Fat metabolism in the predisposition to obesity.
Explore the source record for details and available documents.
Animals↗
Biomedical subjects
A Raben
Publications and source records attributed to A Raben.
Long-term regional control after radiation therapy and neck dissection for base of tongue carcinoma.
PURPOSE: Minimal literature exists with 10-year data on neck control in advanced head and neck cancer. The purpose of this study is to determine long-term regional control for base of tongue carcinoma patients treated with primary radiation therapy plus neck dissection. METHODS AND MATERIALS: Between 1981-1996, primary radiation therapy was used to treat 68 patients with squamous cell carcinoma of the base of tongue. Neck dissection was added for those who presented with palpable lymph node metastases. The T-stage distribution was T1, 17; T2, 32; T3, 17; and T4, 2. The N-stage distribution was N0, 10; N1, 24; N2a, 6; N2b, 11, N2c, 8; N3, 7; and Nx, 2. Ages ranged from 35 to 77 (median 55 years) among the 59 males and nine females. Therapy generally consisted of initial external beam irradiation to the primary site (54 Gy) and neck (50 Gy). Clinically positive necks were boosted to 60 Gy with external beam irradiation. Three weeks later, the base of tongue was boosted with an Ir-192 interstitial implant (20-30 Gy). A neck dissection was done at the same anesthesia for those who presented with clinically positive necks, even if a complete clinical neck response was achieved with external beam irradiation. Neoadjuvant cisplatin-based chemotherapy was administered to nine patients who would have required a total laryngectomy if their primary tumors had been surgically managed. The median follow-up was 36 months with a range from 1 to 151 months. Eleven patients were followed for over 8 years. No patients were lost to follow-up. RESULTS: Actuarial 5- and 10-year neck control was 96% overall, 86% after radiation alone, and 100% after radiation plus neck dissection. Pathologically negative neck specimens were observed in 70% of necks dissected after external beam irradiation. The remaining 30% of dissected necks were pathologically positive. These specimens contained multiple positive nodes in 83% despite a 56% overall complete clinical neck response rate to irradiation. Regional failure occurred in only two patients, neither of whom underwent adjuvant neck dissection. Symptomatic neck fibrosis (RTOG grade 3) was not observed. Actuarial 5- and 10-year local control was 88% and 88%, disease-free survival was 80% and 67%, and overall survival was 86% and 52%. CONCLUSION: For base of tongue cancer, most patients can obtain long-term regional control with no severe complications after definitive radiation therapy, plus neck dissection for those who present with lymphadenopathy. Complete clinical regression of palpable neck metastases after irradiation poorly correlates with pathologic outcome. Our current policy is to include neck dissection at the time of implantation for patients who present with palpable neck metastases. We realize that this therapeutic approach may overtreat some patients, but we are reluctant to change our policy in light of these excellent outcomes.
Adult↗
[Spontaneous weight loss in young subjects of normal weight after 11 weeks of unrestricted intake of a low-fat/high-fiber diet].
The present study investigated the spontaneous, unintended body weight changes observed during the first 11 weeks of an eight months' ad libitum low-fat/high-fibre diet (25.5 energy-% fat, 58.5 energy-% carbohydrate, 3.9 g dietary fiber/MJ), primarily aimed at investigating changes in blood lipid concentrations. Subjects were normal-weight, young, healthy students, 24 in the intervention group, and 24 in the control group (no diet). After 11 weeks, an overall decrease in body weight (1.3 +/- 0.4 kg) (mean +/- SEM) (p < 0.01) and fat mass (1.6 +/- 0.2 kg, p < 0.001) was observed in the intervention group. Fat-free mass remained unchanged. Initial body weight and fat mass correlated significantly to changes in body weight and fat mass. No changes were observed in the control group. In conclusion, the ad libitum intake of a low-fat/high-fibre diet led to a spontaneous, small loss of body weight and fat mass in young, normal-weight subjects.
Adult↗
Detailed quality of life assessment in patients treated with primary radiotherapy for squamous cell cancer of the base of the tongue.
BACKGROUND: This study was conducted to evaluate quality of life in patients treated with primary radiotherapy (RT) for cancer of the base of tongue. METHODS: From 1981 to 1990, 36 patients with primary squamous cell cancer of the base of tongue were managed with primary radiotherapy. Ages ranged from 35 to 71 years (median, 58 years), T Stage was: T1, n = 11; T2, n = 14; T3, n = 10; T4, n = 1. Thirty-one patients (86%) had palpable cervical lymph node metastases at initial examination (N1, n = 16; N2, n = 11; N3, n = 4). Patients received external beam RT to their primary site and necks, followed by a brachytherapy boost to the tongue. Those with neck nodes also had a neck dissection. The median follow-up is 5 years (minimum, 3 years). Actuarial 5-year local control was 85%; regional control was 96%; distant metastases-free survival was 87.5%; and overall survival, 85%. Twenty-nine of the 30 long-term survivors completed (1) Memorial Symptom Assessment Scale (MSAS), (2) Functional Assessment of Cancer Therapy (FACT), (3) Performance Status Scale for Head and Neck Cancer (PSS), and (4) a sociodemographic and economic questionnaire. At the time of cancer diagnosis, 62% were employed full-time, and 21% were employed part-time; 83% were earning > $20,000/year, and 59% were earning > $60,000/year. RESULTS: At follow-up, annual incomes were similar to those at initial examination. Of those who had been working full-time, 72% were still in full-time work, and of those who had been working part-time, 83% were still in part-time work. Average PSS scores were 90 for eating in public, 96 for understandability of speech, and 68 for normalcy of diet. On the MSAS, the following symptoms had prevalence: > 30% xerostomia, difficulty swallowing, decreased energy, pain, worrying, insomnia, cough, drowsy, change in taste, and irritability. Scores on the FACT exceeded published values collected for a mixed cancer population. CONCLUSIONS: The overwhelming majority of patients achieved excellent functional status and quality of life and could maintain their prediagnosis earning potential and employment status after primary radiation for advanced base of tongue cancer.
Actuarial Analysis↗
The role of low-fat diets and fat substitutes in body weight management: what have we learned from clinical studies?
The introduction of low-fat, high-complex carbohydrate diets far the prevention and treatment of obesity was based on the causal link established between dietary fat and body fatness. Observational and mechanistic studies show that because fat possesses a lower satiating power than carbohydrate and protein, a diet rich in fat can increase energy intake. The propensity to gain weight is enhanced in susceptible persons, particularly sedentary people who have a genetic predisposition to obesity. Low-fat diets cause weight loss proportional to pretreatment body weight in a dose dependent manner; that is, weight loss is correlated positively to the reduction in dietary fat content. A reduction of 10% fat energy produces an average 5-kg weight loss in obese persons. As with traditional caloric counting diets, obese persons lose weight only if they adhere to the prescribed low-fat diet. Failure to achieve a weight loss and to maintain it may be attributed in part to lack of adherence to the diet. After a major weight loss, an ad libitum low-fat diet program appears to be superior to caloric counting in maintaining the weight loss 2 years later. Replacing some fat with protein instead of carbohydrate may increase the weight loss further. Moreover, fat substitutes may make it easier to prevent and treat obesity by making the diet palatable. More randomized, controlled, long-term dietary intervention studies are warranted to identify the optimal diet composition for the treatment of obesity.
Appetite↗
Promising survival with three-dimensional conformal radiation therapy for non-small cell lung cancer.
PURPOSE: Local failure is a major obstacle to the cure of locally advanced non small-cell lung cancer. Three-dimensional conformal radiation therapy (3-DCRT) selects optimal treatment parameters to increase dose to tumor and reduce normal tissue dose, potentially representing an enhancement of the therapeutic ratio of radiation therapy for lung cancer. We performed this analysis of 45 non-small cell lung cancer patients treated with 3-DCRT alone, to evaluate the ability of computer derived lung dose volume histograms to predict serious pulmonary toxicity, to assess the feasibility of this approach, and to examine the resulting survival. METHODS: There were 28 males (62%) and 17 females (38%). The median age was 65 (range: 38-82). Tumor stage was Stage I/II in 13%, IIIa in 42%, and IIIb in 44%. The histology was squamous in 44%, adenocarcinoma in 36%, and other non-small cell histologies in the others. Only 47% of patients. had combined favorable prognostic factors (i.e. KPS < or = 80, and < or = 5% wt. loss). The median dose of radiation to gross disease was 70.2 Gy (range: 52.2-72 Gy) delivered in fractions of 1.8 Gy, 5 days per week. RESULTS: Seven patients did not complete 3-DCRT due to disease progression outside the port. Follow-up data are mature: the median follow up of the 6 survivors is 43.5 months (35-59). Thoracic progression occurred in 46%. Median survival (all 45 patients.) is 15.7 months and survival is 32% at 2 years and 12% at 59 months. Pulmonary toxicity > or = grade 3 occurred in 9% of patients. Dose volume histograms were available in 31 patients and showed a correlation between risk of pulmonary toxicity and indices of dose to lung parenchyma. Grade 3 or higher pulmonary toxicity occurred in 38% (3/8) of patients with > 30% of lung volume receiving > or = 25 Gy, versus 4% (1/23) of patients with < or = 30% lung receiving > or = 25 Gy (P = 0.04). Grade 3 or higher pulmonary toxicity occurred in 29% (4/14) of patients with a predicted pulmonary normal tissue complication probability of 12% or higher versus 0% (0/17) in patients with a predicted probability of less than 12% (P = 0.03). CONCLUSIONS: Despite adverse prognostic criteria median survival is encouraging and may be higher than some combined modality approaches. Dose volume histogram parameters may be useful to determine the maximum dose for individual patients and thereby permit avoidance of toxicity.
Adult↗
A method to achieve control of dietary macronutrient composition in ad libitum diets consumed by free-living subjects.
OBJECTIVE: To validate a shop system in controlling macronutrient composition during ad libitum dietary intervention. DESIGN: Six months randomized intervention trial. SETTING: A shop at the department from which all foods were collected free of charge and registered by a purpose-designed computer system. SUBJECTS: Sixty-five free-living obese subjects (25 kg/m2 < BMI < 34 kg/m2) recruited through advertisement and from a waiting list at the Department. Total drop-out rate was 8%. INTERVENTIONS: Ad libitum low-fat diets (30 energy-% (E%) fat): (1) High-protein (25 E% protein, HP) or (2) Low-protein, (12 E% protein, LP) or habitual diet (controls, C). MAIN OUTCOME MEASURES: Compliance was assessed by 24 h urinary nitrogen excretion (24 h UN). RESULTS: After one month of dietary intervention 24 h UN increased significantly in the HP group and decreased significantly in the LP group (Group difference 95% CI):6.8 g (5.0-8.7 g), P < 0.0001). This group difference remained throughout the trial. There was good agreement between protein intake as estimated by the shop computer and as estimated from 24 h UN in both first (r = 0.86) and second half of the intervention (r = 0.80). CONCLUSION: The high dietary compliance demonstrates the potential of this method to control macronutrient composition in ad libitum dietary intervention studies in free-living subjects.
Adolescent↗
Replacement of dietary fat by sucrose or starch: effects on 14 d ad libitum energy intake, energy expenditure and body weight in formerly obese and never-obese subjects.
OBJECTIVE: To investigate the impact of a high-sucrose diet vs a high-starch and a high-fat diet on 14 d ad libitum energy intake, body weight, energy expenditure and sympathoadrenal activity. MEASUREMENTS: Food intake; body weight and composition (bioelectrical impedance); 24 h energy expenditure, substrate oxidation rates, spontaneous physical activity, heart rate and appetite sensations in a respiration chamber (VAS scores); plasma catecholamine concentration and blood pressure. SUBJECTS: Twenty normal-weight, healthy women, 9 post-obese (body mass index (BMI): 22.9 +/- 0.7 kg/m2) and 11 closely matched controls (BMI: 22.6 +/- 0.4 kg/m2). RESULTS: Average 14 d ad libitum energy intake was 13% and 12% lower on the starch diet compared with the sucrose and fat diets, respectively (P < 0.05). In both post-obese and normal-weight subjects, body weight and fat mass decreased significantly on the starch diet (by 0.7 +/- 0.2 kg and 0.4 +/- 0.1 kg, respectively, P < 0.05). No changes were observed on the fat or sucrose diets. After 14 d on the sucrose diet, 24 h energy expenditure as well as postprandial plasma adrenaline and noradrenaline concentrations, were significantly increased compared with the other two diets. Overall satisfy and palatability ratings were also highest on the sucrose diet. CONCLUSION: Intake of a 14-d ad libitum high-starch diet decreased energy intake and body weight compared with a high-fat or high-sucrose diet. The increased energy expenditure observed on the sucrose-rich diet can probably be explained both by the increased intake of energy and fructose (mainly from sucrose) on this diet.
Adult↗
Acetylation of or beta-cyclodextrin addition to potato beneficial effect on glucose metabolism and appetite sensations.
Functional foods are gaining more and more interest from health scientists. One way to improve the nutritional properties of foods may be to modify the starch component, often included to stabilize the food product. In this study two chemically modified starches-a 1-2% acetylated potato starch and a starch enriched with 2% beta-cyclodextrin-and a native, unmodified potato starch (control) were investigated with regard to 6-h energy expenditure, substrate metabolism, hormone concentrations, and subjective appetite sensations. Subjects were 11 healthy, normal-weight, young men. The starch (50 g) was prepared as a pudding with fruit sauce and whipped cream (3180 kJ, 49% of energy from carbohydrate, and 40% of energy from fat). The meal was given in the morning after a 2-d carbohydrate-rich, weight-maintenance diet. After the modified-starch meals, response patterns for plasma glucose (P < 0.01), insulin (P < 0.05); gastric inhibitory polypeptide (P < 0.05), subjective satiety (P < 0.05), and fullness (P = 0.06) were significantly different from response patterns after the meal with the control starch. Thus, a flattening of the glucose curve, a lower insulin and gastric inhibitory polypeptide response, and higher fullness ratings were observed after the meal with the beta-cyclodextrin starch. Satiety ratings were higher after both meals with modified starch than after the meal with the control starch. In conclusion, a minor modification insulinemic (1-2%) of native potato starch improved the glycemia, insulinemic, and satiating properties of a meal. This was especially true for the beta-cyclodextrin-enriched starch. Slower gastric-emptying rate or delayed intestinal absorption of the modified starch may explain the observed differences.
Acetylation↗
Brachytherapy for non-small cell lung cancer and selected neoplasms of the chest.
This article reviews the indications, techniques, and results of brachytherapy in the treatment of non-small cell lung cancer (NSCLC) and selected chest neoplasms. Various isotopes and techniques are used to place radioactive sources directly into a tumor, tumor bed, or the chest. Brachytherapy techniques can be tailored to the clinical situation and can be in the form of permanent interstitial volume or planar implants (radioactive sources permanently imbedded into the tumor or tumor bed) or in the form of temporary interstitial or endoluminal implants (where radioactive sources irradiate a tumor bed over a certain length of time and then are removed). These treatments can be delivered over a short interval (high-dose rate [HDR]) or over a more protracted time (low-dose rate). HDR treatments can be used intraoperatively to deliver a large dose of radiation to a determined target area with selective sparing of surrounding normal structures. Different methods of delivering HDR intraoperative radiation are under investigation. Most reports on brachytherapy for chest malignancies are retrospective and come from a few single institutions. Most of the published data relate to the treatment of NSCLC, but other intrathoracic malignancies, such as malignant pleural mesothelioma and malignant thymoma, have been treated with brachytherapy. To our knowledge, no major randomized trials accurately assess or confirm these retrospective studies yet, complicating the interpretation of these results. Nevertheless, brachytherapy is of value in selected situations and offers the clinician and the patient an innovative method of delivering conformal high-dose radiation to a defined target with preferential sparing of normal surrounding structures. With continued innovations in the development of radioactive isotopes, computerized treatment planning and targeting, and source delivery, brachytherapy should continue to offer an attractive alternative and complement to conventional treatment approaches, and may offer patients improved local control and survival.
Brachytherapy↗
Feasibility study of the treatment of primary unresectable carcinoma of the pancreas with 103Pd brachytherapy.
PURPOSE: The purpose of this study was to assess the feasibility of 103Pd brachytherapy in the management of primary unresectable carcinoma of the pancreas. METHODS AND MATERIALS: Between August 1988 and January 1992, 11 patients with biopsy-proven primary unresectable adenocarcinoma of the pancreas were treated with 103Pd brachytherapy during laparotomy. The median age was 66 (range 57-70). The most common presenting symptoms were weight loss (eight patients), pain (six patients), and nausea/vomiting (four patients). Less common symptoms were jaundice (two patients), early satiety (two patients), and ascites (one patient). All patients underwent laparotomy and surgical staging. Eight patients had T3N0M0 disease, two patients had T3N1M0 disease, and one patient had T3N1M1 disease. The surgical procedure performed was biliary bypass in six patients, biopsy only in four patients, and gastric bypass in one patient. The average tumor dimension was 4.0 cm. The median activity, matched peripheral dose (MPD) and implanted volumes were 95.3 mCi, 124.4 Gy, and 33 cm3, respectively. The median initial dose rate was 0.21 Gy per hour. Five patients received postoperative external beam radiation therapy (median 45 Gy) and seven patients received chemotherapy postoperatively. The median follow-up was 7 months (range 1-19). RESULTS: The median survival for the entire group of patients was 6.9 months. Ten of 11 patients have died, with 1 patient presently alive and receiving chemotherapy for metastatic disease to the liver, but without local progression radiographically. Five of 11 patients (45%) were locally controlled, defined as either a complete response or freedom from progression at the site of the implant as evaluated by computed tomography scan. In the other six patients, the median time to local progression was 6.9 months. Five patients developed distant metastases (four liver, one subcutaneous nodule). Two patients failed in regional sites (one omentum, one paraaortic lymph node). Four of 11 patients (36%) developed acute postoperative complications that included one gastric outlet obstruction, one duodenal perforation, and two with sepsis. One of 11 patients (9%) developed a late complication of radiation enteritis 5 months after implantation. The median survival for patients experiencing complications was 1.7 months as compared to 8.4 months for the patients who did not develop a complication (p = 0.10). Pain relief was obtained in five out of six (83%) of the patients presenting with pain for a median duration of 24 weeks. Local control did not appear to be related to the MPD, dose rate, implanted volume, treatment with external beam irradiation, or the use of chemotherapy. Patients were more likely to develop a complication if the MPD was greater than 115 Gy (four out of six patients) as compared to those whose MPD was less than 115 Gy (one out of five patients) (p = 0.12). CONCLUSIONS: Because there was no improvement in median survival over conventional modalities, and the complication rate was high; we do not recommend 103Pd brachytherapy as a component of the treatment of unresectable adenocarcinoma of the pancreas.
Aged↗
Weight loss during 12 week's ad libitum carbohydrate-rich diet in overweight and normal-weight subjects at a Danish work site.
The effect of 12 week's ad libitum carbohydrate-rich, low-fat diet on total body weight, lean body mass, and fat mass was studied in a group of healthy subjects at a Danish work-site (I) (n = 50, BMI = 28.4 +/- 0.7 kg/m2). Sixteen subjects served as controls (C) (BMI = 27.0 +/- 1.0 kg/m2). After 12 weeks the I subjects had decreased their fat intake from 39.0 +/- 1.1 energy-% (E%) to 28.0 +/- 1.2 E% and increased their carbohydrate intake from 46.0 +/- 1.1 E% to 56.4 +/- 1.1. E% (p < 0.05 vs. C). Moreover, a significant loss of body weight (4.2 +/- 0.4 kg) and fat mass (4.4 +/- 0.6 kg) was observed in I (p < 0.05 vs. C). The weight loss in I was not regained at 24 and 52 weeks' follow-up (82% of I participating) compared to baseline. The cost per kg lost weight amounted to $14.7 / person. In conclusion, instructions at a work site in ad libitum intake of a carbohydrate-rich, low-fat diet resulted in a significant loss of body weight and fat mass in overweight and normal-weight subjects.
Adult↗
Glucostatic control of intake and obesity.
Explore the source record for details and available documents.
Dietary Carbohydrates↗
Defects in substrate oxidation involved in the predisposition to obesity.
Explore the source record for details and available documents.
Dietary Fats↗
Low resting metabolic rate in subjects predisposed to obesity: a role for thyroid status.
A low resting metabolic rate (RMR) for a given body composition has been identified as a risk factor for weight gain and obesity, and has also been reported in formerly obese individuals with the genetic predisposition for obesity. The possible role of thyroid hormone in low RMR was studied in a large sample of postobese women. RMR was measured by indirect calorimetry in 28 weight-stable postobese women with a family history of obesity (PO group) and in a control group of 28 nonobese women closely matched for age, fat mass, and fat-free mass. RMR was 8% lower in the PO than in the control group [[symbol: see text]; 95% Cl:5856 (5520, 6214) compared with 6408 kJ/d (6096, 6768 kJ/d), P < 0.02], and the group difference remained unchanged after fat-free mass and fat mass were adjusted for (552 kJ/d, P < 0.015). The PO group had lower plasma free triiodothyronine [2.4 (1.9, 3.0) compared with 3.4 pmol/L (2.9, 3.9 pmol/L), P < 0.01], whereas plasma androstenedione only tended to be lower in the PO than in the control group. Adjustment for differences in androstenedione did not reduce the difference in RMR, whereas adjustment for differences in plasma free triiodothyronine eliminated the group difference (96 kJ/d, P = 0.59). The present study shows that RMR for a given body composition is lower among postobese than among matched never-obese control subjects. Statistically, the lower plasma free triiodothyronine concentrations of the postobese subjects could explain their lower RMRs, but it remains to be established whether these findings are causally related.
Adult↗
Growth factor modulation of fibroblasts in simulated wound healing.
Growth factors are potent bioactive molecules responsible for the co-ordination of many cells functions and interactions. Of these agents PDGF and IGF have shown particular promise as agents which may be used to stimulate periodontal regeneration. In order to further understand the mechanisms by which growth factors may work, a simple model of in vitro wound healing has been utilized to assess the effects of PDGF on human periodontal ligament fibroblasts and its potential to stimulate wound healing. Human periodontal ligament fibroblasts were plated into 24-well plates and upon reaching confluence were wounded by creating uniform discoid lesions stripped of cells. The influence of various concentrations of PDGF on cell proliferation, cell migration and extracellular matrix synthesis was monitored. The results of this study indicated that in the presence of 10 ng/ml PDGF on 0.2% fetal calf serum, both cell proliferation and cell migration were significantly stimulated. In the wounded cultures, PDGF appeared to cause a moderate stimulation of proteoglycan synthesis compared to unwounded cultures. In conclusion, the model system tested appears to be useful for studying fundamental cellular and biochemical events associated with wound healing. The effects of PDGF in this system confirm that it is capable of modulating fibroblasts in a manner compatible with the events associated with wound repair.
Analysis of Variance↗
Determinants of postprandial appetite sensations: macronutrient intake and glucose metabolism.
BACKGROUND: According to the glucostatic theory and the macronutrient balance concept, blood glucose and liver glycogen concentrations are important mediators of hunger and satiety. Results from acute postprandial studies are, however, still conflicting. OBJECTIVE: To investigate the associations between appetite sensations on the one hand and macronutrient intake and measures of glucose metabolism on the other hand. METHODS: Six group-means from three different studies (a total of 64 test meals) were tested in linear regression analyses. RESULTS: Positive correlations were found between delta-mean postprandial satiety and serving weight (r = 0.84, p < 0.05), and carbohydrate content (g) (r = 0.86, p < 0.05) of the meals. Furthermore, delta-mean satiety correlated to delta-AUC for plasma glucose (r = 0.92, p < 0.01), lactate (r = 0.98, p < 0.001), insulin (r = 0.95, p< 0.01), noradrenaline (r = 0.97, p < 0.01), gastric inhibitory polypeptide (r = 0.93), p < 0.01) and net carbohydrate oxidation (r = 0.86, p < 0.05). CONCLUSION: Total serving weight and carbohydrate content of the meals as well as postprandial glucose metabolism seem to be involved in the changes of postprandial hunger and satiety sensations after a meal. Due to the covariation between the single variables it is not possible, however, to distinguish between the different factors involved.
Adult↗
Manipulating carbohydrate content and sources in obesity prone subjects: effect on energy expenditure and macronutrient balance.
Explore the source record for details and available documents.
Body Weight↗