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Context: Repletion of lean body mass (LBM) that patients lose in human immunodeficiency virus (HIV) infection has proved difficult. In healthy, HIV-seronegative men, synergy between progressive resistance exercise (PRE) and very high-dose testosterone therapy has been reported for gains in LBM and muscle strength.Objective: To determine whether a moderately supraphysiologic androgen regimen, including an anabolic steroid, would improve LBM and strength gains of PRE in HIV-infected men with prior weight loss and whether protease inhibitor antiretroviral therapy prevents lean tissue anabolism.Design: Double-blind, randomized, placebo-controlled trial; post hoc analysis for effect of HIV-protease inhibitor therapy conducted from January to October 1997.Setting: Referral center in San Francisco, Calif.Patients: Volunteer sample of 24 eugonadal men with HIV-associated weight loss (mean, 9% body weight loss), recruited from an AIDS clinic and by referral and by advertisement.Intervention: For 8 weeks, all subjects received supervised PRE with physiologic intramuscular testosterone replacement (100 mg/wk) to suppress endogenous testosterone production. Randomization was between an anabolic steroid, oxandrolone, 20 mg/d, and placebo.Main Outcome Measures: Lean body mass, nitrogen balance (10-day metabolic ward measurements), body weight, muscle strength, and androgen status.Results: Twenty-two subjects completed the study (1 1 per group). Both groups showed significant nitrogen retention and increases in LBM, weight, and strength. The mean (SD) gains were significantly greater in the oxandrolone group than in the placebo group (5.6 [2.1] vs 3.8 [1.8] g of nitrogen per day [P=.05]; 6.9 [1.7] vs 3.8 [2.9] kg of LBM [P=.005]; greater strength gains for various upper and lower body muscle groups by maximum weight lifted [P = .02-.05] and dynamometry [P = .01 -.05]). The mean (SD) high-density lipoprotein cholesterol level declined 0.25 (0.14) mmol/L (9.8 [5.4] mg/dL) significantly in the oxandrolone group (P < .001 compared with placebo). Results were similar whether or not patients were taking protease inhibitors. One subject in the oxandrolone group discontinued the study because of elevated liver function test results.Conclusions: A moderately supraphysiologic androgen regimen that included an anabolic steroid, oxandrolone, substantially increased the lean tissue accrual and strength gains from PRE, compared with physiologic testosterone replacement alone, in eugonadal men with HIV-associated weight loss. Protease inhibitors did not prevent lean tissue anabolism. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to assess the efficacy of a single prophylactic dose of amoxicillin and/or dexamethasone in preventing postoperative complications (PC) after a surgical removal of a single mandibular third molar (M3)., Methods: This study is a randomized, placebo controlled clinical trial. Four groups were included: Group 1 (G1) included a prophylactic dose of 2 g of amoxicillin and 8 mg of dexamethasone; Group 2 (G2) included a prophylactic dose of 2 g of amoxicillin and 8 mg of placebo; Group 3 (G3) included a prophylactic dose of 8 mg of dexamethasone and 2 g of placebo and; Group 4 (G4) placebo., Results: Fifty patients were included. It was observed one case of alveolar infection (2%) and two of alveolar osteitis (4%) resulting in three PC (6%). No statistical differences were observed between therapeutic groups for development of PC, trismus, pain and edema. The use of antibiotics showed an absolute risk reduction (ARR) for PC development of 3.52% and the number needed to treat (NNT) was 29., Conclusion: Prophylactic antibiotics and corticoid in a single dose regimen did not bring any benefit on M3 surgeries.

Objective: To investigate whether smoking has adverse effects in simple exodontia., Methods: A single-centre, prospective study of postoperative inflammatory complications in simple exodontia was performed. All procedures were conducted under similar and sterile conditions. Postoperative complications (PCs) in exodontia were classified as alveolar osteitis (AO) or alveolar infection (AI) and their incidences then added., Results: A logistic regression model for PCs revealed tooth sectioning [odds ratio (OR) = 4.3, 95% confidence interval (CI) 1.0-18.8; P = 0.050], smoking (OR = 4.5, 95% CI 1.0-18.9; P = 0.03) and amount of smoking (> 20 cigarettes/day: OR = 12.3, 95% CI 1.0-149.8; P = 0.04) to be associated with the occurrence of PCs., Conclusions: Tooth sectioning, smoking and degree of smoking are all associated with the development of PCs such as AO and AI after simple exodontia. Dentists must be alert to these factors when performing simple exodontia in smokers in view of the increased risk for PCs., (© 2012 FDI World Dental Federation.)

Serum testosterone concentrations are frequently in the low-normal range (lowest quartile, <500 ng/dl) in men with AIDS-wasting syndrome (AWS) and in other chronic wasting disorders. The response of patients in this group to androgen treatment has not been determined, however. Eighteen men with AWS (mean +/- standard error [SE]: 87% +/- 1% usual body weight; CD4 count 90 +/- 24) and borderline low serum testosterone concentrations (382 +/- 33 ng/dl) completed a 21-day placebo-controlled inpatient metabolic ward study comparing intramuscular (i.m.) placebo (n = 7) with low-dose (65 mg/week; n = 4) and high-dose (200 mg/week; n = 7) nandrolone decanoate, a testosterone analogue. Nitrogen balance, stable isotope-mass spectrometric measurement of de novo lipogenesis (DNL), resting energy expenditure, and gonadal hormone levels were measured. Both low-dose and high-dose nandrolone resulted in significant nitrogen retention (33-52 g nitrogen/14 days, representing gains of 0.5 to 0.9 kg lean tissue/week) compared with placebo (loss of 11 g nitrogen/week). This was reflected biochemically in a borderline significant reduction of high DNL (p < .06). Serum testosterone and gonadotropins were suppressed whereas resting energy expenditure was unchanged by nandrolone treatment. In 10 study subjects completing a 12-week open-label follow-up phase, body weight increased by 4.9 +/- 1.2 kg, including 3.1 +/- 0.5 kg lean body mass, and treadmill exercise performance also improved. In summary, nandrolone decanoate therapy in the absence of an exercise program in borderline hypogonadal men with AWS caused substantial nitrogen retention compared with placebo, similar in extent to the nitrogen retention previously achieved with recombinant growth hormone. It is reasonable to expand the criteria for androgen treatment in AWS to include at least patients in the lowest quartile of serum testosterone.

Studies of body-composition changes during weight loss have had conflicting results with regard to changes in bone mineral content (BMC) and bone mineral density (BMD). We examined BMC and BMD for changes during weight loss. Fourteen women enrolled in a 15-wk weight loss program. Dual-energy X-ray absorptiometry (DXA) measures of the total body were made at baseline (T1), the midpoint of weight loss (T2), and at the end of weight loss (T3). Body weight changed significantly throughout the 15 wk, declining from a high of 89.7+/-3.6 to 74.1+/-3.2 kg. Fat-free mass declined initially (47.8+/-1.7 kg at T1, 45.7+/-1.4 kg at T2, and 46.0+/-1.5 kg at T3) and then stabilized. Fat mass changed significantly during the study (39.2 kg at T1, 32.4 kg at T2, and 29.3 kg at T3). No significant differences were observed in BMC or bone areal measurement during the study. However, BMD declined significantly from baseline (1.217 g/cm2 at T1, 1.197 g/cm2 at T2, and 1.200 g/cm2 at T3). The changes in BMC and BA were in opposite directions, resulting in a significant decline in BMD without a loss of BMC. These data suggest that changes in BMD observed with weight loss may be the result of a lack of instrument sensitivity when body weight and composition change and are simply an artifact and not a physiologic change in BMD. Further research is needed to determine the full effect of weight loss on BMC, bone area, and BMD.

The purpose of this study was to determine whether meal ingestion pattern [large morning meals (AM) vs. large evening meals (PM)] affects changes in body weight, body composition or energy utilization during weight loss. Ten women completed a metabolic ward study of 3-wk weight stabilization followed by 12 wk of weight loss with a moderately energy restricted diet [mean energy intake +/- SD = 107 +/- 6 kJ/(kg.d)] and regular exercise. The weight loss phase was divided into two 6-wk periods. During period 1, 70% of daily energy intake was taken as two meals in the AM (n = 4) or in the PM (n = 6). Subjects crossed over to the alternate meal time in period 2. Both weight loss and fat-free mass loss were greater with the AM than the PM meal pattern: 3.90 +/- 0.19 vs. 3.27 +/- 0.26 kg/6 wk, P < 0.05, and 1.28 +/- 0.14 vs. 0.25 +/- 0.16 kg/6 wk, P < 0.001, respectively. Change in fat mass and loss of body energy were affected by order of meal pattern ingestion. The PM pattern resulted in greater loss of fat mass in period 1 (P < 0.01) but not in period 2. Likewise, resting mid-afternoon fat oxidation rate was higher with the PM pattern in period 1 (P < 0.05) but not in period 2, corresponding with the fat mass changes. To conclude, ingestion of larger AM meals resulted in slightly greater weight loss, but ingestion of larger PM meals resulted in better maintenance of fat-free mass. Thus, incorporation of larger PM meals in a weight loss regimen may be important in minimizing the loss of fat-free mass.

Energy expenditure (EE) was measured at specific steady-state work rates to determine if body fat percentage or gender was associated with exercise EE, substrate oxidation, or work efficiency. Body fat percentage (leaner vs. fatter men, 9-15% vs. 20-25% fat; leaner vs. fatter women, 16-24% vs. 32-48% fat) was not related to work efficiency or submaximal EE. Fatness affected substrate oxidation in men but not in women. Compared to fatter men, leaner men had higher fat oxidation (6.7 +/- 1.6 vs. 1.4 +/- 2.0 mg.kg fat-free mass [FFM]-1.min-1; p < .01) and lower carbohydrate oxidation (26.6 +/- 4.2 vs. 39.3 +/- 5.0 mg.kg FFM-1.min-1; p < .01) at 60% VO2max. When men and women of similar fatness and relative aerobic capacity were compared, men had higher EE measured as kilojoules per minute but similar rates of EE and substrate oxidation per kilogram of FFM at 40-60% VO2max. It was concluded that body FFM, not fatness, is a determinant of exercise EE, whereas fatness is associated with differences in exercise substrate oxidation in men. Along with aerobic fitness, gender and fatness should be considered in future studies of exercise substrate oxidation.

Self-selected food intake of 15 reduced-obese women living in a metabolic ward was studied for 14 consecutive days to determine the effect of exercise and other metabolic and behavioral variables on energy intake. A choice of prepared food items were offered at breakfast, lunch and dinner, and a variety of additional food items were available continuously 24 h/day. Subjects performed either moderate intensity aerobic exercise (A-EX) (n = 8) expending 354 +/- 76 kcal/session or low intensity resistance weight training (R-EX)(n =7) expending 96 +/- kcal/session, 5 days/week. Mean energy intakes (kcal/day, +/- SEM) of the exercise groups were similar: 1867 +/- 275 for A-EX, 1889 +/- 294 for R-EX. Mean energy intakes of individuals ranged from 49 to 157% of the predetermined level required for weight maintenance. Resting metabolic rate per kg 0.75 and the Eating Inventory hunger score contributed significantly to the between subject variance in energy intake, whereas exercise energy expenditure did not. Regardless of exercise, eight women consistently restricted their energy intake (undereaters), and seven other consumed excess energy (overeaters). Overeaters were distinguished by higher Eating Inventory disinhibition (P = 0.023) and hunger (p = 0.004) scores. The overeaters' diet had a higher fat content 34 +/- 1% (p = 0.007). Also, overeaters took a larger percentage of their daily energy, than that of undereaters, 27 +/- 1 energy intake in the evening, 13 +/- 2%, compared to undereaters, 7 +/- 1% (p = 0.005). We conclude that the Eating Inventory is useful for identifying reduced-obese women at risk of overeating, and these individuals may benefit from dietary counseling aimed at reducing fat intake and evening snacking.

The effect of consuming a low carotene diet (approximately 60 micrograms carotene/day) on oxidative susceptibility and superoxide dismutase (SOD) activity in women living in a metabolic research unit was evaluated. The diet had sufficient vitamins A, E, and C. The women ate the diet supplemented with 1500 micrograms/day beta-carotene for 4 days (baseline), then the unsupplemented diet for 68 days (depletion), followed by the diet supplemented with > 15,000 micrograms/day carotene for 28 days (repletion). Production of hexanal, pentanal, and pentane by copper-oxidized plasma low density lipoproteins from carotene-depleted women was greater than their production of these compounds when repleted with carotene. Erythrocyte SOD activity was depressed in carotene-depleted women; it recovered with repletion. Thiobarbituric acid reactive substances in plasma of carotene-depleted women were elevated and diminished with repletion. Dietary carotene seems to be needed, not only as a precursor of vitamin A, but also to inhibit oxidative damage and decrease oxidation susceptibility.

Objective: The objective of this study was to evaluate the effects of endurance exercise on fat-free mass and nitrogen balance, with energy restriction or with energy intake to meet non-exercise needs in obese women., Design: The study was a 14-week metabolic control study with a 2-week baseline period for dietary stabilization followed by a 12-week period of exercise (E) with or without energy restriction (D), E or D+E., Setting: Metabolic research unit of the Western Human Nutrition Research Center., Subjects: Ten obese women between the ages of 19 and 37 years volunteered as subjects. Body weight ranged from 19% to 41% IBW and body fat was 31-40% of body weight., Intervention: Women were assigned to either an energy-restricted or energy-'adequate' group so that group means for weight, body fat, FFM, predicted VO2max and RMR were similar. Data were polled for the 2-week baseline period and in 3-week intervals during the intervention period., Results: The data indicated that E had a slower rate of weight loss and a lower loss of FFM than D+E. Nitrogen balance was more positive in E than D+E. Negative N balance occurred in the D+E group when blood was drawn. There was no decrease in N excretion to compensate for blood losses. N balance for E was positive throughout the study., Conclusion: Changes in FFM, assessed by total body electrical conductivity, were different from the results obtained by classic nitrogen balance. This suggests that losses were due to fluid losses, which were confirmed by deuterium dilution procedures. This study demonstrated that body protein stores remained intact during periods of increased energy expenditure and dietary restriction in obese women.

Substrate and hormone responses to submaximal exercise were studied in 10 overweight women (119-141% ideal body weight) to learn if a moderately restricted diet would influence the responses. Subjects consumed diets with adequate energy (ADEX), N = 5, or low energy (LDEX)--50% reduction in energy, N = 5. Three times during the 12-wk study, blood was drawn before and immediately following exercise; results were combined since there were no differences between replicates. Postexercise free fatty acids and glycerol increased to 465 +/- 27 mg.l-1 in LDEX but only to 245 +/- 19 mg.l-1 in ADEX. Postexercise insulin increased to 129 +/- 13 pmol.l-1 in LDEX, but did not increase in ADEX. Postexercise growth hormone increased to 10.5 +/- 1.0 microgram.l-1 in ADEX but only to 6.6 +/- 1.0 microgram.l-1 in LDEX. All postexercise increases within diet groups were highly significant (P < 0.0001), and the postexercise responses between diet groups were also different (P < 0.01). Respiratory gas exchange indicated that both groups increased fat utilization during exercise, but diet restriction altered postexercise hormones so that fat mobilization and utilization might be inhibited. The postexercise recovery period should be studied further to determine whether diet restriction results in a sustained altered hormone pattern that would curtail lipolysis and possibly limit body fat loss.

During a weight loss study conducted on a metabolic unit, five women lost an average of 8.7 +/- 0.7 kg of body fat mass (FM) with a 12 week treatment of low energy diet plus exercise. Another group of five women lost 4.4 +/- 0.7 kg FM with a 12 week treatment of an adequate diet plus exercise. Within each treatment, the amount of FM lost varied by approximately 2-fold. To explain the variability in FM loss, we tested its association by multiple regression analysis with several physiological and biochemical measurements obtained during a 2 week stabilization period or early in the treatment period. The variable most closely correlated with FM loss was plasma free fatty acid levels following exercise (EX-FFA). This variable alone accounted for 79 percent of the variation in FM loss. EX-FFA was simple to measure and was repeatedly correlated with FM loss, whether FFA values of the first exercise test or EX-FFA values obtained later in the experimental period were used. Of the physiological variables tested, the rate of fat calories expended in response to a test meal was correlated with FM loss and accounted for 71 percent of the variation. Upon subsequent testing, however, this relationship was not repeatable. When a treatment group designation (dummy-coded variable) was added to the regression analysis, the rate of fat calories expended at rest (FATRMR) was related to FM loss. Together, FATRMR and the dummy-coded variable accounted for 87 percent of the variation in FM loss. In a separate multiple regression equation, the combination of EX-FFA and the dummy-coded variable also accounted for 87 percent of the variation in FM loss. Further evaluation of these relationships is required to determine if EX-FFA or FATRMR would be useful as predictors of FM loss under conditions of weight loss where individuals are living freely in the community and consuming a variety of diets.

The metabolic effects of exercise training and the influence of a moderate calorie restriction on the training response were examined in overweight women. Ten healthy women, 119% to 141% of desirable weight, completed the 14-week study. After a 2-week stabilization period, in which diets were designed to maintain body weight (BW), five women were assigned to a 12-week experimental program of diet and exercise (D + EX) that included a 50% reduction in energy intake and a program of moderate intensity aerobic exercise 6 days per week. The other five women were assigned to the same daily exercise (EX) and continued to consume the stabilization diet. Periodic measurements of resting metabolic rate (RMR), thermic effect of food (TEF), energy cost of exercise, and predicted maximal aerobic capacity (VO2 max) were obtained, and the respiratory quotient (RQ) was determined during rest and exercise. Body composition was monitored weekly. Tests of strength and anaerobic capacity were conducted. D + EX lost an average of approximately 1.1 kg/wk, which was 67% fat, 33% lean. EX lost approximately 0.5 kg/wk, which was 86% fat, 14% lean. In both groups, the exercise program resulted in an 11% to 13% improvement in VO2 max and an 8% to 16% decrease in energy expenditure at submaximal workloads. The caloric restriction significantly increased fat utilization during exercise. The RMR declined 9% in D + EX, from 1,550 to 1,411 kcal/d, whereas it was maintained in EX, 1,608 to 1,626 kcal/d. The decrease in RMR observed in D + EX was consistent with the loss of fat-free mass (FFM).(ABSTRACT TRUNCATED AT 250 WORDS)

Twelve moderately overweight women with mild obesity were studied to determine the effect of exercise on nutrient intake and body composition. The women, 16 to 42 percent above desired body weight (BW) and 30 to 41 percent body fat, rotated through three 18-day treatment periods: no exercise (NO-EX), moderate duration exercise (M-EX), and long duration exercise (L-EX). Daily exercise was prescribed to increase energy expenditure by 12.5 (M-EX) or 25 percent (L-EX) of energy intake required for BW maintenance during baseline. Diets were self-selected from a variety of conventional foods, and intake was monitored. Exercise did not affect quantity of energy intake or macronutrient composition of diets during the treatment periods. Energy and carbohydrate intakes tended to be higher in response to M-EX and L-EX compared to NO-EX during the last 5-day interval of the treatment periods, but these trends were not statistically significant. Exercise did affect BW and fat-free mass (FFM); mean FFM values were 49.3, 49.7 and 50.8 kg at the end of NO-EX, M-EX and L-EX, respectively (P = 0.017). Body fat mass (FM) was not consistently affected by exercise. It appears that exercise affects FFM but has no consistent effect on nutrient intake in mildly obese women who are choosing food intake from a variety of foods.