Weight loss expectations and body dissatisfaction in young women attempting to lose weight.

BACKGROUND: Unrealistic weight loss expectations (WLEs) and greater body dissatisfaction may be associated with the poor long-term outcomes of dietary and lifestyle weight loss treatments. We evaluated the association between body size, WLEs and body dissatisfaction in young women attempting to lose weight. METHODS: Forty-four young healthy women [age range 18-35 years, body mass index (BMI) range 23-40 kg/m2] were recruited. Women were classified as obese (BMI ≥ 30.0 kg/m2) and non-obese (BMI <30.0 kg/m2). The Body Dissatisfaction scale of the Eating Disorder Inventory-2 and the Body Image Assessment for Obesity silhouette charts were used to assess body dissatisfaction. WLEs were categorised according to personal (ideal, happiness, satisfaction, weight history), lifestyle (fitness) and social (career, family acceptance, peer acceptance, mass media, social pressure) factors. Individual WLEs were compared with recommended clinical targets (5%, 10% and 20%) for weight loss. RESULTS: Body dissatisfaction was lower in non-obese subjects and was directly associated with BMI (P < 0.05). WLEs were directly associated with BMI and the obese group reported greater expectations. Five non-obese subjects (23%) desired to lose more than 20% of their body weight, whereas the proportion was significantly higher in the obese group (17 subjects; 74%). Subjects derived the greatest WLEs from mass media, whereas they perceived that family and friends were supportive of a lesser degree of weight loss. CONCLUSIONS: We observed a mismatch between clinical and personal expectations, and social pressure and interpersonal relationships appear to have a prominent role with respect to influencing the association.

[Erythropoietin and cisplatin-induced neuropathies in cancer patients]. / Eritropoietina e neuropatie da cisplatino nei pazienti oncologici.

Anaemia commonly occurs in cancer patients on chemotherapy, often necessitating blood transfusion, and, in most recent years, treatment with human recombinant cythropoietin (rHuEPO). However, several extra-hematological effects were reported for EPO, and multi-organ physiological effects on development and repair of tissues are described both on nerves and muscles. Moreover, EPO is presently used in oncological patients with the goal of preventing or limiting anemia secondary to chemotherapy. Ten patients with advanced lung cancer and without neurological impairment assessed by Siegal score and without severe anemia, were studied. Patients (age 56.2 +/- 8.3 years) were random assigned to two groups of 5 patients each: the control group and the EPO treated group. In both groups, at the end of the study, hemoglobin concentration was not different (above 9 mg/dl). In EPO treated group neurological score was 4.00 +/- 1.87, significantly lower (p < 0.004) in comparison with untreated group (score 9.20 +/- 4.32). From these preliminary data we suggest that EPO treatment in cancer patients can exert also a limiting effect on cisplatin peripheral neurotoxicity.

Messenger RNAs in synaptosomal fractions from rat brain.

Synaptosomal fractions from rat brain have been analyzed with semi-quantitative RT-PCR methods to determine their content of mRNAs coding for presynaptic, postsynaptic, glial, and neuronal proteins. Each mRNA was determined with reference to the standard HPRT mRNA. In our analyses, mRNAs were considered to be associated with synaptosomes only if their relative amounts were higher than in microsomes prepared in a polysome stabilizing medium, rich in Mg(++) and K(+) ions, or in the homogenate. According to this stringent criterion, the following synaptosomal mRNAs could not be attributed to microsomal contamination and were assumed to derive from the subcellular structures known to harbor their translation products, i.e. GAT-1 mRNAs from presynaptic terminals and glial processes, MAP2 mRNA from dendrites, GFAP mRNA from glial processes, and TAU mRNA from neuronal fragments. This interpretation is in agreement with the involvement of extrasomatic mRNAs in local translation processes.

[Heart failure and nutritional status in hemodialysis]. / Insufficienza cardiaca e stato nutrizionale in emodialisi.

Left ventricular function is impaired in long-term maintenance dialysis as a consequence of several inter-related conditions. Aim of the study was to assess if different degree of malnutrition can affect diastolic and systolic function of dialysis patients. Bio-electrical whole-body multifrequency impedance analysis (BIA) allows a dynamic assessment of body composition according to a multi-compartment model. This allows an assessment of lean (FFM) and fat mass (FAT), metabolically active cell mass (BCM) and a BIA Nutritional Index (NI). We studied 73 patients (53 M, 20 F), aged 54.41 +/- 3.1 yrs, on maintenance bicarbonate dialysis since 57.3 +/- 61.8 mths, by BIA, performed before and after a dialysis. I-PTH and serum albumin are correlated (r = -0.55, p < 0.001); the same trend is shown by I-PTH vs fat free mass (r = -0.47, p < 0.001) and vs NI (r = -0.51, p < 0.001). Ejection fraction (EF) is correlated with age (r = -0.50, p < 0.001) and with I-PTH (r = -0.59, p < 0.001). Moreover, albumin and EF are closely related (r = 0.36, p < 0.01), as well as EF vs FFM (r = 0.47, p < 0.001), and EF vs NI (r = 0.37, p < 0.01). A/E ratio, assumed as index of left ventricular diastolic function, shows a correlation vs albumin (r = -0.33, p < 0.01), BCM (r = -0.34, p < 0.01) and NI (r = -0.40, p < 0.01), but not with I-PTH. Malnutrition, defined both by BIA measurements and lower serum albumin, could exert unfavourable effects on left ventricular systolic and diastolic function of patients on long-term haemodialysis, even independently by hyperparathyroidism.

[Quality of life in hemodialyis patients: the effect of educational status]. / Qualità della vita in emodialisi: interferenza del grado di istruzione scolastica.

INTRODUCTION: Hemodialysis has a major influence on the quality of life of chronic renal failure patients. Great attention is currently paid to the development of supporting programmes for this patient group. Aim of this study was to evaluate the quality of life in maintenance dialysis and to research the influence of various factors related to treatment and ESRD on quality of life, taking into account also the level of school instruction. PATIENTS AND METHODS: Reduced functional abilities, as measured by the Sickness Impact Profile (SIP), and Functional Living Test (FLT), derived by Karnofsky Activity Scale were assessed; Hospital Anxiety and Depression Scale (HAD) and semistructured interviews, including a clinical grading of symptoms were considered vs. age, duration of dialysis, level of school instruction. The study was performed with 40 hemodialysis patients, aged 57.4 +/- 14.9 years (range 22-79), treated since at least three years. RESULTS: Significant (P < 0.05) independent correlates with higher SIP scores (greater disability) and Functional Living Test were lower educational level, and the score of Hospital Anxiety and Depression Scale (HAD). No correlation was found for any of the three scales vs. age and vs. dialytic age; no gender difference was observed. DISCUSSION: A greater care in considering Quality of Life questionnaires is warranted, especially for the severe interference of instruction level of patients on results. QALY (Quality Adjusted Life Years), used as a tool for decision-making in clinical and political subsets, can include critical bias that invalidate conclusion.

[Hyperthyroidism, therapy with erythropoietin, malnutrition and systolic function in hemodialysis: echocardiography study]. / Iperparatiroidismo, terapia con eritropoietina, malnutrizione e funzione sistolica in emodialisi: studio ecocardiografico.

Secondary hyperparathyroidism is a frequent condition of dialysis patients. Endocrine derangements, with disturbance of calcium metabolism are complex, involving bone, heart (left ventricular hypertrophy-dilatation), bone marrow (anemia and erythropoietin resistance), muscle (increase of body fat mass) and insulin resistance. Aim of the study was to assess how these conditions are inter-correlated in the same patients. 45 patients (m 20, f 25; years 61.8 +/- 11.6) in maintenance bicarbonate three-weekly hemodialysis since > 3 years were studied. Cardiac function was assessed by echocardiography (EF%: left ventricular ejection fraction), which showed an inverse correlation both with parathormone (iPTH vs EF%: r = -0.64; p < 0.001) and with erythropoietin (rHu-EPO vs EF%: r = -0.62; p < 0.001). This suggests the possibility of a multi-endocrine resistance in dialysis patients with chronic renal failure, secondary to the degree of malnutrition. Lower lean mass is correlated with hyperparathyroidism (iPTH vs fat mass%: r = 0.37; p < 0.01), with lower left ventricular systolic function (EF% vs fat mass%: r = -0.41; p < 0.005) and with rHu-EPO resistance. Moreover, patients with higher iPTH show a hypercatabolic disposition, assessed as protein catabolic rate (PCR/kg vs iPTH r = 0.54; p < 0.001). This pattern can be a consequence of chronic renal failure, but bio-compatibility of materials can be involved as well.

[Arterial hypertension in chronic kidney failure: a volume-dependent pathology or a disease due to malnutrition?]. / Ipertensione arteriosa nella insufficienza renale cronica: patologia volume-dipendente o malattia da malnutrizione?

BACKGROUND: Hemodialysis patients are a clinical circulatory model whose main feature is discontinuous fluid removal. Extracorporeal treatment in chronic renal failure exerts blood-volume and circulatory changes with effects on post-dialysis blood pressure (BP). We investigated if pre-dialysis body fluid disposition and body composition, assessed as lean and fat mass, have different relationship with blood pressure. METHODS: Bio-electrical whole-body multifrequency impedance analysis (BIA) enables dynamic assessment of body composition according to a multi-compartment model: extracellular (ECW) and total body water (TBW), lean (FFM) and fat (FAT) mass. We studied 73 patients (53 males, 20 females), mean age 54.4 +/- 13.1 years, on maintenance bicarbonate dialysis for 57.3 +/- 61.8 months. BIA was performed at the start and at the end of three consecutive dialysis sessions; blood pressure was monitored non-invasively throughout dialysis. Twenty-one patients (HP) were hypertensive (systolic BP 183.63 +/- 26.88 mmHg) and on pharmacological treatment, while 52 patients (NP) were normotensive (systolic BP 131.68 +/- 12.63 mmHg). RESULTS: Pre-dialysis assessment of blood pressure (BP) and body compartment in HP showed inverse relationships between systolic BP and percentage of total body water (r = -057, p < 0.001) and between BP vs lean mass/fat mass ratio (r = -0.68, p < 0.001). A high positive correlation was observed between systolic BP and percentage of fat mass (r = 0.73, p < 0.001). At the end of dialysis session, a strong relationship was observed between systolic BP and extracellular water (r = 0.77, p < 0.001). BP changes with dialysis do not show any special correlation with body compartment changes. No significant or overly weak correlations were observed in normotensive patients. CONCLUSIONS: Arterial hypertension of maintenance hemodialysis patients shows a strong relationship with the percentage of body fat and with FFM/FAT ratio, i.e. with the adiposity of diseased malnourished patients. Moreover, as suggested by the relationship between ECW and BP, present only at the end of dialysis, expansion of the extracellular water compartment or in other words, the degree of adequacy of water filtration during dialysis, seems to be an important condition in determining post-dialysis BP levels in hypertensive patients. The increase in BP during the interdialysis period is not closely interrelated with the degree of body hydration, but there is strong evidence that it is connected with the effects of malnutrition, including the increase in body lipids. This condition is multifactorial and can be a consequence of nutritional behavior, as well as of kidney disease and dialysis itself, with metabolic derangement also associated with protein and I-carnitine deficiency.

Body composition and long-term levo-carnitine supplementation.

PURPOSE: To evaluate the effect of long-term levocarnitine supplementation on nutritional state of patients in maintenance dialysis. PATIENTS AND METHODS: We studied by multifrequency-BIA (bioelectric impedance analysis) two groups of patients in maintenance bicarbonate hemodialysis for at least 4 years, comparable with respect to gender and age, and without liver disease, diabetes and malignancy. One group (25 patients) was treated with levocarnitine (1g/die) for three years or more; the control group (35 patients) never received this agent. RESULTS: Long-term levocarnitine supplementation was associated with higher serum levels of total protein and albumin in comparison to the control group. These effects were not associated with an increase in body fat mass and/or in total body water content, which are potentially detrimental conditions, especially considering the reported frequent association with circulatory and blood pressure alterations. CONCLUSIONS: Levocarnitine is able to improve the nutritional state, and this is associated with higher protein catabolism rate, i.e. with a higher protein intake, without detrimental effects on dialysis efficacy and adequacy.

Nifedipine and extracellular water in dialysis arterial hypertension.

Nifedipine is a Ca-antagonist drug that reduces contractility of vascular smooth muscle, and is used in the treatment of arterial hypertension and of stable and vasospastic angina. Aim of this study is to evaluate long-term effect of nifedipine on distribution of body fluid compartment, assessed by BIA (Bio-Impedance Analysis), and on cardiac function, in hypertensive patients on dialysis. Two groups of hypertensive patients were compared: a) a first group of nine patients (5 Male, 4 Female; age 62.67 +/- 10.39) treated with nifedipine (30 mg/day) for one year; b) a control group of sixteen dialysis patients (9 Male, 7 Female; age 56.31 +/- 14.44), previously hypertensive, with normal blood pressure without anti-hypertensive drugs for three months or more. By BIA, extracellular water percentage (ECW%) is higher in nifedipine-treated patients (p < 0.001) in comparison with the control group before dialysis; no other difference is present. The intradialytical variations (before dialysis vs. the end of dialysis) of body fluid compartments are a significant decrease of total body water % (52.33 +/- 2.89 vs. 48.72 +/- 3.35, p < 0.001), ECW% (40.97 +/- 2.2 vs. 37.56 +/- 3.47, p < 0.005), Left Ventricular End-Diastolic Volume (81.1 +/- 14.6 vs. 63.4 +/- 21.66 ml/m2, p < 0.003), Cardiac Output (3.35 +/- 0.71 vs. 2.51 +/- 0.76 l/min/m2, p < 0.04) and Stroke Volume (45.76 +/- 10.21 vs. 34.34 +/- 9.98 ml/m2, p < 0.02) in nifedipine-treated patients. Our findings suggest that nifedipine induces intermittent and prolonged expansion of extra-cellular volume. This condition, in patients otherwise without clinical and echocardiographic signs of heart failure, can be potentially detrimental for cardiac function on long-term nifedipine treatment.

Effects of age, gender and hyperparathyroidism on lean body mass in hemodialysis patients.

Hyperparathyroidism of hemodialysis patients is associated with osteo-dystrophy, impairment of cardiac function, of peripheral nerve conduction, of response to r-HuEPO and with decrease of lean body mass. Primary hyperparathyroidism of post-menopausal women is associated with increased fat mass (FM). The study investigated if gender varies relationship between i-PTH, and body composition, assessed by multifrequency bio-electrical impedance analysis (BIA), cardiac function, assessed by echocardiography, and anemia, in long-term hemodialysis patients. Seventy patients on long-term bicarbonate dialysis, 34 male and 36 post-menopausal female, were studied. i-PTH RIA, multifrequency BIA and Kt/V were assessed at three months intervals. i-PTH (345.88 +/- 199.58 vs. 224.26 +/- 161.62 pg/ml, p < 0.01) and FM% (39.13 +/- 10.42 vs. 30.95 +/- 5.88, p < 0.001) were both significantly higher in women vs men; BMI was not significantly different. In the total group of patients (r = 0.572, p < 0.001) and in women (r = 0.68, p < 0.001) a positive correlation was found between i-PTH and FM%, and reciprocally an inverse negative correlation with free fat mass (FFM) was observed. No significant relationship was observed in men. Decrease of blood pressure measurements and increase of left ventricular Ejection Fraction, in the comparison of beginning and end of three dialysis sessions, were significantly greater in women. Reduced FFM of women on dialysis could have also some relationship with a more close long-term adherence to dietary protein restriction. Hyperparathyroidism in chronic renal failure patients could share liability of bone structural abnormalities, cardiac function impairment, excitable tissue disease, and anemia. However, malnutrition, and its consequent relative decrease of lean mass, resulting from kidney disease and, possibly, from nutritional behavioral modifications, could be responsible of the multi-organ involvement of hyperparathyroidism in end-stage renal disease.

Systolic function impairment in higher erythropoietin requirement patients in hemodialysis.

Circulatory adaptation to hemodialysis (HD) depends on several inter-related factors, due to the particular patient and to technical procedures. The cardiac effects of nutritional status and the improvement that erythropoietin (r-HuEPO) treatment, through the reduction of anemia, can determine, were reported; r-HuEPO requirements are quite different, in different patients, while achieving similar haemoglobin end-point. Thirty-four patients on r-HuEPO and 11 patients not treated, all in hemodialysis, were studied by echocardiography at beginning and at the end of 3 consecutive dialysis sessions. Ejection fraction increased with hemodialysis in all patients of the control group. A slight and not significant decrease of ejection fraction was observed, as average, in the r-HuEPO treated patients. But, more in detail, 20 patients on r-HuEPO showed a worsening of systolic function with hemodialysis; in the other 14 patients on r-HuEPO, as in not treated control patients, systolic function improved. A significant difference between the two sub-groups on r-HuEPO was the higher drug dose requirement, associated with a slightly lower haemoglobin concentration, both observed in patients with decreased ejection fraction after hemodialysis. Moreover, a close relationship between higher r-HuEPO requirements and worsening of systolic function was observed. This trend is not associated with adequacy of dialysis and malnutrition. Patients with higher r-HuEPO requirement share a worse cardiac adaptation to hemodialysis and slightly lower haemoglobin levels.