Evaluation of the state of health of living related kidney transplantation donors.

Renal transplantation is the optimal mode of therapy for patients with end-stage renal disease; the results are even better with living related donors. This procedure, therefore, favours the recipients, but what are the consequences for the donor? At our Department, between 1973 and 1996, 1325 kidney transplantations were performed, 78 from living, related donors (5.89%). We decided to follow up these patients and investigate the function of the remaining kidney and also their current general health status. Thirty donors (38.4%) were investigated. Of these, 25 of had normal blood pressure and 5 were hypertensive, needing antihypertensive treatment. The average age was higher in the hypertensive group (60.2/53.25 years). The time interval since transplantation was longer in the hypertensive group than in the normal one. We carried out a scintigraphy of the kidney with Tc-99mMAG-3. The mean value of the glomerular filtration rate calculated from the MAG clearance was 98.1 ml/min and this value is higher than half of the normal isotope clearance value, i.e. higher then the expected value for a single kidney. We conclude that no impairment of renal function is observed in the living, related kidney donors. In 16.66% a mild hypertension developed. With isotope investigation we found hypertrophy of the remaining kidney. Thus, after a correct preoperative assessment, unilateral nephrectomy has no long-term consequences in healthy donors.

Discrepancy between self-reported and actual caloric intake and exercise in obese subjects.

BACKGROUND AND METHODS: Some obese subjects repeatedly fail to lose weight even though they report restricting their caloric intake to less than 1200 kcal per day. We studied two explanations for this apparent resistance to diet--low total energy expenditure and underreporting of caloric intake--in 224 consecutive obese subjects presenting for treatment. Group 1 consisted of nine women and one man with a history of diet resistance in whom we evaluated total energy expenditure and its main thermogenic components and actual energy intake for 14 days by indirect calorimetry and analysis of body composition. Group 2, subgroups of which served as controls in the various evaluations, consisted of 67 women and 13 men with no history of diet resistance. RESULTS: Total energy expenditure and resting metabolic rate in the subjects with diet resistance (group 1) were within 5 percent of the predicted values for body composition, and there was no significant difference between groups 1 and 2 in the thermic effects of food and exercise. Low energy expenditure was thus excluded as a mechanism of self-reported diet resistance. In contrast, the subjects in group 1 underreported their actual food intake by an average (+/- SD) of 47 +/- 16 percent and overreported their physical activity by 51 +/- 75 percent. Although the subjects in group 1 had no distinct psychopathologic characteristics, they perceived a genetic cause for their obesity, used thyroid medication at a high frequency, and described their eating behavior as relatively normal (all P < 0.05 as compared with group 2). CONCLUSIONS: The failure of some obese subjects to lose weight while eating a diet they report as low in calories is due to an energy intake substantially higher than reported and an overestimation of physical activity, not to an abnormality in thermogenesis.

Chromium in the elderly.

Several studies indicate that glucose tolerance improves and lipid levels decline in the elderly after supplementation with Cr-rich brewer's yeast or inorganic Cr. Other studies report equivocal results or no changes. Interpretation of these investigations is hampered by 1. Lack of a marker to identify Cr-deficient people 2. Artifactually high levels of dietary and body Cr, owing to inadequate analytic techniques and 3. The interplay of chronic health problems, medications, institutionalization, and dietary practices. Investigators have studied the effects of aging on Cr in the body. In the rat, tissue retention of 51Cr decreases, and organ distribution changes with age. In humans, plasma Cr levels of healthy elderly subjects are not different from those of young adults. There is no evidence of malabsorption in aged humans or animals. Nevertheless, higher urinary Cr losses are reported in elderly people. These data suggest that Cr retention may decrease with aging and that aging may alter Cr metabolism. Diets of many healthy elderly people contain less than 30 micrograms Cr. Two elderly men living under controlled conditions maintained Cr balance with 37 micrograms/d. However, these levels may be insufficient during the stresses and illnesses associated with aging.

Absorption of inorganic, trivalent chromium from the vascularly perfused rat small intestine.

The absorption of inorganic, trivalent chromium (Cr) by the rat small intestine was investigated by quantifying three components of the absorptive process: 1) Cr uptake from a test meal, 2) Cr transport into the circulation and 3) Cr retention by the intestine. An in vitro, in situ double-perfusion technique was used in which the intestinal vasculature, from the superior mesenteric artery to the portal vein, and the intestinal lumen, from the duodenum to the ileum, were perfused simultaneously. The vasculature was perfused with a synthetic "plasma" (vascular perfusate) while the lumen was perfused with a nutrient-rich solution (intestinal perfusate) at concentrations of trivalent Cr of 0.2-20 mumol/l (10-1000 ppb). Dose-response curves, in which Cr transport, retention and uptake were plotted against the luminal Cr concentration, revealed that Cr absorption is a nonsaturable process. Regardless of the Cr concentration of the intestinal perfusate, 5.90 +/- 0.33% (mean +/- SEM) of the test dose was taken up from the meal, 5.52 +/- 0.33% was transported into the vascular perfusate and 0.38 +/- 0.03% was retained by the small intestine. Based on the criterion of saturability, it was concluded that inorganic, trivalent Cr is absorbed by the nonmediated process of passive diffusion in the small intestine of rats fed a Cr-adequate diet (1.44 micrograms Cr/g diet).

Metabolic chromium balances in men.

A chromium (Cr) balance study was conducted on a metabolic unit for 12 days in two normal males, ages 62 and 66, ingesting a nutritionally adequate, constant diet. Complete urine and stool collections were obtained daily. The diet, stool, and urine were analyzed for chromium by Zeeman atomic absorption spectrometry. On dietary Cr intakes of 36.9 and 36.7 micrograms/day, only a small fraction of the ingested Cr, 0.9 microgram and 0.5 microgram/day, was absorbed. Most of the dietary Cr, 36.0 micrograms and 36.2 micrograms/day, was excreted in the stool. Urinary Cr was constant from day to day with a mean of 0.30 microgram/day +/- 0.03 SD and 0.28 microgram/day +/- 0.05 SD. The Cr balances (apparent net retention) were positive, 0.6 and 0.2 microgram/day, indicating equilibrium. The average apparent net absorption of Cr for the two subjects was 1.8%.

Rapid enzymatic pretreatment of samples before determining chromium in serum or plasma.

A simplified method for preparing blood serum and plasma for Zeeman electrothermal atomic absorption spectrometry is described and applied to the measurement of chromium in human serum and plasma. This enzymatic degradation with bacterial protease (EC 3.4.21.3) requires little laboratory apparatus, decreases the work and time of sample preparation, and obviates some potential sources of contamination. We used bovine reference serum (USDA No. 7292) to validate Cr concentration. There was less Cr in serum than in plasma, whether sodium heparin or sodium citrate was used as anticoagulant. For six human subjects, Cr in serum averaged 0.15 (SD 0.02) micrograms/L, 0.26 (SD 0.03) micrograms/L in heparinized plasma, and 0.28 (SD 0.02) micrograms/L in citrated plasma. We postulate that the Cr concentration is lower in serum because some of the Cr binds to proteins complexed with the clot in the coagulation process.

The effects of inorganic chromium and brewer's yeast on glucose tolerance, plasma lipids, and plasma chromium in elderly subjects.

Twenty-three healthy, well-nourished, free-living elderly volunteers were given daily, for 10 wk, 5 g brewer's yeast, 200 micrograms Cr3+ as chromic chloride (CrCl3), or placebo. There were no significant changes in glucose tolerance, insulin, cholesterol or triglycerides after supplementation in any of the three groups. Plasma Cr3+ rose significantly after supplementation with CrCl3 but did not change after yeast or placebo supplementation. Plasma Cr3+ did not increase after an oral glucose load and did not correlate with glucose, insulin or lipid values in any of the groups. Calculated intakes of eight indicator nutrients were well above 100% of the RDA except for calcium. These healthy elderly persons, eating nutritious diets, are not at risk for Cr3+ deficiency as measured by the absence of a clinical response to CrCl3 or brewer's yeast supplementation. This study suggests that age per se is not a factor leading to Cr deficiency.

Beneficial effect of chromium-rich yeast on glucose tolerance and blood lipids in elderly subjects.

Twenty-four volunteers, mean age 78, including eight mildly non-insulin-dependent diabetics, were randomly allocated to one of two groups and were fed (daily for 8 wk) 9 g of either chromium-rich brewers' yeast (experimental) or chromium-poor torula yeast (control). Before and after yeast supplementation, the serum glucose and insulin response to 100 g oral glucose was measured at 30 min intervals for 2 h. Fasting serum cholesterol, total lipids, and triglycerides were also determined. In the total experimental group (normals + diabetics) and in both the diabetic and nondiabetic experimental subgroups, glucose tolerance improved significantly and insulin output decreased after supplementation. Cholesterol and total lipids fell significantly after supplementation in the total experimental group. The cholesterol decrease was particularly marked in hypercholesterolemic subjects (cholesterol > 300 mg/dl). In the control group, no significant change in glucose tolerance, insulin, triglycerides, or total lipids was found. Cholesterol was significantly lowered in the nondiabetic but not in the diabetic group. Thus, chromium-rich brewers' yeast improved glucose tolerance and total lipids in elderly subjects, while chromium-poor torula yeast did not. An improvement in insulin sensitivity also occurred with brewers' yeast supplementation. This supports the thesis that elderly people may have a low level of chromium and that an effective source for chromium repletion, such as brewers' yeast, may improve their carbohydrate tolerance and total lipids. The improvement in serum cholesterol in some control subjects, as well as in the total experimental group, also suggests the presence of a hypocholesterolemic factor other than chromium in both brewers' and torula yeast.