Outcomes among African-American/non-African-American patients with advanced non-small-cell lung carcinoma: report from the Cancer and Leukemia Group B.

BACKGROUND: Among patients diagnosed with advanced non-small-cell lung carcinoma (NSCLC), African-Americans have lower survival rates than non-African-Americans. Whether this difference is due to innate characteristics of the disease in the two ethnicities or to disparities in health care is not known. We investigated whether the disparity in survival would persist when patients were treated with similar systemic therapies (i.e., in phase II and phase III Cancer and Leukemia Group B [CALGB] trials). METHODS: We assessed 504 consecutive patients (458 non-African-American and 46 African-American) receiving systemic chemotherapy in CALGB studies for advanced NSCLC during the period from 1989 through 1998. Clinical and demographic characteristics, treatment received, and survival data were obtained from the CALGB database. Cox's proportional hazards model was used to assess the effect of race/ethnicity on survival after adjustment for other known prognostic factors. All statistical tests were two-sided. RESULTS: The unadjusted 1-year survival rate was 22% (95% confidence interval [CI] = 13% to 38%) for African-American patients and 30% (95% CI = 26% to 35%) for non-African-American patients, a statistically significant difference (8%; 95% CI on the difference = 5% to 12%; P =.03). Multivariable adjustment for the effect of treatment arm, histology, and metastatic site at presentation did not alter the worse outcome for African-American patients. However, the effect of race/ethnicity disappeared after adjustment for performance status and weight loss. African-American patients were more likely than non-African-Americans to present with a poor performance status (83% versus 60%) and substantial weight loss (41% versus 27%) and to be unmarried (59% versus 28%), disabled (31% versus 15%), unemployed (17% versus 7%), and Medicaid recipients (30% versus 8%). CONCLUSIONS: The relationship that we observed between poor performance, weight loss, and socioeconomic status suggests that social circumstances lead to African-Americans presenting with poorer prognostic features.

Effects of intraperitoneal administration of gemcitabine and paclitaxel on hepatic regeneration in rats.

BACKGROUND/AIMS: We aimed to test clinical implications of intra-peritoneally administered gemcitabine and paclitaxel on hepatic regeneration after hepatic resection in rats. METHODS: Fifty male, Swiss albino rats weighing between 200 and 240 g were used. After a 30% partial hepatectomy was performed (except Sham group), animals were divided into five groups as: high-dose gemcitabine, low-dose gemcitabine, paclitaxel, control, and Sham operation groups. In the high-dose and low-dose gemcitabine groups, animals received 200 and 12.5 mg/kg intraperitoneal gemcitabine for five days after partial hepatectomy respectively. In the paclitaxel group, animals were administered 6 mg/kg paclitaxel in the same fashion. Control and Sham groups received intraperitoneal 0.9% NaCl. On the sixth postoperative day, the animals were killed liver tissues were resected, proliferating cell nuclear antigen immunopositivity was determined and weight loss and diarrhea were assessed. Results: Gemcitabine and paclitaxel treated animals lost weight and had more severe diarrhea than control and Sham group animals. No significant difference was observed between treatment groups in terms of weight loss, diarrhea, and proliferating cell nuclear antigen. When treatment groups were compared to the control group in terms of proliferating cell nuclear antigen immunopositivity, no significant differences were detected. CONCLUSIONS: It can be concluded that adjuvant chemotherapy with gemcitabine and paclitaxel is a safe option in terms of liver regeneration and side effects such as diarrhea and weight loss.

Failure of preoperative resting energy expenditure in predicting weight loss after gastroplasty.

OBJECTIVE: To evaluate the predictive efficacy of preoperative resting energy expenditure (REE) on weight loss after vertical banded gastroplasty (VBG). When subjected to a gastric restriction procedure of similar extent, the patients with higher energy expenditure should experience a greater negative energy balance than those with lower-energy expenditure, and thus, lose more weight, thereby making REE a reliable predictor of weight loss after VBG. RESEARCH METHODS AND PROCEDURES: This was a prospective investigation after VBG, taking into account the relationship between preoperative REE values and the results at 1-year follow-up in terms of weight loss and success of the procedure. The correlations were evaluated by multiple and logistic regression analysis. RESULTS: The weight loss and the outcome at 1 year after VBG seemed to be completely independent of preoperative energy expenditure. DISCUSSION: These findings suggest that, despite gastric restriction, patients may voluntarily adjust their energy intake, and that the weight outcome after VBG is influenced more by behavioral and cognitive variables than by biological or surgical factors.

Analysis of puberal development and influence of weight loss in obese adolescent girlsTo study several aspects of puberal development in obese adolescent girls, and the influence of weight loss on these aspects. METHODS: A longitudinal retrospective study was performed of a sample of 26 adolescent girls with normal weight and 46 obese adolescent girls at the onset of puberty. The obese teenagers were further divided into two groups (normal and obese) according to their body mass index (BMI) at the end of puberty. Height, chronological and bone age, and growth velocity were evaluated in both groups. RESULTS: Of the teenagers who were obese at the onset of puberty, 63 % remained obese at the end of puberty.The obese teenagers were significantly taller than non-obese teenagers at the onset of puberty (143.2 +/- 6.96 vs 138.9 +/- 5.95 cm, respectively; p < 0.01). However, there were no differences between the two groups in final height. No differences were found between obese teenagers who lost weight and those who did not.There were no differences in chronological or bone age throughout puberal development in any of the groups.The mean growth velocity during puberty was significantly lower in obese teenagers than in non-obese teenagers (6.18 +/- 1.94 and 6.90 +/- 127 cm/year, respectively; p < 0.02). However, there were no differences between obese teenagers who lost weight and those who did not. CONCLUSIONS: Height gain in obese girls is greater in childhood but lower in adolescence. Final height is similar in both groups. Chronological age at the onset and end of puberty and bone maturation are similar in both groups. weight loss during puberty does not modify growth pattern during this period of development.

Hypothalamic-pituitary-adrenal responses to weight loss in mice following diet restriction, activity or separation stress: effects of tyrosine.

We have studied three different types of weight-loss stress caused by Diet restriction, Activity or Separation, for their effects on the hypothalamic-pituitary axis in young female mice and their responses to tyrosine 100 mg/kg/day. Plasma was assayed for ACTH and glucocorticoid determinations, and brain catecholamine concentrations were measured by HPLC/ECD. A similar weight loss of 24-28% was observed in the models despite significant differences in food intake. Diet restriction to 60% and Separation models produced a significant increase in hypothalamic noradrenaline (p < 0.01), while there was a significant decrease (p < 0.05) in the Diet restriction to 40% that was restored after tyrosine. After Activity, noradrenaline levels did not change. ACTH concentrations decreased following Diet restriction (p < 0.05) but were unaffected by Separation or Activity. The peripheral glucocorticoid response increased significantly after Activity and Diet restriction (p < 0.001), but decreased significantly after Separation (p < 0.001). Tyrosine increased glucocorticoid concentrations in the Activity and Separation models (p < 0.05), but not after Diet restriction. Despite similar weight loss in the three models there were no predictable associations between hypothalamic noradrenaline metabolism and plasma ACTH or glucocorticoid concentrations. Tyrosine might alleviate some of the different pathophysiological problems associated with the stress of weight loss.

Insulin resistance precedes weight loss in adults without diabetes : the Rancho Bernardo Study.

Insulin resistance is closely associated with both aging and overweight; yet in old age, weight loss is common, although insulin resistance increases. To study this paradox, the authors evaluated the role of insulin resistance in weight change among older adults from the Rancho Bernardo Study cohort. Participants were 725 nondiabetic men and women who were aged 50-89 years when weight and insulin were measured at baseline (1984-1987). The participants were evaluated again in 1992-1996, at which time weight was remeasured. Fasting insulin and homeostasis model assessment (HOMA) measurements were evaluated in separate but parallel statistical models as surrogates for insulin resistance. Insulin resistance, when defined as the top quartile of fasting insulin level or HOMA value, was significantly associated with weight loss before and after adjustment for baseline weight and age (fasting insulin: beta = -1.30 kg, p = 0.01; HOMA: beta = -1.18 kg, p = 0.01). Results were the same for men versus women, for the overweight (body mass index (weight (kg)/height (m)(2)) > 26.6) [corrected] versus the normal weight (body mass index < or = 26.6) [corrected], and for younger persons (age <70 years) versus older persons (age > or = 70 years). Insulin-resistant individuals had a threefold increased likelihood of losing 10 or more kg compared with those without insulin resistance. The authors conclude that hyperinsulinemia, independently of age and baseline weight, may have a catabolic effect in the elderly.

The Lap-Band is an effective tool for weight loss even in the United States.

BACKGROUND: Despite impressive results with the Lap-Band in Europe and Australia, the early Food and Drug Administration A trial in the United States showed fairly poor results. This prospective study attempts to determine if the Lap-Band can produce effective weight loss in morbidly obese Americans. METHODS: Five hundred four consecutive patients have undergone placement of the Lap-Band (Inamed). Four hundred fourteen patients were women (82%) and 90 were men (18%). The median preoperative weight was 138 kg, and the preoperative median body mass was 49 kg/m(2). RESULTS: Five hundred two bands were placed laparoscopically. One was converted to an open procedure because of lack of exposure, and one was placed open because of multiple previous abdominal surgeries. Median operating time was 50 minutes, and median length of stay was 1.8 days. Percent excess weight loss at 6, 12, 24, and 36 months for all patients was 36%, 50%, 61%, and 65%, respectively. Complications occurred in 96 patients (19%) primarily consisting of port tubing separations, slips, postoperative dysphagia, and port infections. There was one (.2%) mortality. CONCLUSIONS: The Lap-Band system is an effective tool for weight loss surgery in morbidly obese patients in the United States.

Effect of low-calorie diets on plasma retinol-binding protein concentrations in overweight women.

The concentrations of total protein, albumin and retinol-binding protein, a major transport protein for vitamin A, are significantly decreased by protein-calorie malnutrition. weight-loss diets, sometimes involving severe energy deficits over prolonged periods of time, are common in the United States. The effect, if any, of prolonged low calorie weight-loss diets with normal intakes of protein on albumin, total protein and retinol-binding protein concentrations (and potentially on vitamin A metabolism) had not been extensively studied. We measured total protein, albumin, apo + holo retinol-binding protein and holo-free- and holo-transthyretin-bound retinol-binding protein concentrations during the course of a nutritionally adequate weight-loss diet (50% calorie restriction). We found that this type of dieting did not affect total protein, albumin or apo + holo, holo-free or holo-transthretin-bound retinol-binding protein concentrations significantly. This suggests that protein intake is more critical than caloric intake for retinol-binding protein status.