[Principles of dietary treatment of obesity]. / Grundlagen der Diättherapie der Adipositas.

One of the first steps in a clinical approach to any obese subject should be focused on the reduction and/or normalization of any potential or existing metabolic abnormality. Overeating and/or unbalanced food intake remains the major element in the origin and maintenance of obesity. The reduction of energy intake is the basis of successful weight loss. In obese subjects there are huge amounts of energy stored, mainly in the adipose tissue, which are mobilized according to the size and duration of an energy deficit. Considerable studies have been devoted to finding the optimal dietary approach that would promote rapid weight loss while maximizing the depletion of adipose tissue and conserving body protein. During fasting adipose tissue lipolysis rate increases and liberated unesterified fatty acids are oxidized in muscle and liver. The liver produces ketones which are oxidized in muscle and brain. The energy need of the brain is not sufficiently covered by ketone oxidation, therefore additional glucose must be provided. The liver produces glucose by gluconeogenesis using amino acids from muscle protein. Because of limited protein sources, protein must be given during energy restricted diet. Besides protein also vitamins, minerals, trace elements, fiber, and linoleic acid must be substituted during fasting and during treatment with very low calorie diets. Meal replacements are helpful to fulfil all the requirements. There is consensus that the first step in dietary treatment is an energy restricted diet with a calorie deficit of at least 600 Kcal/day, but more than 800 Kcal/day must be provided, with all essential nutrients. Observing the regulations, weight reduction with appropriate diet plans improves metabolic disturbances.

Metabolic and weight-loss effects of a long-term dietary intervention in obese patients.

BACKGROUND: Obesity is a chronic disease that has become one of the most serious health problems in Western society. OBJECTIVE: We assessed the long-term effects of an energy-restricted diet combined with 1 or 2 daily meal replacements on body weight and biomarkers of disease risk in 100 obese patients. DESIGN: Phase 1 consisted of a 3-mo, prospective, randomized, parallel intervention study of 2 dietary interventions to reduce weight. The energy-restricted diet (5.2-6.3 MJ/d) consisted of conventional foods (group A) or an isoenergetic diet with 2 meals and 2 snacks replaced daily by energy-controlled, vitamin-and-mineral-supplemented prepared foods (group B). Phase 2 consisted of a 24-mo, case-control, weight-maintenance study with an energy-restricted diet and 1 meal and 1 snack replaced daily for all patients. RESULTS: Total weight loss (as a percentage of initial body weight) was 5.9+/-5.0% in group A and 11.3+/-6.8% in group B (P < 0.0001). During phase 1, mean weight loss in group B (n = 50) was 7.1+/-3.5 kg, with significant reductions in plasma triacylglycerol, glucose, and insulin concentrations (P < 0.0001). Group A patients (n = 50) lost an average of 1.3+/-2.2 kg with no significant improvements in these biomarkers. During phase 2, both groups lost on average an additional 0.07% of their initial body weight every month (P < 0.01). During the 27-mo study, both groups experienced significant reductions in systolic blood pressure and plasma concentrations of triacylglycerol, glucose, and insulin (P < 0.01). CONCLUSION: These findings support the hypothesis that defined meal replacements can be used for successful, long-term weight control and improvements in certain biomarkers of disease risk.

Fish oil, enriched with polyunsaturated fatty acids of the omega-3-type accelerates the nucleation time in healthy subjects.

The daily administration of fish oil, containing 1.5 g omega-3-fatty acids causes a significant decrease in nucleation time (12.1 +/-7.3 vs. 2.0 +/- 1.2 days, p less than 0.001), as well as in biliary cholesterol saturation and biliary cholesterol composition in 13 healthy subjects. The nucleation time, cholesterol saturation index and biliary lipids showed no significant differences in 11 cholesterol gallstone patients after a six-week treatment period with omega-3-fatty acids. Taurocholate percentage increased significantly in the gallstone group (10.4 +/- 3.9 vs 13.5 +/- 1.7%, p less than 0.05). The levels of the other bile acids remained unchanged during the treatment period. Therefore, the incidence of gallstones might be increased after treatment with fish oil, containing omega-3-fatty acids.

[Severe hyperemesis gravidarum--pathophysiologic observations and new therapeutic approach]. / Schweres Schwangerschaftserbrechen--Pathophysiologische Beobachtungen und neuer therapeutischer Ansatz.

It is reported on a 27 year old female patient who was hospitalized twice during her first pregnancy (16th and 28th week) because of severe hyperemesis gravidarum. Severe clinical symptoms associated with severe alterations in the clinical chemistry posed a series of differential diagnoses. Several diseases as potential causes for unappeasable vomiting were taken into account. All traditional therapeutic efforts to relieve hyperemesis gravidarum including H2-blockers in high dosages were not successful. Treatment with omeprazole proved to be effective by stopping the vomiting immediately. After the delivery of a healthy child in the 37th week of pregnancy, several investigations were performed to exclude organic diseases. Etiology and symptoms of hyperemesis gravidarum are discussed with regard to the gastrointestinal tract and thyroid gland function.

Effect of antacid treatment on endogenous prostaglandin synthesis in human antral and duodenal mucosa.

Using 14C-labeled arachidonic acid as precursor for in vitro prostaglandin synthesis, the effect of an antacid containing Al (OH)3, Mg(OH)2 and CaCO3 on endogenous prostaglandin synthesis was investigated in antral and duodenal mucosa of healthy volunteers. After three weeks of treatment with a high-dose antacid, there was no detectable change in the total capacity of the mucosa for prostaglandin synthesis, but the prostaglandin profile was markedly altered. The relative amounts of PGE2 and PGF2 alpha synthesized by antral and duodenal mucosa increased at the expense of the prostaglandins A2/B2, thromboxane A2, and prostacyclin. In a short-term study, this change was not observed following a single antacid dose within 1 hr after application. It is concluded that long-term antacid treatment may alter the prostaglandin pattern formed by gastroduodenal mucosa and this may be related to its therapeutic effect.

[Effect of omega-3-fatty acids on biliary lipids and lithogenicity]. / Einfluss von Omega-3-Fettsäuren auf biliäre Lipide und Lithogenität.

Until now no studies are available about the influences of omega-3-fatty acids on biliary lipids in men. The effects of 1.5 g omega-3-fatty acids per day on biliary lipid concentration and composition were studied in 13 male healthy persons over six weeks. Biliary cholesterol concentration decreased from 5.4 +/- 0.53 mol% to 3.7 +/- 0.30 mol% (25%) statistically significant. Phospholipids and bile acids remained unchanged. Cholesterol saturation index (CSI) was lowered from 1.13 +/- 0.12 to 0.85 +/- 0.06 (p less than 0.05). Bile acid composition and conjugation rates were unchanged. No significant side effects could be observed. Substitution of omega-3-fatty acids induced in healthy male persons a decrease of biliary cholesterol and lithogenicity.

[Prostaglandin synthesis in stomach and duodenal mucosa of the human: effect of aspirin with and without antacid]. / Die Prostaglandinsynthese in Magen- und Duodenalmukosa des Menschen: Einfluss von Aspirin mit und ohne Antazidum.

A decreased PG E2 content in gastric mucosa of humans receiving a longterm antirheumatic therapy has been reported to be partially reversed after a one week treatment with an antacid (Reimann et al., Fortschr Med 102 [1984], 25-26). Therefore the effect of an Aspirin treatment of healthy volunteers with or without an antacid on the prostaglandin synthesis in gastric or duodenal mucosa was investigated. 14C-labelled arachidonic acid was used as substrate during in vitro incubation of the mucosal homogenate for determination of the endogenous formation of prostaglandins. Aspirin suppressed the total prostaglandin synthesis to less than 10% of control after one week treatment. The addition of a high dose antacid did not influence this inhibition, and no significant effect on the prostaglandin profile was detectable. It is concluded that antacids do not influence the suppression of the endogenous prostaglandin synthesis by NOSAC's, however another effect, eg a prolonged stability of PG E2 in a less acidic environment is more likely.

[Dissolution of recurrent stones in the choledochus by a modified irrigation treatment via an indwelling nasobiliary catheter]. / Auflösung von Rezidivsteinen im Choledochus durch modifizierte Spülbehandlung über eine nasobiliäre Verweilsonde.

Alternating fluid rinsing with a modified glyceromono-octanoate (GMOC) and bile salt-EDTA (BA-EDTA) solution via an endoscopically placed indwelling nasal biliary catheter was performed on 15 patients (13 women, 2 men) with recurrent stones in the choledochal duct after cholecystectomy. Of 12 radiotranslucent and three radioopaque concrements with a mean diameter of 1.72 X 2.05 cm (largest concrement: 3.0 X 3.5, smallest 1.0 X 2.1 cm) 13 were dissolved (87% success rate). In one patient chemolitholysis had to be stopped because of electrolyte abnormalities, before treatment had been completed. After the end of treatment all patients were free of symptoms and during a fairly long follow-up period no stone recurrences were observed.

Influence of dietary cholesterol, saturated and unsaturated lipid on 3-hydroxy-3-methylglutaryl CoA reductase activity in rabbit intestine and liver.

To characterize further the behavior of the rate-limiting enzyme of cholesterol biosynthesis in animal species, we studied the kinetic properties and the influence of dietary lipid on intestinal and hepatic HMG-CoA reductase activity in the rabbit. In intestinal crypt and villous cells isolated by a dual buffer technique, the KM value was 4.2 and 4.6 microM, respectively for DL-HMC-CoA. The specific activity of HMG-CoA reductase in the jejunum was 0.86 nmol/mg per hr, and evenly distributed between crypt and villous cells. By contrast, reductase activity was considerably lower in the ileum: in villous cells it was 0.40 nmol/mg per hr, and in crypt cells only 0.26 nmol/mg per hr. Liver microsomes had a KM value of 3.0 microM, while the reductase activity averaged 2 nmol/mg per hr. An unexpected finding was the uneven distribution of HMG-CoA reductase in the various lobes of the liver in the single animal. The addition of 1% cholesterol to the diet for 48 hours was followed by an average decline of 73% (P less than 0.005) of HMG-CoA reductase activity in villous and crypt cells of the jejunum. In the ileum, the decrease was less marked (38%, P less than 0.01). Whereas the addition of 5% corn oil to a 1% cholesterol diet did not have an additional suppressant effect on intestinal reductase, the addition of 5% coconut oil to 1% cholesterol caused further decrease of HMG-CoA reductase in jejunum and ileum (P less than 0.05). The 1% cholesterol diet resulted in a 25% decrease of hepatic reductase after 24 hours, whereas after 6 days, the enzyme activity was reduced by 90% of normal. Both 5% corn oil or 5% coconut oil, in addition to 1% cholesterol, further suppressed hepatic reductase activity. The weight of the experimental evidence presented in these studies suggests that cholesterol has a major regulatory effect on both intestinal and hepatic reductase in the rabbit.