Comparison of resting energy expenditure measurements by ventilated canopy and by respiration chamber

The study compared measurements of resting energy expenditure (REE) by two methods, namely the commercially available ventilated canopy (Medgraphics CCM system) and the respiration chamber. Thirty-five healthy subjects of both sexes with a wide weight range (BMI 18–33·8 kg m^?2) were measured on both systems. The linear regression equation was REE_canopy=0·66 × REE_resp.cham. + 61·1 (kJ h^?1), and the corresponding SEE% was 8·6%. The correlation was high (r=0·89). However, the mean REE measured using the ventilated canopy was 41 kJ h^?1 (13%) lower than that using the respiration chamber (P<0·01). The Medgraphics CCM canopy system seems valid for measurements of REE. However, the REE results measured by the canopy were systematically lower than when measured by the respiration chamber, but can be converted by the equation given with an accuracy error of 9%.     

Harris-Benedict equation for critically ill patients: Are there differences with indirect calorimetry?

Purpose

The aim of this study was to compare the measured energy expenditure (EE) and the estimated basal EE (BEE) in critically ill patients.

Materials and Methods

Seventeen patients from an intensive care unit were randomly evaluated. Indirect calorimetry was performed to calculate patient's EE, and BEE was estimated by the Harris-Benedict formula. The metabolic state (EE/BEE × 100) was determined according to the following criteria: hypermetabolism, more than 130%; normal metabolism, between 90% and 130%; and hypometabolism, less than 90%. To determine the limits of agreement between EE and BEE, we performed a Bland-Altman analysis.

Results

The average EE of patients was 6339 ± 1119 kJ/d. Two patients were hypermetabolic (11.8%), 4 were hypometabolic (23.5%), and 11 normometabolic (64.7%). Bland-Altman analysis showed a mean of −126 ± 2135 kJ/d for EE and BEE. Only one patient was outside the limits of agreement between the 2 methods (indirect calorimetry and Harris-Benedict).

Conclusions

The calculation of energy needs can be done with the equation of Harris-Benedict associated with lower values of correction factors (approximately 10%) to avoid overfeeding, with constant monitoring of anthropometric and biochemical parameters to assess the nutritional changing and adjust the infusion of energy.     

Increased serum angiotensin converting enzyme activity in type T insulin—dependent diabetes mellitus: its relation to metabolic control and diabetic complications

Abstract. Serum angiotensin-converting enzyme (ACE) was measured in 150 insulin-dependent diabetes mellitus (IDDM) patients and 72 healthy subjects by radioassay, using [³H]-hippuryl-glycyl-glycine as a substrate. Mean (SD) serum ACE activity in diabetic patients was 120 ± 33 nmol ml^?1 min^?1 (range 46–215) and was significantly increased by 56% compared to control values (77 ± 23 nmol ml^?1 min^?1, range 46–125, P < 0·001). ACE activity > 125 nmol ml^?1 min^?1 was observed in 60 of 150 IDDM patients. 96 IDDM patients were normoalbuminuric (< 22 mg 24 h^?1) and 49 patients were micro- or macroalbuminuric (range 22–6010 mg 24 h^?1). Micro- and macroalbuminuric IDDM patients were found to have significantly greater ACE activity values than normoalbuminuric patients (128 ± 36 vs. 115 ± 30 nmol ml^?1 min^?1, P = 0·025). Metabolically well-controlled IDDM patients (glycosylated haemoglobin ≤ 8%) had lower ACE activity values than the patients with glycosylated haemoglobin greater than 8% (109 ± 20 vs. 127 ± 32 nmol ml^?1 min^?1, P < 0·02). A significant correlation between degree of metabolic control and ACE activity was found (r = 0.435, P < 0·001) so that an increase in one glycosylated quartile unit is accompanied by an increase in ACE activity of 10·5 nmol ml^?1 min^?1. Thus ACE activity in the serum of IDDM patients was increased by 56% in 40% of the patients. It was increased in IDDM patients without complications and in patients with retinopathy or nephropathy. In diabetic patients with nephropathy, ACE activity was greater than in diabetic patients without nephropathy. ACE activity was positively correlated with metabolic control. The role of increased ACE activity in the development of diabetic nephropathy remains to be established.     

Day-to-day variation in oxygen consumption and energy expenditure during submaximal treadmill walking in female adolescents

The day-to-day variation in oxygen consumption (V˙O ₂) and energy expenditure (EE) during horizontal treadmill walking was measured using indirect calorimetry in 20 female adolescents (mean age 17·3 years). Two different walking speeds were used: 5 km h^?1 and an individually convenient speed of 3·0 km h^?1 (mean). The two sets of measurements were performed on 2 consecutive days, and great care was taken to minimize possible disturbing factors. The mean V˙O ₂ was 919 ml min^?1 at 5 km h^?1 and 622 ml min^?1 at the individual speed, and the mean values of EE were 4·5 kcal min^?1 and 3·1 kcal min^?1 respectively. The individual day-to-day variation in V˙O ₂ (at 5 km h^?1) was between ?11·7% and +12·6% of the mean V˙O ₂. The coefficient of variation (CV) was 6·4% when values were calculated in ml min^?1 kg^?1. The energy expenditure varied somewhat less between the 2 days (CV = 5·7%). The corresponding value for EE when walking at the individual speed was 7·2%, and the mean day-to day variation in V˙O ₂ was 7·5% (CV). The rate of perceived exertion according to Borg's scale was lower on day 2 (11·9) compared with day 1 (13·0) when walking at 5 km h^?1. There was no difference in heart rate between the 2 days. It is concluded that EE varies somewhat less than V˙O ₂ on successive days, probably because of an interchangeable relationship between breathing gases, depending on which substrate is used for combustion. When using V˙O ₂ and EE for evaluation of physical capacity, the day-to-day variation in the measurements must be taken into consideration.     

The relationship between energy expenditure and lean tissue in monozygotic twins discordant for spinal cord injury

Energy expenditure and fat-free mass (FFM), as well as the relationships between these parameters, were investigated in thirteen pairs of monozygotic twins discordant for SCI. Basal energy expenditure (BEE) and resting energy expenditure (REE) were determined by indirect calorimetry. Measurements for FFM and fat mass were obtained by dual-energy x-ray absorptiometry. Total body potassium was determined by a 4-Pi whole-body counting chamber. Values are expressed as mean standard deviation. BEE and REE of the twins with SCI were significantly less than those of the able-bodied co-twins (1387 268 vs. 1660 324 kcal/d, p < 0.005, and 1682 388 vs. 1854 376 kcal/d, p < 0.05, respectively). Regardless of the group, direct and highly significant relationships were evident between BEE or REE and FFM or TBK. In summary, twins with SCI had lower energy expenditure than their able-bodied co-twins. Regardless of paralysis, direct linear relationships existed between energy expenditure and measures of lean mass.     

The importance of incident reporting in laboratory diagnostics

Uusitupa M, Pöyhönen M, Sarlund H, Laakso M, Kari A, Helenius T, Alakui-jala L, Eloranta T. Increased urinary polyamine excretion after starting a very low calorie diet. Scand J Clin Lab Invest 1993; 53: 811-819.

Urinary polyamine excretion has been suggested to reflect hypermetabolism or catabolism in different illnesses. In the present study, the excretion of urinary polyamines was examined in 12 obese subjects (3 men, 9 women aged 32-55 y, body mass index 33.3-64.7 kgm^?2) before and during a very low calorie diet (the total calorie intake 2100-3350 kJ). In addition, nitrogen balance, basal energy expenditure (BEE) and serum thyroid hormone levels were examined. During the first week on a very low calorie diet (VLCD) the mean body weight declined from 121.8 ± 27.3 to 117.4 ± 26.2kg (mean ± SD, p < 0.001), and after 12 weeks of treatment body weight was 106.6 ± 24.6 kg. Immediate reduction of BEE from 1.44 ± 0.24 to 1.34 ± 0.24 kcalmin¹ (p < 0.001) was found within the first week of therapy and BEE measured on weight-maintaining diet remained lower at 12 weeks (1.25 ± 0.27kcalmin^?1, p < 0.01). Serum free T3 decreased and reverse T3 increased significantly after starting VLCD. Nitrogen balance remained negative during the first 2 weeks on VLCD. A significant increase in total (38%), and in N1-acetyl- and N8-acetylspermidine excretions in the urine (40% and 27%, respectively, p < 0.05) was found during the first week, but later on the levels were not significantly different from the baseline levels. The changes in free T3 and reverse T3 showed moderate correlations with the changes in Nl-acetylspermidine (r = ?0.59 and r = 0.55, respectively, p < 0.05), and N8-acetylspermidine excretion rates (r = ?0.63, p < 0.05 and r = 0.47, N.S.). The present results suggest that during a very low calorie diet increased urinary acetylpolyamine excretion is a marker of catabolism.     

Diet-induced thermogenesis in well-trained subjects

Summary. The purpose of this study was to examine the possible relationship between the thermogenic response to a mixed meal and the aerobic capacity in healthy subjects. Fourteen male subjects participated, and their maximal oxygen uptake was determined on a bicycle exercise ergometer. Two groups, each comprising seven individuals, were compared: a well-trained group, with an oxygen uptake of 58·2 ml min ^-1 kg^-1 and a sedentary group, with an oxygen uptake of 39·2 ml min^-1 kg^-1. Respiratory gas exchange was measured continuously for 1 h in the basal state and then for 3 h postprandially. The subjects ingested a test meal in liquid form, consisting of 17% kJ protein, 28% kJ lipids and 55% kJ carbohydrates, and corresponding to 60% of the individually computed 24-h basal energy expenditure. Basal oxygen uptake and energy expenditure were similar in the two groups. After the meal, pulmonary oxygen uptake and energy expenditure rose rapidly and reached a plateau after 1 h. The responses were no different in the two groups: the average rise in pulmonary oxygen uptake above basal during the whole study period was 24.0±2.1% in well-trained and 26.7±1.5% in sedentary subjects (NS); the corresponding values for energy expenditure were 25.0±2.1% and 29.0±1.6% (NS). Also, when expressed in absolute terms the increments above basal were not significantly different. There was no discernible relationship between the individual thermogenic response and maximal oxygen uptake. In conclusion, the present findings do not indicate that diet-induced thermogenesis is proportional to aerobic capacity in healthy young men.     

Lower sedentary metabolic rate in women compared with men.

Since females have a greater prevalence of obesity compared with males, the question arises whether females have lower metabolic rate than males after adjusting for differences in body weight and composition. 24-h energy expenditure (24EE), basal metabolic rate (BMR), and sleeping metabolic rate (SMR) were measured in a respiratory chamber in 235 healthy, nondiabetic Caucasian subjects (114 males, 121 females). Body composition was determined by hydrodensitometry. 24EE was 124 +/- 38 kcal/d (P less than 0.002) higher in males than females after adjusting for differences in fat-free mass, fat mass, and age. Spontaneous physical activity was not significantly different between males and females. Since adjusted 24EE was 106 +/- 39 kcal/d (P less than 0.01) higher in females during the luteal phase of the menstrual cycle compared with females during the follicular phase, energy expenditure was analyzed in a subset (greater than 50 yr) to minimize the confounding effect of menstrual status. 24EE (160 +/- 66 kcal/d; P less than 0.03), BMR (116 +/- 45; P less than 0.02), and SMR (208 +/- 68 kcal/d; P less than 0.005) were higher in males compared with females of the older subset after adjusting for differences in body composition, age, and activity. In summary, sedentary 24EE is approximately 5-10% lower in females compared with males after adjusting for differences in body composition, age, and activity.     

Diet-induced thermogenesis in patients with liver cirrhosis

Summary. Diet-induced thermogenesis after ingestion of a mixed meal was investigated in eight patients with documented liver cirrhosis and in eight age- and sex-matched healthy controls. Respiratory gas exchange was measured continuously for one hour in the basal state and for three hours after ingestion of a mixed liquid meal, consisting of 17% kJ protein, 28% kJ lipids and 55% kJ carbohydrates and dispensed to correspond to 60% of the individually computed energy expenditure. Arterial substrate and hormone concentrations were determined before and at timed intervals for three hours after the meal. Urine was collected for determination of nitrogen excretion. The patients' oxygen uptake, energy expenditure and respiratory quotient were similar to those of the controls in the basal state. After the meal, pulmonary oxygen uptake and energy expenditure rose markedly in both groups during the first hour and were subsequently stable. The average increase in oxygen uptake above basal during the whole study period was 21·2 ± 1·8% and 22·3 ± 1·2% (NS) in patients and controls, respectively. The corresponding increase in energy expenditure was 24·8 ± 2·0% in the patients and 24·9 ± 1·4% in the controls (NS). The respiratory quotient was elevated throughout the postprandial period in both groups but the quotient was significantly higher in the patients (P<0·05–0·001), suggesting a greater proportion of carbohydrate oxidation. The basal arterial concentrations of insulin and glucagon were significantly higher in the patients. After the meal the insulin level increased 10- to 20–fold in both groups. Glucose concentration rose significantly in both groups to a maximum of 8·82 ± 1·00 and 8·03 ± 0·95 mmol/l in patients and controls, respectively, at 60 min after the meal. This was accompanied by a fall in the levels of glycerol and ketone bodies in both groups, indicating decreased lipolysis. It is concluded that both the basal energy expenditure and the thermogenic response to a mixed meal are similar in patients with liver cirrhosis and in healthy controls. The patients' carbohydrate oxidation rose to a greater extent after the meal, probably as a consequence of excessive increases in insulin concentration, demonstrating that insulin resistance in these patients may be compensated for by postprandial hyperinsulinaemia.     

Differences in glycaemia,hormonal response and energy expenditure after a meal rich in mono- and disaccharides compared to a meal rich in polysaccharides in physically fit and sedentary subjects

Summary. Postprandial glycaemia, hormonal response and energy expenditure (EE) were measured after two isocaloric carbohydrate-rich meals (69 energy-percent [E%] carbohydrate, 16 E% fat) rich in either mono- and disaccharides (47 E%, half of which sucrose) (MD) or polysaccharides (64 E%; P). Both meals were based on natural food items and were tested in a cross-over design in a group of sedentary (S) and trained (T) healthy, young subjects. Compared with the P meal blood glucose concentrations were significantly decreased and plasma insulin concentration significantly increased after the MD meal. A group difference was observed after the P meal with increased glucose and decreased insulin concentrations for T compared with S. Plasma norepinephrine concentrations were significantly increased after the MD meal compared with the P meal, but for S only. For both groups a significantly increased EE was observed 3 and 5 h after the MD meal compared with the P meal. However, no significant differences between the meals were observed in plasma insulin or catecholamine concentrations 3 and 5 h postprandially, when EE was measured. In conclusion, significant differences were observed in postprandial glucose and hormone responses as well as energy expenditure after two meals based on either mono- and disaccharide-rich or polysaccharide-rich food items. Physical fitness level influenced the glucose and hormonal responses but not the relative increases in postprandial energy expenditure.     

Peut-on prédire la dépense énergétique de repos au cours de l’obésité morbide ?

Objectives

The basal energy expenditure (BEE) in patients with morbid obesity is poorly understood, and it is unknown whether the published predictive equations apply to this population. The present study compared measured BEEs with those calculated using equations derived from a population of people with normal weight and certain obese groups.

Subject and methods

BEE (indirect calorimetry) and body composition (body fat, lean body mass, total body water, and a three-compartment model) were measured in 199 morbid obese patients prior to bariatric surgery. The values obtained were compared to those calculated using the most widely employed published equations.

Results

BEE measured 17.1 kcal/kg in men (N = 39) and 15.6 kcal/kg in women (N = 160). This measured expenditure differed significantly from the values estimated by all the equations used for and established by the obese population, except for one. Two thirds of patients, however, had, at best, calculated values precise to ± 10% of the measured values. Body fat is a significant determinant of BEE but only provides a small amount of additional precision to the predictions, compared to lean body mass alone.

Conclusion

The most reliable method of estimating the energy needs of morbidly obese patients is indirect calorimetry, because the values calculated are imprecise. The diagnosis of metabolic deficiency contributing to resistance to weight loss is very difficult to verify without reliable theoretical values.     

Reduced sympathetic nervous activity. A potential mechanism predisposing to body weight gain.

The sympathetic nervous system is recognized to play a role in the etiology of animal and possibly human obesity through its impact on energy expenditure and/or food intake. We, therefore, measured fasting muscle sympathetic nerve activity (MSNA) in the peroneal nerve and its relationship with energy expenditure and body composition in 25 relatively lean Pima Indian males (means +/- SD; 26 +/- 6 yr, 82 +/- 19 kg, 28 +/- 10% body fat) and 19 Caucasian males (29 +/- 5 yr, 81 +/- 13 kg, 24 +/- 9% body fat). 24-h energy expenditure, sleeping metabolic rate, and resting metabolic rate were measured in a respiratory chamber, whereas body composition was estimated by hydrodensitometry. Pima Indians had lower MSNA than Caucasians (23 +/- 6 vs 33 +/- 10 bursts/min, P = 0.0007). MSNA was significantly related to percent body fat in Caucasians (r = 0.55, P = 0.01) but not in Pimas. MSNA also correlated with energy expenditure adjusted for fat-free mass, fat mass, and age in Caucasians (r = 0.51, P = 0.03; r = 0.54, P = 0.02; and r = 0.53, P = 0.02 for adjusted 24-h energy expenditure, sleeping metabolic rate, and resting metabolic rate, respectively) but not in Pima Indians. In conclusion, the activity of the sympathetic nervous system is a determinant of energy expenditure in Caucasians. Individuals with low resting MSNA may be at risk for body weight gain resulting from a lower metabolic rate. A low resting MSNA and the lack of impact of MSNA on metabolic rate might play a role in the etiology of obesity in Pima Indians.     

The effect of a very low-calorie diet-induced weight loss on the severity of obstructive sleep apnoea and autonomic nervous function in obese patients with obstructive sleep apnoea syndrome

The aim of this study was to examine the effect of a very low-calorie diet (VLCD)-induced weight loss on the severity of obstructive sleep apnoea (OSA), blood pressure and cardiac autonomic regulation in obese patients with obstructive sleep apnoea syndrome (OSAS). A total of 15 overweight patients (14 men and one woman, body weight 114 ± 20 kg, age 52 ± 9 years, range 39–67 years) with OSAS were studied prospectively. They were advised to follow a 2·51–3·35 MJ (600–800 kcal) diet daily for a 3-month period. In the beginning of the study, the patients underwent nocturnal sleep studies, autonomic function tests and 24-h electrocardiograph (ECG) recording. In addition, 15 age-matched, normal-weight subjects were studied. They underwent the Valsalva test, the deep-breathing test and assessment of heart rate variability at rest. The sleep studies and autonomic function tests were repeated after the weight loss period. There was a significant reduction in weight (114 ± 20 kg to 105 ± 21 kg, P<0·001), the weight loss being 9·2 ± 4·0 kg (range 2·3–19·5 kg). This was associated with a significant improvement in the oxygen desaturation index (ODI4) during sleep (31 ± 20–19 ±18, P<0·001). Before the weight loss the OSAS patients had significantly higher blood pressure (150 ± 18 vs. 134 ± 20, P<0·05, for systolic blood pressure, 98 ± 10 vs. 85 ± 13, P<0·05, for diastolic blood pressure) and heart rate (67 ± 10 beats min^?1 vs. 60 ± 13, P<0·05) at rest than the control group. They had also lower baroreflex sensitivity (4·7 ± 2·8 ms mmHg^?1 vs. 10·8 ± 7·1 ms mmHg^?1, P<0·01). During the weight reduction, the blood pressure declined significantly, and the baroreflex sensitivity increased by 49%. In conclusion, our experience shows that weight loss with VLCD is an effective treatment for OSAS. Weight loss improved significantly sleep apnoea and had favourable effects on blood pressure and baroreflex sensitivity that may have prognostic implications.     

Energy expenditure in hospitalized patients: implications for nutritional support

An understanding of energy expenditure in hospitalized patients is necessary to determine optimal energy supply in the care of individuals who require nutritional support. A review was conducted of 19 studies in which resting energy expenditure (REE) had been measured using indirect calorimetry and compared with estimated basal energy expenditure (BEE) from the Harris-Benedict equation. Studies of patients with burns, head injuries, and fever were excluded because REE is known to be increased in these conditions. The studies reported data on 1256 patients with the following diagnoses: postoperative (28%), trauma or sepsis (26%), cancer (18%), pulmonary disease (9%), cardiovascular disease (2%), miscellaneous (9%), and unspecified (6%). The average REE in the 19 studies was 113% of the BEE. The mean +/- SD REE/BEE ratio was higher in 11 studies in which the REE was measured during feeding than in 5 studies in which the measurement was made during fasting (117% +/- 3% vs 105% +/- 4%; P = .047). In those 11 studies, overfeeding may have contributed to higher REE values than otherwise would have been observed. Some evidence indicated that the REE/BEE ratio is higher in more severe illness, but results were inconsistent. Unfortunately, little information is available concerning total energy expenditure, which includes the contribution of physical activity. It appears that most patients can be fed adequately with energy equal to 100% to 120% of estimated BEE. Hypoenergetic feeding may be appropriate in some overweight and obese individuals. Additional research in hospitalized patients on total energy expenditure and on the relationship between severity of illness and energy expenditure is needed.     

Acute antithrombotic effects of ximelagatran, an oral direct thrombin inhibitor, and r-hirudin in a human ex vivo model of arterial thrombosis

Summary. Background: Thrombin plays a major role in thrombus formation through activation of platelets and conversion of fibrinogen to fibrin. Objectives: To investigate the antithrombotic effects of the oral direct thrombin inhibitor (DTI) ximelagatran and the parenteral DTI r‐hirudin in humans. Subjects and methods: Healthy male volunteers randomized into four parallel groups each with 15 subjects received either ximelagatran (20, 40 or 80 mg orally) or r‐hirudin (0.4 mg kg^?1 intravenous bolus + infusion of 0.15 mg kg^?1 h^?1 for 2 h and 0.075 mg kg^?1 h^?1 for 3 h). Antithrombotic effects were assessed as changes in total thrombus area (TTA) and total fibrin area (TFA) from baseline, using the Badimon perfusion chamber model at baseline and 2 h and 5 h after drug administration. Results: Two hours postdosing, ximelagatran showed antithrombotic effects at both high and low shear rates (TTA% of mean baseline value ± SEM was 76 ± 13% and 71 ± 17% [both P < 0.05] for the 20‐mg dose, 85 ± 11% [P > 0.05] and 62 ± 15% [P < 0.05] for the 40‐mg dose and 60 ± 11% and 26 ± 7% [both P < 0.05] for the 80‐mg dose, respectively). r‐Hirudin also showed a significant antithrombotic effect at high and low shear rates (76 ± 11% [P = 0.05] and 57 ± 17% [P < 0.05] of baseline values, 2 h postdosing, respectively). The inhibitory effects on TFA were similar to those on TTA. Conclusions: The oral DTI ximelagatran shows antithrombotic effects under both high and low shear conditions. The antithrombotic effect of 40–80 mg ximelagatran appeared comparable to that of parenterally administered r‐hirudin, which has been previously demonstrated to be clinically effective in acute coronary syndromes.     

Left atrial electromechanical conduction time predicts atrial fibrillation in patients with mitral stenosis: a 5-year follow-up speckle-tracking echocardiography study

Prolonged left atrial electromechanical conduction time is related with atrial electrical remodeling, and is predictive of the development of atrial fibrillation. The aim of our study was to examine whether left atrial electromechanical conduction time (EMT) and left atrial strain as measured by speckle tracking echocardiography (STE) are predictors for the development of atrial fibrillation (AF) in patients with mitral stenosis (MS) at 5-year follow-up. A total of 81 patients (61% females; mean age 38.1?±?12.1 years) with mild or moderate MS of rheumatic origin according to ACC/AHA guidelines who were in sinus rhythm, and were asymptomatic or have NYHA class 1 symptom were included in the study. AF was searched by 12-lead electrocardiograms or 24-h Holter recordings during follow-up period. Atrial electromechanical conduction time (EMT), peak atrial longitudinal strain (PALS) and peak atrial contraction strain (PACS) were measured by STE. EMTs was defined as the interval between the onset of P-wave to the peak late diastolic longitudinal strain in the basal lateral and septal wall. During the follow-up period of 5 years (mean follow-up duration, 48.2?±?13.3 months), 30 patients (37%) developed AF on standard 12-lead ECG or at their 24-h Holter recording. At follow-up, patients who developed AF were older than patients without AF (42.4?±?11.3 vs. 35.6?±?11.9, p?=?0.014). Mitral valve area (MVA) (1.39?±?0.14 vs. 1.48?±?0.18, p?=?0.03), PALS (13.4?±?4.6 vs. 19?±?5.2, p?<?0.001) and PACS (6?±?2.7 vs. 8.4?±?3.8, p?=?0.004), were lower in patients who developed AF than in patients who did not develop. However, EMTs-Septal (208.2?±?28.4 vs. 180.2?±?38, p?=?0.001), and EMTs-Lateral (247.1?±?27.6 vs. 213.3?±?43.5, p?<?0.001) were longer in patients with AF than in patients without. In multivariate Cox regression analysis, PALS and left atrial EMTs-Lateral were independent predictors for development of AF at follow-up. In patients with mitral stenosis, left atrial strain and electromechanical conduction time in the lateral wall during the long term follow-up period are predictive for the development of atrial fibrillation. Speckle tracking echocardiography is a basic and easily-implemented method based on left atrial parameters which may be helpful for early detection of atrial fibrillation in patients with mitral stenosis.     

Glucose-induced thermogenesis in patients with small cell lung carcinoma. The effect of acute β-adrenergic inhibition

Summary. Seven patients with histologically verified small cell lung carcinoma were given an oral glucose load of 75 g on two occasions to examine the effect of glucose on whole body and forearm thermogenesis with and without acute (3-adrenergic inhibition with propranolol. Whole body energy expenditure was measured by the open circuit ventilated hood system. Forearm blood flow was measured by venous occlusion strain-gauge plethysmography. The uptake of oxygen in the forearm was calculated as the product of the forearm blood flow and the difference in arteriovenous oxygen concentration. The glucose-induced thermogenesis in the 120 min following the glucose load was significantly reduced by β-adrenergic inhibition with approximately 50% from 63–9 ± 5–8 kJ 120 min^-1 (mean ± SE) to 27–8 ± 9–8 kJ 120 min^-1 (P<0–01). Almost the entire reduction took place from 60 to 120 min (P<0–005). The integrated glucose-induced forearm oxygen uptake in the period 60–120 min following the glucose load was significantly reduced after β-adrenergicinhibition from 103 ± 28 μmol 100 g^-160 min^-1 to 29 ± 29 μmol 100 g^-1 60 min^-1 (P<0–05). The noreadrenaline concentration in the arterial blood was not increased in the baseline period compared to healthy elderly; it increased following the glucose load while there was no demonstrable increase in adrenaline concentration in the two experiments. It is suggested that these patients have increased sensitivity of the β-adrenergic receptors and an early facultative component of the glucose-induced thermogenesis in part takes place in the forearm.     

Acute lymphoblastic leukemia and obesity: increased energy intake or decreased physical activity?

Background  Obesity is a well-known problem in children with acute lymphoblastic leukemia (ALL), and it might be the result of an excess in energy intake, reduced energy expenditure, or both. The aim of this study is to describe energy intake and physical activity during treatment for ALL with intermittent dexamethasone (DEXA). Methods  Body mass index (BMI), energy intake, and physical activity were measured in 16 ALL patients on maintenance treatment and in 17 healthy controls. ALL patients were measured during (“on DEXA”) and in between (“off DEXA”) DEXA treatments. Results  In patients, the mean increase in BMI z-score was 1.4 ± 1.1. Energy intake on DEXA was higher (2,125.9 ± 476.0 vs 1,775.1 ± 426.1 kcal/24 h, p < 0.05) and energy intake off DEXA was lower (1,305.0 ± 249.4 vs 1,775.1 ± 426.1 kcal/24 h, p < 0.05), compared to healthy controls. Physical activity on DEXA was lower compared to healthy controls (30.0 ± 3.9 vs 40.0 ± 6.0 kcal kg⁻¹ 24 h⁻¹, p < 0.001 and 7,303.1 ± 4,622.9 vs 13,927.2 ± 3,822.7 steps, p < 0.05). Physical activity off DEXA was not different compared to healthy controls. Conclusion  Weight gain in patients on ALL treatment might be owing to increased energy intake and decreased physical activity during treatment with DEXA.     

Effects of glucagon-like peptide 1 (7–36 amide) on whole-body protein metabolism in healthy man

The incretin glucagon-like peptide 1 (GLP-1) shows glucose-dependent insulinotropic activity and may exert anabolic effects. Whole-body protein metabolism was assessed by measuring [1-¹³C]-leucine kinetics in 13 healthy volunteers during hyperglycaemic clamping with or without pancreatic clamping (somatostatin infusion) in order to differentiate between insulin-mediated and direct GLP-1 effects. During intact pancreatic secretion leucine flux and leucine oxidation rate as parameters of whole-body protein breakdown decreased markedly after 180 min of synthetic GLP-1 infusion (GLP-1 vs. placebo: P < 0.003). Indirect calorimetry showed an increase in energy expenditure and CO₂ production during GLP-1 administration (P < 0.0005). Plasma insulin increased after 3 h of GLP-1 infusion to 1486 ± 145 pmol L^?1 vs. 185 ± 12 pmol L^?1 for saline (P < 0.0001). When plasma insulin levels were kept constant (GLP-1 vs. saline, NS) during pancreatic clamping, GLP-1 effects on both protein metabolism and energy expenditure were abolished. Thus, GLP-1 infusion in man exerts protein anticatabolic and thermic effects, which are mediated by GLP-1-induced stimulation of insulin secretion.