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Biomedical subjects

M S Jacobson

Publications and source records attributed to M S Jacobson.

At least 19 recordsLinked to original sources
PubMed1997

The metabolic responses to starvation and refeeding in adolescents with anorexia nervosa.

Adaptive changes in metabolism result in decreased energy requirements in AN. A retrospective study of 21 hospitalized female AN patients demonstrated that indirect calorimetry (IC) measurement of resting energy expenditure (REE) was significantly lower than REE calculated by the Harris-Benedict equation (HBE). The HBE was adjusted by multiple-regression analysis to reflect the hypometabolic state of AN, and the adjusted equation was prospectively validated in 37 hospitalized female AN patients. Refeeding requires an understanding of both baseline requirements and metabolic changes that occur during nutritional rehabilitation. In our present study, we prospectively evaluated changes in fasting and postprandial REE in 50 hospitalized female patients meeting DSM-IV criteria for AN. Baseline IC measurements of fasting and postprandial REE were obtained within three days of admission, and every two weeks thereafter. Mean fasting REE increased significantly from 72 (+/-11.7) to 83.2 (+/-12.6) percent of predicted (p < 0.001) during the first two weeks of hospitalization. Likewise, postprandial REE also increased significantly from 17.5 (+/-18.2) to 27.9 (+/-15.9) percent above fasting REE during the same time period (p < 0.01). Significant increases in both REE and postprandial REE persisted in patients requiring longer hospitalizations. Despite the fact that prescribed energy intake and triiodothyronine (T3-RIA) levels increased during refeeding, there was no significant relationship between postprandial REE and energy intake or T3 levels after baseline. We conclude that energy metabolism in AN adapts to semistarvation by a reduction in fasting REE. With refeeding there is a reversal of this adaptive function, demonstrated by an increase in both fasting and postprandial energy expenditure. The increase in postprandial REE is not related to energy intake or thyroid function.

Adolescent↗
PubMed1997

Resumption of menses in anorexia nervosa.

OBJECTIVE: To determine factors associated with resumption of menses (ROM) in adolescents with anorexia nervosa. DESIGN: Cohort study with 2-year follow-up. SETTING: Tertiary care referral center. PATIENTS: Consecutive sample of 100 adolescent girls with anorexia nervosa. INTERVENTIONS: Body weight, percent body fat, and luteinizing hormone, follicle-stimulating hormone, and estradiol levels were measured at baseline and every 3 months until ROM (defined as 2 or more consecutive spontaneous menstrual cycles). Treatment consisted of a combination of medical, nutritional, and psychiatric intervention aimed at weight gain and resolution of psychological conflicts. MAIN OUTCOME MEASURES: Body weight, body composition, and hormonal status at ROM. RESULTS: Menses resumed at a mean (+/-SD) of 9.4 +/- 8.2 months after patients were initially seen and required a weight of 2.05 kg more than the weight at which menses were lost. Mean (+/-SD) percent of standard body weight at ROM was 91.6% +/- 9.1%, and 86% of patients resumed menses within 6 months of achieving this weight. At 1-year follow-up, 47 (68%) of 69 patients had resumed menses and 22 (32%) remained amenorrheic. No significant differences were seen in body weight, body mass index, or percent body fat at follow-up in those who resumed menses by 1 year compared with those who had not. Subjects who remained amenorrheic at 1 year had lower levels of luteinizing hormone (P < .001) and follicle-stimulating hormone (P < .05) at baseline and lower levels of luteinizing hormone (P < .01) and estradiol (P < .001) at follow-up. At follow-up, a serum estradiol level of more than 110 pmol/L (30 pg/mL) was associated with ROM (relative risk, 4.6; 95% confidence interval, 1.9-11.2). CONCLUSIONS: A weight approximately 90% of standard body weight was the average weight at which ROM occurred and is a reasonable treatment goal weight, because 86% of patients who achieved this goal resumed menses within 6 months. Resumption of menses required restoration of hypothalamic-pituitary-ovarian function, which did not depend on the amount of body fat. Serum estradiol levels at follow-up best assess ROM.

Adipose Tissue↗
PubMed1996

Reversibility of cerebral ventricular enlargement in anorexia nervosa, demonstrated by quantitative magnetic resonance imaging.

OBJECTIVE: To determine the reversibility of the loss of brain parenchyma and ventricular enlargement in patients with anorexia nervosa after refeeding. STUDY DESIGN: Quantitative magnetic resonance imaging was performed on three groups of subjects: (1) 12 female adolescents hospitalized with anorexia nervosa, (2) the same 12 patients after nutritional rehabilitation, a mean of 11.1 months later, and (3) 12 healthy age-matched control subjects. Sixty-four contiguous coronal magnetic resonance images, 3.1 mm thick, were obtained. With a computerized morphometry system, lateral and third ventricular volumes were measured by a single observer unaware of the status of the patient. RESULTS: On admission, patients were malnourished and had lost an average of 11.7 kg (body mass index, 14.3 +/- 2.0 kg/m2). After refeeding, they gained an average of 9.7 kg (body mass index, 17.9 +/- 1.5 kg/m2). Total ventricular volume decreased from 17.1 +/- 5.5 cm3 on admission to 12.4 +/- 3.0 cm3 after refeeding (p < 0.01) and returned to the normal range. The degree of enlargement of the third ventricle was greater than that of the lateral ventricles. There was a significant inverse relationship between body mass index and total ventricular volume (r = -0.63; p < 0.05). CONCLUSION: In patients with anorexia nervosa, cerebral ventricular enlargement correlates with the degree of malnutrition and is reversible with weight gain during long-term follow-up.

Adolescent↗
PubMed1995

Nutrient quality of fat- and cholesterol-modified diets of children with hyperlipidemia.

OBJECTIVE: To assess the nutritional adequacy of low-fat, low-saturated fat, low-cholesterol-modified diets of children with hyperlipidemia. DESIGN: Case comparison study. SETTING: Tertiary care ambulatory pediatric atherosclerosis prevention center. PATIENTS AND OTHER PARTICIPANTS: White middle-class suburban children. Subjects were 54 consecutive children with hyperlipidemia (26 boys) with a mean (+/- SD) age of 10.8 +/- 3.4 years. Controls were 44 healthy children (19 boys) aged 10.8 +/- 0.9 years recruited from a local elementary school. INTERVENTION: The subjects received individual nutrition counseling on a National Cholesterol Education Program Step I Diet from a registered dietitian. MAIN OUTCOME MEASURE: The 3-day written food records were analyzed by a registered dietitian using the Minnesota Nutrient Data System. Outcome measures were intakes of energy, fat-soluble vitamins, and minerals as a percentage of the Recommended Dietary Allowance. The means between cases and controls were compared by Student's t test. RESULTS: There was no significant difference in consumption of energy, minerals, or vitamins D and E between the groups. The control group's diet contained significantly greater amounts of fat, saturated fat, and cholesterol. The children with hyperlipidemia consumed significantly more vitamin A (P < .005). CONCLUSION: The nutrient quality of fat- and cholesterol-modified diets of children who have received nutritional counseling compares favorably with the nutrient quality of controls on an unrestricted diet. Therefore, pediatricians can prescribe with confidence a Step I Diet for children with hyperlipidemia and adolescents when nutritional counseling is available.

Adolescent↗
PubMed1995

Indirect calorimetry in the nutritional management of eating disorders.

The caloric prescription, a key component of the nutritional therapy of anorexia nervosa (AN) and bulimia nervosa (BN), may be empirically prescribed, or based on predicted resting energy expenditure (REE), yet adaptive changes in the metabolic rate may render both methods unreliable. Indirect calorimetry measurement of fasting REE was obtained in 32 patients with AN (n = 21) or BN (n = 11). Predicted REE was calculated according to the Harris-Benedict equation, and empiric caloric prescriptions were made by experienced physicians. In the AN group, mean measured REE was significantly lower than predicted REE (p = .00). The empiric caloric prescription was, as intended, significantly higher than the measured REE, but the two methods correlated significantly (r = .53, p < .05). The predicted REE overestimated caloric needs but was also highly correlated with measured REE (r = .69, p < .001). By regression analysis, measured REE could be calculated from predicted REE as follows: measured REE (Kcal/day) = (1.84 x Harris-Benedict predicted REE) - 1,435. In the BN group, mean measured REE was not significantly different from the empiric caloric prescription (p = .09) but was significantly lower than the Harris-Benedict predicted REE (p = .022). Neither correlated with measured REE in BN. Therefore, in BN indirect calorimetry is the only reliable method for determining caloric needs. In AN indirect calorimetry remains the preferred method, but when not available, we recommend the above equation to determine resting energy requirements.

Adolescent↗
PubMed1995

Effect of lipoproteins on macrophage superoxide generation.

Superoxide production by macrophages and leukocytes may have an important role in atherogenesis. Whether lipoproteins modulate the superoxide production of these cells is not clear. Therefore, the effect of lipoproteins on the production of superoxide by rat peritoneal macrophages was tested. VLDL and LDL inhibited digitonin-stimulated superoxide production in a dose-dependent manner. Maximum inhibition was observed at 10 micrograms ml-1 of VLDL protein and 50 micrograms ml-1 of LDL protein respectively. In contrast, HDL (40 micrograms protein ml-1) enhanced digitonin-stimulated superoxide production (by 47 per cent). Macrophage superoxide production induced by arachidonic acid was enhanced by both VLDL (130 per cent) and HDL (84 per cent), whereas LDL had no effect. The lipoproteins had no effect on macrophage superoxide stimulated by other agonists such as phorbol myristate 13-acetate, sodium fluoride or the calcium ionophore, A23187. The effect of lipoproteins was also tested on human polymorphonuclear leukocyte superoxide generation, stimulated by digitonin and PMA. Ten micrograms of VLDL, 50 micrograms of LDL and 50 micrograms of HDL proteins ml-1, inhibited digitonin-induced superoxide production by 50, 100 and 33 per cent respectively. Lipoproteins had no effect on PMA stimulated superoxide generation by human polymorphonuclear leukocytes. The stimulatory and inhibitory effects of lipoproteins on macrophage and neutrophil superoxide generation could be important in the understanding of oxidation-mediated development of atherosclerosis.

Animals↗
PubMed1995

Effects of dietary modification and fish oil supplementation on dyslipoproteinemia in pediatric systemic lupus erythematosus.

OBJECTIVE: To determine if a program of dietary modification and fish oil supplementation is effective in treating the dyslipoproteinemia in pediatric systemic lupus erythematosus (SLE). METHODS: Prospective clinical trial where each patient serves as his/her own control. Twenty-four consecutive adolescents fulfilling SLE classification criteria were screened with fasting lipid profiles. Patients were identified as having dyslipoproteinemia of active disease or of corticosteroid therapy. Patients were treated for 6 weeks with dietary modification and if dyslipoproteinemia did not normalize with another 6 weeks of dietary modification and fish oil supplementation. RESULTS: Seventeen patients (71%) had dyslipoproteinemia; 10 of active disease, 4 of steroid therapy; 3 with a combined pattern. Eleven patients underwent dietary modification. There was a significant decrease in serum triglyceride concentrations (p < 0.05). Total cholesterol, low density lipoprotein cholesterol, and high density lipoprotein cholesterol did not change significantly. A further significant decline in serum triglycerides was achieved with fish oil supplementation (p < 0.05). Five of the 11 patients who underwent treatment continued to have dyslipoproteinemia. CONCLUSION: Dyslipoproteinemia is common in pediatric SLE. Dietary modification and fish oil supplementation appear to be effective in improving serum lipid profiles, and blinded studies are warranted. a significant number of patients may require pharmacologic therapy for persistent dyslipoproteinemia to prevent complications of premature atherosclerosis.

Adolescent↗
PubMed1994

Disturbances in growth hormone secretion and action in adolescents with anorexia nervosa.

Women in whom anorexia nervosa develops during adolescence have failure of linear growth associated with low levels of insulin-like growth factor I (IGF-1). To investigate the pathophysiology of growth retardation in adolescents with anorexia nervosa, we measured basal growth hormone (GH), growth hormone-binding protein (GHBP), IGF-1, and insulin-like growth factor binding protein-3 (IGFBP-3) in three groups of patients: (1) 28 recently hospitalized female adolescents with anorexia nervosa, (2) 23 of the same patients after partial weight restoration, and (3) 28 healthy control subjects matched for age, sex, and pubertal stage. Fasting GH levels in group 1 did not differ significantly from those in group 3. In contrast, serum GHBP (p < 0.001), IGF-1 (p < 0.001), and IGFBP-3 (p < 0.01) were significantly lower in group 1 than in group 3. Serum GHBP and IGFBP-3 levels were positively correlated with body mass index. Serum GHBP levels were low in patients in all five pubertal stages and even in those shown to have adequate GH secretion. In group 2 (after refeeding) the serum IGF-1 concentration increased significantly and GHBP and IGFBP-3 returned to normal. We conclude that patients with anorexia nervosa have diminished GH action resulting in decreased secretion of IGF-1. The positive correlation with body mass index and the reversibility with refeeding suggest that these changes are secondary to malnutrition. Altered GH function that occurs during the years of active growth can explain the growth retardation seen in anorexia nervosa.

Adolescent↗
PubMed1994

Rate of weight gain of inpatients with anorexia nervosa under two behavioral contracts.

OBJECTIVE: To ascertain the rate of weight gain of inpatients with anorexia nervosa under two behavioral contracts, differing in criterion weight gain required to earn increasing privileges. DESIGN: Follow-up comparison of cohorts receiving different interventions. SETTING: Eating disorders service, operating on a general adolescent medicine unit. PATIENTS: Patients admitted consecutively who met the following criteria: (1) weight at least 15% less than that expected for age, sex, and height; (2) female gender; (3) absence of chronic medical illness; (4) hospital stay of at least 28 days. Twenty-two patients meeting these criteria were treated between July 1987 and October 1988, when contract 1 was in effect. This cohort of patients was compared with a group of 31 patients, also meeting the these criteria, who were treated between November 1988 and December 1991, when contract 2 was in effect. INTERVENTIONS: The behavioral contract, signed by the patient on admission, specifies the minimum 4-day weight gain necessary to earn increasing ward privileges, such as use of phone, frequency of visits, etc. Contracts 1 and 2 differed only in the 4-day weight gain criterion: 0.8 lb (0.36 kg) and 1.2 lb (0.55 kg), respectively. RESULTS: The results of analysis of covariance, with admission weight as the covariate, revealed a significant interaction between contract and day, such that patients receiving contract 2 gained weight more rapidly (0.36 lb/d) than those receiving contract 1 (0.20 lb/d). There was no confounding difference between groups in the use of psychotropic medication, and no complications of refeeding in either group. CONCLUSION: Increasing the 4-day criterion weight gain from 0.8 to 1.2 lb in a behavioral contracting intervention was associated with a significant increase in the rate of weight gain, without an accompanying increase in complications of refeeding. This result simultaneously: (a) provides support for the efficacy of behavioral contracting and (b) reveals malleability in the rate of gain based on the targeted gain specified in the contract.

Adolescent↗
PubMed1993

Adolescent obesity and cardiovascular risk: a rational approach to management.

Ten obese adolescents, referred because of elevated cardiovascular disease risk, were treated in a pediatric atherosclerosis prevention center. The focus of treatment was an increase in exercise tolerance and aerobic capacity and a decrease in the percentage of fat in the diet. Weight loss was not a goal of treatment, but continued growth with a slowing of the rate of weight gain was emphasized. All patients were at elevated cardiovascular risk at the entry to the study, and nine of the ten had significant improvements in one or more of their cardiovascular risk parameters. Furthermore, with regard to body composition, eight of the ten patients were able to improve their body mass index. On average, triceps skinfold thicknesses declined 25 percent. Total cholesterol declined 14%, triglycerides declined 33%, LDL cholesterol declined 13%, and HDL cholesterol did not change with this form of treatment. As for systolic and diastolic blood pressure, four of the ten patients who had elevated blood pressures at the initiation of treatment were able to decrease their blood pressure, in absolute terms and on the basis of their percentiles for age and sex. We conclude that, in obese adolescents, improved diet and body composition, a slowed rate of weight gain, and a reduction of cardiovascular risk shown through lipid profiles and blood pressures can be achieved from a multidisciplinary treatment program focused on achievable goals. These goals include (1) increased habitual exercise and increased aerobic exercise and (2) a decrease in the percentage of energy intake from fat and saturated fat, with a concomitant decrease in the balance of energy intake to energy output. It is important to remember that we did not focus on weight loss per se and that the treatment was individualized to the developmental stage of the adolescent.

Adolescent↗