Mary Anne Gorman

Resting Energy Expenditures Measured by Indirect Calorimetry are Higher In Preadolescent Children with Cystic Fibrosis than Expenditures Calculated from Prediction Equations

OBJECTIVE This study compared measured resting energy expenditures to resting energy expenditures calculated using Harris-Benedict equations (HBEs) and the Cystic Fibrosis Consensus Committee equations (CFCCEs). DESIGN We studied 31 preadolescent boys and girls with cystic fibrosis who ranged in age from 3.25 to 12.75 years old. The patients were afebrile and not in pulmonary distress. Measured resting energy expenditures were determined using a portable metabolic measurement cart with fully automated calibration and data management. The measured resting energy expenditures obtained were compared with values obtained using HBEs and CFCCEs. RESULTS For each patient, the measured resting energy expenditure value was above the predicted resting energy expenditure values derived from HBEs (P < or = .0001) and CFCCEs (P < or = .01). APPLICATIONS The HBEs and the CFCCEs underestimated the energy expenditures of the study population by 13% and 8%, respectively. These findings support the usefulness of the measurement of energy expenditures in determining the energy needs of preadolescent patients with cystic fibrosis. In clinical practice, the resting energy expenditures would be multiplied by activity coefficients to determine the total daily energy expenditures of this population.

Are Lipid Values and BMI Related to Hospitalizations in the Hemodialysis Population

OBJECTIVE To examine the relationship between lipid values and BMI (body mass index) on hospitalizations in hemodialysis (HD) patients. DESIGN Retrospective (2-year) study. SETTING Outpatient dialysis center in a large metropolitan city. PATIENTS This study used 158 HD patients stratified on the basis of ethnicity (non-Black and Black) and diabetic status (nondiabetic and diabetic). INTERVENTION Subjects were observed for 2 years. Body weight, BMI, lipid parameters, and hospitalization duration were determined 8 times (3-month intervals). MAIN OUTCOME MEASURES Body weight, BMI, lipid parameters (serum triglyceride concentration, serum total cholesterol, high-density lipoprotein [HDL]-, low-density lipoprotein [LDL]-, very low-density lipoprotein [VLDL]- cholesterol concentrations, serum Apo-protein A1 [Apo-A1] concentration, and serum Apo-protein B [Apo-B] concentration), and morbidity data were recorded. RESULTS Hemodialysis subjects were hospitalized 2.3 +/- 1.6 times over the 2-year experimental period. Length of hospital stay averaged 6.6 +/- 0.5 days/hospitalization. Length of hospital stay was inversely related to HDL concentration (r = -0.21, P <.05, n = 89), but not significantly related to BMI in HD subjects. BMI was positively associated with LDL concentration (r = +0.28, P <.01, n = 97). Cholesterol concentration was directly associated with LDL concentration (r = +0.52, P <.01, n = 138), VLDL concentration (r = +0.47, P <.01, n = 139), and triglyceride concentration (r = +0.54, P <.01, n = 155). Mean concentration of HDL-cholesterol was inversely related serum triglyceride concentration (r = -0.43, P <.01, n = 140). Although Apo-A1 concentration was directly associated with HDL level (r = +0.39, P <.01, n = 139), Apo-B was inversely related to HDL level (r = -0.37, P <.01, n = 138) and directly related to cholesterol concentration (r = +0.71, P <.01, n = 138), VLDL concentration (r = +0.87, P <.01, n = 138), and triglyceride concentration (r = +0.81, P <.01, n = 138). CONCLUSION Cardiac disease remains the primary cause of morbidity and mortality in HD patients, and results of the present study suggest that dyslipidemias present in the HD population negatively impact cardiovascular profiles which, in turn, influence the frequency/duration of hospitalizations. Among all lipid parameters analyzed in the present study, increased LDL and decreased HDL concentrations were more strongly related to length of hospital stay than was BMI.

The Effect of Dietary Omega-3, -6, and -9 Fatty Acid Supplements on Serum Fatty Acid Concentrations in Renal Dialysis Patients: Implications for Immune Response

Abstract •Objective: To alter the serum fatty acid and immunoglobulin concentrations of renal dialysis patients by supplementation of omega-3, -6, or -9 fatty acids during a 6-week period. •Design: Randomized before-and-after-supplementation trial. •Setting: Three dialysis centers in the Dallas, TX, methopolitan area. •Patients: Thirty-five maintenance hemodialysis patients were chosen. Subjects were identified for inclusion in the study by the following criteria: concentrations of triglycerides ( 1.70 mmol/L [150 mg/dL]) and cholesterol ( 4.66 mmol/L [180 mg/dL]), absence of insulin-dependent diabetes, and absence of liver disease. •Interventions: Patients were supplemented daily with either 3g of omega-3 MaxEPA (Seven Seas Health Care, Hull, England), 3g of omega-6 fatty acid cottonseed oil, or omega-9 fatty acid (10% of caloric intake) pecan oil. The control group received no treatment. •Main outcome measures: Fasting serum samples were obtained on days 0, 21, and 42 to determine serum concentrations of eicosapentanoic acid (EPA), docosahexanoic/myristic acids (DHA/MYR), arachidonic acid (AA), linolenic acid (LNA), linoleic acid (LA), oleic acid (OA), immunoglobulin G (IgG), immunoglobulin A (IgA), and immunoglobulin M (IgM). •Results: Twenty-eight subjects completed the study. Within the MaxEPA-supplemented (N = 5) and pecan oil-supplemented (N = 8) groups, serum EPA concentrations were significantly higher at days 21 and 42 than at day 0. Within the cottonseed oil-supplemented group (N = 8), serum EPA concentration was significantly higher at day 21 than at days 0 and 42. The serum concentrations of AA were significantly lower in the MaxEPA-supplemented and pecan oil-supplemented groups at day 21 and 42 than at day 0. No significant change was shown in serum DHA/MYR, LNA, LA, or OA concentrations from day 0 to day 42. There existed no significant difference in serum IgG, IgA, or IgM concentrations for the duration of the study. •Conclusions: Omega-3, -6, and -9 fatty acid supplements exert different effects on serum fatty acid concentrations in renal dialysis patients. These results support findings in the literature indicating that fatty acid metabolite profiles may be manipulated by diet. In turn, immune response may be altered through manipulation of eicosanoid production. Because of a compromised immune status, renal dialysis patients may be the best population for this type of research, and a comparison of such subjects with healthy volunteers is warranted.

Effects of supplemented omega-3 and omega-6 fatty acid rich oils on the cardiovascular system of thermally injured rabbits: changes in plasma and platelet fatty acids.

The effects of omega-3 fatty acid rich oil (MaxEPA oil), omega-6 fatty acid rich oil (soybean oil), and a combination of omega-3 and omega-6 oils (MaxEPA oil + soybean oil) on cardiovascular health-related parameters of thermally injured and control (sham) rabbits were determined. Plasma and platelet analyses of burned rabbits fed with MaxEPA oil revealed significantly higher concentrations of eicosapentaenoic acid and docosahexaenoic acid + myristic acid. Linolenic acid concentrations declined in animals supplemented with soybean oil + MaxEPA oil. At the end of this study the lowest concentrations of linoleic acid and arachidonic acid were found in the sham and burned groups supplemented with soybean oil + MaxEPA oil. Overall, favorable significant differences in plasma and platelet fatty acids concentrations were found in burned or sham groups supplemented with MaxEPA when compared with those of groups supplemented with soybean oil. These favorable changes in plasma and platelet lipids may have an impact on the risk of cardiovascular disease in thermally injured patients.