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 51,768 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Fecal energy (FE) loss was measured using bomb calorimetry in 30 patients; 14 had a history of malabsorption, while 16 had no history of intestinal dysfunction. Average digestibility (and range) of energy and FE loss were 73% (48 to 91%) and 493 kcal/day (177 to 927 kcal/day) in the group with malabsorption, compared to 96% (89 to 99%) and 74 kcal/day (8 to 146 kcal/day) in the group without malabsorption, respectively. Metabolizable energy supplied by the diet (intake kcal -- (fecal kcal + urinary kcal) was below the calculated daily energy requirement in five of seven patients with malabsorption; in three of these five subjects the combination of decreased energy intake and increased FE loss produced negative energy balance, while in the remaining two patients malabsorption alone caused negative energy balance. Inadequate metabolizable energy in these five patients was associated with weight loss and protein-energy malnutrition. The usual clinical laboratory tests applied to the study of malabsorption, including fecal fat, fecal nitrogen, and stool weight, were poor predictors of FE loss. These tests were also of limited value in assessing the effects of dietary modification on energy malabsorption. Contrastingly, bomb calorimetry provided a simple and accurate alternative in quantitatively assessing FE loss in the patient with malabsorption.
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PMID:Energy malabsorption: measurement and nutritional consequences. 728 20

We report herein the case of a 56-year-old woman who developed secondary Kwashiorkor 9 years after undergoing a total gastrectomy for early gastric cancer. Until she began developing the symptoms of Kwashiorkor, including general fatigue, edema of the face and extremities, anemia, alopecia, and weight loss, she had been leading a normal life post-gastrectomy. Her symptoms were alleviated by total parenteral nutrition (TPN) therapy, but reappeared soon after TPN therapy was discontinued. Therefore, she required several subsequent courses of TPN. In an attempt to permanently resolve the ongoing Kwashiorkor symptoms, reconstructive surgery involving transposition of the jejunum from the previous Graham method to the interposition method was performed 10 years after the initial gastrectomy. After the second operation, her malnutrition was completely alleviated, and she has been in good health for the 8 years since. To our knowledge, there has been no other report of the symptoms of secondary Kwashiorkor after total gastrectomy being alleviated by altering the procedure of reconstruction of the intestinal tract. Thus, we recommend surgical treatment to alter the digestive continuity to a more physiological pathway for selected patients with secondary Kwashiorkor syndrome.
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PMID:Successful surgical treatment of secondary Kwashiorkor after total gastrectomy: report of a case. 757 64

Growth in children with congenital heart disease (CHD) is often compromised. For several decades, investigators have tried to identify the factors affecting growth in children with CHD. Cardiac malformations are undoubtedly responsible for malnutrition, which may range from mild undernutrition to severe failure to thrive (FTT). Malnutrition may then significantly undermine the outcome of corrective surgical operations and postoperative recovery. Mechanisms linking CHD to malnutrition may be related either to decreased energy intake and/or to increased energy requirements. Decreased energy intake can involve deficiencies of specific nutrients, or insufficient total caloric intake. Increased respiratory rate accompanying congestive heart failure may be responsible for increased energy requirements. Different types of cardiac malformations and consequent interventions may have different effects on growth and require diverse strategies. Most treatment strategies aim to facilitate "catch-up" growth, providing extra calories and protein that exceed the Recommended Dietary Allowance for age. However, there is no generally accepted set of guidelines that define appropriate caloric intake for catch-up growth. We attempt to identify the most important causes of malnutrition and highlight the most effective nutrition strategies for children with CHD.
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PMID:Children with congenital heart disease: a nutrition challenge. 781 52

Eicosanoids may be important factors for tumor cell proliferation, metastatic formation, and development of cancer cachexia. The present study has evaluated the effect of anti-inflammatory treatment on tumor progression in clinical cancer. Patients (n = 135) with insidious or overt malnutrition due to generalized malignancy (various kinds of solid tumors) and an expected survival of more than 6 months were randomized by a computer-based algorithm to receive placebo, prednisolone (10 mg twice daily), or indomethacin (50 mg twice daily) p.o. until death. Patient groups were stratified in the randomization procedure for sex, tumor type, stage, nutritional state, and previous tumor treatment, and biochemical, physiological, and some functional variables (Karnowsky index, fatigue and pain score). A majority of these variables was then registered during the follow-up. Indomethacin and prednisolone treatment maintained Karnowsky index, while placebo-treated patients experienced a decreased index. Indomethacin-treated patients suffered less pain and consumed less additional analgetics compared to the other patient groups. Indomethacin prolonged mean survival compared to placebo-treated patients from 250 +/- 28 days to 510 +/- 28 days (P < 0.05). Survival analysis on observations from all patients treated with either indomethacin or prednisolone demonstrated a significantly prolonged survival by anti-inflammatory treatment compared to placebo treatment (log rank, P < 0.03). The results suggest that not only may prostaglandin synthesis inhibition offer palliative support to patients with solid advanced cancer, but it may also impact on pathways that ultimately determine outcome.
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PMID:Anti-inflammatory treatment may prolong survival in undernourished patients with metastatic solid tumors. 792 4

Some 9% of deaths in Ghana are attributed to malaria, which also accounts for 30% of outpatient visits and 9% of hospital admissions. A survey conducted in four areas of Ghana revealed that the factors perceived as causing malaria included malnutrition, mosquitos, excessive heat, excessive drinking, flies, fatigue, dirty surroundings, unsafe water, bad air, and poor personal hygiene. Most adolescents had no idea how the disease was spread from person to person. The symptoms most frequently considered to be linked to malaria were yellowing of the eyeballs, chills and shivering, headache, a bitter taste, body weakness, and yellowish urine. Malaria was considered to be the most important disease in the communities of Kojo Ashong, Barekese, Barekuma and Oyereko. There was a widespread understanding that malaria adversely impacted the ability of adults to work and of children to attend school. Herbal preparations for self-medication included liquids for drinking, liquids for use as enemas, and potions for hot fomentation. Most people used the leaves of the neem tree (Adzadi rachta indica) to make such preparations. Most interviewees were aware of chloroquine used in the treatment of malaria. A few people sprayed their rooms with insecticide before going to bed in order to kill mosquitos, while others used repellent coils. Bednets were rarely used. There was little knowledge of how the transmission cycle of the parasite could be broken. One social implication of the disease is that if the breadwinner dies, the children may have to cease attending school. For Africa as a whole the annual economic burden of malaria was $ 0.8 billion in 1987; by 1995 it is expected to be $ 1.7 billion. The first step in any control program should be to educate the people about the cause and treatment of the disease. District assemblies should enact bylaws on the cleanliness of households, which inspectors should enforce.
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PMID:Socioeconomic factors in malaria control. 794 58

Weight loss due to malnutrition and possibly intestinal malabsorption is a well-known phenomenon in high-altitude climbers. Up to approximately 5,000 m, energy balance may be attained and intestinal energy digestibility remains normal. To see whether 1) energy balance may also be attained at 6,542 m and, if not, 2) whether decreased energy digestibility would play a significant role in the energy deficit, energy intake (EI), energy expenditure, body composition, and energy digestibility of 10 subjects (4 women, 6 men; 27-44 yr) were assessed during a 21-day sojourn on the summit of Mt. Sajama, Bolivia (6,542 m). EI was measured during two 3-day intervals: EI1 (days 7-9) and EI2 (days 17-19). Total fecal energy loss during EI1 was calculated from fecal energy measured by bomb calorimetry. Average daily metabolic rate (ADMR) at altitude was measured in six subjects (2 women, 4 men) using doubly labeled water over a 10-day interval (days 9-19). Basal metabolic rate was measured before and after the expedition by respiratory gas analysis. Body composition was estimated from skinfolds and body mass before and during the altitude sojourn. Subjects were in negative energy balance throughout the observation period (EI1-ADMR = -2.9 +/- 1.8 MJ/day and EI2-ADMR = -2.3 +/- 1.8 MJ/day based on a gross energy digestibility of 95%). The activity level, expressed as ADMR to basal metabolic rate, was 1.56-2.39. The loss of fat mass (3.7 +/- 1.5 kg) represented 74 +/- 15% of the loss of body mass.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Energy balance at high altitude of 6,542 m. 800 40

The effects of long-term undernutrition (10 wk) on diaphragm contractility, fatigue, and fiber type proportions were studied in male and female rats. Contractility and fatigue resistance indexes were measured in an in vitro diaphragm costal strip preparation by using direct stimulation at 37 degrees C. Undernutrition allowed for continued growth in males and females but with substantial reductions in weight gain. Relative to control rats of the same sex, final weights were significantly lower in undernourished males (74 +/- 3%) than females (90 +/- 5%), but weight gain was not significantly different between undernourished males (58 +/- 5%) and females (60 +/- 3%). Only in males did undernutrition significantly reduce costal diaphragm weight (to 77 +/- 5% of control). Diaphragm forces, normalized for cross-sectional area, were not significantly different from male or female control values. Fatigue resistance indexes (fatigue/baseline force) were increased at all stimulation frequencies in undernourished males but not in undernourished females. Costal diaphragm atrophy, involving types I and II fibers, occurred in undernourished males but not in undernourished females. In conclusion, despite long-term undernutrition reducing weight gain to similar levels in males and females (relative to control), there was excellent preservation of diaphragm weight, function, and structure in females but, although diaphragm atrophy occurred, there was preserved contractility and increased fatigue resistance in males.
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PMID:Effect of long-term undernutrition on male and female rat diaphragm contractility, fatigue, and fiber types. 804 30

The metabolic cost of walking and jogging following injury to the anterior cruciate ligament is unknown. Economy of motion refers to the oxygen consumption for a submaximal work rate. The purpose of this study was to compare the economy of walking and jogging of an anterior cruciate ligament-deficient population with that of a control population without orthopaedic abnormalities. Steady-state oxygen consumption was measured in 30 patients and 98 controls while they were on a treadmill at various speeds. Deficiency of the anterior cruciate ligament was diagnosed arthroscopically. The patients also were tested for isokinetic knee extension-flexion strength, hip flexion, and abduction and adduction strength and underwent arthrometric measurement of anterior tibial displacement. The patients had a statistically significant increase in oxygen consumption when jogging at 160.9 m/min (p = 0.007); however, there was no significant effect of anterior cruciate ligament deficiency on economy at the other speeds tested. The patients had significant deficits in strength of all muscle groups tested. Steady-state oxygen consumption at 160.9 m/min tended to be inversely related to the deficit of strength of knee flexion (r = -0.44, p = 0.07). Arthrometric measurements and chronicity of injury were unrelated to steady-state oxygen consumption. These data indicate that anterior cruciate ligament deficiency increases oxygen consumption during jogging. In long-distance running, this decreased economy translates into significant additional caloric requirements, which may result in earlier fatigue.
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PMID:Effect of anterior cruciate ligament deficiency on economy of walking and jogging. 806 88

Purkinje cell evoked unit activity was studied in developing normal and undernourished postnatal rats from 5 to 30 days. Ipsilateral electrical stimulation of the sciatic nerve, induced mossy fiber (MF) mediated simple spike activity or climbing fiber (CF) mediated complex multiple discharge activity. MF mediated response exhibited the phenomenon of electrical fatigue, while CF mediated response was augmented on repeated peripheral stimulation. Undernourished rats exhibited irregular and reduced spike amplitudes, spike frequencies, significantly increased stimulus thresholds and increased biological variabilities in their response on repeated electrical stimulation as compared to normal animals which exhibited a typical graded response at increasing stimulus frequencies and stimulus intensities. The after-hyperpolarization duration was also significantly increased in the undernourished as compared to normal rats. These data suggests that undernutrition, imposed during the lactation period can induce impairments in the Purkinje cell membrane dynamics and delays MF as well as CF mediated functional maturation in the developing cerebellum, which may induce delayed motor learning in young undernourished individuals.
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PMID:Purkinje cell evoked unit activity in developing normal and undernourished rats. 833 68

Respiratory muscle strength (RMS) and endurance are often preserved in cystic fibrosis (CF) despite malnutrition, chronic airflow limitation, and hyperinflation. Inspiratory muscle function may be relatively preserved due to a selective "training stimulus" from chronic lung disease. Respiratory and peripheral muscle function were evaluated in 14 stable CF patients and 16 healthy control subjects. RMS was measured using static maximal pressures performed at FRC. Respiratory fatigue (RF) was assessed using 18 repeated static efforts (10 s on/5 s off) over 4.5 min. Peripheral function was evaluated by leg strength (LS) and leg fatigue (LF) measured during sprint efforts on an isokinetic cycle ergometer. Despite a lower weight (mean +/- SD, 94 +/- 9.6% ideal wt for CF patients versus 107 +/- 14.6% for controls) and elevated residual volume (RV)/TLC ratio (38 +/- 13.0 versus 22 +/- 5.3), the CF group maintained RMS (inspiratory 96 +/- 23.2 versus 114 +/- 33.2; expiratory 105 +/- 28.3 versus 123 +/- 40.9 cm H2O) but had decreased LS (590 +/- 201.7 versus 813 +/- 167.1 W). There were no differences between the groups with respect to RF or LF. For the control group, inspiratory and expiratory RMS correlated with LS (p < 0.01) and lean body mass (p < 0.01). For the CF group, while expiratory RMS (p < 0.05) and LS (p < 0.01) correlated with lean body mass and each other (p < 0.01), inspiratory RMS was independent of lean body mass and LS (p > 0.1). Female CF patients appeared to have a better preservation of inspiratory RMS than males with CF.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Respiratory and peripheral muscle function in cystic fibrosis. 846 21


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