儿童基础代谢率与人体组成的关系

目的通过对儿童基础代谢率与人体组成关系的研究,为临床基础代谢率的应用提供资料。方法对114名儿童进行基础代谢能量消耗和人体组成(脂肪组织和去脂组织)测定,分析其相关关系。结果基础代谢的能量消耗肥胖组儿童高于非肥胖组儿童,两者比较差异有显著意义(P<0.05)。用去脂组织(FFM)和脂肪组织(FM)校正后,肥胖组与非肥胖组无显著性差异(P>0.05),但男、女儿童间仍有显著性差异(P<0.05)。基础代谢率与FFM呈显著正相关(r=0.895,P<0.001),FFM可解释基础代谢率变化的80%,是影响基础代谢率的主要因素,性别和FM分别可解释其2.4%和2.7%。用去脂组织、脂肪组织和性别预测基础代谢能量消耗的回归方程:基础代谢率kJ/h=100.984 3.243×去脂组织 15.333×性别 1.533×脂肪组织(性别:男童为1,女童为0)。结论用FFM和FM对基础代谢率校正以后,基础代谢的能量消耗量肥胖儿童与非肥胖儿童无显著性差异。FFM是影响儿童基础代谢率的主要因素,FM对基础代谢率也有一定影响。     

The KEP-1 enteral feeding system for tube hyperalimentation of seriously ill patients

The KEP-1 system is designed for tube hyperalimentation of patients, including burn patients. It consists of a four-channel peristaltic pump and a liquid food mixer tank. The results of clinical testing are given.     

Nutritional dwarfing: growth,dieting, and fear of obesity.

Objective: Current methods for measuring regional body fat are expensive and inconvenient compared to the relative cost-effectiveness and ease of use of a stereovision body imaging (SBI) system. The primary goal of this research is to develop prediction models for android and gynoid fat by body measurements assessed via SBI and dual-energy x-ray absorptiometry (DXA). Subsequently, mathematical equations for prediction of total and regional (trunk, leg) body adiposity were established via parameters measured by SBI and DXA.

Methods: A total of 121 participants were randomly assigned into primary and cross-validation groups. Body measurements were obtained via traditional anthropometrics, SBI, and DXA. Multiple regression analysis was conducted to develop mathematical equations by demographics and SBI assessed body measurements as independent variables and body adiposity (fat mass and percentage fat) as dependent variables. The validity of the prediction models was evaluated by a split sample method and Bland-Altman analysis.

Results: The R² of the prediction equations for fat mass and percentage body fat were 93.2% and 76.4% for android and 91.4% and 66.5% for gynoid, respectively. The limits of agreement for the fat mass and percentage fat were ?0.06 ± 0.87 kg and ?0.11% ± 1.97% for android and ?0.04 ± 1.58 kg and ?0.19% ± 4.27% for gynoid. Prediction values for fat mass and percentage fat were 94.6% and 88.9% for total body, 93.9% and 71.0% for trunk, and 92.4% and 64.1% for leg, respectively.

Conclusions: The three-dimensional (3D) SBI produces reliable parameters that can predict android and gynoid as well as total and regional (trunk, leg) fat mass.     

Estimation of body composition from anthropometric and physiological measurements of obese college women

Relationships between anthropometric and physiological measurements and body composition were examined in 42 obese college women. Estimates of body density (BD), fat weight (FW), and fat free weight (FFW) were obtained by the helium dilution method. Anthropometric measurements included height, weight, 4 body diameters, 4 body girths, hand grip strengths, and 7 skinfold thicknesses; physiological measurements were daily urinary creatinine and basal metabolic rate. Simple correlation coefficients between each of these measurements and the estimates of body composition were less than 0.7, indicating little predictive accuracy from single measurements. Multiple correlation coefficients (R) were higher for FW (R=0.83 to 0.88) than for BD (R=0.64 to 0.75) or FFW (R=0.72 to 0.80). The equations that most accurately estimated body composition included skinfold thickness, hand grip strength, basal metabolic rate, and a variable calculated from height and weight. When equations selected from the literature were used, BD and FFW were consistently overestimated and FW underestimated.     

Protein and carbohydrate absorptive efficiency of chronically malnourished and well-nourished patients during enteral feeding initiation.

To investigate the efficiency of protein and carbohydrate absorption, we studied malnourished and well-nourished subjects during the first 72 hours of tube feeding. We furthermore investigated whether differences in absorptive efficiency existed between malnourished patients with and without nongastrointestinal malignancy. Twenty-one subjects starting tube feeding without edema or major organ failure and not on antibiotics (well-nourished controls = 7; malnourished = 7; malnourished with nongastrointestinal malignancy = 7) received 50 kcal/hr Osmolite continuously for 72 hours. Twelve of these subjects completed an additional 48 hours of study where they received 125 kcal/hr continuously. We performed hydrogen breath tests to assess carbohydrate absorption and determined stool nitrogen content to assess protein absorption. We also measured frequency of defecation, stool weight, and stool moisture content. The results of these tests failed to reveal statistically significant differences between the three groups in terms of protein and carbohydrate absorption, as well as failed to demonstrate the presence of diarrhea. We conclude that patients receiving an isoosmolar diet who are malnourished, or malnourished with nongastrointestinal malignancy, absorb carbohydrate and protein as well as well-nourished patients during enteral hyperalimentation.     

Effect of weight reduction on circulating lipids: an integration of possible mechanisms.

The effect of weight reduction on circulating lipids was studied in 17 normotensive, normolipemic obese women consuming diets with differing carbohydrate contents. Ten subjects consumed an 800-calorie, 10-gram carbohydrate diet, and 7 subjects followed an 800-calorie, 70-gram carbohydrate diet. At the end of 12 weeks of dieting, the mean weight loss was 12.3 kg for both groups (P less than 0.001) but not significantly different between the two groups. Serum insulin decreased by 31% (P less than 0.05) and a reduction of 18% (P less than 0.025) was observed in serum triiodothyronine. Serum potassium and magnesium remained unchanged; however, serum magnesium was marginally low for the duration of the study. Only four nonspecific changes were observed in a total of 68 electrocardiograms (5.8%); there were no arrhythmias. The response of serum cholesterol was biphasic, decreasing initially and returning to the baseline by the twelfth week. The high-density lipid (HDL) cholesterol followed a pattern similar to that of total cholesterol. A possible mechanism explaining the changes in circulating lipids is proposed. The results indicate that, in spite of substantial changes in weight, the cholesterol-to-HDL cholesterol ratio remained unchanged. Although weight reduction did not alter the risk factor in a group of normotensive, normolipemic obese women, hypocaloric diets should be prescribed under medical supervision, especially when cardiovascular or other diseases coexist.     

87例医务人员身体组成测定与分析

目的了解医务人员身体脂肪含量及肥胖率。方法用人体组成分析仪运用生物电阻抗法对87例医务人员进行身体组成的测定与分析。结果男性体重、肌肉组织量、骨矿物量、去脂组织量明显高于女性穴P<0.001雪,脂肪组织量男性与女性无明显差异穴P>0.05雪,身体脂肪率(F%)女性明显高于男性穴P<0.001雪。总体肥胖率以F%法判定为41.38%,体质指数(BMI)法判定为4.60%,超标准体重百分比法判定为21.84%。3种判定方法比较,总体肥胖检出结果F%法明显高于BMI法与超标准体重百分比法穴P<0.005雪。用F%法判定,小于30岁、30～50岁、大于50岁3个年龄段的总体肥胖率分别为33.33%、41.67%、55.56%,无显著性差异(P>0.05)。结论受试医务人员肥胖率偏高,应注意控制。     

New insight into determining indicators of metabolic status in women: Expression of PPARγ and FABP4 in PBMCs

Adiposity and its metabolic disturbances could be regulated by adipocyte-specific peroxisome proliferator-activated receptor gamma and fatty acid-binding protein4. Although these two proteins are mainly expressed in adipose tissues, they can also be expressed in peripheral blood mononuclear cells, which could be useful for predicting body composition and blood parameters. Thus, this cross-sectional study was performed during January 2013–January 2014 with 229 women (age range, 22–52 years) who were classified as obese or nonobese. Serum glucose, insulin, lipids, and body composition were measured in the fasting state. Peripheral blood mononuclear cells were isolated to extract ribonucleic acid (RNA) and to determine gene expression by real time polymerase chain reaction (PCR). All serum parameters and components of body composition were significantly higher in obese than in nonobese women. Gene expression analysis showed that serum levels of glucose and lipids, except high-density lipoprotein (HDL), were higher in the group that expressed high fatty acid-binding protein4. Increased expression of the peroxisome proliferator-activated receptor gamma was associated with a significant reduction of blood sugar and increased HDL and other lipids and visceral fat. Therefore, it seems that the level of expression of these genes in peripheral blood mononuclear cells may indicate metabolic status.     

A 3-month survey of enteral tube feeding and parenteral feeding: a baseline for improvement

This paper presents the results of a 3-month survey of tube feeding and parenteral nutrition in hospital in-patients, undertaken to provide information for the development of guidelines by the Hospitals Nutritional Advisory Group and a baseline for future monitoring. This represents the first steps in the audit cycle. The results highlighted the following problems.

• 1. 

  Total parenteral nutrition is often continued after bowel sounds have returned.
• 2. 

  Enteral tube feeding is often instituted for only a very short period of time and may be of little nutritional benefit to the patient.
• 3. 

  Significantly lower amounts of energy and nitrogen are received by the patients in the enterally tube-fed group than is indicated by their estimated energy and nitrogen requirements.
• 4. 

  The medical staff noted the start of feeding in 60% of the case notes, however, the aims of feeding and the reason for commencing feeding were never documented. Nutritional aims were defined in the case notes by dietitians for all tube-fed and 18 of the 20 patients who were parenterally fed.

     

Another step in the search for better oral rehydration solutions.

Objective: To compare resting metabolic rate (RMR) measured by indirect calorimetry versus RMR predicted by several published formulas in a sample of healthy young women.

Methods: RMR was measured using indirect calorimetry and predicted using 6 commonly used equations (Nelson, 1992; Mifflin, 1990; Owen, 1986; Schofield_Weight, 1985; Schofield_{Weight and Height}, 1985; Harris-Benedict, 1919) in 47 reportedly healthy young females (age = 22.8 ± 2.9 years; body mass index = 21.8 ± 2.1 kg/m²). Comparisons between measured versus predicted RMR were conducted using paired t tests, and agreement using Pearson's correlation coefficient, analysis of variance, and the method of Bland-Altman.

Results: All 6 equations overestimated measured RMR by 140–738 kcal/d (all p < 0.001). The proportion of subjects for whom measured versus predicted RMR differed by ±10% ranged from 74% (Nelson) to 100% (Harris-Benedict). The adjusted coefficients of determination (R²) between measured and predicted RMR ranged from 0.13 to 0.19 (all p < 0.05). Bland-Altman analysis R² values ranged from 0.03 (p = 0.233; Harris-Benedict) to 0.72 (p = 0.000; Owen). Given its continued popularity, we modified the Harris-Benedict equation (RMR_{modified Harris-Benedict} (kcal/d) = 738 / (RMR_{Harris-Benedict} ? 738)). Doing so reduced the mean difference between measured and predicted RMR from +738 kcal/d to ?0.53 kcal/d (p = 0.984).

Conclusion: No equation performed well, and none should be used interchangeably with measured RMR. We recommend that a new equation be validated for, and prospectively tested in, young women. In the interim, RMR should be measured in this population or predicted using the modified Harris-Benedict equation that we developed.     

脑梗死后鼻饲病人发生腹泻的相关因素分析

目的:探讨急性脑梗死后鼻饲病人发生腹泻的可能危险因素以及该危险因素对病人预后的影响.方法:回顾性分析218例急性脑梗死后鼻饲病人的临床资料.以腹泻为观察指标,对可能影响脑梗死后鼻饲病人腹泻相关指标进行单因素、多因素二分类logistic回归分析,并分析影响腹泻病人预后的相关因素以及含纤维素营养液对腹泻的影响. 结果:218例脑梗死后鼻饲病人,发生腹泻85例,无腹泻133例.腹泻组病人3个月时改良RANKIN量表mRS评分高于无腹泻组(P＜0.05).单因素分析显示,入院时NIHSS评分等4个因素有统计学意义(P＜0.05);多因素分析显示,使用抗生素和入院时NIHSS评分是发生腹泻的独立的风险因素,使用益生菌和肠内营养序贯治疗是发生腹泻的独立的保护因素.入院时NIHSS评分可预测影响腹泻病人的不良预后.使用含纤维素的整蛋白营养液病人腹泻发生率降低(P＜0.05). 结论:脑梗死后鼻饲病人的腹泻可增加不良预后的风险.控制抗生素的使用,增加益生菌,选用含纤维素营养液和序贯营养治疗可减少腹泻发生率,提高病人康复的质量.     

Clinical Usefulness of Anthropometric Indices to Predict the Presence of Prediabetes. Data from the ILERVAS Cohort

Prediabetes is closely related to excess body weight and adipose distribution. For this reason, we aimed to assess and compare the diagnostic usefulness of ten anthropometric adiposity indices to predict prediabetes. Cross-sectional study with 8188 overweight subjects free of type 2 diabetes from the ILERVAS project ({"type":"clinical-trial","attrs":{"text":"NCT03228459","term_id":"NCT03228459"}}NCT03228459). Prediabetes was diagnosed by levels of glycated hemoglobin (HbA1c). Total body adiposity indices [BMI, Clínica Universidad de Navarra-Body Adiposity Estimator (CUN-BAE) and Deurenberg’s formula] and abdominal adiposity (waist and neck circumferences, conicity index, waist to height ratio, Bonora’s equation, A body shape index, and body roundness index) were calculated. The area under the receiver-operating characteristic (ROC) curve, the best cutoff and the prevalence of prediabetes around this value were calculated for every anthropometric index. All anthropometric indices other than the A body adiposity were higher in men and women with prediabetes compared with controls (p < 0.001 for all). In addition, a slightly positive correlation was found between indices and HbA1c in both sexes (r ≤ 0.182 and p ≤ 0.026 for all). None of the measures achieved acceptable levels of discrimination in ROC analysis (area under the ROC ≤ 0.63 for all). Assessing BMI, the prevalence of prediabetes among men increased from 20.4% to 36.2% around the cutoff of 28.2 kg/m², with similar data among women (from 29.3 to 44.8% with a cutoff of 28.6 kg/m²). No lonely obesity index appears to be the perfect biomarker to use in clinical practice to detect individuals with prediabetes.     

Assessment of fat-free mass from bioelectrical impedance analysis in men and women with Prader-Willi syndrome: cross-sectional study

We have recently shown that population-specific formulae are required to estimate fat-free mass (FFM) from bioelectrical impedance analysis (BIA) in obese women with Prader-Willi syndrome (PWS) matched by age and percent fat mass (FM) to non-PWS women. The present cross-sectional study was aimed at developing generalised BIA equations that could be used in PWS subjects independently of sex and FM. We used dual-energy X-ray absorptiometry to measure FFM and BIA to measure whole-body impedance at 50?kHz (Z₅₀) in 34 women and 21 men with PWS. The impedance index, that is, height (cm)²/Z₅₀ (Ω), explained 77% (BCa-bootstrapped 95% CI 65 to 85%) of the variance of FFM with a root mean squared error of the estimate of 3.7?kg (BCa-bootstrapped 95% CI 3.2 to 4.5?kg). BIA can be used to estimate FFM in obese and non-obese PWS men and women by means of population-specific equations.     

Dietary diversity and subsequent cause-specific mortality in the NHANES I epidemiologic follow-up study.

Human diets tend to be complex mixtures of foods and nutrients. Therefore, we examined the relation of a measure of overall diet quality (independent of intake of individual foods or nutrients) with mortality from cardiovascular disease (CVD), cancer, and non-CVD, non-cancer (other) causes.

We used data from the NHANES I Epidemiologic follow-up study (n = 10,337; median follow-up time = 14 years; age 25-74 years at baseline), and included 988 CVD, 571 cancer, and 910 other cases. The 24-hour dietary recalls obtained at baseline were scored for quality using a dietary diversity score (DDS). The DDS (range 0-5) counts the number of major food groups–dairy, meat, grain, fruit, and vegetable consumed daily.

Age-adjusted risk of mortality from all three causes (except cancer in women) was inversely related with DDS in both men and women. Adjustment for multiple covariates attenuated the relative risk estimates slightly for CVD and cancer mortality, but markedly for other mortality.

The results are suggestive of an increased risk of CVD and cancer mortality associated with diets characterized by omission of several major food groups.     

超重幼儿血清瘦素水平与体质指数关系的研究

目的 研究超重肥胖幼儿瘦素(leptin,LP)水平与体质指数(body mass index,BMI)的关系。方法 采用卧式身高仪测量儿童身高,电子秤称量体重。利用酶联免疫吸附法(ELISA)测定血清LP水平。采用t检验、Kruskal-Wallis H检验、秩转换的方差分析、Spearman秩相关分析统计数据。结果 共检查238例(男121例,女117例)健康幼儿,正常组152例,超重组61例,肥胖组25例;三组间血清LP水平比较差异均有统计学意义(P<0.05);幼儿血清LP水平与体质指数(body mass index,BMI)之间有正相关性(r_s=0.718,P<0.05);三组间BMI比较差异有统计学意义(P<0.05);三组内男、女童BMI之间比较,差异均无统计学意义(P>0.05)。 结论 随着BMI增加,血清LP水平呈上升趋势,二者之间存在正相关,表明肥胖幼儿可能存在LP抵抗。     

Prevalence of Metabolic Syndrome in Relation to Cardiovascular Biomarkers and Dietary Factors among Adolescents with Type 1 Diabetes Mellitus

The occurrence of metabolic syndrome (MetS) significantly affects the course of diabetes mellitus (DM), resulting in deterioration of insulin sensitivity and metabolic control, as well as many cardiometabolic complications. The aim of the study was to investigate the relationships between cardiovascular biomarkers, nutritional status, dietary factors and the occurrence of MetS among 120 participants from northeast Poland (adolescents with type 1 DM and healthy peers). MetS was assessed using several criteria: nutritional status by anthropometric measurements, body composition analysis by bioelectrical impedance, and diet using a food diary and questionnaire. MetS was diagnosed in every third diabetic. Compared to healthy peers, MetS patients had higher total body fat (26% vs. 14%, p < 0.001) and visceral fat (77 cm² vs. 35 cm², p < 0.001), and lower total antioxidant status (1.249 mmol/L vs. 1.579 mmol/L, p < 0.001). Additionally, their diet was rich in saturated fatty acids, but low in dietary fiber as well as mono- and polyunsaturated fatty acids. The group of diabetics reported many inappropriate eating behaviors. The combination of those with the presence of an excessive content of visceral fat tissue and abnormal values of MetS components may negatively affect metabolic control, thus accelerating the development of cardiometabolic complications.