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ideal body weight [keywords]
- Adult Advanced Chronic Lymphocytic Leukemia: Computational Analysis of Whole-Body CT Documents a Bone Structure Alteration. [JOURNAL ARTICLE]
- Radiology 2014 Mar 5.:131944.
Purpose To assess the presence of alteration of bone structure and bone marrow metabolism in adult patients who were suspected of having advanced chronic lymphocytic leukemia (ACLL) by using a computational prognostic model that was based on computational analysis of positron emission tomography (PET)/computed tomography (CT) images. Materials and Methods In this retrospective study, all patients signed written informed consent as a requisite to undergo PET/CT examination. However, due to its observational nature, approval from the ethical committee was not deemed necessary. Twenty-two previously untreated chronic lymphocytic leukemia patients underwent PET/CT for disease progression. PET/CT images were analyzed by using dedicated software, capable of recognizing an external 2-pixel bone ring whose Hounsfield coefficient served as cutoff to recognize trabecular and compact bone. PET/CT data from 22 age- and sex-matched control subjects were used as comparison. All data are reported as means ± standard deviations. The Student t test, log-rank, or Cox proportional hazards model were used as appropriate, considering a difference with a P value of less than .05 as significant. Results Trabecular bone was expanded in ACLL patients and occupied a larger fraction of the skeleton with respect to control subjects (mean, 39% ± 5 [standard deviation] vs 31% ± 7; ie, 32 of 81 mL/kg of ideal body weight vs 27 of 86 mL/kg of ideal body weight, respectively; P < .001). After stratification according to median value, patients with a ratio of trabecular to skeletal bone volume of more than 37.3% showed an actuarial 2-year survival of 18%, compared with 82% for those with a ratio of less than 37.3% (P < .001), independent from age, sex, biological markers, and disease duration. Conclusion These data suggest that computational assessment of skeletal alterations might represent a new window for prediction of the clinical course of the disease. © RSNA, 2014.
- Nutritional Indicators are Correlated with the Radiological Severity Score in Patients with Mycobacterium avium Complex Pulmonary Disease: A Cross-sectional Study. [Journal Article]
- Intern Med 2014; 53(5):397-401.
Objective Body weight loss in patients with Mycobacterium avium complex (MAC) pulmonary disease can be fatal. The administration of nutritional supplements should be an important component in the treatment of this disease. Objective data regarding the association between the nutritional status and disease severity have not been reported. This cross-sectional study aimed to compare the nutritional status and radiological severity scores in MAC pulmonary disease patients. Methods We retrospectively reviewed the records of 40 patients who were admitted to our institution for the treatment of MAC pulmonary disease between July 2008 and July 2010. Nutritional indices, including the ideal body weight ratio, triceps skinfold, mid-upper arm muscle circumference, and percentage of predicted resting energy expenditure, were compared with the radiological severity scores. Quantitative values of the extent of nodules, infiltration shadows, cavities, and bronchiectasis on the computed tomography scans were used to evaluate the radiological severity scores. Results The patients suffered from a significantly decreased percentage of ideal body weight, body fat and muscle mass. The average radiological score was 17.6±8.4 points. The percentage of ideal body weight (p<0.001), percentage of triceps skinfold (p<0.001) and percentage of mid-upper arm muscle circumference (p<0.002) were negatively correlated with the radiological scores, while the percentage of the predicted resting energy expenditure (p<0.001) was positively correlated with the scores. Conclusion A poor nutritional status is common in patients with progressive MAC pulmonary disease, which supports the hypothesis that aggressive nutritional interventions are indicated in the treatment of this disease.
- [Factors influencing self-perception of overweight people]. [English Abstract, Journal Article]
- Pol Merkur Lekarski 2013 Nov; 35(209):313-5.
Shaping of self-perception is among others influenced by physical, interpersonal, emotional, and cultural factors. In self-perception of overweight people an important role is played by interpersonal factors, which include the opinions of others and the relationship with the surrounding. The evaluation of the body image is also affect by sociocultural factors including the media, which create an unrealistic and impossible to achieve ideal of beauty. Contemporary ideal of beauty, where a slim figure is dominant, more frequently contributes to the occurrence of discrimination and stigmatization of overweight people. This phenomenon causes negative self-perception leading to the occurrence of such emotional problems as low self-esteem, lack of confidence, depression and anxiety disorders. Overweight children and adolescents are also frequently stigmatized and discriminated because of their body weight, which results in the development of a negative body image that may lead to low self-esteem and symptoms of depression.
- Comparison of nephrotoxicity rates associated with colistimethate versus polymyxin B therapy: in vitro assessment and a multicenter cohort study. [JOURNAL ARTICLE]
- Antimicrob Agents Chemother 2014 Feb 24.
Despite concerns of nephrotoxicity, polymyxin antibiotics often remain the only susceptible agents for multidrug-resistant (MDR) gram-negative bacteria. Colistin has been more commonly used clinically due to a perceived safety benefit. We compared the nephrotoxicity of colistin to polymyxin B. The in vitro cytotoxicity of colistin was compared to polymyxin B in two mammalian renal cell lines. To validate the clinical relevance of the findings, we evaluated adult patients with normal renal function who received a minimum of 72 hours of polymyxin therapy in a multicenter study. The primary outcome was the prevalence of nephrotoxicity, as defined by the RIFLE criteria. Colistin exhibited an in vitro cytotoxicity profile similar to polymyxin B. A total of 225 patients (121 colistimethate, 104 polymyxin B) were evaluated. Independent risk factors for colistimethate-associated nephrotoxicity included age (OR 1.04, 95% CI 1.00-1.07; p = 0.03), duration of therapy (OR 1.08, 95% CI 1.02-1.15; p = 0.02), and daily dose by ideal body weight (OR 1.40, 1.05-1.88; p = 0.02). In contrast, cystic fibrosis was found to be a protective factor in patients who received colistimethate (OR 0.03, 95% CI 0.001-0.79; p = 0.04). In a matched analysis based on the risk factors identified (n=76), the prevalence of nephrotoxicity was higher with colistimethate than polymyxin B (55.3% vs. 21.1%; p = 0.004). Polymyxin B was not found to be more nephrotoxic than colistin and may be the preferred polymyxin for MDR infections. A prospective study comparing the two polymyxins directly is warranted.
- Validating the Alterable Weight Loss (AWL) Metric with 2-Year Weight Loss Outcome of 500 Patients After Gastric Bypass. [JOURNAL ARTICLE]
- Obes Surg 2014 Feb 23.
Percentage alterable weight loss (AWL) is the only known weight loss metric independent of the initial body mass index (BMI), a unique feature ideal for use in weight loss research. AWL was not yet validated. The aim of the study is to validate the AWL metric and to confirm advantages over the excess weight loss (EWL) metric.AWL is tested with 2-year weight loss results of all primary laparoscopic Roux-en-Y gastric bypass patients operated in our hospital. Nadir results of patients with higher and lower initial BMI are compared (Mann-Whitney; p < 0.05) using outcome metrics BMI, percentage weight loss (WL), EWL, and AWL, for the whole group, for each gender, and for <40 and ≥40 years separately.Five-hundred patients (401 female) out of 508 (98.4 %) had 2-year follow-up. Of all four metrics, only AWL rendered results not significantly influenced by initial BMI. The AWL outcome is initial BMI independent for both genders and age-groups. Results also confirm that women and younger patients had significantly higher AWL outcome.The recently developed AWL metric, defined as 100% × (initialBMI - BMI) / (initialBMI - 13), is now validated. In contrast to the well-known outcome metrics BMI, EWL, and WL, the AWL metric is independent of the initial BMI. It should replace the misleading EWL metric for comparing weight loss results in bariatric research and for expressing the effectiveness of bariatric procedures. This effectiveness does not act on the total body mass, or on the excess part, but on the alterable part, defined as BMI minus 13 kg/m(2) for all adult patients, female, male, young, and old.
- Abnormal nutrition affects waitlist mortality in infants awaiting heart transplant. [Journal Article]
- J Heart Lung Transplant 2014 Mar; 33(3):235-40.
Although nutritional status affects survival after heart transplant (HTx) in adults and older children, its effect on outcomes in young children is unknown. This study aimed to assess the effect of pre-HTx nutrition on outcomes in this population.Children aged 0 to 2 years old listed for HTx from 1997 to 2011 were identified from the Organ Procurement and Transplantation Network database. Nutritional status was classified according to percentage of ideal body weight at listing and at HTx. Logistic regression analysis evaluated the risk of waitlist mortality. Cox proportional hazard models assessed the effect of nutrition on post-HTx survival.Of 1,653 children evaluated, 899 (54%) had normal nutrition at listing, 445 (27%) were mildly wasted, 203 (12%) were moderate or severely wasted, and 106 (6%) had an elevated weight-to-height (W:H) ratio. Moderate or severe wasting (adjusted odds ratio, 1.9; 95% confidence interval, 1.3-2.7) and elevated W:H (adjusted odds ratio, 1.7; 95% confidence interval, 1.1-2.6) were independent risk factors for waitlist mortality. HTx was performed in 1,167 patients, and 1,016 (87%) survived to 1-year post-HTx. Nutritional status at listing or at HTx was not associated with increased post-HTx mortality. Nutritional status did not affect the need for early reoperation, dialysis, or the incidences of infection, stroke, or rejection before hospital discharge.Moderate or severe wasting and an elevated W:H are independent risk factors for waitlist mortality in patients aged < 2 years but do not affect post-HTx mortality. Optimization of pre-HTx nutritional status constitutes a strategy to reduce waitlist mortality in this age range.
- Dosing in Children: A Critical Review of the Pharmacokinetic Allometric Scaling and Modelling Approaches in Paediatric Drug Development and Clinical Settings. [JOURNAL ARTICLE]
- Clin Pharmacokinet 2014 Feb 11.
It should be recognized that children are not small adults, hence dosing in children should not be a 'small adult dose'. A mean population dose in all age groups is just an average dose and not necessarily the best or the correct dose for a given patient. The dose of a drug varies from patient to patient and individual adjustment of the dose is always ideal but is not always practical. Theoretically, dose selection in paediatric drug development or clinical settings can be done by using either body weight or the clearance of a drug. Over the years, a lot of approaches have been suggested for the prediction of drug clearance or dose in paediatrics. Although some proposed methods are useful for the prediction of clearance or dose in children, there remains a high degree of uncertainty in the prediction of drug clearance or dose in children. In particular, the prediction of clearance or dose in an individual patient remains highly erratic. This review takes a critical look at these approaches and highlights the application and limitations of these proposed methods.
- Functional characterization of variants in MC4R gene promoter region found in obese children. [JOURNAL ARTICLE]
- J Clin Endocrinol Metab 2014 Feb 10.:jc20133711.
Context: Mutations in the MC4R gene are the commonest cause of monogenic obesity and there are few studies on mutations in the promoter region. Objective: To sequence the promoter region of the MC4R gene in a cohort of obese children to identify rare variants. Design, setting and patients: A region 1500 bp upstream of the MC4R gene was sequenced in 267 unrelated local children below 10 years of age, with body weight of at least 150% of ideal. An 891 bp upstream region of the MC4R gene was cloned into a luciferase reporter vector for reporter gene assays. Interventions: none Main Outcome Measures: The basal transcriptional activity of MC4R promoter was analyzed in HEK293 cells using reporter gene assays. Results: Three rare variants were detected: c.-803A>G, c.-105C>G and c.-216C>T. The novel c.-803A>G variant was found in a 9-year old severely obese Malay boy. This variant was not found in his severely obese mother but was present in his overweight father who had type 2 diabetes, and also in his normal-weight brother. The novel c.-105C>G variant was found in an obese 9-year-old Malay boy. The c.-216C>T variant was found in an obese Chinese girl with Down's syndrome. The transcriptional activities of the c.-803A>G and c.-105C>G promoters were significantly reduced compared to wild-type, but not the c.-216C>T promoter. Conclusions: We have described, for the first time, two novel human MC4R gene promoter variants found in obese children that resulted in a decrease in basal transcriptional activity.
- Body image and weight perceptions in relation to actual measurements by means of a new index and level of physical activity in Italian university students. [Journal Article, Research Support, Non-U.S. Gov't]
- J Transl Med 2014.:42.
Body image perception depends on anthropometric and psychological factors. Body dissatisfaction is influenced by the socio-cultural environment and is associated with eating disorders and low self-esteem. This study examined the body image perception, the degree of dissatisfaction and the weight status perception inconsistency in relation to sex, weight status and amount of physical activity in a sample of university students.The participants were 734 university students (354 females aged 21.5 ± 2.9 yrs and 380 males aged 22.1 ± 3.6 yrs) recruited from the second year of the Sport Sciences degree program. A self-administered questionnaire was used to acquire socio-demographic and sport participation information. Height, weight, BMI and weight status were considered for each subject. Body image perception was assessed by a silhouette matching technique. A new index, FAI (Feel status minus Actual status Inconsistency), was used to assess weight status perception inconsistency.A large proportion of the sample had normal weight status. On average, females chose as feel status a significantly higher figure than the males (4.7 versus 3.8) and they would have liked to have a significantly thinner figure than the males (3.4 versus 3.6). Therefore, the mean FID (Feel minus Ideal Discrepancy) values (positive in both sexes) were significantly higher in females than in males, meaning higher dissatisfaction. The mean FAI values were positive in females and negative in males, indicating a tendency of the women to overestimate their weight status and of the men to underestimate it. Men were more physically active than women. Less active women showed significantly lower body weight and BMI than more active women. Men less engaged in physical activity showed significantly higher FID than more active men.These results show greater dissatisfaction and higher weight status perception consistency in females than in males among Italian university students examined. Our findings suggest that the FAI index can be very useful to evaluate the perceived weight status by body image in comparison to actual weight status assessed anthropometrically.
- The association between automatic thoughts about eating, the actual-ideal weight discrepancies, and eating disorders symptoms: a longitudinal study in late adolescence. [JOURNAL ARTICLE]
- Eat Weight Disord 2014 Feb 9.
This study tested the reciprocal relationships between automatic thoughts about eating and the actual-ideal weight discrepancies, and their role in the formation and maintenance of eating disorders (ED) symptoms in a non-clinical sample of adolescents. In particular, we investigated whether thoughts about eating mediated the effects of weight discrepancies on ED formation and whether weight discrepancies mediated the effects of thoughts about eating on ED formation were investigated.Data were collected three times, with a 2-month interval between Time 1 (T1) and Time 2 (T2), and a 9-month interval between T2 and Time 3 (T3). Adolescents (N = 55) aged 15-18 filled out the SCOFF Questionnaire, assessing eating disorders symptoms, and the Eating Disorder Thoughts Questionnaire, evaluating automatic thoughts. To assess weight discrepancies questions about actual (subjectively reported) and ideal body weight were asked followed by objective measurement of height and weight.Negative thoughts about eating (T2) mediated the relation between weight discrepancies (T1) and symptoms of anorexia and bulimia (T3). In addition, the association between negative thoughts (T1) and eating disorders symptoms (T3) was mediated by weight discrepancies (T2).The negative thoughts and the actual (both subjectively reported and objectively measured)-ideal weight discrepancies constitute a vicious cycle, related to higher ED symptoms. Prevention of eating disorders should be directed to adolescents who manifest large weight discrepancies or high levels of negative thoughts about eating, as they are at risk for developing eating disorder symptoms.