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Jejunoileal bypass for morbid obesity is accompanied by excessive morbidity and significant mortality. Weight loss is achieved at the expense of major nutritional changes which in and of themselves produce complications. The operation should be considered investigational and be limited to those centers with special interest in the problem and where longterm follow-up and management can be carried out.
Certain indices of haemodynamics and ECG have been recorded in a biorhythmological study in 141 patients with ischaemic heart disease and in 26 practically healthy individuals. It was established that both the healthy individuals and the patients with ischaemic heart disease have diurnal rhythms of pulse rate, systolic and diastolic pressure, minute heart volume, R--R QRST, TQ intervals and R and T waves on ECG. The acrophases of diurnal rhythms of these indices in the healthy people are in mutual concordance with maximum figures during the daily and early evening hours. In the healthy the acrophase of T wave is seen during the day, in patient with ischaemic heart disease at night and early in the morning. This points to disorders of the bioelectric processes in the myocardium due to its nutritional changes over the 24 hours.
The tendencies in and control of cardiovascular diseases were studied for three years according to the MONICA psychosocial program. A random representative sample of 753 men aged 25-64 years (in the first screening) and 739 men (in the second screening) permanently living in one of the districts of Novosibirsk were examined. The purpose was to investigate the knowledge of the population of the issues related to the health status: self-estimation of the health status, knowledge of blood pressure magnitude, attitude to the prophylaxis, tobacco smoking and changes in nutrition. The data obtained indicate that self-estimation of the health status changed for the worse in all the age groups. The share of persons asserting that they are ill or not entirely well rose by 12% and amounted to 62%. A decrease was recorded in the number of men not aware of the level of their blood pressure, namely from 27% in the first screening to 17% in the second screening. The number of tobacco smokers remained practically unchanged (55 and 54%). However, the number of men who would like to change their attitude toward tobacco smoking increased more than 1.5-fold. The treatment of the proposals concerning alterations in nutrition changed for the better in persons aged 45-64 years. On the contrary, it changed for the worse in persons aged 25-44 years.
The purpose of this descriptive longitudinal study was to describe the relationship of nutritional intake to weight change, symptom distress, and functional status over a six-month period in 28 subjects with progressive lung cancer. The majority of the subjects had non-small cell lung cancer and had lost less than 10% of their body weight at the time of study entry. Body weight, hunger, symptom distress, and functional status were measured every six weeks, beginning two months after diagnosis, for a six-month period. Three-day diet records, which were completed immediately prior to each time point, were averaged to obtain nutrient intake data. Average weight change and nutritional intake showed little variation over time, but the ranges were large. Lower intake of kilocalories was moderately related to functional status at Times 1 and 5 (r = -0.56; r = -0.66, respectively). Kilocalorie intake at a previous time was related to subsequent functional decline at two of the six-week data points (r = -0.71; r = -0.75). Weight change was not directly related to kilocalorie intake. Percentage of weight loss over time was greater in subjects younger than 65 years of age, in those with small cell lung cancer, and in those who received chemotherapy. Symptom distress and symptoms of hunger, nausea, and appetite disturbance showed subtle fluctuations over the six-month period and had inconsistent relationships with food intake over time. Further study is needed to describe nutritional changes that follow a diagnosis of lung cancer and to identify areas for nursing intervention.
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.
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.
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.
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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.
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)
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.
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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.
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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.
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