Plasma leptin association with body composition and energy expenditure in sickle cell disease

OBJECTIVE: To examine the association between fasting plasma leptin concentrations and the hypercatabolic state observed in sickle cell disease (SCD). METHODS: Plasma leptin concentration and resting energy expenditure (REE) were measured in 37 SCD patients (10 men, 12 boys 14 to 18 years-old, seven women, and eight girls 14 to 18 year-old) and in 37 age, gender and fat mass (FM) matched controls. Body composition was measured hydrostatically, REE by whole room-indirect calorimeter, and plasma leptin using an RIA kit. RESULTS: Plasma leptin concentration and leptin normalized for body fat (ng/dL*kg FM(-1)) were significantly lower in SCD patients than in non-SCD controls (4.00+/-3.23 vs. 9.94+/-14.69, p=0.021 and 0.406+/-0.260 vs. 0.643+/-0.561, p=0.024, respectively). A positive linear association between log plasma leptin and FM was observed in both males and females, adjusting for age and SCD status. The strength of this association was greater in females compared with males (slope=0.699 and 0.382 log ng/mL per 10 kg FM, respectively; p=0.013). SCD patients on average demonstrated a higher REE, adjusting for FFM (p<0.0001). Log plasma leptin and FM were not statistically significant predictors of REE after adjustment for FFM and SCD. CONCLUSIONS: Once corrected for body composition, mean plasma leptin concentration was significantly lower among female SCD patients than among non-SCD matched controls. Although REE was higher in SCD patients, there is no simple association between leptin and REE in SCD.     

Body Composition and Energy Expenditure after Weight Loss Following Bariatric Surgery

Objectives: To assess the effectiveness of biliopancreatic diversion (BPD) in the treatment of morbid obesity and to evaluate how the procedure affects body weight.

Subjects: Fourteen morbidly obese subjects studied before and 30 months after BPD and fifteen healthy volunteers matched for age, sex and height (controls).

Methods: Comparison of the following parameters were made in the study groups before surgery and 30 months after BPD and with those of the controls group: fat mass, fat-free mass, non-protein substrate oxidation, basal metabolic rate, plasma glucose, insulin and free fatty acid concentrations.

Results: Obese subjects lost 60.38±10.71 kg of weight during 18 months following surgery and then remained stable for another 12 months, when this study was performed. Weight loss was substantially due to a loss of fat mass (FM: 60.13±13.01 kg before and 19.02±8.61 kg after BPD; p<0.001). FM were not statistically different between post-obese subjects and controls; however, post-obese patients retained significantly more fat free mass (FFM) than controls. Subsequently, basal metabolic rates of post-obese subjects were higher than those of the control group (p<0.05). Fasting non-protein respiratory quotient (npRQ) was significantly lower before BPD than 30 months after the surgery (0.798±0.04 vs. 0.90±0.048, p<0.001), suggesting that, while obese, patients oxidized more lipids than carbohydrates. Moreover, fasting and two-hour plasma glucose and insulin concentrations decreased significantly after BPD to values comparable to those of the control group.

Conclusion: Weight loss in obese patients after BPD is mainly due to lipid malabsorption, but increased energy expenditure associated with retaining a high FFM in physically active post-obese subjects may also play a role, enabling them to maintain long-term reduced body weights.     

Profiling Determinants of Resting Energy Expenditure in Colorectal Cancer

Abstract

Background: Understanding resting energy expenditure (REE) is important for determining energy requirements; REE might be altered in individuals with cancer. The objective of this study was to characterize determinants of REE in patients with stages II–IV colorectal cancer (CRC).

Methods: REE was measured via indirect calorimetry in patients with newly diagnosed CRC. Computerized tomography images from medical records ascertained skeletal muscle and total adipose tissue cross-sectional areas, which were then transformed to lean soft tissue (LST) and fat mass (FM) values (in kg). Linear regression assessed determinants of REE.

Results: 86 patients were included (n?=?55, 64.0% male; 60?±?12?years old; median body mass index: 27.6, interquartile range: 24.3–31.2?kg/m²), with most (n?=?40) having stage III disease. Age, sex, and weight were significant predictors of REE [R² = 0.829, standard error of the estimate (SEE): 128?kcal/day, P?<?0.001]. Replacing weight with LST and FM yielded a similar model, with age, sex, LST, and FM predictive of REE (R² = 0.820, SEE: 129?kcal/day, p?<?0.001).

Conclusion: Age, sex, weight, LST, and FM were the main contributors to REE. Further investigation of REE changes over time and its relationship to total energy expenditure, dietary intake, and clinical outcomes should be explored.     

Effects of Binge Eating Behavior on Fuel Oxidation and Body Composition

Objective: To investigate energy expenditure and glucose metabolism after a standard oral glucose load (75 g) in 8 normal weight bulimic women and 8 normal weight control women and to evaluate the relative endocrine implication.

Design: Serum glucose and insulin were measured both in basal conditions and after the glucose load; a basal endocrine assessment and body composition was evaluated and glucose induced thermogenesis (GIT) was calculated during 300 min following the glucose load.

Results: Serum glucose levels were significantly lower in bulimics both in fasting and in post-prandial state. Insulin levels were similar in bulimic and control women before and after the glucose load. FSH, leptin and free urinary cortisol (FUC) were all within the normal ranges, but significantly lower in bulimic patients compared with controls (p < 0.001). Fat mass (FM) and Fat-free mass (FFM) were reduced in bulimic patients, even if they normalized after correction per body weight. Resting energy expenditure (REE) was similar in the two groups even after FFM normalization, while GIT was lower in bulimic patients and it was strongly related to free urinary chortisol. Glucose oxidation was higher in fasting state and post glucose load, while lipid oxidation was strongly reduced.

Conclusion: An energy preservation mechanism seems to be the key element for normal-weight bulimic patients’ metabolism, consisting in leptin levels and GIT reduction, and lipid oxidation inhibition.     

Leptin and body weight regulation in patients with anorexia nervosa before and during weight recovery

BACKGROUND: Leptin has been considered a starvation hormone, but its role in malnourished patients is unknown. OBJECTIVE: We aimed to characterize the role of leptin in metabolic adaptation in women with anorexia nervosa (AN). DESIGN: In a cross-sectional study, 57 women with AN [mean (+/-SD) body mass index (kg/m(2)) on admission: 15.2 +/- 1.5] were compared with 49 healthy, normal-weight women (mean body mass index: 22.3 +/- 2.3). Nineteen patients were reinvestigated during weight gain 43 and 84 d after baseline. We measured serum concentrations of leptin, soluble leptin receptor, insulin, ghrelin, and thyroid hormones [thyrotropin, triiodothyronine (T(3)), and thyroxine]; fat mass (FM) and fat-free mass (FFM); resting energy expenditure (REE); energy intake; and eating behavior. RESULTS: Compared with values in the control women, leptin, T(3), REE, FM, and FFM were lower in the women with AN, but the leptin secretion rate was not significantly different. Leptin correlated with FM (r = 0.83, P < 0.001), T(3) (r = 0.68, P < 0.001), respiratory quotient (r = -0.47, P < 0.001), and REE (r = 0.58, P < 0.001). The association with REE weakened after adjustment for FFM and disappeared after further adjustment for T(3). Hunger and appetite had positive, whereas satiety and restraint had negative, associations with leptin. During weight gain (9.0 +/- 3.3 kg in 84 d), serum leptin and the leptin secretion rate increased. Changes in leptin secretion were associated with energy intake and REE. The initial changes in the leptin secretion rate (ie, the difference between baseline and 43 d) were negatively associated with changes in body weight from 43 to 84 d. CONCLUSIONS: Leptin contributes to metabolic adaptation in women with AN. The leptin response is associated with weight gain.     

Resting Energy Expenditure Is Not Altered in Children and Adolescents with Obesity. Effect of Age and Gender and Association with Serum Leptin Levels

In children and adolescents, obesity does not seem to depend on a reduction of resting energy expenditure (REE). Moreover, in this young population, the interactions between either age and obesity or between age and gender, or the role of leptin on REE are not clearly understood. To compare the levels of REE in children and adolescents we studied 181 Caucasian individuals (62% girls) classified on the basis of age- and sex-specific body mass index (BMI) percentile as healthy weight (n = 50), with overweight (n = 34), or with obesity (n = 97) and in different age groups: 8–10 (n = 38), 11–13 (n = 50), and 14–17 years (n = 93). REE was measured by indirect calorimetry and body composition by air displacement plethysmography. Statistically significant differences in REE/fat-free mass (FFM) regarding obesity or gender were not observed. Absolute REE increases with age (p < 0.001), but REE/FFM decreases (p < 0.001) and there is an interaction between gender and age (p < 0.001) on absolute REE showing that the age-related increase is more marked in boys than in girls, in line with a higher FFM. Interestingly, the effect of obesity on absolute REE is not observed in the 8–10 year-old group, in which serum leptin concentrations correlate with the REE/FFM (r = 0.48; p = 0.011). In conclusion, REE/FFM is not affected by obesity or gender, while the effect of age on absolute REE is gender-dependent and leptin may influence the REE/FFM in 8–10 year-olds.     

Favorable Effect of Short-Term Lifestyle Intervention on Human Paraoxonase-1 Activity and Adipokine Levels in Childhood Obesity

Objective: The prevalence of obesity is increasing in adult and child populations throughout the world. Childhood obesity has a great impact on adult cardiovascular morbidity and mortality; treatment of this pathological state is important given the significant health consequences. We investigated the effect of short-term lifestyle changes on the alteration of human serum paraoxonase-1 (PON1) activities, leptin, adiponectin, E-selectin, and asymmetric dimethylarginine (ADMA) as atherogenic and antiatherogenic factors in obese children. PON1 protects lipoproteins against oxidation by hydrolyzing lipid peroxides in oxidized low density lipoprotein (LDL) and therefore may protect against atherosclerosis.

Methods: A total of 23 white obese and overweight children (age, 11.43 ± 1.78 years; 8 girls, 15 boys) participated in a 2-week-long lifestyle camp based on a diet and exercise program. Overweight and obesity were defined according to the national body mass index (BMI) reference tables for age and sex.

Results: After a 2-week-long supervised diet and aerobic exercise program, obese children had significantly lower leptin (55.02 ± 33.42 ng/ml vs 25.37 ± 19.07 ng/ml; p < 0.0001), ADMA (0.68 ± 0.15 μmol/l vs 0.55 ± 0.16 μmol/l; p < 0.01), and E-selectin levels (67.19 ± 30.35 ng/ml vs 46.51 ± 18.40 ng/ml; p < 0.0001), whereas they had significantly higher PON1 paraoxonase activity (110.48 ± 72.92 U/l vs 121.75 ± 93.48 U/l; p < 0.05) besides the antiatherogenic alteration of the lipid profile and significant weight change (70.32 ± 19.51 kg vs 67.01 ± 18.75 kg, p < 0.0001; BMI, 28.95 ± 5.05 kg/m² vs 27.43 ± 4.82 kg/m², p < 0.0001). Adiponectin and PON1 arylesterase activity did not change significantly.

Conclusions: Our investigation suggests that modifications in dietary habits and physical activity induce antiatherogenic changes in childhood obesity. These findings emphasize the major role of primary prevention and nonpharmaceutical treatment of childhood obesity through lifestyle changes based on diet and increased physical activity.     

Estimation of Resting Energy Expenditure: Validation of Previous and New Predictive Equations in Obese Children and Adolescents

Objective: Accurate estimation of resting energy expenditure (REE) in childrenand adolescents is important to establish estimated energy requirements. The aim of the present study was to measure REE in obese children and adolescents by indirect calorimetry method, compare these values with REE values estimated by equations, and develop the most appropriate equation for this group.

Methods: One hundred and three obese children and adolescents (57 males, 46 females) between 7 and 17 years (10.6 ± 2.19 years) were recruited for the study. REE measurements of subjects were made with indirect calorimetry (COSMED, FitMatePro, Rome, Italy) and body compositions were analyzed.

Results: In females, the percentage of accurate prediction varied from 32.6 (World Health Organization [WHO]) to 43.5 (Molnar and Lazzer). The bias for equations was ?0.2% (Kim), 3.7% (Molnar), and 22.6% (Derumeaux-Burel). Kim's (266 kcal/d), Schmelzle's (267 kcal/d), and Henry's equations (268 kcal/d) had the lowest root mean square error (RMSE; respectively 266, 267, 268 kcal/d). The equation that has the highest RMSE values among female subjects was the Derumeaux-Burel equation (394 kcal/d). In males, when the Institute of Medicine (IOM) had the lowest accurate prediction value (12.3%), the highest values were found using Schmelzle's (42.1%), Henry's (43.9%), and Müller's equations (fat-free mass, FFM; 45.6%). When Kim and Müller had the smallest bias (?0.6%, 9.9%), Schmelzle's equation had the smallest RMSE (331 kcal/d). The new specific equation based on FFM was generated as follows: REE = 451.722 + (23.202 * FFM). According to Bland-Altman plots, it has been found out that the new equations are distributed randomly in both males and females.

Conclusion: Previously developed predictive equations mostly provided unaccurate and biased estimates of REE. However, the new predictive equations allow clinicians to estimate REE in an obese children and adolescents with sufficient and acceptable accuracy.     

Hypertension and Triglyceride Catabolism: Implications for the Hemodynamic Model of the Metabolic Syndrome

Objective: We sought to determine if hypertensive adults have a blunted triglyceride catabolic rate (TG K₂) and if related hemodynamic and vascular alterations are determinants of TG K₂.

Methods: Fasting levels of insulin, glucose, lipoproteins and plasma catecholamines were measured in 10 normotensive and 10 hypertensive adults. TG K₂ was determined by an intravenous fat tolerance test. Forearm blood flow, maximum forearm blood flow and minimal forearm vascular resistance were determined by strain gauge plethysmography. Vascular compliance and systemic hemodynamics were measured by computerized arterial pulse waveform analysis.

Results: Compared to normotensives, hypertensives had a significantly elevated blood pressure (145 ± 8/94 ± 11 versus 111 ± 15/74 ± 14 mm Hg, p < 0.001), systemic vascular resistance (1695 ± 441 versus 1172 ± 430 dynes × sec × cm^?5, p = 0.02) and reduced large vessel compliance (11.7 ± 3.6 versus 15.1 ± 3.1 ml/mm Hg × 100, p = 0.04). There were no significant group differences in TG K₂ (3.07 ± 2.01 versus 2.88 ± 2.12 mg/dL/min, p = 0.85) or other metabolic and anthropometric variables. TG K₂ was not predicted by the forearm vascular measures or the hemodynamic variables, but was correlated to waist/hip ratio (r = ?0.71, p = 0.001), fasting triglycerides (r = ?0.64, p = 0.003), and male gender (r = 0.56, p = 0.012). An enhanced TG K₂ was independently predicted by a reduced small vessel compliance (r = ?0.61, p = 0.006).

Conclusions: Elevated blood pressure per se and hypertension-related hemodynamic and vascular alterations are not associated with reduced TG K₂ or other metabolic abnormalities. Rather, aspects of the insulin resistance syndrome are closely related to abdominal adiposity. The independent association between small vessel compliance and TG K₂ deserves further investigation.     

Effect of Green Coffee Consumption on Resting Energy Expenditure,Blood Pressure,and Body Temperature in Healthy Women: A Pilot Study

ABSTRACT

Objective: This study was conducted to determine the effects of green coffee consumption on resting energy expenditures (REEs), blood pressure, and body temperature of individuals.

Method: The study was conducted with 24 women. The REE values of the individuals were measured with the COSMED Fitmate PRO. After the first REE measurements, individuals were given 1 cup of green coffee that was prepared to contain 6 mg caffeine per kg of lean body mass. After coffee consumption, REE measurements were made at 30, 60, 120, and 180 minutes. Blood pressure (mm Hg) and body temperature values (°C) were measured simultaneously with REE measurement.

Results: There was a positive correlation between the caffeine amounts given with green coffee and 30-minute (p < 0.05), 60-minute (p = 0.06), and 120-minute (p < 0.05) REE (kcal/d) values. There was also a positive correlation between the total chlorogenic acid taken with green coffee and 30-minute (p < 0.05), 60-minute (p = 0.06), and 120-minute (p < 0.05) REE (kcal/d) values. The intracellular and extracellular fluid amounts liter(l) before and after consumption of green coffee by individuals were 18.7 ± 1.57 versus 18.6 ± 1.44 (p < 0.05) and 11.4 ± 1.01 versus 11.2 ± 0.97 (p < 0.05), respectively. The body temperature (°C) changes observed in the individuals whose usual dietary caffeine intake was less than or equal to the 50th percentile after green coffee consumption were statistically significant (p < 0.05). Similarly, the diastolic blood pressure changes observed in the individuals whose usual dietary caffeine intake was less than or equal to the 50th percentile after green coffee consumption was almost statistically significant (p = 0.06).

Conclusions: The results of this study showed that 6 mg caffeine/kg (lean body mass) intake among women changed body temperature and blood pressure values and liquid balance depending on the usual dietary coffee intake. In addition, chlorogenic acid is also correlated with REE values besides green coffee caffeine.

Key teaching points

? There are several findings, and chlorogenic acid may have antihypertensive effects.

? There is a significant correlation between green coffee chlorogenic acid amount and REE.

? Intracellular and extracellular liquid amounts decrease following green coffee consumption (215–280 mg caffeine), and these changes are observed in individuals whose usual dietary caffeine intake is relatively both low and high.

? The body temperature values of individuals whose usual dietary caffeine intake was in the 50th percentile or greater (relatively high) increased after green coffee consumption.

Eight-Year Longitudinal Changes in Body Composition in Healthy Swiss Adults

Objective: Significant changes in body composition occur during lifetime. This longitudinal study (8.0 ± 0.8 yrs) in a cohort of healthy sedentary and physically active men (n = 78) and women (n = 53), aged 20 to 74 yr describes: 1) the longitudinal changes in weight and body composition and 2) their associations with age and physical activity.

Method: Fat-free mass (FFM) and body fat (BF) were assessed by bioelectrical impedance analysis (BIA). Subjects who regularly performed >3 hours per week of endurance type physical activity were classified as “Active”. Others were classified as “Sedentary”. Subjects were also separated by age (<45 yr vs ≥45 yr).

Results: FFM increased by 1.7 ± 2.8 kg in men <45 yr who gained 4.0 ± 5.0 kg of body weight and was maintained (0.5 ± 1.6 kg) in women <45 y who gained 1.6 ± 3.0 kg of weight. A weight gain of 1.2 ± 3.3 kg in men ≥45 yr was accompanied by stable FFM (?0.1 ± 2.3 kg), and of 1.0 ± 3.2 kg was accompanied by a loss of FFM in women ≥45 yr. In active men ≥45 yr, maintenance of FFM was associated with smaller weight gains than in sedentary; sedentary men ≥45 yr decreased FFM with larger weight gains than active subjects. Sedentary women <45 yr were able to gain FFM; the active women maintained, but did not gain FFM with smaller weight gains than in sedentary women. FFM decreased in ≥45 yr women despite of small weight gains.

Conclusion: Weight change is clearly associated with a change in FFM. Weight gain is necessary to offset age-related FFM loss between 20 and 74 yrs. In active men, a FFM increase was associated with less weight gain than sedentary men. Future studies should evaluate the threshold of weight change and the level of physical activity necessary to prevent age-related losses of FFM.     

The Effect of Lecithin Supplementation on Plasma Choline Concentrations During a Marathon

Background: Previous studies have shown that plasma and urinary free choline concentrations decrease significantly during a marathon, and that these decreases may be associated with decreased performance.

Objective: In a pilot study, we sought to determine whether lecithin supplementation prior to a marathon would maintain plasma free and urinary choline concentrations and improve performance versus placebo.

Methods: 12 accomplished marathon runners, males (7) and females (5), 21 to 50 years of age were randomized to receive lecithin (4 capsules BID; PhosChol 900) or placebo beginning one day prior to the 2000 Houston-Methodist Health Care Marathon. The lecithin supplement provided approximately 1.1 g of choline on a daily basis (2.2 g total). Runners estimated finish time based on recent performance and training. Fasting, pre- and post-marathon plasma and a five-hour urine collection were analyzed for free choline and plasma for phospholipid-bound choline. Pre-race predicted, as well as the actual finish time, were recorded.

Results: All subjects completed the marathon. Plasma free choline decreased significantly in the placebo group and increased significantly in the lecithin group (9.6 ± 3.6 to 7.0 ± 3.6 nmol/mL vs. 8.0 ± 1.2 to 11.7 ± 3.6 nmol/mL, p = 0.001 for the Δ between groups). No significant changes in plasma phospholipid-bound choline concentration were observed. There was a non-significant decrease in urine free choline in both groups. Actual finish time was 256.3 ± 46.3 minutes for the lecithin group vs. 240.8 ± 62.0 for the placebo group and the actual:predicted time was 1.03 ± 0.06 (lecithin) and 1.07 ± 0.08 (placebo), p = 0.36.

Conclusion: Short-term lecithin supplementation prior to a marathon maintains normal plasma free choline concentration during the race, but failed to improve performance.     

The Consumption of Synbiotic Bread Containing Lactobacillus sporogenes and Inulin Affects Nitric Oxide and Malondialdehyde in Patients with Type 2 Diabetes Mellitus: Randomized,Double-Blind,Placebo-Controlled Trial

Objectives: To our knowledge, no reports are available indicating the effects of synbiotic bread consumption on nitric oxide (NO), biomarkers of oxidative stress, and liver enzymes among patients with type 2 diabetes mellitus (T2DM). This study was performed to determine the effects of the daily consumption of synbiotic bread on NO, biomarkers of oxidative stress, and liver enzymes in patients with T2DM.

Methods: This randomized, double-blind, placebo-controlled trial was performed among 81 patients with diabetes, aged 35–70 years old. After a 2-week run-in period, patients were randomly divided into 3 groups: group A (n = 27) received synbiotic bread containing viable and the heat-resistant probiotic Lactobacillus sporogenes (1 × 10⁸ CFU) and 0.07 g inulin per 1 g, group B (n = 27) received probiotic bread containing Lactobacillus sporogenes (1 × 10⁸ CFU), and group C (n = 27) received control bread for 8 weeks. Patients were asked to consume the synbiotic, probiotic, or control breads 3 times a day in 40 g packages for a total of 120 g/day. Fasting blood samples were taken at baseline and after an 8-week intervention for quantificationof related markers.

Results: After 8 weeks, the consumption of synbiotic bread compared to the probiotic and control breads resulted in a significant rise in plasma NO (40.6 ± 34.4 vs 18.5 ± 36.2 and ?0.8 ± 24.5 µmol/L, respectively, p < 0.001) and a significant reduction in malondialdehyde (MDA) levels (?0.7 ± 0.7 vs 0.6 ± 1.7 and 0.5 ± 1.5 µmol/L, respectively, p = 0.001). We did not find any significant effect of the synbiotic bread consumption on plasma total antioxidant capacity (TAC), plasma glutathione (GSH), catalase, serum liver enzymes, calcium, iron, magnesium levels, and blood pressure compared to the probiotic and control breads.

Conclusion: In conclusion, consumption of the synbiotic bread for 8 weeks among patients with T2DM had beneficial effects on plasma NO and MDA levels; however, it did not affect plasma TAC, GSH, catalase levels, serum liver enzymes, calcium, iron, magnesium levels, and blood pressure.     

Prolonged fasting in patients with chronic pain syndromes leads to late mood-enhancement not related to weight loss and fasting-induced leptin depletion

Abstract

Periods of fasting are practiced worldwide on a cultural/religious background, and related mood-enhancing effects are postulated. We aimed to assess the effect of fasting on mood and to explore the interaction with neuroendocrine activation and leptin depletion in a controlled explorative study on consecutive inpatients (BMI < 35 kg/m²) of a nutritional ward. 36 subjects (38.9 ± 7.0 years; 29 female, BMI 26.7 ± 4.1 kg/m²) participated in an 8-day modified fast (300 kcal/day), 19 patients (38.1 ± 5.9 years; 18 female, 23.5 ± 4.1 kg/m²) received a mild low calorie diet. Measurements included daily ratings of mood (VAS), weight and levels of leptin and cortisol at four time-points of the 2-week study period. Weight loss was 4.8 ± 1.2 and 1.6 ± 0.9 kg in fasters and controls, respectively. Fasters showed a more pronounced decrease of leptin (58% vs. 20%; P < 0.001) and a 17% increase of cortisol levels (P < 0.001). Mood ratings increased significantly in the late phase of fasting (P < 0.01) but were not related to weight-loss, leptin-depletion or cortisol increase. Our findings suggest that fasting induces specific mood-enhancement. The physiological mediator appears to be neither leptin nor cortisol, the role of other mechanisms has to be further studied.     

Dietary inflammatory index,bone health and body composition in a population of young adults: a cross-sectional study

Abstract

Diet quality has been postulated as a relevant factor in disorders like obesity and osteoporosis as it modulates inflammatory biomarkers. The aim of this study was to investigate whether the dietary inflammatory index (DII) is associated with bone health status and body composition parameters in a population of young adults. The study population consisted of 599 young adults (aged 20.41?±?2.72). Linear regression analysis revealed that weight and fat-free mass (FFM) were significantly associated with the DII after adjustments for age, sex and total energy (β?=??0.91, 95% CI ?1.782, ?0.213, p?=?.013 and β?=??0.059, 95% CI ?0.842, ?0.107, p?=?.011, respectively). Our results suggest that the inflammatory potential of diet, measured using the DII, is associated with obesity-related parameters such as FFM and weight, although it may not contribute to osteoporosis in early adulthood.     

Sources of Protein and Polyunsaturated Fatty Acids of the Diet and Microalbuminuria in Type 2 Diabetes Mellitus

Background: Albuminuria excretion rate above the reference range and below albustix positive proteinuria (20–199 μg/min) is known as microalbuminuria and has been associated with an increased risk of death and progression to renal failure. Besides hyperglicemia and high blood pressure levels, dietary factors can also influence albuminuria.

Objective: To evaluate possible associations of dietary components (macronutrients and selected foods) with microalbuminuria in type 2 diabetic patients.

Methods: In this cross-sectional study, 119 normoalbuminuric [NORMO; 24-h urinary albumin excretion (UAE) < 20 μg/min; immunoturbidimetry] and 62 microalbuminuric (MICRO; UAE 20–199 μg/min) type 2 diabetic patients, attending the Endocrine Division, Hospital de Clínicas de Porto Alegre (Brazil), without previous dietary counseling, underwent 3-day weighed-diet records, and clinical and laboratory evaluation.

Results: MICRO patients consumed more protein (20.5 ± 4.4 vs. 19.0 ± 3.5% of total energy; p = 0.01) with a higher intake from animal sources (14.5 ± 4.7 vs. 12.9 ± 3.8% of total energy; p = 0.015) than NORMO patients. The intakes of PUFAs (8.6 ± 2.9 vs. 9.7 ± 3.3% of total energy; p < 0.03), PUFAs from vegetable sources (7.3 ± 3.4 vs. 8.6 ± 3.7% of total energy; p = 0.029), plant oils [0.2 (0.1–0.6) vs. 0.3 (0.1–0.9) mg/kg weight; p = 0.02] and margarines [3.3 (0–75.7) vs. 7.0 (0–51.7) g/day; p = 0.01] were lower in MICRO than in NORMO. In multivariate logistic regression models, adjusted for age, gender, presence of hypertension and fasting plasma glucose, intake of total protein (% of total energy; OR 1.104; 95% CI 1.008–1.208; p = 0.032) was positively associated with microalbuminuria. The intakes of total PUFAs (% of total energy; OR 0.855; 95%CI 0.762–0.961; p = 0.008), PUFAs from vegetable sources (% of total energy; OR 0.874; 95%CI 0.787–0.971; p = 0.012) and plant oils (mg/kg weight; OR 0.036; 95% CI 0.003–0.522; p = 0.015) were negatively associated with microalbuminuria.

Conclusions: In type 2 diabetic patients, the high intake of protein and the low intake of PUFAs, particularly from plant oils, were associated with the presence of microalbuminuria. Reducing protein intake from animal sources and increasing the intake of lipids from vegetable origin might-reduce the risk of microalbuminuria.     

Effects of a 12-Week Lifestyle Intervention on Health Outcome and Serum Adipokines in Middle-Aged Korean Men with Borderline High Blood Pressure

Background: High blood pressure, in relation to blood levels of adipokines such as adiponectin and leptin, is highly associated with an unhealthy lifestyle including sedentary behaviors, poor dietary habits such as excess sodium intake, and heavy drinking. Strategies to reduce blood pressure may benefit the levels of adipokines.

Objective: Thus, we aimed to investigate the effects of lifestyle intervention on blood pressure and serum adipokines in middle-aged Korean men with borderline high blood pressure (systolic blood pressure [SBP] ≥ 130 mm Hg or diastolic blood pressure [DBP] ≥ 85 mm Hg).

Methods: Fifty-two men (aged 42.5 ± 8.5 years) with normal weight (body mass index [BMI] < 25 kg/m²) and high BP (NH group) and 40 men (age 42.0 ± 8.4 years) who were obese (BMI ≥ 25 kg/m²) with high BP (OH group) underwent 5 sessions of one-on-one intensive counseling including instruction on a nutritionally balanced diet, a low-sodium diet, how to understand calorie requirements, and strategies to implement regular exercise for blood pressure regulation over 12 weeks. In order to increase the awareness of sodium education, a salt sensory test using an unseasoned soup was performed. Anthropometrics, blood pressure measurements, 24-hour recalls were performed, and blood levels of lipids, fasting plasma glucose, C-reactive protein (CRP), leptin, and adiponectin were analyzed at week 0 and at week 12. Sodium consumption was roughly estimated using the Dish-based Frequency Questionnaire–15.

Results: Weight, BMI, body fat (kg and %), waist circumference, hip circumference, and blood pressure were significantly decreased after 12 weeks (p < 0.05) in all subjects. Similarly, total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and CRP were decreased (p < 0.05), but LDL-C/HDL-C was significantly decreased (p < 0.01) only in the obese subjects. At baseline, blood levels of leptin were significantly higher in the obese subjects than in the normal weight subjects. In the obese subjects, a significantly negative correlation was found between leptin levels at baseline and percentage change in DBP (r = –0.338, p < 0.05). After 12 weeks, blood levels of adipokines did not show significant changes.

Conclusions: These results suggest that a short-term (12 weeks) lifestyle intervention had positive effects on blood pressure control and weight reduction in the subjects, but not on their blood levels of adipokines. It is interesting that blood level of baseline leptin was negatively associated with the changes in blood pressure after this short-term intervention.     

Effect of Micronutrient-Fortified Milk on Zinc Intake and Plasma Concentration in Adolescent Girls

Objective: To assess the effect of dietary fortified milk with zinc and other micronutrients on zinc intake and plasma zinc content of adolescent girls.

Methods: The study included 108 schoolgirls (12–18 years old) from northwest Mexico, randomly assigned to either the control group (CG; n = 55) or the intervention group consuming a regular diet plus fortified milk (MG; n = 53). At the beginning of the study, age, weight, and height were measured. Food intake by the 24-hour recall method and plasma zinc levels assessed by absorption spectrophotometry were determined before and after 27 days of fortified milk intake.

Results: At baseline, no significant group-related differences were observed for energy, protein intake, zinc intake, and plasma zinc level (p > 0.05), and 35.2% of participant girls did not achieve their zinc requirement. After 27 days of treatment, there were no significant differences in energy and protein intake between groups (p > 0.05). Zinc intake was higher for MG than CG (16.7 ± 8.3 mg/d vs 10.5 ± 6.4 mg/d; p < 0.01), and there was a lower proportion of low zinc intake in MG than for CG (7 vs 16, respectively; p = 0.04). In addition, plasma zinc improved in the MG (116.6 ± 26.9 μg/dL, p < 0.01) compared with CG (98.5 ± 26.6 μg/dL), and it was mainly attributed to the fortified milk intake, as the main dietary zinc contributor.

Conclusion: Fortified milk intake is effective in increasing both intake and plasma zinc levels of adolescent Mexican girls; therefore, it could be an adequate strategy for zinc deficiency prevention or correction among adolescent girls.     

Strawberries Added to the Usual Diet Suppress Fasting Plasma Paraoxonase Activity and Have a Weak Transient Decreasing Effect on Cholesterol Levels in Healthy Nonobese Subjects

Objective: Strawberries can improve oxidants–antioxidants balance and reduce some cardiovascular risk factors in obese subjects. Paraoxonase-1 (PON-1) is a high-density lipoprotein–associated enzyme with antioxidant properties that can protect from coronary artery disease in humans. We examined the effect of strawberry consumption on plasma PON-1 activity and lipid profile in healthy nonobese subjects.

Methods: Thirty-one subjects (body mass index [BMI] 24.4 ± 4.0 kg/m²) on their usual diet consumed 500 g of strawberry pulp daily for 30 days (first course) and after a 10-day washout the cycle was repeated (second course). Fasting blood and spot morning urine samples were collected before, during, and after each strawberry course (8 time points) for determination of paraoxonase and arylesterase PON-1 activities and lipid profile. Twenty subjects served as controls with respect to cholesterol and PON-1 activities changes over the study period.

Results: Strawberries decreased mean plasma paraoxonase PON-1 activity and this effect was more evident after the second course (by 11.6%, p < 0.05) than after the first course (5.4%, p = 0.06), whereas arylesterase activity was constant. Strawberries altered total cholesterol levels (p < 0.05) with a tendency to transiently decrease it (by 5.1%) only after 15 days of the first course. Triglycerides and high- and low-density lipoprotein cholesterol did not change in response to fruit consumption. No changes in PON-1 activities and lipid profile were noted in controls. Paraoxonase correlated with arylesterase activity (? from 0.33 to 0.46 at the first 7 time points, p < 0.05). This association disappeared at the end of study (? = 0.07) when the strongest inhibition of paraoxonase was noted.

Conclusions: Supplementation of the usual diet with strawberries decreased paraoxonase PON-1 activity and did not improve lipid profiles in healthy nonobese subjects. Further studies are necessary to establish the clinical significance of paraoxonase suppression and to define a group of healthy subjects who can benefit from strawberry consumption with respect to cholesterol levels.     

Increased Energy Expenditure after Dilutional Exchange Transfusion for Neonatal Polycythemia

Objective: Hypothermia is a known symptom of neonatal polycythemia (NP) and its pathophysiology is unclear. The effect of partial dilutional exchange transfusion (PET) upon resting energy expenditure (REE) is unknown. We aimed to test the hypothesis that PET leads to an increase in REE.

Study Design: 11 patients with NP who underwent PET and 10 controls without polycythemia were studied. NP was defined as a venous HCT ≥0.65. Per protocol, symptomatic infants and/or those with venous HCT ≥0.70 underwent PET. REE was measured just prior and 23 hours after PET in patients with NP and at identical ages in the control group. Infants were studied in a skin servo controlled radiant warmer, while clinically and thermally stable, prone and asleep. Measurements were stopped during body movements (less than 5% of the time of measurement). Metabolic measurements were performed by indirect calorimetry, using the Deltatrac II Metabolic monitor (Datex-Ohmeda, Helsinki, Finland). This instrument uses the principle of the open circuit system that allows continuous measurements of oxygen consumption (Vo₂) and carbon dioxide production (Vco₂) using a constant flow generator. REE measurements were corrected for the infant weight (Kcal/kg/d). Comparison of REE values between groups was performed using paired Wilcoxon ranked test.

Results: Patients with and without NP had nearly identical baseline REE. In patients with NP, REE increased from 44.0 ± 6.6 Kcal/Kg/d to 48.3 ± 5.1 Kcal/Kg/d after PET (P<0.05). Furthermore, the increase in REE following PET correlated inversely with the decrease in hematocrit. There was no significant change in REE over time in the control group. In the NP group, symptomatic infants (n=5) had a significantly greater increase in REE following PET than non-symptomatic ones (1.4 ± 6.3 vs. 7.8 ± 4.9 Kcal/Kg/d, p<0.05).

Conclusions: Energy expenditure of polycythemic infants increases following PET, in a manner proportional to the decrease in hematocrit. Symptomatic polycythemic infants have a greater rise in REE following PET than non-symptomatic ones. We speculate that polycythemia leads to a decreased REE that might be remedied by PET.