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Biomedical subjects

A M Madden

Publications and source records attributed to A M Madden.

9 recordsLinked to original sources
PubMed1999

Resting energy expenditure should be measured in patients with cirrhosis, not predicted.

Measurements of resting energy expenditure (REE) can be used to determine energy requirements. Prediction formulae can be used to estimate REE but have not been validated in cirrhotic patients. REE was measured, by indirect calorimetry, in 100 cirrhotic patients and 41 comparable healthy volunteers, and the results compared with estimates predicted using the Harris-Benedict, Schofield, Mifflin, Cunningham, and Owen formulae, and the disease-specific Müller formula. The mean (+/- 1 SD) measured REE in the healthy volunteers (1,590 +/- 306 kcal/24 h) was significantly greater than the mean Harris-Benedict, Mifflin, Cunningham, and Owen predictions but comparable with the mean Schofield prediction; individual predicted values varied widely from measured values (95% limits of agreement, -460 to +424 kcal). The mean measured REE in the cirrhotic patients was significantly greater than in the healthy volunteers (23.2 +/- 3. 8 cf 21.9 +/- 2.9 kcal/kg/24 h; P <.05). The mean measured REE in the cirrhotic patients (1,660 +/- 337 kcal/24 h) was significantly different from mean predicted values (Harris-Benedict, 1,532 +/- 252 kcal/24 h, P <.0001; Schofield, 1,575 +/- 254 kcal/24 h, P <.0005; Mifflin, 1,460 +/- 254 kcal/24 h, P <.0001; Cunningham, 1,713 +/- 252 kcal/24 h, P <.05; Owen, 1,521 +/- 281 kcal/24 h, P <.0001; Müller, 1,783 +/- 204 kcal/24 h, P <.0001); individual predicted values varied widely from measured values (95% limits of agreement, -632 to +573 kcal). Simple regression analysis showed that fat-free mass (FFM) was the strongest predictor of measured REE in the cirrhotic patients, accounting for 52% of the variation observed. However, a population-specific prediction equation, derived using stepwise regression analysis, which incorporated FFM, age, and Pugh's score, accounted for only 61% of the observed variation in measured REE. REE should, therefore, be measured in cirrhotic patients, not predicted.

Adult↗
PubMed1999

Patterns of energy intake in patients with cirrhosis and healthy volunteers.

Fuel utilization and N economy are optimized in patients with cirrhosis by provision of several small meals throughout the day and a late-night snack of complex carbohydrate. Currently, however, only limited information is available on the patterns of energy intake in patients with chronic liver disease. The aims of the present study were to determine the number of days required to undertake such an investigation and to observe the daily distribution of energy intake in this patient population. Eight patients with cirrhosis and eight matched healthy volunteers kept weighed dietary intake records for fifteen separate days over a 6-month period. The records were analysed for energy intake per hour and the number and size of energy intake episodes per 24 h calculated. Intake was verified against resting energy expenditure. Fourteen separate observational days were required to investigate the pattern of energy intake in the cirrhotic patients while 20 d were required for healthy volunteers. Considerable inter- and intrasubject variations in the number and size of energy intake episodes were observed in both the patients and healthy volunteers. However, no significant differences were observed between the mean total number of daily energy intake episodes (6.3 (SD 1.6) v. 7.0 (SD 1.4)) or in the distribution of daily energy intake between the two groups. Most patients and volunteers tended to eat frequent small meals, often including a late-night snack, rather than two or three large meals daily. It should, therefore, be possible to establish optimum patterns of energy intake in these patients in line with recent guidelines.

Adult↗
PubMed1997

Taste perception in cirrhosis: its relationship to circulating micronutrients and food preferences.

Impairment of gustatory acuity may influence nutrient intake and hence nutritional status. The aim of this study was to evaluate gustatory acuity in patients with cirrhosis and its relationship to circulating concentrations of micronutrients, and food preferences. Gustatory evaluation was undertaken, using a rinsing technique, in 75 cirrhotic patients and 75 comparable healthy volunteers. Circulating concentrations of magnesium, zinc, vitamin A, and alpha- and beta-carotene were measured, and food preferences were assessed by questionnaire. The cirrhotic patients showed impaired gustatory function with significantly higher (less sensitive) median thresholds for detection of salt, sweet, and sour and for recognition of bitter, salt, sweet, and sour, together with a higher overall median gustatory score (P < .0001). Mean circulating concentrations of magnesium, zinc, vitamin A, and alpha- and beta-carotene were significantly lower in the patient population. Serum magnesium was significantly negatively associated with detection of salt (P = .02) and gustatory score (P = .02). Patients' subjective assessment of taste acuity did not correspond with objective measurements. Overall, no differences were observed in food preferences between the two groups, nor was any association found between food preferences and gustatory acuity. Patients with cirrhosis have impaired gustatory acuity that is associated with hypomagnesemia but apparently does not affect food selection.

Adult↗
PubMed1997

The potential role of dual-energy X-ray absorptiometry in the assessment of body composition in cirrhotic patients.

Very little information is available on body composition in patients with cirrhosis. Difficulties arise in studying these patients because they tend to retain fluid and this results in changes in tissue density and in the hydration fraction of fat-free mass. As the classic body composition techniques rely on the assumption that these variables remain constant, use of these methods will result in either under- or overestimates of body composition variables. Use of multicomponent models, employing two or more measurement techniques, will obviate the need for some of the assumptions inherent in the use of single techniques, thereby increasing the accuracy of the assessments without loss of precision. Dual-energy x-ray absorptiometry can be used to measure total body bone mineral, fat, and fat-free soft tissue mass. In healthy individuals excellent agreement is observed between data obtained using this technique and data obtained from the more established reference methods. However, the degree to which the absorptiometry measurements of soft tissue are sensitive to the hydration is not known. Thus, in order to assess this method of body composition analysis in patients with chronic liver disease, a multicomponent model must be devised which incorporates the absorptiometry technique and allows cross-validation of the individual component measures.

Absorptiometry, Photon↗
PubMed1996

The assessment of body composition in patients with cirrhosis.

Very little information is available on body composition in patients with cirrhosis. Difficulties arise in studying these patients because they tend to retain fluid and this results in changes in tissue density and in the hydration fraction of fat-free mass. As the classic body composition techniques rely on the assumption that these variables remain constant, use of these methods will result in either under- or overestimates of body composition variables. Use of multi-component models, employing two or more measurement techniques, will obviate the need for some of the assumptions inherent in the use of single techniques, thereby increasing the accuracy of the assessments, without loss of precision.

Adult↗
PubMed1994

A comparison of skinfold anthropometry and bioelectrical impedance analysis for measuring percentage body fat in patients with cirrhosis.

Percentage body fat was determined by skinfold anthropometry and bioelectrical impedance analysis in 60 patients with cirrhosis, 30 of whom had overt fluid retention, and in 60 age- and sex-matched healthy volunteers. In the control population the mean +/- 1SD percentage body fat assessed using bioelectrical impedance analysis, 22.6 +/- 6.5%, and skinfold anthropometry, 22.5 +/- 6.9%, were comparable. However, there was considerable variation in individual values such that measurements made using bioelectrical impedance analysis could be from 9% less to 8% more than the corresponding anthropometric values. In patients with cirrhosis the mean percentage body fat assessed using bioelectrical impedance analysis, 24.4 +/- 8.9%, was significantly greater than the value obtained using skinfold anthropometry, 20.3 +/- 8.4% (p < 0.01) for the whole group and for the subgroup of patients with fluid retention, 24.5 +/- 8.5% cf. 18.4 +/- 7.1% (p < 0.005); estimates of body fat in the subgroup of patients without overt fluid retention were comparable between methods, 24.4 +/- 9.4% cf. 22.1 +/- 9.2%. In the whole patient group individual measurements made using bioelectrical impedance analysis could be from 10% less to 18% more than the corresponding anthropometric values; similar degrees of variation in individual values were observed in the two patient subgroups. Bioelectrical impedance analysis should not be used interchangeably with skinfold anthropometry for assessment of percentage body fat in patients with cirrhosis, irrespective of their state of hydration.

Adipose Tissue↗
PubMed1989

Combined abdominal hernia repair and continuous ambulatory peritoneal dialysis (CAPD) catheter insertion.

Out of a series of 290 surgically inserted continuous ambulatory peritoneal dialysis (CAPD) catheters, 19 patients had 24 abdominal hernias repaired at the same time as CAPD catheter insertion. All catheters were used immediately after our normal postoperative break in protocol. There were no fluid leaks from the hernia repair site but 3 catheters failed due to complications unrelated to the hernia repair. CAPD technique survival was not adversely affected in the hernia repair group.

Catheterization↗
PubMed1987

Validation of a computer based system for assessing dietary intake.

Dietary intake was assessed in 50 patients in hospital by using a dietary history method and computer based system for data collection and standard food tables to calculate the composition of nutrients. The results were compared with those from a weighed assessment that was calculated by using both food tables and manufacturers' food analyses. The use of the food tables overestimated mean (SEM) individual nutrient intakes by between 2.5% (1.5%) and 15.5% (3.0%). The mean errors associated with the dietary history assessment varied from -23% (7.8%) for fat intake to +21.4% (8.5%) for carbohydrate intake. Overall, 30% of the assessments of total nutrient intakes that were calculated using this method were within -20% to +20% of actual values; 18% were within -10% to +10%. The mean errors associated with the computer based assessment varied from -1.0% (4.3%) for carbohydrate intake to +8.5% (3.4%) for protein intake. Overall, 56% of the assessments of total nutrient intakes were within -20% to +20% of actual intakes; 31% were within -10% to +10%. The computer based system provides an accurate, reproducible, convenient, and inexpensive method for assessing dietary intake.

Data Collection↗