Bioelectrical impedance in young patients with cystic fibrosis: Validation of a specific equation and clinical relevance.

BACKGROUND: Body composition (BC) analysis based on bioelectrical impedance analysis (BIA) provides conflicting results. The purpose of the study was to validate an equation specific for young patients with cystic fibrosis (CF), describe their BC and investigate its association with lung function. METHODS: Fifty-four young CF patients were evaluated by BIA and dual X-ray absorptiometry (DXA). An empirically derived CF-specific equation for fat-free mass (FFM) estimation by BIA was elaborated after stepwise multivariate regression and the agreement between BIA and DXA was assessed by Bland-Altman plots. The association between BC and lung function was investigated by regression analysis. RESULTS: The mean difference between the BIA and DXA assessment was close to zero. A total of 22.5% of patients (n=9) presented a FFM z-score≤-2. They had a worse pulmonary function and diaphragmatic impairment. Among these 9 patients, 7 had a normal BMI z-score>-1. CONCLUSIONS: BIA, based on a CF-specific equation, is a reliable method for BC assessment and allows the identification of patients at risk of nutritional degradation and bad respiratory prognosis.

Combination of micellar casein with calcium and vitamins D2 and K2 improves bone status of ovariectomized mice.

UNLABELLED: Nutritional approaches may help to preserve bone quality. The purpose of our study was to demonstrate the efficiency of an innovative bone health product (BHP) including micellar casein rich in calcium, vitamin D2 and vitamin K2, to improve bone mineral density. INTRODUCTION: The aim of postmenopausal osteoporosis treatment is to decrease bone resorption and/or increase bone formation. Because of the slow bone turnover, osteoporosis prevention and therapies are long-lasting, implying great costs and poor compliance. Even if the effects of nutrition on bone are not as marked as that of pharmaceutical agents, it can be of great help. The purpose of our study was to demonstrate the efficiency of an innovative bone health product (BHP) containing micellar casein rich in calcium, vitamin D2 and vitamin K2, for the improvement of bone mineral density (BMD). METHODS: An ovariectomized mice model was used to study the effect of different concentrations of the ingredient on BMD and microarchitectural parameters. Blood concentrations of C-terminal telopeptide of type I collagen (CTX), N-terminal propeptide of type 1 procollagene (PINP), alkaline phosphatase (ALP), osteocalcin (OC) and RANKL were also measured to evaluate bone remodelling, To evaluate the efficiency of the product to modulate osteoblast and osteoclast growth and differentiation, primary murine bone cells were used. RESULTS: In vivo studies showed that BMD and microarchitectural parameters were dose-dependently improved after ingestion of the supplement for 3 months. We also report increased osteoblast activity as shown by increased OC activity and decreased osteoclastogenesis as shown by reduced CTX activity. In vitro studies support that BHPs stimulate osteoblast differentiation and mineralization and inhibit osteoclast resorption activity. CONCLUSION: Our results show that, when chronically ingested, BHPs improve BMD of ovariectomized mice. This work supports that providing an ingredient including micellar casein rich in calcium, vitamin D2 and vitamin K2 is more efficient than the control diet to maintain bone quality.

The cumulative effect of small dietary changes may significantly improve nutritional intakes in free-living children and adults.

BACKGROUND/OBJECTIVES: The ELPAS (Etude Longitudinale Prospective Alimentation et Santé) study was an 8-month randomized controlled dietary modification trial designed to test the hypothesis that family dietary coaching would improve nutritional intakes and weight control in 2026 free-living children and parents. It resulted in significant nutritional changes, with beneficial effects on body mass index in adults. In these ancillary analyses, we investigated dietary changes throughout the intervention. SUBJECTS/METHODS: Before the study, modeling analyses were carried out on the French Association Sucre Produits Sucrés Consommation et Communication (ASPCC) food-consumption database to identify the most efficient dietary intervention strategy. During the study, all participants performed monthly three nonconsecutive 24-h dietary recalls: this allowed for measuring changes in the number of servings per day and serving size for each targeted food category throughout the intervention. RESULTS: Modeling analyses showed that targeting only the 10 main foods contributing to fat and carbohydrate intakes did not allow for reaching the ELPAS nutritional goals. As a result, it was decided to target more foods and to propose several types of dietary advice (such as change in serving size, change in cooking method, food substitution). This strategy led to many appropriate dietary changes during the intervention, but only a few of them reached significance. The mean number of servings per day was indeed significantly modified for only 7% of the targeted food categories in children and 17% in parents. The mean serving size was modified for only 12% of targeted food categories in children and 9% in parents. CONCLUSIONS: The cumulative effect of small dietary changes may induce significant nutritional improvements, with limited burden for populations.

[A 6-year study of glycopeptides-resistant enterococci in 3 intensive care units of the University Hospital of Montpellier]. / Dépistage des entérocoques résistants aux glycopeptides: six ans d'étude dans trois services de réanimation au CHU de Montpellier.

AIM OF THE STUDY: The aim of this study was to evaluate the rate of glycopeptides-resistant enterococci (GRE) fecal carriage (species and resistance determinants). Strains isolated between 1999 and 2005 during systematic screening for multiresistant bacteria in patients hospitalized in 3 intensive care units (ICU) of the University Hospital of Montpellier were studied. METHODS: The systematic screening was weekly performed. Rectal swabs were cultured on D-Coccosel agar medium containing 4 mg/l vancomycin and MICs for vancomycin and teicoplanin were determined by E-test. Strains were subjected to both phenotypic and genotypic identification and vanA, vanB and vanC genes were detected by PCR. RESULTS: We analyzed 13003 samples for 5113 patients. Among them, 401 (7.84%) patients were GRE carriers with 280 Enterococcus gallinarum (vanC(1)), 102 Enterococcus casseliflavus-flavescens (vanC(2)-C(3)), 5 Enterococcus faecalis (3 vanA, 2 vanB), and 14 Enterococcus faecium (10 vanA, 4 vanB). A unique case of cross contamination between two patients was observed. During the same time, only one strain of GRE was isolated during an infectious process in another unit. Carriage rate of E. faecium and E. faecalis vanA or vanB was 0.37%: 68.4, 21 and 10.6% in the gastrointestinal, in the polyvalent and the respiratory ICU, respectively. CONCLUSION: Our results were in agreement with national data showing a relatively low GRE fecal carriage rate in ICUs, E. faecium vanA being the mainly encountered GRE. Since 2004, GRE detection is increasingly reported in France and an emerging E. faecium vanA clone has been identified during outbreaks. In contrast, only one E. faecium vanB strain has been isolated in our institution since this date and a unique strain of E. faecalis vanA was isolated during an infectious process since 1999. These data underlined the efficacy of transmission prevention measures established when GRE are identified.

Short- and long-term evolution of body composition in 1389 obese outpatients following a very low calorie diet (Pro'gram18 VLCD).

One thousand three-hundred and eighty-nine obese outpatients were followed by 28 practitioners. They were enrolled in a multidisciplinary weight control program for at least 1 year. The major components of the program include a commercial very low calorie diet (Pro'gram18 VLCD), behavior modification, and exercise. There was a significant decrease in body weight compared with baseline of approximately 12.3+/-5.3 kg at the end of the maintenance period; the weight loss was achieved essentially at the expense of fatty mass, -10.3+/-5.5 kg at 90 days while fat-free mass loss was -2.0+/-2.5 kg at 90 days. Mean serum total cholesterol and triglycerides were also lowered and systolic and diastolic blood pressure and fasting blood glucose values were normalized at the end of the weight-loss phase. Obese outpatients lost substantial amounts of weight using VLCD, reduced the risk factors associated with obesity, and had encouraging long-term results, with weight loss maintained at 2-year follow-up.

A paradoxical increase in resting energy expenditure in malnourished patients near death: the king penguin syndrome.

BACKGROUND: The metabolic expression of extreme starvation on the verge of death is unknown in humans. OBJECTIVE: The objective was to compare the resting energy expenditure (REE) of 5 extremely malnourished dying patients [body mass index (in kg/m(2)): 9.77 +/- 0.1] with that of 16 less-malnourished anorexia nervosa (AN) patients. DESIGN: REE was measured by indirect calorimetry and body composition was measured by anthropometry and dual-frequency bioelectrical impedance analysis. Fasting serum insulin, thyroid hormone, and catecholamine concentrations were also determined. RESULTS: At the start of refeeding, REE was high in each of the 5 extremely malnourished dying patients, whereas it was low in the 16 AN patients (mean +/- SD: 5174 +/- 391 kJ/d compared with 3844 +/- 619 kJ/d; P < 0.05). The high REE value in the 5 extremely malnourished dying patients was associated with almost no fat mass (FM), high urinary nitrogen loss (16.4 +/- 2.9 g/d), low serum fatty acid concentrations (0.36 +/- 0.23 mmol/L), and low or normal serum insulin, thyroid hormone, and catecholamine concentrations. During the first 2-4 wk of refeeding, REE and nitrogen loss decreased, whereas fatty acid concentrations increased in each of the 4 surviving patients; REE and urinary nitrogen output increased in the 16 AN patients. CONCLUSION: In malnourished persons near death, there is an increase in REE and in protein catabolism. The reason for this increase is unknown but could relate to consumption of the last mobilizable muscle mass and to diseased cellular membranes.

Paraoxonase polymorphism (Gln192Arg) as a determinant of the response of human coronary arteries to serotonin.

Background-Oxidation of LDL plays a role in endothelial dysfunction. Paraoxonase, an enzyme present on HDL, protects LDL against oxidation. Paraoxonase activity is genetically determined in part, and 3 genotypes have been described with variable enzymatic activity. We hypothesized that the paraoxonase polymorphism might influence endothelial function. Methods and Results-Twenty-seven patients with clinical manifestations of coronary artery disease underwent provocative testing by intracoronary administration of serotonin. None of the coronary arteries studied had significant (>50%) stenosis. Ten patients had the QQ genotype and 17 had the QR genotype. At proximal segments, the mean percentage reduction in lumen diameter in response to serotonin was greater in QQ patients than in QR patients (10(-5) mol/L: P<0.05; 10(-4) mol/L: P<0.006). Similarly, at distal segments, constriction in response to serotonin was greater in QQ patients than in QR patients (10(-6) mol/L: P<0. 03; 10(-5) mol/L: P<0.07). Conclusions-These results suggest a higher synthesis or release of endothelium-derived relaxing factors to counteract the vasoconstrictor effect of serotonin in patients with the R allele. These findings provide evidence that the paraoxonase polymorphism may play a role in the regulation of coronary vasomotor tone.

Malnutrition and wasting, immunodepression, and chronic inflammation as independent predictors of survival in HIV-infected patients.

To analyze the long-term survival factors associated with HIV infection, a prospective follow-up study of 165 HIV-infected patients was performed after a clinical, nutritional, and biological evaluation. Survival rate could be determined in 129 patients after a follow-up of 42 mo before the use of protease inhibitors. After univariate analysis, multivariate analysis was performed with the Cox regression proportional-hazard model. Survival curves were calculated and compared with the Kaplan, Meier, and log-rank tests. The study also analyzed the factors associated with impaired nutritional status at the beginning of the study and their effects on the long-term follow-up. Factors that could explain body weight loss before the study were the level of intakes, resting energy expenditure, chronic diarrhea, and the number of previous opportunistic infections. In the long-term follow-up, univariate analysis showed that nutritional status could be separated into four classes of body weight loss (BWL) by degree of loss (BWL < or = 5%, 5% < BWL < or = 10%, 10% < BWL < or = 20%, BWL > 20%); lean body mass (adjusted to height), body cell mass, CD4 count, albumin, prealbumin, and C-reactive protein (CRP) were all significant predictors. Age, stage of disease, number of previous opportunistic infections, and antiviral therapies were not associated with a change in survival. With the multivariate model, only CD4 counts, lean body mass/height squared, and CRP remained significant independent predictors of survival after controlling for other factors.

Bioelectrical impedance analysis measurements of total body water and extracellular water in healthy elderly subjects.

OBJECTIVE: To address whether: (1) bioelectrical impedance analysis (BIA) can provide precise and accurate estimates of total body water (TBW) and extracellular water (ECW) in healthy elderly subjects, that display age-induced changes in body composition, (2) BIA models are improved by introducing variables related to geometrical body-shape and osmolarity. DESIGN: Cross-validation of available BIA models and models developed in the study. SUBJECTS: 58 healthy elderly subjects (31 women, 27 men, 66.8+/-4.7 y, mean +/- s.d.) MEASUREMENTS: BIA at 5, 50 and 100 kHz, 18O labelled water measurements of TBW, Br measurements of ECW, anthropometric variables, plasma osmolarity. RESULTS: Published BIA models for estimating TBW, entail various degrees of bias. Precise models (SEE of the models 0.8 L at 100 kHz, 1.0 L at 50 kHz) involving height2/resistance, weight, gender, circumferences and plasma osmolarity were established with data from 30 subjects chosen at random. Cross-validation of an independent group (n = 28) showed no bias (-1.5+/-3.2 L at 100 kHz, -1.4+/-3.2 L at 50 kHz, P = NS). CONCLUSION: We conclude that BIA models with increased accuracy and precision for predicting ECW and TBW can be derived in healthy elderly subjects. Repeated measures had a mean difference of 0.2+/-1.2 L.

Increase in diet-induced thermogenesis at the start of refeeding in severely malnourished anorexia nervosa patients.

Many reports describe the difficulty for anorexia nervosa patients to gain weight during refeeding. To assess whether an increase in diet-induced thermogenesis (DIT) participates to this resistance, we studied DIT by indirect calorimetry in 11 severely malnourished anorexia nervosa patients [body mass index (BMI; in kg/m2) = 13] to accomplish two purposes: 1) to compare DIT in a strict semistarvation state with that obtained after 1 wk refeeding, when metabolism is shifted to a dynamic trend toward regaining weight, without significant change in body composition; 2) to study the effect on DIT of two energetic loads representing each one-third of the energy intake during semistarvation and refeeding, respectively: 1.25 and 2.92 MJ. To avoid bias, the two liquid loads were infused intragastrically in a random double-blind fashion. A significant increase in DIT during refeeding was observed for the two loads (204 +/- 23 kJ for the 1.25-MJ liquid meal and 482 +/- 78 kJ for the 2.92-MJ one, P < 0.02). The higher the load, the larger the increase with refeeding (P < 0.001). This increment in DIT exceeded the increase in active lean body mass and was poorly correlated with lean body mass. These results provide clear evidence of a strong cellular "waste" mechanism in anorexia nervosa patients during the early phase of refeeding, which enhances the adaptative resistance to overfeeding that we have already shown for resting energy expenditure.

Body composition determined with MR in patients with Duchenne muscular dystrophy, spinal muscular atrophy, and normal subjects.

Magnetic resonance imaging was used to determine total fat mass of patients with neuromuscular disorders, accounting for intramuscular fat. Nineteen boys aged 9 to 12 (eight with Duchenne muscular dystrophy, three with type II spinal muscular atrophy and eight control subjects) underwent whole-body magnetic resonance imaging examination and anthropometric measurements. Whole-body fat mass was deduced from automated analysis of images normalized by a reference signal. Intramuscular and subcutaneous fat masses were deduced from manual analysis of twelve reference slices. Affected children significantly differed from control subjects for higher total fat mass, mostly related to intramuscular fat mass. Shorter protocols validated from whole-body data were shown to be more accurate than fat mass estimation derived from anthropometric measurements.

Efficacy of 2-month total parenteral nutrition in AIDS patients: a controlled randomized prospective trial. The French Multicenter Total Parenteral Nutrition Cooperative Group Study.

OBJECTIVE: To evaluate the efficacy of total parenteral nutrition in AIDS patients. DESIGN: A prospective, randomized, controlled, multicentre trial. METHODS: Over a period of 2 months, 31 malnourished and severely immunodepressed AIDS patients were assigned to receive either dietary counselling (n = 15) or home total parenteral nutrition (TPN; n = 16) via a central venous access after an educational program. Results were analysed by intent-to-treat basis. RESULTS: Bodyweight change was +8 kg (+13 +/- 3%) in the TPN group and -3 kg (-6 +/- 2%) in the control group (P < 0.0006). Lean body mass increased in the TPN group (+9 +/- 3%) and decreased in the control group (-5 +/- 3%; P < 0.004) while body cell mass increased in the former (+15 +/- 4%) and decreased in the latter (-12 +/- 6%; P < 0.002). Nutritional subjective global assessment, subjective self-reported health feeling and Karnofsky index were also improved by TPN. Infection line sepsis incidence remained low (0.26 per 100 patient-days). However, no difference in survival rate was exhibited between the two groups by the log-rank test. CONCLUSION: We conclude that home TPN is an efficient treatment of malnutrition in severely immunodepressed AIDS patients.

Reproducible measurement of postprandial energy expenditure in young healthy males.

The reproducibility of measurements of postprandial energy expenditure (PEE) was determined by assessing, for 345 min, the diet-induced thermogenesis (DIT) of a 4055-kJ mixed meal in 10 lean young men on four occasions. The DIT was determined by using either a 20-min premeal baseline metabolic rate (method 1) or a single resting metabolic rate (RMR) measured on a separate day (method 2). The DIT, in kilojoules, for a given subject calculated by method 1 varied significantly between occasions, CV 15.4% (P < 0.05). The D peak (PEE peak minus baseline) did not vary significantly between the four trials (CV 13%). The results obtained by using method 2 were much more reproducible for both the DIT (CV 4.2%) and the D peak (CV 4.8%). Thus, the reproducibility of the PEE measurement is enhanced by using an RMR measured on a separate day and by using the postprandial peak value instead of the DIT.

Resting energy expenditure in human immunodeficiency virus-infected patients: comparison between patients with and without secondary infections.

Resting energy expenditure (REE) was measured in 165 malnourished patients with human immunodeficiency virus infection and compared with that of 31 control subjects. Of these patients, 129 had no symptoms of secondary infections (NI), whereas 36 had evolving secondary infection (I) despite a body temperature < 38 degrees C. Mean REE was 11% higher in the NI group than in the control group (P < 0.05); it was 34% higher in the I group than in the control group (P < 0.001) and 21% higher than in the NI group (P < 0.01). In all cases the best predictive variable for REE was the fat-free mass (FFM) (r = 0.77, P < 0.001 in NI; r = 0.70, P < 0.001 in I; r = 0.78 in the control group. The REE-FFM ratio was 152.5 +/- 1.2 and 207 +/- 5.4 kJ.kg-1.d-1 in the NI and I groups, respectively. A high energy expenditure may be a harbinger of secondary infection in acquired immunodeficiency syndrome and may participate in accelerated weight loss.

Fat-free mass estimation by the two-electrode impedance method.

In 202 healthy subjects (81 men, 121 women) aged 12-71 y, impedance (Z) was measured with a two-electrode analyzer. Fat-free mass was assessed by hydrodensitometry (FFMd). This population was randomized into two groups for cross-validation. In group 1 the relationship between ht2/Z at 1 MHz and FFMd was highly significant (r = 0.85, P less than 0.001). The equation for predicting FFMd from impedance, height2, weight, and age obtained in group 1 (r = 0.97) was applied to group 2 (r = 0.96) without reduction in r value. The accuracy of this equation was not different between men and women or between active and sedentary people. These data indicate that the two-electrode impedance method is a reliable and valid approach not only for the determination of extracellular water (as previously shown) but also for that of FFM.

[Pleural involvement and functional effect of asbestosis in 380 exposed patients]. / Atteintes pleurales et retentissement fonctionnel de l'asbestose chez 380 sujets exposés.

A large number of pleural abnormalities was detected by radiological and functional monitoring of 380 persons (mean age: 47 years) working in an asbestos processing factory. There were 127 cases of parietal pleura thickening (after 22 1/2 years' exposure), 11 cases of pleural calcifications (after 26 years' exposure) and 29 cases of obliteration of the costophrenic angle. Fourteen images of pulmonary asbestosis were encountered, 7 of which were associated with pleural effusion; they occurred at a mean age of 50 years, after 22 years' exposure. Pleural lesions had a restrictive influence on respiratory function in 24% of the cases and were sometimes painful. Small airway obstruction was detected by flow-volume loops in 9% non-smokers with pleural thickening, which suggests that intra-radiological lung lesions exist in asbestosis.

[Relation between the HLA system and the development of asbestosis fibrosis in a group of workers exposed to asbestos]. / Etude des relations entre le système HLA et l'apparition d'une fibrose asbestosique dans un groupe de travailleurs exposés à l'aminate.

The various studies which have dealt up to the present with a possible relationship between asbestosis and HLA groups have led to differing conclusions. The present study evaluated this relationship by comparison of 57 workers with asbestosis confirmed radiologically (minimum S1 type opacities) and functionally (VC and/or DuaCO less than 88%) with 58 controls from the same population. In a second phase, statistical analysis involved the combination of these cases with those reported in the literature, estimating the mean relative risk and, for each gene, the heterogeneity of the results thus collected. No relation was found between class I (A and B) HLA antigens and asbestosis. The authors suggest extension of this study to class II (DR) and III (components of complement) antigens and to seek possible links between combinations of antigens and the development of asbestosis.