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Query: UMLS:C0028754 (obesity)
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Metabolic parameters were studied in 6 patients before and for 18 months after jejunoileal bypass for obesity. The postoperative changes in plasma concentration of amino acids were characterized by a decrease in essential amino acids, while the non-essential amino acids were unchanged or elevated, indicating a state of protein-caloric malnutrition. The pattern of fatty acids in serum the first year after operation: an unchanged sum of unsaturated and saturated fatty acids accompanied by a significant fall in linoleic acid and a corresponding increase in oleic acid, showed that even during this period the patients were in a state of essential fatty acid deficiency. The oral glucose tolerance test and the levels of serum immunoreactive insulin activity indicated a general improvement in glucose tolerance and a normalization of preoperative hyperinsulinism. A 40-50% reduction was found both in serum triglycerides and cholesterol levels. Serum iron was reduced by approximately 30%, whereas TIBC levels remained unchanged. The Schilling test showed a significant fall in vitamin B12 absorption postoperatively with subnormal values at 6 and 12 months. Vitamin B12 in serum dropped, but remained within the normal range, suggesting that the preservation of 25 cm of distal ileum is sufficient to secure adequate absorption of vitamin B12. Folic acid levels in serum fell after the bypass, demanding supplementation in 5 of the 6 patients at 6 months postoperatively.
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PMID:Metabolic changes after jejuno-ileal bypass for obesity. 63 57

National Nutrition Surveillance includes nutritional assessment surveys to ascertain the extent of malnutrition in populations, to identify possible causes, to establish baseline data for monitoring nutrition, and to select mechanisms for nutrition surveillance (in a restricted sense). An example of the results from a recent nutritional assessment survey in the United States is the negative association of obesity with energy intake, exercise and socioeconomic status, which has implications for public nutritional policy. Nutritional monitoring measures changes in population nutrition over time. An example of the results from nutritional monitoring is the unexpected and presently unexplained decrease in serum cholesterol levels of middle-aged women in the United States over the past decade. Nutritional surveillance in the restricted sense not only identifies malnutrition but is administratively organized to intervene rapidly. National Nutrition Surveillance depends on metabolic and clinical research to decide on its priorities. This research indicates that malnutrition involves more than under-nutrition, and greater emphasis should be given in National Nutrition Surveillance to this wider context of malnutrition. These results will in turn help set priorities for basic and applied research in nutrition. It is important that the research community participate in the review presently under way of the role of the National Center for Health Statistics in National Nutrition Surveillance.
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PMID:National nutrition surveillance. 64

Nutrient requirements do not change markedly with advancing age, but life style, socioeconomic status, psychologic changes, and the presence of chronic disease alter nutrient intake in the elderly. It is important to recognize and deal with these factors in attempting to correct malnutrition and in prescribing dietary treatment. Malnutrition includes a variety of disorders: undernutrition, nutrient deficiencies and imbalances, and obesity. Frequent small feedings, with nutritional supplements for patients with profound weight loss, are the initial treatment for undernutrition. Iron supplements and a diet of foods rich in iron and in promoting iron absorption are required in treating iron deficiency anemia. Management of macrocytic anemia should include specific nutrient therapy plus improvement of diet to include leafy vegetables and animal foodstuffs. Diet is an important adjunct in treating chronic diseases. Maturity-onset diabetes mellitus often can be managed by diet alone, with attention to correct proportions of fat, carbohydrate, and protein and to the decreased caloric requirements of elderly patients. The importance of continuing dietary modifications in hyperlipidemia and hypertension is well known. Although dietary manipulation in osteoporosis is not curative, a diet high in calcium and containing adequate floride and vitamin D affords maximum dietary protection against progress of the disease.
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PMID:Guidelines for maintaining adequate nutrition in old age. 64 78

Preventive medicine perhaps achieved its earliest and most complete successes in the field of pediatrics. Work on the problems of main concern in the last third of the century has reached a stage where preventive medicine has virtually mastered those of nutrition and infection in our countries. The current problems are malformation, accidents, and suicide, and this has meant a major shift of interest for preventive activity. In some fields, prevention-detection of neonatal affections takes place in the prenatal period: here, the pediatrician joins hands with the geneticist and the obstetrician. In other fields, such as accident prevention, the pediatrician's role is of particular importance to the authorities, industry, and the family. Finally, and this is new, the pediatrician is responsible for the prevention of diseases occurring in the adult. His role in this was a matter of course in nutritional diseases such as malnutrition and rickets, and in infections such as tuberculosis. It is assuming increasing importance in the detection and prevention of certain risk factors and common affections of the adult such as obesity, hypertension and atheroma.
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PMID:[Current aspects and prospects of preventive pediatrics in France]. 65 40

In 40 obese patients, the liver function and the morphological picture were examined before and after jejuno-ileostomy. In 94% of the patients, distinct fatty liver was observed already before the small bowel exclusion, and the function tests showed an impaired function of this organ in 25% of the subjects before the operation. No clinical symptoms of liver insufficiency were recorded during the postoperative period. During one to three months after surgery, an increased impairment of the liver function was ascertained but, later on, a gradual improvement. More than one year after jejuno-ileostomy, the function test results were considerably better than before the operation. The degree of steatosis increased in the majority of the patients within 6 months after surgery, and some time later a considerable decrease in fatty liver was observed. Within 18 to 24 months after the jejunoileostomy, the morphological picture of the liver did not differe from the normal. The impaired function and the increased degree of steatosis were noted during diarrhea and rapid loss of body weight. The reson for this is most probably the protein malnutrition caused by the radical reduction in the absorption surface of the small bowel. The improved function and morphological picture of the liver are related to the progress of adaptation changes of the active part of small bowel. The results of the author's research do not confirm the hypothesis of permanent, harmful effect of jejuno-ileostomy on the state of the liver. The symptoms observed are definitely of a periodical and transient character, and are therefore not contra-indicated in the application of this operation in morbid extreme obesity treatment.
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PMID:Function and morphological picture of the liver in obese patients before and after jejunoileostomy. 74 72

During pregnancy estrogen-medicated augmented prolactin secretion is presumably responsible for a 10-20 fold increase in circulating plasma prolactin; significant differences in basal levels between nursing and nonnursing women persist into the puerperium, reflecting the influence of sucking on maternal plasma prolactin. The release of prolactin is induced via a neurogenic pathway from nipple to hypothalamus and it is proportionate to the length of nursing and to the intensity of the stimulus. There is evidence supporting catecholamine/serotonin control of prolactin release, and the influence of changes in hypothalamic dopamine turnover. The composition of human milk is dependent on various factors; overall, fat composition is 2-5% and protein 9% at 3 weeks and 5% thereafter; milk delivers 20-25 calories per ounce; total fluid and nutritional requirements of the newborn can be met by breastfeeding up to 6 months postpartum. Maternal malnutrition negatively affects lactation; gestational, rather than progestational, food intake influences lactation. Immunity in the newborn is provided also by breast milk through immunoglobulins, thus enhancing the child's protection against internal pathogens. The incidence of gastrointestinal disorders is 1.5/1000 in breastfed infants, and 84.7/1000 in bottle fed infants; the incidence of respiratory infection is .4/1000 and 48/1000, respectively. Prolactin may exert an inhibitory influence on ovarian steroidogenesis, and gonadotropin secretion is disrupted by nipple stimuation; this may account for the low percentage of ovulation among nursing mothers. Lactational amenorrhea has been proven to have great demographic impact; dramatic variations in fertility on the basis of variations in lactational amenorrhea have been described in rural areas of Latin America, Asia, and Africa. Reduction of lactational amenorrhea results not only from changes in sociocultural patterns, but from improved maternal nutrition, often through nutrition programs. When nursing has to be interrupted because of complications full lactation may be restored by oral administration of thyrotropin-releasing hormone. Breastfeeding is possible in 99% of women; the denial of lactation may cause the retention of unwanted weight, which can be compounded by the use of oral contraceptives. Moreover, infantile obesity may stem from the lack of a satiety signal in bottle fed newborns.
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PMID:Mechanisms of puerperal lactation. 83 86

Although the treatment of massive obesity by intestinal bypass can clearly effect substantial weight loss, data are not yet available to compare the morbidity and mortality of the operation with those of marked obesity per se. Surgical mortality rates range from 2 to 10 percent. The majority of patients obtain beneficial, satisfactory results. Close observation is required for management of problems, which may include liver failure, urinary calculi, enteritis, arthralgias, malnutrition and electrolyte depletion.
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PMID:Surgical treatment of obesity: current status. 84 11

Diseases of urban and rural Blacks in South Africa are reviewed. In rural Blacks the major problems are infection and malnutrition. Other important disorders include cancer of the oesophagus, liver and cervix, and rheumatic heart disease and cardiomyopathy. The diseases in urban Blacks are those of a population in transition. Characterised by all gradations of socioeconomic development, from the relatively primitive to the completely westernised, these people exhibit a correspondingly wide and varied range of disease embracing the afflictions of rural dwellers and the new diseases of the city. Whereas the prevalence of some of the former, such as infection and malnutrition, is declining, they still constitute a considerable problem in urban Blacks. More important is the increasingly serious impact of the new disorders, which may be divided into two groups: (a) a large range and variety of alcohol-related disorders with serious effects at the social, economic, psychological and physical levels; and (b) most, if not all, of the diseases encountered in western populations. Some of these, such as obesity and hypertension, have not only attained epidemic proportions among urban Blacks, but their prevalence may actually have exceeded that among Whites. Other conditions, such as coronary heart disease, gout, gallstones and colonic cancer, which emerged later, are relatively uncommon or rare. A plea is made for much greater epidemiological research. This is necessary in order to obtain reliable knowledge of the prevalence of disease, to determine the best ways of applying present knowledge with existing and future resources, and to obtain knowledge regarding both old and new diseases of which the pathogenesis is still obscure.
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PMID:Diseases in urban and rural Black populations. 85 Aug 43

The physical disease profiles of 135 female and 736 male inpatient alcoholics, similar in age, social class, and referral pattern, were compared to further clarify the widespread clinical impression that female alcoholics are more illness-prone. Although the women had been drinking hazardously for fewer years, at admission the prevalence of most diseases was similar in men and women. There was, however, an excess of anemia in women and of fatty liver and chronic obstructive lung disease in men. Furthermore, the average duration of hazardous drinking before the first recorded occurrence of almost all illness events was shorter in women, the sex differences being statistically significant for fatty liver, hypertension, obesity, anemia, malnutrition, gastrointestinal hemorrhage, and an ulcer requiring surgery. These findings suggest that the development of physical morbidity in relation to hazardous drinking may be accelerated in women.
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PMID:Morbidity in alcoholics. Evidence for accelerated development of physical disease in women. 87 27

Countries of the English-speaking Caribbean are in epidemiological transition. Following 30 years of socioeconomic change, obesity and chronic diseases have almost replaced malnutrition and infectious diseases as major health problems. Major risk factors for this modern epidemic are lifestyle-related. Project Lifestyle seeks to develop positive health lifestyles in schoolchildren gradually, sequentially, and systematically from grades 1-12 and throughout the school system on the island of Antigua. The four health habits addressed include weighing right, eating right, doing daily physical exercise, and having a positive self-concept. Since risk interventions with schoolchildren have produced positive results in several developed countries, this project developed an intervention methodology in the Caribbean context.
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PMID:Project lifestyle: developing positive health lifestyles for schoolchildren in Antigua. 128 54


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