Effect of three different doses of arginine enhanced enteral nutrition on nutritional status and outcomes in well nourished postsurgical cancer patients: a randomized single blinded prospective trial

OBJECTIVE

Patients with head and neck cancer undergoing surgery have a high occurrence of postoperative complications. The aim of our study was to investigate whether postoperative nutrition of head and neck cancer patients, using an enhanced enteral formula with three different doses of arginine could improve nutritional variables as well as clinical outcome, depending of arginine dose.

PATIENTS AND METHODS

A population of 84 patients with oral and laryngeal cancer was enrolled. At surgery patients were randomly assigned to three different treatment groups, each one containing at less 28 patients. Group I (28 patients) received an enteral diet supplements with a low physiological dose of arginine (5.7 g per day), group II (28 patients) received an isocaloric, isonitrogenous enteral formula with a medium dose of arginine (12.3 g per day) and group III (28 patients) received an isocaloric, isonitrogenous enteral formula with a high dose of arginine (18.9 g per day).

RESULTS

The length of postoperative stay had a trend to be better with high dose of arginine received (31.9 ± 17.2 days in group I vs 27.8 ± 15.2 days in group II vs 24.8 ± 18.3 days in group III: p = 0.034). No differences were detected in postoperative infections complications and diarrhea. Fistula was less frequent in groups II and III than I (10.7% group I vs 3.6% group II vs 3.6% group III: p = 0.033), The length of postoperative stay had a trend to be better with high dose of arginine received (31.9 ± 17.2 days in group I vs 27.8 ± 15.2 days in group II vs 24.8 ± 18.3 days in group III: p = 0.034).

CONCLUSIONS

Our results suggest that these patients could benefit from a high dose of arginine enhanced enteral formula to decrease length of hospital stay and fistula wound complications.

Relation of -55CT polymorphism of UCP3 gene with weight loss and metabolic changes after a high monounsaturated fat diet in obese non diabetic patients

AIMS

The aim of our study was to investigate the influence of -55CT polymorphism of UCP3 gene on metabolic response, weight loss and serum adipokine levels to a high monounsaturated fat hypocaloric diet in obese patients.

PATIENTS AND METHODS

A sample of 128 obese patients was analyzed in a prospective way during 3 months.

RESULTS

Eighty eight patients (21 males/67 females) (68.8%) had the genotype 55CC (wild genotype group) and 40 patients (8 males/32 females) (31.3%) 55CT (mutant genotype group). In wild genotype group, BMI (-1.6±1.3 kg/m2), weight (-4.3±3.7 kg), fat mass (-3.5±3.3 kg), waist circumference (-5.1±2.9 cm), total cholesterol (-7.2±10.6 mg/dl), LDL cholesterol (-5.3±12.8 mg/dl) and leptin (-4.7±10.1 ng/ml) decreased. In mutant genotype group, BMI (1.3±2.2 kg/m2), weight (-3.0±1.4 kg), fat mass (-2.5±1.1 kg), waist circumference (-2.8±3.1 cm) and leptin (-5.8±10.7 decreased.

CONCLUSIONS

In patients with -55CC UCP3 genotype, a high mono-unsaturated hypocaloric diet reduced BMI, weight, waist circumference, waist to hip ratio, fat mass, LDL-cholesterol, total cholesterol and leptin levels. Carriers of T allele had a different response than -55CC patients, with a significant decrease of the same antropometric parameters, but lower than in the wild genotype group, and without significant changes in cholesterol levels.

Allelic frequency of G380A polymorphism of tumor necrosis factor alpha gene and relation with cardiovascular risk factors and adipocytokines in obese patients

BACKGROUND

The aim of our study was to investigate the allelic frequency of the G308A polymorphism in the TNF alpha gene and the influence of G308A this polymorphism on cardiovascular risk factors and adipokine levels in obese patients.

DESIGN

A population of 834 obesity patients was analyzed. A nutritional evaluation and a blood analysis were performed. The statistical analysis was performed for the combined G308A and A308A as mutant group and type G308G as wild group.

RESULTS

A total of 630 patients (181 males/449 females) (75.5%) had the genotype G308/G308 (wild genotype group) with an average age of 43.5 ± 14.8 years, 188 patients (61 males/127 females) (22.5%) had the genotype G308/A308 (mutant genotype group-heterozygote) and 16 patients (5 males/11 females) (1.9%) with an average age of 44.5 ± 14.2 years had the genotype A308/A308 (mutant group-homorozygote) with an average age of 44.3 ± 11.4 years, without statistical differences in the mean age or sex distribution. Genotypes G308/A308 and A308/A308 was designed (mutant genotype group) as a dominant model. Allelic frequency of the A substitucion -308 was 13.19%. Anthropometric, adipokines, insulin resistance, lipid levels ad dietary intake were similar in both genotypes.

CONCLUSION

In conclusion, allelic frequency of G308A polymorphism is is in accordance with allelic frequencies observed in other populations. Carries of A308 allele have the same anthropometric and metabolic profile than wild type carriers.

Lys656Asn polymorphism of leptin receptor, leptin levels and insulin resistance in patients with non alcoholic fatty liver disease

BACKGROUND

Some studies have pointed to a role of leptin and insulin resistance in pathogenesis of non alcoholic fatty liver disease (NAFLD). The aim of our study was to investigate the influence of Lys656Asn polymorphism LEPR gene on the histological changes, insulin resistance and leptin levels in overweight patients.

MATERIAL AND METHODS

A population of 76 patients with NAFLD was recruited in a cross sectional study. A biochemical analysis of serum was measured. Genotype of LEPR gene Lys656Asn was studied.

RESULTS

Nineteen patients (25%) had the genotype Lys656Asn and 4 patients genotype Asn656Asn (mutant type group) and 53 patients (69.7%) Lys656Lys (wild type group). Body mass index, weight, fat mass, waist circumference, waist to hip ratio, glucose levels and HOMA-IR were higher in mutant than wild type group. LEPR polymorphism is in any way related with liver lesions. The multivariate analysis adjusted by age, sex, BMI and genotype showed an independently association of lobular inflammation 4.19 (CI95%: 1.37-12.77), portal inflammation 1.97 (CI95%: 1.05-3.74) and steatosis 9.23 (CI95%: 1.47-57.83) with HOMA. Liver steatosis was associated with leptin levels (1.09 (CI95%: 1.06-1.18)), too.

CONCLUSION

Lys656Asn polymorphism of LEPR gene is associated with obesity parameters, insulin resistance and glucose levels in patients with NAFLD. In logistic regression analysis, only insulin resistance was associated with portal inflammation), lobular inflammation and steatosis; liver steatosis was related with leptin levels, too.

Roles of G1359A polymorphism of the cannabinoid receptor gene (CNR1) on weight loss and adipocytokines after a hypocaloric diet

BACKGROUND

A intragenic biallelic polymorphism (1359 G/A) of the CB1 gene resulting in the substitution of the G to A at nucleotide position 1359 in codon 435 (Thr), was reported as a common polymorphism in Caucasian populations. Intervention studies with this polymorphism have not been realized.

OBJECTIVE

We decided to investigate the role of the polymorphism (G1359A) of CB1 receptor gene on adipocytokines response and weight loss secondary to a lifestyle modification (Mediterranean hypocaloric diet and exercise) in obese patients.

DESIGN

A population of 94 patients with obesity was analyzed. Before and after 3 months on a hypocaloric diet, an anthropometric evaluation, an assessment of nutritional intake and a biochemical analysis were performed. The statistical analysis was performed for the combined G1359A and A1359A as a group and wild type G1359G as second group, with a dominant model.

RESULTS

Forty seven patients (50%) had the genotype G1359G (wild type group) and 47 (50%) patients G1359A (41 patients, 43.6%) or A1359A (6 patients, 6.4%) (mutant type group) had the genotype. In wild and mutant type groups, weight, body mass index, fat mass, waist circumference and systolic blood pressure decreased. In mutant type group, resistin (4.15 ± 1.7 ng/ml vs. 3.90 ± 2.1 ng/ml: P < 0.05), leptin (78.4 ± 69 ng/ml vs 66.2 ± 32 ng/ml: P < 0.05) and IL-6 (1.40 ± 1.9 pg/ml vs 0.81 ± 1.5 pg/ml: P < 0.05) levels decreased after dietary treatment.

CONCLUSION

The novel finding of this study is the association of the mutant allele (A1359) with a decrease of resistin, leptin and interleukin-6 secondary to weight loss.

Effect of a probiotic on liver aminotransferases in nonalcoholic fatty liver disease patients: a double blind randomized clinical trial

OBJECTIVE

The present pilot trial was carried out to evaluate the effects of an acute treatment with a mixture containing 500 million of Lactobacillus bulgaricus and Streptococcus thermophilus per day in patients with non alcoholic fatty liver disease (NAFLD).

RESEARCH METHODS

A sample of 30 patients with NAFLD (diagnosed by liver biopsy) was enrolled and 28 patients were analyzed in a double blind randomized clinical trial. Patients were randomized to one of the following treatments during 3 months: group I, treated with one tablet per day with 500 million of Lactobacillus bulgaricus and Streptococcus thermophilus and group II, treated with one placebo tablet (120 mg of starch).

RESULTS

In group I, alanine amino transferase (ALT: 67.7 +/- 25.1 vs. 60.4 +/- 30.4 UI/L; p < 0.05), aspartate aminotransferase activity (AST: 41.3 +/- 15.5 vs. 35.6 +/- 10.4 UI/L; p < 0.05) and gammaglutamine transferase levels (gammaGT: 118.2 +/- 63.1 vs. 107.7 +/- 60.8 UI/L; p < 0.05) decreased. In group II, all liver function parameters remained unchanged (ALT: 60.7 +/- 32.1 vs. 64.8 +/- 35.5 UI/L; p < 0.05), aspartate aminotransferase activity (AST: 31.7 +/- 13.1 vs. 36.4 +/- 13.8 UI/L; ns) and gammaglutamine transferase levels (gammaGT: 82.1 +/- 55.1 vs. 83.6 +/- 65.3 UI/L; ns). Anthropometric parameters and cardiovascular risk factors remained unchanged after treatment in both groups.

CONCLUSION

A tablet of 500 million of Lactobacillus bulgaricus and Streptococcus thermophilus, with a randomized clinical design, improved liver aminotransferases levels in patients with NAFLD.

Lys656Asn polymorphism of leptin receptor gene and metabolic syndrome in obese patients

BACKGROUND

The etiology of common obesity is complex, because many genetic, environmental and metabolic factors might act. Alterations of the normal leptin receptor gene be involved in the development of obesity. The polymorphism on codon 656 produces a change in charge, making this change a possibility to be functional.

OBJECTIVE

The aim of our study was to investigate the relationship between metabolic syndrome and Lys656Asn polymorphism in obese patients.

DESIGN

A population of 714 obese patients (body mass index > 30) was analyzed in cross-sectional survey. A bioimpedance, blood pressure, a serial assessment of nutritional intake with 3 days written food records and biochemical analysis were performed.

RESULTS

Four hundred and seventy eight patients (66.9%) had the genotype Lys656/Lys 656 (wild group), whereas 236 (33.1%) had either the genotype Lys656/Asn656 (212 patients, 29.7%) or the genotype Asn656/Asn656 (24 patients, 3.4%) (mutant group). Prevalence of metabolic syndrome (MS) with ATP III definition was 49.4% (353 patients; 35.1% males and 64.9% females) and 50.6% patients without MS (n = 361; 25.2% males and 75.8% females). Prevalence of leptin receptor (LEPR) genotypes was similar in patients with metabolic syndrome (65.5% wild genotype and 34.5% mutant genotype) and without metabolic syndrome (68.3% wild genotype and 31.7% mutant genotype). No differences in anthropometric and biochemical parameters were detected between genotypes in the same group of metabolic syndrome.

CONCLUSION

The finding of our study is the lack of association of the Lys656/Asn656 and Asn656/ Asn656 genotypes with metabolic syndrome.

Nutritional status in a multicenter study among institutionalized patients in Spain

INTRODUCTION

The aim of our study was to investigate and evaluate, in a multicenter study, the prevalence of malnutrition as well as the relationship between different anthropometric and biochemical markers with Mininutritional assessment (MNA) scores.

SUBJECTS AND METHODS

A representative sample of the institutionalized Spanish population aged 65 and older (stricly speaking, born in 1942 or earlier), is covered in this cross-sectional survey. Anthropometric variables, MNA test and biochemical evaluation were performed by Geriatrics Units specialists.

RESULTS

The percentage of patients classified as well nourished (27.8%) was larger in the 85-94 (39.4%) range than in the 65-74 (26.2%), 75-84 (24%) and > 95 (14.8%) age ranges. A population of 254 patients (49.6%) were at risk of undernutrition, a number which was larger in 75-84 (52%), 65-74 (53.8%) and > 95 (53.7%) than in the 85-94 (44.1%) ones. On the other hand, undernourishment (22.5%) was larger in those of 95 and older (31.5%) than in 85-94 (16.5%), 75-84 (24%) and 65-74 (20%) patients. According to our investigation females are worse nourished (Odd's Ratio 0.51 CI 95%: 0.33-0.79) and, consequently, more undernourished (Odd's Ratio 2.36 CI 95%: 1.48-3.74) than males. No significant differences in the "at risk of undernutrition category" (Odd's Ratio 0.76 CI 95%: 0.52-1.10) were observed but, in transferrin, iron, haemoglobin and total cholesterol, statistical differences among MNA classification were detected. MNA scores were correlated with iron, total cholesterol, albumin, transferrin, age and haemoglobin.

CONCLUSION

In this multicenter study, institutionalized patients have a high prevalence of undernutrition or are at-risk, as well as females are more undernourished than males.

Lack of effect of a moderate hypocaloric diet on visfatin levels in morbid obese patients: relationship with insulin resistance

OBJECTIVES

The insulin-mimetic adipocytokine visfatin has been related to obesity. The aim of this study was to examine whether weight loss could change visfatin concentrations in morbidly obese patients and its relationship with insulin resistance.

MATERIAL AND METHODS

This was an interventional study analyzing a population of 41 morbidly obese patients. A biochemical analysis was realized before and after 2 months on a hypocaloric diet.

RESULTS

After weight loss (average 4.41%), BMI, weight, fat mass, fat free mass, waist circumference, systolic blood pressure, serum glucose, total cholesterol, insulin and HOMA decreased. The serum concentrations of visfatin did not decrease (43.5 + 30.8 vs. 47.1 + 38.1 ng/ml). In the multivariate analysis visfatin concentrations as a dependent variable, only C reactive protein remained as an independent predictor in the model before diet, with an increase of 1.82 ng/ml (CI 95%: 0.02 - 3.61) basal visfatin concentrations with each increase of 1 mg/dl of CRP. Only HOMA remained as an independent predictor in the model after diet, with an increase of 11.4 ng/ml (CI 95%: 1.76 - 21.11) posttreatment visfatin concentrations with each increase of 1 unit HOMA.

CONCLUSION

Weight reduction after a 2 months on a hypocaloric diet is not associated with a significant change in circulating visfatin in morbidly obese patients.

A randomized double-blind clinical trial with two different doses of arginine enhanced enteral nutrition in postsurgical cancer patients

OBJECTIVES

Patients with head and neck cancer undergoing surgery have a high incidence of postoperative complications. The aim of our study was to investigate whether postoperative nutrition of head and neck cancer patients, using an enteral high dose of arginine (20 g per day) vs a medium dose (12.3 g per day) could improve nutritional variables as well as clinical outcome.

MATERIAL AND METHODS

A population of 115 patients with oral and laryngeal cancer was enrolled. At surgery patients were randomly allocated to two groups: group I (58 patients) received an enteral diet supplements with a high dose of arginine (20 g per day) and group II (57 patients) received an isocaloric, isonitrogenous enteral formula with a medium dose of arginine (12.3 g per day).

RESULTS

Gastrointestinal tolerance (diarrhea) of both formulas was good (3.44% group I and 3.51% group II: ns). The postoperative infections complications were similar in both groups (8.6% group I and 12.2% group II: ns). Fistula was less frequent in enriched nutrition group (3.4% group I and 10.5% group II: p = 0.006). The length of postoperative stay was similar in both groups (27.2 +/- 17.8 days in group I vs 25.7 +/- 18.8 days in group II: ns).

CONCLUSIONS

Enriched arginine formula improves fistula wound complications in postoperative head and neck cancer patients. Our results suggest that these patients could benefit from a high dose of arginine enhanced enteral formula.

Effects of olmesartan vs irbesartan on metabolic parameters and visfatin in hypertensive obese women

BACKGROUND

Angiotensin II regulates the production of adipokines. The objective was to study the effect of treatment with irbesartan versus olmesartan in obese hypertensive women.

SUBJECTS

A sample of 34 obese hypertensive women was analyzed in a prospective way with a randomized trial. Patients were randomized to irbesartan (300 mg/day) or olmesartan (40 mg/day) for 3 months. Weight, body mass index, blood pressure, basal glucose, insulin, total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides, HOMA and visfatin were determined at basal time and after 3 months of treatment.

RESULTS

Thirty four patients gave informed consent and were enrolled in the study. A significative decrease in systolic and diastolic blood pressures was reached without changes in weight. Patients treated with olmesartan had a significative decrease of total cholesterol, LDL cholesterol, insulin, HOMA and visfatin levels. Decrease in total cholesterol and LDL cholesterol was similar with both angiotensin receptor blockers. Decrease in insulin (2.28 +/- 2.77 vs 0.66 +/- 4.4 mUI/L: p < 0.05), HOMA (0.69 +/- 1.1 vs 0.48 +/- 1.6 units: p < 0.05) and visfatin (5.16 +/- 13 vs 1.85 +/- 9.1 ng/ml: p < 0.05) levels was higher in olmesartan than irbesartan group.

CONCLUSION

The administration of olmesartan improved blood pressure, insulin, HOMA, visfatin and lipid profile in hypertensive obese women. Irbesartan improved blood pressure and lipid levels.

Role of -55CT polymorphism of UCP3 gene on non alcoholic fatty liver disease and insulin resistance in patients with obesity

BACKGROUND AND AIMS

Some studies have pointed to a role of UCP3 in the regulation of biochemical and fat parameters in overweight patients. The aim of our study was to investigate the influence of -55CT polymorphism of UCP3 gene (rs1800849) on histological changes and insulin resistance in patients with non-alcoholic fatty liver disease (NAFLD).

MATERIAL AND METHODS

A population of 39 patients with NAFLD was recruited in a cross sectional study. The inclusion criterion was the presence of biopsy-proven NAFLD. A biochemical analysis of serum (lipid profile, and adipocytokines) was measured. An anthropometric analysis was assessed, too. Genotype of UCP3 gene -55CT was studied.

RESULTS

Nine patients (23%) had the genotype 55CC (mutant type group) and 30 patients (77%) 55CT (wild type group).TT genotype was not detected. Insulin levels and HOMA were higher in mutant type group (insulin: 17.7 +/- 10.9 mUI/L vs 11.9 +/- 4.7 mUI/L/; p < 0.05) and (HOMA: 3.2 +/- 1.8 vs 4.5 +/- 2.8; p < 0.05). Adiponectin levels were lower in mutants type group (36.5 +/- 28.1 ug/ml vs 21.5 +/- 18.6 ug/ml:p < 0.05). Moderate-severe inflammation and moderate-severe steatosis were more frequent in mutant type group, with higher levels of insulin and lower levels of adiponectin than mild stages.

CONCLUSION

-55CT genotype is associated with high insulin resistance and low adiponectin levels than -55CC genotype. Patients with -55CT genotype have more frequently moderate-severe steatosis and inflammation than -55CC genotype.

Resistin levels and inflammatory markers in patients with morbid obesity

BACKGROUND

The aim of the present study was to explore the relationship of resistin levels with inflammatory markers and anthropometric parameters in morbid obese patients.

SUBJECTS

A population of 46 morbid obese was analyzed. A complete nutritional and biochemical evaluation was performed. Patients were divided in two groups by median resistin value (3.49 ng/ml), group I (low values, average value 2.60 +/- 0.5) and group II (high values, average value 5.71 +/- 2.25).

RESULTS

Patients in the group II had higher weight, BMI, fat mass, waist circumference, LDL-cholesterol, triglycerides, fibrinogen and C reactive protein than patients in group I. In the multivariate analysis with age- and sex-adjusted basal resistin concentration as a dependent variable, only fibrinogen and LDL cholesterol remained as an independent predictor in the model (F = 8.5; p < 0.05). Resistin concentration increase 0.01 ng/ml (CI 95%: 0.003-0.017) for each mg/dl of fibrinogen increased. Resistin concentration increase 0.03 ng/ml (CI 95%: 0.003-0.049) for each mg/dl of LDL-cholesterol increased.

CONCLUSION

Circulating resistin concentrations are associated with different inflammatory markers, triglycerides, LDL cholesterol and anthropometric variables in morbid obese patients. Further studies are needed to explore these interesting relationships.

[Dietary intakes in a group of marihuana smoking patients]

BACKGROUND

Marihuana use has effects on appetite; studies in the literature on this topic area are limited. The aim of our work was to evaluate the dietary intake of marihuana smoking patients.

PATIENTS AND METHODS

A total of 32 male subjects were enrolled (average age 37.25 +/- 8.8 years). In all patients were determined weight, height and body mass index and a three days nutritional questionnaire.

RESULTS

Total calories intakes were higher (3,350.1 +/- 979 kcal/day). Distribution of calories was 44.3% of carbohydrates, 14% of proteins and 41.7% of lipids (50.6% mono-unsaturate fats, 36.3% saturate fats and 13.1% poluunsaturated fats). Total protein intake was 109.6 +/- 38.5 g/day and corrected by weight was 1.62 +/- 0.73 g/kg. Low intake of vitamin D, E, folic, magnesium and iodine were detected. High intake of vitamin A, C, K, thiamine, riboflavine, B6, niacin, B12, calcium, iron and zinc were observed. No statistical differences in dietary intake or weight were detected between groups of marihuana users by median of consumption time of this drug.

CONCLUSIONS

Marihuana smoking patients realized a hipercloric and hiperproteic diet, with high amounts of fats and with an intake of micronutrients above international recommendations. This dietary intake has not related with weight.

Nutritional treatment for ambulatory patients with acquired immunodeficiency virus infection and previous weight loss using a formula enriched with n3 fatty acids: a randomized prospective trial

BACKGROUND AND AIMS

Dietary counseling and oral supplementation have unclear results in preventing the progressive weight loss in human deficiency virus (HIV)-infection. The aim of the study was to compare the progression of nutritional indicators with or without a formula enriched with n-3 fatty acids.

PATIENTS AND METHODS

30 HIV patients were enrolled. 15 were randomized to group I (standard formula) and 15 were randomized to group II (formula enriched with n-3 fatty acids). A nutritional evaluation was realized at basal time and at 3 months.

RESULTS

An increase in protein and calories intakes was detected in both. There was a significant increase in n3 fatty acid intake from baseline in group II, without statistical changes in group I. Treatment with both supplements resulted in a significant and sustained increase in weight (4.5% in group I and 5.4%, in group II). This increase was mostly due to fat free mass in group I. In group II it was due to an increase in fat free mass and fat mass.

CONCLUSIONS

Oral nutritional supplements for a 3-months period were well tolerated and resulted in body weight gain in HIV-infected patients with previous weight loss.

Prevalence of metabolic syndrome with International Diabetes Federation Criteria and ATP III Program in patients 65 years of age or older

BACKGROUND

The relationship between cardiovascular factors and death can vary with age, very few studies have examined metabolic syndrome in the elderly.

OBJECTIVE

The aim of this study is to assess the prevalence of the MS in a sample of elderly institutionalized patients (> 65 years) using ATPIII and IDF definitions.

DESIGN

This was a cross-sectional survey covering a sample of representative of the institutionalized Spanish population aged above 65 years. The final sample study consisted of 862 patients, 556 females and 306 males. ATPIII and IDF definitions were used to classify the patients.

RESULTS

Prevalence of MS was different according to the two definitions used. When the IDF definition was applied, total prevalence was 48.91% (CI 95%:43.47-50.25), while prevalence according to ATPIII criteria was 46.80% (CI = 43.47-50.25). a higher prevalence of MS was found in females as compared to males. Using IDF criteria, odds ratio was 1.9 (CI 95%:1.4-2.6) and 1.7 (CI 95%:1.2-2.2) according to ATPIII criteria. a steady decrease is seen in MS prevalence as the age of patients increases (the last two groups (85-94 ys and > 95 ys), both for the ATP III and the IDF definitions.

CONCLUSION

A higher prevalence of MS in this elderly population as compared to general population was observed. A decrease of this prevalence above 95 years was detected.

Influence of Ala54Thr polymorphism of fatty acid-binding protein 2 on insulin resistance and adipocytokines in patients with diabetes mellitus type 2

BACKGROUND

A transition G to A at codon 54 of FABP2 results in an amino acid substitution (ala 54 to Thr 54). This polymorphism could be associated with insulin resistance and adipocytokines in patients with diabetes mellitus type 2.

OBJECTIVE

The aim of our study was to investigate the influence of Thr54 polymorphism in the FABP2 gene on adipocytokines and insulin resistance in the fasted state in naïve patients with diabetes mellitus type 2.

DESIGN

A population of 58 naïve patients with diabetes mellitus type 2 (fasting glucose > 126 mg/dl) and obesity (body mass index > 30) was analyzed in a prospective way. An indirect calorimetry, tetrapolar electrical bioimpedance, blood pressure, a serial assessment of nutritional intake with 3 days written food records and biochemical analysis (lipid profile, adipocytokines, insulin, CRP and HOMA) were performed. The statistical analysis was performed for the combined Ala54/Thr54 and Thr54/Thr54 as a mutant group and wild type Ala54/Ala54 as second group.

RESULTS

Thirty-three patients (56.9%) had genotype Ala54/Ala54 (wild type group) and 25 (43.1%) patients Ala54/Thr54 (19 patients, 32.8%) or Thr54/Thr54 (6 patients, 10.3%) (mutant group). C-reactive protein (5.6 +/- 4.2 vs 8.7 +/- 5.3 mg/dl: p < 0.05), insulin (22.9 +/- 11 vs 6.6 +/- 12 mUI/L: p < 0.05) and HOMA (7.65 +/- 5.3 vs 9.1 +/- 6.3: p < 0.05) were higher in mutant group than wild group. Anthropometric parameters, dietary intakes and adipocytokines were similar in both genotypes.

CONCLUSION

The novel finding of this study is the association of the Thr54/Ala54 and Thr54/ Thr54 FABP2 genotypes with higher levels of C reactive protein, insulin and HOMA.

Influence of Ala54Thr polymorphism of fatty acid-binding protein 2 on histological alterations and insulin resistance of non alcoholic fatty liver disease

A transition G to A at codon 54 of fatty acid binding protein type 2 (FABP2) produces an amino acid substitution (Ala 54 to Thr 54). This amino acid substitution was associated with modifications of insulin resistance, adipokines and insulin concentrations. The aim of this study was to evaluate the influence of Ala54Thr polymorphism in the FABP2 gene on the histological alterations of non-alcoholic fatty liver disease (NAFLD) and insulin resistance. Thirty subjects with the presence of biopsy-proven NAFLD were enrolled for this study. Glucose, Insulin, Insulin resistance (HOMA), total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides, resistin, leptin, adiponectin, interleukin-6 and TNF-alfa serum levels were measured at basal time. A tetrapolar bioimpedance, BMI, waist circumference, waist to hip ratio, blood pressure and a prospective serial assessment of nutritional intake with 3 days written food records were examined. Genotype of Ala54Thr FABP2 gene polymorphism was studied. The mean age was 41.6 +/- 11 years and the mean BMI 29.2 +/- 6.6 with 24 males (80%) and 6 females (20%). Fifteen patients (50%) had the genotype Ala54/Ala54 (wild type group) and 15 (50%) patients Ala54/Thr54 (13 patients) or Thr54/Thr54 (2 patients) (mutant type group). Both genotype groups have the similar anthropometric parameters. Serum aspartate aminotransferase and alcaline phosfatase were higher in wild type group than mutant type group, with an unclear explanation. Dietary intake was similar in both groups. A non-statistical significant low levels of adiponectin in mutant group was observed. No differences were detected among other adipokines. There were no differences between genotypes in histological results of inflammation (portal or lobular inflammation) or grade of steatosis or fibrosis. In conclusion, the present study demonstrates that the polymorphism Ala54Thr of FABP in patients with NAFLD doesn't predict liver histological changes, nor both insulin resistance and serum adipokines variations.

High dose of arginine enhanced enteral nutrition in postsurgical head and neck cancer patients. A randomized clinical trial

OBJECTIVE

Patients with head and neck cancer undergoing surgery have a high incidence of postoperative complications. The aim of our study was to investigate whether postoperative nutrition of head and neck cancer patients, using a higher dose of arginine (20 g per day) could improve nutritional variables.

MATERIALS AND METHODS

A population of 72 patients with oral and laryngeal cancer was enrolled. At surgery patients were randomly allocated to two groups: a) patients were receiving an enteral diet supplements with arginine and fiber (group I); b) patients were receiving an isocaloric, isonitrogenous enteral formula (group II).

RESULTS

No significant intergroup differences in the trend of the three serum proteins and lymphocytes were detected. Gastrointestinal tolerance (diarrhea) of both formulas was good (7.89% group I and 5.88% group II: ns). The postoperative infections complications were similar in both groups (23.6% group I and 20.6% group II: ns). Fistula was less frequent in enriched nutrition group (5.2% group I and 17.6% group II: p = 0.026). The length of postoperative stay was better 24.3 +/- 14 days in the immunonutrition group than 36.1 +/- 27 days in the control group (p = 0.036).

CONCLUSIONS

Enriched formula improves local wound complications in postoperative head and neck cancer patients and decreases length of stay.

Are beta-blockers useful in the prevention of osteoporotic fractures?

Atherosclerosis and osteoporosis are highly prevalent chronic diseases that affect populations of similar ages who are clinically asymptomatic until complications appear. Therefore, research into new drugs that are useful for both processes and may improve therapeutic compliance appears to be reasonable. beta-blockers are widely used in the treatment of hypertension and its complications, ischemic heart disease and heart failure. Their use has been associated with a decrease in cardiovascular mortality. Experimental data have demonstrated that the sympathetic nervous system inhibits bone formation and increases resorption due to the binding of catecholamines to receptors located in osteoblasts. This produces a decrease in bone mineral density and a higher risk of fractures. The effect is eliminated by the administration of beta-blockers. Retrospective case-control and cohort studies have shown a beneficial effect of beta-blockers on fractures reduction, with a protective effect being observed in eight studies and no effect being found in two studies. The aim of this paper is review these data and the possible role of beta-blockers in the prevention of osteoporotic fractures in patients with cardiovascular disease.

[Effects of a diet with products in texture modified diets in elderly ambulatory patients]

BACKGROUND

Decrease in the capacity to deglution solids and liquids is a problem in many people, this problem decreases quality of life. The main objective of our work was to evaluate the influence in elderly ambulatory patients with dysphagia of a texture modified diet ready to use on nutritional parameters and quality of life.

METHODS

We enrolled 29 patients from Nutrition Department with dysphagia and an age over 70 years. Patients received a texture modified diet supplemented with dehydrated nutritional products (Resource Ready) (1,633 kcal, 59,9 g proteins (16%), 52,1 g lipids (29%), 231,7 g carbohydrates (57%), 11,1g de fiber, 82 mg cholesterol). Before and after 3 months of starting the treatment, we recorded a blood analysis, nutritional anthropometric evaluation (tricipital skinfold, midarm circumference, midarm muscle circumference, weight, height and body mass index), a bipolar bioimpedance and a dietary questionnaire of 3 days. SF36 as a questionnaire of quality of life was used before and after nutritional treatment.

RESULTS

A total of 29 patients were recruited with a sex distribution of (18 females and 11 males), and an average age of 79,5+8,59 years. A 25,7% of patients had head and neck tumors, a 24% dementia and a 41,3% chronic neurological deterioration. After treatment, we detected an improvement in weight, fat mass, fat free mass, total proteins, albumin, transferrin and lymphocytes. Caloric, protein fat and carbohydrate intakes increased in a significative way. Caloric intake corrected by weight improved (26.1 +/- 5.7 cal/kg vs 28.9 +/- 4.5 cal/kg: p < 0.05). Quality of life improved significantly (SF 36 score 94.7 +/- 15 points vs 99.3 +/- 10 points; p < 0.05).

CONCLUSION

A texture modified diet with dehydrated nutritional products improved dietary intake, nutritional status and quality of life of ambulatory elderly patients with dysphagia.

Effect of omega-3 fatty acids on cardiovascular risk factors in patients with type 2 diabetes mellitus and hypertriglyceridemia: an open study

BACKGROUND AND OBJECTIVES

Epidemiological and interventional studies suggest that a high dietary intake of n-3 polyunsaturated fatty acids may confer a protective effect against atherosclerotic disease and reduce serum triglycerides levels. The aim of our study was to investigate the effectivity on triglyceride levels and inflammatory markers of a concentrated of n-3 fatty acids in patients with type 2 diabetes mellitus and hypertriglyceridaemia.

SUBJECTS

A total of 30 patients (16 males and 14 females) with diabetes mellitus type 2 and hypertriglyceridemia (> 200 mg/dl) were included in the study. Patients received two capsules of eicosapentaenoic 465 mg and docosahexanoic 375 mg daily for 12 weeks.

RESULTS

Triglycerides levels and non HDL-cholesterol decreased (326 +/- 113.5 vs. 216.4 +/- 57 mg/dl; p < 0.05) and (103.87 +/- 44 vs. 89.6 +/- 14 mg/dl; p < 0.05), respectively. HDL-cholesterol levels increased (39.6 +/- 10.7 vs. 46.4 +/- 8.7 mg/dl; p < 0.05). C reactive protein decreased (5.98 +/- 3.9 vs. 3.9 +/- 1.6 mg/dl; p < 0.05) and TNF-alpha levels decreased (16.24 +/- 5.5 vs. 13.3 +/- 5.8 pg/dl; p < 0.05), without significant changes in IL-6 levels. In conclusion, an n-3 polyunsaturated intervention improved lipid profile and inflammatory markers in patients with diabetes mellitus type 2 and hypertriglyceridaemia.

Effects of lifestyle modification on adipocytokine levels in obese patients

OBJECTIVE

Adipose tissue is considered an active secretory organ of adipocytokines. The principal aim of our study was to examine the changes in adipocytokines levels after weigth reduction in obese patients.

MATERIALS AND METHODS

A population of 126 obese (body mass index > 30) non-diabetic outpatients was analyzed in a prospective way. Before and after three months of a lifestyle modification program, an indirect calorimetry, a tetrapolar electrical bioimpedance, blood pressure, a serial assessment of nutritional intake with 3 days written food records and a series of biochemical analyses were performed. The lifestyle modification program consisted of a daily hypocaloric diet (1520 kcal: 52% of carbohydrates, 25% of lipids and 23% of proteins). The exercise program consisted of an aerobic exercise for at least 3 times per week (60 minutes each).

RESULTS

The mean age was 45.6 +/- 16.9 years and the mean BMI 34.5 +/- 5.2, with 33 males (26.2%) and 93 females (73.8%). A total of 88 patients completed the follow up during 3 months, with a percentage of weight loss of 3.1%. Seventy two patients lost weight after treatment (responders) with an average age of 45.4 +/- 16.8 years and a percentage of weight loss of 4.2%. Sixteen patients did not respond (no-responders), with an increase in weight (88.9 +/- 10.5 vs 88.7 +/- 10.9 kg: p < 0.05) and BMI (34.7 +/- 5.4 vs 35.5 +/- 5.5 kg: p < 0.05). The average age (45.9 +/- 15.9 years) of this group was similar than that of responders. In responders (weight loss), BMI, weight, fat mass, glucose, total cholesterol, LDL cholesterol and systolic blood pressure decreased and VO2 increased. After treatment, no statistical differences were detected in energy intake: carbohydrate, fat, and protein. Exercise improved after treatment in responder group. Only serum leptin levels had a significant decrease in responder group (12%). After treatment, no responder group has similar values of all adipokines, including leptin (81.3 +/- 70.6 vs. 76.1 +/- 43 ng/ml).

CONCLUSION

Three months of lifestyle modification significantly improved anthropometric and cardiovascular risk factors, regardless of their minimal decrease in energy intake and the weight loss. Additional studies will be need to clarify the contribution of lifestyle modification in changes of serum adipocytokine levels.

Nutritional status in head and neck cancer patients

OBJECTIVE

Patients suffering from cancer of head and neck are at risk of nutritional depletion. The aim of our study was to investigate the role of type, location and stage of tumors in nutritional status.

PATIENTS AND METHODS

A population of 230 consecutive patients with head and neck cancer was enrolled. A nutritional evaluation was realized.

RESULTS

The distribution of tumour sites was: oral cavity (77 patients), pharynx (30 patients) and larynx (123 patients). Subjective Global Assessment (SGA) test showed significant differences. Midly malnourished frequency is higher in larynx site than others. Severely malnourished is higher in larynx and oral cavity than pharynx. In pharynx, larynx and oral cavity tumours is more frequent to be well nourished than severely malnourished. In pharynx and larynx tumours is more frequent to be mildly malnourished than severely malnourished. In stages II, III and IV are more frequent to be well nourished than severely malnourished and in stages II and III is more frequent to be mildly malnourished than severely malnourished.

CONCLUSIONS

SGA test shows a good nutritional status in patients with head and neck tumours. However, SGA test shows statistical differences in some categories of tumours stages or sites.

[Spanish registry of Home-Based Parenteral Nutrition for the years 2004 and 2005 (NADYA-SENPE Group)]

OBJECTIVE

To report the results of the Home Parenteral Nutrition (HPN) registry of the NADYA-SENPE working group of the years 2004 and 2005.

MATERIAL AND METHODS

We summarized the data of the new on-line HPN registry of the NADYA-SENPE group for the period 2004-2005.

RESULTS

During the year 2004, 70 HPN-patients (23 males and 47 females) were registered from 14 hospitals. Mean age of adults was 53,7 +/- 14,87 years (m +/- SD) and 6 +/- 2,83 years for those younger than 14 years. The most frequent etiologies of the intestinal failure were neoplasia (24%) and mesenteric ischaemia (19%). Tunnelled catheters were used in 75% of the patients. The catheter-related infections were the most frequent complications, with a rate of 0,98 episodes/10(3) days. In 69% of the cases the nutritional support was maintained for more than 2 years. HPN solutions and disposables were supplied by the hospital pharmacy in 81% and 83%, respectively. Up to 54% of the patients had a normal activity level. The most frequent reasons to end HPN treatment were the transition to oral intake (41%), or exitus (28%). During the year 2005, 79 patients (33 males and 46 females) were registered from 14 hospitals. Mean age of adults was 52,39 +/- 14,21 years and 6,5 +/- 5,21 years for those younger than 14 yrs. The most frequent etiologies of the intestinal failure were neoplasia (22%), and mesenteric ischaemia (15%). Tunnelled catheters were used in 63% of the patients. The catheter-related infections were the most frequent complications, with a rate of 1,14 episodes/10(3) days. In 51% of the cases the nutritional support was maintained for more than 2 years. HPN solutions and disposables were supplied by the hospital pharmacy in 76% and 81%, respectively. Up to 50% of the patients had a normal activity level. The most frequent reasons to end HPN treatment were the transition to oral/enteral feeding (41%) and exitus (31%).

CONCLUSIONS

We have observed a mild decrease in the number of HPN patients registered in the period 2004-2005, probably related to the change of the registry. The characteristics of the patients are similar to previous years. We have observed an increase in the septic catheter-related complications in the year 2005.

Influence of insulin resistance in obese patients on elevated serum alanine aminotransferase

BACKGROUND AND OBJECTIVE

Insulin resistance has been associated with fat liver and non-alcoholic fatty liver disease. The aim of our study was to study the influence of insulin resistance in obese patients on elevated serum alanine aminotransferase.

RESEARCH METHODS

A population of 91 obesity non diabetic outpatients was analyzed in a cross sectional study. HOMA-IR was calculated as indicator of insulin resistance.

RESULTS

The mean age was 39.2 +/- 16.7 years and the mean BMI 34.4 +/- 5.2. Patients were classified as group I (control, n=74) when serum (Alanine Aminotransferase) ALT activity was normal or group II (NAFLD, n=17) when serum ALT activity was greater than the upper limit of normal reference laboratory (> or =43 UI/L). Waist circumference, fat mass and hip to waist ratio were higher in group II. Insulin (13.5 +/- 7.8 mUI/L vs 24.9 +/- 16.7 mUI/L; p < 0.05), HOMA-IR (1.9 +/- 1.1 vs 3.9 +/- 2.8), and triglycerides levels (115.1 +/- 66.8 mg/dl vs. 153.2 +/- 71.2 mg/dl; p < 0.05) were higher in group II than group I. In the logistic regression analysis with a dependent dicotomic variable (ALT; group I and group II), the HOMA-IR remained in the model, with an Odd's Ratio to develop ALT >43 U/L of 2.18 (CI:95%: 1.12-4.2) with each 1 unit of HOMA-IR adjusted by age, sex, weight, and dietary intake.

CONCLUSION

Insulin resistance in obese patients is associated with ALT activity. Further study is needed to evaluate histological changes and new treatments in these patients.

Resting energy expenditure and insulin resitance in obese patients, differences in women and men

BACKGROUND AND OBJECTIVE

There is little research about the relation of REE and insulin resistance with gender. The aim of our work was to study gender differences in REE and insulin resistance in obese patients.

RESEARCH METHODS AND PROCEDURES

A population of 131 obesity patients was analyzed in a prospective way. The following variables were specifically recorded: age, smoking habit, drinking habit, weight, body mass index (BMI), waist circumference, and waist-hip ratio. Blood pressure, basal glucose, insulin, fibrinogen, and C-reactive protein. HOMA was calculated. An indirect calorimetry, tetrapolar electrical bioimpedance and a serial assessment of nutritional intake with 3 days written food records were performed.

RESULTS

The mean age was 31.7 +/- 9.2 years and the mean BMI 34.4 +/- 5.3. Cardiovascular risk factors were similar in both groups. Anthropometric measurements showed an average waist circunference (107.8 +/- 16.1 cm), waist-to hip ratio (0.93 +/- 0.11), and average weight (94.8 +/- 20.2 kg). Bipolar body electrical bioimpedance showed the next data; fat free mass (55.2 +/- 17.1 kg) and fat mass (35.7 +/- 12.3 kg). Indirect calorimetry showed higher resting metabolic rate (REE) in males (2001.7 +/- 443 Kcal/day vs. 1774.7 +/- 344 Kcal/day; p < 0.05). REE corrected by fat free mass was similar (male 34.2 +/- 17 Kcal/day/kg vs female 39 +/- 11.6 Kcal/day/kg; ns). Nutritional intake and HOMA were similar in males and females. In the multivariate analysis with a dependent variable (RMR), the fat free mass remained in the male model (F = 18.5; p < 0.05), with an increase of 17.8 (CI 95%: 9.1-26.2) kcal/day with each 1 kg of fat free mass adjusted by age. In the female model, the fat free mass remained in the model (F = 1 2.5; p < 0.05), with an increase of 15.2 (CI 95%: 6.3-24.2) kcal/day with each 1 kg of fat free mass adjusted by age.

CONCLUSION

REE was higher in males than females, with a higher influence of fat free mass in males than females. No association between insulin resistance and REE was detected.

Tissue Electric Properties in Head and Neck Cancer Patients

BACKGROUND

The phase angle of the impedance vector was lower because of a decreased Xc component in hemodialysis patients with poorer prognosis, patients with hemodynamic instability, and in critically ill patients. The phase angle is easy to obtain. The aim of our study was to investigate in a case-control study the utility of phase angle and other impedance parameters in a population of male patients with head and neck cancer.

MATERIAL AND METHODS

A case-control study was designed. A population of 67 ambulatory post-surgical male patients was enrolled with the following inclusion criteria: oral and/or laryngeal cancer confirmed by biopsy, without a recent loss weight (<5% during previous 3 months) and signed informed consent. As reference group, we selected 70 male subjects from the same geographic region and matched by age, which were selected from a database of healthy people of our hospital. Basal blood sampling was performed for determinations of blood chemistry. Weight, height, body mass index and tetrapolar body electrical bioimpedance were performed in both groups.

RESULTS

A total of 67 head and neck cancer male patients were enrolled, mean age was 58.49 +/- 14.54 years, weight 73.32 +/- 11.4 kg and BMI 28.53 +/- 3.5. A total of 70 controls subjects were studied, mean age was 62.33 +/- 12.4 years. Weight 64.31 +/- 8.38 kg and BMI 24.33 +/- 3.2 were significantly lower than in cancer patients (p < 0.05). Renal function and blood sodium levels were similar in both groups. Anthropometric evaluation in cancer patients showed a mean fat mass lower than control patients (13.9 +/- 6.1 vs. 12.1 +/- 6.1 kg; p < 0.05). In control patients, fat-free mass was higher than in cancer patients (58.7 +/- 8.2 vs. 51.23 +/- 8.4 kg; p < 0.05). In cancer patients, reactance (62.3 +/- 17.2 vs. 56.6 +/- 15.1 ohm; p < 0.05) and phase angle (8.02 +/- 1.3 vs. 6.9 +/- 1.5 degrees ; p < 0.05) were lower than in control patients.

CONCLUSION

Impedance in male head and neck cancer patients were characterized by a reduced reactance and phase angle. These early altered tissue electric properties appeared with a normal weight and body mass index.

[Efficacy of quinagolide in the treatment of a patient with hypophyseal resistance to thyroid hormones]

The pituitary resistance to thyroid hormones (PRTH) is not very frequent and well-known entity, their treatment it continues being topic of controversy. In this work we have evaluated the quinagolida effectiveness in the treatment of it unites patient with (PRTH). The relationship among thyroid stimulating hormone (TSH) and free triiodothyronine (FT3) it was used as marker of the thyroid resistance and of the response to the treatment. The concentrations of TSH and FT3 were normalized after adding quinagolida to methimazole. These results suggest that the quinagolida could be an useful drug in the treatment of this pathology, next to the classic treatments.

Effect of cerivastatin on serum cholesterol levels in patients with type 2 diabetes mellitus

The incidence of coronary heart disease (CHD) is greatly increased in overweight diabetic patients. Modification of dietary intake and weight loss improve hypercholesterolaemia. However, cholesterol goal levels are not achieved in several patients under this treatment. The aim of our study was to evaluate the effect of Cerivastatin, an inhibitor of 3-hydroxy-3-methylglutaryl coenzyme A reductase, in patients with type 2 diabetes mellitus. A population of 40 diabetic type 2 outpatients were analyzed in a prospective way. The mean+/-SD age was 60.7+/-11.6 years, with a diabetes duration of 8.5+/-6.6 years. All patients were treated with cerivastatin (0.2 mg once a day) for 6 months. Weight HbAlc fasting blood glucose, urine microalbuminuria, total cholesterol, LDL-cholesterol, HDL-cholesterol and triglycerides were measured at the beginning of the study and again after 3 and 6 months of treatment with cerivastatin. An improvement in lipid levels was achieved, with a significant decrease in LDL-cholesterol (27.7%), total cholesterol (21.4%), triglycerides levels (10.4%) and a significant increase in HDL-cholesterol levels (8.3%) (P<0.05). Cardiovascular risk ratios such as; total cholesterol/HDL-cholesterol and LDL-cholesterol/HDL-cholesterol improved during treatment, decreasing 11.3% and 30%, respectively (P<0.05). Low incidence of side effects was demonstrated. In summary, cerivastatin improved lipid control in patients with type 2 diabetes, with a low incidence of side effects.

A randomized cross-over study comparing cabergoline and quinagolide in the treatment of hyperprolactinemic patients

Quinagolide (QUI) and cabergoline (CAB) are dopamine agonists recently introduced for the treatment of hyperprolactinemia. In the present study, these drugs have been compared in terms of effectiveness and tolerability. Twenty patients (18 females and 2 males) with hyperprolactinemia (8 with microprolactinomas, 6 with idiopathic hyperprolactinemia and 6 with empty sella turcica syndrome) were treated with oral QUI (75 microg once daily) and CAB (0,5 mg twice weekly), in a randomized cross-over trial with placebo between both drugs. Each drug was administered for 12 weeks, separated by other 12 weeks with placebo. PRL levels decreased with both drugs at 2 or 4 weeks of starting the treatment, without differences between both drugs at weeks 4, 8 and 12. At week 12, normal PRL levels (<20 ng/ml) were attained in 90% patients with CAB and only in 75% patients with QUI (p<0.05). After discontinuation of treatment, significant increase in serum PRL was higher after QUI withdrawal than after CAB. Clinical efficacy of both treatments was similar in terms of improvement amenorrhea, oligomenorrhea, galactorrhea, and impotence. All patients completed both cycles of treatment, and the most frequent side-effects were nausea, headache and dizziness, without significant differences between CAB (30%) and QUI (55%). Our study indicates that, at the doses employed here, CAB showed a high percentage of patients with normal PRL at the end of treatment and long-lasting efficacy in the levels of PRL. Clinical response and side-effects were similar in both drugs.

Lipoprotein(a) and other lipoproteins in hypothyroid patients before and after thyroid replacement therapy

AIMS

To analyse the influence of thyroid hormones on serum lipoprotein(a) (Lp(a)) concentration and other lipid parameters, and hence potentially on coronary artery disease (CAD) risk.

METHODS

Thirty-six patients with hypothyroidism and 165 age-matched control euthyroid subjects were evaluated in a cross- sectional study, determining thyroid function tests and fasting serum lipids and lipoproteins. In a follow-up study for those hypothyroid patients the same determinations were repeated after normalization of thyroid state by levothyroxine (L-T(4)) replacement therapy. Patients needing other treatments were excluded. At baseline, patients with hypothyroidism had significantly higher levels of Lp(a), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), apolipoprotein (apo) A-I and apo B, and a higher TC/high-density lipoprotein cholesterol (HDL-C) ratio than control subjects.

RESULTS

Severity of the hypothyroid state, expressed by serum thyroid-stimulating hormone, was correlated with serum levels of Lp(a), LDL-C, and TC (r= 0.64, 0.52, 0.49, P= 0.005, P= 0.033, P= 0. 048, respectively). The pretreatment Lp(a) levels were also correlated with those of posttreatment Lp(a)(r= 0.68, P= 0.002). All patients, who presented basal Lp(a) levels higher than 30 mg/dl, showed a decrease in Lp(a) concentrations by L-T(4)therapy, and these normalized in eight cases (22.2%). Euthyroid state gave rise to a significant reduction of serum Lp(a) by 32.3%, of LDL-C by 22. 8%, of TC by 17%, of apo A-I by 9.6%, and of apo B by 9.3%. After L-T(4)therapy, CAD risk, expressed as TC/HDL-C ratio, decreased by 19.9%.

CONCLUSIONS

These results show that hypothyroidism is associated not only with elevated serum levels of LDL-C but also with elevated serum Lp(a) concentrations. Lp(a) levels may be at least partially modulated by thyroid hormone-dependent mechanisms, thus increasing the risk of developing premature atherosclerosis in hypothyroid state, that might be reduced by L-T(4)therapy.

Fulminant acute Budd-Chiari syndrome stemming from an adrenal tumor

Adrenal neoplasm is a rare cause of Budd-Chiari syndrome. We report a case of fulminant acute Budd-Chiari syndrome due to inferior vena cava thrombosis stemming from invasion by a clinically nonfunctioning adrenal neoplasm. We also review briefly the clinical characteristics of the seven previously reported cases.

Spontaneous bacterial peritonitis. Clinical and microbiological study of 233 episodes

We made a retrospective study of 233 episodes of spontaneous bacterial peritonitis that were treated at our Service between January 1980 and September 1996 in order to analyze the clinical presentation, microbiological data, possible pathogenic factors, treatment, and evolution of this clinical entity. Ascites, abdominal pain, and fever were the most frequent symptoms. Only 3.43% of the episodes developed asymptomatically. Thirty-six episodes resulted in the patient's death (15.45%) and, of all the factors analyzed, only a prothrombin time of < 35%, bilirubin > 8 mg/dl, and serum creatinine > 2.1 mg/dl were statistically correlated with a higher death rate. The culture of the ascitic fluid gave a positive result in 47.6% of the cases, whereas no clinical differences were noticed between these patients and those with negative results. The most frequently isolated microorganisms turned out to be Gram negative (49.54%). A proportion of 71.24% of the episodes were treated with cephotaxime (i.v.), whereas 28.76% were treated with other drugs or pharmacological combinations. The death rate was much lower with cephotaxime (4.81% vs. 41.79%, p < 0.01%).

Properties of a transient K+ current in chemoreceptor cells of rabbit carotid body

1. Adult rabbit carotid body chemoreceptor cells, enzymatically dispersed and short-term cultured, exhibit an inactivating outward K+ current that is reversibly inhibited by low PO2. In the present work we have characterized the biophysical and pharmacological properties of this current using the whole-cell voltage clamp recording technique. 2. Inactivating current was recorded after blockage of Ca2+ currents with extracellular Co2+, Cd2+, or after complete washing out of Ca2+ channels. 3. The threshold of activation of this inactivating current was about -40 mV. Current activated very quickly (mean rise time 4.8 +/- 0.42 ms at +60 mV) but inactivated more slowly. Inactivation was well fitted by two exponentials with time constants of 79.7 +/- 6.6 and 824 +/- 42.8 ms (at +40 mV). The inactivation process showed a little voltage dependence. 4. The steady-state inactivation was well fitted by a Boltzman function. Inactivation was fully removed at potentials negative to -80 mV and was complete at voltages near -10 mV; 50% inactivation occurred at -41 mV. 5. Recovery from inactivation had several components and was voltage dependent. Initial recovery was fast, but full recovery, even at -100 mV, required more than 30 s. 6. Inactivating current was selectively blocked by 4-aminopyridine (4-AP), in a dose-dependent manner (IC50, 0.2 mM). The duration of chemoreceptor cells action potentials was augmented by 1 mM 4-AP from 2.3 +/- 0.36 to 7.0 +/- 0.25 ms at 0 mV. Tetraethylamonium (TEA), at concentrations above 5 mM, blocked inactivating and non-inactivating components of the whole K+ current. 7. Inactivating current was modulated by cyclic AMP (cAMP). Bath application of 2 mM dibutyryl cAMP reduced peak amplitude by 18.7 +/- 2.9% (at +30 mV) and slowed down the rise time of the current. The effect was not voltage dependent. Forskolin (10-20 microM) also affected inactivating current, by accelerating the inactivation process. In the same preparations neither dibutyryl cAMP nor forskolin affected Ca2+ currents. 8. It is concluded that modulation of K+ channels by cAMP might play a physiological role potentiating the low PO2 inhibition of K+ channels.