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Longitudinal study on the effect of treatment on body composition and anthropometry of celiac disease patients.

OBJECTIVES: This prospective study was designed to assess the nutritional changes associated with the long-term treatment of celiac disease. In addition, we analyzed whether these changes were related to the degree of compliance with a gluten-free diet. METHODS: We studied nutritional parameters and body composition in 25 newly diagnosed celiac patients after a mean period of 37 months (range 25-49 months) on a gluten-free diet. Body composition parameters (fat, lean tissue, and bone masses) were measured by dual energy x-ray absorptiometry. Anthropometry was measured according to conventional formulas. RESULTS: At diagnosis, fat (-49%), lean tissue (-12%), and bone (-24%) compartments were reduced, compared with that of sex- and age-matched controls. After treatment, we noted a significant increase in body weight (p < 0.0001), fat mass (p < 0.0005), bone mass (p < 0.002), and body mass index (p < 0.005). In contrast, we did not observe a significant increase in lean-tissue mass or muscle mass. Patients who adhered strictly to a gluten-free diet experienced a greater, though nonsignificant improvement in fat mass, body weight, and body mass index than patients whose compliance had been partial. Mean caloric intake at the end of the study was significantly lower among those patients who had adhered strictly to a gluten-free diet, compared with those who had complied only partially with the diet (p < 0.05). CONCLUSIONS: This study shows that the institution of a gluten-free diet in celiac disease patients results in a significant improvement in nutritional parameters, as measured by anthropometry and/or body composition. This effect was more pronounced in patients who followed strict gluten restriction and was related mainly to changes in fat and bone compartments.

Adult↗

From physiology to neuroendocrinology: a reappraisal of risk factors of body weight gain in humans.

Obesity results from a chronic imbalance between energy intake and energy expenditure. However, the biological mechanism(s) underlying possible alterations of energy balance is(are) still poorly defined. Advances in the understanding of body weight regulation in humans are represented by the discovery of: a) metabolic risk factors of body weight gain (i.e. low resting energy expenditure, low level of physical activity, high carbohydrate-to-lipid oxidation rate); b) the role of the autonomic nervous system in the control of energy metabolism and nutrient partitioning; and c) leptin, a previously unknown hormone produced by the adipocyte which seems to be quite involved in the complex neurohormonal regulation of energy balance. In view of these discoveries, current models of human body weight regulation concord on the existence of crosstalks between central nervous system and peripheral tissues. The brain monitors the nutritional status of the body (using several peripheral afferent signals including leptin) and reacts to nutritional changes by modulating the activity of its neurohormonal efferent signaling systems (autonomic nervous systems and endocrine organs). A low sympathetic nervous system (SNS) activity and a relative plasma leptin deficiency have been shown to predict body weight gain. Furthermore, plasma concentration of leptin and activity of the SNS seem to regulate each other. This paper reviews the evidence that previously described metabolic risk factors of body weight gain (i.e., low resting energy expenditure, low level of physical activity, and high carbohydrate-to-lipid oxidation rate) may in fact be the phenotypic expression of a dysfunctional leptin-SNS activity body weight regulatory loop.

Basal Metabolism↗

Effectiveness of megestrol acetate in patients with advanced cancer: a randomized, double-blind, crossover study.

PURPOSE: To evaluate the effect of megestrol acetate at a lower dose than previously investigated on the symptoms of cachexia in patients with advanced cancer. METHODS: A total of 84 patients with advanced, solid tumours not responsive to hormone therapy were enrolled in this double-blind, crossover study. During phase 1, patients were randomly assigned to receive megestrol acetate (160 mg 3 times daily) for 10 days or placebo. During phase 2, after a 2-day washout period, patients received the alternate treatment for 10 days. Patients underwent daily assessments of activity, nausea, appetite and well-being by means of a visual analogue scale (VAS). In addition, nutritional status (weight, tricep skinfold measure, arm muscle circumference), energy intake, fatigue (Piper Fatigue Scale) and quality of life (Functional Living Index-Cancer [FLIC]) were assessed. RESULTS: Among the 53 evaluable patients megestrol acetate resulted in a significant improvement in appetite (p = 0.005), activity (p = 0.007) and well-being (p = 0.03). There was no significant change in the intensity of nausea, nutritional parameters, energy intake or FLIC scores. There was a significant improvement in 2 of the 3 factors measured by the Piper Fatigue Scale and in the overall fatigue score. Upon completion of the study, while still blind to the treatment condition, 30 patients indicated that they felt better overall after megestrol, 15 said they felt better after placebo, and 10 indicated no preference (p = 0.001). CONCLUSION: Treatment with megestrol acetate results in rapid and significant improvement of symptoms in terminally ill patients at lower doses than previously reported. The effects are not secondary to nutritional changes. The FLIC quality-of-life questionnaire was unable to detect these changes.

Adult↗

Consistent improvement in the nutritional status of Colombian children between 1965 and 1989.

Three national anthropometric surveys carried out in Colombia in 1965-1966, 1977-1980, and 1986-1989 provide a reasonably standardized basis for comparing the nutritional status of infants and young children in those years. That comparison, presented here together with appropriate socioeconomic data, indicates marked reduction of malnutrition paralleling strong socioeconomic gains.

Adult↗

The use of anthropometry to assess nutritional status.

Anthropometry (the use of body measurements to assess nutritional status) is a practical and immediately applicable technique for assessing children's development patterns during the first years of life. An evaluation of their growth also provides useful insights into the nutrition and health situation of entire population groups. Anthropometric indicators are less accurate than clinical and biochemical techniques when it comes to assessing individual nutritional status. In many field situations where resources are severely limited, however, anthropometry can be used as a screening device to identify individuals at risk of undernutrition, followed by a more elaborate investigation using other techniques. Similarly, growth monitoring permits the detection of individuals with faltering growth, who can then be appropriately referred to specialized care. Thanks to the standardization that has taken place in recent years, changes in trends over time with respect to the nutritional situation can be evaluated in countries where national food and nutrition surveillance systems have been developed, or where nationally representative cross-sectional surveys have been conducted some years apart using identical, or nearly identical, methodologies. Although data that can be used to evaluate trends are limited, some insight can be gained into the nutritional situation and changes occurring over time in a number of countries. Prevalence figures for underweight (low weight-for-age) have been prepared using standard methods of data collection, analysis and presentation, for several countries in Africa, the Americas and Asia. As such, they fail to differentiate between wasting and stunting, or to evaluate differences between age groups. Also, they do not necessarily reflect trends in other countries in the same or other regions. Still, it is interesting, if not statistically significant, that there has been a general improvement in the nutritional status of preschool children. Intercountry trend comparisons are difficult for two main reasons. Firstly, the time between surveys is occasionally different and, secondly, despite efforts to standardize data analysis and presentation, different cut-off points have been used to calculate prevalence figures and estimate the extent of undernutrition. However, the use of identical cut-off points is not essential for making intercountry trend analyses since it is the general trends in growth deficit and nutritional status over time which are being evaluated.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗

Reducing the risk of cardiovascular disease: effects of a community-based campaign on knowledge and behavior.

In 1972 the Stanford Heart Disease Prevention Program launched a three-community field study. A multimedia campaign was conducted for two years in two California communities (Watsonville and Gilroy), in one of which (Watsonville) it was supplemented by an intensive-instruction program with high-risk subjects. A third community (Tracy) was used as a control. The campaigns were designed to increase participants' knowledge of the risk factors for cardiovascular disease, to change such risk-producing behavior as cigarette smoking, and to decrease the participants' dietary intake of calories, salt, sugar, saturated fat, and cholesterol. Results of a sample survey indicate that substantial gains in knowledge, in behavioral modification, and in the estimated risk of cardiovascular disease can be produced by both methods of intervention. The intensive-instruction program, when combined with the mass-medica campaign, emerged as the most effective for those participants who were initially evaluated to be at high risk. The results after two years of intervention are reported for effects on knowledge and behavioral change for the total participant samples and for the high-risk subsamples in each of the three communities.

Attitude to Health↗

Growth charts and the assessment of infant feeding practices in the western world and in developing countries.

Changes during the past ten years in infant feeding practices are described and it is demonstrated that with the growing popularity of breast feeding, plus the later addition of solids, dietary energy intakes are substantially lower than they were. These dietary changes would appear to be associated with alterations in the detailed pattern of growth. When exclusively breast-fed, babies, if anything, grow more quickly than growth standard rates, but after 3-4 months a relative deceleration in growth velocity becomes apparent. The anthropometric and dietary findings are discussed in relation to the use of growth charts for the assessment of the adequacy of infant feeding practices in the western world and especially in the Third World. A reanalysis of data indicates that diet-related growth faltering probably does not occur in many developing country situations until later than would be suggested by growth standards currently in use.

Anthropometry↗

Effects of biosocial variables on changes in nutritional status of rural Bangladeshi children, pre- and post-monsoon flooding.

This study examined the effects of biosocial variables on changes in nutritional status of rural Bangladeshi children, aged less than 2 years, pre- and post-1987 monsoon flooding. Nutritional status was measured by weight for age: variables included were age, sex, sickness during 2 weeks preceding the survey, intake of vitamin A capsules, socioeconomic status of household, and mother's education. A multivariate logistic regression analysis revealed an adverse effect of flood on nutrition and the effect was dependent on sex of child and intake of vitamin A. After the flood the proportion of severely malnourished children was significantly greater among those who had not taken vitamin A. For boys the proportion with severe malnutrition increased after the flood and the increase was greater than for girls; however, boys always had a lower risk of severe malnutrition than girls.

Bangladesh↗

The effect of improved nutrition on plasma prolactin concentrations and postpartum infertility in lactating Gambian women.

A substantial increase in food consumption of lactating Gambian women has been shown to be associated with a reduction in their plasma prolactin concentration. Women receiving food supplements during pregnancy as well as in lactation exhibited an even greater lowering of the postpartum plasma levels of this hormone. Consequently prolactin values of supplemented women returned more quickly to levels which allowed the resumption of menstrual and ovulatory activity. Concurrent measurements of the plasma concentrations of estradiol and progesterone in addition to prolactin allowed the calculation of prolactin values at which half the lactating women could be expected to have resumed menstruation and ovulation. These values were 1007 and 759 microU/ml, respectively. Dietary improvement during lactation alone resulted in these critical prolactin concentrations being reached 21 wk earlier than in nonsupplemented counterparts, while those receiving the extra food in both pregnancy and lactation showed a 35-wk shortening of postpartum amenorrhea and infertility.

Amenorrhea↗

Infant mortality and childhood nutritional status among Afghan refugees in Pakistan.

In 1984 and again in 1985, systematic surveys were undertaken to evaluate infant mortality and childhood nutritional status among the Afghan refugee population in Pakistan. The entire Afghan refugee population under the administration of the United Nations High Commissioner for Refugees was sampled. Infant mortality rates were estimated to be 156 per 1000 for 1984 and 119 per 1000 for 1985. A decline was also suggested in neonatal mortality rates from 61 per 1000 for 1984 to 46 per 1000 for 1985. For neither infant nor neonatal mortality was the difference statistically significant. Improvements were seen in the percentage of children who died before their fifth birthday (22.5% in 1984 and 18.8% in 1985), in the percentage of children who were malnourished (3.5% in 1984 and 2.3% in 1985), and an increase in the percentage of children above the WHO/NCHS/CDC weight-for-height reference median (26% in 1984 and 35% in 1985). Diarrhoea was the most frequently reported cause of death for both years and was a particularly important cause of death among one-year-old children. In 1985, measles was related to 24% of the deaths and neonatal tetanus to 9% of the deaths, an increase from 8% for measles and 6% for tetanus in 1984.

Afghanistan↗

The infant food industry and international child health.

Declining breast-feeding, with accompanying increased marasmus and diarrhea, has occurred in developing countries because of many factors, including inappropriate health services, new urban life styles, and so forth. The infant food industry must bear a considerable burden of blame as a result of "unethical" advertising. Responses have most recently included various journalistic and legal actions. There is a need for revised roles for the infant food industry, and for mechanisms to monitor intrinsically harmful practices.

Advertising↗

Consumption pattern of infant foods by Turkish immigrants.

Fifty-nine Turkish infants in metropolitan Stockholm and two adjacent communities have been studied regarding food consumption pattern. The infants were breastfed for a shorter period than expected in Turkey and shorter than in Swedish children. Illiterate mothers breastfed longer than those who had received some kind of education. Formula feeding was extensively used. Supplementary semisolid feeding was introduced, mainly at 4-6 months of age, much earlier than in Turkey but rather later than in Swedish families. Some problems were noted with the bottle feeding, most importantly with regard to hygienic practices, dangerous especially on summer visits to Turkey. Unsatisfactory handling of bottle feeding was linked to the mother's educational level. Further interest in nutrition education for this and other immigrant groups is important.

Animals↗

Nutritional status of Brazilian children: trends from 1975 to 1989.

The prevalence of malnutrition among under-5-year-olds in Brazil fell by more than 60% between 1975 and 1989. The benefits were smaller for population strata that were more affected by malnutrition in the 1970s, i.e., children from the North and North-east regions and those from poor families in general. Regional and socioeconomic differentials in the prevalence of malnutrition therefore increased between 1975 and 1989. Trends in family income indicate extraordinary economic gains in the 1970s, some losses in the 1980s, and a modest net gain over the period 1975-89. The availability of sanitation, health, and education services, and the provision of preschool supplementary feeding programmes increased markedly in the 1970s and 1980s. Demographic trends were also positive, reducing the demand for services and programmes, increasing the economic efficiency of families, and concentrating the population in urban areas, where incomes, job opportunities, and social and material infrastructures are better. The observed nutritional improvement was therefore probably due to a moderate increase in family income associated with a substantial expansion in the provision of services and programmes, both of which were facilitated by favourable demographic trends. Also, the nutritional improvement was probably concentrated during the 1970s, while little, if any, occurred after 1980; prospects for the 1990s point to a stagnant situation. This is a reason for great concern particularly in the North and North-east regions of the country, where high rates of child malnutrition are still found.

Brazil↗