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Biomedical subjects

C Roongpisuthipong

Publications and source records attributed to C Roongpisuthipong.

12 recordsLinked to original sources

Nutritional assessment in various stages of liver cirrhosis.

OBJECTIVES: The aims of this study were to determine the prevalence of protein-calorie malnutrition, characteristics, and clinical importance of nutrition disorders in patients with liver cirrhosis according to severity of disease. METHODS: Nutrition assessments such as subjective global assessment, anthropometric and biochemical measurements, immunocompentency, thiamin and riboflavin status in 60 patients with cirrhosis (33 male and 27 female) were recorded between June 1999 and December 1999 at an outpatient clinic at Ramathibodi Hospital, Bangkok, Thailand. The origin of liver disease was alcohol related in 50% of patients. Child-Pugh criteria were used to establish the severity of liver disease. RESULTS: In terms of energy malnutrition, 13.3% of patients had ideal body weights below 90% and 11.7% had body mass indexes below 18.5 kg/m(2). Protein malnutrition (low albumin) and immunoincompetence (abnormal response to skin tests) were found much more frequently (45% and 22%) than energy malnutrition. Patients with alcoholic cirrhosis had ascites (P < 0.05) and hepatic encephalopathy (P < 0.001) more frequently and less triceps skinfold thickness than those with non-alcoholic cirrhosis. Subjective global assessment and serum proteins correlated with the degree of liver-function impairment, but immunologic tests correlated inversely in cirrhosis patients. Mean values for creatinine-height index, hemoglobin, cholesterol, and complement C4 showed significant decreases in severe liver failure (Child-Pugh class C) only in patients with alcoholic cirrhosis (P < 0.05). Malnutrition was correlated with the clinical severity of liver disease. CONCLUSIONS: The study showed that protein-energy malnutrition is a common complication of liver cirrhosis. Nutritional disorders appeared to be related to the degree of liver injury and the etiology of nutritional disorders. Nutritional disorders were more severe with alcoholic cirrhosis than with non-alcoholic cirrhosis.

Adult↗

Impact of liver cirrhosis on nutritional and immunological status.

The aims of the study were to determine the prevalence of protein calorie malnutrition (PCM) in Thai cirrhotic patients and to evaluate nutritional and immunological status in various stages of cirrhosis. Subjective Global Assessment (SGA) and anthropometric measurement were used as nutritional assessment in sixty cirrhotic patients. Delayed-type hypersensitivity skin test, lymphocyte count, immunoglobulin and complement were assessed for immune status. Blood samples were sent for routine tests, prealbumin, thiamine and riboflavin level. There were 7/60 (11.7%) patients with percentage of ideal body weight (%IBW) less than 90 per cent. SGA, hemoglobin, protein indices and cholesterol level showed the deterioration of nutritional status in the late stage of the disease. Five (8.3%) patients with thiamine deficiency, and thirteen (21.7%) patients with riboflavine deficiency were detected. Lowest levels of complement and highest levels of immunoglobulin also occurred in the late stage of the disease. In conclusion, defining %IBW <90 per cent as malnutrition, the prevalence of malnutrition in Thai cirrhotic patients was 11.7 per cent. Nutritional and immunological status deteriorated according to the advanced stage of disease. If nutritional support is given in the early stage, it may improve nutritional status and reduce morbidity and mortality in cirrhotic patients.

Adult↗

Possible thermogenesis with dexfenfluramine.

Fifty obese patients with a body mass index greater than 25 kg/m2 were randomized into 3 groups: control (C = 19), placebo (P = 18) and dexfenfluramine (D = 18). A behavioral modification program which included eating habits, exercise, attitudes, social relationships and six steps to lifetime weight control was taught every week. All patients strictly followed the food manual and recorded their behavior, physical activity and food intake every day through 12 weeks. Placebo and dexfenfluramine 30 mg/day were given in a double blind placebo controlled study. The results showed that all 3 groups had significant decreases in rest times and increased activity times (p < 0.05) and significant reductions of the average total daily energy, carbohydrate and fat intake (p < 0.05). They all lost weight. Mean +/- SEM cumulative weight loss was 8.3 +/- 0.7 kg in group D, 3.3 +/- 1 kg, in group P and 2.9 +/- 0.7 kg, in group C. The mean additional weight loss of 5 kg, and 5.4 kg seen with dexfenfluramine being highly significant (p < 0.001) from group P and C most likely due to increased thermogenesis. Significant (p < 0.05) and gradual reduction of biceps, triceps skinfold and per cent body fat were constantly observed only in the dexfenfluramine group. There were no significant differences among the 3 groups regarding blood pressure, heart rate, hematologic, lipids and biochemical profiles.

Adolescent↗

Behavior modification in the treatment of obesity: acceptability profiles.

Seventy obese subjects, after receiving an 8-week group therapy program of behavior modification, showed that they had lost weight from fat tissue. There were significant decreases of per cent body fat, biceps, subscapular and iliac skinfold thickness while maintaining arm muscle area. There were significant decreases of both systolic and diastolic blood pressure during the program. The acceptability profiles of heart rate, liver and renal function test, fasting blood sugar, uric acid, serum iron, total iron binding capacity, minerals, electrolytes, hematological and lipid profiles were within normal limits before and after the treatment. The obese subjects rated the behavior modification program as more effective and indicated helpfulness of concepts, information and techniques of the program.

Adolescent↗

Effect of zinc supplementation on zinc status, copper status and cellular immunity in elderly patients with diabetes mellitus.

This preliminary study was to investigate the effects of zinc supplementation on Zn status, Cu status, serum macrominerals and lymphocyte subsets in elderly diabetic patients. The results of Zn supplementation can correct plasma Zn levels to normal values. However, this treatment did not affect the cellular Zn, copper status and serum macrominerals. Enhancement of the percentage of CD4 cells was observed after Zn therapy but had no effect on the percentage of CD8 cells and CD4/CD8 ratios. Our finding implicated that zinc supplementation might be useful to enhance the immune status in these patients.

Aged↗

Behavior modification in the treatment of obesity.

Seventy obese subjects with a body mass index greater than 25 kg/m2 received a behavioral modification and a daily log self management program for weight loss during an 8-wk treatment period. The program included eating habits, exercise, attitudes, social relationships and nutrition. The results indicated that after 8 wks, cumulative weight loss (mean +/- SEM) was 4.3 +/- 0.4 kgs. The decrease in their body weight was due to the loss of their fat store evidenced by the significant decrease in triceps skinfold thickness. (P < 0.0001) The subjects showed significant decrease in total calories, carbohydrate and fat after 4 wks (P < 0.001, 0.001, and 0.008) through 8 wks (P < 0.007, 0.013 and 0.015). The activities in daily life changed significantly from rest level to light exercise level (P < 0.001). It was concluded that behavior modification program for short term showed improved eating habits and daily exercise. But we need time in order to identify variables responsible for maintenance of weight loss over the long term.

Adult↗

Optic neuropathy in a patient with vitamin B12 deficiency: a case report.

A 19-year-old man presented with blurring of vision for 2 weeks. He also complained of anorexia with weight loss during the past 4 months. Eight years ago, his small bowel from midportion of the jejunum, ileum, ascending colon and transverse colon were resected because of gangrene. He gave no history of exposure to tobacco, alcohol or other toxins. The bone marrow aspiration showed hypocellular with panhypoplasia. Serum vitamin B12 level was low while serum and red cell folate were within normal limits. His visual acuity was 5/200 in both eyes with centrocecal scotomas in both eyes. Other neurologic and ophthalmic examinations were found to be normal. The patient was given intramuscular injections of 1,000 micrograms of cyanocobalamin. Four months later, his visual acuity improved, serum vitamin B12 level and the bone marrow returned to be normal. This is a frank case of optic neuropathy in a patient with vitamin B12 deficiency due to a massive small bowel resection.

Adult↗

Postprandial glucose and insulin responses to various tropical fruits of equivalent carbohydrate content in non-insulin-dependent diabetes mellitus.

The plasma glucose and insulin responses were determined in 10 NIDDM female patients following the ingestion of tropical fruit containing 25 g of carbohydrate. The five tropical fruits were pineapple, mango, banana, durian and rambutan. Blood was drawn at 0, 30, 60, 120 and 180 min, respectively. The results showed that the glucose-response curves to mango and banana were significantly less than those to rambutan, durian and pineapple (P less than 0.05). Only the glucose area after mango ingestion was significantly less than the glucose areas of the other fruits (P less than 0.05). The insulin response curve and insulin area after durian ingestion was statistically greater than after ingestion of the others. We concluded that after mango ingestion, the glucose area was lower than it had been after rambutan, durian and pineapple ingestion and the insulin area was lower than that after durian ingestion of equivalent carbohydrate content in type 2 (NIDDM) diabetes.

Blood Glucose↗

Continuous nasoenteral feeding: inverse relation between infusion rate and serum levels of bilirubin.

The relation between nasoenteric formula caloric infusion rate and the serum bilirubin level was examined in 15 healthy subjects. The study protocol spanned 3 days and included fasting studies on day 1, continuous maintenance nasogastric feeding of a formula diet on day 2, and continuous feeding at a rate twice the maintenance level on day 3. Blood studies were performed in the early morning of each day. Fifteen subjects underwent the fasting measurements and the maintenance infusion, while 11 underwent all 3 days of the protocol. With the maintenance infusion serum bilirubin fell from the fasting value of (X +/- SD) 0.77 +/- 0.53 to 0.63 +/- 0.49 mg/dl for a reduction of 18% (p less than 0.05). For the subgroup of 11 subjects receiving two levels of formula infusion, fasting and maintenance serum bilirubin levels were 0.81 +/- 0.57 and 0.65 +/- 0.47 mg/dl, respectively, (p less than 0.05). With the twice maintenance infusion the plasma bilirubin decreased further to 0.46 +/- 0.29 mg/dl, a decrement of 43% relative to fasting (p less than 0.01). No other significant changes were detected during the protocol in the standard blood chemical and hematologic studies. Thus, the serum level of bilirubin is inversely related to the formula caloric infusion rate during continuous nasoenteric feeding.

Adult↗

Hydrocortisone, heparin, and peripheral intravenous infusion.

We studied the effect of low-dose hydrocortisone and heparin added to peripheral intravenous fluid on episodes and severity of thrombophlebitis. Osmolal solutions of 860 mOsm/kg H2O with heparin and hydrocortisone (feed A) and without heparin and hydrocortisone (feed B) were infused into surgical and ear, nose, and throat patients for peripheral intravenous nutrition. The addition of heparin (500 U/L) and hydrocortisone (10 mg/L) in 10% dextrose in half-strength normal saline and 500 ml 5% crystalline amino acid solution infused simultaneously via a Y line significantly reduced the episodes and severity of thrombophlebitis. Thus, the administration of low-dose hydrocortisone and heparin with peripheral fluids is beneficial in preventing thrombophlebitis.

Adult↗