Weight loss
Development and validation of a hospital screening tool for malnutrition: the short nutritional assessment questionnaire (SNAQ).

Kruizenga HM, Seidell JC, de Vet HC, Wierdsma NJ, van Bokhorst-de van der Schueren MA.

Department of Dietetics,VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands. h.kruizenga vumc.nl.

OBJECTIVE: For the early detection and treatment of malnourished hospital patients no valid screening instrument for the Dutch language exists. Calculation of percentage weight loss and body mass index (BMI) by the nurse at admission to the hospital appeared to be not feasible. Therefore, the short, nutritional assessment questionnaire (SNAQ), was developed. RESEARCH, DESIGN AND METHODS: Two hundred and ninety one patients on the mixed internal and surgery/oncology wards of the VU University medical center were screened on nutritional status and classified as well nourished (<5% weight loss in the last 6 months and BMI>18.5), moderately malnourished (5-10% weight loss in the last 6 months and BMI>18.5) or severely malnourished (>10% weight loss in the last 6 months or >5% in the last month or BMI<18.5). All patients were asked 26 questions related to eating and drinking difficulties, defecation, condition and pain. Odds ratio, binary and multinomial logistic regression were used to determine the set of questions that best predicts the nutritional status. Based on the regression coefficient a score was composed to detect moderately (2 points) and severely (3 points) malnourished patients. The validity, the nurse-nurse reproducibility and nurse-dietitian reproducibility was tested in another but similar population of 297 patients. RESULTS: The questions 'Did you lose weight unintentionally?'. 'Did you experience a decreased appetite over the last month?' and 'Did you use supplemental drinks or tube feeding over the last month?' were most predictive of malnutrition. The instrument proved to be valid and reproducible. CONCLUSION: SNAQ is an easy, short, valid and reproducible questionnaire for early detection of hospital malnutrition.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15681104&dopt=Abstract weight loss



Weight loss
Effect of pronounced weight loss on the nontraditional cardiovascular risk marker matrix metalloproteinase-9 in middle-aged morbidly obese women.

Laimer M, Kaser S, Kranebitter M, Sandhofer A, Muhlmann G, Schwelberger H, Weiss H, Patsch JR, Ebenbichler CF.

1Clinical Department of Internal Medicine, Clinical Division of General Internal Medicine, Medical University Innsbruck, Austria.

OBJECTIVE:: Obesity is associated with increased morbidity and mortality from atherosclerotic disease. Nontraditional cardiovascular risk factors such as C-reactive protein (CRP) and interleukin-6 (IL-6) are elevated in obese subjects and weight loss is associated with an attenuation of these risk factors. Matrix metalloproteinase-9 (MMP-9) has been linked to plaque rupture, and is, thus, a candidate marker of future myocardial events. The aim of this study was to determine the influence of weight loss on MMP-9 plasma concentrations. METHODS AND RESULTS:: CRP, IL-6 and MMP-9 were analyzed from samples of 45 morbidly obese, middle-aged women before gastric banding and 1 y postsurgical treatment in this prospective study. The body mass index (BMI) of subjects decreased from 42.5+/-4.9 to 32.3+/-5.3 kg/m(2) 1 y after gastric banding. In parallel, both MMP-9 and CRP were reduced by 23 and 41%, respectively. A positive relationship was found between BMI and MMP-9 (r=0.312, P<0.05), and between CRP and IL-6 (r=0.508, P<0.05), whereas no correlation was found between CRP and MMP-9. CONCLUSIONS:: We conclude that weight loss is associated with a pronounced decrease in the nontraditional cardiovascular risk markers MMP-9 and CRP, which could indicate future beneficial effects of weight loss on the cardiovascular risk in weight loosing subjects.International Journal of Obesity advance online publication, 1 February 2005; doi:10.1038/sj.ijo.0802897.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15685246&dopt=Abstract weight loss



Weight loss
Weight and BMI over 6 years in Korean children: relationships to body image and weight loss efforts.

Lee K, Sohn H, Lee S, Lee J.

Department of Family Medicine, Inje University, Busan, Republic of Korea. fmlky dreamwiz.com

OBJECTIVE: To investigate the relationships among longitudinal weight status, body dissatisfaction, and attitude to weight loss among Korean children from the age of 7-8 to 13-14 years old. RESEARCH METHODS AND PROCEDURES: 351 Korean school children's heights and weights were measured at the ages of 7-8 and 13-14 years old; at the age of 13-14, they completed a questionnaire about body dissatisfaction and weight loss efforts. RESULTS: At the age of 7-8, 15.7% of children were overweight by International Obesity Task Force standards, as compared with 26.2% at the age of 13-14. Of the 55 7- to 8-year-old overweight children, 85.5% were still overweight at the age of 13-14 years old. Greater concerns about body image and stronger desires to be thinner were observed among stable overweight children and among those in whom there had been a rapid increase in BMI over the 6-year study period. Girls favored thinner shapes than did boys, regardless of their weight status or BMI changes. In girls, the level of body dissatisfaction was related only to weight loss desire, regardless of weight status or changes in BMI. In boys, however, weight loss desire was related only to weight loss attempts and was independent of weight status, BMI changes, and level of body dissatisfaction. DISCUSSION: Regardless of weight status, changes in BMI should be considered when dealing with body dissatisfaction and attitudes to weight loss in children.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15687397&dopt=Abstract weight loss



Weight loss
Weight loss expectations in obese patients seeking treatment at medical centers.

Dalle Grave R, Calugi S, Magri F, Cuzzolaro M, Dall'aglio E, Lucchin L, Melchionda N, Marchesini G; QUOVADIS Study Group.

Department of Nutritional Rehabilitation, Villa Garda Hospital, Garda, Italy.

OBJECTIVE: To investigate weight loss expectations (expected 1-year BMI loss, dream BMI, and maximum acceptable BMI) in obese patients seeking treatment and to examine whether expectations differ by sex, weight, diet and weight history, age, psychological factors, and primary motivations for weight loss. RESEARCH METHODS AND PROCEDURES: 1891 obese patients seeking treatment in 25 Italian medical centers (1473 women; age, 44.7 +/- 11.0 years; BMI, 38.2 +/- 6.5 kg/m2) were evaluated. Diet and weight history, weight loss expectations, and primary motivation for seeking treatment (health or improving appearance) were systematically recorded. Psychiatric distress, binge eating, and body image dissatisfaction were tested by self-administered questionnaires (Symptom CheckList-90, Binge Eating Scale, and Body Uneasiness Test). RESULTS: In 1011 cases (53.4%), 1-year expected BMI loss was > or = 9 kg/m2, dream BMI was 26.0 +/- 3.4 kg/m2 (corresponding to a 32% loss), and maximum acceptable BMI was 29.3 +/- 4.4 kg/m2 (-23%). BMI and age were the strongest predictors of weight goals. Weight loss necessary to reach the desired targets was largely in excess of weight loss observed during previous dieting. Psychiatric distress, body dissatisfaction, and binge eating did not predict weight loss expectations. The primary motivation for weight loss was concern for future or present health; women seeking treatment to improve appearance had a lower grade of obesity, were younger, and had first attempted weight loss at a younger age. DISCUSSION: Obese Italian patients had unrealistic weight loss expectations. There were significant disparities between patients' perceptions and physicians' weight loss recommendations of desirable treatment outcome.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15687402&dopt=Abstract weight loss



Weight loss
Laparoscopic adjustable gastric banding for the treatment of morbidly obese patients: early outcome in a Chinese cohort.

Wong SKh, So WY, Yau PY, Chan AK, Lee S, Chan PN, Chow FC, Chung SS.

Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.

OBJECTIVE. To evaluate the efficacy of laparoscopic adjustable gastric banding in the management of morbid obesity in a cohort of Chinese patients. DESIGN. Cohort study. SETTING. University teaching hospital, Hong Kong. PATIENTS. From August 2002 to September 2003, 10 patients (6 male, 4 female) with a median age of 34 years (range, 23-48 years) underwent laparoscopic adjustable gastric banding to treat morbid obesity. Considerable co-existing diseases were present in 90% of the cases. We instituted a team approach that allowed every patient to see our dietitian, physician, psychiatrist (if necessary), and surgeon prior to deciding on the procedure to be used. MAIN OUTCOME MEASURES. Excessive body weight loss, quality-of-life score (SF36), and co-morbidities improvement. RESULTS. The 10 patients had a median weight of 127 kg (range, 115-196 kg) and median body mass index of 47 kg/m(2) (range, 38-67 kg/m(2)). The operation was successful in all patients with a median operating time of 110 minutes (range, 75-240 minutes). The median hospital stay was 3 days (range, 3-4 days) and three of the patients required overnight observation in the intensive care unit because of severe sleep apnoea and asthma. The median follow-up period was 12 months (range, 1-18 months). The mean weight loss at 6, 12, and 18 months was 19.3, 22.4, and 25.9 kg, respectively. Mean percentage of excessive weight loss at 6, 12, and 18 months was 34.9%, 36.5%, and 40.5%, respectively. Unsatisfactory weight loss (<20 kg) occurred in three patients because of poor dietary compliance and non-follow-up. Surgery also considerably improved the patients' co-morbidities (hypertension, diabetes, and obstructive sleep apnoea) and the quality of life. CONCLUSION. In the short term, laparoscopic adjustable gastric banding is certainly an effective procedure for morbid obesity, which results in a substantial weight loss and improvement of co-existing morbidities. Longer follow-up will show whether this weight loss is maintainable.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15687512&dopt=Abstract weight loss



Weight loss
Suppression of hepatocellular carcinoma by transplantation of ex-vivo immune-modulated NKT lymphocytes.

Margalit M, Shibolet O, Klein A, Elinav E, Alper R, Thalenfeld B, Engelhardt D, Rabbani E, Ilan Y.

Liver Unit, Department of Medicine, Hebrew University-Hadassah Medical Center, Jerusalem, Israel.

NKT cells are a regulatory subset of T lymphocytes with immune modulatory effects and an important role in anti-tumor immunity. The feasibility of "ex-vivo education" of NKT cells has recently been demonstrated. To evaluate the anti-tumor effect of ex-vivo immune-modulated NKT lymphocytes in a murine model of hepatocellular carcinoma. Athymic Balb/C mice were sublethally irradiated and transplanted with human Hep3B HCC. NKT cells prepared from immunocompetent Balb/C mice were pulsed ex vivo with HCC-derived antigens (Group A), Hep3B cells (group B) or BSA (group C), and adoptively transferred into HCC harboring mice (1 x 0(6) NKT cells per mouse). Group D mice did not undergo NKT cell transplantation. Group E mice were transplanted with 1 x 10(6) NKT cells from HBV-immunized donors. Mice were followed for tumor size and weight. To determine the mechanism of the anti-tumor effect, intrasplenic lymphocyte populations were analyzed by FACS for NKT, CD4+ and CD8+ lymphocyte subpopulations; STAT 1, 4 and 6 expression in splenocytes was assessed by Western blot, and serum cytokine levels were measured by ELISA. Adoptive transfer of NKT cells pulsed with HCC-derived antigens (group A) and NKT cells from immunized donors (group E) resulted in complete disappearance of tumors within 4 weeks and attenuated weight loss (6.5% and 7% in groups A and E, respectively). In contrast, mice in groups B, C, and D developed large, necrotic tumors and severe weight loss (21%, 17% and 23% weight loss in groups B, C, and D, respectively). NKT/CD4 and CD8/CD4 ratios were significantly increased in groups A and E (12.3 and 17.6 in groups A and D, respectively, compared to 6.4, 4.8 and 5.6 in groups B, C and D, respectively, for the NKT/CD4 ratio; 41 and 19.8 in groups A and E, respectively, compared to 6.5, 11.8 and 3.2 in groups B, C, and D, respectively, for the CD8/CD4 ratio). Expression of the transcription factor STAT4 was evident in group A, but not in groups B-D. Serum IFNgamma, IL12 and IL4 levels were increased in groups A and E. Adoptive transfer of NKT lymphocytes exposed ex vivo by HCC-derived antigens loaded on dendritic cells and NKT cells from immunized donors led to suppression of HCC in mice. NKT-mediated anti-tumor activity was associated increased NKT and CD8+ T lymphocyte numbers, increased expression of STAT4, a marker for IL-12 activity and elevated serum levels of the proinflammatory cytokines IFNgamma and IL12, and of IL4. Ex-vivo modulation of NKT lymphocytes holds promise as a novel mode of immune therapy for HCC. (c) 2005 Wiley-Liss, Inc.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15688366&dopt=Abstract weight loss



Weight loss
Association of intentional changes in body weight with coronary heart disease event rates in overweight subjects who have an additional coronary risk factor.

Eilat-Adar S, Eldar M, Goldbourt U.

Department of Epidemiology and Preventive Medicine, Tel-Aviv University, Tel Hashomer, Israel. eilats post.tau.ac.il

Despite evidence that weight loss improves the severity of coronary heart disease (CHD) risk factors, a direct association between weight loss and CHD incidence has not been demonstrated. In 1994-2001, the authors conducted an observational study of intentional weight loss as related to CHD incidence among patients recruited from a network of clinics in Israel who received nutritional counseling from a dietitian to support the medical recommendation to lose weight. Subjects were outpatients aged 50-75 years with a body mass index of > or =27 kg/m(2), without CHD or cancer but with at least one risk factor for CHD in addition to overweight. Outcomes were documented over 4 years by repeated weight measurements and by medical record verification. Among 1,669 patients, 224 (13.4%) incidents of CHD were recorded. For subjects who underwent at least 6 months of dietetic counseling, the risk-factor-adjusted odds ratio for CHD incidence associated with a weight loss of 4.5 kg (the median level of weight loss) was 0.57 (95% confidence interval: 0.39, 0.84). In this, the largest known study of its type reported to date, intentional weight loss from a 6-month diet predicted lower incidence of CHD over 4 years.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15692079&dopt=Abstract weight loss



Weight loss
Weight loss and improvement of obesity-related illness in 500 U.S. patients following laparoscopic adjustable gastric banding procedure.

Spivak H, Hewitt MF, Onn A, Half EE.

Park Plaza Hospital Professional Bldg., 1200 Binz, Ste. 1470, Houston, TX 77004, USA. hspivak houston.rr.com

BACKGROUND: Obesity and its related illness is a primary health concern today. METHODS: Five hundred morbidly obese patients (mean age 42 years; mean preoperative weight 123 kg) underwent laparoscopic adjustable gastric banding surgery in a private U.S. hospital setting within a comprehensive multidisciplinary bariatric program. Patients were followed up to 36 months. Comorbidity status was assessed for 163 patients who completed > or =18 months' follow-up by comparing medications (type and dosage) prescribed for each comorbid condition before surgery and at follow-up. RESULTS: At 36 months after surgery, mean body mass index (BMI) had decreased from 45.2 to 34.9 kg/m(2) and mean percent excess weight loss (%EWL) was 47%. Complications were as follows: gastric pouch dilatation (6.8%), slippage (2.8%), and stoma obstruction (0.6%). There was no mortality. Resolution or improvement of comorbidities were as follows: gastroesophageal reflux disease (GERD) (87%; usually immediately postsurgery), asthma (81.8%), diabetes (66%), dyslipidemia (65.5%), hypertension (48%), and sleep apnea (33%). CONCLUSIONS: Gastric banding provides good weight loss and significant reduction in comorbidities with few and minor complications.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15701486&dopt=Abstract weight loss



Weight loss
Diet and obesity.

Hensrud DD.

Divisions of Preventive Medicine and Endocrinology, Metabolism, & Nutrition Mayo Clinic, Rochester, Minnesota, USA.

PURPOSE OF REVIEW: Obesity continues to increase in the United States and worldwide. There is controversy surrounding different dietary patterns used to promote weight loss, and none has emerged as clearly more effective. This paper briefly reviews the factors that influence energy intake and dietary treatments used to promote weight loss. RECENT FINDINGS: Increasing portion size, eating away from home, and consuming a variety of high-energy dense foods appear to increase energy intake. Hormonal influences on diet continue to be explored. Very-low-calorie diets and low-carbohydrate diets lead to greater initial weight loss, but long-term results are no better than more moderate calorie-restricted diets. A program using meal replacements appears to lead to weight loss slightly greater than calorie-restricted diets and offers one option to treat obesity. Dietary patterns low in energy density and glycemic index have potential in treating obesity and should be studied further. SUMMARY: Clearly, a dietary pattern that prescribes a lower total energy intake is necessary for weight loss, and this pattern should be sustainable to maintain weight loss. Although many dietary programs can achieve short-term loss of weight, dietary treatment should be recommended that emphasizes lifestyle changes and is consistent with other dietary guidelines to promote long-term health. Features consistent with this are a dietary pattern low in total calories, saturated fat, and refined carbohydrate; moderate in whole grains; and high in low-energy dense vegetables and fruits. Future studies should explore dietary strategies and combination therapies that contribute to weight loss, long-term weight maintenance, and improved health.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15703632&dopt=Abstract weight loss