Dietary fat, lipogenesis and energy balance.

Today, there are still uncertainties about the role of exogenous fat on body fat regulation. Early models of energy utilization (for example, Kleiber's, early 20th century) failed to take into account the nature of substrate oxidized in the control of food intake, whereas more recent models (e.g., Flatt's model, end of 20th century) did. Excess body fat storage is ultimately a problem of chronic positive energy balance mediated by a poor control of energy intake or/and a blunted total energy expenditure. Excess fat storage can stem from exogenous fat and to a more limited extent by nonfat substrates precursors transformed into body fat, mostly from carbohydrates, a process known as de novo lipogenesis. When considered over periods of weeks, months or years, total fat balance is closely related to energy balance. Over periods of days, the net change in fat balance is quantitatively limited as compared to the size of endogenous fat storage. The issues discussed in this article primarily include the stimulation of de novo lipogenesis after acute or prolonged CHO overfeeding and whether de novo lipogenesis is a risk factor for obesity development.

Early dyadic patterns of mother-infant interactions and outcomes of prematurity at 18 months.

OBJECTIVE: With the increased survival of very preterm infants, there is a growing concern for their developmental and socioemotional outcomes. The quality of the early mother-infant relationship has been noted as 1 of the factors that may exacerbate or soften the potentially adverse impact of preterm birth, particularly concerning the infant's later competencies and development. The first purpose of the study was to identify at 6 months of corrected age whether there were specific dyadic mother-infant patterns of interaction in preterm as compared with term mother-infant dyads. The second purpose was to examine the potential impact of these dyadic patterns on the infant's behavioral and developmental outcomes at 18 months of corrected age. METHODS: During a 12-month period (January-December 1998), all preterm infants who were <34 weeks of gestational age and hospitalized at the NICU of the Lausanne University Hospital were considered for inclusion in this longitudinal prospective follow-up study. Control healthy term infants were recruited during the same period from the maternity ward of our hospital. Mother-infant dyads with preterm infants (n = 47) and term infants (n = 25) were assessed at 6 months of corrected age during a mother-infant play interaction and coded according to the Care Index. This instrument evaluates the mother's interactional behavior according to 3 scales (sensitivity, control, and unresponsiveness) and the child's interactional behavior according to 4 scales (cooperation, compliance, difficult, and passivity). At 18 months, behavioral outcomes of the children were assessed on the basis of a semistructured interview of the mother, the Symptom Check List. The Symptom Check List explores 4 groups of behavioral symptoms: sleeping problems, eating problems, psychosomatic symptoms, and behavioral and emotional disorders. At the same age, developmental outcomes were evaluated using the Griffiths Developmental Scales. Five areas were evaluated: locomotor, personal-social, hearing and speech, eye-hand coordination, and performance. RESULTS: Among the possible dyadic patterns of interaction, 2 patterns emerge recurrently in mother-infant preterm dyads: a "cooperative pattern" with a sensitive mother and a cooperative-responsive infant (28%) and a "controlling pattern" with a controlling mother and a compulsive-compliant infant (28%). The remaining 44% form a heterogeneous group that gathers all of the other preterm dyads and is composed of 1 sensitive mother-passive infant; 10 controlling mothers with a cooperative, difficult, or passive infant; and 10 unresponsive mothers with a cooperative, difficult, or passive infant. Among the term control subjects, 68% of the dyads are categorized as cooperative pattern dyads, 12% as controlling pattern dyads, and the 20% remaining as heterogeneous dyads. At 18 months, preterm infants of cooperative pattern dyads have similar outcomes as the term control infants. Preterm infants of controlling pattern dyads have significantly fewer positive outcomes as compared with preterm infants of cooperative pattern dyads, as well as compared with term control infants. They display significantly more behavioral symptoms than term infants, including more eating problems than term infants as well as infants from cooperative preterm dyads. Infants of the controlling preterm dyads do not differ significantly for the total development quotient but have worse personal-social development than term infants and worse hearing-speech development than infants from cooperative preterm dyads. The preterm infants of the heterogeneous group have outcomes that can be considered as intermediate with no significant differences compared with preterm infants from the cooperative pattern or the controlling pattern dyads. CONCLUSION: Among mother-preterm infant dyads, we identified 2 specific patterns of interaction that could play either a protective (cooperative pattern) or a risk-precipitating (controlling pattern) role on developmental and behavioral outcome, independent of perinatal risk factors and of the family's socioeconomic background. The controlling pattern is much more prevalent among preterm than term dyads and is related to a less favorable infant outcome. However, the cooperative pattern still represents almost 30% of the preterm dyads, with infants' outcome comparable to the ones of term infants. These results point out the impact of the quality of mother-infant relationship on the infant's outcome. The most important clinical implication should be to support a healthy parent-infant relationship already in the NICU but also in the first months of the infant's life. Early individualized family-based interventions during neonatal hospitalization and transition to home have been shown to reduce maternal stress and depression and increase maternal self-esteem and to improve positive early parent-preterm infant interactions.

Protein turnover and thermogenesis in response to high-protein and high-carbohydrate feeding in men.

The rates of energy expenditure and wholebody protein turnover were determined during a 9-h period in a group of seven men while they received hourly isocaloric meals of high-protein (HP) or high-carbohydrate (HC) content. Their responses to feeding were compared with those to a short period of fasting (15-24 h). The 9-h thermic response to the repeated feeding of HP meals was found to be greater than that to the HC meals (9.6 +/- 0.6% vs 5.7 +/- 0.4% of the energy intake, respectively, means +/- SEM, p less than 0.01). The rate of whole-body nitrogen turnover over 9 h increased from 17.6 +/- 2.2 g on the fasting day to 27.4 +/- 1.4 g during HC feeding (NS) and there was a further increase to 58.2 +/- 5.3 g resulting from HP feeding (p less than 0.001). By using theoretical estimates (based upon ATP requirements) of the metabolic cost of protein synthesis, 36 +/- 9% of the thermic response to HC feeding and 68 +/- 3% of the response to HP feeding could be accounted for by the increases in protein synthesis compared with the fasting state.

The development and pilot-testing of a training curriculum in adolescent medicine and health.

PURPOSE: To select and propose a set of knowledge, attitudes, and skills essential for the care of adolescents; to encourage the development of adolescent health multidisciplinary networks; and to set up training programs in as many European countries as possible. METHODS: The curriculum was developed by 16 physicians from 11 European countries with various professional specializations. In line with modern guidelines in medical education, it is a modular, flexible instrument which covers the main teaching areas in the field, such as basic skills (i.e. setting, rights and confidentiality, gender and cultural issues) as well as specific themes (i.e. sexual and reproductive health, eating disorders, chronic conditions). It consists of 17 thematic modules, each containing detailed objectives, learning approaches, examples, and evaluation methods. RESULT: Two international one-week summer schools were used to assess the feasibility and appropriateness of the curriculum. The overall evaluation was good, with most of the items surpassing three on a four-point Likert scale. However, it pointed to several aspects (process and content) which will need to be refined in the future, such as an increase in interactive sessions (role playing), and a better mix of clinical and public health issues.

Anorexie mentale et boutimie: I'expérience vaudoise d'une prise en charge interdisciplinaire [Anorexia and bulimia: the canton of Vaud's experience of an interdisciplinary approach].

As psychiatric disorders attacking the body, anorexia and bulimia may have severe psychological, physical and social consequences, often requiring a long-standing interdisciplinary, coordinated and individualized approach. Recently the canton of Vaud has initiated and developed an interinstitutional structure--between the University Hospital (CHUV) and the hospitals of the Northern region of the canton (eHnv)--for the care of patients suffering from eating disorders. This structure, allowing the above mentioned approach for the treatment of eating disorders, consists of an outpatient facility located in the CHUV and an inpatient unit in the hospital of Saint Loup of the eHnv. Within this structure, the general practitioner plays a crucial role in the prevention of the chronification of these disorders by means of their early detection and management.

Antecedents, psychiatric characteristics and follow-up of adolescents hospitalized for suicide attempt of overwhelming suicidal ideation.

OBJECTIVES: To evaluate the socio-demographic as well as the health and psychiatric profiles of adolescents hospitalised for suicide attempt or overwhelming suicide ideation and to assess repetition of suicide attempt over a period of 18 months. PATIENTS AND METHODS: Between April 2000 and September 2001, all patients aged 16 to 21 years admitted to the University Hospitals of Geneva and Lausanne for suicide attempt or ideation were included in the study. At this time (T0) semi-structured face to face interviews were conducted to identify socio-demographic data, mental health and antecedents regarding suicidal conducts. Current psychiatric status was assessed with the MINI (Mini International Neuropsychiatric Instrument). At T1 and T2, reassessments included psychiatric status (MINI) as well as lifestyles, socio-professional situation and suicidal behaviours. RESULTS: At T0, 269 subjects met the study criteria, among whom 83 subjects (56 girls and 27 boys) left the hospital too quickly to be involved or refused to participate in the study (final sample at T0: 149 girls; 37 boys). The participation rate at T1 and T2 was respectively 66% and 62% of the original sample. The percentage of adolescents meeting the criteria for psychiatric diagnoses (91%) was high: affective disorder (78%); anxiety disorder (64%); substance use disorder (39%); eating disorder (9%); psychotic disorder (11%); antisocial personality (7%) with most subjects (85%) having more than one disorder. Around 90% of the subjects interviewed at T1, and/or T2, had received follow-up care after their hospitalisation, either by a primary care physician or a psychotherapist or both. Two subjects died of violent death and 18% made a further suicide attempt. CONCLUSION: Most adolescents hospitalised for suicidal episodes suffer from psychiatric problems which should be addressed by a careful psychiatric assessment, followed up if needed by a structured after care plan.

Relationship of hyperactivity/inattention with adiposity and lifestyle characteristics in preschool children.

We performed a cross-sectional study in 450 nonreferred preschool children aged 4 to 6 years to assess the association between hyperactivity/inattention with adiposity and lifestyle characteristics. Measurements included scores of hyperactivity/inattention, adiposity, objectively measured physical activity, television viewing, and eating habits. Higher scores of hyperactivity/inattention were associated with lower percentage body fat, higher levels of physical activity, and less time spent in sedentary activity (all P ≤ .01). However, higher scores of hyperactivity/inattention were also associated with more television viewing and less healthy eating habits (all P ≤ .04). Except for some selected eating habits (P ≥ .07), those relationships remained significant after adjustment for age, sex, and sociodemographic confounders. To conclude, higher scores of hyperactivity/inattention are linked to different lifestyle characteristics that may in part contribute to a future development of overweight/obesity. Precise mechanisms explaining these associations and possible preventive approaches should be further investigated.

Compliance to dietary advice directed towards increasing the carbohydrate to fat ratio of the everyday diet.

OBJECTIVE: To assess the effects, on food intake, body weight and body composition, of compliance to advice aiming at increasing the carbohydrate to fat ratio of the everyday diet without imposing voluntary restriction on the amount of food consumed. DESIGN: Eight moderately overweight women (body mass index > 27 kg/m2, relative body fat mass > 30%) received dietary advice during a 2 month period. Additionally, each evening the subjects had to consume a meal artificially enriched with 13C-glucose in order to assess their compliance from the 13CO2 enrichment in expired air. MEASUREMENTS: Dietary intakes, body weight, body composition and individual compliance. RESULTS: The energy derived from fat decreased from 44 +/- 1% to 31 +/- 1% and the proportion of carbohydrate increased from 38 +/- 2% to 50 +/- 1%, whereas the absolute carbohydrate intake remained constant (182 +/- 18 g/d). Energy intake decreased by 1569 +/- 520 kJ/d. There was a net loss of fat mass (1.7 +/- 0.7 kg, P = 0.016) with fat free mass maintenance. Dietary compliance ranged from 20 to 93% (mean: 60 +/- 8%) and was positively correlated to the loss of body fat mass. CONCLUSION: Advice aiming at increasing diet's carbohydrate to fat ratio induces a loss of fat mass with fat-free mass maintenance.

Physiology of GLP-1--lessons from glucoincretin receptor knockout mice.

GLP-1 has both peripheral and central actions, as this hormone is secreted by gut endocrine cells and brainstem neurons projecting into the hypothalamus and other brain regions. GLP-1 has multiple regulatory functions participating in the control of glucose homeostasis, beta-cell proliferation and differentiation, food intake, heart rate and even learning. GLP-1 action depends on binding to a specific G-coupled receptor linked to activation of the adenylyl cyclase pathway. Analysis of mice with inactivation of the GLP-1 receptor gene has provided evidence that absence of GLP-1 action in the mouse, despite this hormone potent physiological effects when administered in vivo, only leads to mild abnormalities in glucose homeostasis without any change in body weight. However, a critical role for this hormone and its receptor was demonstrated in the function of the hepatoportal vein glucose sensor, in contrast to that of the pancreatic beta-cells, although absence of both GLP-1 and GIP receptors leads to a more severe phenotype characterized by a beta-cell-autonomous defect in glucose-stimulated insulin secretion. Together, the studies of these glucoincretin receptor knockout mice provide evidence that these hormones are part of complex regulatory systems where multiple redundant signals are involved.

Postprandial thermogenesis at rest and during exercise in elderly men ingesting two levels of protein.

Seven elderly male subjects (69 +/- 3 yr, 67.8 +/- 9.2 kg, 24.5 +/- 3.6% body fat) lived for 12 consecutive weeks in a metabolic unit and maintained their weight with two different diets fed for 6 weeks each: Diet A, consisted of their habitual protein intake as determined on the outside by a dietary record (mean +/- SD, 1.12 +/- 0.22 g/kg d). Diet B was an isocaloric diet with reduced protein intake (70 mgN/kg d, i.e., 0.44 g protein/kg d) at the level of physiological protein requirement [7]. After 3 weeks on each diet, the thermogenic response to single meals A and B containing 38% of weight maintenance energy for each subject (731-994 kcal) was studied by indirect calorimetry under two situations: (1) at rest over a 4 hr period and (2) during graded exercise on a bicycle ergometer at four stepwise workloads (0,80, 200, and 300 kg/min). A postabsorptive control exercise was also performed in order to assess the net effect of the meal during exercise. Eating alone increased the energy expenditure by +0.18 +/- 0.07 kcal/min with meal A and +0.13 +/- 0.06 kcal/min with meal B. There was a positive correlation (r = 0.84, p less than 0.01) between the % energy derived from protein and the thermogenic response expressed as % of the energy content of test meal. Exercise failed to influence the thermogenic response to meals since the overall net increase in energy expenditure induced by the meals while exercising was not different from that obtained at rest: +0.22 +/- 0.17 kcal/min and +0.15 +/- 0.13 kcal/min with meal A and meal B, respectively. This study failed to show any interaction between exercise and postprandial thermogenesis in elderly individuals.

Geophagia secondary to anaemia in a rich country?

Case Report: A 19 year old female, originally from Cameroon, residentin Switzerland for 10 years, consults for chronic fatigue, constipationand menorrhagia. Clinical examination reveals pain in the iliac fossa,laboratory tests show an iron deficiency anaemia with a hemoglobinof 74 g/l (N: 117-157) and a ferritin less than 3 μg/l (N: 30-300).Gynecological aetiology is strongly suspected.Findings: The dietary history reveals a high intake of African chalkcalled "Mabel" in Lingala, for which she has a craving with criteria forsubstance dependence according to the Diagnostic and StatisticalManual IV. Eating non-food products is called "PICA" and the eatingof earth "geophagia". It is often assumed by the patient that geophagiaoffers nutritional virtues of the earth, and that the land would act asantitoxic, anti-emetic, immune-stimulant, strengthen the intestinalbarrier and be rich in calcium, iron and many nutrients. But insteadgeophagia causes anemia, iron chelation, heavy metal poisoningand significant constipation or obstruction.Management: The patient, following our advice, stopped ingestingchalk. Parenteral iron substitution of ferric carboxymaltose 1000 mgstopped the craving, and resolved her subjective state of fatigue andher haemoglobin normalized to 140 g/l. The menorrhagia resolved withhormone replacement and the constipation subsequently disappeared.Discussion: Our patient was suffering from iron deficiency resulting ina craving for non-food products in this case the earth. We advisepractitioners to systematically ask the question in patients of Africanand South American origin by using synonyms for the word "Mabel"(African chalk, kaolin, Kalaba, calabash chalk, calabash Stone, Kaolin,hurdle, or clay Nzu). A simple question can sometimes avoid costlyinvestigations. The ferrous replacement intravenously can probably stopthe practice of geophagy faster. Finally, we must remember that thispractice is underestimated and rarely expressed by patients as it isoften felt to be a shameful practice.

Glycogen storage capacity and de novo lipogenesis during massive carbohydrate overfeeding in man.

The metabolic balance method was performed on three men to investigate the fate of large excesses of carbohydrate. Glycogen stores, which were first depleted by diet (3 d, 8.35 +/- 0.27 MJ [1994 +/- 65 kcal] decreasing to 5.70 +/- 1.03 MJ [1361 +/- 247 kcal], 15% protein, 75% fat, 10% carbohydrate) and exercise, were repleted during 7 d carbohydrate overfeeding (11% protein, 3% fat, and 86% carbohydrate) providing 15.25 +/- 1.10 MJ (3642 +/- 263 kcal) on the first day, increasing progressively to 20.64 +/- 1.30 MJ (4930 +/- 311 kcal) on the last day of overfeeding. Glycogen depletion was again accomplished with 2 d of carbohydrate restriction (2.52 MJ/d [602 kcal/d], 85% protein, and 15% fat). Glycogen storage capacity in man is approximately 15 g/kg body weight and can accommodate a gain of approximately 500 g before net lipid synthesis contributes to increasing body fat mass. When the glycogen stores are saturated, massive intakes of carbohydrate are disposed of by high carbohydrate-oxidation rates and substantial de novo lipid synthesis (150 g lipid/d using approximately 475 g CHO/d) without postabsorptive hyperglycemia.

Short-term, mixed-diet overfeeding in man: no evidence for "luxuskonsumption".

After 13 days of weight maintenance diet (13,720 +/- 620 kJ/day, 40% fat, 15% protein, and 45% carbohydrate), five young men (71.3 +/- 7.1 kg, 181 +/- 8 cm; means +/- SD) were overfed for 9 days at 1.6 times their maintenance requirements (i.e., +8,010 kJ/day). Twenty-four-hour energy expenditure (24-h EE) and basal metabolic rate (BMR) were measured on three occasions, once after 10 days on the weight-maintenance diet and after 2 and 9 days of overfeeding. Physical activity was monitored throughout the study, body composition was measured by underwater weighing, and nitrogen balance was assessed for 3 days during the two experimental periods. Overfeeding caused an increase in body weight averaging 3.2 kg of which 56% was fat as measured by underwater weighing. After 9 days of overfeeding, BMR increased by 622 kJ/day, which could explain one-third of the increase in 24-h EE (2,038 kJ/day); the remainder was due to the thermic effect of food (which increased in proportion with excess energy intake) and the increased cost of physical activity, related to body weight gain. This study shows that approximately one-quarter of the excess energy intake was dissipated through an increase in EE, with 75% being stored in the body. Under our experimental conditions of mixed overfeeding in which body composition measurements were combined with those of energy balance, it was possible to account for all of the energy ingested in excess of maintenance requirements.

1

In this book, the authors present current research in the study of health behavior. Topics discussed include the role of fitness classes in the development of eating disorders among women; first year university female students' lifestyles and attitudes towards health risk and preventive measures; an examination of the extensive cross-sectional and longitudinal evidence that links traditional screen-time to pediatric obesity; gender issue implications on health; and health promotion messages used to inform the population about important health issues and to motivate individuals to adopt healthy behaviors and avoid unhealthy behaviors. (Imprint: Novinka)