Early experience with customized, meal-triggered gastric electrical stimulation in obese patients.

BACKGROUND: We report our initial gastric electrical stimulation experience using the abiliti® system for the treatment of obese patients followed for 1 year. METHOD: Between March 2011 and June 2013, 27 obese patients (BMI 30 to 46 kg/m(2)) were enrolled in a prospective open label study and implanted with a gastric stimulator. The patients were provided with nutritional support, and sensor-based behavioral feedback. RESULTS: At 12 months, percent excess weight loss (%EWL) obtained was 49.3 ± 19.2 % with no significant differences between gender or age sub-groups. The %EWL data were segmented into two groups according to BMI 30-40 kg/m(2) patients (obesity grade I and II) and BMI >40 kg/m(2), with the results of weight loss being significantly higher for the lower BMI group (59.1 ± 19.5 vs. 46.7 ± 13.4, respectively, p < 0.01). One subject requested to have his device explanted, and the minor postoperative adverse events were resolved without hospital admission. All patients experienced early satiety and reduced their intake. CONCLUSIONS: After 12 months of follow-up, gastric electrical stimulation treatment appears to be a safe and effective option for weight loss in obese subjects. Long-term follow-up and further studies are warranted.

Effects of fatty acids and hormones on fatty acid metabolism and gluconeogenesis in bovine hepatocytes.

Primary cultures of hepatocytes were used to study the effects of extracellular oleate concentration and hormones on fatty acid metabolism and gluconeogenesis. Rates of oleate uptake and oxidation to acid-soluble products varied linearly as oleate concentrations increased (0.1 to 2 mM), but rates of triglyceride accumulation varied quadratically. Insulin increased the proportion of oleate that was esterified by 22% without affecting the formation of acid-soluble products. Cells incubated with 2 mM [1-(14)C]oleate for 24 h eliminated 9.6% of the labeled intracellular lipid as acid-soluble products in the following 24 h when no oleate was present during depletion and eliminated 7.7% when 2 mM oleate was present. Insulin reduced labeled triglyceride depletion by 49%. Gluconeogenesis from [2-(14)C] propionate was depressed by 24%, and formation of acid-soluble products was increased by 46% in cells infiltrated with lipid because of previous exposure to 2 mM oleate for 45 h. Rates of gluconeogenesis from propionate were reduced 23% when 2 mM oleate was present during the 3-h period that gluconeogenesis was measured, and the effect was not modified by lipid infiltration. Lipid infiltration influenced hepatic function, and insulin regulated hepatic triglyceride concentration.

Pediatric parenteral nutrition mixtures design program: validity and stability study.

The formulation and elaboration of a correct parenteral nutrition (PN) in infancy requires the use of many parameters, the realization of complicated mathematical calculations, and repeated and individualized adjustments of the final constituents. The use of computer programs in the confection of PN has simplified the whole process, but, to our understanding, the programs being used at the moment lack the flexibility needed to generalize its use in the pediatric age. The aim of this work is to present a new computer program able to make up complete pediatric units of PN by itself, which follow the nutritional requirements and the marketed preparations established for each clinical situation. The program provides, automatically, standard amounts for each nutrient, according to age, water needs, and route of administration. The program turns these amounts, which can be modified before or after knowing the final composition, into milliliters of each commercial product and provides a complete analysis of the PN solution. It is also possible to adapt the basic configuration of the program to the needs of each patient, modifying the nutritional requirements and the products that the program will use. In order to assess the validity of the program, we made up a series of PN solutions, for a simulated sample of patients, which represented different clinical situations and age groups. We analyzed the composition of the mixtures and its physical-chemical stability. No problems in the PN solutions generated by the program when using our standard configuration were found. A study of reproducibility was carried out and no difficulties of execution, errors, or differences in the composition of the PN solutions designed by the different physicians were found. Average time needed for the design of a PN was less than 5 min. The use of computer programs in the design of mixtures of PN reduces errors and time, allowing a better use of this technique of nutritional support.

Effect of prepartum dry matter intake on liver triglyceride concentration and early lactation.

Depression in feed intake during the final week before calving was hypothesized to be a major factor in the etiology of fatty liver development near parturition. Eleven cows were allowed to eat for ad libitum intake prior to calving (control), and 11 cows were maintained at the same level of DMI recorded during d 21 to 17 prior to calving by force feeding the feed refusals via rumen cannulas. Feed intake by control cows decreased 28% during the final 17 d prior to calving. Lipid triglyceride increased 227 and 75% for control and force-fed cows between d 17 prior to parturition and d 1 following calving. Dry matter intake prior to calving was correlated negatively with liver triglyceride immediately after calving (r = -.80). Plasma glucose concentrations for control and force-fed cows were 63 and 76 mg/dl 2 d prior to calving and also were related closely to liver triglyceride immediately after calving (r = -.50). By d 28 after calving, there were no differences in liver triglyceride between treatments. Cows that were force-fed prior to calving tended to yield milk with greater fat percentage (4.22 vs. 3.88%) and to yield more 3.5% FCM (46.1 vs. 41.7 kg/d) during the first 28 d postpartum.