Abstract14C‐methylscopolamine (15 mg) and the nonabsorbable marker polyethylene glycol (PEG) have been given orally to six healthy subjects who had received oral doses of 10–25 mg of the drug for 10–14 days prior to the experiments. With this treatment the subjects experienced dryness in the mouth. Compared to untreated subjects studied previously in the same way, the passage of PEG through the small intestine appeared to be retarded. The absorption of the labelled compound—as evidenced by the concentration of radioactivity per unit marker in gastrointestinal aspirates, the blood levels, and the urinary, faecal and biliary excretion of label—was the same whether the subjects were pretreated with methyl‐scopolamine or not.

PURPOSE:To assess the impact of protein-energy malnutrition (PEM) on mortality and the long-term variations in the nutritional status of subjects admitted as emergency cases in a 9-month prospective follow-up study. PATIENTS AND METHODS:The study comprised 205 patients without cancer aged 75 years (+/- 1). Malnourished subjects were identified as having at least three nutritional variables (which included weight index, triceps skinfold thickness, arm muscle circumference, serum albumin, and delayed cutaneous hypersensitivity reaction) below the reference range. RESULTS:The mortality was 44% in the 41 malnourished patients and 18% in the 164 nonmalnourished subjects (P < 0.001). Among malnourished patients with congestive heart failure the mortality was 80%. Multivariate analysis revealed congestive heart failure, multiple organ disease, and PEM to be predictors of death. When the interaction between these disorders and PEM was considered, the prognostic relevance of PEM remained among the patients with cardiac congestion. Of the surviving subjects, 125 were reexamined after 9 months. At admission, more than half of the patients had displayed elevated levels of serum acid glycoprotein as evidence of an ongoing inflammation and subnormal recordings for serum albumin and delayed cutaneous hypersensitivity. At the reexamination, these variables had normalized in the well-nourished patients and in the 9 patients who had recovered from PEM, but remained unchanged in the 10 patients with persistent PEM. The latter patients were severely malnourished, commonly infected, and often hospitalized. CONCLUSIONS:Protein-energy malnutrition in noncancer medical patients is associated with an excess mortality in those with congestive heart failure. Improvement of PEM is accompanied by a decline in inflammatory activity.

The nutritional status (3 anthropometric records, serum albumin and delayed cutaneous hypersensitivity (DCH)), recent weight loss, dynamometric capacity and mood were assessed in 205 recently admitted non-cancer internal medical patients. 20% of the subjects were classified as malnourished (3 of the 5 nutritional variables below the reference range). The occurrence of malnutrition was higher (1/3) in multiple organ dysfunction or chronic respiratory disease. In order to reduce the risk of overestimating malnutrition, the data for serum albumin and DCH were omitted when they appeared to be influenced by non-nutritional factors. Disease duration >2 years, old age and multiple organ dysfunction were independently related to malnutrition. Serum albumin correlated more strongly with the acute phase reactant, serum acid glycoprotein (r = 0.33, P < 0.001) than with the anthropometric variables (r < 0.24). Recalled recent weight loss >5% was found in 34% of the malnourished subjects. Malnourished, in comparison to well nourished patients, exhibited reduced (p < 0.05) recordings for hand grip strength, peak expiratory flow and time of ambulation. Depressive tendencies were seen in malnourished women (p < 0.05).

Weight index (WI), triceps skinfold (TSF), serum albumin and delayed cutaneous hypersensitivity reaction (DCH) were measured in 96 hospitalized elderly patients and in 100 age- and sex-matched free-living controls. Using the 10th percentile of data obtained in the controls, WI was subnormal in 35% of the patients. Corresponding findings with regard to TSF, serum albumin and DCH were 32, 50 and 31%, respectively. The findings in the controls were mainly within the range observed in national reference groups. Patients were considered malnourished if they showed at least two variables (of which one was required to be anthropometric) below the cut-off limits used. When these limits were set at the 10th percentile of the recordings in the controls, the occurrence of undernutrition in the patients was 39%. By using the 5th percentile the corresponding figure was 16%. Malnourishment was most pronounced in patients with multiple organ disease and malignancy. It is concluded that low nutritional indices are a common occurrence in elderly subjects admitted to hospital and that undernutrition is related to the nature of the disease rather than age.

Six middle-aged patients with noninsulin-dependent diabetes and six normoglycemic control subjects were fed protein-rich and fat-poor (diet A) or protein-poor and fat-rich food (diet B). The patients were hyperglycemic, VLDL triglycerides levels were higher, and HDL cholesterol levels lower than corresponding findings in control subjects. Bile acid formation and biliary lipid composition did not differ between the two groups, but net steroid balance in the patients was elevated by a factor of approximately 2. A switch from diet A to diet B in control subjects was associated with an increase in HDL cholesterol and decreases in bile acid synthesis and net steroid balance. Lipoprotein pattern in the patients remained unchanged, and effects on total bile acid production and steroid balance were less consistent. It is suggested that the response in the patients reflected diabetes-associated abnormalities in lipid metabolism.

Serum lipoproteins, bile and kinetics and net steroid balance were studied in 22 diet-treated and 5 insulin-treated patients with noninsulin-dependent diabetes mellitus, in 6 patients with insulin-dependent diabetes mellitus and in 15 normoglycemic controls. All subjects were middle-aged and the patients were hyperglycemic. Some of the diet-treated patients suffered from obesity and/or dyslipoproteinaemia mainly characterized by elevated levels of triglycerides and cholesterol in VLDL (very low-density lipoproteins). The diet-treated patients had enhanced fractional turnover of both cholic acid and chenodeoxycholic acid but bile acid formation was within the control range in all groups of patients. As the most significant finding net steroid balance (total cholesterogenesis) was raised in the diet-treated patients. Bile acid kinetics and net steroid balance were normal in insulin-treated patients irrespective of type of diabetes.

A previous study demonstrated that the net steroid balance, i.e., the total rate of cholesterogenesis, was within the normal range in insulin-treated patients with both insulin-dependent and noninsulin-dependent diabetes mellitus (NIDD). In contrast, the corresponding findings in diet-treated patients with NIDD were above normal regardless of whether sulfonylurea was also given. The aim of the current study was to reinvestigate nine patients with NIDD 3–38 months after the institution of insulin therapy. At the doses used there were no significant effects on blood glucose control but the bile acid formation and net steroid balance decreased in seven patients. It is suggested that insulin therapy depresses the rate of cholesterogenesis in NIDD. This effect may be achieved without normalizing blood glucose.

Thrombotest (TT) values were studied in patients fed an ordinary diet and on continuous and well controlled warfarin therapy because of deep venous thrombosis or pulmonary embolism. The aim was to characterize the effect of single and multiple administrations (daily during one week) of vitamin K1 (Konakion), vitamin K-rich vegetables such as spinach and broccoli, and table wine. Single administration of 250 micrograms vitamin K1, 250 g spinach, 250 g broccoli and 37.5 cl wine did not result in TT-values outside the therapeutic range. However, when Konakion, broccoli and spinach were given daily during one week the TT-values tended to rise above the therapeutic limit, requiring dose adjustment. On the basis of this study it appears that excessive intake of vitamin K-rich food and a moderate intake of alcohol on one occasion may be permitted during anticoagulant therapy.

Vital capillary microscopy was employed in a study of the toe dorsum capillaries in 92 middle-aged diabetics and 96 controls of similar age and sex distribution. As a general finding most vision fields in the same toe showed an almost identical capillary pattern. In 17% of the toes in the controls compared to about 35% of the toes in the patients the capillaries were dilated more than 3 times. Such findings were unrelated to blood glucose control and a number of metabolic variables. In the patients with non-insulin dependent diabetes an abnormal capillary pattern was particularly common in patients with evidence of obstructive arterial disease. Such a relationship was not observed in patients with insulin-dependent diabetes in whom changes in the capillary pattern to a higher extent may be related to other mechanisms such as neuropathy.

Previous reports have demonstrated that noninsulin-dependent diabetes mellitus often is associated with hypertriglyceridemia linked to hyperinsulinemia and enhanced cholesterogenesis. Studies with single meals have indicated that rice as compared to potato results in a less pronounced blood glucose and insulin response. These findings initiated the current study in which eight middle-aged patients with adult-onset, noninsulin-dependent diabetes were fed a standardized diet with potato or rice as the major carbohydrate source. Blood glucose control was the same during both dietary periods. When rice was the major carbohydrate source the very low density lipoprotein triglycerides decreased in six patients and the formation of bile acid, especially that of cholic acid, showed a significant drop. The results further underline a link between lipoprotein and bile acid metabolism.

Energy-rich phosphagens, water, and electrolytes were determined in skeletal muscle biopsy specimens from five elderly women and five elderly men with moderate liver cirrhosis. At the time of the study the patients were in their usual condition without evidence of deterioration of the disease. When compared with findings in apparently healthy subjects of similar age, the distribution and level of electrolytes and water were within normal limits in the female patients. The male patients showed increased contents of muscle water, and Mg2+ was reduced. The values calculated for the intracellular concentration of K+ and Mg2+ were also below normal. The pattern and levels of energy-rich phosphagens were abnormal in all but one female patient. As a general finding, ATP and the total level of adenine nucleotides were markedly reduced, as were phosphocreatine, the ATP/ADP ratio, and the energy charge potential.

Myoglobin was determined in biopsy specimens from the quadriceps muscle of 3 female and 15 male 48-to 78-year-old patients with chronic obstructive lung disease. The patients were examined after an overnight rest. All but 2 were slightly to moderately hypoxemic. The myoglobin level was in all but 1 instance below the mean previously observed for apparently healthy subjects of similar age. The results are in line with earlier findings of an abnormal pattern of energy-rich phosphagens in the skeletal muscle of patients with chronic obstructive lung disease.

Electrolytes and/or amino acids were determined in leg skeletal muscle biopsies from elderly (age range 57-75 years) and young (age range 20-35 years) apparently healthy women. When compared to the young group, the elderly one was characterized by increased levels of muscular Na+ and Cl-, while the calculated intracellular concentration of Na+ was reduced. The pattern and levels of free amino acids showed only minor differences between elderly and young women. Intracellular Mg2+ and K+ showed a significant correlation with muscle levels of simultaneously determined energy-rich phosphagen compounds that was published previously.

Intramuscular (m. quadriceps) contents of electrolytes, free amino acids and energy-rich phosphagens were determined in 12 patients (51--81 years of age) with moderate chronic obstructive lung disease. At the time of the study the patients were in their habitual condition. After an overnight rest, 8 patients showed hypoxia and five of these also hypercapnia. Compared to apparently healthy controls of similar age and studied under identical conditions, the patients had increased intramuscular concentrations of sodium, chloride and extracellular water, whereas magnesium was slightly reduced. ATP and phosphocreatine, as well as the ATP/ADP and phosphocreatine/total creatine ratios, were reduced. The ATP/ADP ratio correlated significantly to intracellular magnesium. Plasma amino acids were essentially similar in controls and patients but the intramuscular contents of essential amino acids and of the three branched-chain amino acids were slightly enhanced in the patients.