[Infection with Helicobacter pylori--outcome of a cross-sectional investigation]. / Infektion mit Helicobacter pylori--Ergebnisse einer Querschnittuntersuchung.

BACKGROUND AND OBJECTIVE: Different information exists about the prevalence of Helicobacter pylori (Hp) in Germany, ranging from 35 to 40%. Several investigations have identified factors influencing the colonization of Hp in the stomach, but their significance is still being discussed. This study aimed at determining the prevalence of Hp in the metropolitan area of Hannover and defining the impact of education and lifestyle on Hp colonization. SUBJECTS AND METHODS: The study was designed as a cross-sectional survey. Advertisements were placed in newspapers and on the radio. Of 829 who responded and were informed of the study 35 were excluded according to predefined criteria, the remainder sent questionnaires and containers for stool samples. 579 persons returned questionnaires and stool samples, but 16 were excluded because of borderline test results. The detection of Hp was done with a test for Hp-antigens in stool (Femto Lab H. pylori-Cnx-Test, R-Biopharm). RESULTS: Among the final 563 tested persons (322 women, 241 men; mean age 46.6 12.2 years) 21% were Hp-positive and 79% negative. Participants with Hp were older than those without. Neither gender nor the consumption of caffeine, alcohol, nicotine and particular eating behaviour were related to Hp-status. However, persons who had incomplete or lower-level schooling were infected more often than those who had graduated from with high school. CONCLUSION: These results indicate that Hp-prevalence among German adults may be lower than previously published. Known associations between Hp infection and age and education were confirmed.

Impact of fish oil enriched total parenteral nutrition on DNA synthesis, cytokine release and receptor expression by lymphocytes in the postoperative period.

A prospective randomized study on sixty patients was conducted to investigate the effects of a fish oil containing total parenteral nutrition (TPN) regimen in the postoperative period on lymphocyte subset distribution, proliferation, cytokine production and interleukin-2 receptor (IL-2R) expression. Patients who underwent large bowel surgery were divided into three groups. Nineteen patients received TPN with fish oil (0.2 g/kg body weight per day) plus soybean oil (1.0 g/kg per day), twenty patients received soybean oil (1.2 g/kg per day), and twenty-one patients who were on a fat-free regimen served as the control group. Natural killer (NK) cells, total, B-, T-, T4-, T8-lymphocytes, proliferation of lymphocytes, in vitro production of IL-2, IFN-gamma, TNF-alpha, and IL-2R expression were measured. Fish oil administration did not affect subset distribution and proliferation of lymphocytes. Production of interleukin-2 (IL-2), interferon gamma (IFN-gamma) and tumor necrosis factor alpha (TNF-alpha) was augmented, and IL-2R expression less enhanced compared with the controls. It is concluded that administration of 0.2 g/kg per day fish oil after a moderate surgical stress is not immunosuppressive, but enhances the production of IFN-gamma, TNF-alpha and possibly IL-2.

Food and nutritional care in hospitals: how to prevent undernutrition--report and guidelines from the Council of Europe.

In 1999 the Council of Europe decided to collect information regarding Nutrition programmes in hospitals and for this purpose a network consisting of national experts from eight of the Partial Agreement member states was established. The aim was to review the current practice in Europe regarding hospital food provision, to highlight deficiencies and to issue guidelines to improve the nutritional care and support of hospitalized patients. Five major problems seemed to be common in this context: 1) lack of clearly defined responsibilities; 2) lack of sufficient education; 3) lack of influence of the patients; 4) lack of co-operation among all staff groups; and 5) lack of involvement from the hospital management. To solve the problems highlighted, a combined 'team-effort' is needed from national authorities and all staff involved in the nutritional care and support, including hospital managers.

Comparison of serine and hippurate as precursor equivalents during infusion of [15N]glycine for measurement of fractional synthetic rates of apolipoprotein B of very-low-density lipoprotein.

Enrichment in hippurate has been measured to indicate precursor enrichment during glycine tracer infusion studies to estimate fractional synthetic rates of individual hepatic export proteins. However, hippurate tends to overestimate precursor enrichment. Since glycine is rapidly converted to serine by liver cells, we compared tracer enrichment in hippurate and serine with that of glycine incorporated into apolipoprotein (apo) B-100. Ten healthy control subjects were studied in the postabsorptive state during an 8-hour primed-constant infusion of [15N]glycine (10 mumol.kg-1.h-1). Apo B of very-low-density lipoprotein (VLDL) was isolated by standard ultracentrifugation and isopropanol precipitation. Glycine and serine were isolated from plasma and hydrolyzed apo B, hippurate was isolated from plasma, and [15N]enrichment was determined by gas chromatography-mass spectrometry. Enrichment in serine and glycine isolated from apo B was identical at all time points, and their enrichment in apo B increased asymptotically, approaching an apparent plateau (mean +/- SD: 91% +/- 10% of calculated plateau at 8 hours) that was taken to represent hepatic protein precursor enrichment. Enrichment in both plasma serine and hippurate followed a biphasic pattern and continued to increase until the end of the study, raising the possibility that precursor enrichment had not reached a steady state during the study. The apo B plateau was lower (factor 0.76 +/- 0.27) than the final enrichment in hippurate and higher (factor 1.38 +/- 0.36) than that in plasma serine; however, predictions of protein precursor enrichment based on either metabolite were flawed by a large coefficient of variation (35% v 26%).(ABSTRACT TRUNCATED AT 250 WORDS)

[Graduate education in nutritional medicine in Germany--2 years after organization of the "Nutritional Medicine" teaching curriculum]. / Ernährungsmedizinische Fortbildung in Deutschland--zwei Jahre nach Veröffentlichung des Lehrcurriculums "Ernährungsmedizin".

Prophylaxis of nutrition-related diseases and therapy of malnutrition are important duties of physicians. While teaching in nutrition for medical students is poor in German universities, progress has been made in regard to postgraduate training. Stimulated by the chamber of physicians of Germany, a "curriculum for Nutritional Medicine" was developed by the Germany Society of Nutritional Medicine. Experience gained by the Academy of Nutritional Medicine Hannover indicates that the postgraduate training based on this curriculum is well received. This may suggest that nutritional medicine is gaining greater acceptance.

Cytokine production and DNA synthesis by human peripheral lymphocytes in response to palmitic, stearic, oleic, and linoleic acid.

Effects of palmitic, stearic, oleic, and linoleic acid on mitogen-induced DNA synthesis, on production of IL-1 beta, IL-2, IFN-gamma, and TNF-alpha, and on IL-2R expression were determined in human peripheral lymphocytes. Free fatty acids (FFA) were added over a wide range of concentrations to cells cultured under serum free conditions with fatty acid free albumin. DNA synthesis was stimulated by low and inhibited by high FFA concentrations. Physiological concentrations were stimulatory, except for linoleic acid. Cytokine production became affected by all FFA tested. Palmitic acid enhanced the release of IFN-gamma at concentrations that diminished TNF-alpha production. Saturated fatty acids were significantly more potent than unsaturated fatty acids in affecting cytokine production. IFN-gamma secretion was significantly more stimulated or inhibited by the various FFA compared with the other cytokines. IL-2R expression correlated with the production of IL-2. When tested in combination, stimulatory as well as inhibitory effects of the individual FFA became attenuated. It is suggested that palmitic, stearic, oleic, and linoleic acid are physiological regulators of DNA synthesis and cytokine release in human peripheral lymphocytes. Modulation of FFA ratios may be an effective means for the fine tuning of the immune system. As secretory mechanisms of cytokines appear to exhibit substrate specificity for FFA, the release of individual cytokines may be selectively influenced by FFA.

No evidence for feedback inhibition of hepatic apolipoprotein B (apo B) production after extracorporeal low density lipoprotein precipitation as determined by [1-13C]leucine infusion in normal volunteers.

To determine the impact of an acute reduction of the circulating mass of apolipoprotein B (apo B) on apo B metabolism we studied six healthy male volunteers before (day 0), 1 day after (day 2), and 7 days after (day 8) an LDL apheresis treatment which reduced apo B mass by 59%. Appearance of newly synthesized apo B in plasma VLDL and LDL was studied using a primed-constant infusion of [1-13C]-leucine. VLDL apo B pool size and fractional VLDL apo B production rate calculated using a one-compartment model were similar on all 3 study days. Absolute VLDL apo B production was not statistically different throughout the study (19.7 +/- 12.3, 19.5 +/- 7.5, 29.1 +/- 17.7 mg kg-1 day-1). LDL apo B fractional production rate was increased on day 2 (0.38 +/- 0.17, 0.68 +/- 0.08, 0.37 +/- 0.06 pools day-1 on days 0, 2, and 8; P < 0.01). Absolute LDL apo B production, however, remained constant throughout the study (10.8 +/- 3.3, 11.0 +/- 1.9, 10.8 +/- 3.1 mg kg-1 day-1). We conclude that in healthy male volunteers acute reduction of the circulating apo B mass by LDL apheresis does not affect apo B metabolism significantly.

[Total parenteral nutrition in the home of 498 patients with tumor diseases]. / Totale parenterale Heimernährung bei 498 Patienten mit Tumorerkrankungen.

Results of home parenteral nutrition in cancer patients were evaluated by analyzing files from 498 individuals. The predominant malignancies were cancer of the stomach (44% in men, 29% in women), the colon or the ovaries, respectively. Most patients (71%) admitted to home parenteral nutrition were severely malnourished, based on a Broca-Index of 0.8 or less. The majority (78%) of these subjects gained weight while on home parenteral nutrition. The remainder 22% continued to loose weight. Median survival was 64 (one to 720) days.

Relationship between amino-acid metabolism and immune functions in human lymphocytes.

Amino-acid degradation, interleukin-2 (IL-2) production, and DNA synthesis were analysed in concanavalin A (ConA)-treated peripheral venous lymphocytes from healthy blood donors and in lymphocytes from patients after uneventful abdominal surgery. ConA augmented (14)CO(2) production from (U-(14)C) glutamine (492 +/- 44 vs. 2274 +/- 174 pmol/10(6) cells x 40 min(-1)) while it had little effect on (14)CO(2) production from (1-(14)C) leucine (132 +/- 8 vs. 161 +/- 17 pmol/10(6) cells x 40 min(-1)) compared with the respective controls. Similar effects on amino-acid degradation were observed in response to surgery. Glutamine but not leucine amplified IL-2 production from ConA-treated cells, and it was a prerequisite for DNA synthesis. In lymphocytes from operated patients, spontaneous incorporation of ((3)H) thymidine was higher on day 3 and day 6 (310 and 2660 cpm/10(6) cells) after surgery, compared with the pre-operative day (68 cpm/10(6) cells; median values). These results indicate 1) that glutamine is more critical than leucine for the immune function of T-lymphocytes, and 2) that lymphocytes from patients undergoing uneventful abdomional surgery have become stimulated in vivo. It is suggested that these cells may qualify as a suitable experimental model to study the metabolic basis for immunologic functions after antigenic stimulation in vivo.

[Diagnosis and prevalence of latent hepatic encephalopathy]. / Untersuchungen zur Diagnose und Prävalenz der latenten hepatischen Encephalopathie.

To compare the efficacy of various psychometric and neurophysiological tests in the detection of latent hepatic encephalopathy (LHE) cerebral functions were studied in 146 patients with liver cirrhosis but without overt encephalopathy and in 146 matched controls. Patients with liver cirrhosis scored significantly worse than controls in 8 out of 11 tests. Best discrimination between patients with cirrhosis and controls was obtained by testing for reaction time to white and colored light with a reaction time apparatus (DTG), and with the digit symbol (UT1) and block design test (UT4), i.e. with two Wechsler adult intelligence scale performance tests. Thirtyseven out of 146 (25%) patients with cirrhosis reveiled an abnormal result with the DTG alone. A combination of the DTG, UT1 and UT4 yielded the diagnosis in 44 (30%) patients. LHE correlated with the severity of the disease (Child-Pugh classification) but not with its etiology or with portasystemic shunting. In the Federal Republic of Germany about 300,000 subjects suffer from liver cirrhosis. Based on our results 100,000 of them may have LHE.

Characterization of glutamine transport into resting and concanavalin A-stimulated peripheral human lymphocytes.

Characteristics of glutamine transport, its substrate specificity, and its pattern of competitive and non-competitive inhibition in response to amino acid analogues were determined in peripheral human lymphocytes, incubated with or without concanavalin A (Con A). Maximum capacity of transport (Vmax) at 37 degrees C and 136.9 mM Na+ was 30 pmol/10(6) cells/30 seconds, while the apparent Km was 142 microM. In cells exposed to 10 mM histidine, asparagine, serine, or leucine transport of glutamine declined to 28%, 15%, 17%, and 21%, respectively, of the rates in controls. Inhibition by histidine (Ki = 0.58 mM) and serine (Ki = 0.25 mM) was competitive, by leucine was non-competitive (Ki = 0.64), while alpha-methylamino-isobutyric acid and 2-amino carboxy-bicyclo (2.2.1)-heptane had no effect. In cells cultured for 24 hours with or without 10 micrograms/ml Con A, the apparent Km was 70 microM vs. 89 microM and Vmax 73 vs. 26 pmol/10(6) cells/30 seconds. Sodium depletion (9.0 mM NaCl) greatly diminished glutamine transport in resting and stimulated cells. Inhibition of glutamine transport by serine was sodium sensitive, while inhibition by histidine and asparagine was not. Serine had no competitive effect in sodium-depleted media. The data demonstrate what appear to be two carrier systems for glutamine, sodium sensitive and sodium insensitive. It is suggested that glutamine transport into lymphocytes occurs via processes similar to System N and System ASC described in other cells, with System ASC as the sodium-sensitive component. Con A augments the capacity rather than the affinity of glutamine transporting systems.

Comparison between transport and degradation of leucine and glutamine by peripheral human lymphocytes exposed to concanavalin A.

Transport and pathways of leucine and glutamine degradation were evaluated in resting human peripheral lymphocytes and compared with the changes induced by concanavalin A (ConA). Cells were incubated with [1-14C]leucine (0.15 mM), [U-14C]leucine (0.15 mM), or [U-14C]glutamine (0.4 mM) after culture with or without 2, 5, 7, or 10 micrograms/ml ConA for 2, 18, or 24 hours, respectively. Initial rates of transport of leucine and glutamine were augmented 2.7-fold and threefold by the mitogen. Leucine transamination, irreversible oxidation, and catabolism beyond isovaleryl-CoA were increased by 90%, 20%, and 60%, respectively. Glutamine utilization increased threefold; accumulation of glutamate, aspartate, and ammonia increased by 700%, 50%, and 100%, respectively, and 14CO2 production by about 400% in response to ConA. The results indicate that ConA stimulates to about the same extent transport of leucine and glutamine into lymphocytes. Glutamine is mainly channeled into catabolic pathways, while leucine remains largely preserved. It is suggested that these metabolic changes provide more leucine for incorporation into protein and more N- and C-atoms required for the synthesis of macromolecules and energy from glutamine.

Glutamine metabolism in human lymphocytes.

The data indicate that glutamine plays a critical role in the metabolism of human lymphocytes stimulated in vitro and in vivo. The understanding of these processes is a prerequisite if one is to substitute glutamine under conditions of compromised lymphocyte function.

[Home parenteral feeding in advanced tumor diseases]. / Parenterale Heimernährung bei fortgeschrittenen Tumorerkrankungen.

Twenty selected patients with advanced malignant tumour (11 women and 9 men; mean age 52.8 [17-83] years) were on home parenteral nutrition because of ileus and (or) shortintestine syndrome. Mean survival time after onset of total parenteral nutrition in hospital was 107 (23-467) days. Mean treatment period at home was 81 (13-376) days, in hospital 26 (3-91) days. The patients with the shortest survival time all had metastasizing gastric carcinoma. The most common complaint was physical fatigue. In one patient there was a treatment-related complication (catheter sepsis). The results document that total parenteral home nutrition of carefully selected patients with advanced malignant tumour makes it possible for the remaining period of life to be spent, in acceptable conditions, at home rather than in hospital.

Regulation of leucine transport and oxidation in peripheral human lymphocytes by glutamine.

In this study we investigated the influence of physiological levels of glutamine, isoleucine, and valine on leucine oxidation and transport by peripheral lymphocytes in an in vitro system. The presence of glutamine in the incubation mixture inhibited leucine oxidation by 61%. This effect was not significantly augmented by addition of isoleucine and valine. Leucine transport revealed a Km of 124 mumol/L and a Vmax of 24 pmol/10(6) cells/30 sec. Glutamine inhibited leucine transport by 63%. The capacity of lymphocytes for leucine transport exceeded the capacity for leucine oxidation by a factor of 7.8 (13.6 +/- 0.6 v 1.74 +/- 0.1 pmol/10(6) cells/30 sec). It is concluded that glutamine is a regulator of leucine transport and oxidation in human peripheral lymphocytes, and the inhibition of leucine oxidation by glutamine is not due to an alteration of leucine transport but reflects an intracellular event.

[Incorporation of 15N in VLDL and LDL: in vivo synthesis of apolipoprotein B in the post-absorptive and fasting state]. / Einbau von 15N-Glyzin in VLDL und LDL: In-vivo-Synthese von Apolipoprotein B beim Menschen postabsorptiv und im Fastenzustand.

In vivo synthesis of apolipoprotein B 100 (ApoB) was recently determined in man using stable isotopes. With this procedure we analyzed (1) the effect of fasting on synthesis of ApoB from very low density lipoprotein (VLDL) and (2) tracer enrichment in low density lipoprotein (LDL). After a 36-hour fasting period and in the post-absorptive state 4 healthy subjects were given a priming dose (8.7 mumol/kg) of 15N glycine followed by a constant infusion (10 mumol/kg/h for 8 h) to achieve 5% tracer enrichment in the plasma pool of glycine. The K-values, i.e. fractional synthetic rates/hr of ApoB from VLDL were 0.53 +/- 0.26 vs. 0.43 +/- 0.16 (p greater than 0.05). Tracer enrichment in ApoB from LDL at the end of the infusions was 0.19% vs. 1.46% in ApoB from VLDL. The results indicate that (1) in young healthy postabsorptive individuals about 40% of ApoB from VLDL in plasma is synthesized per hour, (2) fasting does not materially affect fractional ApoB synthesis and (3) at 5% 15N enrichment in plasma glycine, tracer enrichment in ApoB from LDL is at the lower limit of detection for the procedure employed.