Daily variations of serum diamine oxidase and the influence of H1 and H2 blockers: a critical approach to routine diamine oxidase assessment

OBJECTIVE AND DESIGN: Histamine in food has been shown to induce intolerance reactions mimicking food allergy. These reactions seem to be due to impaired histamine metabolism caused by reduced diamine oxidase activity. To validate routine serum diamine oxidase assessment, daily variations of diamine oxidase were evaluated. METHODS: Blood was drawn from each of 20 healthy volunteers (10 female, 10 male; mean age 32.5 years) every 2 h from 9 a.m. to 5 p.m., and diamine oxidase activity was measured using the C14 putrescine method. To assess possible influences of H1 and H2 blockers on diamine oxidase activity, diphenhydramine, ketotifen, cimetidine, and ranitidine were incubated at pharmacologic concentrations with human placental diamine oxidase (identical to neutrophilic and eosinophilic diamine oxidase). Inhibition of diamine oxidase activity was calculated as the percentage of inhibition versus control. In addition, the known diamine oxidase inhibitors, dihydralazine and aminoguanidine, were used as positive controls. RESULTS: Serum diamine oxidase levels showed no significant daily variations (0.041 +/- 0.025; 0.037 +/- 0.022; 0.041 +/- 0.023; 0.040 +/- 0.023; 0.038 +/- 0.025 nKat/l) and no significant sex differences (female 0.040 +/- 0.028 nKat/l versus male 0.039 +/- 0.019 nKat/l). Antihistamines had no influence on diamine oxidase activity except for cimetidine, which caused 25% inhibition at the highest dose tested ( p < 0.0002) (positive control: aminoguanidine 85% inhibition (p< 0.0001), dihydralazine 68% inhibition (p<0.0001)) and diphenhydramine, which caused 19% increase (p<0.0001) of enzyme activity. CONCLUSION: Serum diamine oxidase levels do not show daily variations allowing assessment anytime during office hours. However, diagnostic interpretation of serum diamine oxidase levels may be difficult.     

Age and food preferences influence dietary intakes of breast care patients.

Identifying major influences on food choice is an important component of nutrition intervention research. Sensitivity to the bitter taste of 6-n-propylthiouracil (PROP) and self-reported preferences for meats, fats, vegetables, and fruit were examined in 329 female breast care patients. Intakes of fat, saturated fat, fiber, folate, and vitamin C, established using 4-day food diaries, were the chief health outcome variables. The strongest predictor of food preferences was age. Preferences were linked to food intakes. Older women consumed less energy and saturated fat and more dietary fiber and vitamin C than did young women. Age-related decline in taste sensitivity to PROP was associated with increased liking for bitter cruciferous vegetables. Age-associated changes in food preference and eating habits have implications for the dietary approach to cancer prevention and control. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Left ventricular diastolic function in young men with high normal blood pressure

OBJECTIVE: Abnormalities in left ventricular (LV) diastolic filling have been reported in hypertensive patients. This study was designed to compare LV diastolic filling between individuals with high normal blood pressure (HNBP) and optimal blood pressure (OBP). SUBJECTS AND DESIGN: From a survey of 219 young male individuals (age 21 +/- 0.1 years), two groups were selected according to their BP (group A: systolic BP [SBP] 120 mmHg and diastolic BP [DBP] 80 mmHg, n = 23 and group B: SBP 130 to 139 mmHg and/or DBP 85 to 89 mmHg, n = 21). Subjects habits, anthropometric characteristics, LV structure and systolic and diastolic function were compared. RESULTS: No differences were detected between the two groups in habits, systolic function or early diastole. LV mass index (LVMI) was higher in group B (103.6 +/- 4.58 g/m2 versus 90.49 +/- 3.27 g/m2 in group A, P < 0.05), though the values were not high enough to indicate LV hypertrophy. The pattern of LV late filling was different between the two groups. The peak late diastolic flow velocity (A) was 0.45 +/- 0.02 m/s in group B and 0.52 +/- 0.03 m/s in group A (P < 0.05). The early peak velocity (E):A ratio was 1.82 +/- 0.08 in group A and 1.59 +/- 0.08 in group B (P < 0.05). The early filling fraction also demonstrated a significant shift to more prominent late diastolic filling in group B (0.68 +/- 0.01% versus 0.73 +/- 0.01% in group A, P < 0.05). This pattern in LV filling did not correlate to inheritance, age, sex, heart rate, habits or body mass index. CONCLUSIONS: This shift in filling pattern to a late flow in young men with HNBP seemed to be an early indicator of an increased dependence of LV filling on atrial contraction and may reflect an impairment in LV relaxation.     

The instability of dietary iodine supply over time in an affluent society

In the Bernese region, where goiter was formerly endemic, alimentary salt has been supplemented by increasing amounts of potassium iodide (KI): 5, 10, 20 mg KI/kg in 1922, 1965 and 1980 respectively. Ioduria rose from < 30 micrograms I/g creatinine in 1920 to > 100 micrograms I/g creatinine in the 1980s. In 1992 ioduria was estimated in 55 healthy volunteers (group A and individual B) and 234 thyroid carcinoma patients after thyroidectomy: hypothyroid patients with (C) and without thyroid remnants (D) and euthyroid patients on T4 substitution (E). The arithmetic mean iodine excretion of the healthy volunteers in group A and individual B was found to be 87 +/- 40 micrograms I/g creatinine. This is insufficient according to the recommendations of the WHO. In all groups, the iodine excretion reached the recommended level only in some members: 24% (A, B), 19% (C), 38% (D) and 81% (E). It was thought in the 1980s that in a formerly iodine-deficient society, iodinated salt would continue to provide an adequate supply of iodine. However, iodine intake in this affluent society has proved to be unstable. This can be attributed to modifications of eating habits, which include a reduction of total salt consumption, combined with a growing consumption of manufactured food of cosmopolitan origin, prepared using salt containing little or no iodine.     

RNA virus in Allomyces arbuscula: ultrastructural localization during the life-cycle

Three experiments were concerned with tolerance to anorexia induced by d-amphetamine. In experiment 1, one group of rats on a 2 hr food deprivation schedule received 2 mg/kg of d-amphetamine 15 min before eating every other day for a month. A second group of rats on a similar schedule received the same dose of d-amphetamine immediately after eating. When compared to a saline-treated control group, the former group showed significant decreases in weight and food intake; tolerance to the amphetamine-induced anorexia began to occur toward the end of the experiment. The latter group showed a significant decrease in food intake on the non-drug days and an overall weight loss when compared to the control group. Experiment 2 demonstrated that tolerance to d-amphetamine-anorexia was related to the duration of drug administration per se. Experiment 3 showed that taste can be a factor in influencing the rate of tolerance to d-amphetamine-induced anorexia. These results indicate that both pharmacological and experiential factors play an important role in determining the rate of tolerance to this action of d-amphetamine.     

Meal patterns in obese and normal weight men: the ''Gustaf'' study

OBJECTIVE: To compare the reported meal patterns between obese and normal weight men. DESIGN: A dietary survey, by means of 12 repeated telephone-administered 24-hour dietary recalls, was conducted in obese and normal weight men. The study period was three months with all seven days of the week included. The contribution of intake types to the reported daily energy intake (EI) was studied as well as the circadian distribution of EI and the reported number of intakes. SUBJECTS: 86 obese men (BMI 37.7 +/- 4.4 kg/m2, mean +/- SD) from the waiting list of the outpatient clinic completed the study altogether with 61 normal weight men (BMI 23.0 +/- 1.9 kg/m2), randomly selected from the Stockholm County Census Bureau. All men were 20-60 years old. RESULTS: Results were analyzed for Group A = all men who completed the study and for Group B = the men who exceeded the CUT-OFF 1 limit for energy intake (reasonably true report as defined by Goldberg). The obvious under-reporters amounted to 73% of the obese and to 28% of the normal weight men. The meal patterns were similar for the obese and the normal weight men. The greatest contributors to EI in both groups were cooked meals, sandwich meals, snacks and breakfast-like meals. The circadian eating pattern was mainly the same in both obese and normal weight men. The reported number of intakes was 5.3 (median) per day in all obese men vs 5.6 in all the controls (P = 0.02), and in Group B 5.3 s 5.9 (P = 0.16) intakes. No specific "obese eating style' could be detected in this study.     

Effects of warning and information labels on consumption of full-fat, reduced-fat, and no-fat products.

Participants in a taste test study were randomly assigned to 1 of 3 groups: warning label (e.g., "In this product, 90% of the calories come from fat. Warning: The U.S. Surgeon General has determined that eating high fat food increases your risk of heart disease." ), information label (e.g., "In this product, 90% of the calories come from fat." ), and no label. Participants rated how much they wanted to taste full-, reduced-, and no-fat cream cheeses, and they chose I type to eat. People in the warning- and no-label groups wanted to taste the full-fat product more than those in the information-label group. People in the warning- and information-label groups were less likely to eat the full-fat product than those in the no-label group. People reacted to the warning label but avoided the full-fat product. For products with credible and familiar risks, information labels may be more effective than warning labels because they don't arouse reactance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Does the presence of diabetic nephropathy in parents influence the metabolic response in the offspring?

Non-insulin dependent (Type 2) diabetes mellitus (NIDDM) and long-term complications such as nephropathy have a strong genetic predisposition. Insulin resistance is thought to be a pathogenetic factor, predisposing genetically prone individuals to develop the microvascular complications of diabetes. To test these hypotheses, two groups of young individuals were studied: 28 offspring of parents having NIDDM and diabetic nephropathy (group 1) aged 29.5 +/- 6.1 years, BMI 25.2 +/- 4.7 kg m(-2) and 31 offspring of diabetic parents with no history of nephropathy, aged 31.6 +/- 4.1 years and BMI 26.3 +/- 4.9 kg m(-2) (group 2). All underwent a standard oral glucose tolerance test with measurement of serum insulin levels and serum lipid profile. Urine albumin:creatinine ratio (A/C ratio) and blood pressure were also recorded. Diabetes was detected in 2/28 (7.1%) and 3/31 (9.7%) and IGT was detected in 5/28 (25%) and 8/31 (25%) of groups 1 and 2, respectively. These differences were not statistically significant, but were higher than in a group of non-diabetic controls with healthy parents. Comparison of the normoglycaemic subjects (19 and 20 in group 1 and 2, respectively) showed no significant differences between blood pressure readings, fasting and 2 h plasma glucose, and lipid profiles. Plasma insulin values, fasting and 2 h, and the area under the graph were also similar in both groups, indicating an absence of higher insulin response in group 1 in comparison with group 2. These values were also not different from those in the non-diabetic controls. A delay in insulin response to glucose was noted in many of the offspring as indicated by a low deltaI/deltaG at 30'. We conclude that offspring of diabetic parents with nephropathy do not show higher risk of glucose intolerance or insulin resistance compared to those with diabetic parents without nephropathy. The relatively high plasma glucose values in the presence of normal insulin secretion in both groups of offspring of diabetic parents suggest the presence of insulin resistance.     

Amrinone versus dopamine-nitroglycerin after reconstructive surgery for complete atrioventricular septal defect

OBJECTIVES: To compare the effectiveness and safety of amrinone and a combination of dopamine and nitroglycerin in infants after reconstructive surgery for congenital heart disease. DESIGN: A prospective, randomized, double-blind study. SETTING: Pediatric intensive care unit in a university hospital. PARTICIPANTS: Thirty-two infants with complete atrioventricular septal defect. INTERVENTIONS: Amrinone loading dose, 2 mg/kg, followed by a maintenance infusion, 7.5 micrograms/kg/min, was given to 17 infants before separation from cardiopulmonary bypass. The remaining 15 patients received a combination of dopamine, 5 micrograms/kg/min, and nitroglycerin, 1 microgram/kg/min. MEASUREMENTS AND MAIN RESULTS: The circulatory state of the patients was evaluated from 4 to 18 hours after cardiopulmonary bypass. The systemic blood flow index, calculated using the Fick principle, was higher in the amrinone group (2.5 +/- 0.7 L/min/m2) compared with the dopamine-nitroglycerin group (2.0 +/- 0.6 L/min/m2, mean +/- SD). The pulmonary blood flow index in the amrinone group was higher (2.9 +/- 0.6 L/min/m2) than in the dopamine-nitroglycerin group (2.2 +/- 0.6 L/min/m2); no significant difference was noted in the mean pulmonary artery pressure. The oxygen extraction ratio was higher in the dopamine-nitroglycerin group (0.41 +/- 0.07) compared with the amrinone group (0.34 +/- 0.08). Despite lower platelet counts in the amrinone group, no hemorrhagic complications were seen in any patient. CONCLUSIONS: With this dosage regimen, amrinone provides a higher cardiac output, more favorable oxygen dynamics, and lower pulmonary vascular resistance than dopamine and nitroglycerin.     

Class differences in the food rules mothers impose on their children: a cross-national study

Many studies indicate that children in middle-class families have healthier eating habits than children in lower class families. Class differences in food rules, which parents and especially mothers impose on their children, may underlie these social inequalities in food consumption. The present study uses education as a classifying variable and analyses whether mothers with higher education prescribe more "healthy" foodstuffs for their children and whether they restrict more "unhealthy" food items than less educated mothers. Moreover, the study examines whether higher class mothers consider health aspects more often and the preferences of their family members less often in their choice of food, and whether class differences in these considerations explain class differences in food rules. To answer these questions, questionnaires on the food practices of 849 women living in middle-class or lower class districts in Maastricht (the Netherlands), Liège (Belgium) and Aachen (Germany) were collected and analysed. The majority of mothers in each city prescribed primarily foods that were served at dinner like meat and vegetables, and most mothers limited their children's consumption of sweet foods, soft drinks and snacks. Higher class mothers restricted more foods, but prescribed as many food items as their lower class counterparts. Class differences in the number of restricted foods were partly, but not completely, explained by class differences in health and taste considerations. Despite national variations in dietary habits and possibly in the education of children, class differences in food rules and the explanatory power of health and taste considerations were comparable in the three cities.     

Sucrose intake in Germany

The present investigation reevaluated the German National Food Consumption Survey in order to obtain data on sucrose intake and food sources of sucrose intake in Germany. Moreover, it focused on the effect of sucrose intake on nutrient intake. By means of the food composition data base Bundeslebensmittelschlüssel, version II.2, 7-days dietary records of a representative sample of 15,838 persons aged 4 years and older were analyzed. The relation between sucrose and nutrients intake was investigated by variance and regression analyses. Low, moderate, and high sucrose intake categories were defined by means of sucrose density quartiles and comparisons were made for the percentages of persons meeting the German nutrient intake recommendations. Mean daily sucrose intake ranges between 43.2 g/d (f, 51-64 years) and 82.3 g/d (m, 13-14 years). The mean contribution of sucrose to total energy intake is highest with 14% in young age (4-6 years) and decreases to 9% and 7% in 51-64 year old women and men, respectively. The food groups "table sugar", "confectionery and ice cream", "biscuits, cake and pastries", "preserves", "dairy products", and "non-alcoholic beverages" are the main sucrose sources with varying importance in different age groups. The average amount of naturally occurring sucrose in the Germans' diet is estimated to 15-25% of total sucrose intake. Sucrose contributes 80-90% to total disaccharides intake in Germany. With each gram of sucrose the intake of energy rises on the average by 12.5 kcal (52.4 kJ), of protein by 0.3 g (9% of the energy increase), of fat by 0.5 g (34%), and of carbohydrates by 1.8 g (57%). Consequently, the higher the sucrose content of a diet, the lower is the contribution of fat to total energy intake. In contrast, the energy-adjusted effect of sucrose was found to be negative for energy-providing nutrients (except mono- and disaccharides) as well as for all the selected micronutrients, except calcium, vitamin E, vitamin C, and dietary fiber. Accordingly, the comparison between moderate and high sucrose consumers revealed a lower percentage of persons meeting nutrient intake recommendations in the high sucrose category under the condition of a comparable energy intake. This unfavorable effect of high sucrose intake is most prominent in 4-6 year old boys and girls as the groups with the highest sucrose intake. Since from the present data no exact figure for a sucrose or sugars intake recommendation can be deduced, it is suggested to keep on the WHO recommendation for a moderate sugar intake of 10% of energy intake.     

Randomised double-blind clinical trial of intermediate- versus high-dose chloral hydrate for neuroimaging of children

Orally administered chloral hydrate is the most widely used sedative in children undergoing MRI. We compared intermediate- and high-dose oral chloral hydrate in 97 consecutive children undergoing MRI in a prospective, controlled, double-blind, randomised clinical trial. There were 50 girls and 47 boys, mean weight (+/- SD) 14.7 +/- 6.4 kg, and mean age 38 +/- 31. The children were randomly allocated to receive chloral hydrate syrup either 70 mg/kg (group A, n = 50) or 100 mg/kg (group B, n = 47). These two groups were not significantly different in sex, weight, age, diagnosis or ambulatory medication. The mean initial dose (+/- SEM) was 64 +/- 2 mg/kg for group A and 93 +/- 2 mg/kg for group B. Because adequate sedation was not achieved, 14 patients in group A and 6 in group B required a second dose, giving a mean total dose of 70 +/- 2 mg/kg for group A and 96 +/- 2 mg/kg for group B. The percentage of successful examinations after the initial dose (A: 64%, B: 87%; p < 0.05) and the total dose (A: 92%, B:100%; p = 0.14) was higher in group B. Significant differences were found for the time of onset of sedation (A:28 +/- 2 min, B: 21 +/- 1 min; p < 0.05), but not for the time to spontaneous awakening after the completion of the examination. The rate of adverse reactions was similar (A: 20%, B: 21%; p = 1.00). We conclude that high-dose oral chloral hydrate improves the management of children undergoing MRI.     

Typical food allergens for pollinosis in selected regions of Poland. Multiagent studies

The analysis of the incidence of the positive prick test with food allergens among patients with pollen allergy was performed. The 270 patients with pollinosis from four allergy centres in Poznań, Lód? and Katowice were examined. In each centres the different results were obtained. The influence for this had the different status socioeconomic of the patients, the regional habits of eating, and often eating the new products in our country. However, among examination patients the most positive test with food allergens from all centres were nuts, celery, rye flour, carrot, strawberry, pork and beans. The succession of this food allergens were changed in four examination centres in respect to the number of made prick test but the same allergens had been repeated. These results premises to establish the list of the allergens that are needed during diagnosis the patients with pollinosis.     

Evidence for leptin regulation of food intake in humans

The adipocyte hormone leptin regulates body weight in mice by decreasing food intake and increasing energy expenditure. Whether leptin is of physiological importance for these processes in humans is, however, not clear. We therefore studied the relation between leptin and habitual food intake in 64 healthy postmenopausal women. Dietary habits were assessed with a modified diet history method. Body fat content was measured using bioelectrical impedance. In the 64 women, aged 58.6+/-0.4 yr (mean+/-SD), serum leptin was 19.3+/-12.7 ng/mL, body mass index was 25.0+/-3.5 kg/m2, body fat content was 31.6+/-4.3%, fasting glucose was 4.6+/-0.5 mmol/L, and fasting insulin was 56+/-21 pmol/L. Leptin levels were negatively correlated to total energy intake (r=-0.34; P=0.006), carbohydrate intake (r=-0.36; P=0.004), and total (r=-0.27; P=0.034) as well as saturated fat intake (r=-0.31; P=0.014). Leptin was correlated to the absolute, but not to the percent, intake of these nutrients. When normalized for body fat content, the correlations remained significant. Our results suggest that plasma leptin is involved in the physiological regulation of food intake in humans, and that leptin is related to the quantity rather than the quality of habitual food intake.     

Estimates of food and macronutrient intake in a random sample of Northern Ireland adolescents

Estimates of food consumption and macronutrient intake were obtained from a randomly selected population sample (2%) of 1015 adolescents aged 12 and 15 years in Northern Ireland during the 1990/1991 school year. Dietary intake was assessed by diet history with photographic album to estimate portion size. Reported median energy intakes were 11.0 and 13.1 MJ/d for boys aged 12 and 15 years respectively and 9.2 and 9.1 MJ/d for girls of these ages. Protein, carbohydrate and total sugars intakes as a percentage of total energy varied little between the age and sex groups and were approximately 11, 49 and 20% respectively of daily total energy intakes. Median dietary fibre intakes were approximately 20 and 24 g/d for boys aged 12 and 15 years respectively and 18 and 19 g/d for girls of these ages. Major food sources of energy (as a percentage of total energy intakes) were bread and cereals (15-18%), cakes and biscuits (12-14%), chips and crisps (13-14%), dairy products (9-11%), meat and meat products (9-11%) and confectionery (9%). Fruit and vegetable intakes were low at about 2.5% and 1.5% respectively of total energy intakes. Median fat intakes were high at 39% of total daily energy intakes. Major food sources of fat as a percentage of total fat intakes were from the food groupings: chips and crisps (16-19%), meat and meat products (14-17%), fats and oils (14-16%), cakes and biscuits (13-16%) and dairy products (12-15%). Median intakes of saturated fatty acids were also high at approximately 15% of daily total energy intake while intakes of monounsaturated fatty acids averaged 12% of daily total energy intake. Median polyunsaturated fatty acid (PUFA) intakes were low, comprising 5.2 and 5.5% of daily total energy intake for boys aged 12 and 15 years respectively and were lower than the PUFA intakes (5.9 and 6.3% of daily total energy intake) for girls of these ages. About 1.3% for boys and 1.4% for girls of daily total energy intake was in the form of n-3 PUFA. Ca and Mg intakes were adequate for both sexes. Based on these results, some concern about the dietary habits and related health consequences in Northern Ireland adolescents appears justified.     

Thermoregulatory effects of caffeine ingestion during submaximal exercise in men

BACKGROUND: The exclusive effect of caffeine ingestion on exercise thermoregulation is unclear; data indicate that caffeine may have a positive effect, a negative effect, or no effect. METHODS: Rectal (TRE) and mean skin (TSK) temperatures, skin heat conductance (HSK), and sweat rate (MSW) were measured during 30 min of rest and subsequent 70 min of submaximal cycle-ergometer exercise (67% VO2PEAK) in 11 aerobically conditioned men (mean +/- SD 29 +/- 6 yr, 49 +/- 6 mL x min(-1) x kg(-1) VO2PEAK) under two conditions: a caffeine (10 mg x kg(-1) ingestion (CI) session and a noncaffeine ingestion (NCI) control session. RESULTS: There were no significant differences in physiological or thermoregulatory parameters during exercise: X (+/-SE) end exercise levels for the NCI and CI sessions, respectively, were VO2 = 2.50 +/- 0.09 vs. 2.55 +/- 0.09 L x min(-1); heart rate = 145 +/- 7 vs. 145 +/- 5 bpm; HSK = 30 +/- 3 vs. 28 +/- 3 kcal x m(-2) x h(-1) x degrees C(-1); MSW = 393 +/- 35 vs. 378 +/- 36 g x m(-2) x h(-1); and TRE = 38.3 +/- 0.2 vs. 38.4 +/- 0.1 degrees C. Control TSK was lower than that for CI by 0.4 to 0.5 degrees C at rest and during exercise. CONCLUSION: Ingestion of a high level (10 mg x kg(-1) of caffeine has no effect on skin heat conductance, sweating, or the rate of increase and final level of rectal temperature during moderate, submaximal leg exercise.     

Age and sex differences in health habits and beliefs of schoolchildren.

Surveyed 1,981 boys and 1,952 girls in Grades 3–12 about health habits and beliefs, including smoking and eating habits, perceptions of exercise, weight, and parental involvement in health. Factors that emerged were smoking habits, family discussion of health, family thinking about health, nutritional habits, and health locus of control. Girls generally reported healthier food habits than did boys. However, adolescent girls reported more cigarette smoking than did adolescent boys. Also, boys consistently reported higher levels of exercise. There were also changes in habits and belief with age; trends that emerged in junior high school continued through high school. Adolescence also seems to be a transitional time for health habits, as suggested by personal experimentation and individual variation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of false weight feedback on mood, self-evaluation, and food intake in restrained and unrestrained eaters.

Restrained and unrestrained eaters were weighed 5 lb (2.27 kg) heavier or 5 lb lighter than their actual weight or were not weighed at all. Unrestrained eaters and restrained eaters who were told they weighed 5 lb less were not affected by the false weight feedback. However, restrained eaters who were informed that they weighed S lb more reported lower self-esteem, less positive moods, and more negative moods than did restrained eaters in the other 2 conditions. Furthermore, restrained eaters who were led to believe that they weighed heavier ate significantly more food during a subsequent "taste test" than did each of the other groups. Restrained eaters who believed that they were heavier experienced lowered self-worth and a worsening of mood that led them to relinquish their dietary restraint and overindulge in available food. lmplications for patients with eating disorders are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Conversion of proximal to distal gastric bypass for failed gastric bypass for superobesity

The purpose of this study was to analyze outcome following malabsorptive distal gastric bypass (D-GBP) in superobese patients who were reoperated for recurrent obesity comorbidity after a failed standard gastric bypass (S-GBP). Twenty-seven formerly superobese patients with a failed S-GBP converted to a D-GBP were studied. The small bowel was anastomosed 250 cm from the ileocecal valve to the disconnected Roux limb; the bypassed small intestine was connected to the ileum 50 cm from the ileocecal valve in five patients between 1985 and 1986 and 150 cm from the ileocecal valve in 22 patients thereafter. Comorbidity was reassessed yearly following conversion to D-GBP. Malnutrition occurred in all five patients with a 50 cm "common tract"; all required further revision and two died of hepatic failure. Three of 22 patients with a 150 cm common tract were reoperated with bowel lengthening because of malnutrition. Initial body mass index was 57+/-2 kg/m2 and fell from 46+/-2 kg/m2 before revision to 37+/-2 kg/m2 at 1 year and 32+/-2 kg/m2 at 5 years after revision; the percentage of excess weight lost went from 30+/-4% to 61+/-4% at 1 year and 69+/-5% at 5 years after revision. Preoperative comorbidity in patients undergoing revision included 14 with insulin-dependent type II diabetes mellitus, 11 with sleep apnea, 14 with hypoventilation, 13 with hypertension, and two with venous stasis ulcers. Obesity comorbidity was corrected within 1 year in all but two patients with hypertension and remained stable in all patients followed for 5 years. Revision of a failed S-GBP to a 150 cm common tract D-GBP corrects failed weight loss and severe obesity comorbidity but requires nutritional support to prevent protein-calorie malnutrition, iron and fat-soluble vitamin deficiencies, and further revision in some patients to correct malnutrition. A 50 cm common tract has an unacceptable morbidity and mortality.