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OBJECTIVE To determine the changes in body composition, muscle function and energy expenditure after radical cystectomy (RC). PATIENTS AND METHODS Eleven consecutive men (median age 66 years, range 44–79) who had a RC over a 1-year period had measurements made of their total body protein, by neutron-activation analysis, total body water by tritium dilution, total body potassium by whole-body counting, resting energy expenditure by indirect calorimetry, and grip strength and respiratory muscle strength. These variables were measured on the day before surgery and at 2 weeks and 6 months after RC. Total body fat was derived using a multicompartment model. Artificial nutritional support was not provided after RC and no oral caloric intake was provided until bowel function returned. RESULTS Five patients were malnourished before RC and four had significant complications afterward. Over the first 2 weeks there were significant losses in mean (sem) protein levels, at 0.68 (0.17) kg ( P < 0.001) and water, at 3.00 (0.73) L ( P < 0.001), while body fat was unchanged. Resting energy expenditure was 11% higher than predicted at 14 days after RC ( P < 0.001). Body potassium changes mirrored the protein changes but were not statistically significant. Over the subsequent 6 months, 63%, i.e. 0.43 (0.24) kg, of the body protein lost after surgery was regained. Muscle function had returned to baseline levels at 6 months. CONCLUSIONS This study shows that the catabolic loss of body protein after RC is not regained by 6 months. Regimens directed at early nutritional support after RC for these patients might improve the recovery of body composition, with consequent clinical benefits. [ABSTRACT FROM AUTHOR]

Aim: Protein energy malnutrition is common in children with chronic renal failure (CRF) and may negatively impact on clinical outcome. Although the aetiology of malnutrition is multifactorial, descriptive information on body composition may guide nutritional interventions aimed at optimising nutritional status. Methods: This prospective cohort study in children with CRF was conducted from April 1999 to November 2000. Patients were categorised according to their glomerular filtration rate (GFR) into CRF and end-stage renal failure (ESRF). Body composition was assessed based on anthropometry, total body potassium (TBK), total body protein (TBP) and dual X-ray absorptiometry (DEXA). Results: Fifteen patients (10 male, 5 female; mean age: 13.4 ± 4.3 years) were studied, including eight patients with CRF (mean GFR: 17.0 ± 7.2 mL/min/1.73 m2) and seven patients with ESRF (mean GFR: 6.4 ± 1.7 mL/min/1.73 m2). Patients in both groups ( n = 15) had deficits in height and TBP (mean z-score height-for-age: −1.19 ± 1.05, P < 0.01; mean z-score TBP: −0.71 ± 0.71, P < 0.05). There were no significant differences in weight, height, fat-free mass, TBK and TBP between patients with CRF and ESRF. Conclusions: Linear growth impairment and decreased TBP are common in children with chronic and ESRF. TBK and DEXA may underestimate the degree of malnutrition in these patients. [ABSTRACT FROM AUTHOR]

Most reports of outcome following obesity surgery report weight and co-morbidity changes only. We studied body composition changes in 17 adult patients (15 F, 2 M, age 43±2 years, range 28–58 years), with morbid obesity (initial BMI 40.4±4.9 kg/m2, range 34.7–48.8) who were managed surgically by laparoscopically inserting an adjustable gastric band. Body composition was studied before and after surgery (mean interval of 909±51 days, range 441–1,155 days) using anthropometry (abdominal circumference, AC, sum of four skinfold thicknesses, SFSUM), whole-body potassium counting (TBK), in vivo neutron activation analysis total body nitrogen (TBProtein) and whole-body dual-energy ray absorptiometry (total body percent fat TBF%, and total body bone mineral density TBBMD). Weight loss over the study period was 23.4±2.5 kg. (p<0.0003) with an AC reduction of 20.0±4.5 cm (p<0.008). Both SFSUM and TBF% were significantly reduced (p<0.02 and p<0.0005 respectively). Both TBK and TBProtein after normalization for sex and height, were significantly (p<0.0054 and p<0.001 respectively) reduced, but the ratio of loss of fat mass to fat-free mass, at 4.4:1 was usual for weight loss, and there was no significant changes in the ratio of potassium to protein. TBBMD, after normalization relative to a young same sex adult, was not significantly changed. In this group of patients, most of the substantial weight loss over a 2- to 3-year period was due to loss of fat mass, with relatively less reduction in the components of fat-free mass. Adjustable laparoscopic gastric banding induces fat loss without significant other deleterious effects on body composition. [ABSTRACT FROM AUTHOR]