Disturbed eating at high altitude: influence of food preferences, acute mountain sickness and satiation hormones

Purpose: Hypoxia has been shown to reduce energy intake and lead to weight loss, but the underlying mechanisms are unclear. The aim was therefore to assess changes in eating after rapid ascent to 4,559m and to investigate to what extent hypoxia, acute mountain sickness (AMS), food preferences and satiation hormones influence eating behavior. Methods: Participants (n=23) were studied at near sea level (Zurich (ZH), 446m) and on two days after rapid ascent to Capanna Margherita (MG) at 4,559m (MG2 and MG4). Changes in appetite, food preferences and energy intake in an ad libitum meal were assessed. Plasma concentrations of cholecystokinin, peptide tyrosine-tyrosine, gastrin, glucagon and amylin were measured. Peripheral oxygen saturation (SpO2) was monitored, and AMS assessed using the Lake Louis score. Results: Energy intake from the ad libitum meal was reduced on MG2 compared to ZH (643±308 vs. 952±458kcal, p=0.001), but was similar to ZH on MG4 (890±298kcal). Energy intake on all test days was correlated with hunger/satiety scores prior to the meal and AMS scores on MG2 but not with SpO2 on any of the 3days. Liking for high-fat foods before a meal predicted subsequent energy intake on all days. None of the satiation hormones showed significant differences between the 3days. Conclusion: Reduced energy intake after rapid ascent to high altitude is associated with AMS severity. This effect was not directly associated with hypoxia or changes in gastrointestinal hormones. Other peripheral and central factors appear to reduce food intake at high altitud

Bone geometry in older adults with subclinical hypothyroidism upon levothyroxine therapy: a nested study within a randomized placebo controlled trial

The effect of levothyroxine (LT4) therapy for subclinical hypothyroidism (SHypo) on appendicular bone geometry and volumetric density has so far not been studied. In a nested study within the randomized, placebo-controlled Thyroid Hormone Replacement for Subclinical Hypothyroidism (TRUST) trial, we assessed the effect of LT4 therapy on bone geometry as measured by peripheral quantitative computed tomography (pQCT). In the TRUST trial, community-dwelling adults aged ≥65 years with SHypo were randomized to LT4 with dose titration vs. placebo with mock titration. We analyzed data from participants enrolled at the TRUST site in Bern, Switzerland who had bone pQCT measured at baseline and at 1 to 2 years follow-up. The primary outcomes were the annual percentage changes of radius and tibia epi- and diaphysis bone geometry (total and cortical cross-sectional area (CSA) and cortical thickness), and of volumetric bone mineral density (bone mineral content (BMC) and total, trabecular and cortical volumetric bone mineral density (vBMD)). We performed linear regression of the annual percentage changes adjusted for sex, LT4 dose at randomization and muscle cross-sectional area. The 98 included participants had a mean age of 73.9 (±SD 5.4) years, 45.9% were women, and 12% had osteoporosis. They were randomized to placebo (n = 48) or LT4 (n = 50). Annual changes in BMC and vBMD were similar between placebo and LT4-treated groups, without significant difference in bone geometry or volumetric bone mineral density changes, neither at the diaphysis, nor at the epiphysis. For example, in the placebo group, epiphyseal BMC (radius) decreased by a mean 0.2% per year, with a similar decrease of 0.5% per year in the LT4 group (between-group difference in %ΔBMC 0.3, 95% CI -0.70 to 1.21, p = 0.91). Compared to placebo, LT4 therapy for an average 14 months had no significant effect on bone mass, bone geometry and volumetric density in older adults with subclinical hypothyroidism. TRIAL REGISTRATION: The trial was registered on ClinicalTrials.gov numbers NCT01660126 (TRUST Thyroid trial) and NCT02491008 (Skeletal outcomes)

Acknowledgements

Without notice, this research has become a large project to which so many people have contributed in various ways. First of all, I want to express my gratitude to my supervisor, Riccardo Bocco, whose encouragement and willingness to engage with my ideas throughout the process was pivotal for the present result. Furthermore, I owe many thanks to my family, who were always prepared to listen to my ideas and to give feedback. I also want to thank my friends, Andi for his feedback on my draft, an..

8. References

8.1. South Sudanese documents Ajak, O. D., Minister of Investment of the Government of Southern Sudan (2011a) Proposal for the development of the new capital city of Southern Sudan, Cabinet Memorandum, February. Ajak, O. D., Minister of Investment of the Government of Southern Sudan (2011b) Proposal for the development of the new capital city of Southern Sudan, PowerPoint presentation, February. Bari Community (2011) The position of Bari community on the proposed new capital territory for Sou..

6. Annex I: Chronology

1820 – Turco-Egyptian invasion of what is now Sudan and South Sudan 1881 – Al-Mahdi’s revolt leads to the withdrawal of the Turco-Egyptians 1898 – Anglo-Egyptians recapture Sudan 1930 – “Southern Policy”, intended to culturally separate North and South, implemented 1949 – Marshall Report presents a vision of local governments, with aim of democratizing Sudan 1951 – Local Government Ordinance establishes local councils 1953 – First national elections 1955 – Violent conflict breaks out between ..

Abbreviations

CANS – Civil Authority of New Sudan CES – Central Equatoria State COTAL – Council of Tradition Authority Leaders CPA – Comprehensive Peace Agreement 2005 EES – Eastern Equatoria State GoSS – Government of South(ern) Sudan GTZ – Deutsche Gesellschaft für Technische Zusammenarbeit ICS – Interim Constitution of Sudan ICSS – Interim Constitution of Southern Sudan LGA – Local Government Act 2009 MDGs – Millennium Development Goals OECD – Organisation for Economic Co-operation and Development SPLM..

Abbreviations

CANS – Civil Authority of New Sudan CES – Central Equatoria State COTAL – Council of Tradition Authority Leaders CPA – Comprehensive Peace Agreement 2005 EES – Eastern Equatoria State GoSS – Government of South(ern) Sudan GTZ – Deutsche Gesellschaft für Technische Zusammenarbeit ICS – Interim Constitution of Sudan ICSS – Interim Constitution of Southern Sudan LGA – Local Government Act 2009 MDGs – Millennium Development Goals OECD – Organisation for Economic Co-operation and Development SPLM..