[Treatment of obesity. Useful and useless methods].
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Diet, Reducing↗
Biomedical subjects
H Göschke
Publications and source records attributed to H Göschke.
[Metabolic regulation in surgical patients].
The concentration of circulating hormones and substrates was determined in 7 patients before, during and after major elective surgery. On the basis of these and other of our studies, as well as data in the literature, a tentative scheme of postoperative and post-traumatic metabolism has been drawn up. It is based on the classical division into a "shock phase", a catabolic healing phase and an anabolic healing phase. The adjustment of intravenous feeding to these metabolic phases is discussed.
Gluconeogenesis↗
[Management of postoperative intestinal fistulas with elemental diet (author's transl)].
From 1973-1976 sixteen patients with clinically manifest post-operative fistulas (7 small intestinal and 9 colonic) were studied. These patients received an elemental diet (ED) as their only nutritional support for 9-44 days. On ED spontaneous closure was observed in 4 out of 7 small intestinal fistulas and in 7 out of 9 colonic fistulas. Hemoglobin and serum albumin increased significantly on ED and nitrogen balance performed on 7 patients was in equilibrium or positive. Advantages of ED over intravenous nutrition in the treatment of intestinal fistulas are discussed.
Adult↗
Glucagon, insulin, cortisol, and growth hormone levels following major surgery: their relationship to glucose and free fatty acid elevations.
Circulating hormone and substrate levels were measured in 7 patients at regular intervals before, during and after pulmonary surgery. During surgery, cortisol and growth hormone were significantly elevated, pancreatic glucagon was unchanged and insulin was depressed. One and two days after surgery, growth hormone had almost returned to preoperative fasting values, but cortisol, insulin and glucagon levels were significantly increased. The mean insulin:glucagon molar ratio declined from a preoperative fasting value of 3.2 +/- 0.5 (+/- SEM) to 1.7 +/- 0.4 during operation but was within normal limits 1 and 2 days after surgery due to a parallel rise and fall in plasma insulin and glucagon. Plasma glucose was elevated both during operation and for several days thereafter, whereas free fatty acid levels were increased only during operation. Thus, there was no consistent relation between insulin:glucagon ratio or any of the hormone levels and the observed elevations in plasma glucose and free fatty acids. It is concluded that neither any of the hormones assayed nor the insulin:glucagon ratio was the primary determinant of plasma glucose and free fatty acid responses to surgery. Rather, fuel homeostasis appeared to result from the combined effects of glucagon, insulin, growth hormone, cortisol and adrenergic activity.
Adult↗
On the mechanism of action of biguanides. evidence against an inhibition of gluconeogenesis from protein in normal fasting subjects.
The effect of phenformin on fuel homeostasis and on gluconeogenesis from protein was studied in 8 normal subjects who underwent two 4-day fasts 8-12 weeks apart. Each person received placebo or phenformin 50 mg every 12 hours for 3 days before and during the fasts. Circulating glucose, lactate, pyruvate, free fatty acid and ketone levels as well as urinary nitrogen excretion observed during placebo and phenformin treatment were not significantly different from each other. The lack of an effect of phenformin on urinary nitrogen excretion and plasma glucose level strongly suggests that gluconeogenesis from amino acids was unaltered by phenformin in these fasting subjects. The present findings are at variance with those by other authors which may be related to differences in methodology.
Adult↗
[Carbohydrate intolerance during complete fasting].
In the first part of the study oral glucose tolerance tests (GTT) or insulin tolerance tests (ITT) were performed in 22 lean and 22 obese nondiabetics before and after fasts of at least 6 days' duration. Deterioration of glucose tolerance was greater in lean than in obese individuals. Plasma levels of factors known to influence glucose tolerance (glucagon, growth hormone, free fatty acids, ketones) were significantly higher in fasting lean than in fasting obese subjects. Furthermore, delayed insulin rise (GTT) and decreased insulin sensitivity (ITT) were observed after starvation in lean subjects but not in the obese, which could explain the greater deterioration of glucose tolerance in the lean population. In the second part of the study glucose and fructose tolerance were compared during 4-hour infusions of these substrates (0.5 g/kg/h) in 8 normal subjects before and after two 4-day fasts. After starvation, glucose as well as fructose infusion resulted in plasma levels of the infused hexose significantly higher than in control, and the rise in plasma lactate and pyruvate was delayed. These results contradict the view widely held in the literature, that fructose metabolism remains unimpaired in the fasting state.
Adult↗
[Comparative studies during postoperative infusion of glucose or a combination of glucose, fructose and xylitol over five days (author's transl)].
Two groups of 12 cholecystectomized or vagotomized patients were given central venous infusions of either a combination of glucose, fructose and xylitol at the ratio of 1:2:1 or of glucose alone for 5 days. The dose was increased stepwise from 1.43 g/kg/h on operation day up to 7.14 g/kg/24 h on the fourth day after surgery, which equals 100-500 g/24 h for the average 70 kg patient. On both infusion regimens mean blood glucose values ranged from 98-124 mg/100 ml. Urinary losses of infused substrates amounted to 0.2-0.8 g/24 during glucose infusion and to 2.22-13.4 g/24 h during infusions of the carbohydrate combination. Regarding mean blood or serum values of lactate, pyruvate, uric acid, sodium, potassium, phosphorus, insulin and free fatty acids, no significant differences were found between the two types of carbohydrate infusion. Side effects were not observed. The results obtained allow conclusion that in clinical situations with moderate stress, such as the selective operations mentioned above, the combination of glucose, fructose and xylitol studied offers no advantage over glucose alone. However, in severely ill patients presenting with more pronounced glucose intolerance, further studies with sugar substitutes are warranted.
Cholecystectomy↗
[Parenteral hyperalimentation (author's transl)].
Intravenous hyperalimentation allows complete nutrition and anabolism in patients who cannot be fed by the oral route. However, several complications have been reported, e.g. septicaemia and hyperglycaemina. In 51 intensive-care patients receiving hyperalimentation, 18% were found to be hyperglycaemic in spite of insulin administration. Hyperglycaemia was frequently associated with stress. In 8 patients undergoing major surgery, which was chosen as a stress model, decreased insulin and increased glucagon, growth hormone and cortisone levels were observed. These findings could explain stress-induced glucose intolerance. In a further experiment, 8 intensive-care patients were given alternative intravenous feedings with either 600g of a mixture of glucose, fructose and xylitol in a ration of 1:2:1 or 600g glucose per day. During both regimens insulin administration was required in 4 patients, but the insulin dosage was lower with the mixture. Plasma glucose during glucose infusion was 205+/-25mg/100ml(M+/-SEM) and the sum of plasma glucose, fructose and xylitol during infusion of the mixture was 176+/-33mg/100ml, the difference being of borderline significance (p less than 0.05). The advantages and disadvantages of infusable substrates are summarized on the basis of the available literature and it is concluded that, in general, glucose is preferable. However, if hyperglycaemia is difficult to control, partial replacement of glucose by glucose substitutes or fat emulsions may be advantageous. A routine infusion programme for central venous feeding is suggested. Causes and prevention of side-effects are reviewed. In many patients receiving central venous nutrition less hazardous and less expensive methods could be used such as nasogastric tube feeding, elemental diet or peripheral venous nutrition.
Blood Glucose↗
[Elementary diet as an alternative to parenteral feeding in severe gastrointestinal diseases].
21 patients with gastroenterological disease and indication for the use of intravenous nutrition received an elemental diet (ED) for 5-44 days. In 6 out of 8 patients with exacerbation of Crohn's disease remissions were achieved, apart from 3 persistent fistulas. In 5 out of 9 cases with various primary diseases and postoperative intestinal fistulas, spontaneous healing was observed. Furthermore, 2 patients with ulcerative colitis, 1 with radiation enteritis and 1 with pancreatitis were treated with ED. On ED, hemoglobin increased from 11.3 +/- 0.4 (m +/- SEM) to 12.0 +/- 0.5 g% (p less than 0.01) and serum albumin from 2.7 +/- 0.1 to 3.4 +/- 0.1 g% (p less than 0.001). Nitrogen requirements were studied in 11 patients receiving various quantities of ED. Nitrogen balance was found to be in equilibrium or positive in 7 patients, and negative in 4. In one patient with severe ulcerative colitis, fecal nitrogen losses were higher than urinary nitrogen losses. The unpleasant taste of ED resulting from free amino acids limited the ED supply in 3 patients and led to premature ending of ED administration in 3 other patients. In such cases ED may be given by nasogastric tube feeding. From the results presented it appears that ED is indicated in Crohn's disease and intestinal fistulas. However, the results obtained require confirmation by further observations and comparison with an intravenously fed control group.
Adolescent↗
Mechanism of glucose intolerance during fasting: differences between lean and obese subjects.
Oral glucose tolerance tests were performed on 14 lean and 14 obese nondiabetic subjects before and after a 6-day fast. In addition, insulin tolerance tests were performed on 8 lean and 8 obese subjects before and after starvation. Both in lean and obese subjects glucose tolerance deteriorated during starvation, but much more so in the lean population. During fasting, insulin elevation after a glucose load was significantly delayed in lean subjects but not in the obese. Circulating levels of factors known to affect glucose tolerance, such as glucagon, growth hormone, free fatty acids, and ketone bodies were higher in fasting lean than in fasting obese individuals. In normals fasting resulted in a significant decrease of the blood glucose response to insulin injection, whereas in fasting obese subjects glucose response was unchanged. The results obtained suggest that the effect of fasting on insulin release and insulin sensitivity was more pronounced in lean than in obese subjects, which resulted in greater deterioration of glucose tolerance in the lean population.
Adult↗
[Problems with hyperalimentation in intensive care units (author's transl)].
The application of parenteral nutrition in patients in intensive care units can be limited by shock, septicemia and metabolic disorders. Stress- or trauma-induced glucose intolerance sometimes makes it difficult to maintain the caloric requirements with glucose. Sugar substitutes seem to be of advantage in these cases. Meticulous care is essential to avoid severe complications arising from the use of the central venous feeding catheters.
Critical Care↗
Acid-base patterns in lean and obese subjects during total fasting.
During prolonged starvation blood gas analyses on 24 lean and 78 obese subjects were performed. A statistically significant sex difference of acid-base status was found in that lean females were more acidotic after 4 - 6 days of fasting than lean males. This sex difference was abolished by severe and long-standing obesity, since females suffering from this condition were not significantly different from lean and obese males. Out of 78 obese patients fasted for 1 - 4 weeks 8 had one or more pH values below 7.30. It is concluded that regular blood gas analyses are indicated in all patients subjected to prolonged total fasting.
Acid-Base Equilibrium↗
[Studies on the heredity and pathogenesis of familial combined hyperlipidemia ("multiple lipoprotein type" hyperlipidemia)].
A family with familial combined hyperlipidemia (multiple-lipoprotein type hyperlipidemia) was investigated with regard to mode of inheritance, phenotypic expression, presence of genetic markers, and biochemical parameters related to lipid metabolism. The family of 22 subjects (13 males, 9 females) was composed of 5 type IIa, 8 type IIb, 1 type IV hyperlipoproteinemias and 5 normolipidemics. The distribution of serum cholesterol and serum triglyceride concentration was bimodal. No relationship was observed between hyperlipidemia and blood groups or histocompatibility antigens. Subjects with high HLA 8 or W 15 had, on the average, higher lipid levels than others. However, these antigens were observed in normolipidemics too. The response to therapy with alufibrate (2g/day) was not uniform. Subjects with marked triglyceride lowering exhibited only moderate cholesterol lowering, and marked cholesterol lowering was associated with poor triglyceride lowering. The reduction in serum lipids was observed in unaffected family members as well. It is therefore concluded that alufibrate does not exert an effect on the defect in familial combined hyperlipidemia but on some unspecific sites probably on lipoprotein lipase. The familial combined hyperlipidemia appears to be transmitted in an autosomal dominant mode and very probably determined by more than one gene.
Adolescent↗
[Metabolic differences between males and females and between normal and obese subjects during total fast].
In 24 normal and 24 obese subjects of both sexes circulating substrates (blood sugar, free fatty acids, ketone bodies) and hormones (insulin, growth hormone, pancreatic glucagon) were determined during 6 days of total fast. In normals the blood sugar fell to lower levels than in the obese. Plasma free fatty acids and ketone concentrations rose faster in normal than in obese subjects, and faster in females than in males. Plasma insulin concentrations declined to a greater extent in obese than in normal subjects. In all groups studied a significant increase of the pancreatic glucagon level within 1-3 days of fasting was observed, however, its rise occurred faster in normal females than in males. Growth hormone (GH) rose significantly in normal males but not in obese males. Following high overnight fasting values in some normal females showed no significant increase in GH levels but significantly higher GH values than obese females after 1-6 days of fasting. After summarizing starvation-induced metabolic changes common to all study groups the respective differences found between males and females and between normal and obese subjects are discussed.
Adult↗
[Long-term results of fasting. Results from 132 consecutive patients after 1-6 1/2 years].
132 consecutive patients were reexamined 1-6.5 years (m = 2.8) after total fasting in hospital. 37 patients had continued to lose weight, 20 patients had maintained their fasting result (+/-2 kg) and 7 patients had slightly regained (less than 1/3 of their weight loss during fast). These 3 groups, totalling 64 patients (48%), were considered successful. Their mean overweight was diminished from 57 to 29%, corresponding to a 60% reduction of mortality in certain age groups. On the other hand, 63 patients (48%) had regained more than 1/3 of their original weight loss. Five patients (4%) were lost to follow-up. Selection of patients and long-term follow-up appeared to have a decisive bearing on long-term results of fasting, whereas factors such as age, sex, degree of overweight, onset of overweight in childhood and sports were without significant effect. From the long-term results presented, it is concluded that under certain conditions fasting in hospital is warranted. Behaviour therapy is a possible alternative in the treatment of obesity.
Adolescent↗
[Today's possibilities in the treatment of obesity (author's transl)].
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Amino Acids↗
Growth hormone in osteoporosis.
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Calcium↗
Postoperative tolerance to glucose and sugar substitutes.
In 51 surgical intensive-care patients, who were given 400 to 650 g glucose per day i.v., 18% of arterial blood sugar values were found to be above 250 mg/100 m1 in spite of frequent insulin administration. In 8 lobectomized patients increased plasma levels of pancreatic glucagon, cortisol, and growth hormone were observed which may in part explain postoperative glucose intolerance. In addition previous carbohydrate deprivation was found to impair glucose tolerance. Several measures are suggested to reduce the incidence of hyperglycemia during i.v. glucose feeding. In a further study 24 cholecystectomized or vagotomized patients received in alternate sequence either a combination of glucose (G), fructose (F) and xylitol (X), the G/F/X-ratio being 1/2/1, or glucose alone for 5 days. The infusion rate was 1.42 g carbohydrate/kg/24 hrs. On operation day and was increased by the same amount every day up to 7.14 g/kg/24 hrs. Tolerance was good in both groups but urinary losses of infused substrates were higher in the group receiving the GFX-combination. It is concluded that after surgery of intermediate magnitude the GFX-combination offers no advantage over glucose alone. However, in severely ill patients, where glucose intolerance is more pronounced, further carefully monitored studies with sugar substitutes appear of interest.
Adult↗