Cytokine pattern is solely influenced by priming vaccine but immunity and disease by both priming and boosting vaccines in mice challenged with respiratory syncytial virus.

Vaccine formulation can influence cytokine and disease patterns in mice following respiratory syncytial virus (RSV) challenge. The influence of different live and killed dual-vaccine combinations on subsequent immune responses was investigated. BALB/c mice received either killed followed by killed (KV/KV), killed followed by live (KV/LV), live followed by killed (LV/KV), or live followed by live (LV/LV) RSV vaccines intramuscularly. Mouse weight loss, viral replication, cytokine expression patterns, immunoglobulin isotype antibody profiles, neutralizing antibody responses, and cytotoxicity T lymphocyte (CTL) activities in lungs were compared on subsequent live RSV challenge. On challenge, mice vaccinated initially with KV and boosted with either KV or LV expressed significantly skewed ratios of IL-4 to IFN-gamma mRNA and IgG1 to IgG2a antibody, when compared to those vaccinated initially with LV. Low levels of RSV replication were detected in lungs of mice vaccinated with KV/KV, KV/LV, and LV/KV, but not in mice vaccinated with LV/LV. Mice vaccinated with KV/LV, LV/KV, or LV/LV had RSV-specific CTL activity in lungs six days after RSV challenge, while no CTL activity was detected in KV/KV-vaccinated mice. Mice vaccinated with KV/KV had the greatest weight loss, while LV/LV-vaccinated mice resulted in the least. Mice vaccinated with either KV/LV or LV/KV had intermediate weight loss after challenge. These data indicate that an original antigenic sin-like phenomenon was exhibited in cytokine and immunoglobulin isotype responses in mice after challenge. T helper (Th)-like immune responses were determined solely by the initial vaccination, while weight loss, viral replication, neutralizing antibody responses, and CTL activities were also influenced by boosted vaccinations.

Effects of short-term modest weight loss on fasting and post-prandial lipoprotein sub-fractions in type 2 diabetes mellitus patients.

OBJECTIVE: We assessed the efficacy of a modest weight loss (1.5 +/- 0.3 kg) and simultaneous rapid improvement in glycemic control on fasting an post-prandial lipoprotein sub-fractions in nine overweight (BMI=28 +/- 1.7 kg/m(2)) well controlled Type 2 diabetic patients (HbA(1c)=7.3 +/- 0.1%). MATERIAL AND METHODS: They followed a non-drastical hypocaloric balanced diet (1 561 +/- 39 kcal/day) over ten days in hospital. The fat content of the diet was significantly lowered from 96 +/- 12 g/day to 62 +/- 4 g/day (p<0.03). Plasma lipid and lipoprotein levels were measured in fasting and four hours after standard breakfast and four hours after standard lunch twice before and after ten days of hospitalization. The sub-fractions of very low density and low density lipoprotein were obtained by cumulative flotation ultracentrifugation. RESULTS: This weight loss reduced two well known independent cardiovascular risk factors such as the post-prandial glycemic excursions (p<0.05) and the post-prandial lipemia (p<0.05). Multiple linear regression analyses identified weight loss as an independent variable accounting for the ability to predict post-prandial capillary triglyceride clearance (p<0.05). Improvements in post-prandial glycemic excursions which was also entered as a parameter did not appear as a variable being able to predict these changes (p=0.4). In addition to the 23% improvement in post-prandial capillary triglyceride clearance (p<0.02), a decrement in post-prandial VLDL-2 triglyceride enrichment was found (p<0.05). Finally, fasting and post-prandial LDL-3 cholesterol levels were diminished (p<0.05) and the LDL-2/LDL-3 mass ratio post-prandial kinetics were improved (p<0.05). CONCLUSIONS: Even a modest weight loss in overweight, average controlled type 2 diabetic patients can achieve a significant improvement in two cardiovascular risk factors, namely post-prandial triglyceride excursions and the LDL-2/LDL-3 mass ratio kinetics independently from glycemic control improvements.

Perspectives: A Practical Approach to the Dietary Treatment of Hypertriglyceridemia.

Reducing high plasma triglyceride (TG) levels is an important step in the treatment and prevention of coronary artery disease. The rise in plasma TGs seen after subjects consume low-fat, high-carbohydrate diets for a period of time may be due to the simple form of carbohydrate provided and/or prevention of weight loss in these studies. Ad libitum low-fat, high-carbohydrate intake often results in weight loss and decreases in plasma TGs. Replacing dietary carbohydrate with monounsaturated fat lowers serum TG levels and maintains serum high-density lipoprotein levels but fails to result in weight loss. Low-fat, high-complex carbohydrate intake reduces incidence rates of coronary artery disease. On the basis of the evidence, a low-fat, high-complex carbohydrate diet combined with limited alcohol and sugar intake is recommended for the treatment of hypertriglyceridemia. (c)2001 CHF, Inc.

Human plasma ghrelin levels increase during a one-year exercise program.

weight loss resulting from decreased caloric intake raises levels of the orexigenic hormone, ghrelin. Because ingested nutrients suppress ghrelin, increased ghrelin levels in hypophagic weight loss may result from decreased inhibitory input by ingested food, rather than from lost weight. We assessed whether ghrelin levels increase in response to exercise-induced weight loss without decreased caloric intake. We randomized 173 sedentary, overweight, postmenopausal women to an aerobic exercise intervention or stretching control group. At baseline, 3 months, and 12 months, we measured body weight and composition, food intake, cardiopulmonary fitness (maximal oxygen consumption), leptin, insulin, and ghrelin. Complete data were available for 168 women (97%) at 12 months. Exercisers lost 1.4 +/- 0.4 kg (P < 0.05 compared with baseline; P = 0.01 compared with stretchers) and manifested a significant, progressive increase in ghrelin levels, whereas neither measure changed among stretchers. Ghrelin increased 18% in exercisers who lost more than 3 kg (P < 0.001). There was no change in caloric intake in either group and no effect on ghrelin of exercise per se independent of its impact on body weight. In summary, ghrelin levels increase with weight loss achieved without reduced food intake, consistent with a role for ghrelin in the adaptive response constraining weight loss and, thus, in long-term body weight regulation.

Factors of importance for weight loss in elderly patients with Parkinson's disease.

OBJECTIVE: weight loss is reported frequently in patients with Parkinson's disease (PD). The objective of this study was to find the underlying factors of this phenomenon. PARTICIPANTS AND METHODS: Twenty-six L-dopa-treated patients with PD and 26 age- and sex-matched healthy controls were assessed twice within a 1-year interval. Body weight, body fat mass, resting energy expenditure, physical activity, energy intake, thyroid hormones and cognitive function were investigated. RESULTS: Nineteen (73%) of the PD patients lost body weight, although energy intake and the time for rest increased. weight loss was most marked in patients with more severe PD symptoms and in whom cognitive function had decreased. Multiple regression analyses showed that determinants for weight loss were female gender, age and low physical activity. CONCLUSION: weight loss was common in PD patients, in spite of the increased energy intake and was most obvious in patients with increased PD symptoms and decreased cognitive function.

Energy and substrate metabolism in patients with chronic extensive graft-versus-host disease.

BACKGROUND: Allogeneic stem cell transplantation is frequently complicated by graft-versus-host disease (GVHD). weight loss is one of the characteristic features of GVHD. The etiology of weight loss in GVHD is not completely understood. METHODS: We measured resting energy expenditure (REE) and substrate oxidation rates by indirect calorimetry in patients with stable chronic extensive GVHD under immunosuppressive therapy (n=13) and sex-, age-, height-, and weight-matched healthy controls (n=13) in order to evaluate metabolic changes in these patients. Measurements were done on day 518+/-261 after allogeneic stem cell transplantation in the postabsorptive state. Serum concentrations of glucagon, norepinephrine, tumor necrosis factor-alpha, interleukin-6, and free fatty acids were determined. RESULTS: Patients showed a maximum weight loss of 22% during their course of GVHD; nevertheless, they regained 15% of total body weight (TBW) during successful treatment of GVHD. Indirect calorimetry showed an increase in REE per kilogram of TBW (patients, 21.8+/-3.1 kcal/kg TBW/day; controls, 19.9+/-2 kcal/kg TBW/day; P<0.05). Respiratory quotient (patients, 0.79+/-0.04, controls, 0.86+/-0.04; P<0.005) and non-protein respiratory quotient (0.78+/-0.05 and 0.87+/-0.05, respectively; P<0.005) were decreased in patients. GVHD patients had elevated serum glucagon and norepinephrine concentrations, whereas tumor necrosis factor-alpha and interleukin-6 were in the normal range. CONCLUSIONS: Patients with chronic extensive GVHD show an increase in REE and alterations in fat and carbohydrate oxidation rates. These changes seem to be the result of increased action of glucagon and norepinephrine.

Tipping the scales: the effect of literacy on obese patients' knowledge and readiness to lose weight.

OBJECTIVES: The purpose of this study was to determine the association between the literacy level of overweight/obese patients and their weight-loss knowledge, attitudes, and readiness. METHODS: Structured patient interviews and a literacy screening instrument were administered in two primary care clinics at a university-based public hospital. RESULTS: A convenience sample of 210 overweight or obese adult outpatients (body mass index > or =25 kg/m2 or > or =30 kg/m2, respectively) were enrolled. Mean respondent age was 52 years; 74% were female, and 76% were black. Two thirds of patients read below a 9th grade level. Half of patients across all literacy levels reported currently attempting weight loss. There was a significant relation between literacy level and weight-loss knowledge, attitudes, and readiness (P < 0.05). CONCLUSIONS: Patients with low literacy were significantly less likely to understand the adverse health consequences of obesity and the need to lose weight and to report being ready to lose weight. Patient education and counseling for weight loss should be tailored for patients with low literacy skills.

Baseline nutritional assessment in advanced cancer patients receiving palliative chemotherapy.

Depletion of nutritional reserves and significant weight loss can lead to an increased risk of morbidity, reduced chemotherapy response, and shorter survival in patients with cancer. weight loss and malnutrition are recognized to result from multifactorial processes, which if assessed and managed appropriately may lead to improved treatment outcome. Numerous methodologies are used for the assessment of nutritional status. However, it remains unclear which of these tools is the most appropriate in the setting of cancer chemotherapy. The aim of this study was to investigate the use of various fundamental assessment tools that could be applied to the routine clinical evaluation of nutritional status in patients with advanced solid malignancies before treatment with palliative chemotherapy. We investigated the interrelationships between biochemical indices, anthropometric measures, and a nutritional screening tool, the Mini-Nutritional Assessment, in 73 patients. Many of these measures were highly interrelated, but the baseline history of weight loss in these patients was strongly correlated to the Mini-Nutritional Assessment (MNA) score (P < 0.0005). In turn, baseline weight loss and the MNA score were strongly correlated to serum C-reactive protein (a marker of acute-phase response). In some patients, malnutrition was linked to disease- or treatment-related upper digestive tract morbidity. Testing for the serum concentration of C-reactive protein at baseline may identify a subset of patients for whom a decline in nutritional status is linked to the presence of an active inflammatory response, a recognized precursor of cachexia