Serum leptin concentrations in patients with short-bowel syndrome

BACKGROUND: Short-bowel syndrome is a state of severe malabsorption resulting from absence or removal of the small bowel for several causes. A number of short-bowel patients develop hyperphagia. Leptin, a protein secreted from adipose tissue, signals the amount of energy stores to the brain. OBJECTIVE: To study body composition and leptin regulation in short-bowel patients and to determine whether or not leptin concentrations are linked with hyperphagia. DESIGN: We studied 25 short-bowel patients (remnant bowel less than 150 cm) and 31 controls and 10 oral nutrition. Fifteen patients received total parenteral nutrition and 10 oral nutrition. Anthropometric measurements, body composition (by bioelectrical impedance), and cholesterol, triacylglycerol and leptin concentrations were studied in all subjects. RESULTS: There were no differences between short-bowel patients and controls in anthropometric variables, body composition, or leptin concentrations. Leptin concentrations were higher in short-bowel women than men (9.21+/-8.54 vs. 3.22+/-1.86 ng/ml, P=0.01). Leptin concentrations correlated positively with age (r=0.4, P=0.045), body mass index (r=0.52, P=0.007), fat mass (r=0.67, P=0.001) and body fat (r=0.68, P=0.0001); there were no correlations with other body composition parameters. We found no correlations between parenteral or oral nutrition and body composition parameters, or between leptin concentrations and the presence of hyperphagia. Logistic regression analysis showed that body fat correctly identified leptin concentrations in 60% of patients. CONCLUSIONS: Body composition, leptin concentrations and leptin regulation in patients with short-bowel syndrome are similar to those of controls. Leptin concentrations do not correlate with hyperphagia in short bowel-patients.     

Expanding the understanding of how parenting influences the dietary intake and weight status of children: A cross‐sectional study

Aim: The present study explored whether existing tools measuring parenting could be combined to assess an expanded parenting definition, specifically to include co‐participation in food‐related activities and teaching children about nutrition. The relationships between parenting, child dietary intake and weight outcomes were explored. Methods: The sample included 93 children aged 4–13 years and their parent/caregiver. Child outcomes were dietary intake and body mass index z‐score. Parent measures included demographics, nutrition knowledge and parenting practices. Exploratory factor analysis was used to identify underlying dimensions of parenting. Hierarchical linear regression was used to investigate the independent effects of parenting on child outcomes (body mass index z‐score, fruit and vegetable, fibre, saturated and total fat) after adjustment for covariates. Results: Five factors were extracted, accounting for 44% of the total variance (α= 0.77–0.87). The regression model for kilojoules explained 31% of the variance (P= 0.001), with a significant independent contribution from construct ‘guide and reward’ (β=?0.249, P= 0.027). For child body mass index z‐score, the model explained 25% of variance, and parenting constructs ‘guide and reward’ (β= 0.274, P= 0.015) and ‘concern about intake’ (β=?0.273, P= 0.008) made significant contributions. Conclusions: The present study adds to our understanding of parenting influences on children's dietary intake and weight status. Results support the inclusion of parenting strategies in obesity prevention interventions. Future research should explore the range of ways parenting influences children's diet and risk of obesity, preferably longitudinally.     

Relationship of serum leptin levels and selected nutritional parameters in patients with protein-caloric malnutrition

Leptin is a protein hormone produced by adipocytes that reflects the body fat content, i.e., its serum concentration in healthy individuals positively correlates with the body mass index and body fat content. Serum leptin levels are lower in both patients with anorexia nervosa and protein-caloric malnutrition caused by chronic non-malignant illnesses. The aim of the present study was to compare serum leptin levels and selected, routinely used nutritional parameters in women with anorexia nervosa (n = 17), severely malnourished patients with short bowel syndrome (n = 13), and control non-obese healthy women (n = 17) to clarify the relation between selected nutritional parameters and serum leptin levels. We found that serum leptin levels in the anorexia nervosa and short bowel syndrome groups were significantly lower than those in the control group (in ng/mL: 3.63 +/- 1.64 and 2.59 +/- 1.17 versus 12.06 +/- 7.59, respectively). Protein malnutrition expressed by decrease in serum concentrations of total protein, albumin, and prealbumin was more pronounced in the short bowel syndrome group. Triceps skin fold, arm muscle circumference, and body mass index were significantly lower in the patient group than in the control group and did not significantly differ between the short bowel syndrome and anorexia nervosa groups. No significant difference in serum leptin concentration between the short bowel syndrome and anorexia nervosa groups was found. Serum leptin levels correlated positively with body mass index and triceps skin fold in the control and anorexia nervosa groups but not in the short bowel syndrome group. We conclude that serum leptin levels in patients with anorexia nervosa and short bowel syndrome are significantly lower than in healthy individuals and have no statistically significant relation to serum total protein, abumin, and prealbumin.     

Maintenance of parenteral nutrition volume reduction, without weight loss, after stopping teduglutide in a subset of patients with short bowel syndrome

Background: Teduglutide was discontinued after being tested for ≥ 24 weeks in patients with parenteral nutrition (PN) ‐dependent short bowel syndrome in a clinical trial for efficacy to reduce PN volume. This study was describes change in body mass index (BMI) and PN volume over 12 months in patients who stopped drug after the clinical trial. Methods: Prescribed PN volume, weight, and complications were reported. Patients with stable (NEUT, n = 15) or decreased (DEC, n = 7) PN volume by 12 months after stopping drug (NEUT/DEC, n = 22) were compared to those who had increased PN volume (INC, n = 15). With drug response defined by ≥20% reduction from pre‐drug PN volume to end of drug therapy, 12 INC and 13 NEUT/DEC patients were drug responders. Results: Eleven of 20 eligible sites reported data for 39 of 53 eligible study participants, with follow‐up data for 37. INC patients had shorter colon and less frequently had colon in continuity than NEUT/DEC. BMI was decreased at 3, 6, and 12 months relative to the first off‐drug visit in INC patients (P = .001), but not in NEUT/DEC patients. Change in BMI off‐drug was predicted by colon and small bowel length, baseline BMI, and on‐drug change in PN volume (adjusted R2 = 0.708). Conclusions: Gastrointestinal anatomy, baseline BMI, and PN volume reduction on‐drug predicted change in BMI off‐drug. Whether this response would be maintained for a longer time or in the context of a challenging clinical situation has not been evaluated.     

Fasting and Postprandial Plasma Citrulline and the Correlation to Intestinal Function Evaluated by 72‐Hour Metabolic Balance Studies in Short Bowel Jejunostomy Patients With Intestinal Failure

Background: Fasting plasma citrulline (p‐citrulline) is a marker of functional enterocyte mass. However, the optimal timing of measurement in relation to meals has yet to be clarified. Furthermore, p‐citrulline has been proposed to be a surrogate marker for small bowel length and intestinal absorption parameters in short bowel syndrome patients with intestinal failure (SBS‐IF). Materials and Methods: Eight patients with SBS‐IF and 8 healthy controls (HCs) were given a standardized mixed test meal, and p‐citrulline was measured 15 minutes before and 60, 120, and 180 minutes after completion of the meal. The patients with SBS‐IF had their intestinal absorption of wet weight, energy, macronutrients, and electrolytes measured in relation to 72‐hour metabolic balance studies. We investigated the possible correlations between p‐citrulline and short bowel length, absorptive parameters, and the dependence on parenteral support (PS). Results: In the patients with SBS‐IF, we found a 12% (P = .041) reduction in postprandial citrulline levels after 180 minutes. In the HCs, there was a 13% postprandial reduction at 60 minutes (P = .018). No significant correlations between fasting p‐citrulline and bowel length, bowel absorptive function, or the dependence on PS were found. Even when excluding 2 patients in whom the intestinal absorption was adjacent to the intestinal insufficiency borderlines, these correlations were not significant. Conclusion: Based on findings in this small study, the optimal timing of p‐citrulline measurement is on fasting samples. However, p‐citrulline seems insufficiently discriminative to serve as a valid biomarker of bowel length, bowel absorptive function, or dependence on PS in patients with SBS‐IF.     

Energy Absorption Is Reduced With Oleic Acid Supplements in Human Short Bowel Syndrome

Background: Oleic acid premeal supplements have been described as a method to trigger the ileal brake and thus lengthen transit time and the opportunity for nutrient absorption. The aims of this study were to determine whether oleic acid supplements would lengthen transit time and improve absorption of nutrients in study participants with short bowel syndrome as well as affect diarrhea or patient weight.Methods: A double‐blind, controlled, random‐order crossover trial was conducted in 8 study participants with longstanding and severe short bowel syndrome, employing blue food color appearance, breath hydrogen testing, and radio‐opaque markers as measures of transit time. Absorption of energy, protein, fat, and fluid was conducted by classic nutrient balance methods. Diarrhea was estimated by daily stool weight and number of bowel actions. Although 8 patients were enrolled, only 7 completed the study.Results: Transit time was not significantly different between oleic acid and placebo treatment, although peptide YY levels trended higher with the oleic acid treatment. Energy absorption was reduced 14% by oleic acid, significantly more than the 3% reduction by placebo. Fat, protein, and fluid absorption was not changed significantly. Neither diarrhea nor patient body weight was changed by oleic acid. Conclusions: Energy absorption is reduced by oleic acid supplements in severe short bowel syndrome. The study may have lacked power to determine whether oleic acid affects diarrhea or body weight.     

Association of Calcium Intake and Adiposity in Postmenopausal Women

Objective: The purpose of this study was to examine the relationship between calcium intake and 1) body composition and 2) body fat distribution in postmenopausal women.

Methods: Archived data from a previous study including forty-nine Caucasian women, aged 51–73 and at least three years postmenopausal, were used for analysis. Data included medical and diet history from a questionnaire, average nutrient intake from computerized analysis of a 3-day diet record, anthropometric measures including height, weight, body mass index (BMI), waist circumference, and waist-to-hip ratio (WHR). Calcium intake represented both food and supplement sources of calcium. Lean and fat mass were determined from dual energy x-ray absorptiometry (DXA) total body scans, and abdominal fat mass was defined as fat mass between the top of the iliac crest and L1 on the DXA scan.

Results: Subjects were 60.5 ± 0.9 y/o with an average BMI of 26.9 ± 0.7 and percent body fat of 42.8 ± 1.2. Average calcium intake was 1151 ± 83 g/d. There was a significant inverse relationship between calcium intake and percent body fat (r = ?0.36, p < 0.01) and abdominal fat mass (r = ?0.25, p < 0.05), but there was no significant correlation between calcium intake and body mass index, fat mass, lean mass, waist circumference, or WHR. When kcalories were controlled, the inverse correlation between dietary calcium intake and percent body fat remained (r = ?0.24, p < 0.05). Total fat was significantly greater (p < 0.05) in the low dairy intake (1–2 servings/d) vs. high dairy intake group (3–4 servings/d), but there were no significant differences between the groups in other body composition variables.

Conclusions: Increased calcium intake was associated with lower percent body fat and higher dairy intake was associated with lower fat mass in postmenopausal women, but there was no association between calcium intake and body fat distribution measures in this population.     

Patients With Short Bowel on Narcotics During 2 Randomized Trials Have Abdominal Complaints Independent of Teduglutide

Background: Narcotic agents are frequently administered to manage increased intestinal motility in patients with short bowel syndrome, but long‐term use is associated with gastrointestinal (GI) complaints. This analysis evaluated the incidence of narcotic use and abdominal adverse events among patients with short bowel syndrome receiving teduglutide. Materials and Methods: Pooled data from patients who received ≥1 dose of teduglutide 0.05 mg/kg/d (n = 77) or placebo (n = 59) in either of 2 randomized, double‐blind, phase III studies were analyzed. Results: Of 136 patients, 52 (38%) received narcotics. GI adverse events occurred more often among patients who received narcotics than among those who did not (abdominal pain, 51% vs 21%; nausea, 42% vs 11%; abdominal distension, 17% vs 8%; vomiting, 19% vs 6%). Logistic regression analysis indicated that the probability of GI adverse events was significantly increased in patients with narcotic use (P = .0009). In contrast, teduglutide treatment, as well as the interaction between teduglutide and narcotic use, did not affect the probability of GI adverse events. Conclusions: These results suggest that patients with short bowel syndrome receiving narcotics have chronic GI complaints independent of teduglutide treatment. Data included in this analysis were derived from ClinicalTrials.gov NCT00081458 and NCT00798967 (EudraCT 2004‐000438‐35 and 2008‐006193‐15).     

Bovine Colostrum to Children With Short Bowel Syndrome

Background: Management of short bowel syndrome (SBS) aims to achieve intestinal autonomy to prevent fluid, electrolyte, and nutrient deficiencies and maintain adequate development. Remnant intestinal adaptation is required to obtain autonomy. In the newborn pig, colostrum has been shown to support intestinal development and hence adaptive processes. Aim: The efficacy of bovine colostrum to improve intestinal function in children with SBS was evaluated by metabolic balance studies. Materials and Methods: Nine children with SBS were included in a randomized, double‐blind, crossover study. Twenty percent of enteral fluid intake was replaced with bovine colostrum or a mixed milk diet for 4 weeks, separated by a 4‐week washout period. Intestinal absorption of energy and wet weight was used to assess intestinal function and the efficacy of colostrum. Results: Colostrum did not improve energy or wet weight absorption compared with the mixed milk diet (P = 1.00 and P = .93, respectively). Growth as measured by weight and knemometry did not differ between diets (P = .93 and P = .28). In these patients, <150% enteral energy absorption of basal metabolic rate and 50% enteral fluid absorption of basal fluid requirement suggested intestinal failure and a need for parenteral nutrition (PN). Conclusion: Inclusion of bovine colostrum to the diet did not improve intestinal function. Metabolic nutrient and wet weight balance studies successfully assessed intestinal function, and this method may distinguish between intestinal insufficiency (non–PN‐dependent) and intestinal failure (PN‐dependent) patients.     

Macronutrient absorption characteristics in humans with short bowel syndrome and jejunocolonic anastomosis: starch is the most important carbohydrate substrate, although pectin supplementation may modestly enhance short chain fatty acid production and fluid absorption

Background: Diet may play an important role in the management of patients with short bowel syndrome who have colon in continuity. However, macronutrient absorption has not been well characterized, and the most appropriate dietary constituents have not been well defined. Objective: To define carbohydrate absorption characteristics in patients with short bowel syndrome and determine the potential role of pectin as a dietary substrate. Methods: The authors studied the effect of a custom pectin‐based supplement in 6 subjects (3 male/3 female) aged 29–67 years with jejunocolonic anastomosis, 4 of whom required long‐term parental nutrition. Small intestinal absorption capacity, macronutrient and fluid balance, gastrointestinal transit time, and energy consumption were measured. Results: Data showed that 53% nitrogen, 50% fat, and 32% total energy were malabsorbed. In contrast, the majority (92%) of total carbohydrate was utilized. Fecal short‐chain fatty acids (SCFAs) were increased, an indication of increased fermentation. Although only 4% of starch was recovered in stool, it is indicative of considerable starch malabsorption, thus providing the main carbohydrate substrate, for colonic bacterial fermentation. In contrast, nonstarch polysaccharide was a relatively minor fermentation substrate with only 49% utilized. Eighty percent of the pectin was fermented. Supplementation was associated with increased total SCFAs, acetate, and propionate excretion. There was a trend observed toward greater fluid absorption (?5.9% ± 54.4% to 26.9% ± 25.2%) following pectin supplementation. Nonsignificant increases in gastric emptying time and orocolonic transit time were observed. Conclusion: Despite malabsorption, starch is the primary carbohydrate substrate for colonic bacterial fermentation in patients with short bowel syndrome, although soluble fiber intake also enhances colonic SCFA production.     

Dietary calcium,dairy food intake and metabolic abnormalities in HIV‐infected individuals

Background: Epidemiological data suggest that calcium intake may influence lipid metabolism. It is unknown whether this influence also occurs in individuals with HIV/AIDS. The present study aimed to assess the relationship between dietary calcium, dairy food intake and metabolic parameters in individuals with HIV/AIDS. Methods: A cross‐sectional study was conducted with 100 individuals with HIV/AIDS. Calcium intakes and food group consumption were determined by a food 24‐h dietary recall and a food frequency questionnaire, respectively. The level of physical activity was determined with the international physical activity questionnaire and metabolic syndrome (MS) was defined by National Cholesterol Education Program Adult Treatment Panel III (2001). Student’s t‐test, one‐way analysis of variance and chi‐square were used to compare the groups. Results: The mean (SD) calcium intake was 559.5 (298.84) mg day^?1 and dairy food consumption was 1.73 (0.78) servings per day. Dietary calcium intake below 700 mg day^?1 had greater waist circumference, body mass index (BMI) but not significant and higher systolic blood pressure (SBP) (P < 0.05) and diastolic blood pressure (DBP) (P = 0.07). Dairy food consumers (>2 servings per day) showed lower BMI (P < 0.01), waist circumference (P = 0.05), SBP and DBP (P < 0.05). There was a significant association between calcium intake, MS and hypertension. The odds ratio for MS was 2.0 [95% confidence interval (CI) = 1.23–3.32] and for hypertension was 2.25 (95% CI = 1.44–4.44). Only 21% of the individuals were categorised in the moderate/intense physical activity level. Conclusions: The results obtained suggest that a dietary pattern with higher proportion of calcium and fruits/vegetables may protect against abdominal obesity and hypertension in HIV‐infected individuals.     

A New Concept to Achieve Optimal Weight Gain in Malnourished Infants on Total Parenteral Nutrition

Background

Infants with intestinal failure (IF) are at increased risk of malnutrition and require adapted nutrition support. Optimal weight gain during nutrition rehabilitation should occur at the velocity of statural age (adjusted to the 50^th percentile of height) and not chronological age. The aim of this study was to assess the relationship between weight gain during catch‐up growth, nonprotein energy intake (NPEI) provided by total parenteral nutrition (TPN), and resting energy expenditure (REE) in children with severe malnutrition due to IF.

Materials and Methods

This retrospective study included all infants with severe malnutrition treated with TPN for IF between January 1, 2010, and December 31, 2013. They all had no or minimal oral intake (<10% REE). The REE was calculated using the Schofield equations.

Results

Seventeen children were included (11 boys) with a mean age at TPN onset of 5 mo. They were followed for a mean duration of 39 days. On admission, body weight and height were –3.1 ± 0.9 and –3.3 ± 1.3 SD, respectively. The indications for TPN were short bowel syndrome (n = 10), congenital enteropathy (microvillous inclusion disease, n = 6) and chronic intestinal pseudo‐obstruction syndrome (n = 1). After 28 days of nutrition rehabilitation with full NPEI from TPN, the observed weight gain was 110 ± 5% of optimal weight gain for statural age. The mean NPEI from TPN was 104.3 ± 8.0 kcal/kg/d. The mean ratio of NPEI over REE was 2.1 ± 0.2.

Conclusion

Optimal weight gain was achieved with NPEI from TPN twice the REE in severely malnourished infants with IF. NPEI values were adequate and not excessive for age.     

Evaluation of Lean Body Weight Equation by Dual‐Energy X‐Ray Absorptiometry Measures

Background: When managing patients with disorders that require clinical intervention, a practical assessment of body habitus is valued. The Duffull‐Green lean body weight (LBW) equation was derived and validated in adults across a wide body mass index (BMI) range. Whether this predictive equation will perform well in patients at BMI extremes or perform better than a widely used empiric “ideal” body weight (IBW) equation is unknown. Materials and Methods: Calculated LBW and calculated IBW were each compared with the dual‐energy x‐ray absorptiometry (DXA)–derived lean body mass (LBM) by simple linear regression. A mixed model was used to determine how well the LBW equation performed over time in patients with more than 1 DXA measurement. Results: At time 0, 32 patients were 18–67 years old, and all were obese (BMI: 36–65 kg/m²), while the remaining 7 had parenteral nutrition–dependent intestinal failure (BMI: 17–25 kg/m²). A subset of patients underwent bariatric surgery after time 0 (BMI at follow‐up: 22–49 kg/m²). The LBW equation was a predictor of LBM (R² = 0.67, P < .0001), while the IBW equation was not (R² = 0.04, P = .25). The LBW equation remained a predictor of LBM over time (P < .0001) without significant interaction by number of months since time 0. Conclusion: The Duffull‐Green LBW equation successfully predicted lean body mass in a patient population with a wide range of BMIs at both a single point in time and after considerable weight loss. In the clinical setting, an equation that performs well in various disease states and body sizes is advantageous.     

Vitamin D deficiency in patients with inflammatory bowel disease: association with disease activity and quality of life

Background: Vitamin D deficiency is common in inflammatory bowel disease (IBD). The aim of the study was to determine the prevalence and predictors of vitamin D deficiency in an IBD cohort. It was hypothesized that vitamin D deficiency is associated with increased disease activity and lower health‐related quality of life (HRQOL). Methods: This was a retrospective cohort study. Harvey‐Bradshaw index and ulcerative colitis disease activity index were used to assess disease activity. Short Inflammatory Bowel Disease Questionnaire scores were used to assess HRQOL. Multivariate logistic regression was used to identify independent predictors of vitamin D deficiency and its association with disease activity and HRQOL. Results: The study included 504 IBD patients (403 Crohn's disease [CD] and 101 ulcerative colitis [UC]) who had a mean disease duration of 15.5 years in CD patients and 10.9 years in UC patients; 49.8% were vitamin D deficient, with 10.9% having severe deficiency. Vitamin D deficiency was associated with older age (P = .004) and older age at diagnosis (P = .03). Vitamin D deficiency was associated with lower HRQOL (regression coefficient –2.21, 95% confidence interval [CI], –4.10 to –0.33) in CD but not UC (regression coefficient 0.41, 95% CI, –2.91 to 3.73). Vitamin D deficiency was also associated with increased disease activity in CD (regression coefficient 1.07, 95% CI, 0.43 to 1.71). Conclusions: Vitamin D deficiency is common in IBD and is independently associated with lower HRQOL and greater disease activity in CD. There is a need for prospective studies to assess this correlation and examine the impact of vitamin D supplementation on disease course.     

Green tea improves metabolic biomarkers,not weight or body composition: a pilot study in overweight breast cancer survivors

Background: Overweight status after breast cancer treatment may increase a woman’s risk for recurrent disease and/or early onset cardiovascular disease. Green tea has been proposed to promote weight loss and favourably modify glucose, insulin and blood lipids. This pilot study tested the effect of daily decaffeinated green tea consumption for 6 months on weight and body composition, select metabolic parameters and lipid profiles in overweight breast cancer survivors. Methods: The effect of daily decaffeinated green tea intake on weight, body composition and changes in resting metabolic rate, energy intake, glucose, insulin, homeostasis model assessment – insulin resistance (HOMA‐IR) and lipids was evaluated in overweight breast cancer survivors. Participants had a mean weight of 80.2 kg; body mass index (BMI) 30.1 kg m^?2; and body fat 46.4%. Participants (n = 54) were randomised to 960 mL of decaffeinated green or placebo tea daily for 6 months. Results: Mean (SD) tea intake among study completers (n = 39) was 5952 (1176) mL week^?1 and was associated with a significant reduction in energy intake (P = 0.02). Change in body weight of ?1.2 kg (green tea) versus +0.2 kg (placebo) suggests a weight change effect, although this was not statistically significant. Decaffeinated green tea intake was associated with elevated high‐density lipoprotein (HDL) levels (P = 0.003) and nonsignificant improvements in the HDL/LDL ratio and HOMA‐IR (?1.1 ± 5.9: green tea; +3.2 ± 7.2: herbal). Conclusions: Intake of decaffeinated green tea for 6 months was associated with a slight reduction in body weight and improved HDL and glucose homeostasis in overweight breast cancer survivors.     

Bowel habit,diet and body weight in preadolescent children

Background: The possible influence of diet and body weight on bowel habit in children is unknown. The present study aimed to investigate the inter‐relationships between bowel function, excess body weight and dietary intake in a group of preadolescent children. Methods: Eighty‐four preadolescent children aged 7–10 years were recruited [mean (SD) age 9.7 (1.0) years]. All children completed a bowel habit diary, examining specific parameters of bowel function and a weighed food inventory concurrently for seven consecutive days. Height and weight measurements were also taken. Children were grouped according to whether they met dietary recommendations and by overweight status; differences in bowel function between the groups were then analysed. Results: Children who exceeded reference values for fat were more likely to report an incidence of straining to start (P = 0.005) and pain during defaecation (P = 0.021). Subjects who met protein recommendations were less likely to report incomplete evacuation (P = 0.000) and those who met zinc recommendations were less likely to report pain during defaecation (P = 0.044). Excess body weight (according to International Obesity Task Force cut‐offs) was also associated with poor bowel habit, with overweight and obese children reporting lower defaecation frequency and a higher incidence of straining and feelings of incomplete evacuation, although these findings were not statistically significant. Defaecation frequency in healthy children was 1.4 defaecations per day compared to 1.2 defaecations for overweight and obese children. Conclusion: A poor diet that fails to meet dietary recommendations as well as being overweight and obese appears to be associated with increased defaecation problems in preadolescent children.     

Effect of Liraglutide Treatment on Jejunostomy Output in Patients With Short Bowel Syndrome: An Open‐Label Pilot Study

Background: An impaired hormonal “ileo‐colonic brake” may contribute to rapid gastric emptying, gastric hypersecretion, high ostomy losses, and the need for parenteral support in end‐jejunostomy short bowel syndrome (SBS) patients with intestinal failure (IF). Liraglutide, a glucagon‐like peptide 1 receptor agonist, may reduce gastric hypersecretion and dampen gastric emptying, thereby improving conditions for intestinal absorption. Materials and Methods: In an 8‐week, open‐label pilot study, liraglutide was given subcutaneously once daily to 8 end‐jejunostomy patients, aged 63.4 ± 10.9 years (mean ± SD) and with small bowel lengths of 110 ± 66 cm. The 72‐hour metabolic balance studies were performed before and at the end of treatment. Food intake was unrestricted. Oral fluid intake and parenteral support volume were kept constant. The primary end point was change in the ostomy wet weight output. Results: Liraglutide reduced ostomy wet weight output by 474 ± 563 g/d from 3249 ± 1352 to 2775 ± 1187 g/d (P = .049, Student t test). Intestinal wet weight absorption tended to increase by 464 ± 557 g/d (P = .05), as did urine production by 765 ± 759 g/d (P = .02). Intestinal energy absorption improved by 902 ± 882 kJ/d (P = .02). Conclusion: Liraglutide reduced ostomy wet weight output in end‐jejunostomy patients with SBS‐IF and increased their intestinal wet weight and energy absorption. If larger, randomized, placebo‐controlled studies confirm these effects, it adds to the hypothesis that many ileo‐colonic brake hormones in conjunction may be involved in the process of intestinal adaptation. By identification of key hormones and addressing their potential synergistic effects, better treatments may be provided to patients with SBS‐IF. This trial was registered at clinicaltrialsregister.eu as 2013‐005499‐16.     

Household Income, Maternal Acculturation, Maternal Education Level and Health Behaviors of Chinese-American Children and Mothers

Objective A cross-sectional study was conducted to examine factors associated with health behaviors, including physical activity and dietary intake, of Chinese women who have immigrated to the United States and their children. Participants Using convenience sampling, a total of 65 Chinese-American children and their mothers in the San Francisco Bay Area participated in the study. Measures Information related to children’s weight, height, level of physical activity (Caltrac accelerometer), and dietary intake (Kids’ food frequency questionnaire) was collected using standardized instruments. Mothers completed questionnaires regarding household income, their levels of education and acculturation (Suinn-Lew Asian Self-Identity Acculturation Scale), dietary intake (SWAN Food Frequency Questionnaire), and level of physical activity (Seven-day physical activity recall). Results 36.9% (n = 24) of the children were overweight (body mass index higher than the 85th percentile). A high household income was related to low maternal body mass index (R ² = .08, P = .04), high maternal fat intake (R ² = .21, P = .0001), and high maternal intake of sweets (R ² = .08, P = .033), and a high level of maternal acculturation was related to low body mass index in children (R ² = .07, P = .034). Conclusions The results suggest that an intervention aimed at reducing obesity and promoting health behaviors must be appropriate for different ethnic groups with various incomes and levels of acculturation.     

Relationship Between Energy Balance and Complications After Subarachnoid Hemorrhage

Background: Subarachnoid hemorrhage patients are hypermetabolic and at risk for developing medical complications. A relationship was hypothesized between energy balance and complications following subarachnoid hemorrhage. Methods: Fifty‐eight consecutive poor‐grade subarachnoid hemorrhage patients (mean age, 58; range, 26–86; 66% women) were studied between 2005 and 2007. Caloric intake and energy expenditure were assessed. In‐hospital complications over the first 14 days posthemorrhage were defined as renal failure, fever (>38.3°C), any infection, anemia, hyperglycemia (>11 mmol/L), and myocardial infarction. Energy balance was calculated by subtracting energy expenditure from caloric intake. Results: Enteral nutrition was begun 1 day posthemorrhage (range, 0–5 days). Recommended (mean ± SD) caloric intake was 28 ± 3 kcal/kg/d, and the actual was 14 ± 5 kcal/kg/d. Enteral nutrition accounted for 67% of caloric intake; propofol and dextrose infusions accounted for 33% of caloric intake. Cumulative energy balance over the first 7 days was –117 ± 53 kcal/kg. The average energy balance during the first 7 days after subarachnoid hemorrhage significantly correlated with the total number of infectious complications (r = –0.5, P < .001) but not medical complications (r = –0.2, P = .1). After adjustment for Hunt‐Hess grade, fever, hyperglycemia, and anemia, negative energy balance during the first 7 days after subarachnoid hemorrhage correlated with the number of infectious complications (P = .01). Conclusions: Infectious complications after subarachnoid hemorrhage are associated with negative energy balance. Studies are needed to better understand the impact of negative energy balance on outcome after subarachnoid hemorrhage.     

Changes in gastrointestinal hormones and leptin after Roux-en-Y gastric bypass surgery

Background: Roux‐en‐Y gastric bypass (RYGB) imparts long‐term weight loss, the mechanisms for which are not well understood. Changes in leptin and gastrointestinal (GI) hormones, including glucagon‐like peptide 1 (GLP‐1), peptide YY (PYY), and ghrelin, may contribute to the relative success of RYGB compared with conventional weight loss methods. This study evaluated changes in GI hormones and leptin post‐RYGB. The study also evaluated whether GI hormones differed after a short‐term dose of protein or fat. Methods: GLP‐1, PYY, ghrelin, and leptin were assessed in 16 women before RYGB and up to 1 year after RYGB. Plasma was collected before and at several times after a short‐term equicaloric dose of protein or fat. Results: GLP‐1 area under the curve (AUC) increased at week 6 and 1 year in the fat beverage (FAT‐BEV) group compared with baseline. PYY AUC remained elevated at 1 year in the FAT‐BEV group. Ghrelin AUC decreased at week 2, week 6, and 1 year in the protein beverage (PRO‐BEV) group compared with baseline. Ghrelin AUC was lower in the PRO‐BEV group compared with the FAT‐BEV group at week 6. Fasted leptin decreased at all visits in both groups and was lower in the FAT‐BEV group compared with the PRO‐BEV group at 1 year. Conclusions: Changes from baseline were evident for all GI hormones and leptin; some differences were evident soon after surgery (ghrelin, leptin), whereas others were maintained long term (GLP‐1, PYY, ghrelin, leptin). In response to a short‐term stimulus, protein suppressed ghrelin and fat potently stimulated GLP‐1 and PYY. Future work in this area is warranted.