Hypertension in early alcohol withdrawal in chronic alcoholics.

AIMS: Hypertension is an established risk factor in chronic alcoholics, but little is known about the relationship between blood pressure (BP), severity of their alcohol abuse, and severity of alcohol withdrawal syndrome (AWS). METHOD: BP was assessed daily for 18 days in a series of chronic alcoholics on early alcohol withdrawal (AW), while also assessing the severity of their AWS on the CIWA-Ar scale. RESULTS: A sharp and sustained decrease in BP was observed after AW; at T0, BP had increased in 55% of patients, and at T18 in 21%. The variation of BP is partially explained by years of at-risk drinking and AWS severity, but other factors may play a role in hypertension in alcoholics, as a large amount of BP variation was not explained by the alcohol-abuse-related parameters that we studied. BP values were not correlated with cigarette smoking, anxiety, or depression. Hypertension found in 'detoxified' alcoholics (approximately 20%) may be related to alcohol-independent hypertension or to a long-lasting alcohol-induced derangement of the BP regulating mechanisms. Further research is needed in these patients to elucidate the mechanisms of persistent hypertension and to set up a treatment protocol. At present, careful monitoring is advisable, as well as pharmacological treatment for moderate or severe hypertension; often a modification of life-style is needed which includes physical activity and possibly sodium (Na) restriction, since hypertension in detoxified alcoholics seems to be Na sensitive. CONCLUSION: Complete alcohol abstinence must be recommended to all hypertensive alcoholics, as AW-induced transient hypertension was found to be harmless in all our subjects, and abstinence leads to a complete recovery from hypertension in most cases.

Erythrocyte thiamine (Th) esters: a major factor of the alcohol withdrawal syndrome or a candidate marker for alcoholism itself?

AIMS: Thiamine (Th) deficiency is a major problem in alcoholics. In this study, the relationship of alcohol withdrawal syndrome (AWS) to Th and its esters, as well as the diagnostic power of Th and its esters were investigated. PATIENTS AND METHODS: Th and its esters were assessed in a series of chronic alcoholics (and in controls) using an improved method. RESULTS: No association was found between AWS severity and Th and its esters, while the diagnostic power of thiamine diphosphate (TDP) and Th was very high. TDP was the most significant among the parameters under study, confirming that erythrocyte TDP is a suitable marker of alcoholism: TDP sensitivity across subjects was 84.1%, specificity 85.4%, positive predictive value 82.4%, and negative predictive value 88.0%.

Body composition changes induced by chronic ethanol abuse: evaluation by dual energy X-ray absorptiometry.

OBJECTIVE: Nutritional disorders in alcoholics remain one of the most relevant medical problems in Western societies. As ethanol can supply >50% of the dietary energy in alcoholics, body composition alterations may easily occur. The aim of the present study was to evaluate the influence of chronic alcohol consumption on body composition in alcoholics compared to healthy social drinkers. METHODS: A total of 34 alcoholics defined according to DSM III R criteria, aged 41.6 +/- 9.3 yr and with a body mass index (BMI) 23.8 +/- 3.2 kg/m2, were consecutively enrolled in the study. In addition, 43 healthy male social drinkers were used as controls. Body composition was assessed using dual energy x-ray absorptiometry (DXA), and dietary habits were determined by a 3-day food diary. RESULTS: Mean daily alcohol intake was 194 +/- 62.4 g/day in alcoholics and 35.7 +/- 5.2 in healthy subjects (p < 0.0001). Body weight did not differ between alcoholics and controls (70.1 +/- 9.9 vs 71.8 +/- 6.4 kg). Alcoholics had a lower percent body fat (PBF) than control subjects (18.7 +/- 3.7 vs 23.9 +/- 3.9%; p < 0.01), as well as a lower fat mass content (13.4 +/- 3.8 vs 17.0 +/- 3.7 kg; p < 0.01). BMI was highly correlated with PBF in the patient population studied (R = 0.79; p < 0.0001). Significantly higher waist-to-hip ratios were found in alcoholics than in healthy subjects (p < 0.01). No correlation was found between dose of ethanol or duration of alcohol abuse and any of the variables examined. CONCLUSIONS: Alcoholics showed a reduced fat mass and a good preservation of lean body mass with respect to control subjects, and duration of alcohol use and alcohol dose did not seem to influence body composition. These data suggest that, unlike control subjects, alcoholics cannot store the calories provided by ethanol as fat deposits.

Assessment of body composition by bioelectrical impedance in adolescent patients with celiac disease.

OBJECTIVE: Assessment of body composition is of primary importance in the management of celiac adolescents. We aimed to evaluate body composition by dual-energy x-ray absorptiometry and bioelectrical impedance in celiac adolescents on a gluten-free diet to investigate whether impedance may provide an alternative method to assess nutritional status in these patients. METHODS: We studied body composition in 43 adolescents affected by celiac disease on a gluten-free diet for > or = 1 yr and 30 healthy subjects. Fat, fat-free, and bone masses were assessed by dual-energy x-ray absorptiometry. Fat and fat-free masses were also assessed by bioelectrical impedance. All anthropometric measurements were performed according to standard procedures. RESULTS: All patients had a significantly lower body weight, height, fat-free mass, bone mineral density (p < 0.001), and body mass index (p < 0.01) compared with controls. In contrast, parameters predicting fat compartment (sum of skinfolds and fat mass) did not differ from those of controls. No significant difference was found between patients strictly adherent to a gluten-free diet and patients partially compliant. Compared with dual-energy x-ray absorptiometry measurements, bioelectrical impedance showed a high accuracy to estimate fat-free mass (R2 = 0.97) and limited accuracy for fat mass (R2 = 0.75). Furthermore, impedance was more reliable for estimating hydration of soft tissue underlying the fat-free mass changes. CONCLUSIONS: In adolescents with celiac disease, after a mean of 1 yr of gluten-free diet all the parameters assessing body compartments, except fat mass, were affected, compared with healthy controls. Bioelectrical impedance holds promise for routine assessment of body composition changes in celiac adolescents on a gluten-free diet.

Effects of weight loss on body composition and pulmonary function.

BACKGROUND: The relationship between obesity, impaired respiratory function and weight loss is established. OBJECTIVE: Some aspects need further elucidation: the different impact of the pathological modifications of body compartments (total and regional fat mass and lean body mass) on respiratory function, the choice of a restricted diet, the relationship between the modifications of body compartments and the variations in respiratory parameters after weight loss. METHODS: The restricted diet was elaborated according to the traditional Mediterranean diet. In a series of 16 obese patients, respiratory function was assessed by spirometry; body composition was assessed by dual-energy X-ray absorptiometry, allowing the direct estimation of total and segmental body fat and lean body mass. RESULTS: Weight loss was sustained mainly by fat mass decrease, mostly upper body fat. Total and truncal lean body mass were not affected. Lung volumes and function were improved. A correlation was observed between lean body mass and respiratory parameters, and was unmodified after weight loss. CONCLUSIONS: Mediterranean-style restricted diet was well accepted and enabled a selective decrease in fat mass, with a good improvement in lung function. Truncal fat (as well as abdominal fat) was decreased, while truncal lean body mass (i.e. respiratory muscles) were not affected, as expected in obese subjects with respiration problems.

Fat-free mass by bioelectrical impedance vs dual-energy X-ray absorptiometry (DXA).

Body composition (BC) assessment is a useful tool for a careful evaluation of nutrition status. Bioelectrical impedance analysis (BIA) is a safe, low-cost and reliable method for BC assessment. For epidemiological and clinical research in children, paediatric-age specific formula for fat-free mass (FFM) prediction from BIA is needed. Thus, in 35 children (age 7.7-13.0 years) with different levels of body fatness (relative weight for age 70.6-133.8%), FFM was calculated from dual-energy X-ray absorptiometry (DXA). A regression equation from BIA and DXA data was elaborated. The impedance index (ZI = height2/bioelectrical impedance) was the strongest predictor of FFM, explaining 89% of its variance. However, the variance increased to 96% when body weight was added with ZI in the regression model. No variable, including sex and age, contributed to the prediction of FFM in the presence of ZI and body weight. The regression formula [FFM = 2.330 + 0.588 ZI (cm2/omega) + 0.211 Weight (kg) (r = 0.96, SEE = 1.0 kg)], allows a reliable prediction of FFM in children from body impedance values.

Marked decrease of plasma neuroactive steroids during alcohol withdrawal.

The neuroactive steroids allopregnanolone (ALLO) and allotet-rahydrodeoxycorticosterone (THDOC) are the most potent endogens positive modulators of gamma-aminobutyric acid (GABA) on GABAA receptors, a receptor system presumably responsible for some behavioral responses to alcohol withdrawal. In a group of nine alcoholic subjects, the levels of plasma ALLO and THDOC were markedly lower than those of control subjects during the early withdrawal phase (day 4 and 5), when anxiety and depression scores were higher. In contrast ALLO and THDOC plasma levels did not differ from those of control subjects during the late withdrawal phase when anxiety and depression scores were low. These results suggest that the decrease of neuroactive steroid biosynthesis may contribute to the withdrawal symptoms.

Improved prediction formula for total body water assessment in obese women.

OBJECTIVE: To validate an improved formula for the calculation of total body water (TBW) from impedance values in obese women. SUBJECTS: A sample of 37 overweight females BMI ranging from 29.5 to 44.1 kg/m2. MEASUREMENTS: The reference measurements for TBW were obtained by deuterium oxide dilution. Body height (h), hip circumference (C) as well as body impedance at 100 kHz (Z100) were also measured. RESULTS: The values obtained for h, C and Z100 were introduced in the calculations and the following developed formula for total body water was determined: TBW = 0.069 [hC2/(4 pi .Z100)]+19.671. The validity of this formula was assessed through the statistical test of Bland and Altman which we also performed for other formulas containing the weight and/or the height. CONCLUSION: We found that the accuracy of the prediction of TBW by our formula, although lower than those formulas using body weight, is higher than that which takes into account only body height. We conclude that body volume, expressed through body height and hip circumference, is a good choice of parameter in bioelectrical impedance measurements. The new approach can be useful in clinical settings for repeated monitoring of obese women, during diet-restricted treatment.

Multifrequency impedance in the assessment of body water losses during dialysis.

Multifrequency bioelectrical impedance was used to predict changes in body water compartments during renal dialysis. Weight loss during dialysis was assumed to be water loss. Predicted total body water (TBW) from impedance after dialysis did not differ significantly from TBW determined by deuterium oxide dilution. However, the predicted change in TBW from bioelectrical impedance largely exceeded the observed weight (water) loss. The predicted change in extracellular water was slightly but significantly lower compared to the observed weight loss. The ratio of impedance at 1-100 kHz increased in all subjects during dialysis, and may be a simple tool to assess body water distribution.

Body impedance measurements during dialysis.

Changes in body weight in relation to changes in body impedance were studied in six male and four female patients before and during dialysis. Before dialysis, fat-free mass from skinfolds was 46.5 +/- 6.8 kg, and total body water calculated from bio-electrical impedance was 36.9 +/- 5.2 kg. Body water expressed as a percentage of fat-free mass was calculated to be 80 +/- 4%. Mean weight loss, which was assumed to be only loss of water, was 2.7 +/- 0.7 kg. Total body impedance increased by 80 +/- 16 omega from 495 +/- 39 omega to 575 +/- 47 omega. Weight loss and increase in body impedance were highly correlated (r = -0.91, P less than 0.001). However, based on prediction formulas for total body water from bio-electrical impedance, the observed weight (water) loss should be associated with an increase in impedance of only 39 +/- 11 omega. It is concluded that the impedance value before dialysis is a relatively low value, due to the low specific resistivity of the excess of extra-cellular water in the body before dialysis. As a consequence, prediction formulas for body composition from bio-electrical impedance, developed in normal hydrated subjects, overestimate body composition (total body water, fat-free mass) in subjects with oedema.

Bioelectrical impedance assay (BIA) of total body composition in alcohol-induced migraine patients. Preliminary report.

"Whole body composition" was investigated in 30 people subject to alcohol-induced migraine. The control group was 30 people matched for age, sex, height and weight, who were not subject to migraine and who consumed moderate amounts of alcohol. The following were evaluated: anthropometric data, alcohol intake in grams per day, total body water, fat-free mass, fat mass, and body mass index (kg/m2). Two methods of measurement were used: skin fold thickness evaluation, and bioelectric impedance assay (BIA). BIA is a non-invasive method based on the principle that lean tissues conduct a low frequency alternating current of electricity better than do fatty tissues. Body mass index was increased in the alcohol-induced migraine patients (p less than 0.04), as was fat mass, (p less than 0.03) as evaluated by skin fold measurements. Bioelectric impedance assay demonstrated a slight total body water increase in alcohol-induced migraine patients (p less than 0.07). Possibly, if this total body water increase was reflected at the neuronal level, the bioelectric properties of the migrainous brain may be altered, thus creating a hypothetical link with the phenomenon of spreading depression.

Lecithin: cholesterol-acyltransferase (LCAT) activity in alcoholic liver disease.

The activity of LCAT (the controlling enzyme for cholesterol esterification in plasma) is known to be reduced in alcoholic cirrhosis, while little is known about early stage (liver steatosis) alcoholics. In this study, LCAT activity was assayed by Stokke and Norum's method, before and after a 15-day sobriety period, in liver steatosis and in cirrhosis alcoholics. Before alcohol withdrawal, LCAT activity was depressed in both groups. After the sobriety period, LCAT activity was significantly raised in liver steatosis patients, but was still lower than in controls; in cirrhosis patients, it was increased, but not significantly. According to our results, LCAT activity impairment in alcoholic liver disease is sustained by both the hypothesized mechanisms, alcohol-related metabolic disorders and lowered LCAT-enzyme production, but to different degrees, depending on the stage of the disease. In liver steatosis, metabolic disorders play a major role, as a liver-impairment-induced decrease in LCAT production seems rather unlikely, and increased LCAT activity is more likely to be sustained by metabolic normalisation than by any recovery of the damaged liver. However, the lack of improvement in about 20% of patients, and the fairly wide scattering of individual data, suggest a minor LCAT production impairment in liver steatosis too. In cirrhosis, the major role seems to be played by a permanent decrease in LCAT production, as no significant rise in LCAT activity was observed after alcohol withdrawal. However the restored LCAT activity observed in some patients could be related to improvement in the metabolic disorder, thus confirming the effectiveness of this mechnism in cirrhosis too.(ABSTRACT TRUNCATED AT 250 WORDS)

[Esterification of cholesterol in patients with renal transplants. Determination of lecithin:cholesterol-acyl-transferase (LCAT) activity]. / Esterificazione del colesterolo in portatori di trapianto renale. Determinazione dell'attività lecitin: colesterol-acil-transferasica (LCAT).

In man, cholesterol esterification is controlled by lecithin:cholesterol-acyl-transferase (LCAT), which is a key-role enzyme of lipid metabolism. Though LCAT is synthesized by the hepatocytes, its activity seems to be linked to the kidney: in fact, LCAT activity is lowered in uremic and anephric subjects, and probably also in long-term haemodialysis patients. On the contrary, in successfull renal allografts we found fully restored LCAT activity. But physiopathological mechanisms underlying relationships between LCAT and kidney are still unclarified.

Lecithin: cholesterol-acyl-transferase (LCAT) activity in renal allograft patients. Preliminary report.

LCAT activity is impaired in chronic renal failure. Our data show that LCAT activity is restored in successful renal transplant patients. Hence, relationship between kidney and LCAT activity can be postulated, but the underlying mechanisms are not yet fully clarified.

Pure red cell aplasia: studies on an IgG serum inhibitor neutralizing erythropoietin.

A new type of IgG serum inhibitor in adult pure red cell aplasia (PRCA) has been investigated. This inhibitor is directed against circulating erythropoietin (Ep) (PRCA type B), rather than the erythroid marrow (PRCA type A). Thus, the IgG inhibitor, after interaction with Ep in solution, is precipitated together with Ep by addition of goat anti-human gamma-globulins. Pre-therapy PRCA serum, although apparently devoid of Ep, shows considerable Ep activity following acidification and boiling. The inhibitor is absent from post-therapy serum, while Ep levels are elevated. An experimental model for PRCA type B has been established in normal mice after prolonged administration of pre-remission serum IgG.