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y composition was studied in 31 patients receiving chemotherapy for small-cell lung cancer. Patients were randomly assigned to receive either 4 weeks of total parenteral nutrition (study group) or to continue a self-regulated oral diet (control group). The relationship between height and total body nitrogen was altered initially for patients who had lost more than 5% of body weight. During the 4 weeks of parenteral nutrition, body weight, total body fat, and total body potassium, but not total body nitrogen, increased significantly in the study group (p less than 0.001). However, after parenteral nutrition was stopped, body weight and potassium levels in the study group fell significantly and to the same extent as in the control group. Nitrogen levels showed an overall fall in the 32 weeks of observation for both groups. After the period of parenteral nutrition, the decrease in body fat was significantly greater in the control group than in the study group (p less than 0.05). Thus, parenteral nutrition increased body fat and total body potassium, but not total body nitrogen. [ABSTRACT FROM AUTHOR]

In population studies, in which patients and controls are of comparable size, bone mineral area density (BMD) gives reliable results for mean bone mass data although, with sequential data, BMD may under-estimate the degree of change in bone mass. In children BMD data should be reliable, provided that patients and controls, matched for age and sex, are also of the same size. With disease children may be small for their age so that low bone mass by BMD may be due to small body size and not necessarily to osteopoenia. In these situations the bone mineral content (BMC) index may be more reliable than BMD. To assess bone mass status in individuals, BMC index, as well as BMD, should be used, particularly with adults at the extremes of body size (the very small or very tall).

Measurements of body composition are made to assess nutritional status. The measurements used for these studies should be selected on the basis of reliability, as well as simplicity and costs, and reliability depends on the information required. In normal adults simple estimates of fat and lean tissue (LBM), i.e. the anthropometric measurements of weight, height and skin fold thickness, should be sufficient since the proportions, in LBM, of water, protein and bone mineral are relatively constant. Measurements of body water (by isotope dilution or bioelectrical impedance) allow indirect estimates of fat and LBM that are reliable, provided that water is a constant proportion of LBM. In disease states, however, including renal disease, it is well established that the proportion of water in LBM varies from significant water overload to dehydration. In disease, it is important to determine not only total LBM but also the quality of LBM, determining essential body protein as well as body water. Body protein can be measured directly by nuclear techniques. This procedure should be more readily available for the clinical investigation of nutritional status.

Nuclear magnetic resonance techniques can measure the fluoride levels in bone of the finger after a patient has ingested F in the treatment of osteoporosis, but does uptake in cortical bone reflect uptake in the critical trabecular bone? Investigation has been made of the relative uptake of fluoride from drinking water into trabecular and cortical bone of the rat. For fine detail of the uptake of F into the femur and vertebra, microprobe techniques were used with a spatial resolution of 10 microns; for broader studies, treating the femur as representative of cortical bone and the vertebra as typical of trabecular bone, chemical techniques using spectroscopy and ion-selective electrodes were employed. The conclusion is that in the rat uptake of F by cortical bone is indicative of uptake by trabecular bone, and that therefore as a working hypothesis NMR measurement of F in the finger may be taken as reflecting uptake of F by trabecular bone.

We have developed a localized noninvasive nuclear magnetic resonance (NMR) method for determining the accumulated bone fluoride content in human index fingers. Using a 27 MHz "split-ring" resonator probe, we measure the total fluoride (F) content within a 6.5 cm length of the distal end of the index finger from a calibrated determination of the intensity of the observed 19F free induction decay (FID) signal. Since fluoride impurities accumulate almost exclusively in bone mineral, the 19F resonance signal is broadened by rigid lattice magnetic dipole-dipole interactions, causing the FID signal to have a relatively short lifetime of approximately 75 microseconds. This short signal lifetime, plus the weakness of the signal strength prevents conventional magnetic resonance imaging equipment from observing the 19F in bone mineral. Nevertheless, we have achieved an in vivo sensitivity of +/- 0.5 mg fluoride in an observation period of 30 min. Assuming an index finger has between 0.25 and 0.5 g of bone calcium, this sensitivity is just sufficient to detect fluorides in the index finger of most adults whose bone fluoride concentration is greater than 2.0 mg fluoride/g calcium (0.8 mg/g ash weight). We are particularly interested in using this new NMR technique to monitor the rate of bone fluoride accumulation in osteoporotic patients receiving therapeutic levels of fluoride in their diets.

19F free induction decay (FID) signals have been observed from the index fingers of four male and two female adult volunteers using a 27-MHz pulsed nuclear magnetic resonance spectrometer equipped with a split ring resonator probe. The value of the in vivo spin-lattice relaxation time T1 of the fluoride ions naturally accumulated in bone mineral has been determined to be 2.0 +/- 0.3 s. The shape of the observed FID signals in the inhomogeneous external magnetic field indicates that the F distribution is not uniform along the length of the finger. The fluoride ion content of the index finger (within a 65-mm length from its distal end) was measured with a sensitivity of +/- 0.5 mg F within a 30-min observation time.