Lars Ellegård

Body fluid volume determination via body composition spectroscopy in health and disease

The assessment of extra-, intracellular and total body water (ECW, ICW, TBW) is important in many clinical situations. Bioimpedance spectroscopy (BIS) has advantages over dilution methods in terms of usability and reproducibility, but a careful analysis reveals systematic deviations in extremes of body composition and morbid states. Recent publications stress the need to set up and validate BIS equations in a wide variety of healthy subjects and patients with fluid imbalance. This paper presents two new equations for determination of ECW and ICW (referred to as body composition spectroscopy, BCS) based on Hanai mixture theory but corrected for body mass index (BMI). The equations were set up by means of cross validation using data of 152 subjects (120 healthy subjects, 32 dialysis patients) from three different centers. Validation was performed against bromide/deuterium dilution (NaBr, D2O) for ECW/TBW and total body potassium (TBK) for ICW. Agreement between BCS and the references (all subjects) was -0.4 +/- 1.4 L (mean +/- SD) for ECW, 0.2 +/- 2.0 L for ICW and -0.2 +/- 2.3 L for TBW. The ECW agreement between three independent reference methods (NaBr versus D2O-TBK) was -0.1 +/- 1.8 L for 74 subjects from two centers. Comparing the new BCS equations with the standard Hanai approach revealed an improvement in SEE for ICW and TBW by 0.6 L (24%) for all subjects, and by 1.2 L (48%) for 24 subjects with extreme BMIs (<20 and >30). BCS may be an appropriate method for body fluid volume determination over a wide range of body compositions in different states of health and disease.

Inulin and oligofructose do not influence the absorption of cholesterol, or the excretion of cholesterol, Ca, Mg, Zn, Fe, or bile acids but increases energy excretion in ileostomy subjects

OBJECTIVE: To investigate the effects of inulin and oligofructose on cholesterol absorption and excretion of cholesterol, bile acids, energy, nitrogen and minerals in man.DESIGN: Double-blind cross-over study.SETTING: Metabolic kitchen with policlinic visits, Sahlgrenska Hospital, Göteborg, SwedenSUBJECTS: Patients with conventional ileostomy because of ulcerative colitis.INTERVENTIONS: 17 g of inulin, 17 g of oligofructose and 7 g of sucrose were added to a controlled diet during three experimental periods of three days each. Ileostomy effluents were collected and analysed. Differences between experimental and control diet were investigated with the Wilcoxon’s sign and values test.RESULTS: Inulin and oligofructose were recovered in the ileostomy effluent to 88% (95% CI, 76–100%) and 89% (64–114%) respectively. Dry solid excretion increased by 14.4 g (11.3–17.5) on inulin, and by 14.7 g (13.0–16.4 g) on oligofructose and energy excretion increased 245 kJ (190–307 kJ) on inulin and 230 kJ (217–315 kJ) on oligofructose compared to control diet (P<0.05). Cholesterol absorption, excretion of cholesterol, bile acids, nitrogen, fat, calcium, magnesium, zinc and iron were not affected by inulin and oligofructose.CONCLUSIONS: Inulin and oligofructose are not digested in the small intestine. They do not affect mineral excretion and hence hardly mineral absorption. They do not increase fat or nitrogen excretion from the small intestine. Any physiological effect of inulin and oligofructose is probably mediated through other mechanisms than altered excretion from the small intestine.SPONSORSHIPS: This work was supported by grants from Swedish Council for Agriculture and Forestry, from Gothenburg Medical Society and from ORAFTI Ltd Belgium.

Plant sterols and plant stanols in the management of dyslipidaemia and prevention of cardiovascular disease

OBJECTIVE This EAS Consensus Panel critically appraised evidence relevant to the benefit to risk relationship of functional foods with added plant sterols and/or plant stanols, as components of a healthy lifestyle, to reduce plasma low-density lipoprotein-cholesterol (LDL-C) levels, and thereby lower cardiovascular risk. METHODS AND RESULTS Plant sterols/stanols (when taken at 2 g/day) cause significant inhibition of cholesterol absorption and lower LDL-C levels by between 8 and 10%. The relative proportions of cholesterol versus sterol/stanol levels are similar in both plasma and tissue, with levels of sterols/stanols being 500-/10,000-fold lower than those of cholesterol, suggesting they are handled similarly to cholesterol in most cells. Despite possible atherogenicity of marked elevations in circulating levels of plant sterols/stanols, protective effects have been observed in some animal models of atherosclerosis. Higher plasma levels of plant sterols/stanols associated with intakes of 2 g/day in man have not been linked to adverse effects on health in long-term human studies. Importantly, at this dose, plant sterol/stanol-mediated LDL-C lowering is additive to that of statins in dyslipidaemic subjects, equivalent to doubling the dose of statin. The reported 6-9% lowering of plasma triglyceride by 2 g/day in hypertriglyceridaemic patients warrants further evaluation. CONCLUSION Based on LDL-C lowering and the absence of adverse signals, this EAS Consensus Panel concludes that functional foods with plant sterols/stanols may be considered 1) in individuals with high cholesterol levels at intermediate or low global cardiovascular risk who do not qualify for pharmacotherapy, 2) as an adjunct to pharmacologic therapy in high and very high risk patients who fail to achieve LDL-C targets on statins or are statin- intolerant, 3) and in adults and children (>6 years) with familial hypercholesterolaemia, in line with current guidance. However, it must be acknowledged that there are no randomised, controlled clinical trial data with hard end-points to establish clinical benefit from the use of plant sterols or plant stanols.

Low-dose recombinant human growth hormone increases body weight and lean body mass in patients with short bowel syndrome.

OBJECTIVE The authors investigate the effects of low dose recombinant human growth hormone (rhGH) on body composition and absorptive capacity in patients with short bowel syndrome from Crohns disease. SUMMARY BACKGROUND DATA Patients with short bowel syndrome usually are malnourished because of malabsorption. The anabolic effects of high doses of rhGH have been tested in different clinical catabolic conditions, recently including patients with short bowel syndrome. The authors have investigated the effects of low-dose rhGH in short bowel syndrome in a placebo-controlled crossover clinical trial. METHODS Ten patients were treated with daily subcutaneous doses of rhGH/placebo (0.5 international units/kg-1 per week-1 = 0.024 mg/kg-1 per day-1) for 8 weeks in a randomized, double-blind, placebo-controlled crossover clinical trial with a minimum of 12 weeks wash-out. Absorptive capacity and biochemical parameters were investigated in a metabolic ward before treatment and during first and last week of treatment. Body composition was determined by DEXA-Scan (Lunar DPX, Scanexport Medical, Helsingborg, Sweden), impedance analysis, and whole body potassium counting. RESULTS Low-dose rhGH doubled serum levels of insulin-like growth factor-1 (IGF-1) and increased body weight, lean body mass, and total body potassium by 5% (p < 0.05). Fat-free mass and total body water increased by 6% (p = 0.008). Increases in IGF-1 levels correlated with increases in fat-free mass (r = 0.77, p < 0.02). No significant changes in absorptive capacity of water, energy, or protein were detected. CONCLUSION Eight weeks of low-dose rhGH treatment leads to increases in body weight, lean body mass, and fat-free mass in patients with short bowel syndrome, correlated to increases in IGF-1 levels.

Intake of dietary plant sterols is inversely related to serum cholesterol concentration in men and women in the EPIC Norfolk population: a cross-sectional study

Objective: We examined the relation between intake of natural dietary plant sterols and serum lipid concentrations in a free-living population.Design, setting and participants: Cross-sectional population-based study of 22 256 men and women aged 39–79 y resident in Norfolk, UK, participating in the European Prospective Investigation into Cancer (EPIC-Norfolk).Main exposure and outcome measures: Plant sterol intake from foods and concentrations of blood lipids.Results: Mean concentrations of total cholesterol and low-density lipoprotein cholesterol, adjusted for age, body mass index and total energy intake, decreased with increasing plant sterol intake in men and women. Mean total serum cholesterol concentration for men in the highest fifth of plant sterol intake (mean intake 463 mg daily) was 0.25 mmol/l lower and for low-density lipoprotein cholesterol 0.14 mmol/l lower than those in the lowest fifth of plant sterol consumption (mean intake 178 mg daily); the corresponding figures in women were 0.15 and 0.13 mmol/l. After adjusting for saturated fat and fibre intakes, the results for total cholesterol and low-density lipoprotein cholesterol were similar, although the strength of the association was slightly reduced.Conclusions: In a free-living population, a high intake of plant sterols is inversely associated with lower concentrations of total and low-density lipoprotein serum cholesterol. The plant sterol content of foods may partly explain diet-related effects on serum cholesterol concentration.

Oat bran rapidly increases bile acid excretion and bile acid synthesis: an ileostomy study

Objective:To study whether oat bran with native β-glucans increases bile acid excretion and bile acid synthesis as measured by serum concentrations of 7α-hydroxy-4-cholesten-3-one (7α-HC).Design:Short-term interventional crossover study evaluating cholesterol absorption, ileal excretion of cholesterol and bile acids, and serum levels of cholesterol and bile acid metabolites. Differences between diets evaluated with Wilcoxons signed rank-sum test.Setting:Outpatients at a metabolic-ward kitchen.Subjects:Nine volunteers with conventional ileostomies.Methods:Two 3-day-diet periods, with controlled, blinded basal diet including 75 g extruded oat bran breakfast cereal daily, with either 11.6 g native or hydrolysed β-glucans.Results:Native oat bran increased median excretion of bile acids by 144% (P=0.008). Cholesterol excretion remained unchanged, cholesterol absorption decreased by 19% (P=0.013), whereas the sum of bile acid and cholesterol excretion increased by 40% (P=0.008) compared with hydrolysed oat bran. 7α-HC reflecting bile acid synthesis increased by 57% (P=0.008) within 24 h of consumption, whereas serum lathosterol concentration reflecting cholesterol synthesis increased by 12% (P=0.015).Conclusions:Oat bran with native β-glucans increases bile acid excretion within 24 h of consumption and this increase can also be detected by rising serum concentrations of 7α-HC. Thus, 7α-HC could be used for rapid detection of dietary effects on bile acid metabolism. These effects could possibly be explained by entrapment of whole micelles in the gut owing to higher viscosity.

Body composition in the elderly: Reference values and bioelectrical impedance spectroscopy to predict total body skeletal muscle mass☆

BACKGROUND & AIMS To validate the bioelectrical impedance spectroscopy (BIS) model against dual-energy X-ray absorptiometry (DXA), to develop and compare BIS estimates of skeletal muscle mass (SMM) to other prediction equations, and to report BIS reference values of body composition in a population-based sample of 75-year-old Swedes. METHODS Body composition was measured by BIS in 574 subjects, and by DXA and BIS in a subset of 98 subjects. Data from the latter group was used to develop BIS prediction equations for total body skeletal muscle mass (TBSMM). RESULTS Average fat free mass (FFM) measured by DXA and BIS was comparable. FFM(BIS) for women and men was 40.6 kg and 55.8 kg, respectively. Average fat free mass index (FFMI) and body fat index (BFI) for women were 15.6 and 11.0. Average FFMI and BFI for men were 18.3 and 8.6. Existing bioelectrical impedance analysis equations to predict SMM were not valid in this cohort. A TBSMM prediction equation developed from this sample had an R(2)(pred) of 0.91, indicating that the equation would explain 91% of the variability in future observations. CONCLUSIONS BIS correctly estimated average FFM in healthy elderly Swedes. For prediction of TBSMM, a population specific equation was required.

Supraphysiological growth hormone: less fat more extracellular fluid but uncertain effects on muscles in healthy active young adults.

Objectives  To study the effects on body composition after 1 months administration of supraphysiological doses of growth hormone (GH) in healthy, active young adults with normal GH‐IGF‐I axis.

Food sources of plant sterols in the EPIC Norfolk population

Objective:To investigate the intake of plant sterols and identify major dietary sources of plant sterols in the British diet.Subjects:A total of 24 798 men and women recruited during 1993–1997, participating in the European Prospective Investigation into Cancer (EPIC-Norfolk).Interventions:A database of the plant sterol (campesterol, β-sitosterol, stigmasterol, campestanol and β-sitostanol) content in foods, based on gas-liquid chromatography (GLC) analyses, was linked to nutritional intake data from food frequency questionnaires in the EPIC-Norfolk population.Results:The mean (s.d.) intake of total plant sterols was 300 (108) mg/d for men and 293 (100) mg/d for women. Bread and other cereals, vegetables and added fats were the three major food sources of plant sterols representing 18.6 (8.9), 18.4 (8.5) and 17.3 (10.4)% of the total plant sterol intake respectively. Women had a higher plant sterol density than men (36.4 vs 32.8 mg/1000 kJ, P<0.001) and in relation to energy intake higher intakes of plant sterols from vegetables, bread and other cereals, added fats, fruits and mixed dishes (all P<0.001), whilst men had higher intakes of plant sterols from cakes, scones and chocolate, potatoes (all P<0.001) and other foods (P<0.01).Conclusions:The intake of plant sterols in UK, mainly from bread, cereals, fats and vegetables, is much higher than previously reported but comparable to recent European studies.

Will recommended changes in fat and fibre intake affect cholesterol absorption and sterol excretion? An ileostomy study.

Objective: To study cholesterol absorption and excretion in ileostomy subjects with different intakes of saturated fat and dietary fibre.Design: Short-term experimental study, with four controlled diets in repeated measurements.Setting: Out-patients at metabolic-ward kitchen.Subjects: Nine healthy volunteers with conventional ileostomy after colectomy because of ulcerative colitis.Interventions: Four diet periods, each of 3 days duration: high saturated fat and low dietary fibre (STAND); reduced saturated fat (RESAT); high saturated fat and high fibre (FATFIB); and reduced saturated fat and high fibre (RESATFIB).Main outcome measures: Absorption of cholesterol, and ileal excretion of cholesterol, bile acids, fat and energy. Differences between diets evaluated with Friedman’s two-way analysis of variance by rank sum with Bonferroni adjustment, and post hoc differences assessed by rank sum comparison.Results: RESAT and RESATFIB reduced fractional cholesterol absorption by 7% and 10%; RESATFIB and FATFIB increased net cholesterol excretion by 46% and 54% respectively. Further, RESATFIB increased net sterol excretion by 18%, all compared to STAND (P<0.05 for all). All three intervention diets contained more phytosterols than STAND (P<0.05), and the phytosterol content was inversely correlated to fractional cholesterol absorption (r=−0.77, P<0.01).Conclusions: Current nutrition recommendations to reduce saturated fat and increase dietary fibre affect sterol excretion additively. The effect on cholesterol absorption might be partly explained by the content of dietary plant sterols.Sponsorship: Supported by grants from the Gothenburg Medical Society, grant numbers 94/086 and 99/082, and by the University of Gothenburg.European Journal of Clinical Nutrition (2000) 54, 306–313