Weight loss
Accelerated radiochemotherapy in pancreatic cancer is not necessarily related to a pathologic pancreatic function decline in the early period.

Horst E, Seidel M, Micke O, Rube C, Glashorster M, Schafer U, Willich NA.

Department of Radiation Oncology, University of Munster, Munster, Germany. horste uni-muenster.de

PURPOSE: To evaluate the functional effects of ionizing radiation in patients with unresectable pancreatic cancer in the early period after accelerated radiochemotherapy (ART). METHODS AND MATERIALS: To analyze the exocrine component, the amino acid consumption test and fecal elastase 1 were performed in 13 patients immediately before and 4-8 weeks after ART. Pancreatic duct morphology was evaluated before therapy. Weight loss and clinical steatorrhea were recorded. Endocrine parameters were examined according to standardized criteria. RESULTS: The relative change of the amino acid consumption test results and the median elastase concentration was 41.2% and 56.4%, respectively. Five patients still had normal test results after ART and 5 patients developed pathologic values. The median relative weight loss of the total body weight was 7.7% +/- 4.5%. No steatorrhea occurred. Of the 5 patients with normal values, 3 had a mean organ dose of <40 Gy. Of the 5 patients with pathologic values, 4 had a mean organ dose of >41 Gy. The endocrine function measurements remained unchanged. CONCLUSION: Although a nominal reduction of exocrine function parameters occurred in most patients, ART was not necessarily related to a pathologic level in the early period. Diabetes was not established. The functional impairment that was existent in the patient population presumably contributed to the weight loss. Pancreatic enzyme preparations may also play a role in maintaining an anabolic state during and after radiochemotherapy.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11872274&dopt=Abstract weight loss



Weight loss
Early mortality after radical radiotherapy for non-small-cell lung cancer: comparison of PET-staged and conventionally staged cohorts treated at a large tertiary referral center.

Mac Manus MP, Wong K, Hicks RJ, Matthews JP, Wirth A, Ball DL.

Department of Radiation Oncology, Peter MacCallum Cancer Institute, Melbourne, Victoria, Australia. mmanus petermac.unimelb.edu.au

PURPOSE: At our center, approximately 30% of radical radiotherapy (RRT) candidates become ineligible for RRT for non-small-cell lung cancer (NSCLC) after positron emission tomography (PET). We hypothesized that early cancer death rates would be lower in patients receiving RRT after PET staging compared with conventionally staged patients. METHODS AND MATERIALS: Two prospective cohorts were compared. Cohort 1 consisted of all participants in an Australian randomized trial from our center given 60 Gy conventionally fractionated RRT with or without concurrent carboplatin from 1989 to 1995. Eligible patients had Stage I--III, Eastern Cooperative Oncology Group status 0 or 1, <10% weight loss, and had not undergone PET. Cohort 2 included all RRT candidates between November 1996 and April 1999 who received RRT after PET staging and fulfilled the above criteria for stage, Eastern Cooperative Oncology Group status, and weight loss. RESULTS: Eighty and 77 eligible patients comprised the PET and non-PET groups, respectively. The PET-selected patients had significantly less weight loss; 73% and 49% of the PET and non-PET patients, respectively, received chemotherapy. The median survival was 31 months for PET patients and 16 months for non-PET patients. Mortality from NSCLC and other causes in the first year was 17% and 8% for PET patients and 32% and 4% for non-PET patients, respectively. The hazard ratio for NSCLC mortality for PET vs. non-PET patients was 0.49 (p = 0.0016) on unifactorial analysis and was 0.55 (p = 0.0075) after adjusting for chemotherapy, which significantly improved survival. CONCLUSION: Patients selected for RRT after PET have lower early cancer mortality than those selected using conventional imaging.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11872280&dopt=Abstract weight loss



Weight loss
Accuracy of bioelectrical impedance spectroscopy in measuring changes in body composition during severe weight loss.

Cox-Reijven PL, van Kreel B, Soeters PB.

Department of Dietetics, University Hospital Maastricht, The Netherlands. ncox bze5.azm.nl

BACKGROUND: Bioelectrical impedance spectroscopy (BIS) is an attractive method for measuring body composition because it is noninvasive, simple, and cheap. The effect of obesity on the accuracy of impedance measurements has been recognized for some time, but no conclusive explanations or ways to correct the measurement errors have been published. We studied the effect of the composition of weight loss on the accuracy of BIS to measure changes in body fluid volumes during severe weight loss. Within subjects the effect of variable losses of fat mass was studied. METHODS: In 10 morbidly obese female subjects who underwent gastric reduction surgery, changes in total body water (TBW) and extracellular water (ECW) were monitored for 1 year by deuterium (Deu) and bromide (Br) dilution and by BIS. Measurements were performed before the operation and after 2 weeks, 3 months, and 1 year. Extrapolated resistance values of extracellular (Recw) and intracellular water (Ricw) were used in mixture equations for calculating the corresponding fluid volumes. RESULTS: After 1 year, weight decreased by 53 kg, TBW (Deu) loss was 8.7 L, and ECW (Br) loss was 4.3 L. Comparison of BIS with reference methods for measuring all possible changes over 6 time-intervals revealed a mean overestimation of TBW (2.4 L, SD = 2.9) and ECW (0.74 L, SD = 2.6) losses by BIS. Overestimation increased significantly with increasing fat losses, expressed as percentage fat of the weight loss and as change in triceps skinfolds. Measured changes in Recw and Ricw were less than expected for an ideal agreement between dilution methods and mixture equations. CONCLUSIONS: BIS with the use of mixture equations overestimates fluid losses during weight loss. The error is associated with the amount of fat loss. The large contribution of the factor weight in the mixture equations is likely to be responsible. The assumptions of mixture theory are not valid in obesity.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11873761&dopt=Abstract weight loss



Weight loss
Weight loss increases circulating levels of ghrelin in human obesity.

Hansen TK, Dall R, Hosoda H, Kojima M, Kangawa K, Christiansen JS, Jorgensen JO.

Medical Department M (Endocrinology and Diabetes), Aarhus University Hospital, DK-8000 Aarhus C, Denmark. tkh dadlnet.dk

OBJECTIVE: Ghrelin, a novel endogenous ligand for the GH secretagogue receptor, has been reported to have adipogenic actions and induce weight gain in addition to its GH-releasing properties. Interestingly, recent data indicate that ghrelin is downregulated in human obesity, which is also known to be accompanied by reduced GH levels. PATIENTS AND METHODS: To investigate the influence of weight loss on circulating levels of ghrelin we recruited eight obese women among patients attending a 6-month weight-loss course organized by The Danish Heart Association. We measured body composition including computerized tomography as well as fasting plasma ghrelin concentrations before and after weight loss. RESULTS: Plasma ghrelin concentrations increased by 12% following weight loss (P < 0.01), and the increase in ghrelin levels was positively correlated with the extent of weight loss (r = 0.68, P < 0.05). Exposure to exogenous GH intravenously did not influence fasting ghrelin levels either before or after weight loss. Our data further suggest the existence of hyperghrelinaemia in a single subject with long-standing obesity but no signs of GH excess. CONCLUSIONS: This study provides evidence of a reversible suppression of ghrelin associated with obesity. The feasibility of measuring ghrelin in the circulation provides a new tool for the investigation of the complex hormonal regulation of appetite and energy balance.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11874411&dopt=Abstract weight loss



Weight loss
Comparison of methods for assessing body composition changes during weight loss.

Weyers AM, Mazzetti SA, Love DM, Gomez AL, Kraemer WJ, Volek JS.

Human Performance Laboratory, Department of Kinesiology, University of Connecticut, Storrs, CT 06269, USA.

PURPOSE: Four cross-sectional studies have reported that percent body fat (%BF) measured by dual-energy x-ray absorptiometry (DXA) is significantly higher compared with values obtained with air displacement plethysmography (ADP) using the Bod Pod(R) in normal-weight individuals. This study was performed to confirm these findings in an overweight population and to assess whether DXA and ADP detected similar changes in body composition after moderate weight loss. METHODS: Twelve women (42 +/- 8 yr) and 10 men (40 +/- 11 yr) had their %BF, fat mass (FM), and fat-free mass (FFM) measured using DXA and ADP before and after an 8-wk weight-loss program involving moderate energy restriction and exercise. RESULTS: Body weight decreased significantly in women (-4.3 +/- 3.4 kg) and men (-4.7 +/- 3.1 kg). There were significant method (ADP vs DXA) and time (pre and post) effects but no method by time or gender interactions. Methods were significantly different in estimating %BF, FM, and FFM with ADP estimates of %BF and FM being lower and estimates of FFM higher than corresponding DXA values (P = 0.000). There were significant correlations accounting for a high degree of the shared variance between DXA and ADP (r = 0.98 to 0.99) for %BF, FM, and FFM and lower correlations for the changes in %BF (r = 0.66), FM (r = 0.86), and FFM (r = 0.34). In response to weight loss, the mean changes in %BF, FM, and FFM were not significantly different between methods (P > 0.05). CONCLUSION: Both DXA and ADP measure changes in body composition after small to moderate weight loss to the same extent and with similar sensitivity.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11880815&dopt=Abstract weight loss



Weight loss
[Treatment in the community health centers in accordance with recommendations of the Medical Products Agency. Unsatisfactory weight reduction with orlistat]

[Article in Swedish]

Hedqvist M, Eggertsen R.

Molnlycke vardcentral.

We treated 44 individuals, 31 women and 13 men, for 12 months; each one had a body mass index > or = 28 kg/m2. Mean age was 53 years (range 20-75 years). Each individual visited a nurse regularly for diet recommendations, and each was provided a prescription for orlistat from his or her own doctor. The target weight loss of 2.5 kg prior to treatment with orlistat was obtained by 28 patients. After 3 months the average weight loss was 3.3 kg, and after 6 months, when 10 women and 6 men remained, the average weight loss was 6.1 kg and 6.5 kg respectively. The average weight decrease between 6 and 12 months was 0.3 kg and 2.7 kg for 7 women and 4 men respectively. Total cost for medical staff's working hours was approximately 700 Swedish crowns per kg weight loss. This cost seems rather high in comparison with the unsatisfactory results obtained for the group as a whole.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11881245&dopt=Abstract weight loss



Weight loss
The effect of participation in a weight loss programme on short-term health resource utilization.

van Walraven C, Dent R.

Department of Medicine, Institute for Clinical Evaluative Sciences, University of Ottawa, Ottawa, Ontario, Canada. carlv ohri.ca

Obese people consume significantly greater amounts of health resources. This study set out to determine if health resource utilization by obese people decreases after losing weight in a comprehensive medically supervised weight management programme. Four hundred and fifty-six patients enrolled in a single-centred, multifaceted weight loss programme in a universal health care system were studied. Patient information was anonymously linked with administrative databases to measure health resource utilization for 1 year before and after the programme. Mean body mass index (BMI) decreased by more than 15%. The mean annual physician visits (pre = 9.6, post = 9.4) did not change significantly after the programme. However, patients saw a significantly fewer number of different physicians per year following the programme (pre = 4.5, post = 3.9; P < 0.001). Mean annual number of emergency visits (pre = 0.2; post = 0.2) and hospital admissions (pre = 0.05; post = 0.08) did not change. Neither baseline BMI, nor its change during the programme, influenced changes in health resource utilization. Our study suggests that weight loss in a supervised weight management programme does not necessarily decrease short-term health resource utilization. Further study is required to determine if patients who maintain their weight loss experience a decrease in health utilization.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11882100&dopt=Abstract weight loss



Weight loss
Seasonal variation of alterations in exercise-induced body composition in obese Japanese women.

Shimamoto H, Adachi Y, Tanaka K.

Graduate School of Human-Environment Studies, Kyushu University, 6-1 Kasugakoen, Kasuga, Fukuoka 816-8580, Japan. shimamoto-hideki ihs.kyushu-u.ac.jp

Although many investigations have been conducted to determine the effects of exercise and/or diet prescription, seasonal variations in weight loss have not been thoroughly investigated in Japan. The present investigation was undertaken to determine seasonal variations in body composition and anthropometric characteristics during a weight-loss program. One hundred and twenty-seven women [mean (SD) age 44.3 (11.7) years] participated in this study. The subjects were categorized into four groups based on the season in which the weight-loss program was begun: subjects who joined our exercise program in winter (group WE), subjects who joined in summer (group SE), and two control groups, one for winter and one for summer (group WC and group SC, respectively). The subjects of groups WE and SE completed a 3-month exercise and food-restriction program. Analyses of covariance revealed that the subjects of group WE seemed to have attained more desirable changes. This group showed a decrease in body mass (-1.9 (1.5) kg) and percent body fat (-4.6 (4.8)%), while an increase in fat-free mass (1.6 (3.2) kg) during the experimental period. Our data suggest that the better season for desirable weight loss in Japan is winter, compared to summer. These alterations may be attributable, at least in part, to the fact that Japanese people are generally acclimatized to a cold climate in this season. The mechanisms involved in our speculation have not been well validated, but it seems clear that a significant difference in dietary intake might have affected the results of this study.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11882922&dopt=Abstract weight loss



Weight loss
Weight change in old age and its association with mortality.

Newman AB, Yanez D, Harris T, Duxbury A, Enright PL, Fried LP; Cardiovascular Study Research Group.

Division of Geriatric Medicine, University of Pittsburgh, Pennsylvania 15213, USA.

OBJECTIVES: Previous studies of weight change and mortality in older adults have relied on self-reported weight loss, have not evaluated weight gain, or have had limited information on health status. Our objective was to determine whether 5% weight gain or loss in 3 years was predictive of mortality in a large sample of older adults. DESIGN: Longitudinal observational cohort study. SETTING: Four U.S. communities. PARTICIPANTS: Four thousand seven hundred fourteen community-dwelling older adults, age 65 and older. MEASUREMENTS: Weight gain or loss of 5% in a 3-year period was examined in relationship to baseline health status and interim health events. Risk for subsequent mortality was estimated in those with weight loss or weight gain compared with the group whose weight was stable. RESULTS: Weight changes occurred in 34.6% of women and 27.3% of men, with weight loss being more frequent than gain. Weight loss was associated with older age, black race, higher weight, lower waist circumference, current smoking, stroke, any hospitalization, death of a spouse, activities of daily living disability, lower grip strength, and slower gait speed. Weight loss but not weight gain of 5% or more was associated with an increased risk of mortality that persisted after multivariate adjustment (Hazard ratio (HR) = 1.67, 95% CI = 1.29-2.15) and was similar in those with no serious illness in the period of weight change. Those with weight loss and low baseline weight had the highest crude mortality rate, although the HR for weight loss was similar for all tertiles of baseline weight and for those with or without a special diet, compared with those whose weight was stable. CONCLUSIONS: This study confirms that even modest decline in body weight is an important and independent marker of risk of mortality in older adults.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11890489&dopt=Abstract weight loss