Energy balance in congenital generalized lipodystrophy type I.

Congenital generalized lipodystrophy type 1 (CGL-1) is characterized by an absence of adipose tissue and decreased serum leptin levels. Low leptin levels in CGL-1 support the claim that subjects are hypermetabolic and hyperphagic. The present study examines this claim. We determined 24-hour energy expenditure (24-h EE) (kilocalories) (n = 2) and resting metabolic rate (RMR) per kilogram of lean body mass (LBM) (n = 3) in CGL-1 and in 18 healthy control subjects. The 24-h EEs of control and subjects with CGL were compared with respect to kilocalories required per day relative to kilograms of LBM and with respect to RMR relative to kilograms of LBM. Fasting leptin, adiponectin, and 24-hour ghrelin levels were also measured in subjects with CGL-1. The 24-h EE per kilogram of LBM for the subjects with CGL-1 falls on the same regression line observed for this relationship in the controls. The RMR per kilogram of LBM in subjects with CGL-1 also was similar to that in controls. Both 24-h EE and RMR were quite increased when reported per kilogram of total body weight. Subjects with CGL-1 also have decreased fasting leptin and adiponectin hormone levels and no premeal ghrelin rise. People with CGL-1 have similar RMR and daily caloric requirements as healthy controls when these parameters are expressed as a function of LBM. Appetite-regulating hormone levels in CGL-1 suggest that multiple factors act to control appetite in these individuals.

Chronic health conditions and survival after out-of-hospital ventricular fibrillation cardiac arrest.

OBJECTIVE: To investigate whether chronic clinical comorbidity, as collected from emergency medical services (EMS) reports, influences survival after out-of-hospital ventricular fibrillation (VF) cardiac arrest. METHODS: In this observational retrospective cohort study in King County, Washington, USA 1043 people who suffered out-of-hospital VF arrest due to heart disease between 1 January 1999 and 31 December 2003 were studied. Chronic conditions were ascertained and tallied from EMS reports using a uniform abstraction form by people blinded to outcome status. The outcome was survival to hospital discharge. RESULTS: 75% (776/1043) of patients had at least one chronic health condition and 51% (529/1043) had prior clinically recognised heart disease. Overall, the increasing count of chronic conditions was inversely associated with the odds of survival to hospital discharge after adjustment for potential confounders (OR 0.84 (95% CI 0.74 to 0.95) for each additional chronic condition). The chronic condition-outcome association tended to be more prominent among those with longer EMS response intervals (p = 0.07 for interaction term between condition count and response interval). For example, the OR of survival was 0.72 (95% CI 0.59 to 0.88) for each additional chronic condition when the EMS response interval was 8 min compared with an OR of 0.95 (95% CI 0.79 to 1.14) when the EMS response interval was 3 min. CONCLUSION: In this cohort, an increasing burden of clinical comorbidity based on a review of EMS reports was associated with a lower odds of survival after VF arrest. This finding suggests that chronic conditions influence arrest pathophysiology and in turn could help guide resuscitation care.