Enhanced recovery after surgery for liver resection.

INTRODUCTION: Enhanced recovery after surgery (ERAS) reduces postoperative length of hospital stay and patient stress response to liver surgery. The aim of the present study was to evaluate the efficacy and feasibility of an ERAS programme for liver resection. METHODS: A multidisciplinary ERAS protocol was implemented for both open and laparoscopic liver resection in a tertiary hospital in Hong Kong. The clinical outcomes of patients who underwent liver resection and underwent the ERAS perioperative programme were compared with those who received a conventional perioperative programme between September 2015 and July 2016. Propensity score matching analysis was used to minimise background differences. RESULTS: A total of 20 patients who underwent liver resection were recruited to the ERAS programme. Their clinical outcomes were compared with another 20 patients who received hepatectomy under a conventional perioperative programme after propensity score matching. The ERAS programme was associated with a significantly shorter length of hospital stay (P=0.033) without an increase in complication rates in patients who underwent open liver resection. There was no such significant association in patients who underwent laparoscopic liver resection. No patients required readmission in this cohort. CONCLUSIONS: The ERAS perioperative programme for liver resection is safe and feasible. It significantly shortened the hospital stay after open liver resection but not after laparoscopic liver resection.

Absorption of benzoic acid in segmental regions of the vascularly perfused rat small intestine preparation.

Oral bioavailability is a consequence of intestinal absorption, exsorption, and metabolism and is further modulated by the difference in activities among segmental regions. The influence of these factors on the net absorption of benzoic acid (BA), a substrate that is metabolized to hippurate and is transported by the monocarboxylic acid transporter 1, was studied in the recirculating, vascularly perfused, rat small intestine preparation. Metabolism of BA was not observed for both systemic and intraluminal injections into segments of varying lengths. But, secretion of BA into lumen was noted. Absorption of BA (0.166-3.68 micromol) introduced at the duodenal end for absorption by the entire intestine was complete (>95% dose at 2 h) and dose-independent, yielding similar absorption rate constants (k(a) of 0.0464 min(-1)). The extent of absorption remained high (92-96% dose) when BA was injected into closed segments of shorter lengths (12 or 20 cm), suggesting a large reserve length of the rat intestine. However, k(a) was higher for the jejunum (0.0519 and 0.0564 min(-1), respectively, for the 12- and 20-cm segments) and exceeded that for the duodenum (12-cm segment, 0.0442 min(-1)) and ileum (20-cm segment, 0.0380 min(-1)) at closed injection sites. The finding paralleled the distribution of monocarboxylic acid transporter isoform 1 detected by Western blotting along the length of the small intestine. Fits of the systemic and oral data (based on duodenal injection for absorption by the whole intestine) to the traditional, physiological model and to the segregated flow model (SFM) that describes partial intestinal flow to the enterocyte region showed a better fit with the SFM even though metabolite data were absent.

Behavioral and body size correlates of energy intake underreporting by obese and normal-weight women.

OBJECTIVE: To examine behavioral and body size influences on the underreporting of energy intake by obese and normal-weight women. DESIGN: Seven-day estimated food records were kept by subjects before they participated in a 49-day residential study. Self-reported energy intake was compared with energy intake required to maintain a stable body weight during the residential study (reference standard). Energy intake bias and its relationship to various body size and behavioral measures were examined. SUBJECTS: Twenty-two, healthy, normal-weight (mean body mass index [BMI] = 21.3) and obese (mean BMI = 34.2) women aged 22 to 42 years were studied. STATISTICAL ANALYSES: Analysis of variance, paired t test, simple linear regression, and Pearson correlation analyses were conducted. RESULTS: Mean energy intake from self-reported food records was underreported by normal-weight (-9.7%) and obese (-19.4%) women. BMI correlated inversely with the energy intake difference for normal-weight women (r = -.67, P = .02), whereas the Beck Depression Inventory correlated positively with the energy intake difference for obese women (r = .73, P < .01). CONCLUSION/APPLICATIONS: Results suggest that body size and behavioral traits play a role in the ability of women to accurately self-report energy intake. BMI appears to be predictive of underreporting of energy intake by normal-weight women, whereas emotional factors related to depression appear to be more determinant of underreporting for obese women. Understanding causative factors of the underreporting phenomenon will help practicing dietitians to devise appropriate and realistic diet intervention plans that clients can follow to achieve meaningful change.

Cognitive function, iron status, and hemoglobin concentration in obese dieting women.

OBJECTIVE: To determine the relationships between cognitive function and iron status in dieting obese women. DESIGN: Longitudinal weight loss study (repeated measures within-subject design) with 3 weeks of baseline, 15 weeks of 50% caloric restriction, and 3 weeks of weight stabilization. Dietary iron was fed at twice the US Recommended Dietary Allowance with half of the iron from food sources and half from an oral supplement. SETTING: This was a free-living study with the exception that subjects came to the research center for one meal per day and were provided all other meals and snacks to take home. SUBJECTS: Healthy, premenopausal, obese women (mean BMI=31.5) were recruited through local newspaper, poster and radio advertising. Twenty-four women volunteers were recruited and 14 completed the study. MEASUREMENTS: Cognitive function, iron and hematological status, height, body weights and body composition were measured at baseline; at weeks 5, 10, and 15 of the energy restriction period; and at the end of weight stabilization. Computerized cognitive tests included: Bakan vigilance task, two finger tapping, simple reaction time, immediate word recall, and a focused attention task. Iron status and hematological measures included: serum iron, total iron binding capacity (TIBC), transferrin saturation, serum ferritin, hemoglobin (Hb), hematocrit, red cell count, MCV, MCH, MCHC, and RDW. RESULTS: A significant reduction in Hb, hematocrit, and red blood cell count occurred across the study. Hb at the end of the study was positively correlated (r=0.72, P < 0.01) with mean performance on a measure of sustained attention. Transferrin saturation also correlated positively to sustained attention task performance for those subjects whose Hb declined across the study (r=0.86, P < 0.01). CONCLUSIONS: These findings suggest that dieting diminishes iron status in obese women, even when sufficient dietary iron is available, and that the inability to sustain attention may be an early sign of developing iron deficiency in dieting women.

Cognitive effects of a long-term weight reducing diet.

OBJECTIVE: To investigate if long-term caloric restriction under controlled conditions adversely affects cognitive function in obese women. SUBJECTS: Healthy, premenopausal women between 23-42 y. Dieting group: n = 14. CONTROL GROUP: n = 11. DESIGN: Longitudinal weight loss study (repeated measures within-subject design) with 3 weeks of baseline, 15 weeks of 50% caloric restriction, and 3 weeks of weight stabilization. MEASUREMENTS: Computerized cognitive function tests (sustained attention, short-term memory, simple reaction time, motor performance and attentional focus), height, body weight, body composition (TOBEC) and behavioral questionnaires (Dutch Eating Behaviour Questionnaire, Eating Attitudes Test, and State-Trait Anxiety Inventory). RESULTS: Dieting women lost 12.3 +/- 5.5 kg (mean +/- s.d.) of body weight. Controlled long-term caloric restriction significantly slowed simple reaction time but did not diminish sustained attention, motor performance or immediate memory. Word recall performance significantly improved by 24% at the end of caloric restriction. CONCLUSIONS: The slowing of simple reaction time is a short-term and long-term consequence of caloric restriction. In contrast to previous short-term dieting studies, sustained attention and immediate memory were not impaired with long-term caloric restriction.

Effects of a carotene-deficient diet on measures of oxidative susceptibility and superoxide dismutase activity in adult women.

The effect of consuming a low carotene diet (approximately 60 micrograms carotene/day) on oxidative susceptibility and superoxide dismutase (SOD) activity in women living in a metabolic research unit was evaluated. The diet had sufficient vitamins A, E, and C. The women ate the diet supplemented with 1500 micrograms/day beta-carotene for 4 days (baseline), then the unsupplemented diet for 68 days (depletion), followed by the diet supplemented with > 15,000 micrograms/day carotene for 28 days (repletion). Production of hexanal, pentanal, and pentane by copper-oxidized plasma low density lipoproteins from carotene-depleted women was greater than their production of these compounds when repleted with carotene. Erythrocyte SOD activity was depressed in carotene-depleted women; it recovered with repletion. Thiobarbituric acid reactive substances in plasma of carotene-depleted women were elevated and diminished with repletion. Dietary carotene seems to be needed, not only as a precursor of vitamin A, but also to inhibit oxidative damage and decrease oxidation susceptibility.

Changes in dietary intake, urinary nitrogen, and urinary volume across the menstrual cycle.

The effect of four menstrual cycle phases on changes in dietary intake, urinary nitrogen excretion, and urinary volume was examined in nine women confined to a metabolic unit, maintained at a constant activity level, and fed an ad libitum, rotating, staff-weighed diet. No significant changes in intakes of energy, protein, and fat occurred throughout the menstrual cycle although significant changes were found for intakes of ascorbic acid and water in food. A significant increase in consumption of carbonated, sugar-containing beverages was found in the luteal phase as was a significant increase in urine volume. Results suggest food choices and urine volume may be responsive to physiological regulators associated with hormonal changes in the menstrual cycle. Findings also suggest that energy intake is not altered across the menstrual cycle when physical activity is controlled and an accurate dietary assessment method is employed.

Nutrition Evaluation Scale System reduces time and labor in recording quantitative dietary intake.

A time and labor cost study was conducted to evaluate two quantitative techniques for recording dietary intake of individuals: the Nutrition Evaluation Scale System (NESSy) and the weighed food record. NESSy, a new computerized method, uses interactive software to prompt and guide participants through the recording of food weights and descriptions. Twelve men and nine women (aged 23 to 36 years, with 11 to 16 years of education) utilized NESSy for 16 consecutive days while residing in a metabolic research unit. Concurrently, food intake was weighed and manually recorded by trained dietary staff. Analysis of variance on data gathered from NESSy showed no statistically significant differences among sex, age, and educational groupings in the time spent using NESSy. NESSy required 1.73 +/- 0.3 minutes (mean +/- SD) to weigh in, weigh out, and record each food item consumed, whereas the manual technique required 8.4 minutes. The reason for the magnitude of time difference between the two methods is that NESSy provides the flexibility of weighing and recording only foods eaten whereas the manual method requires complete entry of all foods served whether eaten or not. Using the Nutrition Evaluation Scale System to record food intake provides savings in time and labor of about 80%.

Validation of a new computerized technique for quantitating individual dietary intake: the Nutrition Evaluation Scale System (NESSy) vs the weighed food record.

A validation study was conducted in which food intake recorded by research volunteers using a new computerized technique, the Nutrition Evaluation Scale System (NESSy), was compared with food intake obtained from a weighed food record concurrently measured and recorded by metabolic unit dietary staff. Nine women between ages 23 and 35 y resided in the metabolic research unit and recorded their food intake with NESSy for 16 consecutive days. The mean of the differences between NESSy and the manual technique was not significant on a group basis (p less than 0.05) for food energy or any other nutrient. All mean differences were less than 5% and Pearson correlation coefficients ranged from 0.81 to 0.98 (p less than 0.0001), with all but iron, potassium, sodium, and preformed niacin having correlations greater than 0.92. For the majority of the individuals, accuracy within 10% of their actual dietary intake was found for energy and selected nutrients. NESSy is a new computerized approach to dietary intake assessment that yields accurate data on both a group and individual basis.

Nutrient content of the diet when the fat is reduced.

When the fat content of the typical US diet was reduced from 40 to 44% of total energy (en %) to approximately 25 en % there was a marked improvement in the overall nutrient content of the diet. Cholesterol, saturated fatty acid, and monounsaturated fatty acid intake were decreased and the polyunsaturated fatty acid content was moderately increased. This kind of dietary change was achieved without changing the usual intake of meats, dairy products, fish, and eggs. As the amount of fat was decreased, carbohydrates in the form of grains, fruits, and vegetables were increased, providing an improvement in the vitamin and mineral content of the diet. Vitamin C, thiamin, riboflavin, niacin, B-6, B-12, and folates increased in the 25 en % diet. Potassium, calcium, magnesium, phosphorus, iron, zinc, and copper intake also increased when the dietary fat decreased.