摘要:

The effect of whole protein and L‐amino acid ingestion on plasma amino acid (PAA) and urea nitrogen (UN) concentrations was investigated. Ten males ingested equivalent amounts of nitrogen as (trial 1) cottage cheese, (trial 2) an L‐amino acid mixture, (trial 3) cottage cheese and L‐amino acids. Mean changes in total PAA between trials 1 (342 μmol/liter) and 2 (719 μmol/liter) and trials 1 (342 μmol/liter) and 3 (981 μmol/liter) at 30 min and trials 1 (547 μmol/liter) and 3 (143 μmol/liter) at 150 min differed significantly. Mean changes in essential PAA between trials 1 (180 μmol/liter) and 2 (420 μmol/liter) and trials 1 (180 μmol/liter) and 3 (500 μmol/liter) at 30 min differed significantly. Mean changes in essential PAA between trials 1 (247 μmol/liter) and 3 (334 μmol/liter) at 60 min and between trials 1 (252 μmol/liter) and 3 (80 μmol/liter) at 150 min differed significantly. Mean increments in total and essential PAA were higher and peaked faster but decreased more quickly after trials 2 and 3 than after trial 1. Mean changes in plasma UN did not differ between trials. Ingestion of either L‐amino acids, whole protein or the mixture of L‐amino acids and whole protein was equally effective in increasing total PAA over 4 hr.(Journal of Parenteral and Enteral Nutrition15:48–53, 1991)

ISSN:0148-6071    

DOI:10.1177/014860719101500148

出版商:SAGE Publications    

年代:1991

数据来源: WILEY

摘要:

A 5‐year prospective study was performed to monitor liver function tests (LFTs) in patients receiving total parenteral nutrition (TPN). A gradual and progressive rise was seen in the plasma concentration of bilirubin, aspartate transaminase, and alkaline phosphatase. The rate of rise was not increased in patients with LFT abnormalities before the start of TPN. Half of the patients had an episode of sepsis during TPN, but overall abnormal LFTs did not appear more common in these patients than in those without obvious sepsis. Patients with malignant disease, those requiring long‐term TPN, and those requiring a nonstandard TPN regimen were more likely to develop raised LFTs. (Journal of Parenteral and Enteral Nutrition15:54–59, 1991)

ISSN:0148-6071    

DOI:10.1177/014860719101500154

出版商:SAGE Publications    

年代:1991

数据来源: WILEY

摘要:

Transient hyperglycemia in patients receiving total parenteral nutrition may be associated with impaired immune function. The effects of short‐term hyperglycemia on one aspect of antimicrobial immune function, ie, the ability of IgG to fix complement, were investigated. Aliquots of antihuman albumin, anti‐horse ferritin, and anti‐alkaline phosphatase were incubated for 0, 8, 16, 24, 48, and 96 hr with either 0 or 240 mg of glucose per deciliter of buffer. All samples were analyzed for the degree of glycation using a thiobarbituric acid assay, and for complement fixation ability using a microcomplement fixation assay. Significant increases in glycation over control samples were observed after only 16 hr (31 us 15 mmol 5‐hydroxymethylfurfural/mol IgG, p<0.01). Complement fixation was significantly altered after 48 hr of incubation (76 ± 5%vs90 ± 8% total serum complement fixed by albumin/antialbumin complex, p<0.03) when four of the 84 (4.7%) IgG lysine residues were glycated. It is demonstrated that a significant reduction in complement fixation by immunoglobulin occurs with elevated glucose concentrations and that this may play a clinically significant role in transiently hyperglycemic patients.(Journal of Parenteral and Enteral Nutrition15:60–64, 1991)

ISSN:0148-6071    

DOI:10.1177/014860719101500160

出版商:SAGE Publications    

年代:1991

数据来源: WILEY

摘要:

Rates of oxidation of infused13C‐labeled substrates are calculated from CO2production and13C enrichment in breath CO2. Breath sampling through a mouthpiece is not appropriate in severely ill patients; the authors therefore validated the use of direct air sampling from the ventilated canopy of an indirect calorimeter for measuring the oxidation of13C‐labeled substrates. Infusions of H13CO3Na or L‐[1‐13C]leucine were performed in four healthy postabsorptive adults and six malnourished patients receiving total parenteral nutrition (TPN). At each sampling point, air was collected from the canopy to compare with breath air sampled through a mouthpiece and13CO2enrichment determined by isotope ratio mass spectrometry. Despite five‐fold dilution of expired air by room air within the canopy (a dilution required to maintain safe CO2levels in inspired air): (1) Breath13CO2enrichment was accurately predicted using samples from the canopy, with a correction taking into account the measured CO2fractions in canopy and room air; (2) the precision in isotopic determination was similar with both methods (SD/mean of 12 determinations = 2.5 ± 1.0% us 3.0 ± 1.0%). These data demonstrate that the use of a ventilated canopy allows for combined assessment of energy expenditure and rates of oxidation of13C‐labeled substrates even in sick, debilitated patients receiving total parenteral nutrition.(Journal of Parenteral and Enteral Nutrition15:65–70, 1991)

ISSN:0148-6071    

DOI:10.1177/014860719101500165

出版商:SAGE Publications    

年代:1991

数据来源: WILEY

摘要:

The administration of total parenteral nutrition through umbilical artery catheters in 48 neonates (birth weight 1.7 ± 0.58 kg) was compared with administration via central venous catheters in 26 infants (birth weight 2.05 ± 0.89 kg). There was no significant difference in the amount of calories delivered (72 ± 12 us 78 ± 18 cal/kg/day) or in the mean daily weight gain (16.6 ± 13.3vs18 ± 13.9 g/day). The incidence of sepsis was significantly lower in the umbilical artery catheter group (10.4% us 15.4%) but there was no significant difference in the rate of infection when adjustment was made for number of days of catheter life (1 per 224 days of catheter life in the umbilical artery group us 1 per 199 days in the central venous catheter group). Other major complications included transient hypertension in 2 (4%) of the 48 umbilical artery catheter infants and in 1 (3.8%) of the central venous catheter group, aortic thrombosis in 1 (2%) of the 48 umbilical artery catheter infants and a tricuspid vegetation in 1 (3.8%) of the central venous catheter group. Results suggest that the umbilical artery is a reasonable route for the infusion of total parenteral nutrition in low birth weight infants who require arterial access for blood gas analysis. Use of the umbilical artery catheter for parenteral alimentation may avoid the need for surgical placement of central venous lines and the risk of the attendant complications. Nevertheless, safer routes and improved methods of infusion of parenteral infusion must continue to be developed.(Journal of Parenteral and Enteral Nutrition15:71–74, 1991)

ISSN:0148-6071    

DOI:10.1177/014860719101500171

出版商:SAGE Publications    

年代:1991

数据来源: WILEY

摘要:

The gastrointestinal tract is a major target of the human immunodeficiency virus. Many AIDS patients have weight loss and/or diarrhea. Parenteral nutrition can be used to treat malnutrition associated with malabsorption. We reviewed retrospectively the clinical course of 22 patients with AIDS and weight loss greater than 10% who received home parenteral nutrition (HPN) for 56.2 patient‐months. Mean weight loss was 21.4%, mean duration of HPN 2.55 months, mean age 37.4 years. Fifteen patients gained weight, six stabilized and two continued to lose weight. Nine patients returned to previous activity. Five died. The rates of catheter‐related sepsis, complications, and metabolic disturbances were 0.12, 0.25, and 0.12/100 catheter days, respectively, results identical to those reported in other patient populations where HPN is commonly applied. We found that HPN induced weight gain and clinical improvement in most patients without higher risks of sepsis than in patients with malignancies.(Journal of Parenteral and Enteral Nutrition15:75–79, 1991)

ISSN:0148-6071    

DOI:10.1177/014860719101500175

出版商:SAGE Publications    

年代:1991

数据来源: WILEY

摘要:

The acute effects of continuous intragastric administration of 1500 ml (4200 kJ/liter) of a polymeric and of a nonpolymeric formula on gastric function were studied in 15 healthy subjects. During 450 min 1500 ml, containing 6300 kJ (1500 kcal), was given through a nasogastric tube. At regular intervals the volume, the pH, the titratable acidity, and the pepsin activity of the gastric contents and the plasma gastrin concentration were determined. Maximal observed intragastric volumes occurred after 120 min (118 ± 16 ml during polymeric formula, 212 ± 37 ml during nonpolymeric one) and volumes subsequently halved (at 450 min 68 ± 13 and 104 ± 16 ml, respectively). During the administration of both polymeric and the nonpolymeric formula intragastric pH fell progressively to 3.15 and 2.67, respectively, at 450 min. Incremental plasma gastrin values increased between 120 and 450 min from 7 to 12 ng/liter during the polymeric formula. During the nonpolymeric one it stabilized after 120 min at 12 ng/liter. When the whole test periods were considered integrated, mean intragastric volumes tended to be larger during the nonpolymeric formula (153 ± 23 ml) than during the polymeric formula (107 ± 12 ml), but this difference was not statistically significant. Median integrated mean pH was lower during the nonpolymeric formula (2.89) compared with the polymeric one (3.26). Despite the limitation that the investigations were performed in healthy subjects only, it is concluded from this study that the risk of aspiration during continuous nasogastric tube feeding is probably greatest during the first few hours of administration because of the larger intragastric volumes. The findings further suggest that the risk of aspiration may be less with the polymeric formula because of the smaller intragastric volumes observed. However, studies in ill patients are necessary to confirm the clinical validity of our observations.(Journal of Parenteral and Enteral Nutrition15:80–84, 1991)

ISSN:0148-6071    

DOI:10.1177/014860719101500180

出版商:SAGE Publications    

年代:1991

数据来源: WILEY

摘要:

Records of 20 consecutive pediatric patients receiving total parenteral nutrition over a 1‐month period were reviewed for appropriateness of nutritional assessment and management. Each patient was monitored until total parenteral nutrition was discontinued or for a maximum of 2 weeks. A total of 124 therapy days were reviewed. Results demonstrated that only 35% of these patients had a nutritional assessment performed prior to initiation of therapy, and only 65% had nutritional goals determined. Nutritional goals were defined as patient‐specific goals for fluid volume (FV), calories, protein, and fat emulsion. Analysis of data demonstrated that goals for FV were met on 62% of therapy days. Of the days on which FV goals were met, goals for calories, protein, and fat emulsion were met on 54%, 59%, and 51% of therapy days, respectively. Baseline serum triglyceride levels were measured in one of 20 patients. Serial laboratory monitoring was adequate, with the exception of hepatic enzymes and serum triglycerides, which were measured in 14 and 9 patients, respectively. Recommendations for pediatric parenteral nutrition therapy are discussed, as well as methods to implement these recommendations.(Journal of Parenteral and Enteral Nutrition15:85–88, 1991)

ISSN:0148-6071    

DOI:10.1177/014860719101500185

出版商:SAGE Publications    

年代:1991

数据来源: WILEY

摘要:

Children who are unable to maintain an intake of energy and nutrients adequate to meet their needs for growth and maintenance of nutritional status require modifications in feeding. A new pediatric enteral product (PediaSure) was formulated to meet the nutrient needs of children 1 to 6 years of age in a volume that can be tolerated. We designed a noncontrolled, nonrandomized study to evaluate the suitability of this product in young children with respect to growth, protein status, metabolic responses, and gastrointestinal tolerance. Fourteen chronically disabled children were fed the study formula for 12 weeks, receiving daily at least 90% of their estimated energy requirements. Anthropometric measurements and biochemical parameters were obtained throughout the study period. Weight, weight for age, length, weight index, triceps skin fold thickness, mid‐arm circumference, mid‐arm muscle circumference, and mid‐arm muscle area all increased over the study period. Gastrointestinal tolerance and acceptance of the study formula were excellent; there were no clinically significant changes in the biochemical measurements. This study demonstrates that PediaSure is both safe and efficacious in the maintenance of the nutritional status and the promotion of growth in chronically disabled children who require specialized nutritional support.(Journal of Parenteral and Enteral Nutrition15:89–92, 1991)

ISSN:0148-6071    

DOI:10.1177/014860719101500189

出版商:SAGE Publications    

年代:1991

数据来源: WILEY

摘要:

Advances in long‐term venous access devices and in parenteral nutrition solutions have made it possible for patients with severe short bowel syndrome to survive and to live in our society. The spectrum of this disease is such that some patients may be able to lessen their dependence or even become free from parenteral therapy. This review will discuss the role of nutrition support in the patient with short bowel syndrome.(Journal of Parenteral and Enteral Nutrition15:93–101, 1991)

ISSN:0148-6071    

DOI:10.1177/014860719101500193

出版商:SAGE Publications    

年代:1991

数据来源: WILEY