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Biomedical subjects

Matthias Pirlich

Publications and source records attributed to Matthias Pirlich.

At least 19 recordsLinked to original sources
PubMed2006

Malnutrition affects quality of life in gastroenterology patients.

AIM: To investigate the association between malnutrition and quality of life in patients with benign gastrointestinal disease. METHODS: Two hundred patients (104 wellnourished and 96 malnourished) were assessed according to the Subjective Global Assessment, anthropometric measurements and bioelectrical impedance analysis. Quality of life was determined with the validated Medical Outcomes Study 36-item Short-Form General Health Survey (SF 36). Muscle function was assessed by hand grip strength and peak flow. RESULTS: Body mass index, body cell mass, arm muscle area and hand grip strength were significantly lower in the malnourished patients. Quality of life was generally lower when compared to norm values. Seven out of eight quality of life scales (excluding bodily pain) were significantly reduced in the malnourished patients. Comparing patients with liver cirrhosis and inflammatory bowel disease (IBD), patients with IBD experienced significantly lower values in the perception of bodily pain,social functioning and mental health. Malnourished liver cirrhotics suffered reductions in more scales (six out of eight) than malnourished IBD patients did (four out of eight). CONCLUSION: Quality of life is generally low in benign gastrointestinal disease and is further reduced in patients who are classified as malnourished. It appears that liver cirrhosis patients experience a higher quality of life than IBD patients do, but the impact of malnutrition seems to be greater in liver cirrhosis than in IBD.

Adult↗
PubMed2006

Effects of creatine supplementation on nutritional status, muscle function and quality of life in patients with colorectal cancer--a double blind randomised controlled trial.

BACKGROUND & AIM: Nutritional status frequently deteriorates during chemotherapy in cancer. This is associated with a poor outcome. Since creatine supplementation has shown promising results in various diseases, we investigated the effects of creatine on nutritional status in patients with colorectal cancer undergoing chemotherapy. METHODS: Thirty patients with colorectal cancer undergoing chemotherapy were randomised to receive either creatine (n=16) or placebo (n=15) for 8 weeks. Body composition was determined with bioelectrical impedance analysis; muscle function by hand grip, hip flexion and knee extension strength and quality of life (QoL) was assessed by the QLQ30 questionnaire. RESULTS: Neither muscle function, body cell mass (BCM) nor QoL improved, but phase angle, a marker of BCM and cell integrity, increased significantly in the intervention patients (5.3+/-0.3 degrees to 5.4+/-0.2 degrees , P=0.030). Evaluating patients with different chemotherapy regimens, however, only intervention patients undergoing less aggressive chemotherapy were shown to benefit, increasing phase angle (5.11+/-0.22 degrees to 5.51+/-0.30 degrees , P=0.043) as well as BCM (27.22+/-2.85 to 29.60+/-3.54kg, P=0.043). CONCLUSION: Creatine failed to improve muscle mass or function and QoL in colorectal cancer patients but improved bioimpedance parameters that are predictive of poor outcome. Creatine might therefore be useful in patients with milder chemotherapy in order to maintain or increase BCM whereas patients undergoing aggressive chemotherapy however are not likely to benefit.

Administration, Oral↗
PubMed2006

The German hospital malnutrition study.

BACKGROUND & AIMS: Malnutrition is frequently observed in chronic and severe diseases and associated with impaired outcome. In Germany general data on prevalence and impact of hospital malnutrition are missing. METHODS: Nutritional state was assessed by subjective global assessment (SGA) and by anthropometric measurements in 1,886 consecutively admitted patients in 13 hospitals (n=1,073, university hospitals; n=813, community or teaching hospitals). Risk factors for malnutrition and the impact of nutritional status on length of hospital stay were analyzed. RESULTS: Malnutrition was diagnosed in 27.4% of patients according to SGA. A low arm muscle area and arm fat area were observed in 11.3% and 17.1%, respectively. Forty-three % of patients 70 years old were malnourished compared to only 7.8% of patients <30 years. The highest prevalence of malnutrition was observed in geriatric (56.2%), oncology (37.6%), and gastroenterology (32.6%) departments. Multivariate analysis revealed three independent risk factors: higher age, polypharmacy, and malignant disease (all P<0.01). Malnutrition was associated with an 43% increase of hospital stay (P<0.001). CONCLUSIONS: In German hospitals every fourth patient is malnourished. Malnutrition is associated with increased length of hospital stay. Higher age, malignant disease and major comorbidity were found to be the main contributors to malnutrition. Adequate nutritional support should be initiated in order to optimize the clinical outcome of these patients.

Adolescent↗
PubMed2006

Role of intestinal function in cachexia.

PURPOSE OF REVIEW: Cachexia is a prominent feature in many chronic diseases, but its pathogenesis is still not fully understood. This article reviews recent research into the role of the gut barrier in the pathogenesis of inflammation and cachexia with special emphasis on two potentially catabolic diseases: liver cirrhosis and chronic heart failure. RECENT FINDINGS: There is increasing evidence that catabolic diseases such as liver cirrhosis and chronic heart failure are associated with increased gut permeability, endotoxemia and enhanced expression of proinflammatory cytokines. In liver cirrhosis normalization of portal hypertension by insertion of a transjugular intrahepatic portosystemic stent shunt obviously causes improvement not only of gut barrier function, but also of nutritional status. SUMMARY: Although its pathogenesis is not yet completely understood, proinflammatory cytokines have been implicated in the onset and progression of cachexia. Recent data support the hypothesis that impaired gut barrier function and increased permeability further translocation of endotoxins. Increased endotoxemia might be a potent trigger of systemic inflammatory response which is involved in the pathogenesis of the cachexia syndrome. Thus, it is tempting to speculate that therapeutic strategies for the improvement of gut barrier function will concomitantly improve nutritional status.

Bacterial Translocation↗
PubMed2005

The Subjective Global Assessment reliably identifies malnutrition-related muscle dysfunction.

BACKGROUND: Muscle dysfunction is a common finding in malnourished patients and is associated with poor outcome. We investigated whether the Subjective Global Assessment (SGA) is a valuable tool for identifying malnutrition-related muscle dysfunction. METHODS: Two hundred eighty seven consecutive patients were assessed on admission to hospital according to the SGA, anthropometric measurements, and to the results of bioelectrical impedance analysis. The SGA was used as the main criterion for the classification of malnutrition. Muscle function was assessed by handgrip strength. RESULTS: Maximal voluntary handgrip strength was significantly lower in malnourished than in well-nourished male and female patients (45.22 (13.51-67.7)kg versus 30.82(11-48) kg in men; 23.81 (5.60-56.5) kg versus 18.5 (5.90-48.8) kg in women). Handgrip strength tended to decline with age. Handgrip strength was positively correlated to body cell mass (BCM) (r=0.72, P<0.001 in men and: r=0.56, P<0.001 in women) and to body mass index (r=0.271, P=0.03 in men and r=0.183, P=0.02 in women). BCM was identified as a powerful contributor to the variation in handgrip strength (delta r2=0.645, P<0.001). CONCLUSION: The SGA appears to be a reliable bedside assessment tool for malnutrition and malnutrition-related dysfunction. Patients classified malnourished according to the SGA have an impaired functional status. Every effort should be made to provide both nutritional and physical therapy in order to improve the patients' outcome.

Adolescent↗
PubMed2005

Increased length of hospital stay in underweight and overweight patients at hospital admission: a controlled population study.

BACKGROUND: Reduced lean tissue as well as high fat mass may be independent nutritional risk factors resulting in increased length of hospital stay (LOS). This controlled population study (1707 patients, 1707 volunteers) aimed to evaluate the association between LOS in Geneva and Berlin patients at hospital admission and high fat mass index (FMI, kg/m2) and low fat-free mass index (FFMI, kg/m2), and the respective value of body mass index (BMI) and of FFMI and FMI for nutritional assessment. METHODS: Patients (891 men, 816 women) were prospectively recruited at hospital admission and compared to gender-, age- and height-matched healthy volunteers. Fat-free mass and fat mass, determined at admission by 50 kHz-bioelectrical impedance analysis, were expressed as indices (FFMI and FMI-kg/m2) to normalize for height. Patients were classified in four groups: normal, low FFMI, high FMI, or low FFMI and high FMI. Logistic regressions were used to determine the association between body composition and LOS. RESULTS: Higher FMI and lower FFMI were found in patients at hospital admission than in sex- and age-matched healthy volunteers. Low FFMI, high FMI, and low FFMI/high FMI combined, adjusted for age, were all significantly associated with longer LOS (high FFMI: 1-5 days OR 2.4, CI 2.0-2.9; 6-10 days OR 2.3, CI 1.8-3.0; 11 days OR 2.8, CI 2.2-3.5); low FMI: 1-5 days OR 1.9, CI 1.6-2.2; 6-10 days OR 2.7, CI 2.0-3.5, 11 days OR 2.1, CI 1.7-2.7; low FFMI/high FMI: 1-5 days OR 7.8, CI 5.3-11.4; 6-10 days OR 13.6, CI 7.8-23.5, 11 days OR 11.8, CI 7.0-19.8). CONCLUSION: Increased LOS is associated with adiposity (high FMI) and low muscle mass (low FFMI). The current study shows that both depletion of lean tissue and excess of fat mass negatively affect the LOS. Finally, we found that excess fat mass reduces the sensitivity of BMI to detect nutritional depletion.

Adipose Tissue↗
PubMed2005

Does nutritional risk, as assessed by Nutritional Risk Index, increase during hospital stay? A multinational population-based study.

BACKGROUND: Progressive nutritional depletion has been reported during hospital stay. This prospective study compared the proportion of nutritional risk at hospital admission in three European countries and further evaluated nutritional risk at late versus early phase of hospitalization in one hospital. METHODS: Nutritional risk was determined in Geneva, Switzerland (n = 652), Berlin, Germany (n = 621) and Nice, France (n = 107) at hospital admission, and during hospital stay (0-100 d) in Nice (n = 527) by the Nutritional Risk Index (NRI) = (1.519 x serum albumin, g/l)+41.7 x (present weight/usual weight). NRI score of >100: no risk (NR); 97.5-100: mild risk; 83.5-97.5: moderate risk (MR); 83.5: severe risk (SR). Logistic regressions were used to determine the odds ratios (OR) between MR or SR and length of hospital stay (LOS) 16d compared to 1-15 d or nutritional assessment at 16-100 d compared to 1-15 d of hospitalization. RESULTS: Patients, assessed at hospital admission, who were hospitalized >16d were more likely (P < 0.001) to be at MR (OR 2.0, CI 1.4-3.0) or SR (OR 3.3, CI 1.7-6.2) than patients hospitalized 1-15 d. Nice patients assessed at 16-100 d were more likely (P < 0.001) to be at MR (OR 5.4, CI 2.1-14.3) and SR (OR 14.7, CI 5.4-40.0) than patients assessed at 1-15 d of hospitalization. CONCLUSIONS: The risk of MR or SR by NRI was greater in patients assessed during hospitalization than in patients assessed at hospital admission, which suggests that patients evaluated later during hospitalization are at greater risk than patients evaluated in the early phase of hospitalization. Ongoing assessment during hospitalization seems important to identify patients who are at increased risk for complications.

Analysis of Variance↗
PubMed2005

Social risk factors for hospital malnutrition.

OBJECTIVE: Disease severity is considered an important risk factor for malnutrition in hospitalized patients. We investigated the effect of social factors and disease parameters on the development of malnutrition. METHODS: Nutritional state was assessed by the Subjective Global Assessment in 794 consecutively admitted patients in two hospitals in Berlin (n = 493, university hospital; n = 301, district hospital). The influences of age, sex, social status, life habits, and disease parameters on nutritional state was analyzed with univariate and multivariate logistic regression methods. RESULTS: Malnutrition was diagnosed in 22% of patients. Its prevalence was significantly higher in patients with malignant than with benign diseases (odds ratio [OR] = 1.568, P < 0.05) and in patients with multiple prescriptions (OR = 1.154, P < 0.001), but no difference was found between medical or surgical patients. The strongest risk factors for malnutrition in univariate analysis were age older than 60 y (OR = 2.861, P < 0.001), living alone (OR = 1.769, P = 0.002), and achieving a lower level of education (OR = 1.589, P < 0.05). Therefore, multivariate analysis was performed after stratification for age. Demonstrated independent additional risk factors were polypharmacy (OR = 2.367, P < 0.001) and malignant disease (OR = 4.114, P < 0.001) in young patients and polypharmacy (OR = 1.109, P < 0.002) and living alone (OR = 1.830, P = 0.008) in patients 60 y and older. CONCLUSIONS: These data show that patients who are older, less educated, and live alone are at high risk of developing malnutrition. Thus special attention should be given to these risk groups when evaluating nutritional status and nutritional support.

Age Factors↗
PubMed2004

Alterations in glucose metabolism associated with liver cirrhosis persist in the clinically stable long-term course after liver transplantation.

With increasing long-term survival rates after orthotopic liver transplantation (OLT), metabolic alterations complicating the clinical course, such as diabetes mellitus (DM), become increasingly important. Liver cirrhosis is associated with severe alterations in glucose metabolism. However, it is currently unclear whether these changes are reversed by successful OLT. We therefore characterized glucose metabolism in patients with liver cirrhosis and normal fasting glucose levels before OLT (cir), in the clinically stable long-term course after OLT (OLT), and control subjects (con) using oral glucose tolerance tests (cir = 100, OLT = 62, con = 32), euglycemic-hyperinsulinemic clamps (cir = 10, OLT = 27, con = 14), and positron emission tomography (PET) scan analysis with 18F-fluorodeoxyglucose (FDG) as a tracer (cir = 7, OLT = 7, con = 5). Fasting insulin and C-peptide levels were significantly elevated in patients with liver cirrhosis compared with both control subjects (P <.001) and patients after OLT (P <.001). After OLT, insulin was normalized, whereas C-peptide remained elevated (P < 0.01). In the patients with liver cirrhosis, 27% had a normal glucose tolerance, 38% had an impaired glucose tolerance (IGT), and 35% were diabetic. After OLT, 34% had a normal glucose tolerance, 29% an IGT, and 37% were diabetic. Comparison of the same patients before and after OLT demonstrated that IGT or diabetes before OLT was the major risk factor for these conditions after OLT, which was independent of either immunosuppression (cyclosporine vs FK506) or low-dose prednisolone. Total glucose uptake was reduced in patients with liver cirrhosis to less than half the values in control subjects (21.2 +/- 2.8 vs 43.7 +/- 2.4 micromol/kg/minute, respectively, P <.001), whereas patients after OLT showed intermediate values (35.7 +/- 1.4 micromol/kg/minute, P < 0.05 vs con, P < 0.01 vs cir). This difference was caused by a reduction in nonoxidative glucose metabolism in patients with liver cirrhosis compared with control subjects (7.4 +/- 1.9 vs 28.7 +/- 1.8 micromol/kg/minute, respectively, P <.01) and patients after OLT (20.1 +/- 1.4 micromol/kg/minute, P < 0.05 vs con and OLT). In the PET study, skeletal muscle glucose uptake was significantly reduced in patients with liver cirrhosis compared with control subjects (3.5 +/- 0.4 vs 11.8 +/- 2.5 micromol/100g/minute, respectively, P <.05). After OLT, muscle glucose uptake improved compared with patients with liver cirrhosis (5.9 +/- 1.0 micromol/100g/minute, P <.05) but remained significantly lower than in control subjects (P <.05). In conclusion, these results demonstrate that preexisting IGT or diabetes are the major risk factors for IGT and diabetes after OLT. This finding was independent of the immunosuppressive medication. The peripheral insulin resistance in cirrhosis is characterized by a decrease in nonoxidative glucose disposal that is improved, but not normalized, after OLT.

Adult↗
PubMed2004

Bioelectrical impedance analysis--part I: review of principles and methods.

The use of bioelectrical impedance analysis (BIA) is widespread both in healthy subjects and patients, but suffers from a lack of standardized method and quality control procedures. BIA allows the determination of the fat-free mass (FFM) and total body water (TBW) in subjects without significant fluid and electrolyte abnormalities, when using appropriate population, age or pathology-specific BIA equations and established procedures. Published BIA equations validated against a reference method in a sufficiently large number of subjects are presented and ranked according to the standard error of the estimate. The determination of changes in body cell mass (BCM), extra cellular (ECW) and intra cellular water (ICW) requires further research using a valid model that guarantees that ECW changes do not corrupt the ICW. The use of segmental-BIA, multifrequency BIA, or bioelectrical spectroscopy in altered hydration states also requires further research. ESPEN guidelines for the clinical use of BIA measurements are described in a paper to appear soon in Clinical Nutrition.

Body Composition↗
PubMed2004

Bioelectrical impedance analysis-part II: utilization in clinical practice.

BIA is easy, non-invasive, relatively inexpensive and can be performed in almost any subject because it is portable. Part II of these ESPEN guidelines reports results for fat-free mass (FFM), body fat (BF), body cell mass (BCM), total body water (TBW), extracellular water (ECW) and intracellular water (ICW) from various studies in healthy and ill subjects. The data suggests that BIA works well in healthy subjects and in patients with stable water and electrolytes balance with a validated BIA equation that is appropriate with regard to age, sex and race. Clinical use of BIA in subjects at extremes of BMI ranges or with abnormal hydration cannot be recommended for routine assessment of patients until further validation has proven for BIA algorithm to be accurate in such conditions. Multi-frequency- and segmental-BIA may have advantages over single-frequency BIA in these conditions, but further validation is necessary. Longitudinal follow-up of body composition by BIA is possible in subjects with BMI 16-34 kg/m(2) without abnormal hydration, but must be interpreted with caution. Further validation of BIA is necessary to understand the mechanisms for the changes observed in acute illness, altered fat/lean mass ratios, extreme heights and body shape abnormalities.

Algorithms↗
PubMed2004

Weight gain after transjugular intrahepatic portosystemic shunt is associated with improvement in body composition in malnourished patients with cirrhosis and hypermetabolism.

BACKGROUND/AIMS: To search for changes in body composition and energy metabolism associated with the repeatedly observed weight gain of cirrhotic patients after portosystemic shunting. METHODS: Twenty-one patients were studied prospectively before and 6 and 12 months after transjugular intrahepatic portosystemic shunt (TIPS) to assess body cell mass by two independent methods (total body potassium counting: body cell mass determined by TBP, BCMTBP, bioelectric impedance analysis: body cell mass determined by BIA, BCMBIA), muscle mass (anthropometry), resting energy expenditure (REECALO) by indirect calorimetry, and nutritional intake by dietary recall analysis. RESULTS: Prior to TIPS patients were hypermetabolic in terms of measured vs. predicted REE (REECALO median 1423 (range 1164-1838) vs. REEPRED 1279 (1067-1687) kcal; P<0.05) and their body cell mass was lower (19.1 (10.9-33.4) vs. 31.7 (16.8-47.1) kg; P=0.001). After TIPS body cell mass (BCMBIA) increased to 23.5 (12.7-44.3) (P<0.025) and 25.7 (14.2-39.7) kg (P=0.05) at 6 and 12 months after TIPS and this was confirmed by total potassium counting (BCMTBP before TIPS: 18.8 (10.6-26.7) vs. 22.4 (12.9-28.5) kg at 6 months; P<0.01). Hypermetabolism persisted throughout the study period. Energy and protein intake increased significantly by 26 and 33%. CONCLUSIONS: An increase of prognostically relevant variables body cell and muscle mass contributes to the weight gain after TIPS in malnourished patients with cirrhosis and hypermetabolism.

Adult↗
PubMed2003

Manifestation of thyrotoxic periodic paralysis in two patients with adrenal adenomas and hyperandrogenaemia.

Hypokalaemic periodic paralysis is a fairly common complication of hyperthyroidism in Asian populations, but a rare event in Caucasians. In the present work we describe 2 male Caucasian patients with thyrotoxic periodic paralysis (TPP) as initial clinical manifestation of Graves' disease. Further diagnostic procedures demonstrated unilateral adrenal adenoma and hyperandrogenaemia in both patients. To date, only few data are available concerning the hormonal status of Caucasian patients with TPP. The constellation of TPP and adrenal adenomas with increased levels of androgens has not been described previously. Since androgens are capable of inducing sodium-potassium ATPase, which is thought to be centrally involved in the pathogenesis of TPP, hyperandrogenaemia may have triggered the manifestation of paralytic attacks in our patients. It may be of interest to focus not only on thyroid dysbalances in patients with TTP but also to investigate other hormonal disturbances.

Adenoma↗
PubMed2003

Prevalence of malnutrition in hospitalized medical patients: impact of underlying disease.

BACKGROUND/AIMS: Malnutrition is common among hospitalized patients. We investigated whether certain diseases predispose more frequently for malnutrition than others. METHODS: Nutritional state was assessed by clinical scores, anthropometry and bioimpedance analysis in 502 consecutively admitted patients in the departments of internal medicine in two hospitals in Berlin (n = 300, university hospital; n = 202, district hospital). The prevalence of malnutrition was compared in patient groups with a different diagnosis. RESULTS: Malnutrition was present in 24.2% of all patients. A clear association between diagnoses and malnutrition was found: the prevalence of malnutrition was significantly higher in malignant than in non-malignant diseases (50.9 vs. 21.0%, p < 0.0001). High prevalence rates >30% were observed in subgroups of patients with inflammatory bowel diseases, chronic heart failure and benign lung diseases. Patients with gastrointestinal diseases, however, were not more frequently malnourished than other medical patients (28.8 vs. 22.0%). Malnourished patients were significantly older (70.0 +/- 13.6 vs. 58.3 +/- 15.6 years, p < 0.0001) and had a 40% longer hospital stay (13.1 +/- 8.1 vs. 9.3 +/- 6.8 days, p < 0.0001) than well-nourished patients. CONCLUSIONS: Patients with malignancies, inflammatory bowel disease, chronic heart failure and benign lung diseases need special attention due to the high prevalence of malnutrition.

Age Factors↗
PubMed2002

Alpha-lipoic acid prevents ethanol-induced protein oxidation in mouse hippocampal HT22 cells.

Oxidative stress is involved in a number of neurological disorders, including the neurotoxic effects of ethanol. Recent studies have described a neuroprotective potential of alpha-lipoic acid (LC) in several models of neuronal cell death related to oxidative stress. We tested the hypothesis that LC could be effective in preventing ethanol-induced neurotoxicity employing the clonal hippocampa cell line HT22. A 24 h incubation with ethanol 100-600 mM caused a dose-dependent loss of cell viability and a significant increase of the overall intracellular protein oxidation. Coincubation with LC 0.1 mM resulted in a significant decrease of ethanol-related neurotoxicity and a complete prevention of the ethanol-induced intracellular protein oxidation. These results indicate that the radical scavenging properties of LC are effective to ameliorate ethanol-induced neurotoxicity.

Alcohol-Induced Disorders, Nervous System↗