Massive obesity in adolescents: dietary interventions and behaviours associated with weight regain at 2 y follow-up.

OBJECTIVE: To compare the influence of weight-reducing diets containing different amounts of protein and CHO on body composition in obese adolescents and to examine dietary and physical activity behaviours during follow-up. DESIGN: Prospective randomised study comparing two weight-reducing diets with the same energy (1750 kcal) and fat (31%) content, but different protein and carbohydrate contents: PROT- (15% protein, 54% CHO) vs PROT+ (19% protein, 50% CHO). PATIENTS: Massively obese 11- to 16-year-old children (32 boys and 89 girls). SETTING: A 9-month treatment in a medical centre (boarding school) plus a 2-y follow-up in free-living patients examined at home 1 and 2 y after treatment. MEASUREMENTS: Anthropometry, bioelectrical impedance, nutritional intakes and physical activity. RESULTS: Of the 121 eligible children (61 in PROT- and 60 in PROT+), 82% completed the trial until the end of weight loss treatment and 60% were followed 2 y after treatment. Body mass index (BMI) value at inclusion was 36.3 kg/m(2) or 4.3 z-scores (2.9-5.9). BMI z-score decreased to 1.7 at the end of treatment and went back to 2.8 (0.8-6.1) 2 y after treatment. This corresponded to a weight loss of 30.3 kg and weight regain of 21.3 kg. After treatment, energy intake increased and physical activity decreased. The contribution of energy ingested at breakfast decreased while snacking increased. For all measurements, no dietary group differences existed at baseline or at any time during the intervention and follow-up. CONCLUSION: A higher protein content of the diet did not confer any benefit in the treatment of childhood obesity. Substantial weight loss was obtained with a moderately energy-restricted diet and normal fat content. After weight loss, mean weight increased in spite of moderate energy intake, together with a drift towards obesity-associated behavioural patterns. The causes of the inability to adopt normal weight subjects' behaviour permanently deserve to be investigated further.

Clinical status of nutritional origin involving immune deficiency.

The relationships between nutrition and immune defence in man are poorly understood. The clinical situations of nutritional origin involving immune deficiency: protein energy malnutrition (marasmus and kwashiorkor), nutritional disorders in developed countries, anorexia, obesity, mineral salt and vitamin deficiencies, hypercholesterolemia and alcoholism are reviewed.

[Incidence of lipid changes in rhegmatogenous retinal detachment, retinal vein occlusion and primary chronic glaucoma]. / Incidence des altérations lipidiques au cours du décollement de rétine rhegmatogène, de l'occlusion veineuse rétinienne, du glaucome chronique primitif.

Several studies suggest that vascular factors may play a role in the pathogenesis of rhegmatogenous retinal detachment, retinal vein occlusion and primary chronic glaucoma. We explored the lipoprotein abnormalities in three groups of 45 patients suffering from each of these diseases compared to three control groups. We did not find significant abnormalities of cholesterol, cholesterol lipoproteins, nor Apolipoprotein B. The only significant abnormality was the presence of a higher rate of hypertriglyceridemia in the retinal vein occlusion and primary chronic glaucoma groups in comparison with their control group. In these two affections, hypertriglyceridemia should be systematically researched and treated.

Determination of 3 methyl-L-histidine in human urine by ion exchange high performance liquid chromatography. Applications to patients in post-operative surgical care.

A new chromatographic procedure is proposed for measuring 3 methyl-L-histidine (3 MH) in human urine. The sample was purified on a cation-exchange resin (AGR 50W-X4) and analysed by ion exchange high performance liquid chromatography on a PARTISIL 10 SCX Whatman column in UV light at 210 nm within 16 min. This procedure gave similar outputs of 3 MH to those described in human normal urine (mean +/- SEM = 213 +/- 15 mumol X 24 h-1, n = 19). It was used to measure the urinary outputs of 3 MH of five patients admitted to an intensive surgical care unit, for 48, 28, 25, 15 and 10 days, respectively. The urinary outputs of 3 MH were normal or lower than normal. The 10(3) urinary 3 MH/creatinine molar ratios were also calculated; this new 3 MH analysis could help the reanimator to prescribe an adequate nutritional assessment.

Quantification of lipoprotein X and its relationship to plasma lipid profile during different types of parenteral nutrition.

An abnormal lipoprotein (LP), detected in plasma during total parenteral nutrition, has been shown to be similar to LPX observed in cholestasis and in familial lecithin-cholesterol-acyl-transferase (LCAT) deficiency. However, the conditions which facilitate the appearance of LPX during total parenteral nutrition are unclear; potential determining factors could be lipid input, plasma lipid levels, and/or inhibition of LCAT activity. An investigation was conducted on 12 patients receiving total parenteral nutrition for 3 wk by simultaneously evaluating plasma LPX (via a quantitative method) as well as total cholesterol, phospholipids (PL), triglycerides (TG), apolipoprotein B, and LCAT activity. Daily total nonprotein calories (40 kcal/kg body weight) and nitrogen input (250 mg/kg body weight) were fixed in this study. Three 7-day periods were defined: during periods 1 and 3, lipid emulsion (10 or 20% Intralipid) and glucose were given as nonprotein calories (glucose-lipid periods); in period 2, glucose was administered alone as the sole source of nonprotein energy (glucose period) so that the total energy input was not modified. During periods 1 and 3, the patients were randomly assigned to receive either 9 g (period 1) and 12 g (period 3) of PL/day for 7 days, or 12 and 9 g of PL/day. By infusing either 10 or 20% Intralipid, TG input was varied concomitantly so that the subjects received 75, 100, or 150 g/day in periods 1 and 3. During the glucose-lipid periods, plasma LPX was measurable from the 2nd day and increased progressively. Its increment was closely related to a rise in unesterified cholesterol and PL (r = 0.7; p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Energy and nitrogen balances in 24 severely burned patients receiving 4 isocaloric diets of about 10 MJ/m2/day (2392 Kcalories/m2/day).

Twenty-four subjects with burns ranging from 25-70 per cent received for 12 days exclusively per os a series of 4 isocaloric diets of about 4000 Kcal--'normal', or hyperproteic, or hyperlipidic, or hyperglucidic according to a randomized schedule. Oxygen consumptions were measured at the end of each diet and nitrogen balance was determined every day. Though patients were not massively overfed there remained a positive energy gap. The nitrogen balance was found to be equilibrated on the whole but clearly positive with the hyperproteic diet and clearly negative with the hyperlipidic-normoproteic diet. Thus there is no rationale for the huge energy overfeeding classically used.

Effects of slimming and composition of diets on VO2 and thyroid hormones in healthy subjects.

Oxygen consumption and plasma thyroid hormone concentrations are modified by both low- and high-calorie diets. It has been suggested that the trigger may be changes in weight ("adipostatic" hypothesis involving the difference between the actual weight and the "set point") or changes in amount of carbohydrate in the diet ("carbohydrate" hypothesis). Two experiments were performed in order to test both hypotheses. Fourteen young healthy volunteers were studied: 1) at their spontaneous stable weight; 2) while losing weight rapidly on a calorically restricted diet; 3) and then at their stable new weight when consuming a refeeding diet. The calorie restricted diet resulted in decrease of VO2, and T3, and an increase of rT3; the refeeding diet resulted in values of VO2, T3, and rT3 intermediate between those of the spontaneous diet and those of the restricted diet. Another group of nine subjects were studied at their spontaneous caloric and proteic levels, comparing a diet containing only protein and carbohydrate with a diet containing only protein and fat. During the low carbohydrate diet rT3 increased and T3 decreased but they remained unchanged during the carbohydrate-rich diet. Thus neither the adipostatic hypothesis nor the carbohydrate hypothesis is sufficient alone to explain the observed changes in serum T3 and rT3.

Carbohydrate intake affects insulin binding to human erythrocytes in normal weight subjects but not in subjects with family obesity.

The effects of different carbohydrate intakes on insulin binding to human erythrocytes were studied in thirty nine obese and twelve normal weight subjects belonging to twelve families with a strong penetrance of obesity("family experiment"), and in nine normal weight subjects with no family or personal history of obesity or diabetes ("diet experiment"). In the "family experiment," the mean insulin binding in obese subjects was significantly lower than in control normal weight siblings and parents. This difference cannot be related to an increase in carbohydrate or caloric intakes, since there was no difference in daily food intake between the obese and the control subjects. In the "diet experiment," the volunteers were studied four times: twice with their spontaneous diet, one with a normocaloric carbohydrate rich diet and once with a normocaloric fat rich diet. Both the carbohydrate and fat rich diets resulted in a significant lowering of binding when compared to the period of spontaneous diet. In the two experiments, the decrease in binding is due to a decrease in the number of receptors per erythrocyte. The possibility of a common underlying mechanism is discussed.

Effects of a high protein very-low-energy diet on ambulatory subjects with special reference to nitrogen balance.

Forty young healthy ambulatory volunteers were given a very-low-energy diet (2.34 MJ, 560 kcal) containing 70 g of proteins of good biological value, 36 g carbohydrates, 2 g potassium, 0.5 g sodium, polyvitamins and 21 water. The nitrogen balance reached equilibrium on the 8th day. No risk factors were found. These results were compared with 4000 cases collected over 12 years. The latter were given a protein diet with neither salt nor carbohydrates. The addition of salts and carbohydrates resulted only in an increase of the subjects' comfort. The analysis of deaths occurring in the U.S.A. after protein diets lead to the conclusion that these very probably linked to the duration of the protein diet, the poor biological value of proteins provided, the insufficiency in potassium intake. The conditions for a safe use of a very-low-energy diet, are a large intake of proteins of good biological value, a large intake of potassium and probably small intake of carbohydrates and sodium.

[Oral contraceptives, risk factor of myocardial infarction related to blood lipids (author's transl)]. / Pilule-Lipides sanguins et risque coronarien.

PIP: Retrospective studies show that OC (oral contraception) increases female mortality due to cardiovascular deficiency. According to a 1977 study of the Royal College of General Practitioners, the mortality rate for pill users between 15-24 is 14.9/100,000, against 11.8/100,000 for nonusers, and 241.50/100,000 against 119.50/100,000 in the age group 45-49. While between 1950-60 the incidence of infarction diminished for women in all age groups, between 1960-70 mortality for infarction increased 50%, and strictly in those countries where the pill had a great diffusion. It is believed that about 40% of infarctions before 45 are among OC users. Cardiovascular risk is increased by perturbations of the lipid metabolic system, and the combined effects of estroprogestational agents on circulating cholesterol level differs according to the composition used. Ethinyl estradiol increases the level of circulating cholesterol, while derivates from norethindrone diminish it. It can be concluded that estroprogestational associations tend to increase the level of circulating triglycerides, except when this effect is moderated by the presence of Norgestrel. Any prescription for OC must be preceded by a severe lipid evaluation; for women over 40 the use of an IUD would be better indicated than OC.^ieng