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Biomedical subjects

D Hallberg

Publications and source records attributed to D Hallberg.

At least 19 recordsLinked to original sources
PubMed1989

Meal-induced thermogenesis in obese patients before and after weight reduction.

The purpose of this study was to find out whether human obesity is associated with a diminished meal-induced thermogenesis and, if so, to what extent this response is influenced by weight reduction. Ten obese subjects (body mass index 42 +/- 2) and 10 age- and sex-matched non-obese volunteers were studied with continuous indirect calorimetry in the basal state and after the ingestion of a standardized test meal. Six obese subjects (body mass index 44 +/- 2) were examined on two occasions, once before and once after gastric banding and an average weight reduction of 18 +/- 3 kg. Basal oxygen uptake and energy expenditure were 30% (P less than 0.001) greater in the obese subjects compared to non-obese controls. After the meal, pulmonary oxygen uptake and energy expenditure increased rapidly and reached a relatively constant level after 60 min; for pulmonary oxygen uptake the average rise above basal was less in the obese (17.7 +/- 1.6%) than the non-obese (27.8 +/- 1.9%, P less than 0.001); the increase in energy expenditure was 18.5 +/- 1.7% in obese and 30.8 +/- 2.1% in non-obese subjects (P less than 0.001). After weight reduction, oxygen uptake and energy expenditure in the basal state were 20% lower (P less than 0.05) than before weight reduction. The average post-prandial increase in oxygen uptake was greater after weight reduction (24.8 +/- 2.0%) than before (16.7 +/- 1.6%, P less than 0.001). Corresponding values for energy expenditure were 27.2 +/- 2.2 and 18.2 +/- 2.2% (P less than 0.001). It is concluded that: (1) the thermogenic response to a mixed meal is lower in obese compared to non-obese individuals; and, (2) this impaired response is partly normalized after weight reduction. These findings suggest that a diminished meal-induced thermogenesis is a secondary phenomenon rather than a primary pathogenic factor in human obesity.

Adult↗
PubMed1985

Experiences with antireflux valves in jejunoileal bypass surgery.

Intussusception valves were created in the small intestine of jejunoileal bypass-operated dogs and patients with the intention to prevent reflux of chyme into the excluded intestinal loop and thereby increase weight loss. In the dogs the valves were shown to withstand a pressure of at least 100 cm of water. All patients with end-to-side bypass were at X-ray examination found to have sufficient valves whereas only four of fourteen with end-to-end bypass, where the defunctionalized loop was implanted into the cecum, had tight valves. During five years of observation no significant difference in weight loss was seen between the patients with valves and control groups without valves. It is concluded that reflux of chyme only plays a minor role for weight loss after jejunoileal bypass for obesity.

Adult↗
PubMed1985

Neurotensin-like immunoreactivity in plasma after fat intake in normal and obese subjects and after jejunoileal bypass.

The plasma concentration of neurotensin-like immunoreactivity (p-NTLI) was measured after oral intake of fat in (a) healthy non-obese volunteers, (b) grossly obese but otherwise healthy persons, and (c) patients who had undergone jejunoileal bypass because of gross obesity. In addition, p-NTLI was measured after intravenous infusion of fat in healthy non-obese volunteers. Basal p-NTLI levels were significantly higher in the patients with bypass than in the obese group. After oral intake of fat, the increase in p-NTLI was much greater and more sustained in the bypass group than in the two other groups. The type of bypass (end-to-end, end-to-side or biliointestinal) and the time after the operation did not correlate with the p-NTLI response. Intravenous infusion of fat evoked no increase in p-NTLI. To produce a rise in p-NTLI level, therefore, the fat does not have to be absorbed and hematogenously distributed to the N-cells (neurotensin-storing cells). This observation may suggest that direct contact between chyme and the N-cells, or local neural or hormonal factors, are required to stimulate release of NTLI. The authors suggest that increase in the postprandial release of neurotensin may promote the diarrhoea after bypass operations, and possibly has other physiologic effects in such patients.

Adult↗
PubMed1983

The effect of clindamycin on the intestinal flora in patients with enteric hyperoxaluria.

Enteric hyperoxaluria is due to increased absorption of oxalate, especially in the colon. However, this mechanism is not fully understood. Little is also known about the composition of the intestinal flora in these patients. Eleven patients with hyperoxaluria (greater than 0.45 mmol/24 h) after jejunoileal bypass were therefore studied under surgical ward conditions for 5 days. The patients were maintained on a constant diet. During days 3, 4, and 5 clindamycin (Dalacina), 1.8 g/24 h, was given parenterally in three divided doses. All patients had hyperoxaluria, with a mean oxalate absorption of 0.94 +/- 0.09 mmol/24 h (+/- SEM). No significant disturbances in the colonic microflora were found. The degree of hyperoxaluria did not change during clindamycin administration, in spite of a significant decrease in the number of anaerobic bacteria. Our patients with enteric hyperoxaluria seem to have a normal colonic microflora. The degree of hyperoxaluria did not seem to be related to changes in the intestinal anaerobic flora.

Adult↗
PubMed1982

Magnesium deficiency following jejunoileal bypass operations for obesity.

Skeletal muscle biopsies, blood samples, and 24-hour urines, before and after magnesium infusions, were obtained from 12 patients who had undergone jejuno-ileal bypass surgery several years earlier, selected for probable magnesium deficiency on the basis of repeated hypomagnesemia. The patients retained significant amounts of the infused magnesium, and exhibited elevation of low skeletal muscle magnesium and potassium, with concomitant decreases of muscle sodium and chloride. These changes were accompanied by increased urinary calcium and sodium and decreased urinary phosphorus excretion.

Adult↗
PubMed1982

Serum carotene, vitamin A, retinol-binding protein and lipoproteins before and after jejunoileal bypass surgery.

The plasma vitamin A and carotene transport in 45 obese patients was examined before and at various times after bypass surgery. The serum levels of lipoproteins, carotene, vitamin A and retinol-binding protein (RBP) were monitored and compared to those of healthy controls. LDL-cholesterol levels were decreased by 40 per cent (P less than 0.001) within the first year after surgery and remained low thereafter. The reduction of serum carotene (from a mean of 64 to 17 micrograms/dl) was rapid and constant. This change was observed already within 1-2 weeks post-surgery. The serum concentrations of carotene and LDL-cholesterol were highly correlated (r = 0.74). The concentrations of vitamin A and RBP were normal before the operation and remained so until 30 months after surgery, when slight reductions were observed compared to the control values [46 +/- 28 vs 66 +/- 11 micrograms/dl for vitamin A (P less than 0.01) and 32 +/- 8 vs 41 +/- 6 mg/l for RBP (P less than 0.01)]. No overt signs of vitamin A deficiency were observed. The mechanisms by which carotene (but not vitamin A) decreases so rapidly after bypass surgery cannot be explained by the decreased LDL levels.

Adult↗
PubMed1982

A roentgenological study of the small intestine after different intestinal bypass operations for treatment of morbid obesity.

Twenty-nine patients who had undergone four different types of jejunoileal bypass for obesity were examined roentgenologically after ingestion of barium contrast. Functional intestinal length, blind loop reflux and speed of contrast through the small intestine were recorded. Weight loss was not correlated to any of the mentioned parameters or to operative method. Length of functioning intestine increased and speed of contrast decreased with time after surgery.

Barium Sulfate↗
PubMed1982

An oral amino acid loading test before and after intestinal bypass operation for morbid obesity.

Blood samples were taken from six overweight women after an overnight fast on three different occasions, before an jejunoileal bypass operation and 1 and 6 months after the operation. The preoperative levels of several plasma free amino acids were significantly elevated, e.g. leucine, isoleucine, valine, lysine, phenylalanine, tyrosine, proline and glutamic acid. One month after the operation all indispensable plasma amino acid concentrations had fallen, in particular the levels of the branched-chain amino acids (BCAA), lysine and tryptophan. Among the dispensable amino acids, plasma tyrosine, arginine and ornithine concentrations were significantly reduced. No further changes of significance were observed in samples taken 5 months later. A close correlation was observed between the plasma levels of retinol-binding protein (RBP) and thyroxine-binding prealbumin (TBPA). One month after the operation the levels of RBP and TBPA had fallen slightly in two subjects and substantially in one subject. A test diet, containing crystalline amino acids, glucose and fat emulsion was given before operation and twice after the operation. Plasma amino acid changes were studied for a period of 2 hours after the meal. The increases in plasma levels following the test meal were lower for many amino acids after the operation. A linear correlation was found between the postprandial increases in BCAA concentrations and the levels of RBP and TBPA. By using complete, carefully defined diets in loading tests, it should be possible to screen for glucose tolerance and amino acid and lipid malabsorption.

Adult↗
PubMed1980

Polymorphonuclear (PMN) function after small intestinal shunt operation for morbid obesity.

The possible influence on blood polymorphonuclear (PMN) granulocyte functions of the small intestinal shunt operation for obesity was studied in 10 massively overweight patients. They were investigated prior to operation and for 9 months afterwards, when they had lost an average of 32 kg body weight. Preoperatively they showed reduced PMN bactericidal capacity and increased PMN adherence compared with controls of normal weight. During the first 2--4 months postoperatively all patients displayed a gradually increasing bactericidal capacity, which then reached levels similar to the controls and remained so for the rest of the follow-up period. This enhancement was more easily assessed by a new in vitro assay in which each PMN was provided with 30--40 bacteria, than by a standard assay using 2--4 bacteria per granulocyte. PMN adherence decreased during the first postoperative months and then returned to preoperative levels. The changes in PMN functions were not statistically related either to each other or to the continuous loss of body wieght. Thus, impairment of PMN killing function occurring in extremely obese patients became normalized after small bowel shunt operation, while the high adherence remained unchanged.

Adult↗
PubMed1980

Polymorphonuclear function in patients with skin and joint symptoms after small-intestinal shunt operations.

Previous studies have shown that the small-bowel shunt operation for morbid obesity may be followed by signs of enhanced cell-mediated immunity and polymorphonuclear (PMN) granulocyte bactericidal capacity. In the present study seven patients, operated 4 months--4.5 years previously and exhibiting postoperative arthralgias, arthritis, and/or skin rashes, were investigated with regard to their PMN adherence and bactericidal capacity and plasma levels of complement factors 3 and 4 (C3 and C4). There patients showed a decreased PMN bactericidal capacity compared both with 10 other shunt-operated patients without skin and joint symptoms and with healthy controls, whereas PMN adherence was lower than for the non-symptomatic patients but similar to that of the controls. Two patients had C3 levels above the reference value; all had normal C4 values. Thus, a small-bowel shunt operation for obesity, complicated by skin and joint symptoms, might be associated with decreased PMN bactericidal capacity.

Adult↗