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Biomedical subjects

J M Bengoa

Publications and source records attributed to J M Bengoa.

At least 19 recordsLinked to original sources
PubMed1991

Intestinal absorption of cholecalciferol and 25-hydroxycholecalciferol in patients with both Crohn's disease and intestinal resection.

We compared the intestinal absorption of cholecalciferol and 25-hydroxycholecalciferol in patients with Crohn's disease and resections of the small bowel. Patients were subgrouped into those with small (less than 100 cm), intermediate (100-300 cm), and large (greater than 300 cm) resections. [3H]cholecalciferol or [3H]25-hydroxycholecalciferol were given orally and serial blood samples were taken for measurement of plasma radiolabeled vitamin. Absorption of both forms of the vitamin decreased with extent of resection but 25-hydroxycholecalciferol absorption was always greater than that of cholecalciferol. When compared with normal control subjects, 25-hydroxycholecalciferol absorption in these patients was better maintained than that of cholecalciferol. These data indicate that vitamin D malabsorption reflects the extent of distal small-bowel resection in Crohn's disease. Treatment with oral cholecalciferol is sufficient in those with small or moderate resections but oral 25-hydroxycholecalciferol supplementation may be preferred in those with a severe short-bowel syndrome.

Absorption↗
PubMed1990

Dietary supplementation in elderly patients with fractured neck of the femur.

59 elderly patients (mean age 82) with femoral neck fractures were randomised into two groups. 27 patients received daily an oral nutrition supplement (250 ml, 20 g protein, 254 kcal) for a mean of 32 days; 32 patients acted as controls. On admission most patients had nutritional deficiencies. Despite being offered adequate quantities, nutritional requirements were not met during the hospital stay. Clinical outcome was significantly better in the supplemented group (56% favourable course vs 13% in controls) during the stay in the convalescent hospital. The rates of complications and deaths were also significantly lower in supplemented patients (44% vs 87%). 6 months after the fracture the rates of complications and mortality were significantly lower in supplemented patients (40% vs 74%). The median duration of hospital stay was significantly shorter in the supplemented group (24 vs 40 days). Thus the clinical outcome of elderly patients with femoral neck fracture can be improved by once daily dietary oral supplementation.

25-Hydroxyvitamin D 2↗
PubMed1988

[Nutrition yesterday and today].

The history of human nutrition from primitive times to actuality is briefly outlined. Many of the modern nutritional problems can be traced back to changes caused by the introduction of agriculture and, more recently, food technology. These developments have changed the composition of the diet to which the primitive hunter-gatherers had adapted themselves during millions of years. Changes in food habits and the beginning of the science of nutrition are discussed, and a brief review of nutritional recommendations is provided. The terms of nutritional goals and rules, so much used today, are of recent introduction. Nevertheless, norms, normal allowances and other similar expressions have since long ago been in use. Nutritional goals should be based on the vital habits of the population for which they are intended, and should be adapted to the ever emerging new findings in nutritional sciences.

Biological Evolution↗
PubMed1987

Intestinal absorption of cholecalciferol and 25-hydroxycholecalciferol in chronic cholestatic liver disease.

We compared the absorption of cholecalciferol and 25-hydroxycholecalciferol in normal subjects and in patients with mild and severe cholestatic liver disease. 3H-cholecalciferol and 3H-25-hydroxycholecalciferol were given orally and serial blood samples were drawn for measurement of the serum level of radiolabeled vitamin. Absorption of 25-hydroxycholecalciferol peaked earlier and was greater than absorption of cholecalciferol at all times in all three groups. Patients with mild cholestasis (normal bilirubin and fecal fat excretion) absorbed both forms of the vitamin normally. Those with severe cholestasis (jaundice and steatorrhea) had minimal absorption of cholecalciferol but relatively preserved absorption of 25-hydroxycholecalciferol. Absorption of cholecalciferol and 25-hydroxycholecalciferol was inversely related to fecal fat excretion. The superior absorption of 25-hydroxycholecalciferol may partly explain its greater efficacy in oral treatment of vitamin D deficiency in patients with severe cholestasis.

Adult↗
PubMed1987

Altered fractional excretion of uric acid during total parenteral nutrition.

The presence of crystal proven podagra coincident with a 52% decrease in plasma urate after a 3-day course of total parenteral nutrition (TPN) prompted a study of urate excretion in 9 patients with Crohn's disease. By Day 9 in those receiving TPN, plasma urate decreased 58% (p less than 0.001), while fractional urate excretion increased 94% (p less than 0.005). Twenty-four hour urate excretion and serum creatinine were not significantly altered. These findings persisted for the duration of TPN. In 2 patients with ileocolitis, the addition or deletion of either lipid emulsion or multivitamin infusions during TPN had no effect on urate values. Rather, the amino acid load or a specific constituent appears to be the causal factor. These data suggest that hypouricemia due to extensive net urate excretion is common during TPN therapy. Finally, patients with established gout may be at risk for acute gouty attacks during TPN therapy.

Adult↗
PubMed1986

[Gastrointestinal manifestations of acquired immunodeficiency syndrome; case studies of 14 patients].

The gastrointestinal manifestations seen in acquired immune deficiency syndrome (AIDS) are discussed based on the observation of 14 patients with a positive serology for LAV/HTLV III antibody. AIDS was confirmed in 8 cases and AIDS related complex (ARC) in 6 cases. Risk groups included 6 homosexuals, 6 drug abusers and 2 patients from Zaïre. All the AIDS cases underwent gastrointestinal endoscopy and biopsy; in 5 patients a necropsy was performed. Evaluation of the immune status showed lymphopenia and a decreased ratio of OKT4/OKT8. Clinical and pathological observations are discussed sequentially. Acute esophagitis includes cases of Candida albicans super-infection, cytomegalovirus and herpes simplex. Acute enteritis and colitis were seen in association with cryptosporidium, Isospora belli and CMV. 3 cases were found to have chronic duodenitis and malabsorption. Digestive lesions of Kaposi's sarcoma were seen in 3 cases. Diagnosis and treatment of gastrointestinal infections in AIDS is important in view of the high morbidity and serious secondary complications.

Acquired Immunodeficiency Syndrome↗
PubMed1986

[Clinical approach to weight control].

In defining the therapeutic strategy the clinical evaluation of obesity relies on ideal body weight tables and the calculation of the body weight index (kg/m2). The distribution of fat tissue must also be considered, since the increased risk of cardiovascular disease appears to be associated with the android type of obesity. A number of factors influence the development of obesity, including heredity, energy balance and appetite, which is under physiologic and psychological control. A balanced hypocaloric diet remains the basic approach to weight control as it alone provides nutritional education. Under medical supervision, unbalanced diets, such as the protein-sparing modified fast, have been shown to be very effective. The surgical treatment of morbid obesity is controversial, although good results are claimed for gastroplasty. Whatever the approach, appropriate supportive measures must be included in order to modify behavior towards food and maintain weight loss.

Adult↗
PubMed1986

[Nutritional problems related to acute renal insufficiency].

The catabolic stress induced by acute renal failure is multifactorial in origin. Uremia is associated with increased protein degradation presumably due to toxic effects of increased metabolic products and to hormonal alterations. Moreover, anorexia and loss of nutrients during dialysis further contribute to protein-energy malnutrition. The goals of nutritional support are to reduce uremia, preserve nutritional status and accelerate renal function recovery. In fact, the indications for enteral or parenteral nutritional support in acute renal failure are primarily founded on clinical criteria rather than on a controlled demonstration of efficacy. The specific metabolic conditions imposed by renal failure on protein, carbohydrate, lipid and micronutrient homeostasis must be addressed. Total parenteral nutrition can be administered safely in acute renal failure, provided strict control of prescription and follow-up is achieved in order to avoid potentially serious complications.

Acute Kidney Injury↗
PubMed1985

[Bacteriological safety of enteral nutrition with continuous delivery].

Enteral nutrition can be administered as bolus feedings or by pump-assisted continuous drip. We have compared these two techniques in regard to bacterial contamination of nutritional solutions for given periods of administration set utilisation. A total of 103 patients were treated for 3 months. Bacterial contamination of nutritional solutions was important, but clinical complications, particularly diarrhea, were seen only in 11%. In several cases osmotic diarrhea was produced by too rapid administration. Factors associated with a high level of bacterial growth included utilisation time of administration sets, hanging time of feeding formula, and, mainly, maintenance of the connection between the administration set and the nasogastric tube during pump-assisted continuous drip. Retrograde colonisation of the nasogastric feeding tube is likely in view of the bacterial flora identified. The absence of relationship between microbial contamination of nutritional solutions and infectious diarrhea, as demonstrated in this study, is indicative of the appropriate bacterial safety of continuous drip or bolus enteral nutrition.

Adolescent↗
PubMed1985

Calciuretic effect of cyclic versus continuous total parenteral nutrition.

Metabolic bone disease has been reported in patients receiving long-term cyclic administration of total parenteral nutrition (TPN). The exact etiology of this disturbance in mineral homeostasis has not been identified, however many of these patients are markedly hypercalciuric and in negative calcium balance. We have studied the effects of cyclical versus continuous infusion of nutrients on urinary calcium losses in a group of patients beginning a program of long-term home TPN. Cyclic TPN, when administered over either 18 or 12 hours, significantly increased daily urinary calcium excretion compared to continuous 24-h TPN infusion by 19 and 28%, respectively. During cyclic TPN, frank negative calcium balance was observed in 3 of 5 patients studied compared to 2 of 5 patients during continuous TPN. The pattern of urinary calcium loss during cyclic TPN was such that approximately 80% of the daily urinary calcium losses occurred during the 12 hours of TPN infusion. Cyclic administration of TPN increased the urinary calcium losses in all patients suggesting that an intermittent TPN infusion schedule, as typically utilized in home TPN programs, increases the risk of developing negative calcium balance, at least during the early phase of cyclic TPN administration.

Adult↗
PubMed1985

Urinary C-peptide measurements in patients receiving continuous and cyclic total parenteral nutrition.

Urinary C-peptide excretion has been found to be an accurate index of insulin secretion under a variety of physiologic conditions, such as acute starvation and exercise, and after oral and intravenous glucose administration. We investigated urinary C-peptide responses in a group of patients who were receiving all of their nutrient intake by intravenous administration. In these patients receiving total parenteral nutrition (TPN), we were able to monitor changes in insulin secretion when the same nutrients were infused at different rates, for example, during cyclic vs. continuous TPN administration, and to observe changes in the insulin secretory response as the pattern of nutrient delivery was altered in the same individual. We found that increasing the TPN infusion rate by 50% during cyclic TPN caused a 65% increase in serum insulin levels over levels observed during continuous TPN administration (93 vs. 60 microU/ml), whereas a 100% increase in the cyclic TPN infusion rate above the continuous TPN rate increased insulin levels by 147% (147 vs. 60 microU/ml). The molar ratio of insulin to C-peptide was increased by increasing rates of TPN infusion, from 0.116 during fasting periods to 0.151 during maximum rates of TPN administration. An additional finding of this study is that 24-hour insulin secretion, estimated by urinary C-peptide measurements, was equivalent in all treatments regardless of the pattern of insulin response elicited.

Adult↗