Medicine & Science in Sports & Exercise, 1987
To better characterize the athletes who participate in ultraendurance triathlons, 14 triathletes ... more To better characterize the athletes who participate in ultraendurance triathlons, 14 triathletes in training for the Hawaii IRONMAN triathlon were studied. A physical and physiological profile was developed from anthropometric measurements and oxygen uptake during maximal exercise on a treadmill, cycle ergometer, and arm ergometer. A comparison of the maximal values among exercise modes and between males and females was made. A comparison of height, weight, and percent body fat of these triathletes with elite athletes from the sports of swimming, cycling, and running showed the physique of triathletes to be most similar to that of cyclists. Oxygen uptake at maximal exercise was, for males and females, respectively: 68.8 ml X kg-1 X min-1, 65.9 ml X kg-1 X min-1 on the treadmill; 66.7 ml X kg-1 X min-1, 61.6 ml X kg-1 X min-1 on the cycle ergometer; and 49.1 ml X kg-1 X min-1, 39.7 ml X kg-1 X min-1 on the arm ergometer. When comparing the highest oxygen uptake attained at maximal exercise in any one of the three exercise modes, the male triathletes are comparable to swimmers, but have a lower aerobic capacity than cyclists or distance runners. The female triathletes studied were able to attain oxygen uptake values greater than those previously reported for female athletes.
Changes in bone morphometry during chronic undernutrition were evaluated in 14 young women with a... more Changes in bone morphometry during chronic undernutrition were evaluated in 14 young women with anorexia nervosa (mean age +/- SEM = 25.5 +/- 4.4 yrs). Bone morphometry studies using the second metacarpal of the left hand showed significant depression for percent cortical area (p less than 0.05); cortical area (p less than 0.001) and combined cortical thickness (p less than 0.01) as compared to age, sex and race matched controls. A trend (p less than 0.10) was observed in study subjects for reductions in bone width and total area. Using percent cortical area (PCA) as the standard, subjects had mean cortical bone morphometry equivalent to 60-year-old women. Appendicular bone mass is significantly decreased in adults with anorexia nervosa. Anorexia nervosa should be considered in the differential diagnosis of osteopenia in young women, and serves as a model for studying the effects of chronic calorie and mineral malnutrition on bone remodeling at the time of attainment of peak bone mass.
Nonrestraining" superior vena cava (SVC) cannulae are commonly used in rat metabolic studies. The... more Nonrestraining" superior vena cava (SVC) cannulae are commonly used in rat metabolic studies. The objective of this study was to evaluate the level of stress and metabolic alterations associated with surgical placement and subsequent maintenance and use of an indwelling intravenous cannula as measured by resting energy expenditure (REE), respiratory quotient (RQ), urinary nitrogen excretion, and substrate utilization pattern. Nine rats underwent SVC cannulation and six rats underwent sham operation. Postoperatively, animals were starved for 48 hr and then refed either parenterally or orally for 48 hr. Sham-operated animals adapted appropriately to starvation within 24 hr by decreasing REE 14% and increasing utilization of fat (RQ:0.89-0.78). Hypometabolic adaptation to starvation was delayed in cannulated animals until the second postoperative day, but appropriate alterations in energy substrate utilization were not affected by the presence of cannulae. Cannulae did not affect the metabolic response to oral refeeding with similar increases in REE and similar patterns of substrate utilization in sham-operated and cannulated animals. Animals refed parenterally demonstrated higher REE and apparent fat deposition (RQ > 1) consistent with continuous bypercaloric glucose administration. Urinary nitrogen excretion was not affected by the presence of cannulae. Cannula-associated metabolic alterations are minimal and transient and do not preclude detection and quantification of alterations associated with composition or utilization of exogenous substrates. 0 1985 Academic FTW, IX.
Cancer cachexia, a common finding in patients with gastrointestinal (GI) malignancy, is frequentl... more Cancer cachexia, a common finding in patients with gastrointestinal (GI) malignancy, is frequently attributed to tumor-induced aberrations in host energy expenditure. To characterize the frequency and severity of aberrations in energy expenditure in GI cancer patients, and to identify the potential influence of tumor characteristics in this group, the authors measured resting energy expenditure (REE) by indirect calorimetry in 173 patients and compared REE to predicted-energy expenditure (PEE) from the Harris-Benedict formulae based on current body weight. Fifty-eight percent of patients had abnormal REE (normal REE = +/- 10% PEE); 36% (62 of 173) were hypometabolic (REE less than 90% PEE), and 22% (39 of 173) were hypermetabolic (REE greater than 110% PEE). Host and tumor factors were compared between metabolic groups to identify potential determinants of abnormal energy expenditure. Differences between groups cannot be explained by differences in patient age, sex, body size, nutritional status, tumor burden, or duration of disease. Resting energy expenditure does not correlate with percent of weight loss, serum albumin, or duration of disease. Analysis by tumor site reveals patients with pancreatic or hepatobiliary tumors to be predominantly hypometabolic; gastric cancer patients tend to be hypermetabolic, whereas patients with colorectal or esophageal neoplasms are more evenly distributed across metabolic groups, the largest portion being normometabolic (X2 = 20.7, P less than 0.02). The majority of GI cancer patients have abnormal REE which is unpredictable and not uniformly hypermetabolic. The determinants of these abnormalities do not appear to be age, sex, body size, nutritional status or tumor burden. Primary tumor site is a major determinant of energy expenditure in GI cancer patients.
Toxemia of pregnancy is a perplexing clinical problem that has defied accurate elucidation of its... more Toxemia of pregnancy is a perplexing clinical problem that has defied accurate elucidation of its etiology because the disorder does not occur in undisturbed lower mammalian species that are currently used as animal models of reproductive physiology. We propose that toxemia of pregnancy occurs as the end stage human fetal-placental unit response to decreased maternal uterine blood flow, and that this fetal-placental unit response may be unique to the human species. The human fetus increases insulin secretion in response to progressive intrauterine asphyxia, which may result in decreased fetal-placental prostacyclin production (a vasodilator and inhibitor of platelet aggregation) and increased fetal-placental thromboxane A2 production (a vasoconstrictor). This could result in increased uteroplacental perfusion pressure, maternal hypertension, and increased maternal platelet aggregation. We also suggest that women who develop idiopathic toxemia of pregnancy are at increased risk for adult onset diabetes later on in life because they have a mild derangement in glucose-insulin homeostasis during their reproductive years that results in increased uterine vascular damage, that leads to decreased uterine blood flow, and ultimately the fetal hyperinsulinemia-prostaglandin pressor release mechanism. Therefore, prevention of toxemia may be possible by correction of mild derangements in glucose-insulin receptor homeostasis before conception occurs.
The relative efficacy of prehepatic and central venous infusion of total parenteral nutrition (TP... more The relative efficacy of prehepatic and central venous infusion of total parenteral nutrition (TPN) was evaluated in a chair-adapted primate model. Four adult male monkeys (Macaca fascicularis) underwent surgical placement of a silastic catheter in both the portal vein (PV) and superior vena cava (SVC). Following recovery (10 days), each animal received two courses of TPN (100 kcal and 4 g of protein/kg/day) for 10 days each via the PV and SVC in an alternating crossover manner. The prehepatic (PV) infusion of TPN in the well nourished, chair-adapted primate results in maintenance of weight (PV: delta - 0.07 kg; SVC:delta - 0.07 kg), nitrogen equilibrium (PV:+ 0.8 g N/day; SVC: + 0.7 g N/day), and trends in serum albumin (PV:delta - 0.35 g %; SVC: delta - 0.38 g %), and total iron binding capacity (PV:delta + 44 mg %; SVC:delta + 8.67 mg %) comparable to the SVC route. No significant abnormalities in liver enzyme production were observed with either route of infusion. Whole body protein synthesis rates using 15N-glycine tracer were likewise comparable (PV = 2.05 g N/kg/day; SVC = 2.18 g N/kg/day). Prehepatic delivery and primary hepatic modulation of substrates does not substantially improve the efficacy of parenteral nutrient administration. Intestinal modification of substrates may be the most important contributing factor in the supposed superiority of enteral alimentation.
JEFFRY SHEARER, MS, MICHAEL CALDWELL, MD, PH.D., LON O. CROSBY, PH.D., ELIZABETH MILLER, PH.D., G... more JEFFRY SHEARER, MS, MICHAEL CALDWELL, MD, PH.D., LON O. CROSBY, PH.D., ELIZABETH MILLER, PH.D., GORDON P. BUZBY, MD, AND JAMES L. MULLEN, MD ... From the University of Pennsylvania School of Medicine and the Philadelphia Veterans Administration ...
ABSTRACT. A multidisciplinary group of nutritional care providers was surveyed to assess degree o... more ABSTRACT. A multidisciplinary group of nutritional care providers was surveyed to assess degree of agreement on the relative importance of various areas of nutrition knowledge. A 35-item nutrition content area survey was mailed to a stratified, random sample (n = 400) of the American Society for Paren-teral and Enteral Nutrition (ASPEN) membership representing dietitians, nurses, pharmacists, and physicians. Through the use of modified Delphi survey, respondents rated each content area as ’essential, ’ ’useful, ’ or ’nonessential ’ for inclusion in a proposed test to assess nutrition knowledge. Respondents from all disciplines agreed that they should be knowledgeable in 22 of the 35 content areas. Chi square tests were used to assess significant response differences among disciplines. Systematic differences were primarily between dietitians and pharmacists. The study results provide direction to multidisciplinary contin-
Farmers may be the Pharmarmaceutical producers of the 21st Century. The technology exists, and pr... more Farmers may be the Pharmarmaceutical producers of the 21st Century. The technology exists, and practices commonly used in agrculture can be modified to mett envisioned GMPs - and those modifications are within reach.
Resting energy expenditure (REE), measured by bedside indirect calorimetry, was compared to estim... more Resting energy expenditure (REE), measured by bedside indirect calorimetry, was compared to estimated REE by the Harris-Benedict and Kleiber predictors in 200 clinically stable hospitalized patients (100 males, 100 females) and 72 healthy control subjects (20 males, 52 females). Mean predicted values were not significantly different from measured REE for the male patients and control subjects, but measured REE was significantly overestimated by the Kleiber formula in female patients and controls (p Since no method exists for identifying the clinically stable patient for whom REE cannot be estimated via these commonly employed predictors, the bedside measurement of resting energy expenditure is the most appropriate method for deriving caloric expenditure and designing subsequent caloric provision regimens for adequate and safe nutritional repletion or maintenance.
Animal studies suggest that hyperglycemia (glucose concentrations > 225 mg/dl) occurring prior... more Animal studies suggest that hyperglycemia (glucose concentrations > 225 mg/dl) occurring prior to periods of brain ischemia exacerbates neurologic damage. Neurosurgical patients, a group at risk for intraoperative brain ischemia, often receive glucose. Therefore, the effects of intraoperative glucos
Resting energy expenditure (REE) was measured in 112 morbidly obese adults prior to elective gast... more Resting energy expenditure (REE) was measured in 112 morbidly obese adults prior to elective gastric bypass surgery. The patients studied ranged from 157 to 327% of ideal body weight. Standard nutritional assessment indices (serum total protein, albumin, ...
Metabolic rates and substrate utilization patterns were evaluated by using a rate cecal ligation ... more Metabolic rates and substrate utilization patterns were evaluated by using a rate cecal ligation and perforation model. Animals that survived for 48 hours after the induction of sepsis were hypermetabolic and responded appropriately to varying exogenous substrate infusions. In contrast, animals that did not survive to 48 hours were premorbidly hypometabolic and failed to adjust their oxidation patterns in response to the exogenous substrate supply. These findings suggest the benefit of individually tailoring the supply of exogenous nutrients in critically ill patients with sepsis and of frequent reassessment of metabolic parameters, including the resting energy expenditure and respiratory quotient.
It is widely believed that the presence of a malignancy causes increased energy expenditure in th... more It is widely believed that the presence of a malignancy causes increased energy expenditure in the cancer patient. To test this hypothesis, resting energy expenditure (REE) was measured by bedside indirect calorimetry in 200 heterogeneous hospitalized cancer patients. Measured resting energy expenditure (REE-M) was compared with expected energy expenditure (REE-P) as defined by the Harris-Benedict formula. The study population consisted of 77 males and 123 females with a variety of tumor types: 44% with gastrointestinal malignancy, 29% with gynecologic malignancy, and 19% with a malignancy of genitourinary origin. Patients were classified as hypometabolic (REE < 90% of predicted), normometabolic (90-110% of predicted) or hypermetabolic (>1 10% of predicted). Fifty-nine per cent of patients exhibited aberrant energy expenditure outside the normal range. Thirty-three per cent were hypometabolic (79.2% REE-P), 41% were normometabolic (99.5% REE-P), and 26% were hypermetabolic (121.9% REE-P) (p < 0.001). Aberrations in REE were not due to age, height, weight, sex, nutritional status (% weight loss, visceral protein status), tumor burden (no gross tumor, local, or disseminated disease), or presence of liver metastasis. Hypermetabolic patients had significantly longer duration of disease (p < 0.04) than normometabolic patients (32.8 vs. 12.8 months), indicating that the duration of a malignancy may have a major impact upon energy metabolism. Cancer patients exhibit major aberrations in energy metabolism, but are not uniformly hypermetabolic. Energy expenditure cannot be accurately predicted in cancer patients using standard predictive formulae. EIGHT LOSS is a common clinical finding in the VY patient with cancer. In many instances, it is seen late in the course of the disease, while in other cases it is the first symptom that induces the patient to seek medical attention. Many factors contribute to loss of weight and progressive cachexia. No direct correlation between the size, site, extent, stage, or cell type of the neoplasm and the incidence and severity of the cachexia Presented in part at the 6th Clinical Congress of the American Society Parenteral and Enteral Nutrition, San Francisco, 1982. The research project supported in part by the following grants: Ed
... Although some argue that the production of pharmaceuticals in transgenic plants should be unr... more ... Although some argue that the production of pharmaceuticals in transgenic plants should be unregulated, we find that stance inappropriate (13). We examined the issues asking four basic questions: What are the issues? What are the solutions? Is the technology available? ...
Medicine & Science in Sports & Exercise, 1987
To better characterize the athletes who participate in ultraendurance triathlons, 14 triathletes ... more To better characterize the athletes who participate in ultraendurance triathlons, 14 triathletes in training for the Hawaii IRONMAN triathlon were studied. A physical and physiological profile was developed from anthropometric measurements and oxygen uptake during maximal exercise on a treadmill, cycle ergometer, and arm ergometer. A comparison of the maximal values among exercise modes and between males and females was made. A comparison of height, weight, and percent body fat of these triathletes with elite athletes from the sports of swimming, cycling, and running showed the physique of triathletes to be most similar to that of cyclists. Oxygen uptake at maximal exercise was, for males and females, respectively: 68.8 ml X kg-1 X min-1, 65.9 ml X kg-1 X min-1 on the treadmill; 66.7 ml X kg-1 X min-1, 61.6 ml X kg-1 X min-1 on the cycle ergometer; and 49.1 ml X kg-1 X min-1, 39.7 ml X kg-1 X min-1 on the arm ergometer. When comparing the highest oxygen uptake attained at maximal exercise in any one of the three exercise modes, the male triathletes are comparable to swimmers, but have a lower aerobic capacity than cyclists or distance runners. The female triathletes studied were able to attain oxygen uptake values greater than those previously reported for female athletes.
Changes in bone morphometry during chronic undernutrition were evaluated in 14 young women with a... more Changes in bone morphometry during chronic undernutrition were evaluated in 14 young women with anorexia nervosa (mean age +/- SEM = 25.5 +/- 4.4 yrs). Bone morphometry studies using the second metacarpal of the left hand showed significant depression for percent cortical area (p less than 0.05); cortical area (p less than 0.001) and combined cortical thickness (p less than 0.01) as compared to age, sex and race matched controls. A trend (p less than 0.10) was observed in study subjects for reductions in bone width and total area. Using percent cortical area (PCA) as the standard, subjects had mean cortical bone morphometry equivalent to 60-year-old women. Appendicular bone mass is significantly decreased in adults with anorexia nervosa. Anorexia nervosa should be considered in the differential diagnosis of osteopenia in young women, and serves as a model for studying the effects of chronic calorie and mineral malnutrition on bone remodeling at the time of attainment of peak bone mass.
Nonrestraining" superior vena cava (SVC) cannulae are commonly used in rat metabolic studies. The... more Nonrestraining" superior vena cava (SVC) cannulae are commonly used in rat metabolic studies. The objective of this study was to evaluate the level of stress and metabolic alterations associated with surgical placement and subsequent maintenance and use of an indwelling intravenous cannula as measured by resting energy expenditure (REE), respiratory quotient (RQ), urinary nitrogen excretion, and substrate utilization pattern. Nine rats underwent SVC cannulation and six rats underwent sham operation. Postoperatively, animals were starved for 48 hr and then refed either parenterally or orally for 48 hr. Sham-operated animals adapted appropriately to starvation within 24 hr by decreasing REE 14% and increasing utilization of fat (RQ:0.89-0.78). Hypometabolic adaptation to starvation was delayed in cannulated animals until the second postoperative day, but appropriate alterations in energy substrate utilization were not affected by the presence of cannulae. Cannulae did not affect the metabolic response to oral refeeding with similar increases in REE and similar patterns of substrate utilization in sham-operated and cannulated animals. Animals refed parenterally demonstrated higher REE and apparent fat deposition (RQ > 1) consistent with continuous bypercaloric glucose administration. Urinary nitrogen excretion was not affected by the presence of cannulae. Cannula-associated metabolic alterations are minimal and transient and do not preclude detection and quantification of alterations associated with composition or utilization of exogenous substrates. 0 1985 Academic FTW, IX.
Cancer cachexia, a common finding in patients with gastrointestinal (GI) malignancy, is frequentl... more Cancer cachexia, a common finding in patients with gastrointestinal (GI) malignancy, is frequently attributed to tumor-induced aberrations in host energy expenditure. To characterize the frequency and severity of aberrations in energy expenditure in GI cancer patients, and to identify the potential influence of tumor characteristics in this group, the authors measured resting energy expenditure (REE) by indirect calorimetry in 173 patients and compared REE to predicted-energy expenditure (PEE) from the Harris-Benedict formulae based on current body weight. Fifty-eight percent of patients had abnormal REE (normal REE = +/- 10% PEE); 36% (62 of 173) were hypometabolic (REE less than 90% PEE), and 22% (39 of 173) were hypermetabolic (REE greater than 110% PEE). Host and tumor factors were compared between metabolic groups to identify potential determinants of abnormal energy expenditure. Differences between groups cannot be explained by differences in patient age, sex, body size, nutritional status, tumor burden, or duration of disease. Resting energy expenditure does not correlate with percent of weight loss, serum albumin, or duration of disease. Analysis by tumor site reveals patients with pancreatic or hepatobiliary tumors to be predominantly hypometabolic; gastric cancer patients tend to be hypermetabolic, whereas patients with colorectal or esophageal neoplasms are more evenly distributed across metabolic groups, the largest portion being normometabolic (X2 = 20.7, P less than 0.02). The majority of GI cancer patients have abnormal REE which is unpredictable and not uniformly hypermetabolic. The determinants of these abnormalities do not appear to be age, sex, body size, nutritional status or tumor burden. Primary tumor site is a major determinant of energy expenditure in GI cancer patients.
Toxemia of pregnancy is a perplexing clinical problem that has defied accurate elucidation of its... more Toxemia of pregnancy is a perplexing clinical problem that has defied accurate elucidation of its etiology because the disorder does not occur in undisturbed lower mammalian species that are currently used as animal models of reproductive physiology. We propose that toxemia of pregnancy occurs as the end stage human fetal-placental unit response to decreased maternal uterine blood flow, and that this fetal-placental unit response may be unique to the human species. The human fetus increases insulin secretion in response to progressive intrauterine asphyxia, which may result in decreased fetal-placental prostacyclin production (a vasodilator and inhibitor of platelet aggregation) and increased fetal-placental thromboxane A2 production (a vasoconstrictor). This could result in increased uteroplacental perfusion pressure, maternal hypertension, and increased maternal platelet aggregation. We also suggest that women who develop idiopathic toxemia of pregnancy are at increased risk for adult onset diabetes later on in life because they have a mild derangement in glucose-insulin homeostasis during their reproductive years that results in increased uterine vascular damage, that leads to decreased uterine blood flow, and ultimately the fetal hyperinsulinemia-prostaglandin pressor release mechanism. Therefore, prevention of toxemia may be possible by correction of mild derangements in glucose-insulin receptor homeostasis before conception occurs.
The relative efficacy of prehepatic and central venous infusion of total parenteral nutrition (TP... more The relative efficacy of prehepatic and central venous infusion of total parenteral nutrition (TPN) was evaluated in a chair-adapted primate model. Four adult male monkeys (Macaca fascicularis) underwent surgical placement of a silastic catheter in both the portal vein (PV) and superior vena cava (SVC). Following recovery (10 days), each animal received two courses of TPN (100 kcal and 4 g of protein/kg/day) for 10 days each via the PV and SVC in an alternating crossover manner. The prehepatic (PV) infusion of TPN in the well nourished, chair-adapted primate results in maintenance of weight (PV: delta - 0.07 kg; SVC:delta - 0.07 kg), nitrogen equilibrium (PV:+ 0.8 g N/day; SVC: + 0.7 g N/day), and trends in serum albumin (PV:delta - 0.35 g %; SVC: delta - 0.38 g %), and total iron binding capacity (PV:delta + 44 mg %; SVC:delta + 8.67 mg %) comparable to the SVC route. No significant abnormalities in liver enzyme production were observed with either route of infusion. Whole body protein synthesis rates using 15N-glycine tracer were likewise comparable (PV = 2.05 g N/kg/day; SVC = 2.18 g N/kg/day). Prehepatic delivery and primary hepatic modulation of substrates does not substantially improve the efficacy of parenteral nutrient administration. Intestinal modification of substrates may be the most important contributing factor in the supposed superiority of enteral alimentation.
JEFFRY SHEARER, MS, MICHAEL CALDWELL, MD, PH.D., LON O. CROSBY, PH.D., ELIZABETH MILLER, PH.D., G... more JEFFRY SHEARER, MS, MICHAEL CALDWELL, MD, PH.D., LON O. CROSBY, PH.D., ELIZABETH MILLER, PH.D., GORDON P. BUZBY, MD, AND JAMES L. MULLEN, MD ... From the University of Pennsylvania School of Medicine and the Philadelphia Veterans Administration ...
ABSTRACT. A multidisciplinary group of nutritional care providers was surveyed to assess degree o... more ABSTRACT. A multidisciplinary group of nutritional care providers was surveyed to assess degree of agreement on the relative importance of various areas of nutrition knowledge. A 35-item nutrition content area survey was mailed to a stratified, random sample (n = 400) of the American Society for Paren-teral and Enteral Nutrition (ASPEN) membership representing dietitians, nurses, pharmacists, and physicians. Through the use of modified Delphi survey, respondents rated each content area as ’essential, ’ ’useful, ’ or ’nonessential ’ for inclusion in a proposed test to assess nutrition knowledge. Respondents from all disciplines agreed that they should be knowledgeable in 22 of the 35 content areas. Chi square tests were used to assess significant response differences among disciplines. Systematic differences were primarily between dietitians and pharmacists. The study results provide direction to multidisciplinary contin-
Farmers may be the Pharmarmaceutical producers of the 21st Century. The technology exists, and pr... more Farmers may be the Pharmarmaceutical producers of the 21st Century. The technology exists, and practices commonly used in agrculture can be modified to mett envisioned GMPs - and those modifications are within reach.
Resting energy expenditure (REE), measured by bedside indirect calorimetry, was compared to estim... more Resting energy expenditure (REE), measured by bedside indirect calorimetry, was compared to estimated REE by the Harris-Benedict and Kleiber predictors in 200 clinically stable hospitalized patients (100 males, 100 females) and 72 healthy control subjects (20 males, 52 females). Mean predicted values were not significantly different from measured REE for the male patients and control subjects, but measured REE was significantly overestimated by the Kleiber formula in female patients and controls (p Since no method exists for identifying the clinically stable patient for whom REE cannot be estimated via these commonly employed predictors, the bedside measurement of resting energy expenditure is the most appropriate method for deriving caloric expenditure and designing subsequent caloric provision regimens for adequate and safe nutritional repletion or maintenance.
Animal studies suggest that hyperglycemia (glucose concentrations > 225 mg/dl) occurring prior... more Animal studies suggest that hyperglycemia (glucose concentrations > 225 mg/dl) occurring prior to periods of brain ischemia exacerbates neurologic damage. Neurosurgical patients, a group at risk for intraoperative brain ischemia, often receive glucose. Therefore, the effects of intraoperative glucos
Resting energy expenditure (REE) was measured in 112 morbidly obese adults prior to elective gast... more Resting energy expenditure (REE) was measured in 112 morbidly obese adults prior to elective gastric bypass surgery. The patients studied ranged from 157 to 327% of ideal body weight. Standard nutritional assessment indices (serum total protein, albumin, ...
Metabolic rates and substrate utilization patterns were evaluated by using a rate cecal ligation ... more Metabolic rates and substrate utilization patterns were evaluated by using a rate cecal ligation and perforation model. Animals that survived for 48 hours after the induction of sepsis were hypermetabolic and responded appropriately to varying exogenous substrate infusions. In contrast, animals that did not survive to 48 hours were premorbidly hypometabolic and failed to adjust their oxidation patterns in response to the exogenous substrate supply. These findings suggest the benefit of individually tailoring the supply of exogenous nutrients in critically ill patients with sepsis and of frequent reassessment of metabolic parameters, including the resting energy expenditure and respiratory quotient.
It is widely believed that the presence of a malignancy causes increased energy expenditure in th... more It is widely believed that the presence of a malignancy causes increased energy expenditure in the cancer patient. To test this hypothesis, resting energy expenditure (REE) was measured by bedside indirect calorimetry in 200 heterogeneous hospitalized cancer patients. Measured resting energy expenditure (REE-M) was compared with expected energy expenditure (REE-P) as defined by the Harris-Benedict formula. The study population consisted of 77 males and 123 females with a variety of tumor types: 44% with gastrointestinal malignancy, 29% with gynecologic malignancy, and 19% with a malignancy of genitourinary origin. Patients were classified as hypometabolic (REE < 90% of predicted), normometabolic (90-110% of predicted) or hypermetabolic (>1 10% of predicted). Fifty-nine per cent of patients exhibited aberrant energy expenditure outside the normal range. Thirty-three per cent were hypometabolic (79.2% REE-P), 41% were normometabolic (99.5% REE-P), and 26% were hypermetabolic (121.9% REE-P) (p < 0.001). Aberrations in REE were not due to age, height, weight, sex, nutritional status (% weight loss, visceral protein status), tumor burden (no gross tumor, local, or disseminated disease), or presence of liver metastasis. Hypermetabolic patients had significantly longer duration of disease (p < 0.04) than normometabolic patients (32.8 vs. 12.8 months), indicating that the duration of a malignancy may have a major impact upon energy metabolism. Cancer patients exhibit major aberrations in energy metabolism, but are not uniformly hypermetabolic. Energy expenditure cannot be accurately predicted in cancer patients using standard predictive formulae. EIGHT LOSS is a common clinical finding in the VY patient with cancer. In many instances, it is seen late in the course of the disease, while in other cases it is the first symptom that induces the patient to seek medical attention. Many factors contribute to loss of weight and progressive cachexia. No direct correlation between the size, site, extent, stage, or cell type of the neoplasm and the incidence and severity of the cachexia Presented in part at the 6th Clinical Congress of the American Society Parenteral and Enteral Nutrition, San Francisco, 1982. The research project supported in part by the following grants: Ed
... Although some argue that the production of pharmaceuticals in transgenic plants should be unr... more ... Although some argue that the production of pharmaceuticals in transgenic plants should be unregulated, we find that stance inappropriate (13). We examined the issues asking four basic questions: What are the issues? What are the solutions? Is the technology available? ...
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