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J Rund

Publications and source records attributed to J Rund.

5 recordsLinked to original sources
PubMed1990

Contribution of elevated protein turnover and anorexia to cachexia in patients with hepatocellular carcinoma.

Severe cachexia of extremely rapid onset typifies the young Black African patient with hepatocellular carcinoma (HCC). In order to assess whether this is a consequence of tumor-associated increases in protein metabolism or simply due to inadequate dietary intake, the following study was undertaken. The technique of constant i.v. infusion of 14C-labeled leucine was used to measure whole body protein flux, breakdown, synthesis, and oxidation rates in 8 adults with HCC, 4 patients with massive hepatomegaly due to metastatic adenocarcinoma from bowel, 6 patients with chronic liver disease, and 10 controls. Endogenous protein breakdown and oxidation were similar between patients with chronic liver disease (breakdown, 4.4 +/- 1.2 g/kg/day; oxidation, 0.8 +/- 0.4 g/kg/day) and controls but were significantly (P less than 0.002) higher in patients with liver tumors, the highest rates being observed in those with HCC (breakdown, 8.5 +/- 4.3 g/kg/day; oxidation, 1.4 +/- 0.5 g/kg/day). Protein turnover was generally higher in the HCC group, with increased rates of reincorporation of amino acids into protein synthesis (P less than 0.05). In one HCC patient a synchronized diagnostic liver biopsy demonstrated high fractional synthesis of rates of HCC proteins of 86%/day. In addition, the incorporation rates of labeled amino acid into fibrinogen, immunoglobulin G, and transferrin were also highest (P less than 0.03) in HCC patients. In order to assess the relative importance of diet in weight loss, dietary intake levels were assessed from hospital records of HCC patients and by dietary recall during the week prior to study. Intakes ranged from 30 to 70% of calculated requirement levels. In conclusion, our results suggest that the rapid wasting seen in patients with HCC is due to an imbalance between the metabolic demands, which can be elevated in some patients, and inadequate dietary replenishment.

Adolescent↗
PubMed1990

Milk tolerance and the malnourished African.

Adult (primary) lactose malabsorption is practically universal in Africans of Bantu and San ('Bushmen') stock. Recent environmental changes, especially in rural areas, have exacerbated rates of malnutrition in hospital patients belonging to these groups. In order to assess the advisability of using milk as a nutritional supplement for such patients, the tolerance and absorption of 350 ml boluses of whole milk (containing 17 g lactose) was measured in 110 malnourished hospitalized patients in Namibia and South Africa belonging to Bantu (ie, Zulus, Hereros, and Kavangos) and San (ie, Bushmen) populations and compared with 22 healthy Westernized controls. Mild symptoms of intolerance were noted in about 10 per cent of Bantus and 20 per cent of Bushmen in comparison to 33 per cent of lactose-malabsorbing controls consuming Westernized diets and reported rates of 48 and 80 per cent in American population studies. The average increase in breath hydrogen excretion of 20 parts per million was also lower than the value of 34 parts per million in controls. Fasting breath methane concentrations were high in between 60-84 per cent of the groups of patients, but the level was not significantly affected by milk ingestion. Despite the combination of hypolactasia and malnutrition, 350 ml drinks of milk were well tolerated by African patients. Thus, milk should form an appropriate nutritional supplement for Africans hospitalized in rural areas.

Africa↗
PubMedDate not supplied

Steroids and bowel rest versus elemental diet in the treatment of patients with Crohn's disease: the effects on protein metabolism and immune function.

Recent studies have shown an elemental diet to be as effective as bowel rest plus steroids in the management of acute Crohn's disease. In order to investigate the metabolic and immunological effects of these two therapies, six patients with an acute inflammatory attack of ileal Crohn's disease were randomly assigned to receive steroids or elemental diet for 7 days. Immunological and protein metabolic studies were performed before and after therapy, protein kinetic rates being measured by the method of constant intravenous infusion of 14C-labeled leucine tracer. Clinical and symptomatic improvement was noted in all six patients with significant falls in sedimentation rate and platelet counts and increases in albumin concentrations. Both forms of treatment increased plasma amino acid flux and oxidation rates, whole body protein turnover and rates of incorporation of amino acid into albumin. However, the increased rates of protein metabolism in the patients given steroids were at the expense of body protein stores with a net (average) loss of 58 g of nitrogen over 7 days. While both forms of therapy were associated with suppression of lymphocyte subsets, complement and circulating immune complexes only the steroid regimen was associated with suppression of in vivo IgG synthesis rates. The results indicated that both forms of therapy were associated with clinical improvement, increases in protein turnover and evidence of reduced inflammatory activity. However, the beneficial effects of steroid regimen must be balanced against the deleterious effects on body protein stores; steroids and bowel rest without nutritional support should be avoided in malnourished patients.

Adult↗