scholarly journals Dialysis or a Plant-Based Diet in Advanced CKD in Pregnancy? A Case Report and Critical Appraisal of the Literature

2019 ◽  
Vol 8 (1) ◽  
pp. 123 ◽  
Author(s):  
Rossella Attini ◽  
Benedetta Montersino ◽  
Filomena Leone ◽  
Fosca Minelli ◽  
Federica Fassio ◽  
...  
Keyword(s):  
Body Weight ◽  
Ideal Body Weight ◽  
Normal Weight ◽  
Favourable Effect ◽  
Dietary Management ◽  
Restricted Diet ◽  
Unilateral Renal Agenesis ◽  
Advanced Stages ◽  
Female Baby ◽  
Protein Restricted Diet

Pregnancy is increasingly reported in chronic kidney disease (CKD), reflecting higher awareness, improvements in materno-foetal care, and a more flexible attitude towards “allowing” pregnancy in the advanced stages of CKD. Success is not devoid of problems and an important grey area regards the indications for starting dialysis (by urea level, clinical picture, and residual glomerular filtration rate) and for dietary management. The present case may highlight the role of plant-based diets in dietary management in pregnant CKD women, aimed at retarding dialysis needs. The case. A 28-year-old woman, affected by glomerulocystic disease and unilateral renal agenesis, in stage-4 CKD, was referred at the 6th week of amenorrhea: she weighed 40 kg (BMI 16.3), was normotensive, had no sign of oedema, her serum creatinine was 2.73 mg/dL, blood urea nitrogen (BUN) 35 mg/dL, and proteinuria 200 mg/24 h. She had been on a moderately protein-restricted diet (about 0.8 g/kg/real body weight, 0.6 per ideal body weight) since childhood. Low-dose acetylsalicylate was added, and a first attempt to switch to a protein-restricted supplemented plant-based diet was made and soon stopped, as she did not tolerate ketoacid and aminoacid supplementation. At 22 weeks of pregnancy, creatinine was increased (3.17 mg/dL, BUN 42 mg/dL), dietary management was re-discussed and a plant-based non-supplemented diet was started. The diet was associated with a rapid decrease in serum urea and creatinine; this favourable effect was maintained up to the 33rd gestational week when a new rise in urea and creatinine was observed, together with signs of cholestasis. After induction, at 33 weeks + 6 days, she delivered a healthy female baby, adequate for gestational age (39th centile). Urea levels decreased after delivery, but increased again when the mother resumed her usual mixed-protein diet. At the child’s most recent follow-up visit (age 4 months), development was normal, with normal weight and height (50th–75th centile). In summary, the present case confirms that a moderate protein-restricted diet can be prescribed in pregnancies in advanced CKD without negatively influencing foetal growth, supporting the importance of choosing a plant-based protein source, and suggests focusing on the diet’s effects on microcirculation to explain these favourable results.

A universal formula based on cystatin C to perform individual dosing of carboplatin in normal weight, underweight, and obese patients

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 2527-2527
Author(s):  
E. Chatelut ◽  
A. Schmitt ◽  
A. Lansiaux ◽  
C. Bobin-Dubigeon ◽  
M. Etienne-Grimaldi ◽  
...  
Keyword(s):  
Body Weight ◽  
Lean Body Mass ◽  
Body Mass ◽  
Cystatin C ◽  
Ideal Body Weight ◽  
Normal Weight ◽  
Percentage Error ◽  
Pharmacokinetic Analysis ◽  
Obese Patients ◽  
Ideal Body

2527 Background: It has recently been shown that it is possible to improve the prediction of carboplatin clearance by adding plasma cystatin C level (cysC), an endogenous marker of glomerular filtration rate, to the other patient characteristics routinely used for carboplatin individual dosing, namely serum creatinine (Scr), body weight (BW), age, and sex. This multi-center pharmacokinetic study was performed to evaluate prospectively the benefit of using cysC for carboplatin individual dosing. Methods: The 357 patients included in the study were receiving carboplatin as part of established protocols. A population pharmacokinetic analysis was performed using the NONMEM program. Seven covariates were studied: Scr, cysC, age, sex, BW, ideal body weight, and lean body mass. Results: The best covariate equation was: carboplatin clearance (mL/min) = 105. (Scr/75)-0.433. (cysC/1.00)-0.290 . (BW/65)+0.547 . (age/56)-0.351 . 0.855sex, with Scr in μmol/L, cysC in mg/L, BW in kg, age in years, and sex = 0 for male. Using an alternative weight descriptor (ideal body weight or lean body mass) did not improve the prediction. This final covariate model was validated by bootstrap analysis. The bias (mean percentage error) and imprecision (mean absolute percentage error) were +2% and 15% respectively on the total population, and were of a similar magnitude in each of the three subgroups of patients defined according to their body mass index. Conclusions: For the first time, a unique formula is proposed for carboplatin individual dosing to patients which is shown to be equally valid for underweight, normal weight, and obese patients. No significant financial relationships to disclose.

Effects of Underfeeding and of Starvation on Thermoregulatory Responses to Cooling in Women

1989 ◽  
Vol 77 (3) ◽  
pp. 245-252 ◽  
Author(s):  
P. I. Mansell ◽  
I. A. Macdonald
Keyword(s):  
Body Weight ◽  
Central Body ◽  
Ideal Body Weight ◽  
Young Female ◽  
Normal Weight ◽  
Fed State ◽  
Young Females ◽  
Thermoregulatory Responses ◽  
Ideal Body ◽  
Thermogenic Response

1. The effects of acute alterations in energy intake on the thermoregulatory responses to a cooling stimulus were studied in healthy, normal weight, young female subjects. On separate occasions, seven subjects were underfed for 7 days at 60 kJ day−1 kg−1 ideal body weight and six subjects were starved for 48 h. The cooling stimulus was provided by a coverall perfused with water at 16°C. 2. After the application of the cooling stimulus, central body (auditory canal) temperature rose initially in both studies. After underfeeding, the magnitude of this rise in temperature was not significantly different from that seen in the normally fed state. After 48 h starvation, the rise in temperature on cooling was reduced from 0.30 (sem 0.03) to 0.10 (0.04)°C (P < 0.01). In two subjects in whom central body temperature had been maintained in the normally fed state, a fall occurred after starvation. 3. Underfeeding for 7 days did not affect thermogenesis or the degree of vasoconstriction in the forearm or hand in response to cooling. 4. After 48 h starvation, the thermogenic response to cooling was abolished and blood flow in the forearm remained higher than in the normally fed state. 5. In normal weight young females, thermoregulatory responses to a cooling stimulus were therefore substantially affected by 48 h starvation but not by 7 days underfeeding.

The Impact of Obesity and Disease on Busulfan Oral Clearance in Adults

Blood ◽  
1999 ◽  
Vol 93 (12) ◽  
pp. 4436-4440
Author(s):  
John P. Gibbs ◽  
Ted Gooley ◽  
Bruce Corneau ◽  
Georgia Murray ◽  
Patricia Stewart ◽  
...  
Keyword(s):  
Body Weight ◽  
Ideal Body Weight ◽  
Normal Weight ◽  
Myelogenous Leukemia ◽  
Obese Patients ◽  
Oral Clearance ◽  
Plasma Level Monitoring ◽  
Ideal Body ◽  
The Impact ◽  
Level Monitoring

The apparent oral clearance (CL/F, mL/min) of busulfan was measured in 279 adolescent and adult patients. Significant (P< .05) determinants of CL/F by linear regression were: actual body weight (BW; r2 = 0.300), body surface area (BSA; r2 = 0.277), adjusted ideal body weight (AIBW; r2 = 0.265), and ideal body weight (IBW; r2= 0.173); whereas body mass index (BMI), height, age, gender, and disease were less important predictors. CL/F (mL/min) for normal weight patients (BMI, 18 to 27 kg/m2) was 16.2% lower (P< .001) than for obese patients (BMI, 27 to 35 kg/m2). Thus, expressing CL/F relative to BW did not eliminate statistically significant differences between normal and obese patients. However, busulfan CL/F expressed relative to BSA (110 ± 24 v 110 ± 24 mL/min/m2, P = 1.0) or AIBW (3.04 ± 0.65 v 3.19 ± 0.67 mL/min/kg, P = .597) were similar in normal and obese patients. Non-Hodgkin’s lymphoma patients (n = 10) had approximately 32% lower mean busulfan CL/F expressed relative to BW, BSA, or AIBW compared with patients with chronic myelogenous leukemia (n = 73). Routine dosing on the basis of BSA or AIBW in adults and adolescents does not require a specific accommodation for the obese. However, dosing based on BSA may be improved by considering CL/F differences in certain diseases. Adjusting dose for body size or disease does not diminish interpatient variability sufficiently to obviate plasma level monitoring in many indications.

Estimation of Creatinine Clearance in Patients with Cushing's Syndrome

DICP ◽  
1989 ◽  
Vol 23 (12) ◽  
pp. 974-977 ◽  
Author(s):  
Jimmi Hatton ◽  
Michael D. Parr ◽  
Robert A. Blouin
Keyword(s):  
Body Weight ◽  
Creatinine Clearance ◽  
Cushing’S Syndrome ◽  
Ideal Body Weight ◽  
Total Body Weight ◽  
Cushing's Syndrome ◽  
Normal Weight ◽  
Poor Correlation ◽  
Obese Patients ◽  
Total Body

The predictive value of the Cockcroft-Gault equation in patients with Cushing's syndrome was evaluated in 23 patients. Patients were subdivided based on total body weight into two groups, obese and nonobese. Estimated creatinine clearance (EC1cr) values were obtained by the Cockcroft-Gault method using ideal body weight (IBW) and total body weight (TBW). These values were then compared with a 24-hour measured creatinine clearance (MClcr). EClcr values based on TBW consistently overestimated measured values in all patients (p<0.05). In obese patients with Cushing's syndrome IBW predictions were not statistically different. However, linear regresson analysis revealed a poor correlation (r=0.32). Daily creatinine production rates (Ucr) were calculated and contrasted with an appropriate historical control for obese and nonobese subjects. Nonobese patients revealed a marked reduction in total Ucr compared with normal-weight controls (p<0.05). Obese patients also showed a reduction in Ucr when compared with a normal obese control population (p<0.05). Difficulty in predicting creatinine clearance in patients with Cushing's syndrome appears to be related to alterations in Ucr. These data suggest that the pathophysiologic changes that accompany Cushing's syndrome are sufficient to alter Ucr and may limit the usefulness of existing methods to predict creatinine clearance and renal function in these patients.

scholarly journals Prospective, Controlled Study of Acyclovir Pharmacokinetics in Obese Patients

2016 ◽  
Vol 60 (3) ◽  
pp. 1830-1833 ◽  
Author(s):  
R. Brigg Turner ◽  
Aaron Cumpston ◽  
Michael Sweet ◽  
Frank Briggs ◽  
Douglas Slain ◽  
...  
Keyword(s):  
Body Weight ◽  
Single Dose ◽  
Plasma Concentrations ◽  
Systemic Exposure ◽  
Ideal Body Weight ◽  
Normal Weight ◽  
Controlled Study ◽  
Pharmacokinetic Analysis ◽  
Obese Patients ◽  
Time Curve

The current recommendations for intravenous (i.v.) acyclovir dosing in obese patients suggest using ideal body weight (IBW) rather than total body weight (TBW). To our knowledge, no pharmacokinetic analysis has validated this recommendation. This single-dose pharmacokinetic study was conducted in an inpatient oncology population. Enrollment was conducted by 1:1 matching of obese patients (>190% of IBW) to normal-weight patients (80 to 120% of IBW). All patients received a single dose of i.v. acyclovir, 5 mg/kg, infused over 60 min. Consistent with current recommendations, IBW was used for obese patients and TBW for normal-weight patients. Serial plasma concentrations were obtained and compared. Seven obese and seven normal-weight patients were enrolled, with mean body mass indexes of 45.0 and 22.5 kg/m2, respectively. Systemic clearance was substantially higher in the obese than normal-weight patients (mean, 19.4 ± 5.3 versus 14.3 ± 5.4 liters/h;P= 0.047). Area under the concentration-time curve was lower in the obese patients (15.2 ± 2.9 versus 24.0 ± 9.4 mg · h/liter;P= 0.011), as was maximum concentration (5.8 ± 0.9 versus 8.2 ± 1.3 mg/liter;P= 0.031). Utilization of IBW for dose calculation of i.v. acyclovir in obese patients leads to lower systemic exposure than dosing by TBW in normal-weight patients. While not directly evaluated in this study, utilization of an adjusted body weight for dose determination appears to more closely approximate the exposure seen in normal-weight patients. (This study has been registered at ClinicalTrials.gov under registration no. NCT01714180.)

scholarly journals BMI Helps to Calculate the Initial Levothyroxine Dose After Total Thyroidectomy

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A825-A825
Author(s):  
Sara Correia ◽  
Lucia Santos Almeida ◽  
José Diogo Silva ◽  
Patrícia Tavares ◽  
Gustavo Rocha ◽  
...  
Keyword(s):  
Body Weight ◽  
Total Thyroidectomy ◽  
Ideal Body Weight ◽  
Female Gender ◽  
Volume Of Distribution ◽  
Normal Weight ◽  
Obese Patients ◽  
Actual Weight ◽  
A Value ◽  
Multidisciplinary Consultation

Abstract After total thyroidectomy, an initial dose of levothyroxine is often prescribed based on the patient’s body weight (1.6 mcg / kg / day), regardless of body mass index (BMI). The current literature required that hormone maintenance therapy (THR) in obese patients differs from non-obese patients. Review of the clinical processes of patients with papillary carcinoma followed in the multidisciplinary consultation of Endocrine Pathology at CHVNG / E followed a total thyroidectomy from 2015 to 2017. Patients who achieved euthyroidism with THR were included in the analysis and divided according with BMI. Statistical analysis was performed using SPSS version 25.0. A value of p &lt;0.05 was considered statistically significant. The sample included 82 patients, 90.2% (n = 74) female and 9.8% (n = 8) male, with an average age of 53.02 ± 14.27 years. Of the female gender, 52.4% (n = 43) were in menopause. In the postoperative period, 14 patients (17.1%) had a normal BMI, 46 (50%) were overweight and 22 (32.9%) were obese. The average follow-up time was 75.3 months (32-128). A dose of LT4 required to achieve euthyroidism based on the BMI categories mentioned above was 1.70; 1.54 and 1.49 mcg / kg. Patients with a higher BMI needed a higher dose of LT4 to achieve euthyroidism (p &lt;0.05), but the dose was lower in relation to weight (mcg / kg) (p &lt;0.05). There were no differences related to age and need for L-T4 suplementation (p&gt; 0.05). Our study shows that de calculation of the initial levothyroxine dose should also take into account BMI. Overweight and obese individuals should receive a lower dose than that used in normal weight patients, which goes against what has been described in the literature. The weight-based formula, unlike BMI, does not account for the volume of distribution of L-T4 well. Other methods, which include, for example, ideal body weight instead of actual weight, are being developed to help choose the starting levothyroxine dose.

Fear of Obesity Among Adolescent Girls

PEDIATRICS ◽  
1989 ◽  
Vol 83 (3) ◽  
pp. 393-398
Author(s):  
Nancy Moses ◽  
Mansour-Max Banilivy ◽  
Fima Lifshitz
Keyword(s):  
High School ◽  
Body Weight ◽  
High School Students ◽  
Adolescent Girls ◽  
Eating Behaviors ◽  
Ideal Body Weight ◽  
Nutrition Knowledge ◽  
Normal Weight ◽  
School Students ◽  
Ideal Body

The perceptions concerning weight, dieting practices, and nutrition of 326 adolescent girls attending an upper middle-class parochial high school were studied in relation to their body weight. Underweight or overweight students were those with greater than 10% body weight differential for height. The high school students reported an exaggerated concern with obesity regardless of their body weight or nutrition knowledge. Underweight, normal weight, and overweight girls were dieting to lose weight and reported frequent self-weighing practices. As many as 51% (n = 60) of the underweight adolescents described themselves as extremely fearful of being overweight and 36% (n = 43) were preoccupied with body fat. A distorted perception of ideal body weight was documented, particularly among the underweight students; the greater the underestimation of perceived ideal body weight, the greater the actual deficit in ideal body weight for height of the students (r = .73; P &lt; .001). Normal weight and overweight girls had better concordance between their actual and perceived ideal body weight for height. The frequency of bingeing and vomiting behaviors was similar among the three weight categories. The data suggest that fear of obesity and inappropriate eating behaviors are pervasive among adolescent girls regardless of body weight or nutrition knowledge.

scholarly journals Prevalence of Obesity and Body Weight Perception among Pregnant Women

2020 ◽  
Vol 15 (2) ◽  
pp. 17-25
Author(s):  
Rachael Shamini Danasamy ◽  
Keyword(s):  
Body Weight ◽  
Pregnant Women ◽  
Weight Status ◽  
Weight Perception ◽  
Ideal Body Weight ◽  
Normal Weight ◽  
Weight Category ◽  
Prevalence Of Obesity ◽  
Normal Body Weight ◽  
Body Weight Perception

Obesity is rapidly increasing worldwide and there is a general misconception regarding body weight perception. The aim of this study was to determine the prevalence of obesity and body weight perception among pregnant women. A total of 315 pregnant women participated in this study. Their Body Mass Index (BMI) was recorded and weight perception was assessed using a questionnaire. About two third (60.6%, n=191) participants in the study had excess weight out of which, 29.8% (n=94) were obese and 30.8% (n=97) were overweight. There was poor agreement between participant’s true body weight category and their perception (k=0.185 (95% CI, 0.119 to 0.258), p<0.001). Majority of participants who were obese (84%, n=79) and overweight (77.4%, n=75) underestimated their weight status. Only a very small percentage of obese (16%, n=15) and overweight 18.6% (n=18) participants had correct perception of their weight. However, the majority (84.3%, n=86) of participants with normal body weight had correct perception regarding their body weight. This study found that most obese and overweight women tend to underestimate their weight status while those of normal weight had correct perception of their body weight. The inaccurate perception of those who are obese and overweight may impact weight gain during pregnancy and affect pregnancy related complications. Education regarding ideal body weight and its benefits needs to be instilled during pre-pregnancy care to achieve better overall outcome.

The Impact of Obesity and Disease on Busulfan Oral Clearance in Adults

Blood ◽  
1999 ◽  
Vol 93 (12) ◽  
pp. 4436-4440 ◽  
Author(s):  
John P. Gibbs ◽  
Ted Gooley ◽  
Bruce Corneau ◽  
Georgia Murray ◽  
Patricia Stewart ◽  
...  
Keyword(s):  
Body Weight ◽  
Ideal Body Weight ◽  
Normal Weight ◽  
Myelogenous Leukemia ◽  
Obese Patients ◽  
Oral Clearance ◽  
Plasma Level Monitoring ◽  
Ideal Body ◽  
The Impact ◽  
Level Monitoring

Abstract The apparent oral clearance (CL/F, mL/min) of busulfan was measured in 279 adolescent and adult patients. Significant (P&lt; .05) determinants of CL/F by linear regression were: actual body weight (BW; r2 = 0.300), body surface area (BSA; r2 = 0.277), adjusted ideal body weight (AIBW; r2 = 0.265), and ideal body weight (IBW; r2= 0.173); whereas body mass index (BMI), height, age, gender, and disease were less important predictors. CL/F (mL/min) for normal weight patients (BMI, 18 to 27 kg/m2) was 16.2% lower (P&lt; .001) than for obese patients (BMI, 27 to 35 kg/m2). Thus, expressing CL/F relative to BW did not eliminate statistically significant differences between normal and obese patients. However, busulfan CL/F expressed relative to BSA (110 ± 24 v 110 ± 24 mL/min/m2, P = 1.0) or AIBW (3.04 ± 0.65 v 3.19 ± 0.67 mL/min/kg, P = .597) were similar in normal and obese patients. Non-Hodgkin’s lymphoma patients (n = 10) had approximately 32% lower mean busulfan CL/F expressed relative to BW, BSA, or AIBW compared with patients with chronic myelogenous leukemia (n = 73). Routine dosing on the basis of BSA or AIBW in adults and adolescents does not require a specific accommodation for the obese. However, dosing based on BSA may be improved by considering CL/F differences in certain diseases. Adjusting dose for body size or disease does not diminish interpatient variability sufficiently to obviate plasma level monitoring in many indications.

scholarly journals Effects of a protein‐restricted diet on body weight and serum tyrosine concentrations in patients with alkaptonuria

JIMD Reports ◽  
2021 ◽  
Author(s):  
Birgitta Olsson ◽  
Lakshminarayan Ranganath ◽  
Jean‐Baptiste Arnoux ◽  
Richard Imrich ◽  
Anna Milan ◽  
...  
Keyword(s):  
Body Weight ◽  
Restricted Diet ◽  
Protein Restricted Diet
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