Phosphorus magnetic resonance spectra and changes in body composition during weight loss.

OBJECTIVE: The use of magnetic resonance spectroscopy (MRS) to monitor cellular bioenergetics during weight loss may provide novel insights regarding metabolic functioning. METHODS: Changes were noted in 18 sedentary, moderately overweight women following a 7-week program consisting of a low-fat, 422-428 MJ/day (1010-1025 kcal/day) diet, a progressive walking program, a vitamin-mineral-fortified, isolated-protein meal supplement drink and a weekly group meeting. Mitochondrial energy production and utilization were assessed by measuring the concentrations of inorganic phosphate (Pi) and phosphocreatine (PCr) through magnetic resonance spectroscopy. Anthropometric changes were also monitored. RESULTS: Dietary analysis of subjects' pre-intervention food records showed intakes of numerous vitamins and minerals below 100% of the Recommended Dietary Allowances (RDA), most commonly for folic acid, vitamin E, magnesium, iron and zinc. Relative to pre-intervention levels, final measurements showed that all women lost body weight, ranging from 2.6 to 10.0 kg. Body mass index declined in all subjects, from 0.55 to 3.86 kg/m2. All subjects lost fat mass, ranging from 0.9 to 10.4 kg. Seventeen of 18 women showed a decline in their percentage of body fat, ranging from 2.3 to 10.1%. Twelve of 18 subjects showed an increase of 0.1-3.5 kg of fat-free mass, with half of these values increasing by > 1.0 kg. No changes from baseline levels were found in the Pi/PCr ratio over 7 weeks under resting, exercise or recovery conditions, suggesting a preservation in muscle energy function over the course of the study while the subjects were losing fat mass and total body weight. CONCLUSIONS: The possible metabolic advantage associated with a program that employs moderate energy restriction, repletion of vitamin and mineral intakes to RDA levels, and a regular aerobic exercise program is proposed.

Role of water-soluble dietary fiber in the management of elevated plasma cholesterol in healthy subjects.

Guidelines for the use of water-soluble dietary fibers (WSDF) in the dietary management of elevated plasma cholesterol are not well-established. Consequently, 4 studies were conducted to explore the plasma lipid-lowering effects of a variety of WSDF. Studies were randomized, double-blind, placebo-controlled trials involving healthy men and women (plasma cholesterol greater than 5.17 mmol/liter; greater than 200 mg/dl). Study duration ranged from 4 to 12 weeks. The WSDF acacia gum yields a low viscosity, palatable beverage when mixed in water. However, despite its WSDF classification, acacia gum consumed for 4 weeks as the sole WSDF source (15 g of WSDF/day) or primary source in a WSDF mixture (17.2 g of WSDF/day; 56% derived from acacia gum) did not produce a significant lipid-lowering effect versus placebo. When 15 g of WSDF/day consisting of psyllium hust, pectin, and guar and locust bean gums (medium viscosity) was consumed for 4 weeks, significant reductions in cholesterol resulted (total cholesterol 8.3%, low-density lipoprotein cholesterol 12.4%; p less than 0.001) that were comparable to changes achieved with 10 g of WSDF/day from high-viscosity guar gum. The magnitude of the lipid-lowering effect was related to intake of WSDF ranging from 5 to 15 g/day (low-density lipoprotein cholesterol +0.8% [placebo], -5.6% [5 g/day], -6.8% [10 g/day], -14.9% [15 g/day]; p less than 0.01 for trend). The effects of WSDF on plasma lipids were similar for men and women. A diet rich in selected WSDF may be a useful adjunct to the dietary management of elevated plasma cholesterol.

Rational ordering of electrolytes in the emergency department.

STUDY OBJECTIVE: To validate the predictive abilities of a retrospectively developed set of clinical criteria for detecting clinically significant electrolyte abnormalities, using a different patient population. DESIGN: Cross-sectional study. SETTING: The emergency department of a busy public hospital. TYPE OF PARTICIPANTS: Nine hundred eighty-two patients on whom the emergency physician ordered serum electrolytes. INTERVENTIONS: The predictive properties of ten clinical criteria were evaluated; these included poor oral intake, vomiting, chronic hypertension, taking a diuretic, recent seizure, muscle weakness, age of 65 years or more, alcoholism, abnormal mental status, and recent history of electrolyte abnormality. MEASUREMENTS AND MAIN RESULTS: Seven hundred thirty patients (74.3%) had one or more electrolytes outside of the laboratory normal range, but only 143 (14.6%) had clinically significant electrolyte abnormalities. The clinical criteria predicted 135 of the clinically significant electrolyte abnormalities (sensitivity, 94.4%). When the eight "false-negative" cases were reviewed, none of the electrolyte abnormalities affected patient outcome. Implementation of the criteria would have avoided unnecessary testing in 233 patients (23.7%). CONCLUSION: Although no set of clinical criteria can eliminate the need for clinical judgment, use of a set of clinical criteria could substantially decrease electrolyte ordering without compromising patient care.