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1.
Objective. The purpose of this study was to determine the effect of dietary intakes on nutritional indicators of patients on hemodialysis. Method. This study was carried out at the hemodialysis unit at the Ministry of Health, Ankara Hospital, from 2003–2004. Sixty-seven patients on regular hemodialysis were enrolled in the study. Nutritional status was assessed by biochemical parameters (urea, uric acid, creatinine, Na, K, Cl, Ca, P, alkaline phosphatase, SGOT, SGPT, cholesterol, total protein, albumin, hemoglobin, hematocrit) and anthropometric measurements (height, dry weight, body mass index), and dietary intakes were calculated. Results. In this study, the mean age of the patients was 45.3 ± 13.49, and the duration of hemodialysis was 4.9 ± 3.64 year. Dialysis time was 12.4 ± 2.7 h/week. The ratio of individuals with BMI of 20 kg/m2 or below this value was 19.4%. Blood hemoglobin and hematocrit levels were below than the recommended level. Mean serum urea (148.0 ± 27.76 mg/dL) and creatinine (8.8 ± 2.13 mg/dL) were found to be high, while a significant negative correlation was found between blood urea level and dietary fat (p < 0.01, r = ?0.31). A significant positive correlation was found between vitamin B1, vitamin B6, folate, potassium, iron, and magnesium; between uric acid and vitamin D; between blood creatinine level and dietary vitamin B1, vitamin B6, folate, vitamin C, potassium, iron, magnesium; between blood potassium level and dietary vitamin C only; and between blood cholesterol level and dietary vitamin D only (p < 0.01). 相似文献
2.
Silverstein DM Srivaths PR Mattison P Upadhyay K Midgley L Moudgil A Goldstein SL Feig DI 《Pediatric nephrology (Berlin, Germany)》2011,26(7):1123-1128
Serum uric acid (UA) is positively associated with hypertension (HTN). HTN is common in pediatric patients receiving hemodialysis
(HD) and peritoneal dialysis (PD). We assessed the relationship between UA and BP in 63 pediatric dialysis patients by measuring
pre-treatment UA levels and BP in HD patients and in-center UA levels and blood pressure (BP) in PD patients. UA levels were
similar in both groups [6.8 ± 0.2 (HD) vs. 6.5 ± 0.3 (PD), p = 0.6]. Pre-treatment systolic BP percentile was associated with a high UA level [91.9 ± 2.3 (>6.0 mg/dL) vs. 79.3 ± 5.8 mm
Hg (≤6.0 mg/dL), p = 0.01] in HD patients only. There was a negative relationship between UA and dialysis vintage (r = −0.31, p = 0.01). In both groups, there was no relationship between UA and Kt/V. In HD patients, fluid overload was unrelated to UA
level [4.2 ± 0.6% (≤6.0 mg/dL) vs. 4.3 ± 0.3% (>6.0 mg/dL), p = 0.9]. Moreover, pre-HD treatment systolic BP percentile correlated with UA (beta 0.36, p = 0.02) independent of volume. UA levels were higher in patients receiving anti-hypertensive medications [6.3 ± 0.2 (No Meds]
vs 7.0 ± 0.2 (BP Meds) mg/dL, p= 0.01]. Finally, there was no relationship between serum UA and normalized protein catabolic rate (r = 0.14; p = 0.4). In summary, serum UA impacts BP in pediatric HD patients, independent of volume, nutritional and weight status. 相似文献
3.
Rejnmark L Vestergaard P Hermann AP Brot C Eiken P Mosekilde L 《Calcified tissue international》2008,82(1):1-11
Folate, vitamin B2 (riboflavin), and vitamin B12 may affect bone directly or through an effect on plasma homocysteine levels. Previously, a positive association has been found
between plasma levels and bone mineral density (BMD) as well as risk of fracture. However, there are limited data on whether
dietary intakes affect bone. Our aim was to investigate whether intake of folate, vitamin B2, and vitamin B12, as assessed by food records affects BMD and fracture risk. In a population-based cohort including 1,869 perimenopausal women
from the Danish Osteoporosis Prevention Study, associations between intakes and BMD were assessed at baseline and after 5 years
of follow-up. Moreover, associations between intakes and 5- and 10-year changes in BMD as well as risk of fracture were studied.
Intakes of folate, vitamin B2, and vitamin B12 were 417 (range 290–494) μg/day, 2.70 (range 1.70–3.16) mg/day, and 4.98 (range 3.83–6.62) μg/day, respectively, i.e., slightly
above the intakes recommended by the United Nations Food and Agriculture Organization. At year 5, but not at baseline, cross-sectional
analyses showed positive correlations between daily intake from diet and from diet plus supplements of folate and BMD at the
femoral neck (P < 0.01). However, no associations were found between intakes and changes in BMD. During 10 years of follow-up, 360 subjects
sustained a fracture. Compared with 1,440 controls, logistic regression analyses revealed no difference in intakes between
cases and controls. A high dietary intake of folate, but not vitamin B2 or B12, exerts positive effects on BMD; but further studies are needed to confirm this association. 相似文献
4.
Background Sleeve gastrectomy is thought to decrease the appetite and body weight of morbid obesity patients in the clinic. The purpose
is to investigate the effect of sleeve gastrectomy on preventing steatohepatitis in morbid obesity rats.
Methods Thirty rats were randomized into normal chow group (NC), high-fat-diet group (HD), and sleeve group (SG). Rats in the SG group
received sleeve gastrectomy operation. After operation, rats in SG and HD group received a high-fat diet, while rats in the
NC group received normal chow. Body weight was measured every 10 days. Thirty days later, animals were sacrificed and blood
samples were collected to check total cholesterol, HDL, and triglyceride. Fresh liver sections were made and stained with
Nile red and observed under a fluorescence microscope.
Results Rats in the SG group received a moderate body weight decrease (191 ± 16.2 g) in the first 10 days, while this did not happen
in the other two groups (213 ± 13.7 g and 243 ± 11.9 g). At the sacrifice date, weight of rats in the SG group was still much
lower than those in the HD group. Plasma triglycerol (102.3 ± 18.6 mg/dL) and cholesterol (84.3 ± 6.1 mg/dL) of rats in the
SG group were much lower than those in the HD group (198.5 ± 18.5 mg/dL, 133.9 ± 22.0 mg/dL). Under the fluorescence microscope,
adipose infiltration was very obvious in the liver of the HD animals, while adipose infiltration was not serious in the SG
group.
Conclusion High-fat diet can result in obvious body weight increase and hepatic adipose infiltration compared with normal chow. Sleeve
gastrectomy can decrease body weight even in high-fat-diet models. Body weight control caused by sleeve gastrectomy can relieve
high-fat-diet-induced steatohepatitis in rats.
Authors have no commercial interest in the subject of study.
This investigation was supported by National Foundation of Liaoning Province (110035). 相似文献
5.
Coupaye M Puchaux K Bogard C Msika S Jouet P Clerici C Larger E Ledoux S 《Obesity surgery》2009,19(1):56-65
Background Gastric bypass (GBP) is more efficient than adjustable gastric banding (AGB) on weight loss and comorbidities, but potentially
induces more nutritional deficits. However, no study has compared the prevalence of nutritional deficiencies after these two
bariatric procedures.
We prospectively compared To prospectively compare the prevalence of nutritional deficiencies after AGB and GBP.
Methods We have performed a 1-year prospective study of nutritional parameters in 70 consecutive severe obese patients, who had undergone
bariatric surgery, 21 AGB and 49 GBP. After GBP, multivitamin supplements were systematically prescribed and vitamin B12 supplementation
was introduced if a deficiency was observed.
Results Patients lost more weight after GBP than after AGB (40 ± 13 vs 16 ± 8 kg, p < 0.001). Vitamins B1 and C and iron deficiencies were frequent before surgery but were not worsened by GBP. AGB only induced
a slight decrease of vitamin B1 at 1 year, whereas GBP induced significant decreases of vitamins B12 and E, serum prealbumin,
and creatinine concentrations, with only minor clinical consequences. Anemia was observed in 10% of the patients after bariatric
surgery. Hemoglobin concentration was not correlated to vitamin B12 or folate concentrations but was related to iron status.
Risk of iron deficiency anemia was better assessed by transferrin saturation than by serum ferritin concentration in this
obese population.
Conclusion Severe nutritional deficits can be avoided after bariatric surgery if patients are systematically supplemented with multivitamin
and carefully monitored. However, specific care is required to avoid iron and vitamin B12 deficiencies, anemia, and protein
malnutrition. 相似文献
6.
Background Roux-en-Y gastric bypass (RYGBP) has been found to be the most efficient way to lose weight and maintain the weight loss in
morbid obesity. However, with the formation of a new stomach and the modification of intestinal anatomy, there are significant
changes on bone metabolism. The objectives of this study were to evaluate effects of weight loss on bone metabolism after
Roux-en Y gastric bypass in patients with morbid obesity.
Methods Our study included 70 patients with morbid obesity; RYGB was done for all patients. Daily postoperative oral supplementation
with 1,000 mg of calcium and 800 IU of vitamin D was done for each patient. Body weight (BW), body mass index (BMI), total
body fat, total lean tissue mass, bone mineral content (BMC), bone mineral density (BMD), total bone area (TBA; using dual
energy X-ray absorptiometry), serum calcium, parathyroid hormone (PTH), 25-OH vitamin D, 24-h urinary calcium, and bone-specific
alkaline phosphatase (BSAP) were assessed preoperatively and 1 year after surgery.
Results In our study, females comprised 70% of cases. The mean age was 35 ± 8.8 years. One year after RYGB, BW decreased significantly
from 132.8 ± 26.5 to 90.3 ± 17.3 kg (p = 0.001). BMI decreased significantly from 48 ± 7.3 to 32.6 ± 4.1 kg/m2 (p = 0.001). BMC decreased significantly from 2,968.6 ± 71.4 to 2,700.8 ± 45.4 g (p = 0.001). BMD decreased significantly from 1.026 ± 0.03 to 1.22 ± 0.015 g/cm2 (p = 0.001). TBA decreased significantly from 2,356.2 ± 35.4 to 2,216.3 ± 43.5 cm2 (p = 0.001). Serum calcium, 24-h urinary calcium, and BSAP were not significantly decreased while 25-OH vitamin D and PTH were
not significantly increased after surgery.
Conclusions From this study, it is shown that RYGBP operation gives very good results as regards reduction of body weight in morbidly
obese patients. Postoperative supplementation with calcium and vitamin D partially corrects osteoporosis. Thus, these patients
need periodic follow-up for BMD, PTH, calcium, serum vitamin D, and markers of bone resorption and formation specially postmenopausal
female. 相似文献
7.
Background Bariatric surgery has been proven the most effective treatment of morbid obesity, but micronutrient deficiency following bariatric
surgery is a major concern. Increasing evidence points to a generally poor micronutrient status in obese subjects.
Methods We assessed micronutrient status in 232 morbidly obese subjects (BMI ≥ 35 kg/m2) prior to bariatric surgery. Serum albumin, calcium, phosphate, magnesium, ferritin, hemoglobin, zinc, folate, vitamin B12, 25-OH vitamin D3, and intact parathormone (iPTH) were determined. In a sub-sample of 89 subjects, we additionally assessed copper, selenium,
vitamin B1, B3, B6, A, and E levels.
Results Deficiencies were found in 12.5% of the subjects for albumin, 8.0% for phosphate, 4.7% for magnesium, 6.9% for ferritin, 6.9%
for hemoglobin, 24.6% for zinc, 3.4% for folate, and 18.1% for vitamin B12. In addition, 25.4% showed a severe 25-OH vitamin D3 deficiency, which was accompanied by a secondary hyperparathyroidism in 36.6% cases. Prevalence of albumin deficiency (p < 0.007) and of anemia (p < 0.003; in women only) significantly increased with BMI. Of note, 48.7% of the subjects showed at least one of the most
prevalent deficiencies, i.e., vitamin B12, zinc and severe 25-OH vitamin D3 deficiency. In the sub-sample, 32.6% showed a selenium, 5.6% a vitamin B3, 2.2% a vitamin B6, and 2.2% a vitamin E deficiency. Copper, vitamin B1, and vitamin A deficiency was found in none of the subjects.
Conclusion Data indicate a high prevalence of micronutrient deficiencies in morbidly obese subjects. Based on these results, we strongly
recommend a systematic assessment of the micronutrient status in all candidates for bariatric surgery.
The authors have no commercial interest to disclose. The study was financially supported by a grant from Johnson & Johnson.
The funder had no role in the study design, analysis and publication of the data. 相似文献
8.
E. Pardina A. Lecube R. Llamas R. Catalán R. Galard J. M. Fort H. Allende V. Vargas J. A. Baena-Fustegueras J. Peinado-Onsurbe 《Obesity surgery》2009,19(8):1150-1158
Background Although bariatric surgery is currently the most common practice for inducing weight loss in morbidly obese patients (BMI > 40 kg/m2), its effect on the lipid content of adipose tissue and its lipases (lipoprotein lipase [LPL] and hormone-sensitive lipase
[HSL]) are controversial.
Methods We analyzed LPL and HSL activities and lipid content from plasma as well as subcutaneous (SAT) and visceral (VAT) adipose
tissue of 34 morbidly obese patients (MO) before and after (6 and 12 months) Roux-en-Y gastric bypass surgery and compare
the values with those of normal weight (control) patients.
Results LPL activity was significantly higher in MO (SAT = 32.9 ± 1.0 vs VAT = 36.4 ± 3.3 mU/g tissue; p < 0.001) than in control subjects (SAT = 8.2 ± 1.4 vs VAT = 6.8 ± 1.0 mU/g tissue) in both adipose depots. HSL activity had
similar values in both types of tissue (SAT = 32.8 ± 1.6 and VAT = 32.9 ± 1.6 mU/g) of MO. In the control group, we found
similar results but with lower values (SAT = 11.9 ± 1.4 vs VAT = 12.1 ± 1.4 mU/g tissue). Twelve months after surgery, SAT
LPL activity diminished (9.8 ± 1.4 mU/g tissue, p < 0.001 vs morbidly obese), while HSL (46.6 ± 3.7 mU/g tissue) remained high. All lipids in tissue and plasma diminished
after bariatric surgery except plasma nonesterified fatty acids, which maintained higher levels than controls (16 ± 3 vs 9 ± 0 mg/dL;
p < 0.001, respectively).
Conclusions When obese patients lose weight, they lose not only part of the lipid content of the cells but also the capacity to store
triacylglycerides in SAT depots.
E. Pardina and A. Lecube contributed equally to this study.
J.A. Baena-Fustegueras and J. Peinado-Onsurbe share senior authorship. 相似文献
9.
Cano F Alarcon C Azocar M Lizama C Maria Lillo A Delucchi A Gonzalez M Arellano P Delgado I Droguett MT 《Pediatric nephrology (Berlin, Germany)》2011,26(8):1303-1310
The short half-life of erythropoietin (rHuEPO) leads to repeated fluctuations in hemoglobin levels and the need for frequent
administration. Continuous erythropoietin receptor activator (CERA) therapy has been approved for once or twice a month in
adult dialysis patients. To evaluate the efficacy and safety of CERA therapy in the management of anemia in pediatric peritoneal
dialysis (PD) stable PD children under twice-a-week EPO were converted to a subcutaneous CERA, scheduled every 2 weeks. The
follow-up was 6 months. The primary efficacy parameter was hemoglobin > 11 g/dL. The exclusion criteria were ferritin <100 ng/ml
and Hb saturation <20%. Sixteen children, aged 9.75 ± 3.6 years, including 11 boys, participated in the study. Mean Hb level
at month 0 was 10.8 ± 1.9 g/dL. A decrease in hemoglobin to 10.38 ± 1 g/dL at month 2 was observed. The CERA dose was increased
from 0.86 ± 0.33 to 1.67 ± 0.4 μg/kg at month 3. The target Hb level was reached by the 3rd month. The Hb level and CERA dose
were 12.2 ± 1.2 and 1.6 ± 0.67 μg/kg respectively at the end of the study. No adverse events were observed during the protocol.
CERA is an effective and safe therapy for maintaining hemoglobin levels when administered twice, up to once a month, in PD
children. Doses required to reach target Hb were higher than published experiences in adult populations. 相似文献
10.
Juan P. Valderas Soledad Velasco Sandra Solari Yessica Liberona Paola Viviani Alberto Maiz Alex Escalona Gilberto González 《Obesity surgery》2009,19(8):1132-1138
Background The effects of Roux-en-Y Gastric Bypass (RYGB) on bone in the long-term remains unclear. We assessed bone metabolism and bone
mineral density (BMD) 1 to 5 years after RYGB.
Methods We designed a retrospective cohort study in 26 postmenopausal women (58.0 ± 3.9 years old) with RYGB 3.5 ± 1.1 years before
(body mass index (BMI) 29.5 ± 3.8 kg/m2, presurgery 43.6 ± 5.5 kg/m2) and 26 nonoperated women (57.5 ± 4.7 years old, BMI 29.2 ± 4.1 kg/m2) matched by age and BMI. The main measures were BMD, serum carboxy telopeptide (CTx), total alkaline phosphatases (ALP),
parathyroid hormone (PTH), 25-hydroxyvitamin D (25OHD), and ghrelin.
Results RYGB group, compared to nonoperated women, had higher CTx (0.71 ± 0.21 vs. 0.43 ± 0.15 ng/ml; P < 0.01) and PTH (68.3 ± 35 vs. 49.4 ± 16 pg/ml; P = 0.02). There were no differences between RYGB and nonoperated women in: calcium and vitamin D intake (759 ± 457 vs. 705 ± 460 mg/day;
176 ± 160 vs. 111 ± 86 UI/day), ghrelin (763 ± 336 vs. 621 ± 274 pg/ml), ALP (101 ± 22 vs. 94 ± 25 UI/l), 25OHD (18.8 ± 7.6
vs. 17.4 ± 5.9 ng/ml), lumbar spine BMD (1.059 ± 0.32 vs. 1.071 ± 0.207 g/cm2), or femoral neck BMD (0.892 ± 0.109 vs. 0.934 ± 1.1 g/cm2).
Conclusions RYGB is associated to high bone resorption and hyperparathyroidism prevalence in postmenopausal women in the long-term. This
occurs independently of the intake of calcium, vitamin D status, or ghrelin and does not seem to affect BMD after RYGB. 相似文献
11.
Katherine Wesseling-Perry G. Chris Harkins He-Jing Wang Shobha Sahney Barbara Gales Robert M. Elashoff Harald Jüppner Isidro B. Salusky 《Pediatric nephrology (Berlin, Germany)》2009,24(7):1355-1361
Amino-terminally truncated parathyroid hormone (PTH) fragments are detected to differing degrees by first- and second-generation
immunometric PTH assays (PTH-IMAs), and acute changes in serum calcium affect the proportion of these fragments in circulation.
However, the effect of chronic calcium changes and different vitamin D doses on these PTH measurements remains to be defined.
In this study, 60 pediatric dialysis patients, aged 13.9 ± 0.7 years, with secondary hyperparathyroidism were randomized to
8 months of therapy with oral vitamin D combined with either calcium carbonate (CaCO3) or sevelamer. Serum phosphorus levels did not differ between groups. Serum calcium levels rose from 9.3 ± 0.1 to 9.7 ± 0.1 mg/dl
during CaCO3 therapy (p < 0.01 from baseline) but remained unchanged during sevelamer therapy. In the CaCO3 and sevelamer groups, baseline serum PTH levels (1st PTH-IMA; Nichols Institute Diagnostics, San Clemente, CA) were 964 ± 75 and
932 ± 89 pg/ml, and levels declined to 491 ± 55 and 543 ± 59 pg/ml, respectively (nonsignificant between groups). Patients
treated with sevelamer received higher doses of vitamin D than those treated with CaCO3. The PTH values obtained by first- and second-generation PTH-IMAs correlated closely throughout therapy and the response
of PTH was similar to both PTH-IMAs, despite differences in serum calcium levels. 相似文献
12.
Goldner WS Stoner JA Lyden E Thompson J Taylor K Larson L Erickson J McBride C 《Obesity surgery》2009,19(2):173-179
Background Vitamin D deficiency is common following bariatric surgery and is due to a combination of baseline deficiency and postoperative
malabsorption. There are few prospective studies evaluating the appropriate dose of vitamin D to prevent and treat vitamin
D deficiency following bariatric surgery.
Methods We evaluated three doses of vitamin D3 (800, 2,000, and 5,000 IU/day) in a prospective, randomized pilot trial of 45 patients
undergoing Roux-en-Y gastric bypass. Serum 25 hydroxy Vitamin D (25OHD), intact PTH (iPTH), calcium, and urine calcium/creatinine
ratios were measured at 6, 12, and 24 months postoperatively. Due to a high dropout rate at 24 months, we focus on the 12-month
data.
Results At 12 months, the 800-, 2,000-, and 5,000-IU groups had a mean ± SD increase in 25OHD of 27.5 ± 40.0, 60.2 ± 37.4, and 66.1 ± 42.2 nmol/L,
respectively (p = 0.09) with a maximum increase in each group of 87.4, 114.8, and 129.8 nmol/L. Forty-four percent, 78%, and 70% achieved
25OHD levels ≥75 nmol/L (p = 0.38). Results for the 6- and 24-month time points were similar to the 12-month results. Mean weight loss at 24 months
of the study was not different among groups (p = 0.52). Serum calcium did not change significantly, and there were no cases of hypercalcemia or sustained hypercalciuria.
Conclusions Higher doses of vitamin D supplementation trend towards higher levels of 25OHD. Vitamin D replacement as high as 5,000 IU
/day is safe and necessary in many patients to treat vitamin D deficiency following Roux-en-Y gastric bypass yet is still
suboptimal in others. 相似文献
13.
Summary This study reports on oral treatment with different doses of vitamin D3 ranging from 25 to 200 μg in females with 25-hydroxyvitamin
D3 levels < 60 nmol/L screened for participation in an osteoporosis trial. A guidance to safely and efficiently achieve 25-hydroxyvitamin
D3 levels > 60 nmol/L is presented.
Introduction The importance of vitamin D for skeletal health has been implemented in clinical trials in osteoporosis. The threshold of
25-hydroxyvitamin D for inclusion has changed from 30 to 60 nmol/L. This study reports on oral treatment with different doses
of vitamin D3 in females with 25-hydroxyvitamin D3 levels < 60 nmol/L.
Methods In 131 postmenopausal females screened for participation in an osteoporosis trial, the 25-hydroxyvitamin D3 concentration
was < 60 nmol/L. They were treated with 25 (n = 22), 50 (n = 19), 75 (n = 19), 100 (n = 41) or 200 μg (n = 30) of vitamin D3 daily for at least 10 days.
Results In the females treated with 25, 50, 75, 100 and 200 μg of vitamin D3 daily the 25-hydroxyvitamin D3 concentrations increased
significantly from 32.4 ± 2.7 (mean ± SEM) to 50.8 ± 2.9, from 46.7 ± 2.8 to 65.8 ± 2.6, from 41.6 ± 2.7 to 67.4 ± 2.9, from
46.7 ± 1.4 to 64.4 ± 2.2 and from 42.1 ± 2.0 to 71.2 ± 2.8 nmol/L, respectively (p < 0.001). S-calcium increased significantly but within the reference range (p < 0.006).
Conclusion Oral vitamin D3 safely increased 25-hydroxyvitamin D3 concentrations in all females above 60 nmol/L. This study demonstrates
how to achieve the new recommended 25-hydroxyvitamin D concentrations within the screening period of a clinical trial. 相似文献
14.
Background: Vitamin B12 deficiency after gastric surgery for obesity is due to a failure of separation of vitamin B12 from protein foodstuffs and to a failure of absorption of crystalline vitamin B12 in the presence of intrinsic factor. The purpose of this study was to determine which of four oral doses of crystalline vitamin
B12 was most effective in treating vitamin B12 deficiency in 102 patients. Methods and Results: At time of entry into the study, the patients had a serum vitamin B12 < 100 pmol L −1, were 29.9 ± 21.7 months post-op, were 37 ± 8 years old and had a body mass index of 30 ± 6 kg m−2. Eight (8%) had had a vertical banded gastroplasty and 94 (92%) a gastric bypass. For the first 3 months all patients received
350 μg per day of crystalline vitamin B12 and all increased their serum vitamin B12 levels to over 100 pmol L−1. The patients were then assigned to receive for a further 3 month period one of four oral doses of crystalline vitamin B12-100 μg, 250 μg, 350 μg and 600 μg. Serum vitamin B12 levels were greater than 150 pmol L−1 after 6 months in 83.3% of patients who received 100 μg; 92.3% of patients who received 250 μg; 94.7% after 350 μg and 95.2%
after 600 μg (p%0.525). Conclusion: At least 350 μg per day is the appropriate oral dose of crystalline vitamin B12 after gastric surgery for obesity to correct low serum vitamin B12 levels in 95% of patients. 相似文献
15.
Pires LV Martins LM Geloneze B Tambascia MA Hadad do Monte SJ do Nascimento Nogueira N Santos de Sousa G Marreiro DN 《Obesity surgery》2007,17(5):617-621
Background Researchers have found that zinc nutritional status in obese and diabetic subjects is altered: low zinc concentrations in
plasma and erythrocytes, with high urinary zinc excretion, were observed. This study evaluated the effect of Roux-en-Y gastric
bypass (RYGBP) on plasma, erythrocyte and urinary zinc concentration.
Methods 22 morbidly obese patients were studied before and 6 months after RYGBP. Fasting blood sample and 24-hour urine were collected
in the pre- and postoperative phases. A software analyzed the diet information from 3-day food records after RYGBP. Zinc nutritional
status was evaluated by determination of the concentration of this mineral in plasma and erythrocytes, and the urinary excretion
of zinc / 24 hours by atomic absorption spectrophotometry.
Results The diets consumed by the patients had adequate average concentrations of zinc. Zinc concentration in plasma, erythrocytes
and urine were within the values of normality before RYGBP, with mean values of 93.25 ± 19.34 μg/dL, 43.85 ± 7.76 μg Zn/gHb
and 583.05 ± 359.30 μg Zn/24 hours, respectively. At 6 months after RYGBP, there was a change in these parameters to 69.82 ± 10.95 μg/dL,
51.80 ± 6.92 μg Zn/gHb, 535.29 ± 216.40 μg Zn/24 hours in the concentration of plasma, erythrocyte and urinary zinc.
Conclusion These results suggest that RYGBP promoted, besides change in body composition, an alteration in the zinc plasma and erythrocytes
concentrations which in the medium and long term, could cause problems for these patients. 相似文献
16.
C. J. Bacon G. D. Gamble A. M. Horne M. A. Scott I. R. Reid 《Osteoporosis international》2009,20(8):1407-1415
Summary Daily dosing with vitamin D often fails to achieve optimal outcomes, and it is uncertain what the target level of 25-hydroxyvitamin
D should be. This study found that large loading doses of vitamin D3 rapidly and safely normalize 25OHD levels, and that monthly dosing is similarly effective after 3–5 months. With baseline
25OHD > 50 nmol/L, vitamin D supplementation does not reduce PTH levels.
Introduction There is concern that vitamin D supplementation doses are frequently inadequate, and that compliance with daily medication
is likely to be suboptimal.
Methods This randomized double-blind trial compares responses to three high-dose vitamin D3 regimens and estimates optimal 25-hydroxyvitamin D (25OHD) levels, from changes in parathyroid hormone (PTH), and procollagen
type I amino-terminal propeptide (P1NP) in relation to baseline 25OHD. Sixty-three elderly participants were randomized to
three regimens of vitamin D supplementation: a 500,000-IU loading dose; the loading dose plus 50,000 IU/month; or 50,000 IU/month.
Results The Loading and Loading + Monthly groups showed increases in 25OHD of 58 ± 28 nmol/L from baseline to 1 month. Thereafter,
levels gradually declined to plateaus of 69 ± 5 nmol/L and 91 ± 4 nmol/l, respectively. In the Monthly group, 25OHD reached
a plateau of ~80 ± 20 nmol/L at 3–5 months. There were no changes in serum calcium concentrations. PTH and P1NP were only
suppressed by vitamin D treatment in those with baseline 25OHD levels <50 and <30 nmol/L, respectively.
Conclusions Large loading doses of vitamin D3 rapidly and safely normalize 25OHD levels in the frail elderly. Monthly dosing is similarly effective and safe, but takes
3–5 months for plateau 25OHD levels to be reached. 相似文献
17.
Background Patients undergoing bariatric surgery with a gastric bypass lose about 66% of excess weight. Although this procedure induces
weight loss, it is unknown whether it leads to protein malnutrition, which is studied here.
Methods One hundred ten obese patients (body mass index, 47.9 ± 8.6 kg/m2) undergoing gastric bypass had a measurement of plasma albumin and transthyretin (formerly prealbumin) and a calculation
of nutritional risk index (NRI) before and throughout the 2 years following the surgery.
Results All but five patients lost more than 15% of initial weight; the mean loss of excess weight was 65.2 ± 26.4% at 2 years. Plasma
concentrations of albumin and transthyretin decreased after surgery, but while albumin returned to initial values after 12 months,
transthyretin remained low. Only one patient had an albumin below 30 g/l; another one had a transthyretin lower than 110 mg/l.
All NRI scores were lower than 83.5 (62 ± 5, ranging 44–70), qualifying patients for severe malnutrition.
Conclusion Malnutrition is difficult to diagnose in obese patients undergoing surgery. The large weight loss is most often not associated
with protein malnutrition. Whether gastric bypass induces protein malnutrition remains to be established. 相似文献
18.
Pajecki D Dalcanalle L Souza de Oliveira CP Zilberstein B Halpern A Garrido AB Cecconello I 《Obesity surgery》2007,17(5):601-607
Background Short-term results (24 to 36 months) after Roux-en-Y gastric bypass (RYGBP) have been extensively described. Little is reported
on the patients operated ≥ 5 years ago. We analyzed the results of weight loss, resolution of co-morbidities and nutritional
complications of patients submitted to the silicone ring RYGBP, at least 5 years before.
Methods 75 morbidly obese patients who underwent silicone ring RYGBP between Oct 1995 and Dec 1999, 18 men and 57 women, were studied.
Demographic data, nutritional status and the presence of co-morbidities (type 2 diabetes, hypertension, sleep apnea, dyslipidemia)
were accessed. Pre- and postoperative BMI were registered, along with excess weight loss (EWL). Nutritional deficiencies were
accessed by laboratory assays.
Results Mean follow-up was 87 months. Initial BMI was 56.7 ± 10 kg/m2. After 2 years, BMI had dropped to 29.3 ± 6.8, and by the last interview BMI was 35.5 ± 10. %EWL after 2 years was 80.2 ± 17.3%,
and at the end was 71.8 ± 21.6%. After 2 years, only 1 of the 75 patients (1.33%) had not achieved an EWL of at least 50%.
At the end, 23 patients (30.6%) could not maintain this EWL. Resolution of diabetes was 76.5%, arterial hypertension 37.3%
and sleep apnea 93.5%. Iron, vitamin B12 and vitamin D were the most common nutritional deficiencies.
Conclusions Long-term follow-up (5 to 9 years) after the RYGBP was associated with satisfactory mantainance of EWL, and resolution or
improvement of the main co-morbidities was observed in the majority of the patients. 相似文献
19.
S. Kukuljan C. A. Nowson S. L. Bass K. Sanders G. C. Nicholson M. J. Seibel J. Salmon R. M. Daly 《Osteoporosis international》2009,20(7):1241-1251
Summary We examined the independent and combined effects of a multi-component exercise program and calcium–vitamin-D3-fortified milk on bone mineral density (BMD) in older men. Exercise resulted in a 1.8% net gain in femoral neck BMD, but
additional calcium–vitamin D3 did not enhance the response in this group of older well-nourished men.
Introduction This 12-month randomised controlled trial assessed whether calcium–vitamin-D3-fortified milk could enhance the effects of a multi-component exercise program on BMD in older men.
Methods Men (n = 180) aged 50–79 years were randomised into: (1) exercise + fortified milk; (2) exercise; (3) fortified milk; or (4) controls.
Exercise consisted of high intensity progressive resistance training with weight-bearing impact exercise. Men assigned to
fortified milk consumed 400 mL/day of low fat milk providing an additional 1,000 mg/day calcium and 800 IU/day vitamin D3. Femoral neck (FN), total hip, lumbar spine and trochanter BMD and body composition (DXA), muscle strength 25-hydroxyvitamin
D and parathyroid hormone (PTH) were assessed.
Results There were no exercise-by-fortified milk interactions at any skeletal site. Exercise resulted in a 1.8% net gain in FN BMD
relative to no-exercise (p < 0.001); lean mass (0.6 kg, p < 0.05) and muscle strength (20–52%, p < 0.001) also increased in response to exercise. For lumbar spine BMD, there was a net 1.4–1.5% increase in all treatment
groups relative to controls (all p < 0.01). There were no main effects of fortified milk at any skeletal site.
Conclusion A multi-component community-based exercise program was effective for increasing FN BMD in older men, but additional calcium–vitamin
D3 did not enhance the osteogenic response. 相似文献
20.
Nishimaki S Shima Y Sato M An H Fujita S Iwasaki S Horiguchi H Seki K Yokota S 《Pediatric nephrology (Berlin, Germany)》2011,26(12):2185-2191
It is important to identify premature infants with prenatal inflammation as it contributes to short- and long-term complications.
Our object was to study how prenatal inflammation affects the urinary β2-microglobulin (β2-MG) level. Preterm neonates were divided based on the presence of chorioamnionitis (CAM) into the CAM (n = 100) and non-CAM groups (n = 117). These were further subdivided into five groups each: 30 preterm neonates of 23–26; 42 neonates of 27–28; 54 neonates
of 29–30; 51 neonates of 31–32; and 40 neonates of 33–34 weeks’ gestation. The urinary β2-MG level within 48 h of birth was significantly higher in the CAM group than in the non-CAM group among the neonates of 23–26 weeks’
gestation (18.3 ± 6.9 vs 10.0 ± 5.6 × 104 μg/gCr, p = 0.0018) and the neonates of 27–28 weeks’ gestation (16.2 ± 10.8 vs 8.8 ± 3.3 × 104 μg/gCr, p = 0.0101). However, there was no difference in urinary β2-MG level between the CAM and the non-CAM group among the neonates ≥ 29 weeks ’gestation. Moreover, the elevated urinary β2-MG level in the neonates ≤ 28 weeks ’ gestation with CAM had disappeared by 1 week after birth. The reasons for the increase
in urinary β2-MG level within 48 h of birth in very preterm neonates (≤ 28 weeks’ gestation) with CAM are believed to be not only prematurity,
but also prenatal inflammation. It is suggested that the urinary β2-MG level during the early postnatal period can identify prenatal inflammation. 相似文献