Gene/Protein Disease Symptom Drug Enzyme Compound
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A white female, now age 40 and receiving total parenteral nutrition for more than 5 years, developed unexpected 15% weight loss after 3 1/2 years of regimen, together with peripheral neuropathy confirmed by nerve conduction measurements. An intravenous glucose tolerance test showed that the fractional rate (K) had decreased to 0.89%/min (normal greater than 1.2). There was observed during this glucose infusion a borderline normal insulin response with a fall in plasma free fatty acids and in plasma leucine. During daily infusion of well over 400 g of glucose, the respiratory quotient was 0.66. Chromium balance was negative. Chromium levels were, in blood 0.55 ng/ml (normal 4.9 to 9.5) and in hair 154 to 175 ng/g (normal greater than 500). Regular insulin daily (45 micron) in the infusate nearly maintained euglycemia but despite this, and even with further glucose intake to restore weight loss, intravenous glucose tolerance test (K) and respiratory quotient were unchanged. Administration of insulin was then stopped and 250 microng of Cr added to the daily total parenteral nutrition infusate for 2 weeks. After this the intravenous glucose tolerance test (K) and respiratory quotient became normal (1.35 and 0.78, respectively). Over the next 5 months insulin was not needed and glucose intake had to be reduced substantially to avoid overweight. In this period nerve conduction and well-being returned to normal. With a maintenance addition of chromium to the total parenteral nutrition infusate (tentatively this addition is 20 microng/day) the patient has remained well for 18 months (to July 1976). These results suggest that relatively isolated chromium deficiency in man, hitherto poorly documented, causes 1) glucose intolerance, 2) inability to utilize glucose for energy, 3) neuropathy with normal insulin levels, 4) high free fatty acid levels and low respiratory quotient and, 5) abnormalities of nitrogen metabolism.
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PMID:Chromium deficiency, glucose intolerance, and neuropathy reversed by chromium supplementation, in a patient receiving long-term total parenteral nutrition. 19 66

A method of measuring body density is presented which allows much greater precision in calculating the fat content of the human body than the usual methods of under-water weighing. Using this method, body fat was determined for three groups: normal weight, moderately overweight, and obese subjects. In spite of vast amounts of energy stored in the obese patient, no advantages for the pre- or post-surgical phase result. The explanation for this paradoxical situation is seen in two factors: 1. The cardiovascular system is not capable of delivering more energy because mobilisation of fat depends on corresponding oxygen intake. 2. Aside from this, a metabolic limiting factor exists in the mobilisation of protein reserves for the production of glucose, which leads to a considerable protein loss the first few weeks of a period of abstinence. In posttraumatic or post-operative situations, this protein mobilisation is particularly strong, especially when connected with a high metabolic intake. The high nitrogen loss and/or the high metabolic rate, is illustrated on the basis of severe skull and brain traumas. The differences between absolute fasting and a 200kcal-protein formula diet were experimentally investigated. The nitrogen loss under the protein diet was decisively less. An anabolic phase even reappeared after three weeks of the diet. The 200kcal-diet therefore represents a means of pre-operative weight reduction without protein loss. The alterations in body composition are almost exclusively the results of reduction in excess fat. This is demonstrated by means of clinical examples.
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PMID:[Changes in body composition during various reducing diets]. 55 59

Issuing from the present state of the influence of the basic nutritive substances (protein, fat, carbohydrates) and various nutritive factors discussed again and again (cholesterol, erucaic acid, sodium, calcium/magnesium quotient, pressor amines) on the development of the arteriosclerosis, the indididual factors of influence are critically evaluated. The investigations are getting under way, so that ascertained results are standing beside insufficiently claified or open problems, From the abundance of the observations conclusions are drawn which are of significance for practice. Unfavourable influences of nutrition on the factors of risk (hyperlipoproteinaemia, disturbance of the carbohydrate tolerance, hyperuricaemia, hyperalimentation) and on the manifest diseases (hypertension, diabetes mellitus, uric arthritis, obesity) of the metabolic syndrome which finally contribute to the development of arteriosclerosis are emphasized. In front of this background a clinically and ambulatorily tested basic metabolic diet is described. About 20% of the energy content (kcal or kJ) of this diet are protein, 35% fat and 45% are carbohydrates. The saturated fatty acids lie below 30%, the manifold saturated fatty acids, however, above 20% of the total fat proportion. The cholesterol content is below 400 mg, the purin-nitrogen below 200 mg, and the sodium content is about 2g per day. This diet can be produced for the treatment of persons with normal weight and overweight in different energetic degradations.
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PMID:[Nutrition and arteriosclerosis]. 70

Preoperative pulmonary parameters were evaluated in 37 extremely obese but otherwise healthy patients. They were on average 100.9% overweight. X-ray of the chest, electrocardiograms, and residual volume, vital capacity, total lung capacity, maximum breathing capacity, forced expired volume in 1 second, and related ratios were all within the normal range. The alveolar-arterial oxygen gradient and the arterial carbon dioxide tension were also within the normal range. The only abnormal finding was a substantially reduced arterial oxygen tension. It is suggested that the measurement of functional residual capacity, closing volume, and the slope of the alveolar plateau (phase III in the single breath nitrogen washout technique) might give more valuable information.
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PMID:Pulmonary function in obese patients scheduled for jejuno-ileostomy. 90 90

The protein-sparing capability of glucose was investigated in overweight subjects prior to and during the performance of prolonged therapeutic fasts. Blood (for hormones and substrates) and urine (for nitrogen and ketoacids) specimens were collected prior to, during, and subsequent to the performance of the following studies. Three subjects ingested, as their only source of calories, 37.5 g of glucose every 6 hours for 7 days (glucose I). The same group of subjects was then fasted for 3 weeks following which the above glucose protocol was repeated (glucose II). In both groups, glucose administration diminished nitrogen excretion, urea being decreased in the first group and ammonia in the second.
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PMID:Metabolic effects of glucose in brief and prolonged fasted man. 113 Mar 10

Studies were conducted in a group of patients with varose deformity. The present paper gives the results of indicidual bone metabolism studies conducted on 663 healthy controls and patients with articular disease without genu varum or with varose deformity. In subjects with genu varum intravenous administration of calcium causes the urinary elimination of hydroxyproline and nitrogen to fall. Among the groups under investigation this group of patients excretes the least amount of urine, has a relatively low calciuria and shows the highest retention rate of intravenously administered calcium. Patients with gonarthrosis associated to varose deformity excrete, a day after intravenous administration of calcium, the relatively least amounts of phosphorus, as compared to the healthy controls and other degenerative joint diseases without genu varum. Although the retention of intravenous calcium in the studied group resembles that seen in the process of generalized osteomalacia, no coinciding signs of osteomalacia c ould be found in subjects with gonarthrosis and varose deformity. X-ray examination of patients with genu varum revealed more marked changes in the bone structure, namely sclerosis, necrosis and osteophytes of shapes and sizes other than in gonarthrosis without varose deformity. Epidemiological analysis of 30 patients showed 83.3% of patients to have overweight type I to III according to the Broca formula. Pains in the knee joints started appearing at the mean age of 50 years. A large part of the patients showed the presence of serious varicose syndrome and relapsing phlebitis of the lower limbs. Although the clinical and X-ray pictures make it possible to conisder a larger amount of disease types, we assume that gonarthrosis with varose deformity may be regarded as an isolated clinical entity which refers primarily to a localized bone process.
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PMID:[Is gonarthrosis with varus deformity a clinical entity]. 113 97

A study was conducted to investigate whether there is a diurnal pattern of nutrient utilization in man and how this is affected by meal frequency to explain possible consequences of meal frequency for body weight regulation. When the daily energy intake is consumed in a small number of large meals, there is an increased chance to become overweight, possibly by an elevated lipogenesis (fat synthesis and accumulation) or storage of energy after the meal. Thirteen subjects, two males and eleven females, were fed to energy balance in two meals per day (gorging pattern) and seven meals per day (nibbling pattern) over 2-day intervals. On the second day on each feeding regimen, the diurnal pattern of nutrient utilization was calculated from simultaneous measurements of oxygen consumption, carbon dioxide production and urinary nitrogen excretion over 3 h intervals in a respiration chamber. A gorging pattern of energy intake resulted in a stronger diurnal periodicity of nutrient utilization, compared to a nibbling pattern. However, there were no consequences for the total 24 h energy expenditure (24 h EE) of the two feeding patterns (5.57 +/- 0.16 kJ/min for the gorging pattern; 5.44 +/- 0.18 kJ/min for the nibbling pattern). Concerning the periodicity of nutrient utilization, protein oxidation during the day did not change between the two feeding patterns. In the gorging pattern, carbohydrate oxidation was significantly elevated during the interval following the first meal (ie from 1200 h to 1500 h, P less than 0.01) and the second meal (ie from 1800 h to 2100 h, P less than 0.05). The decreased rate of carbohydrate oxidation observed during the fasting period (from rising in the morning until the first meal at 1200 h), was compensated by an increased fat oxidation from 0900 to 1200 h to cover energy needs. In the nibbling pattern, carbohydrate and fat oxidation remained relatively constant during the active hours of the day.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Influence of the feeding frequency on nutrient utilization in man: consequences for energy metabolism. 190 98

In critically ill patients, the inaccuracy of predictive formulas for nutritional assessment often leads to inappropriate and potentially detrimental feeding regimens. This study evaluates the clinical utility of the metabolic cart in an urban university hospital setting. Twenty-six studies were performed on each of 26 patients (18 surgical, 8 medical) using an MMC Horizon metabolic cart. Although 58% of patients were overweight, 42% were still shown to have a kwashiorkorlike pattern of malnutrition. Three patients demonstrated a marasmic-like pattern. Fifteen percent of studies showed patients to be hypometabolic and 62% hypermetabolic. Harris-Benedict resting energy expenditure, based on actual or ideal body weight, underestimated needs; however, addition of a metabolic activity factor overestimated needs. Only 32% of patients were fed appropriately; 41% were underfed, and 27% were overfed. Urine area nitrogen correlated poorly with energy expenditure. Measured RQ appropriately reflected substrate utilization in 77% of studies; multiple factors may have caused differences between measured and predicted RQ in 23%. Use of the metabolic cart determines precisely the metabolic state, identifies problems with substrate utilization, and enables the physician to design the most efficacious nutritional regimen.
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PMID:Clinical application of the metabolic cart to the delivery of total parenteral nutrition. 212 41

The aim of this study was to ascertain whether overweight men and women of comparable age, body surface area and weight would display any differences in weight loss or changes in body composition while receiving identical calorie intakes. 15 men and 15 women of mean age 46.7 (26-57) years with obesity (body mass index 29-36 kg/m2) were given a reducing diet containing 700 kcal/d for 4 weeks. The two groups were identical in age, body weight and height. The change in body composition was studied by means of ultrasound and nitrogen balance. The women had thicker layers of subcutaneous fat (241 +/- 8 mm) over all parts of the body than the men (137 +/- 10 mm) (summated measurements at 14 points). Among the men body weight fell from 93.1 +/- 2.1 to 83.8 +/- 2.0 kg, but the women declined only from 92.9 +/- 2.0 to 84.7 +/- 1.9 kg. Although men achieved a greater weight loss (13%; P less than 0.001) the decrease in their subcutaneous fat layer was 33% less (to 117 +/- 9 mm) than in the women (211 +/- 8 mm). Cumulative nitrogen balance among the men was 4.7 times more negative than in women (-104 +/- 14 g versus -22 +/- 11 g); this points to accentuated muscle breakdown. More fat was mobilized in the women than in the men, chiefly from the regions of the limbs and hips.
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PMID:[Sex-specific changes in body composition during weight reduction]. 219 87

The effects on weight reduction of three different 1,200-kcal diets followed for a 10-week period were examined in adult, sedentary, overweight women. Diet patterns contained 25%, 45%, or 75% carbohydrate, with variations in fat and protein. Parameters evaluated and compared for each diet were body composition, cholesterol, triglycerides, blood urea nitrogen (BUN), uric acid, percent body fat, and nutrient intake. Each diet group contained at least 11 women. Behavioral approaches were used to ensure that subjects complied with the caloric intake and the dietary pattern. No significant differences were found in the parameters except for BUN, which was significantly greater in the 25% carbohydrate group. Each 1,200-kcal diet contributed to weight loss. Selection of a weight reduction diet can be designed around preferred food patterns and nutrition needs of individuals rather than a proportion of the energy provided by carbohydrate in healthy adult women. Practitioners may use this research to demonstrate to clients that body weight can be lost while following a variety of nutritious diets.
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PMID:The effects of variations in carbohydrate, protein, and fat content of the diet upon weight loss, blood values, and nutrient intake of adult obese women. 231 73


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