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Balance in Blood: Habits & Risks”

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Preface
The Meal by Meal Dynamic Energy
Balance in Blood: Habits & Risks
1. Background

Mario Ciampolini
Preventive Gastroenterology Unit, Department of Paediatrics
Università di Firenze, 50132 Florence, Italy

Aim
Eating begins and ends on the evaluation of sensations that are subjective, i.e. not shared with other people, e.g., a headache in comparison with sounds and figures. We have trained an order in this subjectivity to improve energy balance in young, clinically healthy subjects with normal BG.
A target sensation of hunger before meals produced this order (Chapter V). After training, meals adapted content (e.g., 50 grams in order to eat after 2 hours and 100 grams in order to eat beyond 4 hours with the same physical activity) to the arousal of the target sensation before the planned, subsequent intake. The association with glucose concentration (BG) proved the identity of the recognized sensation as target for meal consumption. In healthy people with normal levels of insulin, BG is representative of other nutrients in blood because of the close correlation with other nutrients, exhaustibility, operative experience and published and unpublished results.
BG increases in the first hour after a meal and slowly declines in the subsequent hours, reaching the pre-prandial level in healthy conditions after two – five hours. Later, BG lowers and is, usually, subjectively insufficient.
At this point, subjects focused and memorized characteristics of hunger sensations, and validated from one to three sensations by BG labeling.
We termed the validated sensations together with the name: Initial Hunger (IH, Chapter V). 111 We investigated 1) if meal consumption may be adapted to IH arousal three times a day (Initial Hunger Meal Pattern, IHMP, or better “recognizing hunger”, Chapters VI - VIII); 2) if this meal pattern sustains usual daily activity (Chapter VII); 3) if it maintains body weight in lean subjects who are insulin sensitive (Chapter VIII); 4) if it increases insulin sensitivity (Chapter VI); 5) if it decreases body weight in insulin resistant or overweight subjects (Chapters VI and VIII); 6) if it lowers immune stimulation, the basic mechanism in the development of subclinical inflammation (Chapter IX). 7) and lastly, BG and body weight homeostasis (stability) are the final objectives. In Chapter VII stability may be maintained at high levels that are associated with high risks (High mean BG, HBG). Homeostasis is an ideal objective which includes stability of nutrients at a level that prevents risks and deterioration (suppression of subclinical inflammation, Chapter IV and actual results reported by Chapters VI - IX) and improves body functions (Low mean BG, LBG). Chapter VII shows the point of division of LBG from HBG.
In this research, “recognizing hunger”, prevents insulin resistance and non-insulin dependent diabetes (NIDD; Chapters V –VIII). The aim is suppressing subclinical inflammation and the associated functional disorders and evolving diseases (Chapter IV). The adaptation of “recognizing hunger”, in the treatment of the elderly with fully developed NIDD requires further investigation.
The results modify views on metabolism and on insulin resistance. We present our views, although the content of this Chapter has not been the center of our studies.

 
Contents  

1

M. CIAMPOLINI. Infants do request food at the hunger glycemic level, but adults don’t any more. 14th SSIB (Society for the Study of Ingestive Behavior) annual meeting, July 18-22, 2006, Naples, USA. Appetite 2006, 46:345. DEPENDENCE OF GLYCEMIC LEVEL, ENERGY INTAKE AND EXPENDITURE ON FOOD REQUEST IN INFANCY.
Infants up 3 years of age do not need to be trained by glucometer as required by adults to pratice Initial Hunger Meal Pattern. Current education habituates infants to forestall request for food.

We reported previously that mothers could be trained to interpret their toddlers food cues appropriately by pairing measurements of blood glucose concentrations with a child’s food requests. We demonstrated that following a two- week intervention toddlers reduced ad libitum energy intakes by 24% and yet maintained activity levels. The study summarized in this report followed up those earlier observations by measuring energy expenditure in two other groups of children whose mothers received similar training omitting daily glycemic measurements in the toddlers. Total energy intake was measured by 7-day food diaries and energy expenditure was characterized by the doubly labeled water method and indirect calorimetry in two groups of children, 10 in one and 14 in the other. These measurements were obtained before and 50 days after training was initiated. Daily energy intake decreased from 928±212 kcal to 684±117 kcal (-26%) and from 941±244 kcal to 673±172 kcal (-28%) in the two groups of toddlers, respectively. TEE fell from 80.1±6.9 kcal per kg body weight per day to 67-8±10.0 kcalkg-1d-1 and SMR from 59.1±8.0 kcalkg-1d-1 to 49,3±9.4 kcalkg-1d-1. Thus energy expenditure fell approximately 16% in both groups. The fall in metabolic rates was influenced by whether food was offered by the mother or provided only upon the toddler’s request. The similar decreases in energy intake in all studies support the view that mothers and their infants can be trained to interpret and give, respectively, food cues appropriately without the inclusion of glucose measurements in the training period.

The complete article is at:
http://www.dovepress.com/articles.php?article_id=9690

2

ATTENTION TO METABOLIC HUNGER FOR A STEADIER (SD DECREASE TO 60%), SLIGHTLY LOWER GLYCEMIA (10%), AND BODY WEIGHT RECOVERY IN MALNUTRITED INFANTS.
Mario Ciampolini, Giuliana Fognani, Martine van Weeren, Lorenzo Borselli. Dept. Pediatrics, Meyer Hospital 50132 Firenze, Italy, & AMC, 1100 DD Amsterdam, The Nederlands.

Four types of metabolic feelings were identified: 1. Satiety (postprandial). 2. Appetite or consumption of available food at perception of it; 3. Unsolicited, bearable Yes hunger feelings between 3.9 mmol/l and 4.7 mmol/l. 3. Unbearable Yes hunger under 3.6 mmol/l. Methods: 13 malnutrited infants (weight for age lower than 70%) with diarrhea in the first year of life were investigated in a controlled, randomized study. Organic disease was excluded by conventional procedures, including intestinal biopsy. Nine were assigned to the intervention and 4 to the control group. Compliance with observation of bearable Yes hunger before meals, intake, and anthropometry were recorded in hospital for 2 months, and then by frequent visiting and 7-day home diary under intervention for 5 times in two years. Results: Under intervention, one subject dropped out for non-compliance in the first day and two for delay in weight increase after a month intervention. One of 4 controls dropped the follow-up after 3 months for edema relapse. Six subjects under intervention and three controls were followed for at least 2 years. Serum triglycerides decreased from 151±30mg/dl to 70±10mg/dl under intervention, and increased from 119±47 mg/dl to 139±59mg/dl in controls (P = 0.002). The daily energy intake and the number of days with diarrhea and vomiting of three months were constantly lower, while increase in weight for height and for age constantly higher under intervention (P = 0.02; Chi square for trends). The sum of arm and leg skinfold thickness decreased in the first month under intervention, and increased in controls (NS). Weight for age reached 88.8±8.7% under intervention, and 79,7±10.2% in controls after two years (NS). Psychomotorial development was normal except in one control. Attention to metabolic hunger promoted rapid lean tissue recovery by improvement of indices of insulin resistance.

Key words: Malnutrition, Energy intake, Insulin resistance, Hyperglycemia.

Table 4. Anthropometric, functional and nutritional outcomes in six infants under intervention for two years.

 

Months under intervention

0

1.7

3

6

11

26

Months of age

10.0 ± 5.6 (5)

11.7 ± 5.4

13.1  ± 5.8

15.7 ± 5.8

21.8  ± 7.6

34.2 ± 5.5

Weight

5.6 ± 2.1

6.1 ± 2.0

6.7 ± 1.8

7.7 ± 1.3 (5

9.6 ± 1.5 *

12.5 ± 0.8 *

Weight for age (1)

62.3 ± 8.9

62.8 ±  10.6

66.9 ± 10.6

72.2  ± 6.7

80.3 ± 10.0 *

88.8 ± 8.7 *

Sum of skinfolds (2)

10.9 ± 3.4

10.3 ± 3.6

12.1 ± 3.5

13.0 ± 4.4

17.9 ± 5.7 (4)

18.9 ± 6.3 (4)

Normal reference

20.6 ± 3.7

20.8 ± 3.6

21.5 ± 3.0

21.9 ± 3.7

21.4 ± 3.2

20.7 ± 5.7

Sum of muscle areas (3)

27.0 ± 9.2

27.4 ± 9.8

31.7 ± 7.8

36.2 ± 7.3*

45.6 ± 10.1*

60.0 ± 10.1*

Normal reference

45.5 ± 12.0

47.4 ± 12.0

49.4 ± 13.4

53.6 ± 11.5

62.5 ± 11.3

70.8 ± 11.6

Height (cm)

65.2 ± 11.4

66.7 ± 9.9

69.6 ± 9.2

72.2 ± 8.7*

77.9 ± 7.4

89.3 ± 3.8

Weight for height

79.4 ± 5.3

82.1 ± 6.0

82.4 ± 7.5

88.3 ± 10.7

93.4 ± 9.1

97.0 ± 8.1

Hb

9.7 ± 1.4

 

 

11.1 ± 1.5*

 

12.8 ± 0.9

MCV

79.8 ± 7.7

 

 

71.3 ± 9.2

 

77.0 ± 3.1

Albumin

3.6 ± 0.6

 

 

3.9 ± 0.4

 

4.1 ± 0.5

Triglicerides

151 ± 30

 

 

70 ± 9.6

 

73.2 ± 12.3

transf. saturation (%)

22.9 ± 10.7

 

 

16.6 ± 9.3

 

22.2 ± 9.4

Alanin aminotransf.

79.2 ± 80.6

 

 

38.0 ± 21.0

 

21.0 ± 10.9


(1) = NCHS, USA
(2) = tricipital + quadricipital skinfold thickness
(3) = tricipital + quadricipital muscle area
(4) = t test = 2.58; 2.91 both P < 0.05
(5) = SD
* = significant vs baseline

 

Table 5. Anthropometric, functional and nutritional outcomes in three control infants followed for two years.


months under intervention

0

2

3

7

11

30

months of age

7.3 ± 4.0

9.3 ± 4.0

10.7 ± 4.2

14.7 ± 6.0

18.0 ± 6.1

36.7 ± 5.5

 

 

 

 

 

 

 

weight

5.4 ± 1.9 (SD)

6.0 ± 1.3

6.3 ± 1.1

7.7 ± 0.7

8.2 ± 0.7

11.5 ± 1.2

weight for age

66.6 ± 12.1

66.9 ± 5.2

67.5 ± 3.3

73.9 ±  1.2

74.1 ± 3.0

79.7 ± 10.2

weight for height

75.4 ± 5.2

76.6 ± 4.9

76.6 ± 3.9

81.0  ± 2.2

81.0 ± 3.4

86.5 ± 5.8

height

65.3 ± 10.3

67.9 ± 8.1

69.5 ± 6.7

74.3 ± 5.5

77.1 ± 4.6

90.8 ± 2.2

sum of skinfolds (2)

11.4 ± 3.3

12.1 ± 2.6

12.6 ± 2.2

14.3 ± 2.4

14.3 ± 2.4

15.0 ± 1.6

sum of muscle areas (3)

26.6 ± 10.3

28.2 ± 8.0

29.1 ± 6.8

32.3 ± 4.3

35.0 ± 4.5

50.6 ± 6.3

Hb

11.9 ± 2.0

 

 

11.4 ± 0.4

 

11.7 ± 0.7

MCV

83.3 ± 6.7

 

 

78.7 ± 8.6

 

79.3 ± 2.1

albumin

3.2 ± 1.0

 

 

4.0 ± 0.3

 

3.9 ± 0.9

triglycerides

119 ± 47

 

 

139 ± 59

 

89 ± 37

Transf. saturation (%)

41.0 ± 26.8

 

 

18.0 ± 8.9

 

23.9 ± 11.8

Alanin aminotransf.

52.7 ± 46.6

 

 

35.3 ±  28.3

 

35.3 ± 30.9

 

Table 6. Last functional and nutritional outcomes.


 

 

 

weight

weight/age

height

height/age

 

 

 

 

 

 

 

B Pablo

18 years

High school diploma

54.3

75.6

161

91.1

V Daniele

10 years

elementary student

29.3

93.2

139

101.1

DI Luca

3 years

100 words

12.8

88.6

86

91.3

F Francesca

15 years

high school student

38

60.8

153

88.0

Z Lorenzo

10 years

elementary student

21.3

70.7

124.5

92.4

C Giovanni

16 years

high school student

61.4

99.0

173

99.7

 

 

 

 

 

 

 

B Letizia

15 years

high school student

42.9

84.8

153

95.3

P Giampiero

4.9 years

hypertension, convulsion, death

19

104.5

104.5

96.5

Z Filippo

33 m

walking at 18 months

11

78.2

88.5

95.5


energy intake
vomiting
thickn
diarrhea
muscle area

3

Eliciting Clear-Cut Initial-Hunger at Proper Time

http://www.omicsonline.org/2161-1017/2161-1017-1-102.digital/2161-1017-1-102.html

Available online at: OMICS Publishing Group

www.omicsonline.org

Recognizing Hunger, chapter 23 in Atiq M, Ed. Cardiovascular risk factors, InTech, Rijeka, Croatia.
ISBN 978-953-51-0321-9

http://www.intechopen.com/subjects/cardiology-and-cardiovascular-medicine

www.intechopen.com

Initial Hunger and exhaustion of previous energy intake- Recognizing hunger, and energy balance.
Rcent. Res. Devel. Nutrition, 8, ISBN: 978-81-308-0468-2

http://www.ressign.com/UserBookDetail.aspx?bkid=1281&catid=247

Rcent. Res. Devel. Nutrition, 8 (2011): 115-128 ISBN: 978-81-308-0468-2

www.ressign.com

Interruption of scheduled, automatic feeding and reduction of excess energy intake in toddlers

http://www.dovepress.com/article_12104.t15115810

An introduction to the book: meal by meal dynamic balance of energy in blood

http://www.ressign.com/UserBookDetail.aspx?bkid=1337&catid=291