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To enhance physicians' awareness of nutritional problems in the elderly, a nutritional risk assessment scale was developed and validated. 126 patients (mean age 82.0 +/- 6.7, range 65-96 years) admitted from home to a geriatric hospital were enrolled in the study. After informed consent was obtained, they underwent a comprehensive geriatric assessment of physical, emotional, and cognitive functions, overall functional capacity, and social situation. The nutritional status was assessed by the nutritional risk assessment scale. This scale consists of items relating to gastrointestinal disorders, chronic diseases with pain, immobility, alterations in body weight, appetite, difficulties in eating, cognitive or emotional problems, medication, smoking and drinking habits, and social situation. The maximum score which indicates a high risk is 12. The scores from the nutritional risk assessment scale were compared with a physician's clinical judgement (patients being graded as "obese', "well-nourished', "undernourished') as the "gold standard' and with body mass index, other anthropometric findings, and serum albumin and prealbumin levels. The nutritional risk assessment scale was reliable (inter- and intrarater) and showed construct and concurrent validity. There was a significant correlation with clinical judgement (p < 0.01) and other parameters of nutritional status (p < 0.05). The scores of undernourished patients (n = 37; 5.35 +/- 1.60, range 3-8) were significantly different (p < 0.05) from those who were classified as well nourished (n = 63; 2.66 +/- 1.59, range 0-7) or obese (n = 26; 2.73 +/- 1.76, range 0-7). When implemented as part of a comprehensive geriatric assessment, this questionnaire can be completed within 5-10 min. The nutritional risk assessment scale is simple and reliable and helps in the identification of elderly patients at risk of poor nutrition.

Nutritional status was assessed in 300 geriatric patients aged 75 years or more using clinical, anthropometric, biochemical and immunologic methods. Relations between different assessment methods and their prognostic significance with regard to 18-month mortality were examined. For biochemical variables 10% (prealbumin, vitamin B6) to 37% (vitamins A and C) were below conventional limits. In 44% of the patients lymphocytes were diminished. 44% were anergic. Judgement of nutritional status by clinical impression resulted in 22% being deemed undernourished. Clinical diagnosis of undernutrition was associated with low anthropometric measurements (p less than 0.05 for all parameters) and a high prevalence of low biochemical values (p less than 0.05 for albumin, prealbumin, transferrin, vitamin A, vitamin B1). The mean values of all anthropometric variables, plasma proteins, vitamins A and C were significantly lower in patients who died within the following 18 months compared to survivors. The greatest prognostic significance was related to the clinical diagnosis of malnutrition. We conclude that clinical assessment is useful for the evaluation of nutritional status in geriatric patients and the best of numerous nutritional parameters to estimate risk of long-term mortality.

The effects of low fat diet and intensive physical exercise were examined in a randomized prospective study in patients with angiographically documented coronary heart disease. In addition to supervised regular physical exercise, patients of the intervention group (n = 18) were subjected to intensive dietary counselling with the aim of a low fat, low cholesterol diet to be maintained for at least 12 months. The control group (n = 27) received relevant advise only and usual care by private physicians. In the intervention group there was significant lowering of plasma triglycerides (202 +/- 82/141 +/- 74 mg/dl) and body weight (78.2 +/- 9.5/73.7 +/- 10.4 kg) while total and LDL cholesterol did not change significantly. There was a tendency for a rise of HDL-cholesterol (35.6 +/- 9.0/40.4 +/- 14.8 mg/dl, p = 0.07). According to 24-hour diet protocols there was a significant lowering of energy intake (2.298 +/- 697/1.602 +/- 758 kcal/day), of fat intake (111.7 +/- 44.4/52.0 +/- 23.9 g/day) and of intake of dietary cholesterol (402.8 +/- 186/161.3 +/- 100.3 mg/day) as well as of saturated fatty acids (42.5 +/- 20.4/14.3 +/- 8.1 g/day). Fatty acid composition of adipose tissue was not correlated with the patients' 24-hour dietary protocols. In the control group there were no changes of plasma lipids, body weight or diet composition according to 24-hour protocols after 1 year compared to data at the beginning of the study. There was, however, a marked correlation of adipose tissue composition and dietary information given by the patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Plasma phosphate (Pi) and several indices of Ca-Pi metabolism were measured in 129 randomly selected healthy female individuals of the general population, of whom 59 were on hormonal contraceptives and 70 were not. Fasting plasma Pi was significant (p less than 0.01) lower in those taking hormonal contraceptives (0.96 +/- 0.17 mmol/l) than in those not taking them (1.06 +/- 0.16). Those on hormonal contraceptives had identical age, body weight and UVcr. Systolic and diastolic blood pressure was higher in those on hormonal contraceptives, and there was an inverse relationship between blood pressure and plasma Pi. Between those on hormonal contraceptives and those not on them, no significant difference of urinary cAMP (non-hormone 4.69 +/- 1.48 nmol/l GF; hormone 4.43 +/- 1.18) or iPTH could be shown. The present study documents that hormonal contraceptives with estrogen (less than or equal to microgram/dl) decrease plasma Pi and urinary Ca in premenopausal nonosteoporotic women.

During 4 weeks, 40 obese subjects (body mass index 30-45 W/H2) were treated with a 300-kcal mixed diet alone or in combination with exercise training on a bicycle ergometer in a metabolic ward. Exercise had a minor effect on body weight, reflected by an additional fat loss of 1.7 kg (expected loss: 4.0 kg). Hyperinsulinemia was improved by diet and normalized by diet combined with exercise; a similar effect was observed regarding C-peptide levels. Plasma concentrations of epinephrine and norepinephrine decreased in both groups. At maximal work, norepinephrine levels were higher in the group with exercise. Free fatty acids and free glycerol increased at rest as well as during exercise in subjects on both regimens, the difference being more pronounced in the exercise group. Enhanced oxidation of fat was substantiated by lower respiratory quotients during endurance exercise. Working capacity increased and blood pressure decreased considerably as a consequence of physical training. It is concluded that exercise training in addition to a hypocaloric diet lowers body weight and body fat, although to a lower degree than expected. During and following bouts of exercise, fat mobilization and oxidation is enhanced, but these effects are probably counteracted at rest. On the other hand, the diet-induced deterioration of physical performance is overcompensated.

The effects of fasting or a 600-cal diet on biliary lipid composition were studied in 20 persons with overweight. With complete fasting for 20 days and a mean weight loss of 650 g/day, biliary cholesterol fell significantly from 10.1 to 6.9 mol% and the 'lithogenic index' from 1.0 to 0.7. Following fasting, the index, in 10 of the 11 patients, was in the normal range below 1.0. With a 600-cal diet, in agreement with findings by other authors, there was no significant change of individual bile lipids or of the lithogenic index. While it has been shown that lithogenicity increases up to 16 h of fasting, it obviously significantly decreases with continued fasting. Fasting, therefore, in addition to manipulation of dietary cholesterol and, possibly, fiber consumption, appears to be an effective method for rapid lowering of biliary cholesterol saturation.

10 patients with primary, endogenous hypertriglyceridemia (type IV hyperlipoproteinemia) underwent three different isocaloric dietary regimes of 10 days duration each. The diets contained either 30, 43 or 79% of calories as carbohydrate with 20% of calories from protein. Analyses of insulin, blood sugar and free fatty acids were conducted on the last day of each dietary period, at frequent intervals. There were no differences in either fasting or diurnal blood sugars with the different diets. Insulin levels were positively correlated with the amount of carbohydrate in the diet and there was an inverse correlation between the carbohydrate contents of the diets and circulating free fatty acid levels during waking hours. Since glucose tolerance is maintained, and diurnal plasma lipid levels are lowest with the low fat regime, such diets may be advantageously used for patients with endogenous hypertriglyceridemia.

The effect of typical fat-modified diets on serum lipids, lipoproteins and apolipoproteins, on the intravenous fat-tolerance test and on fecal sterol excretion were observed in a group of men living at home and compared to that of their normal diets. Two 4-week-long diet periods alternated with four periods of 6 weeks' duration during which the men followed their normal dietary habits and accustomed life-styles. According to a randomized cross-over design sunflower oil and corn oil were used as the main fat sources for the fat-modified diets. Both diets lowered total cholesterol considerably acting mainly on LDL cholesterol, without affecting plasma triglycerides significantly. Apolipoprotein A-I and A-II concentrations in serum remained constant, and clearance of triglyceride-rich lipoproteins, as measured by an intravenous fat-tolerance test (Intralipid test), was not significantly affected. While changes of all measured parameters pointed in the same direction, serum total and LDL cholesterol levels were significantly lower with corn oil than with the sunflower oil. Excretion of endogenous sterols (fecal sterol balance) was higher with the fat-modified than with the normal diet. This increase in sterol excretion closely corresponded to the extent of serum cholesterol lowering.

The composition of fasting gallbladder bile was investigated in a group of 14 healthy men both on their normal diets and on a low cholesterol diet containing less saturated and more polyunsaturated fat given twice for 4 weeks. These dietary changes caused a 21.6% reduction of total serum cholesterol levels. With the use of the fat-modified diet lithogenic indices of fasting gallbladder bile were not significantly changed despite increased relative concentrations of bile acids and decreased relative concentrations of phospholipids and cholesterol in bile. Thus, the experiment provided no evidence for an increased cholelithiasis risk in healthy men ingesting 'prudent diets'.