Impact of liver cirrhosis on nutritional and immunological status.

The aims of the study were to determine the prevalence of protein calorie malnutrition (PCM) in Thai cirrhotic patients and to evaluate nutritional and immunological status in various stages of cirrhosis. Subjective Global Assessment (SGA) and anthropometric measurement were used as nutritional assessment in sixty cirrhotic patients. Delayed-type hypersensitivity skin test, lymphocyte count, immunoglobulin and complement were assessed for immune status. Blood samples were sent for routine tests, prealbumin, thiamine and riboflavin level. There were 7/60 (11.7%) patients with percentage of ideal body weight (%IBW) less than 90 per cent. SGA, hemoglobin, protein indices and cholesterol level showed the deterioration of nutritional status in the late stage of the disease. Five (8.3%) patients with thiamine deficiency, and thirteen (21.7%) patients with riboflavine deficiency were detected. Lowest levels of complement and highest levels of immunoglobulin also occurred in the late stage of the disease. In conclusion, defining %IBW <90 per cent as malnutrition, the prevalence of malnutrition in Thai cirrhotic patients was 11.7 per cent. Nutritional and immunological status deteriorated according to the advanced stage of disease. If nutritional support is given in the early stage, it may improve nutritional status and reduce morbidity and mortality in cirrhotic patients.

Possible thermogenesis with dexfenfluramine.

Fifty obese patients with a body mass index greater than 25 kg/m2 were randomized into 3 groups: control (C = 19), placebo (P = 18) and dexfenfluramine (D = 18). A behavioral modification program which included eating habits, exercise, attitudes, social relationships and six steps to lifetime weight control was taught every week. All patients strictly followed the food manual and recorded their behavior, physical activity and food intake every day through 12 weeks. Placebo and dexfenfluramine 30 mg/day were given in a double blind placebo controlled study. The results showed that all 3 groups had significant decreases in rest times and increased activity times (p < 0.05) and significant reductions of the average total daily energy, carbohydrate and fat intake (p < 0.05). They all lost weight. Mean +/- SEM cumulative weight loss was 8.3 +/- 0.7 kg in group D, 3.3 +/- 1 kg, in group P and 2.9 +/- 0.7 kg, in group C. The mean additional weight loss of 5 kg, and 5.4 kg seen with dexfenfluramine being highly significant (p < 0.001) from group P and C most likely due to increased thermogenesis. Significant (p < 0.05) and gradual reduction of biceps, triceps skinfold and per cent body fat were constantly observed only in the dexfenfluramine group. There were no significant differences among the 3 groups regarding blood pressure, heart rate, hematologic, lipids and biochemical profiles.

Effect of zinc supplementation on zinc status, copper status and cellular immunity in elderly patients with diabetes mellitus.

This preliminary study was to investigate the effects of zinc supplementation on Zn status, Cu status, serum macrominerals and lymphocyte subsets in elderly diabetic patients. The results of Zn supplementation can correct plasma Zn levels to normal values. However, this treatment did not affect the cellular Zn, copper status and serum macrominerals. Enhancement of the percentage of CD4 cells was observed after Zn therapy but had no effect on the percentage of CD8 cells and CD4/CD8 ratios. Our finding implicated that zinc supplementation might be useful to enhance the immune status in these patients.

Behavior modification in the treatment of obesity: acceptability profiles.

Seventy obese subjects, after receiving an 8-week group therapy program of behavior modification, showed that they had lost weight from fat tissue. There were significant decreases of per cent body fat, biceps, subscapular and iliac skinfold thickness while maintaining arm muscle area. There were significant decreases of both systolic and diastolic blood pressure during the program. The acceptability profiles of heart rate, liver and renal function test, fasting blood sugar, uric acid, serum iron, total iron binding capacity, minerals, electrolytes, hematological and lipid profiles were within normal limits before and after the treatment. The obese subjects rated the behavior modification program as more effective and indicated helpfulness of concepts, information and techniques of the program.

Behavior modification in the treatment of obesity.

Seventy obese subjects with a body mass index greater than 25 kg/m2 received a behavioral modification and a daily log self management program for weight loss during an 8-wk treatment period. The program included eating habits, exercise, attitudes, social relationships and nutrition. The results indicated that after 8 wks, cumulative weight loss (mean +/- SEM) was 4.3 +/- 0.4 kgs. The decrease in their body weight was due to the loss of their fat store evidenced by the significant decrease in triceps skinfold thickness. (P < 0.0001) The subjects showed significant decrease in total calories, carbohydrate and fat after 4 wks (P < 0.001, 0.001, and 0.008) through 8 wks (P < 0.007, 0.013 and 0.015). The activities in daily life changed significantly from rest level to light exercise level (P < 0.001). It was concluded that behavior modification program for short term showed improved eating habits and daily exercise. But we need time in order to identify variables responsible for maintenance of weight loss over the long term.

Optic neuropathy in a patient with vitamin B12 deficiency: a case report.

A 19-year-old man presented with blurring of vision for 2 weeks. He also complained of anorexia with weight loss during the past 4 months. Eight years ago, his small bowel from midportion of the jejunum, ileum, ascending colon and transverse colon were resected because of gangrene. He gave no history of exposure to tobacco, alcohol or other toxins. The bone marrow aspiration showed hypocellular with panhypoplasia. Serum vitamin B12 level was low while serum and red cell folate were within normal limits. His visual acuity was 5/200 in both eyes with centrocecal scotomas in both eyes. Other neurologic and ophthalmic examinations were found to be normal. The patient was given intramuscular injections of 1,000 micrograms of cyanocobalamin. Four months later, his visual acuity improved, serum vitamin B12 level and the bone marrow returned to be normal. This is a frank case of optic neuropathy in a patient with vitamin B12 deficiency due to a massive small bowel resection.