Thermogenic responses to graded doses of noradrenaline in undernourished Indian male subjects

1. Seventeen male subjects with an energy intake of 10.6 (SD 1.7) MJ/d and ten male undernourished labourers with an energy intake of 8.0 (SD 1.2) MJ/d were studied. The controls were subdivided into ten underweight controls with a body mass index (weight/height2; BMI) less than 18 (17.2 (SD 0.9)) and seven normal-weight controls with a BMI greater than 20 (21.3 (SD 1.6)), while the undernourished labourers had a BMI less than 18 (16.8 (SD 1.2)). 2. Comparison of thermogenic responses to increasing doses of noradrenaline showed no overall significant inter-group differences when subjected to a nested analysis of variance (ANOVA). For the initial doses of 0.05 and 0.1 micrograms noradrenaline, significantly lower responses were seen in the undernourished subjects, while the highest dose showed comparable responses in all three groups. Thermogenic responses to the initial two doses, when corrected for fat-free mass (FFM) differences, were 40% lower in the undernourished group when compared with the underweight group with similar BMI and FFM values. However, this finding was not statistically significant. 3. The basal oxygen consumption of the undernourished group, expressed per unit FFM, was significantly higher than that of the controls.     

Prediction of 24-hour urinary creatinine excretion from age, body weight and height of an individual and its application]

Equations to predict 24-hour urinary creatinine excretion (UcrV) from age, body weight (W) and body height (H) were developed based on the data for UcrV determined by collecting 24-hour urine for 3-5 days in 256 male and 231 female clinically healthy subjects, aged from 20 to 84 years. By regression analysis a regression equation was developed. Multiple regression analysis revealed that age, W and H contributed most to the measured value of UcrV. The regression equations to predict UcrV from age, W and H were as follows: Predicted value of UcrV (PRCr) = -12.63 x Age + 15.12 x W + 7.39 x H - 79.90 (male: mg/day) PRCr = -4.72 x Age + 8.58 x W + 5.09 x H - 74.50 (female: mg/day) The multiple correlation coefficients were 0.87 for males and 0.73 for females, respectively. The difference between PRCr and measured UcrV (residual) was +0.81 +/- 154 (SD) mg/day on the average. An analysis of residuals by means of plotting of standardized residuals and predicted standardized dependent variables showed no remarkable deviations in both sexes, suggesting that these equations are applicable to the prediction of UcrV. These equations were applied to 38 Japanese men and women who were asked to collect 24-hour urine for 14 days on average, and also to 47 foreigners (American, Nepalese and Italian). The average residual in the former was +27 +/- 87 mg/day and that in the latter -3 +/- 85 mg/day, suggesting that these equations can be applied not only to the Japanese but also to the foreigners as a useful index in predicting 24-hour urinary creatinine excretion.     

Thermic effect of a meal. 2. Role in chronic undernutrition.

The thermic effect of a standard liquid meal (TEM; energy 2.5 MJ; containing (g/kg) protein 100, fat 150, carbohydrate 750; volume 350 ml) was measured in a chronically undernourished (UN; n 9) group of human subjects and was compared with results from two control groups, one normal weight (NW)-for-height (BMI greater than 20; n 10) and the other underweight (UW)-for-height (BMI less than 18, n 10), using a ventilated-hood system over a period of 6 h after ingestion of the meal. Results indicated that the UN subjects had lower values for body-weight, height, percentage fat and fat-free mass (FFM) compared with those of either control group. Basal metabolic rates were lowest in the UN group in absolute terms; however, there were no significant differences among groups on an analysis of covariance (ANACOVA) with FFM as the covariate. TEM responses in the UN group were significantly higher when expressed either in absolute terms or as a percentage of the energy density of the meal. The post-meal total energy output was significantly lower (P less than 0.05) in the UW and UN groups as compared with the NW group in absolute terms; however, on adjusting for differences in FFM (by ANACOVA) there were no significant differences among groups. This would suggest that in the chronically undernourished thermogenic responses to a meal are unlikely to contribute towards any energy saving and may not constitute a part of any adaptive response to the undernourished state.     

Intrauterine undernutrition in rats interferes with leukocyte migration, decreasing adhesion molecule expression in leukocytes and endothelial cells

Experimental and epidemiologic data have shown that malnutrition predisposes individuals to infections. Immune responses are compromised, particularly in undernourished children. Therefore, we investigated the migratory capacity of leukocytes, using the intravital microscopy technique, in male Wistar rats (8-9 wk of age) that were undernourished in utero after their dams were fed 50% less food than the amount consumed by control dams. The number of leukocytes rolling along the venular endothelium, sticking after stimulation with leukotriene B4, tumor necrosis factor-alpha (TNF-alpha) or zymosan-activated plasma, or migrating after TNF-alpha stimulation was significantly reduced in the undernourished rat offspring. Compared with nourished rat offspring, undernourished offspring had significantly reduced numbers of circulating leukocytes, higher blood pressure, and higher leukocyte rolling velocity (V(WBC)), as well as a higher ratio between V(WBC) and RBC velocity (V(RBC)). Endothelial P-selectin and intercellular adhesion molecule-1 (ICAM-1) expression, analyzed by immunohistochemistry, and basal leukocyte L-selectin expression, analyzed by flow cytometry, were significantly reduced in the undernourished rat offspring. Because the groups did not differ in leukocyte CD11/18 expression, endothelial expression of platelet-endothelial cell adhesion molecule-1, or venular blood flow velocity and, consequently, venular shear rate, we conclude that intrauterine undernutrition in rats reduces leukocyte migration, downregulates endothelial expression of P-selectin and ICAM-1, as well as leukocyte expression of L-selectin, while reducing leukocyte counts. The higher V(WBC) and V(WBC)/V(RBC) ratio may also play a role in this reduced leukocyte migration. Our data suggest that this phenomenon is involved in the increased predisposition to infections in undernourished subjects.     

Relationship between body mass indices and measures of body adiposity.

We examined the relationship between various body mass indices (BMIs), skinfold measures, and laboratory measures of body fat in 474 males aged 20-70 years. Evaluations included height, weight, skinfold thickness, and hydrostatic measurements of adiposity. The weight-height ratio (W/H), Quetelet index (W/H2), Khosla-Lowe index (W/H3), and Benn index (W/HP) were calculated. The correlations among the various BMIs were high, ranging from 0.91 to 0.99, and all were strongly correlated with weight (rs = 0.81 - 0.98), while only W/H2 (r = -.03) and W/HP (r = -.01) were not correlated with height. The W/H2 and W/HP had the strongest correlation with hydrostatic and skinfold measurements, although all the BMIs were significantly correlated with these measurements. Results suggest that the Benn index and the Quetelet index are equally valid estimates of body fat in respect to their relationship with hydrostatic measures.     

Optimized predictions of absolute and relative amounts of body fat from weight, height, other anthropometric predictors, and age 1

BACKGROUND: Body mass index (BMI) is the dominating weight-for-height index, but its validity as a body fat (BF) index has not been properly examined. OBJECTIVES: Our aims were to establish and validate optimal weight-for-height indexes for predicting absolute and relative (percentage) amounts of BF, to examine whether other commonly available anthropometric variables or age could add to the predictive power, and to explore the upper limit for percentage BF. DESIGN: One thousand one hundred twelve randomly selected subjects, and an additional 149 obese subjects, were included in the study. The subjects were randomly allocated to either a primary study group or a validation group. BF was measured with dual-energy X-ray absorptiometry. The relations between weight/heightx (W/Hx) and BF (absolute or percentage) were examined for values of the exponent x that ranged from 0.0 to 3.0. The predictive power of equations that were based on optimal weight-for-height indexes was compared with equations based on weight, height, other anthropometric variables, and age. RESULTS: Absolute BF was optimally and linearly predicted by W/H1, whereas the percentage BF was optimally and nonlinearly predicted by W/H2. The percentage BF asymptotically approached 52% in women and 56% in men. The percentage BF increased only marginally from BMI (in kg/m2) values of >35 in women and >60 in men. Predictions of absolute BF were associated with smaller errors (8.5% for men and 5.7% for women) than were predictions of percentage BF (8.7% for men and 7.9% for women). The addition of other anthropometric measurements for both men and women, and the addition of age for women only, in the regression analyses moderately reduced these errors. CONCLUSION: Our data suggest that W/H may be a more optimal weight-for-height index than is BMI, particularly at high body weights.     

W／H、W／H~2和W／H~3三种指数法评价儿童、青少年肥胖的比较

通过对２４４８名７～１８岁儿童、青少年身高和体重的调查，研究了Ｗ／Ｈ、Ｗ／Ｈ~２和Ｗ／Ｈ~３三个指数与儿童、青少年身高、体重的关系。结果表明，在三个指数中，Ｗ／Ｈ~２与身高相关性最小，与体重的相关系数仅次于Ｗ／Ｈ，Ｗ／Ｈ~２似更适合作为评价儿童肥胖的指数。而不同年龄性别儿童、青少年的Ｗ／Ｈ~２指数应不尽相同。     

Oral supplements differing in fat and carbohydrate content: effect on the appetite and food intake of undernourished elderly patients

BACKGROUND & AIMS: Since fat, relative to other macronutrients, has low satiety and high energy density, it may have therapeutic application for supplementing energy intake. This study compared the effect of isoenergetic (1050 kJ) high fat or high carbohydrate oral supplements, given at breakfast, on the short-term appetite and energy intake in undernourished elderly subjects. METHODS: Sixteen hospitalised, undernourished (body mass index: 20 +/- 3 kg/m2), elderly (77 +/- 8 yr) people were randomly allocated to a control or 1 of 2 supplement groups [fat: carbohydrate: protein (% energy) was 70:25:5 or 25:70:5]. In each group, energy intake (24-h food consumption) and appetite (visual analogue scales) were assessed over 3 consecutive days. RESULTS: Mean energy intake significantly (P = 0.0035) increased following supplementation: high fat 6973 kJ/d, high carbohydrate 6906 kJ/d vs. control 6079 kJ/d but mean voluntary 24-h energy intake remained unaffected. Compared to controls, supplemented subjects experienced reduced hunger (P = 0.07) between breakfast and lunch, but showed no difference over the whole day (P = 0.55). CONCLUSIONS: Under these study conditions a 1050 kJ oral supplement, irrespective of macronutrient composition, does not cause voluntary short-term energy intake compensation in undernourished elderly people.     

Are body mass indices interchangeable in measuring obesity-disease associations?

We examined data on body weight and height from 55 male and 26 female lung cancer cases and up to 10 sex-ethnicity-age matched controls per case from a large prospective cohort. All four body mass indices (W/H, W/H2, W/Hp) were highly intercorrelated. Conditional logistic regression, using each index as the exposure variable, yielded odds ratios for lung cancer with magnitude and dose-response gradient that were somewhat different among the four indices. These results suggest that the body mass indices are not necessarily interchangeable in measuring obesity-disease associations.     

Reduced thermoregulatory thermogenesis in undernutrition

Adaptive responses to chronic energy deficiency could occur in one of the important components of energy expenditure ie, regulatory thermogenesis. We assessed the thermogenic responses to standardized noradrenaline (NA) infusions in undernourished labourers, as well as in normally nourished control subjects. There was a significant suppression (greater than 60 per cent) of NA-stimulated oxygen consumption in the undernourished, which remained statistically significant even when the responses were corrected for fat-free mass differences. This first report of a suppression in regulatory thermogenesis indicates its important role in the adaptive response to lower than required energy intakes in human subjects.     

Thermic effect of a meal. 3. Effect of dietary supplementation in chronically undernourished human subjects.

Five apparently healthy, chronically undernourished (UN) male volunteers aged between 18 and 30 years were studied before and after 12 weeks of dietary supplementation. The thermic effect of a meal (TEM) was measured over a period of 6 h using a ventilated-hood system. Results indicated a significant increase in body-weight after supplementation due to increases in body fat and fat-free mass (FFM) in the proportion of 69% and 31% respectively. The basal metabolic rates (BMR) measured post supplementation were significantly higher in absolute terms, with a trend towards higher values when adjusted for the changes in FFM. TEM responses measured after 12 weeks of supplementation were significantly lower when expressed either in absolute terms (presupplementation 227.0 kJ v. post supplementation 193.5 kJ), or as a percentage of the energy density of the meal (9.1% v. 7.7%). This lower TEM was reciprocal to the changes in the BMR (r -0.86). The post-meal total energy output (PMTEO) was, however, not significantly different after 12 weeks of dietary supplementation. The unchanged PMTEO would indicate an unaltered 'thermogenic capacity', following supplementation, in these chronically undernourished subjects. These results confirm our earlier conclusion that, in chronic undernutrition, the thermic response to a meal may not contribute to any energy saving.     

Classification of the degree of obesity by body mass index or by deviation from ideal weight

BACKGROUND: The purpose of this study was to compare classifications of subjects as underweight, normal weight, or obese by body mass index (BMI) and the ratio of body weight to ideal weight (W/IW). METHODS: We performed a theoretical comparison of the 2 indices. We compared classifications of the degree of obesity in 1839 women and 5914 men who were followed up in the primary care clinics of a United States federal hospital. Information was extracted from computerized records. Subjects were classified as underweight (BMI < 18.5 kg/m2, W/IW < 0.9), obese (BMI > or = 30.0 kg/m2, W/IW > or = 1.2), or normal weight (BMI, W/IW values between the cutoff values for underweight and obesity). W/IW values were computed assuming small, medium, and large skeletal frame for all. We compared the classifications of subjects as underweight, normal weight, or obese by BMI and W/IW. We used Cohen's kappa ratio to evaluate the agreement between these classifications. RESULTS: Theoretically, the cutoff values of BMI and W/IW for underweight and obesity are not in agreement. Patient data revealed substantial differences in the classifications of subjects as underweight, normal weight, or obese. Kappa ratios ranged between 0.18 (poor agreement) and 0.71 (reasonable, but not high degree of agreement). In general, kappa ratios were higher when assuming large or medium skeletal frame versus small frame. CONCLUSIONS: There are substantial discrepancies in classifying the subjects of a population as underweight, normal weight, or obese by BMI or W/IW. These discrepancies may cause confusion when 2 or more indices are used simultaneously to classify the degree of obesity.     

The body surface area of Saudi newborns

Cancer chemotherapy drugs, fluids and electrolytes are best dosed per square meter of body surface area (BSA). Since newborns have an exceptionally large surface to mass ratio, their BSA needs to be accurately estimated, if it is to serve as a safe denominator for drugs and fluids. In this study, BSA was measured directly in 15 full-term Saudi newborns, using a coating technique. The data was used to construct a BSA weight-length prediction formula. Mean body mass index (BMI +/-SD) of our subjects was 12.56 +/- 1.29 kg/m2 and surface to mass ratio, .068 +/- .005 m2/kg. The closest fit to measured values was given by the regression equation: BSA (m2) = 0.03614H(0.294)W(0.529) +/- 0.0027 (SEE) A simplified formula based on weight alone: BSA = 7.4 + 4.2W +/- 0.0022(SEE) was derived for bedside use, in urgent situations. Our formulae may be applicable to non-Saudi newborns, if as expected, body size and shape variations in different populations develop after birth.     

Peak oxygen uptake, ventilatory threshold and leg extension power in apparently healthy Japanese]

Peak oxygen uptake, ventilatory threshold (VT) and leg extension power were measured in 832 apparently healthy subjects (421 males, 411 females) aged 30-60 decades who performed medical examination at 4 health check up facilities. 1) Peak oxygen uptake was greater in male than female, and decreased with age in both sexes. Single regression formula on age were Y (ml/kg/min) = 46.6 - 0.36 x AGE, (r = 0.447, p < 0.001) in male and Y (ml/kg/min) = 35.3 - 0.23 x AGE, (r = 0.407, p < 0.001) in female. 2) VT was greater in male than female, and less decreased with age compared to maximal aerobic power. Single regression formula on age were Y (ml/kg/min) = 22.6 - 0.13 x AGE, (r = 0.371, p < 0.001) in male, Y (ml/kg/min) = 20.0 - 0.10 x AGE, (r = 0.301, p < 0.001) in female. 3) Leg extension power was greater in male than female, and decreased with age in both sexes. Single regression formula on age were Y (W/kg) = 31.9 - 0.27 x AGE, (r = 0.539, p < 0.001) in male and Y (W/kg) = 20.9 - 0.18 x AGE, (r = 0.510, p < 0.001) in female. Subjects in the present study showed height, weight and walk steps per day similar to those in National Nutrition Survey. Comparison of Peak oxygen uptake, ventilatory threshold and leg extensor power to previous studies revealed that these parameters were quite similar to the counterparts in the previous studies with less selection bias. It was suggested that subjects in this study were quite similar to normal Japanese population, and that Peak oxygen uptake, VT and leg extension power in the present study were of value for the evaluation of health related fitness in community and workplace.     

Anthropometric indices independent of age for nutritional assessment in schoolchildren.

The merits of three indices based on weight (W) and height (H) were examined in the age group six to 15 years: W/H, W/H2, W/H3. The analysis was based ona survey of 1673 schoolchildren of both sexes from a rural housing block in Delhi. It showed that the index W/H2 was invariant with age in the range six to 15 years and that the other two indices were biased with respect to age. The index W/H2 was found to be of value for the proper assessment of nutritional status in the schoolchildren of a developing country.     

Body fatness and frame size: the Caerphilly study

The effect of adjusting height-weight indices for frame size on the prediction of body fatness was investigated in a community sample of 2512 men aged 45-59 years. Body fatness was assessed from skinfold thickness measurements at four sites: triceps, biceps, subscapular and supra-iliac. Body diameters (biacromial, bi-iliocristal, wrist or knee) were used as estimates of frame size. Body diameters were not independent of body fatness, wrist diameter showing the lowest association with skinfold thickness measurements. Adjustment of weight/height2 (W/H2) for frame size had little effect on the prediction of body fatness, the correlation coefficient for body fatness with W/H2 (r = 0.76) being almost identical to that for W/H2 adjusted for wrist diameter (r = 0.74).     

Leucine requirement and splanchnic uptake of leucine in chronically undernourished adult Indian subjects

BACKGROUND: We showed previously by the 24-h direct amino acid balance (DAAB) method that the leucine requirement of well-nourished Western and South Asian subjects is approximately 40 mg x kg(-1) x d(-1). OBJECTIVE: It is not known whether this estimated leucine requirement is applicable in chronic undernutrition; therefore, we assessed the leucine requirement in Indian men with chronic, but stable, undernutrition. DESIGN: We studied 26 chronically undernourished men during 2 randomly assigned 7-d diet periods consisting of an L-amino acid diet (n = 20) and supplying either 14 and 30 (n = 10) or 22 and 40 (n = 10) mg leucine x kg(-1)x d(-1) or consisting of the subjects' habitual cereal-and-lentil-based diets (n = 6). The 24-h DAAB was estimated on day 6 by using a [13C]leucine tracer infusion. The splanchnic uptake of leucine was determined at an intake of 40 mg x kg(-1) x d(-1) by administering [2H3]leucine orally. RESULTS: By using mixed-models linear regression of leucine balance against leucine intake, we estimated a zero leucine balance at a leucine intake of 39.6 mg x kg(-1) x d(-1). The splanchnic first-pass uptake of [2H3]leucine was 22.7% and 11.5% of the intake in the fasted and fed phases, respectively. The subjects were in neutral leucine balance with their habitual cereal-and-lentil-based diets. CONCLUSION: On the basis of the 24-h DAAB approach, a mean leucine requirement of 40 mg x kg(-1) x d(-1) is proposed for healthy and for chronically undernourished Indian adults.     

Body weight changes with protease inhibitor treatment in undernourished HIV-infected patients.

Effective reduction of HIV replication by protease inhibitor (PI) treatment was expected to reverse some of the weight loss associated with HIV infection. Body weight changes in undernourished HIV-infected patients starting PI treatment were compared to its virologic and immunologic effects. This was designed as a retrospective study using prospectively collected weight data; the setting was the HIV outpatient department of a university hospital. Among 223 consecutive HIV-positive patients starting treatment with PI February 1996 to September 1997, 63 undernourished patients were evaluable. The main outcome measures were weight trend, calculated by linear regression of a patient's weight versus time, and its change from a 4-14-wk baseline period to the first 14 wk, and 28 wk, after treatment. In our results, weight trend remained unchanged (baseline, +0.4 +/- 4.0 kg/100 d; 14 wk, +0.7 +/- 4.1 kg/100 d, and 28 wk, +1.0 +/- 3.4 kg/100 d, n.s.). Reduction of viremia and increase in CD4 cell count were unrelated to weight trends. Treatment with PI did not result in an improved weight trend. Altered body composition with PI treatment, as observed in other studies, does not seem to result in body weight changes. Drug side effects may have counteracted any positive effects. The metabolic and nutritional impact of effective antiviral treatment merits further study.     

Application of weight-height relations for assessing adiposity in a United Kingdom offshore workforce.

Weight (W), height (H), and skinfold thicknesses at biceps, triceps, subscapular, and suprailiac sites were measured in a United Kingdom offshore workforce. Weight and height were used to calculate W/H relations. The percentage body fat was estimated from skinfold thicknesses and the correlations of adiposity with the various W/H relations were evaluated. The significant increase in percentage body fat (%BF) with increasing age resulted in the development of age group specific regression equations relating %BF to the indices of W/H1.5 and W/H2 (body mass index or Quetelet index). Little difference regarding the qualities of these two indices were detected in terms of poor correlation with height and strong correlation with weight. Thus either may be used with similar levels of confidence. Comparison with other studies, however, would be more easily accomplished if W/H2 were used. In the absence of skinfold thickness measurements the W/H2 could readily be implemented during a routine medical and applied for the estimation of %BF in the offshore population provided that the appropriate regression equation were used and that the limitations of the technique are recognised. Percentage values for W, H, W/H relations, and %BF by age group are provided for comparison with other population studies.     

Application of weight-height relations for assessing adiposity in a United Kingdom offshore workforce

Weight (W), height (H), and skinfold thicknesses at biceps, triceps, subscapular, and suprailiac sites were measured in a United Kingdom offshore workforce. Weight and height were used to calculate W/H relations. The percentage body fat was estimated from skinfold thicknesses and the correlations of adiposity with the various W/H relations were evaluated. The significant increase in percentage body fat (%BF) with increasing age resulted in the development of age group specific regression equations relating %BF to the indices of W/H1.5 and W/H2 (body mass index or Quetelet index). Little difference regarding the qualities of these two indices were detected in terms of poor correlation with height and strong correlation with weight. Thus either may be used with similar levels of confidence. Comparison with other studies, however, would be more easily accomplished if W/H2 were used. In the absence of skinfold thickness measurements the W/H2 could readily be implemented during a routine medical and applied for the estimation of %BF in the offshore population provided that the appropriate regression equation were used and that the limitations of the technique are recognised. Percentage values for W, H, W/H relations, and %BF by age group are provided for comparison with other population studies.