Validity of some prediction equations to assess resting energy expenditure (REE) in 29 elderly obese subjects (>60 years).

BACKGROUND AND AIMS: Recent estimates in US have shown that more than a third of 65 years old subjects are obese. The objective of this study was to test the accuracy of six prediction equations to estimate resting energy expenditure (REE) in elderly obese subjects (age >60 years). METHODS: Twenty-nine obese Caucasian male (n=8) and female (n=21) subjects (age range: 60-77 years) attended the Outpatient Clinic of the Neuroscience Department of Naples "Federico II" University Medical School (Italy), Section of Aging and Nutrition from January 2005 to January 2006. Weight, height, BMI and body composition (bioimpedance) were measured. REE was measured using a ventilated-hood indirect calorimetry and compared to six prediction equations (Harris-Benedict, Fredrix, Mifflin, Owen, WHO, Livingston). RESULTS: Mean age and body mass index (BMI) were 65.9+/-4.8 years and 36.8+/-5.3 kg/m2, respectively. The measured REE was 1658+/-289 kcal/day. The Harris-Benedict', Owen' and Livingston's equations performed less well than the other equations and they showed a tendency towards underestimation. The equation with the best REE prediction was the Fredrix's one (DeltaREE=-19.4kcal/day) with 66% of REE predictions lying within 10% of measured REE. CONCLUSIONS: These data support the utilization of the Fredrix's equation to calculate REE in obese elderly subjects.

Restriction map of a 35-kb HLA fragment constructed by nested deletion 'drop-out' mapping.

An efficient method for generating detailed restriction maps of large cloned DNA segments is demonstrated. The mapping strategy entails comparing restriction fragments from a parent clone and from nested deletion derivatives of that clone. In a set of deletion plasmids of decreasing size, an individual fragment will be lost, or 'drop-out', according to its position in the cloned fragment. In this demonstration, nested deletions were generated in both directions in a 35-kb DNA segment from the human leukocyte antigen (HLA) region by intramolecular transposition of an engineered gamma delta (Tn1000) element present in a special 'deletion factory' cloning vector [Wang et al., Proc. Natl. Acad. Sci. USA 90 (1993) 7874-7878]. Fifteen plasmids with deletions extending in one direction and eleven plasmids with deletions extending in the opposite direction were digested singly by each of four restriction enzymes. A total of 36 cleavage sites were mapped in the 35-kb HLA fragment. This drop-out approach using nested deletions provides a simple and efficient means of mapping restriction sites, genes and other features of interest in cosmid-sized cloned DNA segments or DNAs.

Helicobacter pylori infection and peptic disease in coeliac disease.

OBJECTIVE: To evaluate Helicobacter pylori (HP) and peptic disease prevalence in coeliac disease patients and in a control group. DESIGN: In the retrospective study, data collected on 690 upper endoscopies in coeliac patients, carried out between 1990 and 1997, were analysed. In the prospective study 263 consecutive adult patients were studied for follow-up of coeliac disease or suspected malabsorption/coeliac disease. Tests included routine blood tests; serum dosage of EMA; IgG anti-HP and, in a subgroup of participants, anti-CagA antibodies; upper endoscopy with multiple gastric and duodenal biopsies; histological examination of gastric and duodenal specimens with staining providing evidence for the presence of HP. SETTING: A centre for the treatment of malabsorptive diseases, University Federico II of Naples, Italy. PARTICIPANTS: Adults with coeliac disease at the time of diagnosis and follow-up. RESULTS: In the retrospective study, peptic disease had a prevalence of 0.72% in the endoscopy series of coeliac patients examined. In the prospective study, the prevalence of HP infection was significantly lower in untreated coeliac patients when compared with treated patients and controls (20.7%, 32.4% and 55.3%, respectively; P = 0.001, chi2). The prevalence of HP was related to both gender and age. It was found more frequently in men and the frequency increased with age in all groups. The study confirmed the low prevalence of peptic disease in coeliac patients compared with controls (0.9% vs 3.8%, P = 0.001). CONCLUSION: Patients with coeliac disease show a significantly lower prevalence of HP infection and peptic disease when compared to controls. Gluten free diet-induced changes in the intestinal environment and/or the host immuno-response may explain the increased HP prevalence in treated coeliac patients.

Increased risk of surgery in undiagnosed celiac disease.

The diagnosis of celiac disease patients may be delayed by misdiagnosis. Our aim was to evaluate in celiac patients the prevalence of surgery before diagnosis. Two hundred forty-four adult celiac patients and 232 controls were retrospectively investigated for surgery before diagnosis of celiac disease. The prevalence of surgery was increased in celiac patients versus controls (P = 0.001). Frequency of appendectomy (P = 0.0001), tonsillectomy (P = 0.009), and hernia repair (P = 0.05) were increased in celiac patients versus controls. Appendectomy was related to anemia (P = 0.006) and abdominal pain (P = 0.005); tonsillectomy was related to diarrhea (P = 0.02) and weight loss (P = 0,04). Appendectomy was elective in 73% of celiac patients and in 46% of controls. Cosmetic surgery was increased in celiac patients versus controls (P = 0.058). In conclusions, surgery before celiac disease diagnosis is increased in celiac patients compared to controls, as a result of doctors' misdiagnosis and/or poor health status, which increases the demand for medical intervention. The frequency of cosmetic surgery in celiac patients may berelated to impaired psychological profile of patients.