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Biomedical subjects

I Bosaeus

Publications and source records attributed to I Bosaeus.

At least 55 records · Page 3Linked to original sources
PubMed1997

The ineffectiveness of cyclical oral clodronate on bone mineral density in glucocorticoid-treated patients with giant-cell arteritis.

OBJECTIVES AND DESIGN: The aim of the present study was to determine whether cyclic oral administration of clodronate, a bisphosphonate, every second month prevents rapid bone loss during the first year of glucocorticoid treatment in patients with giant-cell arteritis (GCA). The trial was designed as a prospective double blind study, assessing total body mineral content (BMC) and bone mineral density (BMD) using DXA technique. Supplementation of calcium was given to both groups of patients. SETTING: The outpatient clinics of the rheumatic and infectious diseases of Sahlgren University Hospital of the city of Göteborg on the west coast of Sweden. SUBJECTS: Twenty-seven patients with confirmed GCA were consecutively included during a 15-month period. RESULTS: An early influence on bone turnover was found with a temporary decrease in BMC after six months of glucocorticoid treatment, which was normalized after 12 months in both study groups. No significant differences between the patients given clodronate and calcium and the controls, who got supplementation with calcium alone, was observed at any assessment point. However, there was a significant and prolonged depression of the osteocalcin levels in the clodronate-treated patients. CONCLUSIONS: Oral administration of clodronate in a moderately high dose given cyclically every other month had no additive effect on BMD compared with calcium supplementation alone during the first year of glucocorticoid treatment. A larger material might have revealed some differences between the categories. In most patients with GCA, however, the BMD seems to recover after one year of glucocorticoid treatment, provided there is good control of the inflammation and patients are kept physically active. It needs to be elucidated whether there are subsets of patients who might benefit from bone sparing agents: women near menopause with a high turnover rate of bone, individuals who have low BMD from the start of glucocorticoid treatment or patients requiring high doses of glucocorticoids during a long period of time.

Administration, Oral↗
PubMed1997

Low-dose recombinant human growth hormone increases body weight and lean body mass in patients with short bowel syndrome.

OBJECTIVE: The authors investigate the effects of low dose recombinant human growth hormone (rhGH) on body composition and absorptive capacity in patients with short bowel syndrome from Crohn's disease. SUMMARY BACKGROUND DATA: Patients with short bowel syndrome usually are malnourished because of malabsorption. The anabolic effects of high doses of rhGH have been tested in different clinical catabolic conditions, recently including patients with short bowel syndrome. The authors have investigated the effects of low-dose rhGH in short bowel syndrome in a placebo-controlled crossover clinical trial. METHODS: Ten patients were treated with daily subcutaneous doses of rhGH/placebo (0.5 international units/kg-1 per week-1 = 0.024 mg/kg-1 per day-1) for 8 weeks in a randomized, double-blind, placebo-controlled crossover clinical trial with a minimum of 12 weeks wash-out. Absorptive capacity and biochemical parameters were investigated in a metabolic ward before treatment and during first and last week of treatment. Body composition was determined by DEXA-Scan (Lunar DPX, Scanexport Medical, Helsingborg, Sweden), impedance analysis, and whole body potassium counting. RESULTS: Low-dose rhGH doubled serum levels of insulin-like growth factor-1 (IGF-1) and increased body weight, lean body mass, and total body potassium by 5% (p < 0.05). Fat-free mass and total body water increased by 6% (p = 0.008). Increases in IGF-1 levels correlated with increases in fat-free mass (r = 0.77, p < 0.02). No significant changes in absorptive capacity of water, energy, or protein were detected. CONCLUSION: Eight weeks of low-dose rhGH treatment leads to increases in body weight, lean body mass, and fat-free mass in patients with short bowel syndrome, correlated to increases in IGF-1 levels.

Adult↗
PubMed1997

Osteoporosis after total gastrectomy. Results of a prospective, clinical study.

BACKGROUND: Osteopenia and enhanced risk of fractures have been reported after partial gastrectomy, but the significance of total gastrectomy is still unknown. METHODS: Twenty-six patients were followed up for at least 3 years after total gastrectomy. The intake and S-levels of vitamin D, phosphate, magnesium, and calcium were prospectively studied, and a whole-body dual-energy X-ray absorptiometry scan was performed at a mean of 5 years after gastrectomy. RESULTS: At this time point we found normal blood levels of vitamin D, calcium, and phosphate. Food intakes of phosphate, calcium, magnesium, and vitamin D reached the recommended daily allowances. Bone mineral density was similar to that of a control population, and increasing values were seen concomitant with an increase in body weight with the time after gastrectomy. CONCLUSIONS: Calcium homeostasis and bone mineral densities seem not to be affected by total gastrectomy, at least when studied over a period of 5 years, an observation that hypothetically can be explained by weight recovery with time after the operation.

Adipose Tissue↗
PubMed1996

Food intake after gastrectomy for gastric carcinoma: the role of a gastric reservoir.

Patients with carcinoma of the stomach who underwent curative resection were randomized to total gastrectomy (n = 49), total gastrectomy and an S-shaped gastric substitute (n = 28) or subtotal gastrectomy (n = 12); all had a Roux-en-Y reconstruction. The gastric substitute and gastric remnant allowed a volume of 400-500 ml to be installed without increments in basal pressures. The corresponding volume in the Roux limb was 100 ml. Energy intake was approximately 120 kJ/kg preoperative weight per day 3 months after operation, and then remained constant. Patients who had subtotal gastrectomy ate less (91.7 kJ/kg preoperative weight) 3 months after operation, but thereafter increased their intake. Patients allocated to have a gastric pouch or subtotal gastrectomy complained more frequently of adverse postprandial symptoms (P < 0.03) as a major cause of reduced calorie intake. The construction of a gastric reservoir did not improve nutritional adaptation after surgery for gastric carcinoma.

Adult↗
PubMed1996

Comparison of methods to estimate body fat in growth hormone deficient adults.

OBJECTIVE: All of the presently used methods for in-vivo determination of body composition have inherent methodological errors and depend on various assumptions. We have therefore compared several different methods used to measure body fat in adult GH deficiency during GH treatment. DESIGN: Comparison of body composition data from a two-phase trial with an initial placebo-controlled, double-blind 6-month period, followed by open treatment with GH until all patients had received GH for 12 months. PATIENTS: Twenty-five patients with known GH deficiency entered the study. Baseline examinations were complete in 23 patients, and 22 patients (16 males, 6 females) completed all examinations after treatment. MEASUREMENTS: Body fat calculated from total body potassium (TBK) by whole-body 40K counting, total body water (TBW) by tritium dilution, total body nitrogen (TBN) by neutron activation, and bioelectric impedance (BIA) measurements were compared to body fat determinations by dual-energy X-ray absorptiometry (DEXA) in two-compartment and multicompartment body composition models. RESULTS: At baseline, DEXA fat mass agreed well at group level with measurements based on TBW or TBK alone, in a four-compartment model based on TBK and TBW, and a multicompartment model based on bone mineral (by DEXA), TBN and TBW. Body fat by BIA agreed less well. After 12 months of GH treatment, body fat decreased by all methods used. This decrease was smaller by DEXA than by the other methods. The four-compartment model based on TBK and TBW, and TBW alone, showed the best agreement with changes in DEXA fat. CONCLUSION: All methods showed a decrease of body fat with GH treatment, but variation between methods was considerable.

Absorptiometry, Photon↗
PubMed1996

Two years of growth hormone (GH) treatment increases bone mineral content and density in hypopituitary patients with adult-onset GH deficiency.

The main purpose of this trial was to determine the effects of 2 yr of GH treatment on bone mineral density (BMD) and bone metabolism in patients with adult-onset GH deficiency. Forty-four patients (24 men and 20 women; aged 23-66 yr) participated in a 2-yr open treatment trial with recombinant human GH. BMD was assessed with dual energy x-ray absorptiometry, and serum concentrations of osteocalcin, carboxy-terminal propeptide of type I procollagen (PICP), and carboxy-terminal cross-linked telopeptide of type I collagen (ICTP) were measured. After 2 yr of GH treatment, the BMD increased in the lumbar spine L2-L4 by 3.8% [95% confidence interval (CI), 2.1-5.5], in the femoral neck by 4.1% (CI, 2.1-6.1) in the femoral trochanter by 5.6% (CI, 3.8-7.4) and in Ward's triangle by 4.9% (CI, 2.2-7.6) compared with baseline. Patients with a z-score (difference in SD from the mean of age- and sex-matched subjects) below -1 SD responded with the most marked BMD increment. The serum concentrations of osteocalcin, PICP, and ICTP remained higher throughout the 2 yr of treatment. Women demonstrated a more marked increase in total body BMD and a less pronounced initial increment in osteocalcin, PICP, and ICTP than men. Two years of GH treatment induced a sustained increase in overall bone remodeling activity, which resulted in a net gain in BMD that was more marked in those subjects with a low pretreatment z-score.

Absorptiometry, Photon↗
PubMed1996

Comparison of different body composition models in acromegaly.

The aberrant body composition of 10 patients with active acromegaly was used to evaluate the validity and limitations of several models and methods to assess body composition. Body composition was determined using either a two-compartment model, dividing the body in a body fat (BF) compartment and a fat-free mass (FFM) compartment, or a four-compartment model in which the FFM compartment comprises the three following components: body cell mass, extracellular water and the fat-free extracellular solids. The measurement techniques consisted of anthropometry, bioelectrical impedance analysis (BIA)-applying various established regression equations-tritiated water dilution, whole body 40K-counting, and whole body computed tomography (CT). This latter method was used as the reference technique. Assessment of total body water using BIA - applying the RJL or Kushner equation-correlated significantly with the assessment using tritiated water dilution (P < 0.01). Body fat assessment using the two-compartment model based on either tritiated water dilution or BIA-applying the RJL or Lukaski equation-as well as body fat assessment using the four-compartment model based on tritiated water dilution and whole body 40K-counting were significantly correlated with body fat assessment using CT (P < 0.01) and resulted in good agreement with each other with respect to the absolute values of the body fat determination. BIA using other regression equations overestimated body fat by 7.2-13.7 kg. Whole body 40K-counting was significantly correlated with CT-determined muscle plus skin volume (P < 0.001). CT-calibrated anthropometric predictions significantly overestimated body fat. It is concluded that in patients with active acromegaly, the determination of body composition using either certain two-compartment models based on measurement of total body water or bioelectrical impedance, or a four-compartment model based on total body water and total body potassium measurements show good agreement with CT-determined body composition.

Acromegaly↗
PubMed1995

Exercise capacity in patients undergoing proctocolectomy and small bowel resection for Crohn's disease.

The effect of proctocolectomy and small bowel resection on working capacity has not been assessed objectively in previous research. Twenty-nine patients with Crohn's disease were investigated with cycle ergometry and a questionnaire, following proctocolectomy with and without small bowel resection. Maximal exercise load is known to correspond well with working capacity, particularly when account is taken of body composition and metabolic variables. Maximal exercise load was reduced marginally (by 9 per cent) in patients without small bowel resection and by 22 per cent in patients with moderate small bowel resection (15-30 per cent resection). Patients with extensive bowel resection (more than 50 per cent) had a 40 per cent reduction in the maximal exercise load. This reduction in maximal exercise load was greater than predicted when accounting for reduction in muscle mass. All patients had a normal oxygen uptake including resting energy expenditure. Urinary sodium and magnesium excretion was low in the group with moderate bowel resection, whereas the extensively resected patients were malnourished and had a reduced body cell mass. The authors conclude that the significantly reduced working capacity was of multifactorial origin secondary to malabsorption. However, the patients seemed unaware of the degree of their diminished working capacity. This reduced capacity makes it unlikely that they would be able to perform any labour involving high energy consumption at the level of 500-700 W, and this inability was reflected by a high rate of unemployment among the patients.

Adult↗
PubMed1995

Effects of recombinant human growth hormone on basal metabolic rate in adults with pituitary deficiency.

The effect of recombinant human growth hormone (rhGH) on basal metabolic rate (BMR) was studied in a placebo-controlled, double-blind, crossover trial. Ten patients with a history of complete pituitary insufficiency were randomized for 26 weeks in each period. Three patients were excluded due to withdrawal, fever, and claustrophobia, respectively. All patients had received adrenal, thyroid, and gonadal substitution therapy for at least 1 year before the study. The dose of rhGH was 0.25 to 0.5 U/kg/wk, administered subcutaneously once a day in the evening. BMR was determined by indirect calorimetry in a computerized ventilated open-hood system. Body composition was examined using four different methods--computed tomography (CT), tritium dilution, 40K determinations, and total body nitrogen (TBN) measured with neutron activation. The body composition data have previously been reported. Fat-free mass (FFM) increased and body fat (BF) decreased during the first 6 weeks of rhGH treatment, but no further changes in body composition occurred between 6 and 26 weeks. Baseline BMRs in GH-deficient (GHD) patients were in the lower part of the reference range, but BMR and the ratio between BMR and FFM (BMR/FFM) were not significantly lower than in a carefully selected control group. BMR increased between 0 and 6 weeks (mean +/- SD: from 6.68 +/- 1.55 to 7.75 +/- 1.35 MJ/24 h, P < .001) and then remained unchanged between 6 and 26 weeks. The increase in BMR was closely related to the increase in FFM (r = .91, P < .01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Effects of low-fat milk and fermented low-fat milk on cholesterol absorption and excretion in ileostomy subjects.

OBJECTIVE: To study small bowel cholesterol absorption and sterol excretion in order to explain possible serum cholesterol-lowering mechanisms of low-fat milk products. DESIGN: Two 24-h sterol balance studies with 1 litre of low-fat milk or one litre of fermented milk, in random order, added to a controlled diet. [3H]Cholesterol absorption was measured during each period. The results were compared to those on two 24-h periods with isocaloric amounts of lemonade given to the same basic diet, before and after the study. One litre of the two milk products was also consumed in addition to their normal diets in a cross-over design of 3 weeks and with run-in and run-out periods of 2 weeks each with 1000 ml of lemonade preceding the balance studies: SETTING: Outpatient clinic, where the subjects were eating their meals during the day and ileostomy bags collected. SUBJECTS: Nine ileostomy subjects, who have earlier participated in similar studies, volunteered for the study. All subjects completed the study. RESULTS: Cholesterol absorption was highest (66%) in the lemonade period, intermediate in the low-fat milk period (61%) and lowest in the fermented low-fat period (55%) (P < 0.05 for differences). Net cholesterol excretion (excretion minus intake) and calculated endogenous cholesterol excretion were significantly (P < 0.05 for differences) higher in the low-fat milk period than in the lemonade period and the fermented low-fat milk period. No significant change in serum cholesterol was, however, seen after 3 weeks on each milk regimen. CONCLUSION: Assimilation of cholesterol by microorganisms could possibly explain the reduced uptake of cholesterol with fermented milk. The mechanism behind the increased endogenous cholesterol excretion, induced by low-fat milk, is unclear.

Adult↗
PubMed1994

Cholesterol absorption and excretion in ileostomy subjects on high- and low-dietary-cholesterol intakes.

Six healthy ileostomy subjects were given [3H]cholesterol and [14C]beta-sitosterol in a single meal together with two controlled diets containing 150 or 450 mg cholesterol/d. Each diet was eaten for 3 d. Cholesterol absorption and excretion of cholesterol, bile acids, fat, energy, and nitrogen were analyzed. Fractional cholesterol absorption increased from 44 +/- 2.6% (mean +/- SE) to 61 +/- 3.4% (P < 0.05), but absolute cholesterol absorption decreased from 191 +/- 11 to 94 +/- 9 mg/d (P < 0.05) on low cholesterol intake compared with high cholesterol intake. Weight of ileostomy effluent, or excretion of energy, nitrogen, fat, and bile acids did not differ between periods. Endogenous cholesterol excretion remained unchanged whereas net cholesterol excretion (output minus intake) was 37% higher (P < 0.05) on low compared with high cholesterol intake.

Adult↗
PubMed1994

Effect of rye bran on excretion of bile acids, cholesterol, nitrogen, and fat in human subjects with ileostomies.

The excretion of bile acids, cholesterol, dry matter, nitrogen, fat, and energy in ileostomy effluent, and plasma lipid concentrations were studied in eight subjects with ileostomies. The subjects consumed a wheat bread-based, low-fiber diet (LFD) for 3 wk and a rye bran bread-based, high-fiber diet (HFD) for 3 wk. The ileal excretion of dry matter, nitrogen, fat, and energy was higher during the HFD period. The daily excretion and the percentage of conjugated bile acids were significantly higher and the percentage of free bile acids lower in the ileostomy effluents during the HFD as compared with the LFD period. No significant difference in the excretion of cholesterol, net cholesterol, sterol, or net sterol was noted between the HFD and LFD periods. No significant differences in plasma concentrations of HDL-, LDL-, and total cholesterol, and apolipoprotein A-I and B were observed between the two 3-wk dietary periods.

Adult↗
PubMed1994

Alginate, small bowel sterol excretion, and absorption of nutrients in ileostomy subjects.

The effect of alginate on ileostomy excretion of sterols and nutrients was investigated in six ileostomy subjects fed a constant low-fiber diet with or without supplementation with 7.5 g sodium alginate. A mean of 95% of uronic acids derived from the sodium alginate was recovered in the ileostomy contents. Supplementation with alginate increased fat excretion by 140% and decreased bile acids excretion by 12%. Sodium and potassium excretion were significantly increased whereas starch and nitrogen excretion were unchanged. Five of six subjects showed a decreased apparent absorption of iron and manganese with alginate, which, however, was not statistically significant. Absorption of phosphorus, calcium, magnesium, and zinc were unchanged. Almost no digestion of sodium alginate occurs in the stomach and small intestine. The increased fatty acids excretion may be explained by the binding or trapping of fatty acids in the gel matrix formed by alginate, which may also cause a reduced bile flow.

Adolescent↗
PubMed1993

Intake of energy, nutrients and food items in an urban elderly population.

This study is part of a transcultural investigation under the auspices of the International Union of Nutritional Sciences, where dietary habits are studied with similar methodology in different populations throughout the world. The present paper describes and evaluates the intake of energy and nutrients, and food habits in an urban elderly population in Sweden, in relation to existing standards. The study population comprised 66 males and 122 females, aged 70 years and over (average 78 years) living in the city of Gothenburg. Energy intake was on average 11.5 MJ in males and 9.9 MJ in females. Nutrient intakes were on average above recommendations, and neither intake nor food choice seemed to change much with increasing age. A validation by a 4-day record and 24-hour urinary nitrogen determination was performed in a subsample, and indicated a probable systematic overestimation of at least 10% for protein consumed. The data from this study support the view that people 70 years of age and older in Sweden are generally healthy, active and have good food habits. This population, however, was not a representative sample. They were all living in a well defined area, with a stable social situation, and belonged generally to middle class. With this background the nutrient data seem reasonable. As long as elderly people stay healthy and do not have other serious risk factors, they seem to keep good food habits and nutritional status up into their eighties and nineties.

Aged↗
PubMed1993

Sugar-beet fibre increases cholesterol and reduces bile acid excretion from the small bowel.

The effect of addition of sugar-beet fibre to the diet on sterol excretion from the small intestine was studied in nine ileostomy subjects. A constant low-fibre diet was given in two 3 d periods with and without 32 g sugar-beet fibre/d in random order. Care was taken to minimize bacterial alteration of the ileostomy contents. The addition of sugar-beet fibre increased net cholesterol excretion by 52 (SE 9)% (P < 0.01), from 294 (SE 99) to 451 (SE 124) mg/d, and decreased bile acid excretion by 26 (SE 15)% (P < 0.01), from 764 (SE 118) to 567 (SE 96) mg/d. The increased cholesterol and decreased bile acid excretion found with sugar-beet fibre addition is different from the pattern associated with fibre sources such as pectin and oat fibre. The interaction between dietary fibre and sterol metabolism may be mediated, therefore, by different mechanisms depending on the fibre source.

Adult↗
PubMed1993

Increased body fat mass and decreased extracellular fluid volume in adults with growth hormone deficiency.

OBJECTIVE: Growth hormone deficiency in adults with hypopituitarism has previously received little attention. Recent data, however, suggest that GH deficiency might be essential for the long-term prognosis of these patients. Earlier studies have documented that GH regulates body composition; in this, body composition in adult patients with hypopituitarism including GH deficiency was studied. DESIGN: A follow-up study of patients with hypopituitarism on routine replacement therapy with L-thyroxine, cortisone acetate and sex steroids. PATIENTS: One hundred and six patients (69 males, mean age 52.5 years and 37 females, mean age 53.4 years) diagnosed as having growth hormone deficiency on the basis of low IGF-I concentration or a maximum GH-response less than 5 mU/l after an insulin/glucagon tolerance test. MEASUREMENTS: Body composition was estimated from body weight, total body water and total body potassium and the results were compared with values predicted from height, weight, age and sex, using data from a large number of healthy subjects. RESULTS: The total body water was significantly lower than that predicted from the observed body weight (P < 0.001), as was the extracellular water (P < 0.001) and the extracellular/intracellular water quotient (P < 0.001). On average, the body cell mass was similar to the predicted value, but the observed/predicted body cell mass ratio correlated positively with age at follow-up. The body cell mass was lower than predicted in subjects below the age of 50 years (P < 0.01). The body fat was higher than predicted (P < 0.001); the increases was also noted in lean subjects. The observed body weight in male subjects was 7.5 kg higher (P < 0.001) than that predicted from healthy subjects of the same body height, a difference explained by an average increase of 6.6 kg in the body fat (P < 0.001) and 1.6 kg in the body cell mass, with a simultaneous reduction of 0.7 kg in the extracellular water (NS). Male patients suffering from untreated androgen deficiency had lower body cell mass than those on androgen treatment. Female subjects weighed 3.6 kg (NS) more on average than healthy women, a difference explained by an increase in the body fat of 6.0 kg (P < 0.001) with a simultaneous decrease of 2.4 kg in the extracellular water (P < 0.001). The body cell mass was similar to that seen in the controls. CONCLUSIONS: Adult patients with growth hormone deficiency have an increased body weight compared to normals of the same age, sex and height, due to an increment of the body fat with a simultaneous reduction in the total body water.

Adolescent↗