Robert M. Suskind

Consequences of modified fasting in obese pediatric and adolescent patients. I. Protein-sparing modified fast

Sixteen obese patients 9 to 16 years of age were treated with a protein-sparing modified fast for four weeks in a metabolic unit, using lean meat as the sole calorie-containing nutrient. Total weight loss was 7.11 +/- 0.33 kg (mean +/- SEM). One-half of the patients achieved positive daily nitrogen balance by the fourth week. Cumulative N balance was -28.8 +/- 10.0 gm. Serum albumin concentration remained normal. Hemoglobin and hematocrit values were stable, but decreases in total lymphocyte (P less than 0.005) and neutrophil counts (P less than 0.01) were noted. Cell-mediated immunity (four patients) remained normal. Protein synthetic and catabolic rates (two patients) revealed only minimal changes. Cumulative N balance correlated (P less than 0.01) with mean fasting serum insulin concentration, which was related (P less than 0.005) to body fat mass. The PSMF has therapeutic potential for achieving safe, rapid weight loss in severely obese older children and adolescents.

Hepatic Insulin Clearance Increases after Weight Loss in Obese Children and Adolescents

BACKGROUND Obesity is a rapidly increasing health problem among US youth. Hyperinsulinemia is associated with obesity and has been found to be a contributory factor for the development of cardiovascular disease in the obese. It has been suggested that hyperinsulinemia of obesity is a result of increased insulin secretion caused by insulin resistance. However, it has been shown in adults that decreased hepatic insulin clearance (HIC) is the primary cause of hyperinsulinemia in this population. METHODS We studied 15 obese children and adolescents (11 F, 4 M; 8.6 to 18.1 years) before and 10 weeks after their enrollment in a multidisciplinary weight reduction program, which included a protein-sparing modified fast, a moderate intensity progressive exercise program, and a behavior-modification intervention. RESULTS All patients lost weight (P < 0.05). Measurements of immunoreactive insulin (IRI) and C-peptide reactivity (CPR) were performed before the program and at 10 weeks. IRI levels dropped significantly, whereas CPR levels did not change. CPR/IRI molar ratios, considered an indirect estimation of HIC, rose significantly after weight loss. CONCLUSIONS Our data suggest that hyperinsulinemia seen in obese children and adolescents is caused by decreased HIC. The cause for this decrease remains unknown, but it is reversible upon weight loss.

Gastrointestinal blood loss in older infants: impact of cow milk versus formula.

&NA; Concerns that consumption of whole cow milk (WCM) by older infants may result in excessive gastrointestinal blood loss and subsequent iron deficiency led us to perform a prospective, randomized study in 104 infants. Infants were assigned to receive WCM beginning at 6 months or one of three formulas beginning at 4‐6 months of age and followed until 12 months of age. Gastrointestinal blood loss was similar for all groups, as determined by both qualitative (Hemoccult II) and quantitative testing (HemoQuant). There was no association between concentration of fecal hemoglobin and volume of WCM consumed or iron status by 12 months of age. Of eight infants (seven WCM, one formula) who became iron‐depleted, none had excessive fecal hemoglobin excretion. When pooled and analyzed regardless of feeding group, fecal hemoglobin increased with age and was greater at 11 and 12 months than at younger ages. We conclude that although infants fed WCM are at increased risk of developing iron depletion, the iron insufficiency is not due to gastrointestinal blood loss. We further conclude, based on our sample of normal infants age 4‐12 months, that fecal hemoglobin concentrations of 0.5‐0.8 mg/g stool correspond to the upper limits of normal, values much lower than in adults.

Endotoxemia in protein−energy malnutrition

The plasma endotoxin levels of 16 severely malnourished Thai children were determined by the Limulus amebocyte lysate assay. Endotoxemia was present in seven children (44%) on admission to the hospital and was associated with the coexistence of vitamin A deficiency. Protein-energy malnutrition is associated with the presence of endotoxemia.

Consequences of modified fasting in obese pediatric and adolescent patients II. Metabolic effects of glucose compared to fat non-protein calories

Abstract We examined the effect of hypocaloric protein and fat compared to protein and carbohydrate-containing diets on 8 obese inpatients 154–226% of ideal body weight. When the carbohydrate-containing diet followed the fat-containing diet, weight loss slowed and nitrogen balance improved from −0.4±0.5 g/day to 3.9±0.8 g/day during the first week of the carbohydrate-containing diet (p 3 and lower β-hydroxybutyrate concentrations on the carbohydratecontaining diet. Although metabolic differences exist between isocaloric high and low carbohydrate-containing weight reduction diets, equivalent weight loss and nitrogen balance can be anticipated by the third week of therapy.

The effect of protein-sparing modified fast in obese children with insulin dependent MODY-type diabetes mellitus. 422

The effect of protein-sparing modified fast in obese children with insulin dependent MODY-type diabetes mellitus. 422

Bone Mineral Content, Lean and Fat Body Mass after Significant Weight Loss in Obese Children and Adolescents

Bone Mineral Content, Lean and Fat Body Mass after Significant Weight Loss in Obese Children and Adolescents

Age as a Factor in Long Term Program Retention and Weight Maintenance in Obese Children and Adolescents |[dagger]| 698

Research indicates that prevention of adult obesity may be accomplished through the treatment of prediatric obesity. However, it is unclear whether treatment should begin during the early or later childhood years. We examined the one-year program retention and weight maintenance of 139 obese children(M=63, F=76; Age=12.11±2.6 yrs.; Range=7.1-17.6 yrs.) enrolled in a multidisciplinary pediatric weight management program. The one-year program consisted of a protein-sparing modified fast diet, followed by a balanced hypocaloric diet, nutrition education, behavior modification, and a moderate-intensity (45-55% VO2max), progressive exercise program. Measures of height, weight, percent of ideal body weight (%IBW), and body mass index (BMI) were obtained at baseline, ten weeks and one year. For statistical analysis, subjects were blocked by age as follows: 7-8 yrs., 9-10 yrs., 11-12 yrs., and 13+ yrs. A repeated measures one way analysis of variance indicated the the results in the table (%IBW, mean±S.D;*Baseline to 10 weeks and baseline to 1 year. 10 weeks to 1 year = N.S.).

Serum lipid profiles in pediatric patients enrolled in a multidisciplinary weight reduction program: differences between White and African-American children. † 578

Serum lipid profiles in pediatric patients enrolled in a multidisciplinary weight reduction program: differences between White and African-American children. † 578

Protein Sparing Modified Fast Versus Dexfenfluramine Hydrochloride(Redux®) as a Treatment for Childhood Obesity in Male Adolescents 580

Protein Sparing Modified Fast Versus Dexfenfluramine Hydrochloride(Redux®) as a Treatment for Childhood Obesity in Male Adolescents 580