Objective: In the clinical practice, visceral proteins are used as indirect markers of protein energy malnutrition (PEM), but their reliability could be reduced with advancing age. The aim of this work is to investigate the reliability of albumin, prealbumin, retinol-binding protein (RBP) and transferrin in evaluating nutritional status in old patients and their relationship with fat-free mass (FFM). Design: Cross-sectional study. Setting: Padua, Italy. Subjects: In 44 underweight (body mass indexo20 kg/m 2 ) (66-97 years) and 69 normal weight or overweight elderly subjects (62-98 years), albumin, prealbumin, transferrin and RBP were determined in the plasma. Body composition and particularly FFM was obtained by dual X-ray absorptiometry. FFM was also expressed as FFM index (FFMI) calculated as FFM divided by height squared. Subjects affected by acute illnesses and inflammatory states were excluded. Results: Albumin, prealbumin and RBP mean values were significantly lower in underweight subjects. No differences between two groups were found for transferrin. Albumin prealbumin and RBP resulted under the normal range in 55, 25 and 54% of underweight subjects, respectively. Transferrin's values were low in about 40% of underweight and normal weight subjects, respectively. In all subjects, FFMI shows a significant correlation with albumin (r: 0.52), prealbumin (r: 0.64) and RBP (r: 0.57). No correlation between FFMI and transferrin was found. Conclusions: Visceral proteins, except for transferrin, seem to be useful indexes in detecting malnutrition in the elderly; low values still in the normal range should also be carefully evaluated because they could suggest a poor nutritional status.

Background/Aims: Surgical gastric banding procedures induce considerable and rapid weight losses in obese subjects. Nevertheless changes in lean mass and body fluids following these surgical treatments are not well known. Methods: We studied 6 obese women aged 38–42 years, before, and 8 and 24 weeks after laparoscopic adjustable silicone gastric banding (LAP-BAND^TM). Fat-free mass (FFM) and fat mass (FM) were investigated using dual energy X-ray absorptiometry (DEXA), while total body water (TBW) and extracellular water (ECW) were assessed by dilution methods. Results: The subjects showed a total weight loss of 16% of initial weight; the weight reduction was greater during the first 8 weeks. FFM decrease after 24 weeks was very limited and represented only 14% of the weight loss. The mean FFM changes per week were similar in the two periods of observation (0–8 and 8–24 weeks after LAP-BAND). TBW showed a global reduction of 2.2 ± 1.8 litres mainly due to a decline in intracellular water (ICW), while ECW remained constant during weight loss. As a consequence, the ECW/ICW ratio increased after LAP-BAND. Conclusion: LAP-BAND seems to achieve satisfactory weight losses while sparing FFM and causing only mild body fluid alterations.

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BackgroundSince direct-acting antivirals (DAAs) have been approved for the treatment of hepatitis C virus (HCV) infection, a small series of patients with new-onset neuropsychiatric alterations have been referred to us. We therefore set out to study neuropsychiatric function in relation to DAAs prospectively.MethodsTen patients with cirrhosis and 12 post-liver transplant (post-LT) patients were enrolled. All underwent wake electroencephalography (EEG) and a neuropsychological evaluation (paper and pencil battery, simple/choice reaction times, working memory task) at baseline, at the end of treatment with DAAs and after 6 months. At the same time points, full blood count, liver/kidney function tests, quantitative HCV RNA, ammonia and immunosuppressant drug levels were obtained, as appropriate.ResultsPatients with cirrhosis were significantly older than post-LT patients (65±12 vs 55±7 years; P<0.05). Neuropsychological performance and wake EEG were comparable in the two groups at baseline. At the end of a course of treatment with DAAs, a significant slowing in choice reaction times and in the EEG (increased relative delta power) was observed in patients with cirrhosis, which resolved after 6 months. In contrast, no significant changes over time were observed in the neuropsychiatric performance of post-LT patients. No significant associations were observed between neuropsychiatric performance and stand-alone/combined laboratory variables.ConclusionSome degree of neuropsychiatric impairment was observed in relation to treatment with DAAs in patients with cirrhosis, but not in post-LT patients, suggesting that the former may be sensitive to mild DAA neurotoxicity.

SF-BIA at 1 kHz is unreliable in predicting body fluids in elderly people with CHF. SF-BIA at 50 kHz and BIS are useful for estimating TBW in healthy elderly people and in cases of water imbalance, but both methods are less reliable in estimating ECW, particularly in conditions of fluid overload.