Results. Subnormal calcidiol levels were present in 52% of the underweight patients and 69% of the normal-weight patients. The resulting models of linear regression showed that for the lumbar spine T scores model, the total variation of 16.7% was explained by group (underweight/normal weight), sex and age. For the femur neck T scores model, the total variation of 20.4% was explained by the interaction of underweight and vitamin D deficiency (with borderline significance) and by arm muscle circumference percentage of standard. In patients with normal calcidiol levels, the median intake of vitamin D was 17 lg in the underweight patients and 11 lg in the normal-weight patients. Conclusions. Vitamin D deficiency was common in both underweight and normal-weight patients, but only in the underweight patients, an association between vitamin D deficiency and reduced femur neck T scores was indicated.
Overweight, in combination with other cardiovascular risk factors, reduces survival after transplantation. The aim of this prospective study was to observe leptin, adiponectin, and energy intake as predictors of body mass index (BMI) and body composition and as risk factors associated with metabolic syndrome after lung and heart transplantation. After pre-operative baseline investigations, 35 lung and 59 heart recipients were followed and re-investigated two, six, and 12 months after transplantation. Linear regressions were performed to predict BMI and body composition. The lung recipients had a substantial weight gain after transplantation. Leptin increased, especially in the lung recipients and positively predicted BMI. Energy intake predicted BMI before and at two months after transplantation, but not after 12 months. Percentage trunk fat increased and lean mass decreased. Before transplantation, the dominant determinant of lean mass was adiponectin (positively associated), while after it was leptin (negatively associated), controlled for possible confounding variables (including prednisolone). Metabolic syndrome 12 months after transplantation was associated with higher leptin, greater weight gain without increased energy intake. After transplantation, a disturbed energy metabolism is indicated, where adiponectin and especially leptin are involved and a disadvantageous body composition is favored with increased body fat and decreased lean mass.
Obejctive: Validation a self-administered form used by patients to record their food intake and compare the recorded data with the observed intake. Design: Data were obtained from an unselected cross-sectional group of hospitalized patients. Subejcts: Forty-®ve adult men and women volunteered to participate. Five of these dropped out. Methods: Observed intake at breakfast, lunch and dinner was obtained by recording the servings of food before they were served to the patients and subtracting weighed leftovers. At meal times the patients recorded food items eaten in fractions of amount served to the nearest 25%. Setting: Inpatients from ®ve different wards at Rikshospitalet, Oslo.Results: There was a signi®cant under-reporting of the number of foods served (P`0.005) resulting in a signi®cant underestimation of energy 231 kJ (P`0.02). There was good agreement between the patients and the observers for the portions of most foods (Kappa 0.44 ± 0.92, P`0.00001). The differences in amount had little in¯uence on the difference in total energy. The difference in number of foods correlated with the difference in energy (r 0.68, P`0.001) and with the difference in protein (r 0.50, P`0.01). Patients with an underestimation of energy above 20% had forgotten seven or more food items. Conclusions: For most patients, the self-administered form adapted to the hospital menu appears to have acceptable validity, but for some patients it was unacceptable, mainly owing to food items being omitted and not because of incorrect estimate of amounts of food. Sponsorship: Rikshospitalet,
Background: Undernutrition in hospitalized patients is often not recognized and nutritional support neglected. Chronic obstructive pulmonary disease is frequently characterized by weight loss. No data exist on the effects of nutritional supplementation in underweight lung transplantation candidates during hospitalization. Objective: To evaluate the effects on energy intake and body weight of an intensified nutritional support compared to the regular support during hospitalization. Methods: The participants were underweight (n = 42) and normal-weight (n = 29) patients with end-stage pulmonary disease assessed for lung transplantation. The underweight patients were randomized to receive either an energy-rich diet planned for 10 MJ/day and 45–50 energy percentage fat and offered supplements (group 1), or the normal hospital diet planned for 8.5–9 MJ/day and 30–35 energy percentage fat and regular support (group 2, control group). The normal-weight control patients (group 3) received the normal diet. Food intake was recorded for 3 days. Results: During a mean hospital stay of 12 days, the energy intake was significantly greater for the patients on intensified nutritional support (median 11.2 MJ) than for the underweight patients on the regular support (8.4 MJ; p < 0.02) and the normal-weight patients (7.0 MJ; p < 0.001). The increase in energy intake in group 1 resulted in a significant weight gain (median 1.2 kg) compared with group 2 (p < 0.01) and group 3 (p < 0.001). Conclusions: In a group of underweight patients with lung disease assessed for lung transplantation, it was possible to increase energy intake by an intensified nutritional support which was associated with a significant weight gain, compared to the regular nutritional support during a short hospital stay.
Background: No data is available on dietary intervention in candidates for lung transplantation and on the effect of different strategies for dietary support in this cohort. Aim: We therefore wanted to evaluate the effects of intensified nutritional support compared with simple support on energy intake and nutritional status. Method: Our participants were underweight (n = 42) and normal-weight (control group, n = 29) candidates for lung transplantation. The underweight patients were randomized into two groups. Group A received intensified dietary counselling, ready-made liquid nutritional supplements free of charge and regular follow-ups, while group B received only one session of individual dietary counselling, no supplements and no follow-ups. Results: The mean intervention time was 21 weeks. Groups A and B both increased their energy intake and gained weight. Group A increased their energy intake from a median of 8.7 to 10.1 MJ (p < 0.01 compared with the control group after intervention) and gained a mean of 2.9 kg body weight (95% CI 1.2; 4.7, p = 0.005 compared with the control group), while group B increased from 7.4 to 10.8 MJ (p = 0.005) and gained 2.3 kg (1.2; 3.3, p = 0.002). Only group B increased their fat-free mass. In this group, an increase in O2 saturation and a decrease in PaCO2 were suggested. None of the groups improved its physical performance. Conclusion: In candidates for lung transplantation we were unable to confirm the hypothesis that intensified nutritional support compared with a simple support increased compliance. Both groups achieved the goal for energy intake and gained weight.
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