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Marinos Elia

Publications and source records attributed to Marinos Elia.

At least 19 recordsLinked to original sources
PubMed2006

Substrate-energy metabolism and metabolic risk factors for cardiovascular disease in relation to fetal growth and adult body composition.

The effect of fetal programming on intermediary metabolism is uncertain. Therefore, we examined whether fetal programming affects oxidative and nonoxidative macronutrient metabolism and the prevalence of the metabolic syndrome in adult life. Healthy older men, aged 64-72 years, with either a lower birth weight (LBW, or=75th %ile; n = 13) had measurements of 1) net oxidative metabolism using indirect calorimetry before and for 6 h after a mixed meal (3,720 kJ) and 2) postprandial oxidation of exogenous [13C]palmitic acid. Body composition was measured using dual-energy X-ray absorptiometry. After adjustment for current weight and height, the LBW group had a lower resting energy expenditure (REE) in the preprandial (4.01 vs. 4.54 kJ/min, P = 0.015) and postprandial state (4.60 vs. 5.20 kJ/min, P = 0.004), and less fat-free mass than the HBW group. The BW category was a significant, independent, and better predictor of REE than weight plus height. There were no significant differences between groups in net oxidative and nonoxidative macronutrient (protein, fat, carbohydrate) metabolism (or of exogenous [13C]palmitate) or in the prevalence of the metabolic syndrome, which was present almost twice as commonly in the LBW than in the HBW group. The study suggests that fetal programming affects both pre- and postprandial EE in older life by mechanisms that are at least partly related to the mass of the fat-free body. BW was found to be a significant predictor of REE that was independent of adult weight plus height.

Aged↗
PubMed2006

Macro- and micronutrient losses and nutritional status resulting from 44 days of total fasting in a non-obese man.

OBJECTIVE: We wanted to establish and understand how the fractional losses of fat, fat-free tissues, and selected nutrients compare with that of body mass during a 44-d voluntary starvation (water only) and measurements of nutrient status. METHODS: We used anthropometry, sequential measurements of urinary substances during the fast, and blood analytes at the end of the fast. RESULTS: At the start of the fast, body weight was 96.0 kg (20% fat) and body mass index was 28.36 kg/m(2). The changes in body mass and arm anthropometry and in the pattern of urinary excretion of creatinine, ammonia, sodium, and ketone bodies during the study were consistent with starvation. At the end of the fast, body mass had decreased by 25.5%, of which a quarter to a third was due to loss of fat and the remainder to fat-free mass, predominantly muscle. There was an estimated loss of 20% of total body protein, 20-25% of fat-free mass, and a greater fractional loss of fat. Total energy expenditure was estimated to be 1638-2155 kcal/d of which 13.0-17.1% was from protein oxidation. Differential losses of minerals in urine ranged from 1.2% of estimated initial body content for manganese to 17.3% for selenium and 40.5% for zinc. At the end of the study, plasma concentrations of zinc and vitamin B12 were increased, those of copper, selenium, and manganese were normal, and there was biochemical evidence of deficiency in thiamine, riboflavin, and vitamin K (prothrombin time). CONCLUSION: The data confirm and extend the available information on prolonged fasting in lean individuals and have relevance to the understanding of the physiologic responses to starvation and the associated homeostatic mechanisms.

Adipose Tissue↗
PubMed2006

Deprivation linked to malnutrition risk and mortality in hospital.

This study aimed to investigate the link between deprivation and in-hospital malnutrition and to assess any independent and interrelated effects of deprivation and malnutrition on clinical outcome in hospital. One thousand patients (mean age 71 (SD 19) years, mean BMI 25.6 (SD 5.4) kg/m(2)) were screened for malnutrition (using the Malnutrition Universal Screening Tool ('MUST')) and their clinical outcome assessed prospectively. The deprivation of patients' locality of residence prior to admission was recorded using the Index of Multiple Deprivation 2000 (IMD). Patients with medium and high malnutrition risk (42 %, n 420) were admitted from areas with significantly greater deprivation (lower ranks) than low-risk patients (IMD 3731 v. 3946; P<0.02). The prevalence of malnutrition increased by multiples of 1.14 (95 % CI 1.02, 1.28) for each increment in quartile of IMD rank. The odds of malnutrition of the most deprived quartile were greater than those of the least deprived quartile by a factor of 1.59 (95 % CI 1.11, 2.28). They were also greater for five of the six components of IMD deprivation (and by a factor of 1.73 (95 % CI 1.20, 2.49) for income and 1.69 (95 % CI 1.18, 2.42) for employment). Greater in-hospital mortality was associated with malnutrition, independently of IMD (or its individual components; odds ratio 2.04 (95 % CI 1.22, 3.44)). Length of stay was associated only with malnutrition risk (P<0.0005). This study highlights that in-hospital malnutrition and deprivation are interrelated, yet have independent, adverse associations with patient outcome. Effective strategies are required to tackle these common health inequalities in both clinical and public health settings.

Aged↗
PubMed2006

'Malnutrition Universal Screening Tool' predicts mortality and length of hospital stay in acutely ill elderly.

Malnutrition and its impact on clinical outcome may be underestimated in hospitalised elderly as many screening procedures require measurements of weight and height that cannot often be undertaken in sick elderly patients. The 'Malnutrition Universal Screening Tool' ('MUST') has been developed to screen all adults, even if weight and/or height cannot be measured, enabling more complete information on malnutrition prevalence and its impact on clinical outcome to be obtained. In the present study, 150 consecutively admitted elderly patients (age 85 (sd 5.5) years) were recruited prospectively, screened with 'MUST' and clinical outcome recorded. Although only 56 % of patients could be weighed, all (n 150) could be screened with 'MUST'; 58 % were at malnutrition risk and these individuals had greater mortality (in-hospital and post-discharge, P<0.01) and longer hospital stays (P=0.02) than those at low risk. Both 'MUST' categorisation and component scores (BMI, weight loss, acute disease) were significantly related to mortality (P<0.03). Those patients with no measured or recalled weight ('MUST' subjective criteria used) had a greater risk of malnutrition (P=0.01) and a poorer clinical outcome (P<0.002) than those who could be weighed and, within both groups, clinical outcome was worse in those at risk of malnutrition. The present study suggests that 'MUST' predicts clinical outcome in hospitalised elderly, in whom malnutrition is common (58 %). In those who cannot be weighed, a higher prevalence of malnutrition and associated poorer clinical outcome supports the importance of routine screening with a tool, like 'MUST', that can be used to screen all patients.

Acute Disease↗
PubMed2006

Small organs with a high metabolic rate explain lower resting energy expenditure in African American than in white adults.

BACKGROUND: African Americans have a lower resting energy expenditure (REE) relative to fat-free mass (FFM) than do whites. Whether the composition of FFM at the organ-tissue level differs between African Americans and whites and, if so, whether that difference could account for differences by race in REE are unknown. OBJECTIVE: The objectives were to quantify FFM in vivo in women and men at the organ-tissue level and to ascertain whether the mass of specific high-metabolic-rate organs and tissues differs between African Americans and whites and, if so, whether that difference can account for differences in REE. DESIGN: The study was a cross-sectional evaluation of 64 women (n = 34 African Americans, 30 whites) and 35 men (n = 8 African Americans, 27 whites). Magnetic resonance imaging measures of liver, kidney, heart, spleen, brain, skeletal muscle, and adipose tissue and dual-energy X-ray absorptiometry measures of fat and FFM were acquired. REE was measured by using indirect calorimetry. RESULTS: The mass of selected high-metabolic-rate organs (sum of liver, heart, spleen, kidneys, and brain) after adjustment for fat, FFM, sex, and age was significantly (P < 0.001) smaller in African Americans than in whites (3.1 and 3.4 kg, respectively; x +/- SEE difference: 0.30 +/- 0.06 kg). In a multiple regression analysis with fat, FFM, sex, age, and race as predictors of REE, the addition of the total mass rendered race nonsignificant. CONCLUSIONS: Racial differences in REE were reduced by >50% and were no longer significant when the mass of specific high-metabolic-rate organs was considered. Differences in FFM composition may be responsible for the reported REE differences.

Absorptiometry, Photon↗
PubMed2006

Two-component models are of limited value for the assessment of body composition in patients with cirrhosis.

BACKGROUND: Most techniques for measuring body composition are based on 2-component models (2-CMs) and depend on assumptions relating to the constancy of the density (D(FFM)) and hydration fraction (HF(FFM)) of fat-free mass (FFM). OBJECTIVES: The objectives were to determine whether these assumptions are systematically violated in patients with cirrhosis and to assess the validity of the estimates of body composition obtained in these patients by using 2-CM techniques. DESIGN: Body composition was assessed by using a 4-component model (4-CM), which was based on data obtained from densitometry, deuterium dilution, and dual-energy X-ray absorptiometry, in 20 patients with cirrhosis who had no evidence of fluid retention and in 20 pair-matched healthy control subjects. The results were compared with those obtained by using "reference" and "bedside" 2-CM techniques. RESULTS: The mean (+/-SD) D(FFM) was significantly lower in the patients with cirrhosis (1.091 +/- 0.008 compared with 1.100 +/- 0.006 kg/L; P < 0.001); no significant difference in HF(FFM) was observed between the patients and control subjects (74.5 +/- 2.6 compared with 73.5 +/- 2.1), although there was greater variability in the patients. Significant differences were observed in the body-composition variables obtained by using the "reference" 2-CM techniques compared with the 4-CM-the 95% limits of agreement in the patients with cirrhosis exceeded 5% body fat and 3 kg FFM; the corresponding values for the "bedside" 2-CM techniques were 11% body fat and 7.5 kg FFM. CONCLUSIONS: Assumptions relating to the constancy of the D(FFM) and HF(FFM) are violated in patients with cirrhosis. Thus, standard 2-CM techniques provide inaccurate body composition estimates in this patient population.

Absorptiometry, Photon↗
PubMed2005

Do interventions which reduce colonic bacterial fermentation improve symptoms of irritable bowel syndrome?

Abnormal fermentation may be an important factor in irritable bowel syndrome (IBS). Gastroenteritis or antibiotic therapy may damage the colonic microflora, leading to increased fermentation and the accumulation of gas. Gas excretion may be measured by whole-body calorimetry but there has only been one such study on IBS to date. We aimed to assess the relationship between IBS symptoms and fermentation rates in IBS. A purpose-built, 1.4-m3, whole-body calorimeter was used to assess excretion of H2 and CH4 in IBS subjects while consuming a standard diet and, again, after open randomization on either the standard diet together with the antibiotic metronidazole or a fiber-free diet to reduce fermentation. Metronidazole significantly reduced the 24-hr excretion of hydrogen (median value compared to the control group, 397 vs 230 ml/24 hr) and total gas (H2 + CH4; 671 vs 422 ml/min) and the maximum rate of gas excretion (1.6 vs 0.8 ml/min), as did a no-fiber polymeric diet (hydrogen, 418 vs 176 ml/min; total gas, 564 vs 205 ml/min; maximum rate of gas excretion, 1.35 vs 0.45 ml/min), with a significant improvement in abdominal symptoms. IBS may be associated with rapid excretion of gaseous products of fermentation, whose reduction may improve symptoms.

Adult↗
PubMed2005

Enteral nutritional support in prevention and treatment of pressure ulcers: a systematic review and meta-analysis.

BACKGROUND: There have been few systematic reviews and no meta-analyses of the clinical benefits of nutritional support in patients with, or at risk of developing, pressure ulcers. Therefore, this systematic review and meta-analysis was undertaken to address the impact of enteral nutritional support on pressure ulcer incidence and healing and a range of other clinically relevant outcome measures in this group. METHODS: Fifteen studies (including eight randomised controlled trials (RCTs)) of oral nutritional supplements (ONS) or enteral tube feeding (ETF), identified using electronic databases (including Pub Med and Cochrane) and bibliography searches, were included in the systematic review. Outcomes including pressure ulcer incidence, pressure ulcer healing, quality of life, complications, mortality, anthropometry and dietary intake were recorded, with the aim of comparing nutritional support versus routine care (e.g. usual diet and pressure ulcer care) and nutritional formulas of different composition. Of these 15 studies, 5 RCTs comparing ONS (4 RCTs) and ETF (1 RCT) with routine care could be included in a meta-analysis of pressure ulcer incidence. RESULTS: Meta-analysis showed that ONS (250-500 kcal, 2-26 weeks) were associated with a significantly lower incidence of pressure ulcer development in at-risk patients compared to routine care (odds ratio 0.75, 95% CI 0.62-0.89, 4 RCTs, n=1224, elderly, post-surgical, chronically hospitalised patients). Similar results were obtained when a combined meta-analysis of ONS (4 RCT) and ETF (1 RCT) trials was performed (OR 0.74, 95% CI 0.62-0.88, 5 RCTs, n=1325). Individual studies showed a trend towards improved healing of existing pressure ulcers with disease-specific (including high protein) versus standard formulas, although robust RCTs are required to confirm this. Although some studies indicate that total nutritional intake is improved, data on other outcome measures (quality of life) are lacking. CONCLUSIONS: This systematic review shows enteral nutritional support, particularly high protein ONS, can significantly reduce the risk of developing pressure ulcers (by 25%). Although studies suggest ONS and ETF may improve healing of PU, further research to confirm this trend is required.

Aged↗
PubMed2005

Multinutrient oral supplements and tube feeding in maintenance dialysis: a systematic review and meta-analysis.

BACKGROUND: This systematic review aims to determine the potential benefits of enteral multinutrient support (oral or tube) in patients with chronic kidney disease (CKD) receiving maintenance dialysis. METHODS: Studies of multinutrient oral supplements and enteral tube feeding that involved comparisons of nutritional support versus routine care (ie, usual diet), disease-specific formulae (with adapted macronutrient and micronutrient composition for use in maintenance dialysis patients) versus standard formulae, and enteral tube feeding versus parenteral nutrition are included in this review. The outcome measures sought were clinical (quality of life, complications, and mortality), biochemical (albumin and electrolyte levels), and nutritional (dietary intake and anthropometry). Meta-analyses were performed when possible. RESULTS: This review of 18 studies (5 randomized controlled trials [RCTs], 13 non-RCTs) suggests that enteral nutritional support increased total (energy and protein) intake and increased serum albumin concentration by 0.23 g/dL (2.3 g/L; 95% confidence interval, 0.037 to 0.418 g/dL [0.37 to 4.18 g/L]; 1 RCT, 2 non-RCTs), with little effect on electrolyte status (serum phosphate and potassium). Few studies reported clinical outcome, and there was insufficient information to compare disease-specific versus standard formulae or enteral versus parenteral nutrition. CONCLUSION: This systematic review suggests that enteral multinutrient support significantly increases serum albumin concentrations and improves total dietary intake. This may improve clinical outcome, especially in malnourished patients, but insufficient published data exist to examine this. Additional research is required to investigate clinical, economic, and nutritional consequences of using oral supplements and tube feeding (using standard or disease-specific feeds) in patients with CKD receiving maintenance dialysis.

Adult↗
PubMed2005

Insights into energy requirements in disease.

Accurate information about the energy needs of a range of acute and chronic diseases and morbidity is lacking and often complicated by the medication prescribed to treat the condition and also because of the presence of pre-existing malnutrition. Assessing the energy requirements of patients with acute and chronic diseases is more complex than for those in good health. These requirements not only depend on the aggressiveness of the disease and level of inactivity it causes, but also on the treatment, and the presence of prior malnutrition. It used to be generally believed that the energy requirements were increased in a number of diseases. It is now realised that this is not usually the case. Therefore, it is necessary to put these changing ideas into context by considering a wide range of acute and chronic diseases which this paper proposes to do. This paper is almost exclusively restricted to studies that have measured total energy expenditure (TEE) using tracer techniques in both hospital and the community (mostly doubly labelled water and to a lesser extent bicarbonate-urea), and continuous 24-hour indirect calorimetry in artificially ventilated patients in hospital.

Acute Disease↗
PubMed2005

Fetal programming of body composition: relation between birth weight and body composition measured with dual-energy X-ray absorptiometry and anthropometric methods in older Englishmen.

BACKGROUND: Reduced fetal growth is associated with differences in body composition in adult life that may predispose to cardiovascular disease and diabetes. Most published data are based on simple anthropometric measures, which incompletely describe body composition. OBJECTIVE: The objective was to assess body composition and fat distribution by using dual-energy X-ray absorptiometry (DXA). DESIGN: This was a case-control study of 64-72-y-old white men (n = 32) with a low (mean: 2.76 kg) or high (mean: 4.23 kg) birth weight. RESULTS: Compared with the high-birth-weight group, after adjustment for weight and height, the low-birth-weight group had a higher percentage body fat (29.31% compared with 25.33%; P = 0.029) and fat mass (P = 0.039) but a lower fat-free soft tissue (56.32 compared with 59.22 kg; P = 0.024), muscle mass (27.25 compared with 29.22 kg; P = 0.022), and muscle-to-fat ratio. Low birth weight was also associated with a higher trunk-to-limb fat ratio after control for total fat mass (1.42 compared with 1.16; P = 0.005) or percentage body fat (P = 0.041). The same body mass index predicted a greater percentage body fat (P = 0.019) in the low- than in the high-birth-weight group, and the same ratio of trunk-to-limb skinfold thickness (or waist-to-hip ratio) predicted a higher trunk-to-limb fat ratio (P < 0.01). CONCLUSION: Lifelong differences in adult body composition and fat distribution between the low- and high-birth-weight groups are consistent with programming in early life. The use of BMI to predict percentage body fat and the use of the trunk-to-limb skinfold thickness ratio (and waist-to-hip ratio) to predict the trunk-to-limb fat ratio measured by DXA can be misleading when low- and high-birth-weight groups are compared.

Absorptiometry, Photon↗
PubMed2005

Enteral nutritional support and use of diabetes-specific formulas for patients with diabetes: a systematic review and meta-analysis.

OBJECTIVE: The aim of this systematic review was to determine the benefits of nutritional support in patients with type 1 or type 2 diabetes. RESEARCH DESIGN AND METHODS: Studies utilizing an enteral nutritional support intervention (oral supplements or tube feeding) were identified using electronic databases and bibliography searches. Comparisons of interest were nutritional support versus routine care and standard versus diabetes-specific formulas (containing high proportions of monounsaturated fatty acids, fructose, and fiber). Outcomes of interest were measures of glycemia and lipid status, medication requirements, nutritional status, quality of life, complications, and mortality. Meta-analyses were performed where possible. RESULTS: A total of 23 studies (comprising 784 patients) of oral supplements (16 studies) and tube feeding (7 studies) were included in the review, and the majority compared diabetes-specific with standard formulas. Compared with standard formulas, diabetes-specific formulas significantly reduced postprandial rise in blood glucose (by 1.03 mmol/l [95% CI 0.58-1.47]; six randomized controlled trials [RCTs]), peak blood glucose concentration (by 1.59 mmol/l [86-2.32]; two RCTs), and glucose area under curve (by 7.96 mmol.l(-1).min(-1) [2.25-13.66]; four RCTs, i.e., by 35%) with no significant effect on HDL, total cholesterol, or triglyceride concentrations. In addition, individual studies reported a reduced requirement for insulin (26-71% lower) and fewer complications with diabetes-specific compared with standard nutritional formulas. CONCLUSIONS: This systematic review shows that short- and long-term use of diabetes-specific formulas as oral supplements and tube feeds are associated with improved glycemic control compared with standard formulas. If such nutritional support is given long term, this may have implications for reducing chronic complications of diabetes, such as cardiovascular events.

Blood Glucose↗
PubMed2004

Changes in circulating concentrations of vitamins and trace elements after cessation of nocturnal enteral tube feeding.

BACKGROUND: This study aimed to examine whether circulating concentrations of a range of vitamins and trace elements in patients receiving long-term cyclic enteral tube feeding vary during the day, and whether standardised time points for blood sampling are required for assessment of nutrient status. METHODS: Circulating concentrations or activities of water-soluble vitamins (thiamine, riboflavin, and vitamins B6, B12, folate and C), fat-soluble vitamins (A, D, E) and trace elements (iron, zinc, copper and selenium (assessed by glutathione peroxidase activity), were measured at 0,3,6 and 9-12h after cessation of nocturnal feeding (fasting), in eight clinically stable patients receiving cyclic nocturnal enteral nutrition. RESULTS: The circulating concentrations of the nutrients did not change between the fed and fasted state (repeated-measures-ANOVA) except the following: plasma folate increased progressively from 10.9 (SD 4.6)nmol/l in the fed state to 14.0 (SD 4.4)nmol/l at 9-12 h after cessation of feeding (P<0.05); plasma zinc increased progressively throughout the fasting period by 33.5% (8.57, SD 0.68 vs. 11.44, SD 1.85 micromol/l, in fed state vs. 9-12h fast respectively, P<0.05); and total tocopherol/cholesterol ratio decreased by 9.6% during the study period (P<0.02), while gamma-tocopherol increased by 59.2% (P<0.05). For all analytes, the concentrations in blood samples taken at 3 and 6h after cessation of feeding were not significantly different from those at 9-12h. CONCLUSIONS: Although cessation of nocturnal tube feeding had no significant effect on the circulating concentrations of most micronutrients, it increased plasma folate and zinc concentrations, and decreased the tocopherol/cholesterol ratio. The timing for blood sampling should be standardised when the status of these nutrients is assessed in patients receiving cyclic tube feeding.

Adult↗
PubMed2004

The development, validation and reliability of a nutrition screening tool based on the recommendations of the British Association for Parenteral and Enteral Nutrition (BAPEN).

BACKGROUND & AIMS: Nutrition screening tools (NST) identify individuals who are malnourished or at risk of becoming malnourished and who may benefit from nutritional support. The aims of this study were to design, pilot and evaluate a NST based on four nutritional parameters (weight, height, recent unintentional weight loss and appetite) recommended by the British Association for Parenteral and Enteral Nutrition as the minimum required to identify patients with nutritional problems. METHODS: A dietitian assessed the nutritional status of 100 patients admitted to the general medical wards. Results from the study were used to design a NST. The concurrent validity of the screening tool was then assessed, by comparing it with a nutritional assessment by an experienced dietitian in 100 patients admitted to acute medical and elderly care wards. The inter-rater reliability of the screening tool was also assessed using three nurses and 26 acute medical patients. RESULTS: All four nutritional parameters were required to identify all at-risk patients. There was good agreement between the screening tool and the dietitian's assessment (kappa = 0.717) and inter-rater reliability was reasonable (mean kappa = 0.66). CONCLUSION: The screening tool was valid and reliable in identifying medical patients at risk of malnutrition and was quick and simple to use.

Appetite↗