Search

Objective We assessed the value of height reduction, calculated using knee height measurement, as a risk factor or predictive sign for osteoporosis in healthy elderly women. Methods In 181 healthy women 76 ± 5 y of age, height, weight, and knee height were evaluated. Femoral and spine bone mineral densities and body compositions were measured using dual-energy X-ray absorptiometry. In 76 young women 27 ± 4 y of age, a regression equation to predict height, based on knee height, was derived. Using this equation, maximum attained height and height loss were calculated in elderly women, which was correlated to bone mineral density. Results The equation to predict height was height (cm) = knee height (cm) × 2.22 + 50.54. The calculated height loss in elderly women was −6.1 ± 3.8 cm or −0.08 ± 0.05 cm/y of age. Height loss and hip circumference were significant predictors of spine bone mineral density. In the case of femoral bone mineral density, to the same predictors, a negative effect of waist circumference was added. Women in the highest quintile of height reduction (>0.199 cm/y) had an odds ratio of 4.5 (95% confidence interval 1.56–13.3, P Conclusion Knee height can be used as an accurate measurement of height loss in the elderly, which is a significant predictor of femur and spine bone mineral densities, in addition to hip circumference.

Summary Potato flour (PF) is a material that does not differ significantly from wheat flour (WF) with regards to its physical appearance and chemical composition. For that reason it may be used in bread making. In this study mixtures of wheat flour and potato flour were prepared containing PF at levels of 0, 2, 4, 6, 8 and 10%. The farinograph properties of wheat flour affected by addition of potato flour were studied. Water absorption increased gradually from 62% for WF to 79% for blend with 8% PF. Other parameters such as development time, weakening of dough (Brabender units) and valorimeter value (W) were adversely modified by the addition of potato flour. The bread properties were studied using mixtures containing 0, 2, 4, 6, 8, 10 and 15% PF. The substitution of WF produced increases in water absorption, loaf weight and loaf volume as compared to all-wheat bread. In addition, bread containing PF retained moisture for longer periods than normal bread. Loaves made from wheat flour and 2, 4, 6, 8 and 10% potato flour were tested for their chemical composition and protein efficiency ratio (PER) in the rat. Moisture of bread increased with each increase in the level of potato flour substitution. The protein content of bread showed a progressive fall from 6.8% (at 4% level) to 6.3% (at 10% level). The protein efficiency ratio did not change significantly with the inclusion of potato flour up to 8% compared to all-wheat, but at the 10% level there was a significant reduction in this parameter (P < 0.05).

Summary Background and aims Weight maintenance within normal standards is recommended for prevention of conditions associated with oxidative injury. To compare oxidative damage in a post mitotic tissue, between adults differing in long-term energy balance. Methods During hernia surgery, a sample of skeletal muscle was obtained in 17 non-obese adults. Subjects were divided into two groups according to their self-reported weight change: weight maintainers (WM) reported 5 kg increment. Muscle immunohistochemistry for 8-hydroxy-deoxyguanosine (8OHdG), 4-Hydroxy-2-nonenal (4HNE), and TNF-α, as markers of oxidative injury and inflammation, were performed. As known positive controls for oxidative injury, we included 10 elderly subjects (66–101 yr). Anthropometric measures and blood samples for clinical laboratory and serum cytokines (TNF-α and IL-6) were obtained. Results 8OHdG was higher in WG compared with WM (149.1±16.2 versus 117.8±29.5, P = 0.03 ), and was associated with anthropometric indicators of fat accumulation. 4HNE was similar in WG compared with WM (10.9±7.6 versus 9.8±6.3) but noticeably higher in elderly subjects (21.5±15.3, P = 0.059 ). TNF-α protein in WG was higher compared with WM (114.0±41.7 versus 70.1±23.3, P = 0.025 ), and was associated with weight increase. Conclusions Moderate self-reported weight increase, and body fat accumulation, suggesting long-term positive energy balance is associated with muscle DNA oxidative injury and inflammation.

The aim was to assess the effects of resistance training and vitamin D supplementation on physical performance of healthy elderly subjects. Ninety-six subjects, aged 70 years or more with 25 OH vitamin D levels of 16 ng/ml or less, were randomized to a resistance training or control group. Trained and control groups were further randomized to receive in a double blind fashion, vitamin D 400 IU plus 800 mg of calcium per day or calcium alone. Subjects were followed for nine months. Serum 25 OH vitamin D increased from 12.4 ± 2.2 to 25.8 ± 6.5 ng/ml among subjects supplemented with vitamin D. Trained subjects had significant improvements in quadriceps muscle strength, the short physical performance test and timed up and go. The latter improved more in trained subjects supplemented with vitamin D. At the end of the follow up, gait speed was higher among subjects supplemented with vitamin (whether trained or not) than in non-supplemented subjects (838 ± 147 and 768 ± 127 m/12 min, respectively, p = 0.02). Romberg ratio was lower among supplemented controls than non-supplemented trained subjects (128 ± 40% and 144 ± 37%, respectively, p = 0.05). In conclusion, vitamin D supplementation improved gait speed and body sway, and training improved muscle strength.

Immune response is impaired in the elderly. Our aim was to study the effects of a special nutritional formula on the immune response and response to influenza and pneumococcal vaccination in elderly subjects.Sixty healthy subjects agedor = 70 years, with a Mini Mental scoreor = 22 were studied. Half of the subjects received a special nutritional formula (in addition to the regular diet) providing, among other nutrients, 480 kcal, 31 g proteins, 120 IU vitamin E, 3.8 microg vitamin B12, 400 microg folic acid, 10(9) cfu Lactobacillus paracasei (NCC 2461), and 6 g of fructo-oligosaccharides. At 4 months of follow-up, subjects were vaccinated against influenza and pneumococcus. Lymphokine production by mononuclear cells (PBMC), lymphocyte subpopulations, and natural killer cell (NK) activity were measured at baseline and 4 months of follow-up (before vaccination). Antibodies against influenza and pneumococcal antigens and flu-stimulated production of interferon gamma and interleukin-2 by PBMC were measured at 4 and 6 months. Skin response to 7 recall antigens and body composition were assessed at baseline and at 4 and 12 months. All infections occurring during the study period were recorded.NK activity increased in supplemented subjects and decreased in nonsupplemented individuals. Interleukin-2 production by PBMC and the proportion of T cells with NK activity decreased in controls and did not change in supplemented subjects. Supplemented subjects reported less infections than nonsupplemented individuals (in 13% and 22% of scheduled visits, respectively; p = .02).This nutritional supplement increased innate immunity and protection against infections in elderly people.

The mechanism by which homocysteine (Hcy) causes endothelial dysfunction is probably mediated by oxidative stress. The aim of this study was to evaluate the effect of oxidative stress on endothelial function in young and elderly hyperhomocysteinemic (HHcy) men. A total of 35 HHcy (Hcy > 15 micro mol/L), young (n = 15; 20-40 y) and elderly men (n = 20; > 65 y) and 33 normohomocysteinemic (NHcy; controls) young (n = 14) and elderly (n = 19) men (Hcy < 13 micro mol/L), without classic cardiovascular risk factors were recruited. Serum Hcy, folate, and vitamin B-12, whole-blood glutathione, plasma total antioxidants status, TBARS, and 8-F(2alpha) isoprostanes were determined. Noninvasive ultrasound measurements of endothelium-dependent (EDVR) and -independent dilatation (EIVR) were performed. EDVR, EIVR, and markers of oxidative stress did not differ among the groups. Folate concentrations were higher in elderly than in young men (P < 0.001), independent of Hcy concentrations. Vitamin B-12 concentrations were lower in HHcy than in NHcy elderly men (P < 0.045). EDVR was correlated with folate concentrations in young men (r = 0.40, P = 0.04) and negatively with BMI in elderly men (r = -0.52, P = 0.002). In the present study, HHcy with normal serum folate concentrations was not associated with poor EDVR or oxidative stress in healthy young and elderly men.

Objective There is a seasonal variation in the incidence of diabetes mellitus and cardiovascular diseases. However, there is very little information about the seasonal variation in insulin sensitivity. We report the seasonal variation in insulin sensitivity in a group of elderly subjects followed for 1 y. Methods Healthy elderly (≥70 y) subjects living independently were included. Fifty percent of subjects received a daily nutritional supplement that provided 400 kcal, 15 g of protein, and 50% of vitamin daily reference values (DRVs). Those receiving and not receiving supplements were randomly assigned to a resistance exercise training program. Every 6 mo (winter, summer, and winter), body composition was measured by dual-energy x-ray absorptiometry and blood samples were used to measure serum lipids, fasting and postprandial glucose, and insulin levels. Results One hundred eight subjects (31 supplemented and trained, 28 supplemented, 16 trained, and 33 without supplementation or training) completed the follow up. Higher homeostasis assessment of insulin sensitivity, postprandial insulin, and fasting triacylglycerol levels were observed during the summer than during the winter. Body fat increased steadily during the study period, and fat-free mass did not change. Serum low-density lipoprotein cholesterol decreased significantly in the supplemented and trained group and increased in the non-intervention group. Conclusions In this group of elderly subjects, insulin resistance and triacylglycerol levels were higher during the summer. Nutritional supplementation and training had a positive effect on serum low-density lipoprotein cholesterol.

Prebiotics stimulate the growth of bifidogenic bacteria in the gut. The aim of this work was to assess the effects of a prebiotic mixture on the immune response in healthy elderly people.Healthy free-living elderly people (age,or = 70 years), receiving a nutritional supplement that provided 1.6 MJ, 15 g of protein, and 50% of vitamin daily reference values per day, were randomly assigned to receive a prebiotic mixture (6 g/d of a 70% raftilose and 30% raftiline mixture) or placebo (6 g of maltodextrin powder) for 28 weeks. At week 2 of the study, all subjects were vaccinated with influenza and pneumococcal vaccines. At weeks 0, 2, and 8 of the study, serum total proteins, albumin, immunoglobulins, saliva secretory immunoglobulin A (IgA), and serum titers of influenza A and B and pneumococcal antibodies were measured. At week 8, cultured peripheral monocyte cell secretion of interleukin-4, interferon-gamma, and lymphocyte proliferation, stimulated with phytohemagglutinin and influenza antigen, were measured.Sixty-six subjects were considered eligible for the study, and 43 (20 receiving prebiotics and 23 receiving placebo) were considered for final analyses on a per protocol basis. No changes in serum proteins, albumin, immunoglobulins, and secretory IgA were observed. Antibodies against influenza B and pneumococcus increased significantly from weeks 0 to 8, with no significant differences between groups. Antibodies against influenza A did not increase. No effects of prebiotics on interleukin-4 and interferon-gamma secretion by cultured monocytes were observed.No immunological effects of prebiotics were observed in this study.

Urea kinetics were measured non-invasively in 12 Chilean schoolboys aged 8-10 years who were receiving one of two diets, either predominantly animal protein or predominantly vegetable protein. Both the diets provided an equivalent level of gross protein, 1.2 g/kg/day. The study diets were given for 10 days to enable adaptation to take place. On the eighth day a single oral dose of 15N15N-urea, 100 mg, was given and the amount of label excreted as 15N15-urea in urine over the subsequent 48 hours was measured. There was little difference in any aspect of urea kinetics between the two diets with urea production (animal, 173 +/- 50 mgN/kg/day; vegetable 179 +/- 53 mgN/kg/day), urea excretion (animal, 86 +/- 19 mgN/kg/day; vegetable, 105 +/- 13 mgN/kg/day), urea nitrogen hydrolysis (animal, 87 +/- 49 mgN/kg/day; vegetable, 74 +/- 42 mgN/kg/day), and the salvaged urea-nitrogen derived from hydrolysis which returned to urea formation (animal, 12 +/- 5 mgN/kg/day; vegetable, 17 +/- 9 mgN/kg/day) all being similar. A very high proportion of the salvage nitrogen derived from urea hydrolysis was maintained within the metabolic pool, about 80%, which was equivalent to 0.4 g protein/kg/day. This is the first time urea kinetics have been measured in children of this age and shows that 57% of the ura produced is excreted in urine on average with about 43% of the urea-nitrogen being salvaged for further metabolic interaction. It is concluded that the vegetable based protein diet taken habitually by Chilean children is metabolically equivalent in terms of urea kinetics to a diet based upon animal protein at this level of intake, but that high rates of salvage of urea nitrogen are found on both diets.

Disrupted eating behaviors and psychological issues can have a role in the development of childhood obesity.To assess the effects of psychological support as an adjunct to the treatment of obesity among children.Retrospective analysis of a group of 152 obese children aged 3 to 16 years, who received medical, Nutritional and physical training treatment. Seventy three (Group I) were invited to participate in a protocol of psychological support and 79 formed the control group (Group 2). Body mass index, body fat mass, waist circumference, insulin sensitivity, lipid profile, eating and physical activity habits were evaluated. Family structure, history of food rejection, psychological, physical and social development, and adherence to the program were also analyzed. To analyze responses to treatment, Group I was further divided into those who attended the psychology sections (intervened group) and those who did not attend (non intervened group).At baseline, there were no differences in anthropometric, metabolic, familial and psychological profile among Groups I and 2. Family structure, eating behaviors and physical and social development were normal. Those associated with lack of control appeared as negative characteristics. There was a significant improvement in eating habits and physical activity among intervened children of Group 1 and Group 2. No significant change in weight was recorded in all three groups. Compliance with the program was significantly better among intervened children in Group 1 (62.1% at sixth months), compared with non intervened children of Group 1 (15.9%) and Group 2 (30.3%).Obese children who attended psychological support therapy as an adjunct to a weight reducing program, had a better compliance with treatment but did not achieve a higher weight loss.

Background: Disrupted eating behaviors and psychological issues can have a role in the development of childhood obesity. Aim: To assess the effects of psychological support as an adjunct to the treatment of obesity among children. Material and Methods: Retrospective analysis of a group of 152 obese children aged 3 to 16 years, who received medical, Nutritional and physical training treatment. Seventy three (Group I) were invited to participate in a protocol of psychological support and 79 formed the control group (Group 2). Body mass index, body fat mass, waist circumference, insulin sensitivity, lipid profile, eating and physical activity habits were evaluated. Family structure, history of food rejection, psychological, physical and social development, and adherence to the program were also analyzed. To analyze responses to treatment, Group I was further divided into those who attended the psychology sections (intervened group) and those who did not attend (non intervened group). Results: At baseline, there were no differences in anthropometric, metabolic, familial and psychological profile among Groups I and 2. Family structure, eating behaviors and physical and social development were normal. Those associated with lack of control appeared as negative characteristics. There was a significant improvement in eating habits and physical activity among intervened children of Group 1 and Group 2. No significant change in weight was recorded in all three groups. Compliance with the program was significantly better among intervened children in Group 1 (62.1% at sixth months), compared with non intervened children of Group 1 (15.9%) and Group 2 (30.3%). Conclusions: Obese children who attended psychological support therapy as an adjunct to a weight reducing program, had a better compliance with treatment but did not achieve a higher weight loss.

Short-term nitrogen-balance response to graded intakes of a vegetable mixed-protein diet and to a milk-egg protein diet was tested in eight healthy male children aged 12-14 y. They received 72, 104, 136, and 168 mg N.kg body wt-1.d-1 for 10 d while on the mixed diet, and 160 mg N.kg-1.d-1 on the milk-egg diet. The mean regression equation was nitrogen balance = 0.64 (nitrogen intake)-74, all values are in mg N.kg-1.d-1. Apparent digestibility was 86% and 85% for the mixed and milk-egg diets when the subjects received 168 and 160 mg N.kg-1.d-1, respectively. Mean nitrogen intake for satisfactory nitrogen retention for growth on the mixed diet was 147 mg N.kg-1.d-1; the recommended protein allowance to cover 97.5% of the population, which was derived by using a CV of 12.5%, is 1.15 g protein.kg-1.d-1. We conclude that FAO/WHO/UNU recommendations are adequate, at least for short-term nitrogen retention; long-term studies are needed to evaluate the chronic safety of this protein allowance.

Background: The study of the effects of bariatic surgery on quality of life in patients of different socioeconomic levels (SEL) is worthwhile. Aim: To study quality of life (QoL), eating behaviour, depressive symptoms and sexuality in patients subjected to a gastric bypass (GBP) more than 1 year before. Material and methods: The sample was composed of 33 GPB patients (19 high SEL and 14 low SEL), and 27 non-operated women (18 high SEL and 9 low SEL) of similar weight and age, as controls. Assessment included medical history, anthropometry, radiological densitometry. Eating behaviour was assessed using the three factor eating questionnaire, quality of life using SF-36 and the Bariatric Analysis of Reporting Outcome System (BAROS) depressive symptoms were assessed using the Beck scale version II and sexual behaviour using the female sexual function index (FSFI). Results: QoL was lower in operated patients from low SEL, especially when compared to high SEL control women. Operated patients had a predominantly restrictive pattern of eating behavior. Eating behavior disorders were detected in 5 of 33 operated patients versus 4 of 27 controls (p =ns). Sexual function was absent or dysfunctional in 22 operated versus 8 controls (p =0,02). No significant differences were observed for depressive symptoms, between operated patients and controls. Conclusions: In the long term, QoL of bariatric patients, especially those from low SEL, is inferior to control women and Chilean general population. Operated patients have restrictive eating patterns and lower sexual satisfaction indexes. Frequency of depressive symptoms was high both in bariatric and control women (Rev Med Chile 2009; 137: 625-33). (Key words: Bariatric surgery; Quality of life; Socioeconomic factors)

Background: Roux-en-Y gastric bypass (RYGBP) has had a positive impact on co-morbidities associated with obesity. However, in the long-term it can induce micronutrient deficiencies. Aim: To perform a complete nutritional assessment in a group of women previously operated of RYGBP, from different socioeconomic levéis (SEL). Patients and Methods: Thirty three women (19 high SEL and 14 low SEL), were assessed by dietary recalls, anthropometric measurements, muscle strength, bone mineral density, routine clinical laboratory, serum levéis of vitamin B12, 250H-vitamin D, Mate, calcium, ferritine, ceruloplasmin and indicators ofbone turnover (parathohormone, osteocalcin and urinary pyridinolines). Their valúes were compared to those of 30 control women (18 high SEL and 12 low SEL). Results: Low SEL operated women consumed fewer vitamin and mineral supplements compared with their high SEL pairs. No cases of vitamin B12, folie acid or copper deficiencies were detected. Frequency of iron deficieney was similar in patients and controls. Vitamin D insufficieney was higher amongpatients than in controls (p =0,04 7), regardless SEL. Patients had also a higher frequency of high serum PTH and osteocalcin and urinary pyridinoline levéis. However, no differences in bone mineral density were observed between operated women and controls. Conclusions: Vitamin and mineral deficiencies were lower than expected among operated women. However, problems associated with vitamin D deficieney were highly prevalent among patients operated of RYGBP, irrespective SEL. These alterations were only detectable through speciñe markers at this stage, because they did not transíate into lower bone mineral density (BMD) of surgicalpatients, probably due to the higher pre-operative BMD of these morbidobese patients.

The increased infantile obesity rates are related to faulty dietary intake (DI) and physical activity (PA) habits, that are probably related to a prolonged stay at school during the day.To investigate DI and PA among elementary and high school students and their association with type of school that they attend.Quality of DI and PA was assessed, using specially designed questionnaires, in 1136 elementary school and 1854 high school children attending public schools managed by city halls (ME), subsidized private (SE) and private (PE) of the Metropolitan Region. The responses to the questionnaires, were qualified using a numeric scale that ranged from 0 to 10 points. A higher score indicated a better habit.Percentile 25 (p 25 th) PA score was 4 and 3 in elementary and high school children respectively and the p 25 th for DI were 5.7 and 4.3, respectively. No differences in DI scores, according to the type of school, were observed. However, physical activity scores were significantly lower in children and adolescents from ME schools than from PE schools. Sixty percent of ME schools had less than 2 hours per week of programmed physical activity compared to more than 3 hours, in 70% of PE schools. Elementary school children and high school adolescents expended 8 and 11 hours per day, respectively, in minimum expenditure activities.There is a greater deterioration of PA than DI among school age children and adolescents. Those attending ME schools have the worst physical activity scores. This fact must be addressed in future healthy lifestyle encouragement policies.

Background: The increased infantile obesity rates are related to faulty dietary intake (DI) and physical activity (PA) habits, that are probably related to a prolonged stay at school during the day. Aim: To investigate DI and PA among elementary and high school students and their association with type of school that they attend. Material and Methods: Quality of DI and PA was assessed, using specially designed questionnaires, in 1136 elementary school and 1854 high school children attending public schools managed by city halls (ME), subsidized private (SE) and private (PE) of the Metropolitan Region. The responses to the questionnaires, were qualified using a numeric scale that ranged from 0 to 10 points. A higher score indicated a better habit. Results: Percentile 25 (p 25 th) PA score was 4 and 3 in elementary and high school children respectively and the p 25 th for DI were 5.7 and 4.3, respectively. No differences in DI scores, according to the type of school, were observed. However, physical activity scores were significantly lower in children and adolescents from ME schools than from PE schools. Sixty percent of ME schools had less than 2 hours per week of programmed physical activity compared to more than 3 hours, in 70% of PE schools. Elementary school children and high school adolescents expended 8 and 11 hours per day, respectively, in minimum expenditure activities. Conclusions: There is a greater deterioration of PA than DI among school age children and adolescents. Those attending ME schools have the worst physical activity scores. This fact must be addressed in future healthy lifestyle encouragement policies (Rev Med Chile 2008; 136: 53-63). (Key words: Child behavior; Child preschool; Exercise)

Background and aims: An accurate diagnosis of sarcopenia is required. The aim of this study is to correlate the results of two methods to define sarcopenia using cross sectional body composition data, with actual loss of fat free mass. Methods: Healthy older subjects (926 females and 381 males aged 70 years or more) and healthy young adults (425 females and 151 males aged 20 to 40 years) were studied. Body composition was assessed by double beam X ray absorptiometry (DEXA). Among older subjects, a contemporary subsample of 148 females and 45 males had two or more measurements, separated by 4.8±1.5 years and loss of fat free mass per year was calculated. In the whole sample, total and appendicular lean body mass index were calculated as total or appendicular lean body mass/height. Using data from young people, sex specific t scores were obtained. In older subjects residuals were derived from a regression equation, using total or appendicular fat free mass as the dependent variable and height, fat free mass and age as independent variables. Results: The concordance between residuals and t scores to define sarcopenia was 68 and 72%, respectively. Among subjects with two or more measurements, men and women lost a mean of 521±454 and 221±399 g/year of fat free mass, respectively. The odds ratio of losing more than 822 g lean body mass/year among men or 514 g lean body mass/year among women was 2.63 and 2.64 for subjects classified in the two lowest quintiles of sarcopenia, using t scores or residuals, respectively. Conclusions: Cross sectional body composition data can predict loss of fat free mass among older people.

Background: In acute illnesses, plasma glucose levels are often increased and generally parallel the severity of stress. Hyperglycemia caused by reduced insulin sensitivity and reduced insulin secretion is associated with increased susceptibility to infections. Maintaining blood glucose levels at or below 110 mg/dl reduces morbidity and mortality in critically ill patients. Aim: To measure the glucose and insulin responses of four commercially available enteral formulas compared with a standard meal reference product. Material and Methods: The glycemic index (GI) and the insulin index (II) were determined in a randomized, cross over protocol in 38 healthy volunteers between 18 and 46 years of age. Each subject underwent five tests: three with the standard meal (bread) and two with the study products. The enteral formulas were Clinutren HPR (whole protein of high protein value), Crucial® (casein peptide based formula), Peptamen®, (whey peptide based formula), Glytrol® (formula for diabetics with whole protein with fiber). Each study product was evaluated 10 times. Results: The diabetic formula and the high protein energy dense formulas induced a significantly lower GI (p

To study the effects of a special nutritional supplement on bone mineral density and bone turnover markers in Chilean elderly subjects with femoral osteoporosis.Public primary health care clinics in Chile.Free living elderly subjects with femoral osteoporosis.Subjects were randomized to receive the usual nutritional supplement provided by the Chilean Ministry of Health or a special nutritional supplement providing, among other nutrients, 90 mg isoflavones, 800 mg calcium, 400 IU vitamin D, 60 ug vitamin K and 31 g proteins per day.At baseline, and after six and twelve months of supplementation, body composition, bone mineral density, serum 25 OH vitamin D, intact parathyroid hormone (iPTH), osteocalcin, decarboxylated osteocalcin, urinary aminoterminal telopeptide of type I collagen (NTX), deoxypyridoline cross links (Dpd) and equol were measured. Every month, urinary daidzein was measured in a morning urine sample.No differences between treatment groups were observed in body composition or bone mineral density changes. The group receiving the special supplement had a significant increase in serum 25 OH vitamin D and a significant decrease in serum iPTH and decarboxylated osteocalcin. No association between daidzein or equol excretion and changes in bone mineralization was observed.A special supplement delivered to elderly subjects with osteoporosis improved serum vitamin D and reduced serum iPTH and undercarboxylated osteocalcin levels but did not affect BMD.

Background:Infantile obesity is associated with metabolic disturbances (hiperinsulinism, impaired glucose, dislypidemia) that determine a higher risk of type 2 diabetes, high blood pressure and atherosclerotic vascular disease in adulthood. Insulin resistance is a central mechanism of complications of obesity and is associated to body fat mass. Aim: To investigate insulin sensitivity and its association with anthropometric and metabolic variables in obese children. Patients and methods: We studied 314 children aged 6 to 15 years. Of these, 235 had a body mass index (BMI) over the 95 percentile for age and sex (classified as obese) and 79 had a normal body mass index; 161 were pre-pubescent and 153 were pubescent. Weight, height, percentage of total body fat (% TBF) using the sum of 4 skinfolds, blood pressure (BP), waist circumference (WC), basal glucose (Glu) and insulin (Ins) were measured. Insulin sensitivity (IS) was calculated with the homeostasis model assessment (HOMA) and QUICKI index. Serum lipids, postprandial Glu and Ins were measured only in obese children. Results: BMI, WC and % TBF had an inverse and significant correlation with basal IS (p

In a large sample of elderly subjects, we assessed the possible protective effect of obesity on the development of osteoporosis.Healthy subjects 70 y or older and of low socioeconomic level were studied. Bone mineral density was measured in the femoral neck by using a Lunar Prodigy double beam densitometer and compared measurements with appropriate standards. Osteoporosis was defined according to criteria of the World Health Organization (WHO). Body weight and height were recorded simultaneously, and body mass index (BMI) was calculated as weight (kg) divided by height (m2). Age-adjusted odds ratios for femoral osteoporosis were calculated for WHO-proposed BMI ranges in women and men, with an odds of one for a BMI below 25 kg/m2.Eight hundred forty-five subjects (615 women and 230 men; mean age, 75 +/- 4.4 y) were studied. Mean BMI was 28.1 +/- 4.7 kg/m2. Twenty five percent of women and 11% of men had osteoporosis (P0.001). Forward stepwise multiple regression analysis showed BMI to be the best independent predictor of bone mineral density in women and men. The age-adjusted odds ratios for femoral osteoporosis were 0.34 (95% confidence interval [CI], 0.21 to 0.55) and 0.13 (95% CI, 0.04 to 0.43) for women and men with a BMI between 25 and 30 kg/m2, respectively. The odds ratios for women and men with a BMI between 30 and 35 kg/m2 were 0.21 (95% CI, 0.11 to 0.39) and 0.09 (95% CI, 0.01 to 0.67), respectivelyThis study confirms the protective effect of a high BMI on femoral neck bone mineral density among elderly subjects. The risk for osteoporosis among men and women with a BMI above 30 kg/m2 was approximately 33% compared with subjects with a normal BMI.

Objective Undernutrition is a frequent complication in patients with cystic fibrosis (CF). Elevated energy requirements have been found to be 4% to 33% higher than in controls in some studies. Whether or not this is caused by a primary defect or energy metabolism is still a matter of controversy. To this end, we assessed energy expenditure, nutrition status, and body composition of clinically stable CF outpatients. Methods Fifteen clinically stable CF patients, ages 2 to 15 y, were paired with 15 healthy control children. Measurements consisted of anthropometry and body composition. Plasma tocopherol, retinol, and hair zinc content were measured. Resting energy expenditure was determined by indirect calorimetry. Physical activity and dietary intake were recorded by recall methods. Results Two children were nutritionally at risk according to the weight/height index, eight were normal, three were overweight, and two were obese. Body composition was similar in both groups. Zinc, tocopherol, and retinol levels were low in three, two, and three patients, respectively. Resting energy expenditures were 4.7 MJ/d (1127 ± 220 kcal/d) in CF children and 4.63 MJ/d (1108 ± 191 kcal/d) in control children ( P = not significant). Physical activity level was sedentary in 86.6% of CF patients; the rest had a light physical activity pattern. Energy intake represented 141% of the estimated daily energy expenditure. Conclusions Non–oxygen-dependent CF children, without acute respiratory infection, had resting energy expenditures comparable to those of matched controls. Total energy expenditure was similar to or slightly lower than that in healthy children. Dietary recommendations for CF patients need to be reassessed.

La presente revisión analiza los roles de los ácidos grasos dietarios; en primer lugar a nivel celular en lo que respecta a la diferenciación adipocítica, expresión génica de enzimas y la síntesis de proteínas involucradas en el metabolismo energético. En segundo lugar, se analiza los efectos de los ácidos grasos en el mejoramiento de la sensibilidad o de la resistencia insulínica, en particular sobre la relevancia de los ácidos grasos saturados versus los poliinsaturados. Finalmente, se describen los efectos de las distintas calidades de ácidos grasos sobre el metabolismo oxidativo de sustratos energéticos. En la actualidad se conoce que la mayoría de estos efectos pueden ser modulados a través de modificaciones dietéticas simples como por ejemplo la variación en el tipo de aceite ingerido. La relevancia de estos procesos en relación a la obesidad y sus alteraciones metabólicas se enfatizan de manera específica This review aims to describe firstly, the most relevant information about the role of dietary fatty acids on cell products linked to adipocyte differentiation, genetic expression of enzymes associated to fat accretion and protein synthesis. Secondly, their effects on insulin sensitivity and insulin resistance, as conditioned by saturated or polyunsaturated fatty acids. Finally, the effects of fatty acids on substrate oxidation metabolism, particularly in relation to fat and CHO oxidation. It is presently evident that most of these effects can be modulated through dietary modifications starting with simple changes such as the type of oil consumed. The relevance of these processes in regards to obesity and its metabolic disorders is particularly stressed

OBJECTIVE: The incidence of protein-calorie malnutrition in hospitalized adult patients can reach 30% to 50% and adversely affect clinical outcome. We evaluated the efficacy of muscle strength to predict functional derangement and detect early changes in nutrition status in hospitalized patients. METHODS: Patients hospitalized at medical and surgical wards from two different hospitals in Santiago, Chile, were studied during their hospital stay. Subjective Global Assessment of nutrition status and laboratory parameters were measured on admission. Anthropometric measures, handgrip dynamometry, and maximal inspiratory and expiratory pressures were measured on admission and discharge. The Karnofsky index was used to assess functional status. Twice weekly, caloric balance was calculated with indirect calorimetry and assessment of dietary intake. RESULTS: From the initial selection of patients (n = 70), 50 patients (26 men and 24 women) completed the study. Median hospital stay was 10 d. Subjective Global Assessment was associated with anthropometric data, handgrip dynamometry, and serum levels of total proteins. Patients in whom functional status declined during hospital stay, on admission had lower left handgrip strength, a worse Subjective Global Assessment classification, were older, and had lower fat mass. No association between caloric balance during hospital stay and changes in muscle strength was observed. CONCLUSIONS: Subjective Global Assessment, handgrip strength, and fat mass were good predictors for the decline in functional status during hospital stay. No association between caloric balance and changes in muscle strength was observed.

Obesity is the most prevalent nutritional disease in people of less than 20 years old. Aim: To report biological, familial and metabolic characteristics in obese children. Patients and methods: A retrospective review of 187 children seen at obesity clinics and that had a complete metabolic study. Results: Ninety five prepuberal and 92 puberal children, aged 8.7±2.2 and 12.6±2.2 years old respectively, were studied. Body mass index was over 4 standard deviations in 48.4% of prepuberal children and in 39.1% of puberal children. Paternal obesity was twice more prevalent (30.2%) than in the general population. The daily caloric intake and basal metabolic rate (BMR) were within the normal range; nevertheless there was a positive caloric balance due to minimal physical activity. The mean daily fat intake was normal (26.4±8.5 and 25.3±9.1% of total calories in prepuberal and puberal children respectively). The daily fiber intake was under 70% of recommendation. The total cholesterol was over 200 mg/dl in 26.6 and 23.9% of prepuberal and puberal children. LDL cholesterol was over 130 mg/dl in 27.3 and 26.6% and triacylglycerol was over 150 mg/dl in 16.9 and 25% of prepuberal and puberal children respectively. Basal serum insulin was over 20 uIU/ml in 27.7 and 42.2% of prepuberal and puberal children, respectively. Post glucose serum insulin was over 60 uIU/ml in 40 and 63% of prepuberal and puberal children, respectively. Conclusions: Infantile and juvenile obesity is a chronic disease with a high incidence of metabolic alterations (Rev Méd Chile 2001; 129: 1155-62)

Body composition changes and loss of functionality in the elderly are related to substandard diets and progressive sedentariness. The aim of this study was to assess the impact of an 18-mo nutritional supplementation and resistance training program on health functioning of elders. Healthy elders aged > or = 70 y were studied. Half of the subjects received a nutritional supplement. Half of the supplemented and nonsupplemented subjects were randomly assigned to a resistance exercise training program. Every 6 mo, a full assessment was performed. A total of 149 subjects were considered eligible for the study and 98 (31 supplemented and trained, 26 supplemented, 16 trained and 25 without supplementation or training) completed 18 mo of follow-up. Compliance with the supplement was 48%, and trained subjects attended 56% of programmed sessions. Activities of daily living remained constant in the supplemented subjects and decreased in the other groups. Body weight and fat-free mass did not change. Fat mass increased from 22.2 +/- 7.6 to 24.1 +/- 7.7 kg in all groups. Bone mineral density decreased less in both supplemented groups than in the nonsupplemented groups (ANOVA, P < 0.01). Serum cholesterol remained constant in both supplemented groups and in the trained groups, but it increased in the control group (ANOVA, P < 0.05). Upper and lower limb strength, walking capacity and maximal inspiratory pressure increased in trained subjects. In conclusion, patients who were receiving nutritional supplementation and resistance training maintained functionality, bone mineral density and serum cholesterol levels and improved their muscle strength.

Malnutrition is usual in patients with alcoholic liver disease and is associated with a poor outcome. Nutritional support decreases nutrition-associated complications.To demonstrate that nutritional support in ambulatory alcoholic cirrhotic patients improves host defenses.Thirty-one male outpatients with alcoholic cirrhosis CHILD-PUGH B or C were included. Twenty-five subjects completed six months consuming daily a nutritional supplement (Ensure, 1000 Kcal and 35 g protein), in addition to their regular diet. At entrance and every three months, a clinical assessment, nutritional evaluation and indirect calorimetry were performed. Liver function tests and LPS-induced monocyte production of cytokines, salivary secretory IgA, lactulose/mannitol ratio and breath hydrogen tests were also measured in these intervals. Delayed cutaneous hypersensitivity and IgG and IgM antibody response to endotoxin were assessed at entrance and at the end of the study.Patients drank 85% of the provided supplement as an average. REE, total body fat and serum albumin increased, basal breath hydrogen decreased and cellular immunity improved significantly during the follow up period (por =0.03). All the other parameters remained unchanged throughout the study. Six patients (16.2%) died during the study, five due to upper gastrointestinal bleeding.Nutritional support in alcoholic cirrhotic patients improves nutritional status and cell mediated immunity.

irfe obtained for a week day and a weekend- A trained observer recorded physical activities performed by each cui d along a 20 rrrutes breck in schoc! duties. Most acrivities were of sedentary type. A striking findrg wcs 'he time soent en sdenfary act'viries such as sleeping and lync dow^ ( 1 1 .5 ± 1.1 to 1 2.0 ± 1 .4 nous in normal and small for height boys and 1 1 .9 ± 1 .2 to 1 2.2 ± 1 .6 hours in normcl and snail for -eight grls). Both boys and girls spent an averace 3 hours a day watching TV on school days and 4 hours or more cr weekends. No s'gnificant differences in time aistr'bution of different physical activities were found oefween normal aid short stature children. Direct cbserva'ion showed that normal aoys spend significantly larger proportion of iheir time |29.6%j :n moderate and heavy activries than short boys and girls and tna" norrra' girls (p < 0.05J. Srra'l for age child'en encage less Ine in '-igh expendifure cctiv'ties than "ormal children, Thus, in general 'hese chilean schoc: children showed sedentary life styles, with minimal physical actviry and they devoted 30% of t^eir daily time to watch TV.

Nitrogen, fat and energy retention were measured in 10 male infants (mean age = 6.8 mo) recovering from marasmic malnutrition while they were fed with either cow's milk based formula (LP) or a modified cow's milk formula (LPM). Their mean weight for age ratio was 72% and their weight for length ratio was 95% (NCHS standards). They went through two consecutive balance periods of 6 days each (3 d. for adaptation and 3 d. for urine and feces collection) beginning with either formula randomly. Both formulas had 85 kcal/dl with 11% protein calories in LPM and 13% in LP. Energy intake, absorption and relative retention were slightly greater with LPM than LP. Fat intake was greater under LPM than LP (5.4 vs. 4.5 g-kg-d, p < 0.025), which resulted in significant differences in fat absorption (LPM 4.3 vs. LP 3 g-kg-d, p < 0.025). Nitrogen intake was significantly lower under LPM than LP (487 vs. 571 mg-kg-d, p < 0.025) with lower urinary nitrogen excretion for LPM than for LP (304 vs. 417 mg-kg-d, p < 0.001). Apparent nitrogen retention averaged 115 mg-kg-d for LPM and only 69 mg-kg-d for LP (NS). A significant correlation was observed between nitrogen intake and nitrogen retention: r = 0.70 (y = 0.57x -167; p < 0.05) with LPM, and r = 0.77 (y = 0.63x -291, p < 0.01) with LP. A correlation was also found between energy intake and weight gain: r = 0.55 (NS) with LPM, and r = 0.88 (y = 0.26x -26; p < 0.001) with LP.(ABSTRACT TRUNCATED AT 250 WORDS)

Short-term nitrogen-balance response to a vegetable-protein mixed diet and to a milk-egg protein diet was tested in eight healthy male children 8-10 y old. They received 96, 128, 160, and 192 mg N.kg body wt-1.d-1 for 10 d while on the mixed diet and 160 mg N.kg-1.d-1 on the milk-egg diet. The mean regression equation was nitrogen balance = 0.52 (nitrogen intake) -68.3, all in mg N.kg-1.d-1. Apparent nitrogen digestibility was 82% and 86% for the mixed and milk-egg diets, respectively, when the subjects received 160 mg N.kg-1.d-1. Mean nitrogen intake for satisfactory nitrogen retention on the mixed diet was 150 mg N.kg-1.d-1; the suggested protein recommended allowance to cover 97.5% of the population was derived by using a CV of 12.5% is 1.2 g protein.kg-1.d-1. We conclude that present recommendations are adequate for short-term nitrogen retention; long-term studies are needed to evaluate the chronic safety of this protein allowance.

The effect of energy supplementation was evaluated in six underweight adults under free-living conditions. Customary energy intake (EI) over 4 wk and estimated body composition were defined. Then for 12 wk subjects were fed their customary EI under controlled conditions to assure stable energy reserve. Finally, intake was increased by a mean of 720 kcal/d for 8 wk adjusted to increase body fat from 9 to 18%. Body weight (means +/- SD) increased from 55.2 +/- 3.4 to 57.0 +/- 4.2 kg. Body fat gain was highly variable ranging from 0.6 to 3.8 kg. Energy expenditure (EE) by the factorial and doubly labeled water methods did not change. Fat storage accounted for 66% of the supplemental energy; 237 kcal/d remained unaccounted for. EE by the factorial method, which uses indirect calorimetry or isotopic measurements, were highly correlated (r = 0.8; p less than 0.01). Under the conditions of this study EI does not affect EE. The labeled water method permits the evaluation of energy expenditure in free-living conditions.

The enrichment of bread with the yeast Candida utilis, at 1, 2, 3, 6 and 10% cultivated on sugar beet molasses, was studied. The physical characteristics, chemical composition and biological quality of the protein were determined in every case. The results showed that the farinograph valorimeter value and the physical dough characteristics were adversely affected by the addition of C. utilis. The loaf volume decreased noticeably at levels of fortification higher than 1%. The colour became increasingly darker with every rise in supplementation level. Chemical analyses of bread showed that addition of C. utilis increased the concentration of crude protein from 14.4% in the control bread to 21.3% in the 10% enriched bread. The biological study in rats showed that p.e.r. progressively increased from 0.84 for the control bread to 1.74 for the highest level of supplementation (P < 0.001). Supplementation of bread with C. utilis can make an important contribution to meeting the daily protein requirements in those countries where this food constitutes a significant part of the diet.

The chemical composition (moisture, ash, protein and non-protein N, amino acids, ether extract, crude fibre, Ca, P, Fe) and biological quality (protein efficiency ratio and available lysine) were investigated in two batches of Candida utilis (Torula yeast). The samples (S1 and S2) were collected from a local factory. S2 was sterilised before drying. Protein, mineral and B-complex vitamin contents were comparatively high. Amino-acid analysis showed a high content of lysine and threonine, but a deficiency in sulphur amino acids. The biological quality measured as the protein efficiency ratio (p.e.r.) and available lysine gave values of 1.80 ± 0.05 and 6.6 g/100g of crude protein, respectively, in S1. These are higher than values reported in the literature. Sterilisation (S2) and storage for 1 year (S1(a)) significantly reduced the biological quality of the protein (p.e.r. 1.15 ± 0.12 and 1.34 ± 0.07, respectively). Supplementation of C. utilis with 0.3% DL-methionine increased the p.e.r. value to 2.77 ± 0.03, close to that of casein. C. utilis appears to be a valuable material for human diets because of the high content and satisfactory quality of its protein and other nutrients.