Fat and carbohydrate metabolism during and following hemorrhagic shock in puppies: A comparison of different resuscitation protocols

Shock states continue to carry a high mortality rate in the pediatric age group. Using a puppy model, we measured the initial metabolic response to hemorrhagic shock and to 3 resuscitation regimens: whole blood 1∶1 (replacement∶shed), lactated Ringer's 3∶1, and 5% albumin in lactated Ringer's 1∶1. Despite the immature nature of the puppy's enzyme, cardiovascular, and nervous systems, responses very similar to those in adult animals were seen. Serum glucose and free fatty acids rose during shock and declined with resuscitation as cardiac output returned toward normal. Serum lactate levels rose similarly but continued to rise for a short period after resuscitation and were associated with a further fall in pH consistent with “hidden acidosis.” Only small changes were noted in triglyceride and cholesterol levels. The metabolic responses noted following each of the 3 resuscitation protocols were similar. This study suggests that the immature animal responds to hemorrhagic shock in ways similar to the adult. The better initial hemodynamic response to resuscitation with high-volume lactated Ringer's or lactated Ringer's with 5% albumin was offset by the better buffering capacity of blood resuscitation. All 3 regimens were equally efficacious in providing initial metabolic recovery in this experimental hemorrhagic shock model. Les états de choc s'accompagnent d'une mortalité élevée chez les enfants. En ayant recours à l'expérimentation chez le chiot, les auteurs ont mesuré les modifications métaboliques initiales en réponse au choc hémoragique et à sa correction par 3 agents différents: sang complet (1∶1), solution de Ringer (3∶1) et solution de Ringer enrichie de 5% d'albumine. Malgré la nature immature des enzymes du chiot, du système cardio-vasculaire et du système nerveux, les réponses furent identiques à celles observées chez le chien adulte. Le glucose et les acides gras libres s'élevèrent au cours du choc et s'abaissèrent lors de la réanimation dès que le débit cardiaque revint à la normale. Les niveaux du lactate sanguin s'élevèrent de la même manière mais l'élévation continua pendant une courte période après la réanimation, cependant que le pH s'abaissait, démasquant une “acidose cachée”. Les taux des triglycérides et du cholestérol furent seulement discrètement altérés. Les réponses métaboliques étudiées en fonction des 3 méthodes de réanimation furent identiques. Cette étude suggère que le chiot répond de la même façon que le chien adulte au choc hémorragique et que les 3 méthodes de réanimation employant chacune des agents différents ont une efficacité identique. Los estados shock mantienen una elevada mortalidad en los grupos de edad pediátrica. Utilizando un modelo de shock en cachorros, se determinó la respuesta metabólica inicial al shock hemorrágico y a tres diferentes regimenes de resucitación: sangre total 1∶1 (reemplazo: pérdida), lactato de Ringer 3∶1, y albúmina al 5% en lactato de Ringer 1∶1. A pesar de la naturaleza inmadura de los sistemas enzimático, cardiovascular y nervioso del cachorro, las respuestas fueron muy similares a las observadas en animales adultos. La glucosa sérica y los ácidos grasos libres ascendieron durante el shock y declinarion en la medida que el débito cardiaco retornaba a lo normal. Los niveles de lactato sérico ascendieron en forma similar, pero continuaron su ascenso por un corto periodo de tiempo después de la resucitación, encontrándose asociados con una caida adicional del pH consistente con “acidosis oculta”. Sólo se presentaron cambios leves en los niveles de triglicéridos y colesterol. Las respuestas metabólicas observadas en cada uno de los tres protocolos de resucitación fueron similares. Este estudio sugiere que el animal inmaduro responde al shock hemorrágico de manera similar al adulto. La mejor respuesta hemodinámica inicial a la resucitación con altos volúmenes de lactato de Ringer o con lactato de Ringer con albúmina al 5%, fue compensada con una mejor capacidad de amortiguación observada en la resucitación con sangre. Los tres regimenes fueron igualmente eficaces en lograr la recuperación metabólica inicial en este modelo experimental de shock hemorrágico.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/41311/1/268_2005_Article_BF01655348.pd

Rising rural body-mass index is the main driver of the global obesity epidemic in adults

Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities 1,2 . This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity 3�6 . Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55 of the global rise in mean BMI from 1985 to 2017�and more than 80 in some low- and middle-income regions�was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing�and in some countries reversal�of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories. © 2019, The Author(s)

A century of trends in adult human height

Being taller is associated with enhanced longevity, and higher education and earnings. We reanalysed 1472 population-based studies, with measurement of height on more than 18.6 million participants to estimate mean height for people born between 1896 and 1996 in 200 countries. The largest gain in adult height over the past century has occurred in South Korean women and Iranian men, who became 20.2 cm (95% credible interval 17.5-22.7) and 16.5 cm (13.3-19.7) taller, respectively. In contrast, there was little change in adult height in some sub-Saharan African countries and in South Asia over the century of analysis. The tallest people over these 100 years are men born in the Netherlands in the last quarter of 20th century, whose average heights surpassed 182.5 cm, and the shortest were women born in Guatemala in 1896 (140.3 cm; 135.8-144.8). The height differential between the tallest and shortest populations was 19-20 cm a century ago, and has remained the same for women and increased for men a century later despite substantial changes in the ranking of countries