A new anthropometric index for body fat estimation in patients with severe obesity.

BACKGROUND: Body mass index (BMI) has been used to assess body adiposity, but it cannot adequately reflect body fat (BF) amount. The body adiposity index (BAI) has been shown a better performance than BMI for this purpose, but it can be inaccurate to estimate BF under extreme amounts of fat. Here, we propose a new anthropometric index, the Belarmino-Waitzberg (BeW) index, for specific estimation of BF in severely obese patients. METHODS: In 144 adult patients with severe obesity, BF was estimated by air displacement plethysmography (ADP), as the reference method, along with the follow anthropometric measurements: height, abdominal circumference (AC), hip circumference (HC), weight, BMI (weight/ height2) and BAI ([HC(cm) / height (m)1.5) - 18] × 100). Patients were proportionately distributed into two distinct databases, the building model database (BMD) and the validation model database (VMD), which were applied to develop and validate the BeW index, respectively. The BeW index was tested for gender and ethnicity adjustment as independent variables. The agreement of BF% values obtained by the new index and by BAI with ADP was also assessed. RESULTS: The BF% was 52.05 ± 5.42 for ADP and 59.11 ± 5.95 for the BeW index (all results are expressed as the mean ± standard deviation). A positive Pearson correlation (r = 0.74), a good accuracy (Cb = 0.94), and a positive Lin's concordance correlation (CCC = 0.70) were observed between the two groups. The 95% limits of individual agreement between the BeW index and ADP were 6.8 to 7.9%, compared to - 7.5 to 14.8% between the BAI and ADP. The new index, called the Belarmino-Waitzberg (BeW) index, showed an improvement of 2.1% for the R2 value and a significant gender effect, therefore resulting in two different indexes for females and males, as follows: Female BeW = - 48.8 + 0.087 × AC(cm) + 1.147 × HC(cm) - 0.003 × HC(cm)2 and Male BeW = - 48.8 + 0.087 × AC(cm) + 1.147 × HC(cm) - 0.003 × HC(cm)2-7.195. CONCLUSIONS: The new BeW index showed a good performance for BF estimation in patients with severe obesity and can be superior to the BAI for this purpose.

Systemic inflammation in morbidly obese subjects: response to oral supplementation with alpha-linolenic acid.

BACKGROUND: Morbidly obese patients frequently display asymptomatic chronic activation of acute phase response, with potentially adverse metabolic and cardiovascular consequences. Nutritional preparations to improve this phenomenon have rarely been administered. Aiming to investigate the supplementation of flaxseed flour, a source of omega-3 fatty acids, a prospective randomized double-blind cross-over study was designed. METHODS: Outpatient obese subjects (n=41) were clinically and biochemically screened, and results for 24 randomized subjects are shown. Age was 40.8 +/- 11.6 years (83.3% females) and body mass index (BMI) was 47.1 +/- 7.2 kg/m2. Flaxseed flour (Farinha de Linhaca Dourada LinoLive, Cisbra, Brazil) in the amount of 30 g/day (5 g of alpha-linolenic acid - omega-3) and an equal mass of placebo (manioc flour) were administered for 2 weeks each. Variables included general biochemical investigation, white blood cell count (WBC), C-reactive protein (CRP), serum amyloid A (SAA) and fibronectin. RESULTS: No intolerance was registered. Body weight and general biochemical indices remained stable. Initial CRP and SAA were elevated (13.7 +/- 9.9 and 17.4 +/- 8.0 ). WBC (8100 +/- 2100/mm3) and fibronectin (463.2 +/- 61.3 mg/dL) were acceptable but in the upper normal range. Corresponding findings after supplementation of flaxseed were 10.6 +/- 6.2 mg/L, 14.3 +/- 9.2 mg/L, 7300 +/- 1800/mm3 and 412.8 +/- 38.6 respectively (P<0.05). No change during the control period regarding baseline occurred when placebo was randomized to be given first; however, when it followed omega-3 supplementation, CRP and SAA recovered, whereas WBC and fibronection remained depressed during those 2 weeks (7500 +/- 2100/mm3 and 393.2 +/- 75.8 mg/dL, P<0.05). CONCLUSIONS: 1) Various inflammatory markers were elevated in the studied population, although not necessarily exceeding the normal range; 2) Significant reduction could be demonstrated; 3) Some persistent effects of flaxseed supplement 2 weeks after discontinuation were observed.

Factors leading to discrepancies between prescription and intake of enteral nutrition therapy in hospitalized patients.

OBJECTIVE: We investigated factors leading to a reduction in enteral nutrition (EN) prescribed by a nutritional support team (NST) at a general hospital in Brazil. METHODS: In this prospective, observational study, hospitalized adults receiving only EN therapy via tube feeding were followed for up to 21 d from July to October 2008. RESULTS: The 152 subjects analyzed included 38 (23.5%) ward patients and 124 (76.5%) intensive care unit (ICU) patients. Eighty percent of the targeted feeding volume was achieved on day 4 by 80% of the patients. Reasons for not receiving the total amount of EN prescribed included delay in EN administration (3.1%), abdominal distention (5.6%), patient refusal of treatment (6.8%), feeding tube obstruction (8.6%), vomiting (10.5%), diarrhea (17.9%), unknown causes (17.9%), interference by a non-NST physician (25.9%), accidental feeding tube loss (34%), presence of high gastric residual (34%), and operational logistics at the hospital's Nutrition and Dietetics Service (99.4%). There was a significant association between patients who received <60% of the prescribed EN and external physician interference (P < 0.016). ICU patients also received inadequate EN (P < 0.025). Neurologic patients had a greater chance of receiving >81% of the prescribed EN amount than cardiac patients (odds ratio 3.75, P < 0.01). CONCLUSION: Major reasons for inadequate EN intake are (in decreasing order) operational logistical problems, gastric stasis, accidental loss of enteral feeding tube, and interference by an external physician (not an NST member). Cardiologic patients and ICU patients are at a higher risk for inadequacy than neurologic patients.

New specific equation to estimate resting energy expenditure in severely obese patients.

Calculating the estimated resting energy expenditure (REE) in severely obese patients is useful, but there is controversy concerning the effectiveness of available prediction equations (PE) using body weight (BW). We evaluated the efficacy of REE equations against indirect calorimetry (IC) in severely obese subjects and aimed to develop a new equation based on body composition compartments. One hundred and twenty severely obese patients had their REE measured (MREE) by IC and compared to the most commonly used PE (Harris-Benedict (HB), Ireton-Jones, Owen, and Mifflin St. Jeor). In a random sample (n = 60), a new REE equation based on fat-free mass (FFM) was developed and validated. All PE studied failed to estimate REE in severe obesity (low concordance correlation coefficient (CCC) and limits of agreement of nearly 50% of the sample ±10% of MREE). The HB equation using actual BW exhibited good results for all samples when compared to IC (2,117 ± 518 kcal/day by HB vs. 2,139 ± 423 kcal/day by MREE, P > 0.01); these results were blunted when patients were separated by gender (2,771 vs. 2,586 kcal/day, P < 0.001 in males and 1,825 vs. 1,939 kcal/day, P < 0.001 in females). A new resting energy expenditure equation prediction was developed using FFM, Horie-Waitzberg, & Gonzalez, expressed as 560.43 + (5.39 × BW) + (14.14 × FFM). The new resting energy expenditure equation prediction, which uses FFM and BW, demonstrates higher accuracy, precision, CCC, and limits of agreement than the standard PE in patients when compared to MREE (2,129 ± 45 kcal/day vs. 2,139 ± 423 kcal/day, respectively, P = 0.1).The new equation developed to estimate REE, which takes into account both FFM and BW, provides better results than currently available equations.

Efeito da suplementação de glutamina sobre variáveis hematológicas e do estado nutricional de ratas desnutridas / Glutamine supplementation effect in hematological parameters and nutritional status of rats submitted to malnutrition protocol

RACIONAL: A glutamina é o aminoácido mais abundante no sangue, por desempenhar importante papel no sistema imune. É considerado aminoácido condicionalmente essencial em situações como desnutrição protéico-calórica. OBJETIVO: Verificar o efeito da dieta suplementada com glutamina sobre variáveis bioquímicas e hematológicas de ratas submetidas a protocolo de desnutrição, induzido por dieta rica em lactose. MÉTODOS: Ratas Wistar fêmeas (n=20) e com 21 dias de idade, foram submetidas ou não à desnutrição calórico-protéica induzida por diarréia, através da administração de dieta rica em lactose 60% durante 15 dias. Após o período de desnutrição, animais eutróficos ou desnutridos permaneceram durante 30 dias com oferta de diferentes dietas (padrão e experimentais). De acordo com estado e tratamento nutricionais, os animais foram distribuídos aleatoriamente em quatro grupos distintos: 1) GC: animais eutróficos + dieta padrão, 2) GD: animais desnutridos + dieta rica em lactose (60%), 3) GDGLN: animais desnutridos + dieta rica em glutamina (2%); e 4) GDP: animais desnutridos + dieta padrão. Após os 30 dias de tratamento nutricional, amostras de sangue foram obtidas por punção cardíaca para avaliação de variáveis bioquímicas (proteínas totais, albumina, uréia) e hematológicas (quantificação da série vermelha e branca). RESULTADOS: Após 15 dias do início do experimento o ganho de peso dos grupos GD (46,4 ± 2,60g), GDGLN (39,2 ± 8,9g) e GDP (33,2 ± 11,5g) foi menor em relação ao controle (64 ± 4,24g, P<0,05). Nos exames bioquímicos observou-se diferença significativa apenas na dosagem de uréia no GD em relação aos demais grupos (33,4 ± 4,77 mg/dL, P<0,05). A contagem de leucócitos do GD (3,68 ± 1,0 x103 cel/mm3) mostrou-se diminuída em relação aos demais grupos (P<0,05) e a série vermelha não apresentou diferenças significativas. CONCLUSÃO: A desnutrição prejudica o número de leucócitos sanguíneos e esse efeito deletério é revertido pela simples re-nutrição, independente da suplementação com glutamina. A ingestão oral de glutamina não influencia o ganho de peso, variáveis bioquímicas de estado nutricional e número de leucócitos de animais desnutridos por ingestão de dieta rica em lactose.

BACKGROUND: Glutamine is the most abundant amino acid in blood stream, playing an important role in the immune system. It is conditionally considered an essential amino acid to certain state conditions such as protein-energy malnutrition. AIM: To verify the effect of glutamine diet supplemented on hematological and biochemical variables in rats subjected to protocol of malnutrition, induced by an enriched lactose diet. METHODS: Total of 20 Wistar females rats, 21 days of age, were submitted or not to the protein-calorie malnutrition induced by diarrhea, using an enriched lactose diet 60% for 15 days. After malnutrition period, eutrophic or malnourished animals remained for 30 days provided with a variety diet (standard and experimental). According to nutritional status and treatment, animals were randomized into four distinct groups: 1) GC: animals eutrophic + standard diet, 2) GD: malnourished animals + enriched lactose diet (60%), 3) GDGLN: malnourished animals + enriched glutamine diet (2%); and 4) GDP: malnourished animals + standard diet. After the 30 days of nutritional treatment, blood samples were obtained by cardiac puncture for biochemical (total protein, albumin and urea) and hematological evaluations (red and white blood cells quantification). RESULTS: After 15 days of experimental study, weight gain in the respective groups GD (46.4 ± 2.60 g), GDGLN (39.2 ± 8.9 g) and GDP (33.2 ± 11.5 g) was lower once compared to the control (64 ± 4.24 g, P <0.05). Biochemical examinations showed a significant difference in the urea dosage in GD as compared to other groups (33.4 ± 4.77 mg / dL, P<0.05). The leukocytes counting of GD (3.68 ± 1.0 cel/mm3 x103) showed reduced comparing to the rest of the groups (P<0.05), while red blood cell counting had not presented significant difference. CONCLUSION: Malnutrition affects leukocytes cell number, although such deleterious counting blood effect can be reversed by simple re-administration of nutrition, regardless of glutamine supplementation. The intake of oral glutamine does not affect the weight gain, biochemical variables of nutritional status, or leukocytes number while malnourished due to enriched lactose diet.