摘要:

Frank clinical selenium deficiency has been described in cystic fibrosis (CF), and a relative deficiency has been proposed as contributing to the pathogenesis of the disease. Because of these possibilities, we investigated the relationship between overall nutritional status in CF with measures of selenium nutriture. Fifteen stable outpatients with CF (group I) were compared to 13 age‐matched controls (group II) and 27 healthy adults (group III). Whole blood, plasma, and red blood cell selenium levels were reduced by 31%, 29%, and 33%, respectively, in CF patients vs controls (all p less than 0.001). In addition, both groups I and II showed significantly lower blood selenium levels than healthy adults (p less than 0.005). Nutritional assessment revealed CF patients to be undernourished, with significant decreases in serum albumin (p less than 0.025), weight‐for‐height deficit (p less than 0.01), and weight‐for‐age (p less than 0.025) vs controls. However, only the triceps skinfold (TSF) measurement correlated significantly with selenium status (r = 0.56: p less than 0.05 for whole blood selenium vs TSF). We conclude, based on the magnitude of decrement in blood selenium, that it is unlikely that selenium plays a significant primary pathogenic role in cystic fibrosis. However, these patients are at high risk for developing clinical selenium deficiencies. The measurement of blood selenium levels using appropriate age‐matched normal standards should be mandatory in all CF patients with malnutrition, or in those requiring parenteral nutritional support.

ISSN:0148-6071    

DOI:10.1177/014860718701100138

出版商:SAGE Publications    

年代:1987

数据来源: WILEY

摘要:

So that the actual contamination rate of intravenous fat emulsions, as well as the type of microbial contamination, could be quantified, 103 bottles of 10% fat emulsion were collected near infusion completion from patients' bedsides. All samples were cultured and compared according to actual hanging time, in addition to the amount and type of microbial contamination. Recovered organisms included Escherichia coli, Staphylococcus epidermidis, diphtheroids, and Micrococcus. Sample analysis failed to demonstrate significant differences in extrinsic microbial contamination rate or organism multiplication between samples infusing for less than or equal to 12 hr and those infusing longer. Although these products support microbial growth, the contaminants introduced into the infusate by environmental or touch contamination yielded minimal colony growth. No patient developed signs or symptoms of bacteremia during the study period. Therefore, infusion of intravenous fat emulsion products over extended periods of time in this study did not increase the risk of developing infectious complications.

ISSN:0148-6071    

DOI:10.1177/014860718701100142

出版商:SAGE Publications    

年代:1987

数据来源: WILEY

摘要:

Four groups of male Wistar rats were alimented parenterally for 3 days. Groups 1 and 2 received medium‐chain triglycerides (MCT) and groups 3 and 4 long‐chain triglycerides (LCT). Groups 2 and 4 were supplemented with 100 mg L‐carnitine/kg/day. The MCT‐alimented rats presented with a distinct excretion of the dicarboxylic acids: adipic acid (C6), suberic acid (C8), and sebacic acid (C10). The acids excreted corresponded to the infused pattern of monocarboxylic acids: caproic acid (C6), caprylic acid (C8), and capric acid (C10). Dicarboxylic acid excretion after MCT administration may reflect an insufficient capacity of beta‐oxidation on one hand or a preferential omega‐oxidation of medium‐chain fatty acids on the other. Carnitine supplementation lead to a further increase of the dicarboxylic acids in the MCT‐group. beta‐OH‐butyric acid excretion decreased after carnitine in the MCT as well as in the LCT group. An increased transport of fatty acid‐carnitine compounds out of the mitochondria is discussed as an important effect of carnitine supplementation. Hereby medium‐chain fatty acids may be more accessible for omega‐oxidation.

ISSN:0148-6071    

DOI:10.1177/014860718701100146

出版商:SAGE Publications    

年代:1987

数据来源: WILEY

摘要:

Whole body nitrogen can be measured by neutron activation analysis with an acceptable radiation dose; it is an index of body protein which, in normal subjects, is 65% cellular protein and 35% extracellular connective collagen. Whole body potassium can be measured by whole body counting without irradiating the subject; it is an index of body cell mass.We measured whole body nitrogen, potassium, extracellular water, intracellular water, and fat‐folds. The differences between 37 malnourished patients and five normal subjects suggested that the patients had 9 kg less cell mass than normal, but no difference in extracellular mass. Measurements were made on eight patients before and after 14 days of total parenteral nutrition; balance of nitrogen intake and excretion also was measured. The changes were consistent with mean increases of 3 kg of cellular mass and 3 kg of fat with no change of extracellular mass.The accuracy and sensitivity of the whole body measurements need further confirmation for use in patients with changing body composition. Where tissue wasting is largely from the cellular compartment, potassium could be a more sensitive index of wasting than nitrogen. Multielement analysis of nitrogen, potassium, chlorine, and carbon will probably be valuable in elucidating body composition in malnutrition. (Journal of Parenteral and Enteral Nutrition11:48S‐50S, 1987)

ISSN:0148-6071    

DOI:10.1177/014860718701100505

出版商:SAGE Publications    

年代:1987

数据来源: WILEY

摘要:

A prospective audit of 100 admissions to a general medical unit was performed to determine the relationship of the initial nutritional status of the patients to the actual length of stay and hospital charges. These data then were compared with the allowed length of stay and estimated reimbursement under the prospective payment system of diagnosis‐related groups (DRGs). Forty‐five percent of the malnourished patients were hospitalized longer than that allowed under DRGs, compared to 30% for normal patients and 37% in the borderline group. The average length of stay was 15.6 +/‐ 2.2 days in the malnourished group compared to approximately 10 days in the other two groups (p less than 0.01). Although the estimated base DRG reimbursement was similar in all three groups ($4352‐$5124), the actual hospital charges were significantly greater in the malnourished ($16,691 +/‐ 4389) and borderline ($14,118 +/‐ 4962) groups compared to normals ($7692 +/‐ 687), (p less than 0.01). The DRG system will have an adverse financial impact in the care of malnourished patients. It is suggested that early recognition of malnutrition and aggressive treatment may lead to a decrease in the length of stay and cost deficit incurred by malnourished patients.

ISSN:0148-6071    

DOI:10.1177/014860718701100149

出版商:SAGE Publications    

年代:1987

数据来源: WILEY

摘要:

Nutritional inadequacies profoundly affect the content and distribution of water and electrolytes in muscle tissue. However, most changes in tissue water and electrolytes are nonspecific and reflect the degree of sickness; they cannot be used for evaluation of malnutrition, except to indicate whether there is a loss or excess of intracellular ions, such as potassium and magnesium. In patients without disturbances in potassium metabolism, muscle cell potassium and protein are strongly correlated, but this relationship does not hold true in patients with potassium depletion. Accumulation and loss of potassium occur in parallel with changes in muscle glycogen, independent of other muscle constituents, eg, magnesium. Potassium depletion and excess, as well as changes in muscle glycogen, must be considered when evaluating the relation of lean body mass and total body protein content to total body potassium. (Journal of Parenteral and Enteral Nutrition 11:51S‐54S, 1987)

ISSN:0148-6071    

DOI:10.1177/014860718701100506

出版商:SAGE Publications    

年代:1987

数据来源: WILEY

摘要:

Current hospital cost containment pressures have prompted a critical evaluation of whether nutritional support teams render more clinically effective and efficient patient care than nonteam management. To address this question with regard to enteral feeding, 102 consecutive hospitalized patients who required enteral nutritional support (ENS) by tube feeding during a 3 1/2‐month period were prospectively studied. Fifty patients were managed by a nutritional support team; the other 52 were managed by their primary physicians. Choice of enteral formula, formula modifications, frequency of laboratory tests, and amounts of energy and protein received were recorded daily. In addition, each patient was monitored for pulmonary, mechanical, gastrointestinal, and metabolic abnormalities. Team‐managed (T) and nonteam‐managed (NT) patients received ENS for 632 and 398 days, respectively. The average time period for ENS was significantly longer in the team‐managed patients (12.6 +/‐ 12.1 days vs 7.7 +/‐ 6.2 days, p less than 0.01). Significantly more of the team patients attained 1.2 X basal energy expenditure (BEE) (37 vs 26, p less than 0.05). Total number of abnormalities in each group was similar (T = 398, NT = 390); however, the abnormalities per day were significantly lower in the team group (T = 0.63 vs NT = 0.98, p less than 0.01). Mechanical (T = 0.05 vs NT = 0.11, p less than 0.01), gastrointestinal (T = 0.99 vs NT = 0.14, p less than 0.05), and metabolic (T = 0.49 vs NT = 0.72, p less than 0.01) abnormalities per day all were significantly lower in the team‐managed patients.(ABSTRACT TRUNCATED AT 250 WORDS)

ISSN:0148-6071    

DOI:10.1177/014860718701100152

出版商:SAGE Publications    

年代:1987

数据来源: WILEY

ISSN:0148-6071    

DOI:10.1177/014860718701100507

出版商:SAGE Publications    

年代:1987

数据来源: WILEY

摘要:

Fifteen healthy young probands (nine males, six females) underwent an intravenous fat tolerance test (IVFTT) and, on the following day, a fat infusion lasting 6 hr. The emulsion tested was Lipofundin MCT 10%. One half of its triglyceride mass contains medium chain fatty acids. The IVFTT was started by injection of 0.1 g lipid per kg body weight into the fasting proband. Lipid elimination was estimated by measurement of light‐scattering intensity of serum samples collected during a 60‐min period. Individual fraction elimination rate constants covered a considerable range (K2 = 8.84 +/‐ 3.45%/min). The infusion test was performed at a rate of 0.1 g lipid per kg body weight and hr and lasted 6 hr. Serum triglyceride concentrations were determined enzymatically. They increased from 0.941 +/‐ 0.285 mmol/liter at the fasting state to a plateau level of 1.753 +/‐ 0.306 mmol/liter during infusion, and returned to initial levels 1 to 2 hr after the infusion was terminated. Individual triglyceride increments during infusion were significantly correlated with half‐life periods of lipid elimination during IVFTT (r = 0.792, p less than 0.001). This relationship was derived using a model of the stationary state during infusion. We conclude that elimination kinetics of exogenous fat given either as bolus or infusion are ruled by the same fractional elimination rate constant K2. The IVFTT provides an estimate of the stationary triglyceride increment during a lipid infusion lasting several hr.

ISSN:0148-6071    

DOI:10.1177/014860718701100157

出版商:SAGE Publications    

年代:1987

数据来源: WILEY

摘要:

The nutritional support of patients with pancreatic and high gastrointestinal fistulas and severe pancreatitis frequently involves intravenous fat infusion. There are conflicting reports on the effect of intravenous fat on pancreatic exocrine secretion. In 10 dogs with chronic pancreatic fistulas, pancreatic juice was collected during secretin (n = 10) or secretin + cholecystokinin (n = 4) stimulation, with and without intravenous fat infusion (5 g/hr). The hormonal‐stimulated secretion of lipase, amylase, trypsin, total protein, bicarbonate, and water was unchanged during fat infusion. This study supports the use of intravenous fat as a nutritional source when it is desirable to avoid stimulation of the pancreas.

ISSN:0148-6071    

DOI:10.1177/014860718701100160

出版商:SAGE Publications    

年代:1987

数据来源: WILEY