Renate Kruschitz

Detecting body fat-A weighty problem BMI versus subcutaneous fat patterns in athletes and non-athletes.

We aimed to describe the relationship between BMI and the subcutaneous adipose tissue topography within young athletes and non-athletic controls, to comparatively evaluate the diagnostic powers of subcutaneous adipose tissue thicknesses at different body sites, furthermore to explore appropriate cut-offs to discriminate between athletes and controls. Measurements were determined in 64 males and 42 females, who were subsequently separated into two even groups (athletes and non-athletes). The optical device LIPOMETER was applied at standardised body sites to measure the thickness of subcutaneous adipose tissue layers. To calculate the power of the different body sites and the BMI to discriminate between athletes and non-athletes, receiver operating characteristic curve analysis was performed. In men, the neck (optimal cut-off value 2.3 mm) and trunk (optimal cut-off value 15.5 mm) provided the strongest discrimination power: with 90.6% (58 of 64) of the subjects being correctly classified into athletes or non-athletes. Discrimination power of the BMI values was 64.1% (41 of 64 were correctly classified). In women, the upper back (optimal cut-off value 3.3 mm) and arms (optimal cut-off value 15.9 mm) provided the strongest discrimination power with 88.1% (37 of 42 being correctly classified). When using BMI to discriminate between athletes and non-athletes only 52.4% (22 of 42) were correctly classified. These results suggest that compared to BMI levels, subcutaneous fat patterns are a more accurate way of discriminating between athletes and non-athletes. In particular the neck and the trunk compartment in men and the upper back and arms compartment in women, were the best sites to discriminate between young athletes and non-athletes on the basis of their fat patterns.

Influence of intravenous thiamine supplementation on blood lactate concentration prior to cardiac surgery: A double-blinded, randomised controlled pilot study.

BACKGROUND Stress related to surgery and critical illness depletes thiamine, essential in energy metabolism, and might result in high blood lactate concentrations and higher mortality. OBJECTIVES We hypothesised that thiamine supplementation would increase blood concentration of thiamine and reduce blood lactate concentration postoperatively. Moreover, we aimed to identify the prevalence of, and risk factors for, high blood lactate concentrations. DESIGN This was a double-blind, randomised controlled pilot study from February to July 2012 including 30 patients scheduled for cardiac surgery with cardiopulmonary bypass. INTERVENTIONS Patients were assigned randomly to receive thiamine (300 mg in 0.9% Normal saline solution) or placebo (0.9% Normal saline) preoperatively. MAIN OUTCOME MEASURES One arterial blood sample was taken preoperatively and another postoperatively to measure thiamine concentration, and multiple samples were taken during surgery and ICU stay to determine lactate concentrations. Twenty-four hour urine samples were collected to measure urinary thiamine concentration. Preoperatively, we assessed extracellular mass to body cell mass ratio (ECM/BCM). RESULTS The mean (SD) age of the patients was 58 (12) years, 73% were overweight, 10% were malnourished and the prevalence of thiamine deficiency was 10%. Patients in the thiamine group had significantly higher blood thiamine concentrations 2 days postoperatively [805.2 ± 289.8 ng g-1 haemoglobin (Hb)] than those in the placebo group (591.2 ± 100.7 ng g-1 Hb, P < 0.01). The mean blood lactate concentration changed significantly over time, but did not differ significantly between the groups. Patients with ECM/BCM more than 1 had higher lactate concentrations on admission to ICU than those with ECM/BCM less than 1 (2.1 ± 0.7 vs. 1.7 ± 0.6, P = 0.09) and were at a significantly greater risk of having a higher lactate concentration on ICU admission [odds ratio (OR) 13.5, 95% confidence interval (95% CI) 1.0 to 179.4, P < 0.05]. On the basis of these results, a sample size calculation for a larger study has been facilitated. CONCLUSION Thiamine supplementation caused normalisation of blood and urine concentrations postoperatively but without a significant reduction in lactate concentration or clinical outcome. Body composition played an important role in lactate formation. Further research focusing on preoperative screening and optimal treatment of high lactate concentrations in this specific population is warranted. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT01524315.

HORMONE SUBSTITUTION AFTER GASTRIC BYPASS SURGERY IN PATIENTS WITH HYPOPITUITARISM SECONDARY TO CRANIOPHARYNGIOMA

OBJECTIVE Craniopharyngiomas (CPs) are benign brain tumors presenting frequently in childhood and are treated by surgery with or without radiotherapy. About 50% of cured patients suffer from eating disorders and obesity due to hypothalamic damage, as well as hypopituitarism, necessitating subsequent hormone substitution therapy. Gastric bypass surgery has been reported to be an efficient treatment strategy for morbid hypothalamic obesity. However, so far it is unknown whether oral hormone substitution is affected by impaired intestinal drug absorption, potentially leading to severe hypopituitarism or pituitary crisis. METHODS Four morbidly obese CP patients with panhypopituitarism treated by gastric bypass surgery were included in this retrospective analysis. Dosages of hormone substitution therapy, blood concentrations of hormones, potential complications of impaired drug absorption, and anthropometric characteristics were investigated pre- and postoperatively after 6 to 14 months and 13 to 65 months. RESULTS In all CP patients (3 female/1 male; baseline body mass index, 49 ± 7 kg/m(2)), gastric bypass resulted in distinct weight loss (-35 ± 27 kg). In follow-up examinations, mean daily dosage of thyroid hormone (levothyroxinebaseline 156 ± 44 μg/day versus levothyroxinefollow-up 150 ± 30 μg/day), hydrocortisone (hydrocortisonebaseline 29 ± 12 mg/day versus hydrocortisonefollow-up 26 ± 2 mg/day), growth-hormone (somatotropinbaseline 0.9 ± 0.5 mg/day versus somatotropinfollow-up 1.0 ± 0.4 mg/day), and desmopressin (desmopressinbaseline 222 ± 96 μg/day versus desmopressinfollow-up 222 ± 96 μg/day) substitution was unchanged. No patient developed adrenal insufficiency. Oral thyroid/hydrocortisone absorption testing performed in 1 patient indicated sufficient gastrointestinal drug absorption after bariatric surgery. CONCLUSION Our preliminary results suggest that oral hormone substitution therapy is not impaired following gastric bypass operation in CP patients with morbid obesity, indicating that it might be a safe and effective treatment strategy.

Long-Term Weight-Loss Maintenance by a Meal Replacement Based Weight Management Program in Primary Care

Objective: Structured obesity treatment programs at primary care level are becoming increasingly important. However, evidence from current treatment approaches in the long term is lacking. In view of this fact we evaluated a standardized, meal replacement-based weight loss program (myLINE®; AENGUS, Graz, Austria) according to the currently applicable guidelines. Methods: Data of overweight and obese individuals (n = 70) who participated at least 36 months in the program were analyzed. Data were collected at baseline (T0) as well as after 1, 3, 6, 12, 24, and 36 (T1-T36) months. Body composition was measured by conventional anthropometry and bioelectrical impedance analysis. Results: Compared to T0, a maximum weight, BMI, fat mass, absolute body cell mass (BCM) reduction and an increase of relative BCM could be seen at T6. Subsequently, the findings reveal a significant reduction of body weight and body fat and a satisfying development of body cell mass during the observation period of 36 months. Conclusion: The evaluated program complies with national and international guidelines for the therapy of obesity in adults and is efficient and meaningful for a long-term therapeutic use in primary care..

Normal weight estonian prepubertal boys show a more cardiovascular-risk-associated adipose tissue distribution than austrian counterparts.

Objective. Risk phenotypes for cardiovascular disease (CVD) differ markedly between countries, like the reported high difference in CVD mortality in Austria and Estonia. Hitherto, the goal of this study was to find out risk profiles in body fat distribution yet present in childhood, paving the way for later clinical end points. Methods. he subcutaneous adipose tissue (SAT) distribution patterns in 553 Austrian (A) and Estonian (E) clinically healthy normal weight boys aged 11.1 (±0.8) years were analysed. We applied the patented optical device Lipometer which determines the individual subcutaneous adipose tissue topography (SAT-Top). Results. Total body fat did not differ significantly between E and A boys. A discriminant analysis using all Lipometer data, BMI, and the total body fat (TBF) yielded 84.6% of the boys correctly classified in Estonians and Austrians by 9 body sites. A factor analysis identified the SAT distribution of E as critically similar to male adult patients with coronary heart disease (CHD). Conclusions. We show in normal weight Estonian boys a highly significant decreased fat accumulation on the lower body site compared to age matched Austrian males. This SAT-Top phenotype may play an important role for the increased cardiovascular risk seen in the Estonian population.

Nutrition for diabetic patients

Evidence demonstrates that medical diabetes treatment has to be accompanied by lifestyle modifications. Structured nutrition interventions and increased physical activity will help patients to normalise, respectively maintain their body weight.The main target of a diabetes therapy are normal or nearly normal blood glucose levels. The following nutritional patterns facilitate reaching this goal: • Carbohydrates from fruits, vegetables,whole grains, legumes • Restriction of mono- and disaccharides are often important factors in normalising body weight and blood glucose • Reduction of dietary fat could be indicated. However, the primary goal is the limiting saturated fatty acids which to high percentage are consumed with animal products. • There is not sufficient evidence to recommend an increase of dietary protein consumption about 20 % of energy intake. • Individuals with diabetes should be aware of the importance of acquiring daily vitamin and mineral requirements. Natural food sources should be preferred.

Ernährungsempfehlungen bei Diabetes mellitus@@@Nutrition for diabetic patients

Evidence demonstrates that medical diabetes treatment has to be accompanied by lifestyle modifications. Structured nutrition interventions and increased physical activity will help patients to normalise, respectively maintain their body weight.The main target of a diabetes therapy are normal or nearly normal blood glucose levels. The following nutritional patterns facilitate reaching this goal: • Carbohydrates from fruits, vegetables,whole grains, legumes • Restriction of mono- and disaccharides are often important factors in normalising body weight and blood glucose • Reduction of dietary fat could be indicated. However, the primary goal is the limiting saturated fatty acids which to high percentage are consumed with animal products. • There is not sufficient evidence to recommend an increase of dietary protein consumption about 20 % of energy intake. • Individuals with diabetes should be aware of the importance of acquiring daily vitamin and mineral requirements. Natural food sources should be preferred.