-phase (active) and light-phase (inactive) mean arterial pressure, heart rate, oxygen consumption, and respiratory quotient. Rats received central infusions of either saline (0.5 microL/h) or leptin (42 ng/h) for 6 days through osmotic pumps and were either fed ad libitum or were fasted for 48 hours followed by refeeding for 4 days. In ad lib animals, continuous intracerebroventricular leptin infusion significantly reduced caloric intake, body weight, and respiratory quotient compared with saline controls while having no effect on mean arterial pressure or heart rate. Fasting reduced mean arterial pressure, heart rate, oxygen consumption, and respiratory quotient in rats receiving saline infusions. Fasting-induced reductions in mean arterial pressure were specific to the active phase and were not attenuated by central leptin infusion. In contrast, intracerebroventricular leptin, at a dose that had no cardiovascular effects in ad lib control animals, completely prevented fasting-induced decreases in light-phase heart rate and oxygen consumption and blunted fasting-induced reductions in dark-phase heart rate and oxygen consumption. The results are consistent with the hypothesis that reductions in central leptin signaling contribute to the integrated cardiovascular and metabolic responses to acute caloric deprivation.

Animals↗
PubMed1986

Effect of dietary protein intake on albumin homeostasis in nephrotic patients.

Animals with experimental renal disease maintained on diets restricted in protein develop less severe renal lesions and less proteinuria than do animals maintained on a normal or high protein diet. To determine whether restriction of dietary protein will reduce urinary albumin excretion in patients with established nephrosis and whether such dietary restriction will result in decreased albumin pools, we performed paired studies on nine nephrotic patients. They were fed sequential diets with a protein content of 1.6 and then 0.8 g/kg body wt, each for 2 weeks. Caloric intake remained constant at 35 Kcal/kg. In six patients the high protein diet was fed first; in three the order of dietary administration was reversed. Urinary albumin excretion was reduced on the low protein diet in all patients regardless of dietary order. Both the renal clearance of albumin and the fractional renal albumin clearance were reduced significantly on the low protein diet. The rate of albumin synthesis was greater on the high protein diet, but so was the rate of albuminuria. Despite the higher rate of albumin synthesis during the period of high protein intake, serum albumin concentration and plasma albumin mass were both less than during the period of low protein intake. Thus, dietary protein restriction in patients with established nephrosis results in decreased urinary albumin excretion in excess of any reduction in creatinine clearance. Total albumin mass is preserved and plasma albumin mass is actually increased during the period of dietary protein restriction. Protein restriction may be feasible in nephrotic patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2005

Imprecise control of energy intake: absence of a reduction in food intake following overfeeding in young adults.

The objective was to examine the extent to which overfeeding reduces spontaneous food intake in humans. Twelve normal-weight adults participated in the three stage study. During the 14 day baseline period and 21 day recovery period, food intake was consumed ad libitum, beyond a minimum 5 MJ (1200 kcal) basal diet. During the 13 day period of overfeeding, each subject consumed 35% more energy than they consumed at baseline. Overfeeding resulted in a weight gain of 2.3+/-0.37 kg, (p<0.0001), approximately half the weight gain was determined to be fat (1.2+/-0.19 kg, p<0.0001) by underwater densitometry. Following overfeeding, mean daily caloric intake was not significantly suppressed returning immediately to baseline values. Despite normal energy intake, participants lost 1.3+/-0.24 kg of body weight (p<0.0001), of which 0.75+/-0.15 kg (p<0.0001) was fat. These results indicated that (1) the physiological control of eating behavior in humans is not the major mechanism responsible for the recovery of body weight following a period of overfeeding and (2) an increase in energy expenditure of 1.28 MJ (307 kcal)/day or about 14% was required to account for the weight loss following overfeeding.

Adult↗
PubMed1994

Alcohol in combination with malnutrition causes increased liver fibrosis in rats.

Rats were malnourished for 12 months with a highly inadequate fat-rich, calorie-sufficient but otherwise poly-deficient liquid diet composed of mashed potatoes with mayonnaise, comparable with the nutritional intake of many chronic alcoholics. When alcohol was incorporated into this diet, administered as whisky in drinking water available ad libitum, the livers of all eight rats showed increased fibrosis and cirrhosis as compared to the livers of the eight non-alcohol-treated, isocalorically fed, paired control rats. Alcohol-treated rats developed fibrosis and cirrhosis on a dietary fat content of 38% of total caloric intake and low blood alcohol levels, ranging from 50 to 126 mg/dl, due to gradual intake over the day and to low absolute intake (mean 11.9 +/- 0.6 g/kg per day). None of the rats died spontaneously. Malnutrition is likely to be an important factor in the development of the fibrosis of alcoholic liver disease, and this rat model may be used to study aspects of the pathogenesis.

Alanine Transaminase↗
PubMed2004

Dietary composition and nonalcoholic fatty liver disease.

Nonalcoholic fatty liver disease (NAFLD) is a common and potentially serious form of chronic liver disease that occurs in patients who do not abuse alcohol. Present dietary recommendations for all Americans, including those with NAFLD, endorse a low-calorie, low-fat diet. However, little is known about the effect of diet composition on liver histopathology in patients with NAFLD. The aim of this study was to determine whether overall calorie intake and diet composition are associated with the severity of NAFLD histopathology. Seventy-four consecutive morbidly obese patients presenting for bariatric surgery from January 2001 to March 2002 were retrospectively reviewed. In addition to a standard surgical and psychological evaluation, all patients underwent a preoperative dietary evaluation using a standardized 24-hr food recall. Food intake was evaluated for total calories and macronutrients and compared to liver histopathology from biopsies routinely obtained during surgery. Associations with the severity of steatosis and the presence of inflammation or fibrosis were assessed separately using chi-square for categorical variables and ANOVA for continuous variables. Further, we conducted multiple logistic regression analyses for each histological outcome. There were no significant associations between either total caloric intake or protein intake and either steatosis, fibrosis, or inflammation. However, higher CHO intake was associated with significantly higher odds of inflammation, while higher fat intake was associated with significantly lower odds of inflammation. In conclusion, present dietary recommendations may worsen NAFLD histopathology.

Adult↗
PubMed1991

The effect on body composition and exercise performance of home parenteral nutrition when given as adjunct to chemotherapy of testicular carcinoma.

This study has evaluated whether long-term and permanent total parenteral nutrition (TPN) can protect body composition and exercise capacity during iterated courses of chemotherapy (PVB) in men with testicular carcinoma. Thirty-three men were randomly allocated by means of a computer based algorithm to receive either TPN (at hospital and home) during the entire chemotherapy period or to rely on spontaneous oral intake only. Nutrition status was assessed by measurements of whole body nitrogen (neutron activation), total body potassium, body water, urine creatinine excretion, loco-regional body nutrition indexes (AMC, TSF) and biochemical plasma concentrations (albumin, thyroid hormones). Whole body respiratory gas exchanges were measured during resting, submaximal and maximal exercise. TPN was prescribed on an individual basis in all study patients to cover 150% of their measured caloric need; nitrogen was given as 0.2 g N kg-1 day. All individuals were allowed to eat freely throughout the study. TPN patients were in overall positive energy balance (+850 Kcal day-1), while the control group was in negative balance (-532 Kcal day-1). This led to weight gain in the TPN group (+2.2 +/- 1.0 kg) while the control group lost significant weight (-4.2 +/- 1.1 kg). The average spontaneous oral caloric intake was 1014 +/- 153 Kcal day-1 in the TPN group and 1484 +/- 200 Kcal day-1 in the control group; total protein intake corresponded to 1.5 g protein kg day-1 in the TPN group and 0.7 kg day-1 in the control group.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1999

Bone mass and dynamic parathyroid function according to bone histology in nondialyzed uremic patients after long-term protein and phosphorus restriction.

One year of a very low protein diet (VLPD) can reverse secondary hyperparathyroidism in uremic patients. We studied bone histology, bone mineral density (BMD), and dynamic parathyroid function (calcium/PTH curves) in 16 nondialyzed patients with advanced renal failure who had been receiving a VLPD for a mean of 5 yr (mean protein intake, 0.34 +/- 0.12 mg/kg x day; mean phosphorus intake, 8.2 +/- 2.1 mg/kg x day) and daily supplementation with essential amino acids and their ketoanalogs (1000 IU vitamin D2 and 1-2 g calcium carbonate). Three patients exhibited a high bone formation rate (BFR), 7 patients had normal bone remodeling, and 6 patients had a low BFR, including 2 with osteomalacia and 4 with adynamic bone disease without aluminum overload. A longer diet duration and lower caloric intake were associated with low BFR. More than half of the patients exhibited moderate or severe osteoporosis at the appendicular skeleton. The t score of femur BMD explained 65% of the BFR variance. Patients with a low BFR had a dynamic parathyroid function similar to that of patients with a normal BFR, except they had a lower capacity to buffer a calcium load, whereas patients with a high BFR had a higher basal PTH/maximum PTH and a steeper calcium/PTH curve slope; the calcium set-point was identical in the three groups.

Adult↗
PubMed1995

Total body nitrogen as a prognostic marker in maintenance dialysis.

In order to assess long-term nutritional adequacy, 154 patients on maintenance dialysis (78 on hemodialysis (HD), 76 on continuous ambulatory peritoneal dialysis (CAPD)) underwent measurement of total body nitrogen (TBN) with concurrent recording of dietary history, anthropometrics, and serum albumin. Seventy-one patients were reassessed 23.3 +/- 2.2 (5 to 76) months later. In cross-sectional analyses, anthropometric measurements and dietary intake remained stable over time in all patients. However, a significant fall in TBN occurred in the HD population with increasing time on dialysis (P < 0.05). In the prospective analyses, CAPD patients (N = 26) had a significant increase in TBN (P < 0.02). In contrast, longitudinal measurements of TBN in HD patients (N = 36) tended to fall but did not reach significance (P = 0.18). TBN correlated with total caloric intake estimated from the dietary history (P < 0.05), but not with estimated protein intake. During follow-up, 38 patients died. These patients were older (P < 0.05), and in the CAPD population, they had been on dialysis for a longer time (P < 0.05). Those who died had a lower TBN expressed both as grams per kilogram lean body mass (P < 0.005) and as the nitrogen index (P < 0.05). The probability of death within 12 months in the patients with a nitrogen index (ratio of the measured nitrogen to the predicted nitrogen for a sex-, age-, and height-matched control) less than 80% of the predicted normal value was 48%. The relative risk of death in this population was 4.1.(ABSTRACT TRUNCATED AT 250 WORDS)

Anthropometry↗
PubMed1994

8-OH-DPAT induces a selective increase in protein intake in ageing overweight animals.

We have examined the effects of a 5-HT1A receptor agonist (8-hydroxy-2-(di-n-propylamino)tetralin, 8-OH-DPAT) on food preference in ageing rats that had been given a 'palatable' meal 15 min before administration of the drug. Ageing rats consumed a greater amount of the 'palatable' pre-meal than the young rats. In young rats lipids were the predominant source of calories, but in old animals lipid and protein consumption was similar. Administration of 8-OH-DPAT resulted in an increase in total caloric intake in both groups. Concomitant with this there was a significant increase in protein intake in both groups, which was most important in ageing rats, where proteins became the predominant source of calories.

8-Hydroxy-2-(di-n-propylamino)tetralin↗
PubMed2003

Total parenteral nutrition in bone marrow transplant: what is the appropriate energy level?

OBJECTIVES: Total parenteral nutrition (TPN), recommended during bone-marrow transplant (BMT), is often withheld following complications. We aim to determine the effective amount of energy supplied and its short-term effects in children requiring BMT. METHODS: Twenty children (11 males, 9 females, mean age 8 years, range 1-18 years) receiving 13 allogenic and 7 autologous BMT for malignant (13) and nonmalignant (7) diseases, were retrospectively evaluated for energy/protein intakes, weight changes, time to engraftment and on TPN, occurrence of complications, and metabolic abnormalities. RESULTS: Each child received approximately 72% of the prescribed calories, an average of 0.87 +/- 0.2 x basal-metabolic rate, 1.14 +/- 0.4 g protein/kg/day, and 176 +/- 34:1 nonprotein calories:nitrogen ratio. Body weight improved during the 35 days (range 14-62) of TPN, with loss thereafter. Engraftment occurred in 20 +/- 7.5 days. Caloric intake and time to engraftment were related (p = 0.002). Ten central-venous-line and 12 gastrointestinal infections occurred. Among laboratory abnormalities, liver function tests resulted temporarily altered in 10 patients, and permanently in 1 child with cholestasis. Eight children developed graft-versus-host disease. Five died of cancer. CONCLUSIONS: The energy supplied with TPN in BMT is less than expected and approximately covers the BMR with mixed effects. Energy intake needs to be calibrated during TPN and adjusted during feeding resumption to expedite recovery.

Adolescent↗
PubMed1993

[Energy metabolism in obese children].

Childhood obesity results from excessive dietary intake as compared with energy expenditure. This imbalance can result from either overeating or a constitutional decrease in one or several of the components of energy expenditure: resting metabolic rate, diet-induced thermogenesis, or exercise-related thermogenesis. Decreased energy expenditure is probably at least partly genetic in origin, contributing to the significant clustering of obesity in families. Management aims at reducing the imbalance by decreasing the caloric intake. Once the desired weight is achieved, intake must be adjusted to expenditure to avoid weight regain.

Adolescent↗
PubMed1991

Lower pleasantness of palatable foods in nalmefene-treated human volunteers.

The involvement of endogenous opioids in control of human food intake and appetite was investigated in a double-blind placebo-controlled study using a single, 2.5 mg oral dose of the opioid receptor antagonist, nalmefene. Ratings of the pleasantness of the smell and the taste, but not the appearance, of a number of foods was significantly lower in nalmefene-treated subjects. The magnitude of this effect was greater in food items independently rated as highly palatable. Caloric intake of a buffet-style meal was 20% lower in nalmefene-treated subjects, with the proportional reduction in intake of individual food items also depending on their palatability. These results lend further support to recent suggestions that opioids are involved in reward-related aspects of ingestion.

Adult↗