ISSN:0148-6071    

DOI:10.1177/0148607195019004255

出版商:SAGE Publications    

年代:1995

数据来源: WILEY

ISSN:0148-6071    

DOI:10.1177/0148607195019004257

出版商:SAGE Publications    

年代:1995

数据来源: WILEY

摘要:

Background:Active nutrition therapy and the anabolic steroid oxandrolone (OX), in selected patients with severe alcoholic hepatitis, significantly improved liver status and survival. We report here on the changes in their nutritional parameters.Methods:Protein energy malnutrition (PEM) was evaluated and expressed as percent of low normal in 271 patients initially, at 1 month and at 3 months. Active therapy consisted of OX plus a high caloric food supplementvsa matching placebo and a low calorie supplement.Results:PEM was present in every patient; mean PEM score 60% of low normal. Most of the parameters improved significantly from baseline on standard care; the largest improvement seen in visceral proteins, the smallest in fat stores (skinfold thickness). Total PEM score significantly correlated with 6 month mortality (p=.0012). Using logistic regression analysis, creatinine height index, hand grip strength and total peripheral blood lymphocytes were the best risk factors for survival. When CD lymphocyte subsets replaced total lymphocyte counts in the equation, CD8 levels became a significant risk factor (p=.004). Active treatment produced significant improvements in those parameters related to total body and muscle mass (ie, mid arm muscle area,p=.02; creatinine height index,p=.03; percent ideal body weight,p=.04).Conclusion:Deterioration in nutritional parameters is a significant risk factor for survival in severe patients with alcoholic hepatitis. This deterioration is reversible with standard hospital care. Active therapy further improves creatinine height index, mid arm muscle area and total lymphocyte counts. Hence, these later parameters appear to be the best indicators for follow‐up assessments.(Journal of Parenteral and Enteral Nutrition19:258–265, 1995)

ISSN:0148-6071    

DOI:10.1177/0148607195019004258

出版商:SAGE Publications    

年代:1995

数据来源: WILEY

摘要:

Background:Inflammatory stimuli and provision of nutrients are important factors regulating both total liver protein synthesis and albumin synthesis.Methods:The influence of interleukin‐1β or turpentine injection and a 2‐hour infusion of a hypocaloric mixture of glucose and amino acids on the synthesis of total liver protein and albumin was investigated in rats. Total liver protein synthesis was measured by an IV flooding dose of L‐[2,63H]phenylalanine and albumin synthesis was determined from the labeling of immunoprecipitated albumin and expressed both as a fraction of total liver protein synthesis and as an absolute rate.Results:Interleukin‐1β or turpentine injection stimulated total liver protein synthesis compared with controls, whereas albumin synthesis, both as a fraction of total liver protein synthesis and as an absolute synthesis rate, decreased. In control animals, the 2‐hour IV infusion with glucose and amino acids resulted in a significant increase of total liver protein synthesis. Albumin synthesis as a fraction of total liver protein synthesis was not altered, but increased when expressed as an absolute rate in control animals. However, interleukin‐1β or turpentine injection abolished this response of albumin synthesis to nutrient supply.Conclusions:Total liver protein synthesis increases under inflammatory conditions and remains responsive to nutrient supply. In contrast, albumin synthesis decreases under the same conditions and does not seem to be responsive to short‐term IV nutrients.(Journal of Parenteral and Enteral Nutrition19:266–271, 1995)

ISSN:0148-6071    

DOI:10.1177/0148607195019004266

出版商:SAGE Publications    

年代:1995

数据来源: WILEY

摘要:

Background:The purpose of the study was to determine the concentrations of free amino acids and the total protein content of the human intestinal mucosa during critical illness.Methods:The free amino acid and protein concentrations in endoscopically obtained biopsy specimens from the duodenum and the distal colonic segments were determined on 19 critically ill patients. The free amino acids were separated by ion exchange chromatography and detected by fluorescence, and the protein content was quantified by the method of Lowry.Results:In general, the typical amino acid pattern of the intestinal mucosa was seen, with very high levels of taurine, aspartate and glutamic acid. The main difference, as compared to a reference series of healthy subjects, was the elevated glutamine concentration of the duodenal mucosa. This amino acid was unaltered in the descending colon and depressed in the rectum. At the same time, the glutamatic acid concentrations were unaltered, suggesting that the degradation of glutamine was not increased in the septic state of the majority of the patients studied. Phenylalanine and the two branched‐chain amino acids, valine and leucine, were elevated in the duodenal mucosa, and in the colonic mucosa, methionine and phenylalanine were elevated; otherwise, all the other individual amino acids were unaltered or depressed.Conclusions:The alterations seen in mucosal free amino acid and protein concentrations in connection with critical illness are different in many respects and contrast with the findings seen after starvation or moderate surgical trauma.(Journal of Parenteral and Enteral Nutrition19:272–278, 1995)

ISSN:0148-6071    

DOI:10.1177/0148607195019004272

出版商:SAGE Publications    

年代:1995

数据来源: WILEY

摘要:

Background:Low muscle glutamine levels during sepsis are associated with reduced protein synthesis and elevated protein breakdown, in particular myofibrillar protein breakdown. It is not known if this is a causal or coincidental relationship. We tested the hypothesis that muscle protein turnover rates are directly regulated by glutamine.Methods:Paired extensor digitorum longus muscles from nonseptic (sham‐operated) and septic rats (16 hours after cecal ligation and puncture) were incubated in the absence or presence of 15 mmol glutamine/L. The effect of glutamine was tested in unsupplemented medium or in medium containing 1 mU/mL of insulin or a mixture of amino acids at normal plasma concentrations. Protein synthesis was measured as incorporation of14C‐phenylalanine into protein; total and myofibrillar protein breakdown was determined by measuring tyrosine and 3‐methylhistidine, respectively.Results:Muscles accumulated intracellular glutamine well above normal concentrations in the presence of 15 mmol glutamine/L. In spite of this, protein synthesis was not affected by glutamine, neither when muscles were incubated in unsupplemented medium nor in medium containing insulin or amino acid mixture. Total protein breakdown was not influenced by glutamine when muscles were incubated in unsupplemented medium or with insulin but was reduced by glutamine in the presence of an amino acid mixture. Myofibrillar protein breakdown was unaffected by glutamine in unsupplemented medium and in medium containing insulin but was increased by glutamine in the presence of amino acid mixture.Conclusion:Reduced muscle protein synthesis and increased myofibrillar protein breakdown during sepsis are probably not caused by the low intracellular glutamine levels noticed in this condition. (Journal of Parenteral and Enteral Nutrition19:279–285, 1995)

ISSN:0148-6071    

DOI:10.1177/0148607195019004279

出版商:SAGE Publications    

年代:1995

数据来源: WILEY

摘要:

Background:Patients on total parenteral nutrition are known to be at risk of the development of essential fatty acid deficiency, presenting as a syndrome with scaly skin lesions and characterized by low plasma and erythrocyte linoleic acid concentrations. The essential fatty acid status of patients on long‐term home parenteral nutrition who do have access to oral feeds has not been studied.Methods:With the use of an isocratic high‐performance liquid chromatography method, fatty acids were measured in the erythrocytes and plasma of 25 nonfasting patients on long‐term home parenteral nutrition and the findings compared with those of 46 hospital outpatients not on nutrition support and five laboratory staff.Results:Statistically significant differences in the two groups were limited to the erythrocytes. Linoleic acid was significantly lower (25.2vs40.7 μmol/106red blood cells,p<.0001) and showed a significant correlation with triceps skinfold thickness(r=.52,p=.013). Palmitoleic and oleic acids were higher in patients than controls (10.8vs8.4 μmol/106red blood cells,p=.009; 61.2vs51.7 μmol/106red blood cells,p=.003).Conclusions:Despite IV linoleic acid administration, patients on long‐term home parenteral nutrition have low erythrocyte stores of this essential fatty acid. This appears to be related to their low body fat stores. We suggest that they may be using much of the infused linoleic acid as an energy source and therefore are at risk of subclinical essential fatty acid deficiency.(Journal of Parenteral and Enteral Nutrution19:286–290, 1995)

ISSN:0148-6071    

DOI:10.1177/0148607195019004286

出版商:SAGE Publications    

年代:1995

数据来源: WILEY

摘要:

Osteomyelitis of the spine is a well‐recognized delayed manifestation of septicemia but has not been recognized as a complication of total parenteral nutrition. We report five cases of spinal osteomyelitis that were clinically recognized 1 to 13 months after total parenteral nutrition catheter‐induced septicemia. Radiographic evidence of osteomyelitis was seen in all five patients. In three patients, culture of bony aspirates was positive for the same organism as from the blood. In one case, the diagnosis was established by histology, and in one the diagnosis was based on radiographic and radionuclide evidence of osteomyelitis. The organism responsible wasStaphylococcus aureusin two cases,Candida albicansin another two cases andC tropicalisin one case. The septic episode that preceded osteomyelitis was treated with systemic antibiotics and catheter removal in four patients, and antibiotics without catheter removal in one patient. Nevertheless, osteomyelitis occurred, requiring bracing or operative debridement as well as prolonged antibiotic therapy. Spinal osteomyelitis may occur as a delayed manifestation of total parenteral nutrition catheter‐induced septicemia. Prompt and effective treatment of septicemia is indicated but may not always be sufficient. Clinical suspicion is the key to the correct and early diagnosis of osteomyelitis and therefore to adequate treatment. (Journal of Parenteral and Enteral Nutrition19:291—295, 1995)

ISSN:0148-6071    

DOI:10.1177/0148607195019004291

出版商:SAGE Publications    

年代:1995

数据来源: WILEY

摘要:

Background:Massive loss of intestinal surface area results in the short bowel syndrome characterized by malabsorption of fluid, electrolytes, and other nutrients. Although the remaining bowel undergoes morphological and functional adaptation, often these changes are inadequate to support the individual by enteral feedings, and parenteral nutrition is required to prevent dehydration, electrolyte disturbances, and malnutrition. Substances such as growth hormone, glutamine, and fiber exert bowel‐specific trophic effects and either directly or indirectly influence nutrient absorption. This study was undertaken to determine whether the co‐administration of exogenous growth hormone, supplemental glutamine, and a modified fiber‐containing diet could enhance nutrient absorption in patients who had undergone massive intestinal resection.Methods:Ten patients (5 men, 5 women, aged 43 ± 4 years) with short bowel syndrome were studied 6 ± 1 years after surgical resection. All patients were admitted to the Clinical Research Center for a 28‐day period; the first week served as a control period when nutritional (enteral and parenteral) and medical management simulated usual home therapy. Thereafter, eight patients received exogenous growth hormone, supplemental glutamine, and a modified high‐carbohydrate, high‐fiber diet. Two patients were treated with the modified diet alone. The efficiency of net nutrient absorption (percent absorbed) for total calories, protein, fat, carbohydrate, water, and sodium was calculated from the measured nutrient intake and stool losses. Results: Three weeks of treatment with growth hormone, glutamine, and a modified diet increased total caloric absorption from 60.1 ± 6.0% to 74.3 ± 5.0% (p≤.003), protein absorption from 48.8 ± 4.8% to 63.0 ± 5.4% (p≤.006), and carbohydrate absorption from 60.0 ± 9.8% to 81.5 ± 5.3% (p≤.02). Fat absorption did not change (61.0 ± 5.3% to 60.3 ± 7.9%,p= NS). Water and sodium absorption increased from 45.7 ± 6.7% to 65.0 ± 7.3% (p≤.002) and from 49.0 ± 9.8% to 69.6 ± 6.5% (p≤.04), respectively. These absorptive changes resulted in a decrease in stool output (1,783 ± 414 g/d control period vs 1,308 ± 404 g/d third week of treatment,p≤.05). Treatment with diet alone did not influence nutrient absorption or stool output.Conclusions:The combined administration of growth hormone, glutamine, and a modified diet enhanced nutrient absorption from the remnant bowel after massive intestinal resection. These changes occurred in a group of patients that had previously failed to adapt to the provision of enteral nutrients. This therapy may offer an alternative to long‐term dependence on total parenteral nutrition for patients with severe short bowel syndrome.(Journal of Parenteral and Enteral Nutrition19:296–302, 1995)

ISSN:0148-6071    

DOI:10.1177/0148607195019004296

出版商:SAGE Publications    

年代:1995

数据来源: WILEY

摘要:

Background:Total parenteral nutrition provides nutrition support in patients who are unable to eat. Long‐term parenteral nutrition is accompanied by alterations in gut and liver function including changes in drug metabolism. This study examined the effects of lipid‐free total parenteral nutrition in rats on (1) the overall elimination pharmacokinetics of acetaminophen, (2) changes in sulfation and glucuronidation pathways during acetaminophen elimination, and (3) hepatic drug metabolizing enzyme activities determinedin vitro. Methods:Chronic indwelling catheters were implanted in the aorta, inferior vena cava, and portal vein of adult male Sprague‐Dawley rats. Total parenteral nutrition, consisting of 25% dextrose, 5% amino acids, electrolytes, and vitamins, was infused via the portal vein for up to 14 days. Acetaminophen pharmacokinetics were characterizedin vivoand selected drug metabolizing enzyme activities were determinedin vitro. Results:Parenteral nutrition for 10 days decreased the total clearance of acetaminophen by 23% (from 11.5 ± 1.4 to 8.9 ± 1.4 mL/min per kg;p<.05) and decreased the formation clearance to acetaminophen sulfate (from 6.2 ± 0.4 to 3.9 ± 0.5 mL/min per kg;p<.05). Parenteral nutrition decreased microsomal cytochrome P450 concentration (47%),p‐nitroanisole demethylase activity (68%) andp‐nitrophenol UDP‐glucuronosyltransferase activity (58%). Cytosolic glutathione‐S‐transferase activity towards 1‐chloro‐2,4‐dinitrobenzene decreased 29%. Sulfotransferase activity towardsp‐nitrophenol and acetaminophen was decreased 48% and 25%, respectively.Conclusion:Lipid‐free, total parenteral nutrition depresses drug conjugative metabolism in rats. The magnitude of this effect in humans remains to be investigated.(Journal of Parenteral and Enteral Nutrition19:303–309, 1995)

ISSN:0148-6071    

DOI:10.1177/0148607195019004303

出版商:SAGE Publications    

年代:1995

数据来源: WILEY