Tumour necrosis factor alpha and oxidative stress as maintaining factors in the evolution of anorexia nervosa.

OBJECTIVE: Aim of the study was to evaluate tumour necrosis factor α (TNF-α) axis and oxidative status in patients with anorexia nervosa (AN) seeking a possible correlation with both nutritional status and evolution of the disease. SUBJECTS AND METHODS: Thirty-nine consecutive women with AN and an age-matched healthy control group were studied. Patients were 26±9 yr, with a body mass index (BMI) of 13.9±2 kg/m(2). TNF-α, its receptors TNF-R55 and TNF-R75, and oxidative status markers (selenium, ascorbic/ dehydroascorbic acid, retinol, α-tocopherol, selenium-dependent gluthatione peroxidase, reduced/oxidated gluthatione) were measured. A correlation with both nutritional indexes (body weight, BMI, albumin, prealbumin, transferrin, lymphocyte count) and disease duration was investigated. Pearson's correlation and unpaired Student's t-test were used to compare patients and controls. RESULTS: TNF-α and oxidative status markers were significantly higher in patients than controls and TNF-α was directly related to dehydroascorbic acid (p<0.05). Both TNF-R55 and TNF-R75 were higher in patients with duration of disease longer than one year as compared to controls and patients with shorter duration. Receptors inversely correlated with BMI (p<0.05 and p<0.01) and directly with disease duration (p<0.05). Inverse correlation between disease duration and BMI was present (p<0.01). CONCLUSIONS: The study showed activation of TNF-α axis and oxidative stress in AN patients, as well as correlation between the two systems. Due to the correlation between TNF receptors and both BMI and disease duration, a possible role of pro-inflammatory cytokines in the evolution of the eating disorder is suggested.

Proposal of a new formula to calculate total urinary nitrogen from urea urinary nitrogen.

Urea urinary nitrogen (UUN) and total urinary nitrogen (TUN) were determined in 15 patients to study their relationship mainly in highly catabolic patients. The subjects were: 7 multiple trauma, 3 autologous bone-marrow transplant, 1 tetanus, 4 postcholecystectomy patients; 180 determination were made, 111 of which in highly catabolic phase (TUN > 15 g/day). TUN and UUN are well correlated (r = 0.9742; p < 0.001) in the range 3 to 52 g/ day of TUN. Urea represents the 83.2 +/- 9.4% (M +/- SD). A double-linear formula to calculate TUN from UUN is proposed (for UUN 15 g/ day: TUN = UUN x 1.17 + 0.7; for UUN > 15 g/ day: TUN = UUN + 4). The least square procedure was used to compare the differences between measured and calculated TUN, and the results obtained with the proposed double-linear formula were compared with that obtained employing pre-existing formulas (Lee's and Mackenzie's). Considering all ranges of values studied (3-52 g of TUN) the results obtained were significantly different (p < 0.005); dividing the levels of TUN in 15 g; 16-29 g and 30 g, the results were always better, but the statistical significancy was not always reached.

Brain manganese deposition and blood levels in patients undergoing home parenteral nutrition.

BACKGROUND: Extrapyramidal syndrome and alterations in brain magnetic resonance images are described in patients undergoing long-term home parenteral nutrition (HPN) and in cholestatic patients. These abnormalities have been correlated to basal ganglia manganese (Mn) accumulation. METHODS: A longitudinal 1-year study was conducted on 15 patients undergoing HPN (median duration, 3.8 years; range, 1.7-10; median Mn parenteral supplementation, 0.1 mg/d). Whole-blood, plasma, intra-erythrocytes, and urinary Mn concentrations were measured and brain magnetic resonance was performed at the beginning (time 0) and after 1 year of Mn intravenous supplementation withdrawal (time 1). No patients showed psychosis, extrapyramidal syndrome, or cholestasis. RESULTS: At time zero, 10 of 15 patients (67%) showed paramagnetic accumulation on cerebral magnetic resonance images; at time 1 there was a reduction of cerebral Mn accumulation. In all patients, blood-Mn levels were significantly reduced after 1 year of Mn intravenous supplementation withdrawal. CONCLUSIONS: Patients receiving long-term HPN showed an elevated incidence of alterations in brain magnetic resonance images with a median Mn intravenous supplementation of 0.1 mg/d. Mn supplementation withdrawal significantly decreased metal levels in blood and brain storage. We noticed that the intra-erythrocyte Mn level was a good index of Mn status.

[Dietetic and pharmacologic treatment of hypercholesterolemia. Study of 32 patients over 14 months]. / Trattamento dietetico e farmacologico delle ipercolesterolemie. Studio su 32 pazienti della durata di 14 mesi.

The aim of the study was to evaluate the effectiveness of dietetic-behavioural and pharmacological treatment on 32 patients with high level hypercholesterolemia (LDL-c greater than 160 mg/dl) over 14 months. Clinical and laboratory tests were performed at time 0 (enrollment), at time 1 (after 2 months dietetic-behavioural treatment only), at time 2 and time 3 (after 6 and 12 months respectively of combined dietetic-behavioural and pharmacological treatment). The dietetic-behavioural treatment consist of reduced intake of saturated fatty acids, cholesterol and rapidly absorbed glycid; increased intake of omega-3 fatty acids and fiber; reduced overall calorie intake. The patients were also advised to take light daily exercise. The pharmacological treatment (sinivastatin 20 mg/die) was given to patients whose total cholesterol levels were over 250 mg/dl after 60 days of dietetic-behavioural only treatment and then continued for the whole study. The result showed an average reduction of 20% (p less than 0.01) in LDL-c in all patients after dietetic-behavioural only treatment and a further 20% (p less than 0.01) reduction after 12 months of combined treatment. There was therefore confirmation of the validity of dietetic-behavioural and pharmacological treatment during our study.

[Nutritional assessment of aged patients with fractures of the proximal epiphysis of the femur]. / Valutazioni nutrizionali in pazienti anziani con frattura dell'epifisi prossimale del femore.

Forty-two patients (M/F 9/33; age 78 +/- 10 years) were studied during Hospital stay for femoral neck fractures (16 neck, 26 pertrochanteric fractures). All underwent fracture surgery (internal fixation in 30, arthroplasty in 12 patients). Food intake was evaluated daily, supplemented with specific recipes. Biochemical assessment of nutritional status (hemoglobin, hematocrit, total proteins, albumin, prealbumin, Na, K, Ca, Fe, P, Mg) was performed before and after surgery. Nitrogen balance was evaluated in 8 patients in the post-operative period (40 determinations). The study group was compared for post-surgical complications and mortality during Hospital stay with a historical control group without any nutritional survey. Mean daily caloric intake was (M +/- DS) 1014 +/- 360 in the preoperative period, 960 +/- 210 and 1036 +/- 185 postoperatively (5-9 and 10-15 days post-surgery, respectively). Mean nitrogen intake was, respectively, 7.5 +/- 2.6, 7 +/- 2.1, 6.9 +/- 1.6 gN/day. No significant differences were found. In the preoperative period, the following tests were found below the normal range: iron (median 30 micrograms/dL), albumin (median 3.1 g/dL), hemoglobin (median 12 g/dL) hematocrit (median 35%). After surgery, they decreased significantly; also prealbumin, in normal limits before surgery (20 +/- 0.7 mg/dl), decreased significantly 5-9 days after surgery. After 10-15 days from surgery, only prealbumin and iron reached the preoperative level.(ABSTRACT TRUNCATED AT 250 WORDS)

[The nutritional aspects in autologous bone marrow transplantation]. / Aspetti nutrizionali nel trapianto di midollo osseo autologo.

The use of total parenteral nutrition (TPN) in bone marrow transplant recipients is well recognized. These patients, as a result of treatment with chemotherapy and immunosuppressive agents, undergo catabolic stress. In stressed patients attention has been focused on the optimal calorie: nitrogen ratio of total parenteral nutrition formulations. Theoretically, TPN formulas of low calorie: nitrogen ratio impede body protein catabolism. In bone marrow transplant patients negative nitrogen balance may persist despite high nitrogen intake. The purpose of the present study is to determine the effect of increasing nitrogen intake on nutritional and metabolic parameters in bone marrow transplant patients. The metabolic effect of an increased nitrogen dose during TPN was studied in 33 bone marrow transplant patients, divided into 2 groups. Patients were given total parenteral nutrition formulas providing a protein intake of 1.4 +/- 0.2 g of protein/kg IBW/day for the first group, and 2.3 +/- 0.12 g of protein/kg IBW/day for the II group. Total calories, non protein and protein, were held constant at 40 kcal/kg IBW/day for all patients. Data have been calculated for 4 weeks starting from the first week pretransplant. As we had expected, the patients who are the object of the present study were well nourished at the time of hospital admission, confirming the description of bone marrow transplant recipients published by other transplant centers. Relative body weight, total serum protein, albumin, prealbumin and cholesterol were not significantly different at any study period.(ABSTRACT TRUNCATED AT 250 WORDS)

[Trace nutrients in total enteral nutrition: the basal status and longitudinal course]. / Oligonutrienti in nutrizione enterale totale: stato basale e andamento longitudinale.

INTRODUCTION: Previous studies demonstrated deficiencies of selenium and other micronutrients in patients receiving total enteral nutrition (TEN). The content and bioavailability of trace elements in enteral formulas can be suboptimal. MATERIAL AND METHODS: Basal blood levels of some trace elements (copper, iron, selenium, zinc) and vitamins (B12, folic acid) were determined in twenty patients at the beginning of TEN. Vitamin E was measured in 7 patients. Primary diagnosis was cancer (no. = 13) and organic brain syndromes (no. = 7). Commercially available polymeric and oligomeric enteral formulas were used, containing respectively, as a percent of RDA in 1500 kcal, 65-39% of copper, 180-135% of iron, 80-100% of zinc. Selenium was not indicated; determinations in our laboratory gave a content of 78-63% of the minimum recommended intake. Blood levels of copper and zinc (no. = 6), selenium (no. = 5), iron, transferrin and ferritin (no. = 13) were measured after two months of TEN (mean intake of 30 +/- 3 kcal/kg/day). Copper, selenium and zinc were measured with atomic absorption; iron with the complessometric method: vitamin B12 and folic acid with RIA; vitamin E with HPLC. RESULTS: Mean values, expressed as mean +/- SD (range) were: copper: 129 +/- 23 (82-300) micrograms/dl; iron: 37 +/- 18 (16-89) mg/dl; selenium: 53 +/- 20 (22-93) micrograms/dl; zinc: 85 +/- 34 (44-185) micrograms/dl; vitamin B12: 632 +/- 450 (140-1575) pg/ml); vitamin E: 5.4 +/- 1.5 (3.3-7.8) mg/dl; folic acid: 11 +/- 8 (2-20) ng/ml. Values below the lower normal limit were found in 100% (vitamin E), 89% (selenium), 60% (iron), 35% (zinc), 24% (vitamin B12) and 14% (folic acid) of the patients studied. Copper was higher than the upper normal limit in 31% of cases; no data below normal range was found. Mean blood levels of depleted subjects were at the 28%, 43%, 54% and 63% of the mean normal value respectively for iron, selenium, vitamin E and zinc. Blood iron (p < 0.05) and selenium (p < 0.001) were significantly lower in more malnourished patients (weight loss > 20% vs < 20% on usual body weight). After two months of TEN, a reduction of 33% of mean blood selenium was observed in 4 of 5 patients studied. Blood copper and zinc remained stable in 6 subjects with initial normal or higher than normal values. Blood iron increased nonsignificantly, ferritin remained stable, transferrin increased significantly (p < 0.05). No clinical deficiency syndromes were observed. CONCLUSIONS: A careful monitoring of micronutrients during TEN is recommended. Selenium content of enteral formulas, unless supplemented by the producers, seems to be insufficient to maintain the initial blood level in two months of TEN.

Effect of regular and decaffeinated coffee on serum gastrin levels.

We evaluated the hypothesis that the noncaffeine gastric acid stimulant effect of coffee might be by way of serum gastrin release. After 10 healthy volunteers drank 50 ml of coffee solution corresponding to one cup of home-made regular coffee containing 10 g of sugar and 240 mg/100 ml of caffeine, serum total gastrin levels peaked at 10 min and returned to basal values within 30 min; the response was of little significance (1.24 times the median basal value). Drinking 100 ml of sugared water (as control) resulted in occasional random elevations of serum gastrin which were not statistically significant. Drinking 100 ml of regular or decaffeinated coffee resulted in a prompt and lasting elevation of total gastrin; mean integrated outputs after regular or decaffeinated coffee were, respectively, 2.3 and 1.7 times the values in the control test. Regular and decaffeinated coffees share a strong gastrin-releasing property. Neither distension, osmolarity, calcium, nor amino acid content of the coffee solution can account for this property, which should be ascribed to some other unidentified ingredient. This property is at least partially lost during the process of caffeine removal.