Role of dietary intervention and nutritional follow-up in heart transplant recipients.

BACKGROUND: Obesity, dyslipidemia, hypertension, and diabetes mellitus are common features after heart transplantation and they lead to coronary artery disease and graft loss. AIM: To determine the effects of a dietary intervention on nutritional status and metabolic outcome of two groups enrolled during or after the first year from the transplant. METHODS: Forty two subjects (mean age 51.36+/-12.4 yr) were studied; 20 were enrolled during the first year by the transplant, 22 were enrolled after the first year from the transplant (7.9+/-3.86 and 56.86+/-38.6 months after surgery, respectively). According to diet compliance both groups were divided into two subgroups and they were prospectively followed for 4 years. Anthropometric measurements, biochemical nutritional markers, and dietary records were collected at baseline (T0) and after a 12-month follow-up period (T12) and a 48-month follow-up period (T48). Body composition was performed at T0 and T12. RESULTS: Diet compliance was associated with a decrease in total cholesterol, triglycerides and glucose plasma level and with a weight loss mainly due to a decrease in fat mass. CONCLUSION: Our study shows the efficacy of dietary intervention to obtain an early and late weight and metabolic control after heart transplant.

Body mass index and bioelectrical vector distribution in 8-year-old children.

OBJECTIVE: To describe bioelectrical impedance vector distribution in relation to BMI (body mass index; body weight/stature(2)) in a population of healthy children in order to detect possible changes in body composition status. DESIGN: Observational study involving 464 healthy 8-year-old children. The subjects were divided into three groups based on their BMI: 218 normal weight (NW) children with BMI<18.4 for male and BMI<18.3 for female; 135 overweight (OW) children with BMI 18.4 to <21.6 for male and with BMI 18.3 to <21.6 for female; 111 obese (OB) children with BMI>/=21.6. Skinfold thickness was measured at the triceps using a Holtain caliper. Bioelectrical impedance analysis (BIA) measurements were performed. Total body water (TBW), fat-mass (FM), fat-free mass (FFM), body cell mass (BCM) and extra-cellular water (ECW) were estimated using conventional BIA regression equations. The resistance-reactance graph (RXc graph) method was used for vector BIA using as reference population the set of 353 children with BMI 14.0-21.5kg/m(2). RESULTS: Mean vector displacement followed a definite pattern, with progressive vector shortening in groups with increasing BMI class, and along a fixed phase angle. This pattern indicates an increase in TBW due to an increase in soft tissue mass with an average, normal hydration. In NW children, vectors out of the right and upper half of the 75% tolerance ellipse indicating leanness, and vectors falling out of the right and lower half of the tolerance ellipse indicating undernutrition, show a significantly reduced value of BCM but no significant differences in FM or triceps skinfold thickness (TST), respectively, compared to vectors falling within the 75% tolerance ellipse. CONCLUSIONS: Although BMI is a reliable measure to grade overweight, it cannot differentiate whether weight change is due to variation of FM, FFM or water. In our study a different impedance vector pattern has been associated with normal weight to obesity, and we have established the trajectory followed by the impedance vector of standardized age, healthy children grouped by BMI. This BIVA may be useful for clinical purposes due to ability to detect changes in hydration or body composition in children.

Role of dietary intervention on metabolic abnormalities and nutritional status after renal transplantation.

BACKGROUND: In these last years, several traditional risk factors for cardiovascular disease, like obesity, dyslipidaemia, hypertension and post-transplant diabetes mellitus have been also identified as important non-immunological risk factors leading to the development of chronic allograft nephropathy, the first cause of graft loss in transplanted patients. The aim of the present study was to determine the effects of a 12-month dietary regimen on the nutritional status and metabolic outcome of renal transplant recipients in the first post-transplant year. METHODS: Forty-six cadaver-donor renal transplant recipients (mean age 40.8 +/- 10.1-years), enrolled during the first post-transplant year (4.8 +/- 3.3 months) and followed prospectively for a 12 month period. Biochemical and nutritional markers, anthropometric measurements, body composition (by conventional bioelectrical impedance analysis) and dietary records (using a detailed food-frequency questionnaire) at baseline and after 12 months. RESULTS: Compliance to the diet was related to sex (male better than female) and was associated with weight loss primarily due to a decrease in fat mass, with decrease in total cholesterol and glucose plasma levels and with a concomitant rise in serum albumin. CONCLUSION: After renal transplantation, health benefits of proper metabolic balance that include reduced body fat, weight loss, lower cholesterol and triglycerides levels and an improvement, fasting glucose levels can be obtained when dietary intervention occurred.

Bioelectrical impedance analysis and age-related differences of body composition in the elderly.

BACKGROUND AND AIM: Significant changes in body composition that have important health related effects may occur in the elderly. In this study, we evaluated the bioelectrical characteristics in a large group of apparently healthy Caucasian men in the age range 50-80 years, as a function of age and body mass index. METHODS: We studied 315 men with ages ranging from 50 to 80 years. They were divided into three groups according to body mass index (kg/m(2)): 18.5-24.9 normoweight (NW); 25.0-29.9 overweight (OW); > or =30 obese (OB), and they were classified in nine age subgroups: 50-59 (young-old, YO); 60-69 (old, O); 70-80 (oldest, OS). Fat-free mass, fat mass and body cell mass were investigated using conventional bioelectrical impedance analysis. Body composition was also assessed by bioelectrical impedance vector analysis and the RXc graph method. RESULTS: Body cell mass decreased significantly with age particularly in subgroups of the OW and OB groups (p<0.05). Mean vector displacement followed a definite pattern, with downward migration of the ellipses in the OW and OB groups, after 70 years of age. CONCLUSIONS: Ageing was associated with a pattern of vector bioelectrical impedance analysis indicating decreased soft tissue mass (fat-free mass and body cell mass), particularly in OW and OB-OS healthy men. We suggest 70 years of age as a cut-off for significant quantitative and qualitative (tissue electrical properties) body composition modifications. This bioelectrical impedance vector analysis pattern associated with ageing and across the different body mass index categories, may be useful for clinical purposes and can be used in geriatric routine to accurately assess the body composition modifications occurring in the elderly.