Showing papers by "Claude Pichard published in 2002"

Fat-free mass index and fat mass index percentiles in Caucasians aged 18-98 y.

Abstract: Objective: To determine reference values for fat-free mass index (FFMI) and fat mass index (FMI) in a large Caucasian group of apparently healthy subjects, as a function of age and gender and to develop percentile distribution for these two parameters. Design: Cross-sectional study in which bioelectrical impedance analysis (50 kHz) was measured (using tetrapolar electrodes and cross-validated formulae by dual-energy X-ray absorptiometry in order to calculate FFMI (fat-free mass/height squared) and FMI (fat mass/height squared). Subjects: A total of 5635 apparently healthy adults from a mixed non-randomly selected Caucasian population in Switzerland (2986 men and 2649 women), varying in age from 24 to 98 y. Results: The median FFMI (18–34 y) were 18.9 kg/m2 in young males and 15.4 kg/m2 in young females. No difference with age in males and a modest increase in females were observed. The median FMI was 4.0 kg/m2 in males and 5.5 kg/m2 in females. From young to elderly age categories, FMI progressively rose by an average of 55% in males and 62% in females, compared to an increase in body mass index (BMI) of 9 and 19% respectively. Conclusions: Reference intervals for FFMI and FMI could be of practical value for the clinical evaluation of a deficit in fat-free mass with or without excess fat mass (sarcopenic obesity) for a given age category, complementing the classical concept of body mass index (BMI) in a more qualitative manner. In contrast to BMI, similar reference ranges seems to be utilizable for FFMI with advancing age, in particular in men.

Nutritional depletion in patients on long-term oxygen therapy and/or home mechanical ventilation.

Abstract: The purpose of this study was to estimate the prevalence of malnutrition in outpatients on long-term oxygen therapy or home mechanical ventilation, to determine the relationships between malnutrition and impairment/disability and smoking and also to identify relevant tools for routine nutritional assessment. In 744 patients (M:F 1.68, aged 65+/-15 yrs) with chronic obstructive pulmonary disease (COPD, 40%), restrictive disorders (27%), mixed respiratory failure (15%), neuromuscular diseases (13%) and bronchiectasis (5%), body mass index (BMI), fat-free mass (FFM), serum albumin, transthyretin, 6-min walking test, forced vital capacity (FVC), forced expiratory volume in one second (FEV1) and blood gases were recorded. FFM was the most sensitive parameter for detecting malnutrition, being abnormal in 53.6% of patients, while BMI was <20 in 23.2%, serum albumin <35 g x L(-1) in 20.7%, and serum transthyretin <200 mg x L(-1) in 20%. FFM depletion predominated in neuromuscular, bronchiectasis and restrictive disorders. BMI and FFM were correlated with FEV1, FVC and 6-min walking test. In multivariate analysis a BMI<20 was related to FEV1 and smoking habits, and a low FFM to smoking, FEV1 and female sex. Malnutrition is highly prevalent in home-assisted respiratory patients and is related to causal disease, forced expiratory volume in one second, smoking and disability. Fat-free mass appeared to be the most sensitive and relevant nutritional parameter according to impairment and disability.

Position paper of the ESICM Working Group on Nutrition and Metabolism. Metabolic basis of nutrition in intensive care unit patients: ten critical questions.

Abstract: The metabolic changes associated with critical illness involve several pathways acting at different steps of the utilization of nutritive substrates. The understanding of the role of these pathways and of their complex regulation has led to the development of new strategies for the metabolic and nutritional management of critically ill patients, including the development of new products for nutritional support. The rationale for changing the profile of nutritional support solutions by adding novel substrates is also discussed. This review focuses on the metabolic specificities of critically ill patients and also includes an analysis of the adequacy of tools to monitor the metabolic status and the adequacy of the nutritional support.

Body composition: what's new?

Abstract: Purpose of reviewBody mass index has been shown to be an imprecise measurement of fat-free and fat mass, and provides no information if weight changes occur as a result of a decrease in fat-free mass or an increase in fat mass.Recent findingsNon-invasive body composition methods (i.e. bioelectrical

Body Composition in 995 Acutely ill or Chronically ill Patients at Hospital Admission: A controlled population Study

Abstract: Objective To determine if fat-free mass and fat mass in acutely ill and chronically ill patients differed from healthy controls at hospital admission and if prevalence of malnutrition differed by body mass index (BMI) or fat-free mass percentile. Subjects/Setting 995 consecutive patients 15 to 100 years of age admitted to the hospital were measured in the hospital admission center and compared with 995 healthy age- and height-matched subjects Design Cross-sectional study. Fat-free mass, fat mass, and percentage fat mass were determined by 50 kHz bioelectrical impedance analysis. Prevalence of malnutrition was determined by BMI 2 or fat-free mass in the 10th percentile. Statistical Analysis Analysis of variance was used to examine differences between acutely ill and chronically ill patients and controls and between age groups. Results Fat-free mass was significantly lower in patients than controls ( P 2 . Applications/Conclusion Weight and BMI do not evaluate body compartments and therefore do not reveal if weight changes result in loss of fat-free mass or gain in fat mass. In spite of minimal differences in BMI between patients and controls, we found that fat-free mass was lower and fat mass was higher in acutely ill and chronically ill patients than controls. The objective measurement of body composition, as part of a comprehensive nutritional assessment, helps to identify subjects who have low fat-free mass or high fat mass. J Am Diet Assoc. 2002;102:944–948,953–955 .

Body composition: whatʼs new?

Abstract: Purpose of reviewBody mass index has been shown to be an imprecise measurement of fat-free and fat mass, and provides no information if weight changes occur as a result of a decrease in fat-free mass or an increase in fat mass. Recent findingsNon-invasive body composition methods (i.e. bioelectrical impedance analysis, air displacement plethysmography) can now be used to monitor fat-free and fat mass with weight gain and loss, and during aging. This review discusses body composition measurements in terms of ethnic differences, physical activity, and age, and the limitations of bedside techniques in obesity and abnormal hydration status. SummaryAn assessment of the fat-free and fat mass provides valuable information about changes in body composition with weight gain or loss and physical activity, and during aging. Non-invasive bedside techniques can now be used to evaluate the nutritional status of healthy and ill individuals.

Physical characteristics of total parenteral nutrition bags significantly affect the stability of vitamins C and B1: a controlled prospective study.

Abstract: BACKGROUND: Vitamin degradation occurring during the storage of total parenteral nutrition (TPN) mixtures is significant and affects clinical outcome. This study aimed to assess the influence of the TPN bag material, the temperature, and the duration of storage on the stability of different vitamins. METHODS: Solutions of multivitamin and trace elements at recommended doses were injected into either an ethylvinyl acetate (EVA) bag or a multilayered (ML) bag filled with 2500 mL of an identical mixture of carbohydrates (1200 kcal), fat (950 kcal), and amino acids (380 kcal). The bags were then stored at 4 degrees C, 21 degrees C, or 40 degrees C. Concentrations of vitamins A, B1, C, and E were measured up to 72 hours after compounding, using high-pressure liquid chromatography. RESULTS: Ten percent to 30% of vitamin C degradation occurred within the first minutes after TPN compounding. Vitamin C was more stable in ML bags (half-life: 68.6 hours at 4 degrees C, 24.4 hours at 21 degrees C, and 6.8 hours at 40...

Is Time Since Hip Fracture Influencing the Discrimination Between Fractured and Nonfractured Subjects as Assessed at the Calcaneum by Three Technologically Different Quantitative Ultrasound Devices

Abstract: Because quantitative ultrasound (QUS) instruments from different manufacturers have significant technical differences, it is difficult to assess whether all of them can discriminate similarly between osteoporotic fractures and age-matched controls. Thus, to avoid any bias, reliable comparative assessment of the QUS devices should be carried out on the same population. Few studies have fulfilled this condition. Another source of variability in cross-sectional studies in which fractured and nonfractured subjects are compared is the time since osteoporotic fracture. Our study evaluated the ability of three calcaneal QUS devices to discriminate patients with osteoporotic hip fracture from control subjects, using the same population. In addition, a subset of patients was re-measured about 9 months after the hip replacement surgery to check how the time since fracture affects the discriminatory ability of the different QUS devices. Fifty postmenopausal hip-fractured patients and 46 postmenopausal age-matched controls were included in this study and measured on three QUS devices, as well as 50 young healthy controls to calculate the T-score. Odds ratio results showed that a decrease in UBIS trade mark BUA of 1 SD was associated with a significant increase in fracture risk (odds ratio adjusted = 2.30) comparable with Sahara broadband ultrasound attenuation (BUA) (OR adj. = 2.30), and Achilles BUA (OR adj. = 3.5). However, given the large overlap between the 95% intervals of each OR and for the areas under ROC curves, no significant difference was found between them. In the subset of 15 hip-fractured subjects, no significant differences were found between ultrasound parameters of the first visit and 9 months after except for the heel width (soft tissue variation). Odds ratio and areas under the curve (AUC) tend to increase from visit 1 to 2 for the BUA and decrease substantially for the SOS for all but the Lunar Achilles+. Nonsignificant correlation was found between the absolute difference of the ultrasound parameters measured at the two visits and the time since fracture, except for the Sahara SOS (r = 0.45; P < 0.04). In conclusion, no significant differences between QUS technologies were observed in their positive and significant ability to discriminate hip-fractured patient from controls. However, this statement is shadowed when taking into account the time since fracture which seems to negatively influence results obtained on dry versus wet QUS systems. As a result, it is advisable that such parameters would be taken into account when designing a study aimed to demonstrate the discriminatory ability of heel ultrasound between normal and hip-fractured patients.

Unlabelled iododeoxyuridine increases the rate of uptake of [125I]iododeoxyuridine in human xenografted glioblastomas.

Abstract: 5-Iodo-2'-deoxyuridine (IdUrd), a thymidine (TdR) analogue, can be radiolabelled with iodine-125, an Auger radiation emitter, to provoke double-strand breaks once incorporated into DNA of cancer cells. We have previously shown that co-incubation of [125I]IdUrd with unlabelled IdUrd provided an additive cytotoxicity in two human glioblastoma cell lines. This observation was unexpectedly correlated with an increase in the rate of DNA incorporation of [125I]IdUrd. Here, we further evaluated the effects of unlabelled IdUrd on the uptake of [125I]IdUrd in vitro and in vivo in mice xenografted with three human glioblastoma lines. The results showed that, in these three glioblastoma lines, unlabelled IdUrd increased the rate of uptake of [125I]IdUrd in vitro by 2- to 4.4-fold and in vivo by 1.5- to 2.8-fold. The rate of uptake of [125I]IdUrd in normal rapidly dividing tissues was also increased by 1.3- to 2.8-fold. TdR completely blocked [125I]IdUrd uptake in tumours and tissues. Analogues of IdUrd, such as deoxyuridine and 5-iodo-1,3-dimethyuracil, did not reproduce the effect of IdUrd on the uptake of [125I]IdUrd, suggesting that it is not related to protection against [125I]IdUrd degradation. It is concluded that combined administration of unlabelled IdUrd may improve the use of radiolabelled IdUrd for cancer diagnosis or therapy.

Assessment of nutritional status in organ transplant: is transthyretin a reliable indicator?

Abstract: Transthyretin has been proposed as a nutritional index to screen for malnutrition and monitor the metabolic response to dietary intervention. In the presence of inflammation, circulating transthyretin levels drop regardless of optimal caloric intake. In this case, due to its rapid turnover, the pattern of transthyretin, monitored by means of repeated measures, could indicate the metabolic status (catabolism vs. anabolism). The aim of this review is to investigate the possible role of transthyretin as a nutritional parameter in organ transplantation. The literature on nutritional assessment in transplantation was reviewed and all the data regarding circulating transthyretin levels were analyzed. It appears that, on the one hand, the transthyretin level reflects closely dietary manipulations; on the other hand, it is affected by the inflammatory status. Consequently, interpretation could be difficult during the acute phase immediately after the transplant. Moreover, the role of transthyretin in monitoring the hepatic synthetic function in liver transplant is discussed. In conclusion, transthyretin is a reliable indicator of nutritional status in transplant candidates and potentially useful in the post-transplant phase if the inflammatory status is taken into account.

Clinical nutrition : early intervention

Abstract: Genotypic influences on metabolic alterations during inflammation and the nutritional outcome, Grimble, R.F. fatty acids and gene expression related to inflammation, Calder, P.C. nutritional modulation of gut inflammation, Seidman, E.G., Bernotti, S., Levy, E. how valid is the concept of antioxidants and cell injury?, Leverve, X.M., Fontaine, E. optimizing IV supply of functional lipid components, Carpentier, Y.A., Dupont, I.E. optimization of dietary protein intake during aging, Beaufr re, B. vitamin and antioxidant supplementation - critical evaluation of clinical outcomes, Bistrian B.R. trace elements - contribution to the efficacy of nutritional support, Shenkin, A. timing of nutritional support, Chioloro, R.L., Tappy, L., Berger, L.L. signalling factors for gut adaptation, Okada, A. parenteral versus enteral nutrition - can we get rid of the myths?, Soeters, P.B., Dejong, C.H.J., von Meyenfeldt, M.F. specialized nutrition support in the critically ill - for whom and when? Griffiths, R.D. the primary target of nutritional support - body composition or muscle function?, Wagenmakers, A.J.M. body composition in paediatrics to geriatrics - a lesson for nutritional monitoring, Heymsfield, S.B., Wang, Z.M., Shen, W. efficacy of nutritional support - evidence-based nutrition and cost-effectiveness, Waitzberg, D.L. nutrition intervention - what of the future, Meguid, M.M. timely nutritional support - thoughts for the future, Pichard, C., Labadarios, D.

[Parenteral nutrition in the Swiss hospitals: a three years national survey].

Abstract: Total parenteral nutrition (TPN) requires the perfusion of more than 40 compounds (glucose, amino acids, lipids, electrolytes, vitamins and trace elements). Many systems of application are used. With the help of pharmacists, the current types of products and methods of TPN administration, as well as the evolution of TPN practice were evaluated in the Swiss hospitals during three consecutive years. Six different TPN systems are commonly used for adult patients. All lead to the administration of TPN in "all-in-one" admixtures. For adults, formula compounding is provided in large hospitals only. For pediatric TPN, formula compounding is routinely performed in the hospitals because individualized compositions are not available commercially. Regarding TPN-admixtures outpatients, they are mostly compounded in hospital pharmacies and delivered by 3 large hospitals. Compositions of TPN formula comply, on average, with European guidelines. An increased number of multidisciplinary nutritional support teams is still necessary to optimize the medical and economical management of TPN.

[ Evaluation of the nutritional state of patients in emergency services: contribution in measurement of body composition].

Abstract: le poids et l'indice de masse corporelle sont utilises de routine pour depister les patients souffrant de malnutrition. Or, une investigation realisee aux urgences de l'Hopital Universitaire de Geneve montre que la prevalence de la malnutrition est fortement sous-estimee si on se base sur l'indice de masse corporelle plutot que sur la masse non grasse. En effet, un tiers des patients avec un indice de masse corporelle normal, i.e. entre 20 et 24.9 kg/m 2 , presentent une masse non grasse inferieure au percentile 10. Ceci suggere que l'indice de masse corporel ne peut pas etre utilise comme seul critere diagnostique de la malnutrition. Cette revue decrit la prevalence de la malnutrition aux urgences de l'Hopital Universitaire de Geneve, la prevalence de la malnutrition dans la litterature et son lien avec la duree d'hospitalisation et la mortalite.

Delivering nutrients how and where they are needed: a lesson from the 17th century.

Abstract: Brother Fox got dressed up one day And invited Sister Stork to dinner. . . .He served that soup on a plate: With her long beak, the stork didn't catch a drop, but the fox's plate was licked in a jiffy. To get even with that trick, The Stork invited him some time later. . . .Dinner was cooked to perfection. Bon appetit! Foxes are always hungry, The meat especially smelled heavenly, Cut in tiny pieces, delicious looking. They were served, to his embarrassment, In a vase with a long and narrow neck. The Stork's beak could pass through But the Fox's snout. . .couldn't! He had to return home hungry,..