摘要:

Our objective was to examine the effect of biosynthetic human growth hormone (BSHGH) on protein and energy metabolism in patients on full intravenous nutrition (IVN). Fifteen patients who had been established on IVN were allocated at random to receive either BSHGH (0.1 mg/kg/day) or placebo daily for 7 days. All patients received the same feeding regimen which contaminated 14 gN, 1000 kcal of glucose and 1000 kcal of fat (Intralipid) daily. The mean nitrogen balance for days 4 to 7 was significantly more positive with BSHGH (7.0 ± 0.6 gN/day) than with placebo (4.4 ± 0.7 gN/ day). The BSHGH group were lighter (53 ± 4.6 kg body weight) than controls (68 ± 5.1 kg), but the difference was not significant. Resting energy expenditure (expressed as percentage of day 1) increased throughout the study in patients receiving BSHGH (day 7, 120.8 ± 5.5%), whereas in patients receiving placebo it remained stable (day 7, 98.9 ± 2.7%). The nonprotein respiratory quotients were similar for BSHGH (mean days 4–7, 0.94 ± 0.04) and placebo (mean days 4–7, 0.93 ± 0.01) (p>0.05). This study demonstrates more positive nitrogen balance, which may in part be due to different substrate loads, and an increase in energy expenditure in patients receiving BSHGH. (Journal of Parenteral and Enteral Nutrition14:437–441, 1990).

ISSN:0148-6071    

DOI:10.1177/0148607190014005437

出版商:SAGE Publications    

年代:1990

数据来源: WILEY

摘要:

The effects of a fat and glutamine‐free orally administered total parenteral nutrition (TPN) solution on intestinal mucosal mass, morphology, barrier function, and cecal bacterial population levels were measured in CD‐1 mice. Ileal mucosal protein content decreased by 63% (p<0.01) in the oral TPN‐fed mice, although they gained weight on this diet. These TPN‐fed mice also exhibited changes in mucosal structure and the normal ecology of their cecal microflora was disrupted leading to overgrowth with Gram‐negative enteric bacilli. These changes in intestinal mucosal mass, morphology, and gut bacterial ecology were associated with an increased incidence of bacterial translocation (BT) (TPN group 70% BT us control group 15% BT:p<0.01). The administration of cellulose fiber or kaolin (bulk‐forming agents), but not of citrus‐pectin (a fully‐fermentable, nonresidue fiber) reduced the incidence of BT in the TPN‐fed mice to control levels. The beneficial effects of these bulk‐forming agents appeared to be due to their ability to prevent TPN‐induced disruption of the intestinal microflora and alterations in intestinal morphology, even though they did not prevent ileal mucosal protein levels from decreasing. These results suggest that the administration of bulk forming agents will prevent the loss of intestinal barrier function against luminal bacteria that occurs in mice fed an oral TPN solution. (Journal of Parenteral and Enteral Nutrition14:442–447, 1990)

ISSN:0148-6071    

DOI:10.1177/0148607190014005442

出版商:SAGE Publications    

年代:1990

数据来源: WILEY

摘要:

To determine whether intravenous carnitine can improve nutritional indices, neonates requiring parenteral nutrition were randomized into carnitine treatment (n = 23) and control (n = 20) groups. Observed plasma lipid indices, carnitine and nitrogen balances, and plasma carnitine concentrations were not different in the prestudy period. Under standardized, steady‐state conditions, 0.5 g/kg Intralipid was administered intravenously over 2 hr prior to carnitine administration, after infants received 7 days of 50 μmol/kg/day, and after a second 7 days of 100 μmol/kg/day of continuous intravenous L‐carnitine as part of parenteral nutrition. Triglyceride (TGY), free fatty acid (FFA), acetoacetate (AA), β‐hydroxybutyrate (BOB), and plasma carnitine concentrations were measured prior to and at 2, 4, and 6 hr after the initiation of the lipid bolus. Twenty‐four‐hour urine collections for nitrogen and carnitine balance were obtained on days 7 and 14. Neonates receiving carnitine had significantly greater concentrations of plasma carnitine on days 7 and 14 (p<0.001). Greater nitrogen (p<0.05) and carnitine (p<0.001) balances and weight gain (week 2, p<0.05) were found in the carnitine‐supplemented group when compared with controls. On day 14, (BOB + AA)/ FFA ratios were significantly higher (p<0.05), and peak TGY concentrations and 6‐hr FFA concentrations were significantly lower (p<0.05) in the treatment group. Carnitine supplementation was associated with modest increases in growth and nitrogen accretion possibly by enhancing the neonate's ability to utilize exogenous fat for energy.(Journal of Parenteral and Enteral Nutrition14:448–453, 1990)

ISSN:0148-6071    

DOI:10.1177/0148607190014005448

出版商:SAGE Publications    

年代:1990

数据来源: WILEY

摘要:

Malnutrition occurs commonly in patients with acquired immunodeficiency syndrome (AIDS). The efficacy of nutritional support is unknown. A prospective, longitudinal study was conducted to determine the effect of prolonged total parenteral nutrition on body composition in 12 AIDS patients. Five patients were malnourished because of problems with food intake or absorption, while seven had systemic infections, with or without a malabsorption syndrome. The AIDS patients gained body weight and body fat content in response to total parenteral nutrition, while mean body cell mass, estimated as total body potassium content, was unchanged. However, all five patients with altered intake or absorption had significant repletion of body cell mass which was significantly different from the patients with systemic infections. Calorie and nitrogen intake did not differ between the two groups. It is concluded that body mass repletion is possible in AIDS patients in whom malabsorption is the major pathogenetic factor in producing malnutrition and is less successful in patients with serious ongoing systemic diseases. Thus, the response to nutritional support is dependent on the particular clinical circumstances. (Journal of Parenteral and Enteral Nutrition14:454–458, 1990)

ISSN:0148-6071    

DOI:10.1177/0148607190014005454

出版商:SAGE Publications    

年代:1990

数据来源: WILEY

摘要:

Intravenous lipid emulsions depress lymphocyte proliferative responses and granulocyte function at concentrations found in the blood circulation during their administration. The effects of Intralipid, a widely used intravenous lipid emulsion, were measured on immunoglobulin productionin vitroby pokeweed mitogen‐activated lymphocytes as a test of B‐cell function. Intralipid decreased IgG, IgM, and IgA production at soybean oil triglyceride concentrations of 2.5–20 mg/ml occurring in the blood circulation during Intralipid infusion. The effects on IgM and IgA production were highest and that on IgG production lowest. Hydrocortisone‐sensitive and concanavalin A‐inducible suppressor cells were more sensitive to Intralipid than other cell populations. In vivo Ig production may not be equally disturbed, inasmuch as Intralipid concentrations in the lymph nodes and the spleen may be lower than in the blood circulation. However, care should be taken to prevent Intralipid concentrations from becoming high enough to depress immune responses. (Journal of Parenteral and Enteral Nutrition14:459–462, 1990)

ISSN:0148-6071    

DOI:10.1177/0148607190014005459

出版商:SAGE Publications    

年代:1990

数据来源: WILEY

摘要:

Since the addition of lipid to intravenous feeding formulas, animal and human studies have shown impairment of the reticuloendothelial system (RES) due to slow rates of clearance and gradual accumulation of long chain triglycerides (LCT) in the liver. Medium chain triglycerides (MCT) accumulate only minimally in the liver and do not impair the RES. However, results from animal studies using technetium sulfur colloid (TSC) to assess RES function have been inconclusive. The present study reevaluates RES function after lipid infusion in guinea pigs as measured by organ distribution of TSC. Guinea pigs were fed 300 kcal/kg/day of total parenteral nutrition (TPN) for 2.5 days, with 50% of nonprotein calories as fat in the form of LCT or MCT, then injected intravenously with 2.5 or 25 μCi of TSC, and uptake by liver, spleen, and lungs was determined. Liver, lungs, and spleen all increased in size after TPN with LCT or MCT. Liver TSC uptake was significantly affected by the dose of TSC (p<0.05), with the high dose probably inducing an increased capacity of the liver to clear TSC from the blood. Liver uptake was not influenced by diet, but feeding MCT did significantly stimulate lung uptake of TSC (p<0.0001). This suggests that the hepatic TSC uptake system is not saturable, and may not be an appropriate measure of Kupffer cell function since the colloid is not phagocytosed. However, TSC blood clearance remains an excellent prognostic indicator for bacteremia and mortality in humans, and is useful for measuring global RES function. (Journal of Parenteral and Enteral Nutrition14:463–466, 1990)

ISSN:0148-6071    

DOI:10.1177/0148607190014005463

出版商:SAGE Publications    

年代:1990

数据来源: WILEY

摘要:

Previous study demonstrated that patients who received total parenteral nutrition (TPN) with standard intermittent infusion of long chain triglyceride (LCT) at 0.13 g kg−1hr−1over 10 hr for each of three days showed a significant decline in99Tc‐sulfur colloid (TSC) clearance rate by the reticuloendothelial system (RES). The present studies evaluated eight patients who received the same total lipid dose of LCT infused continuously as in a three‐in‐one admixture, and another nine patients receiving the same amount of fat as a medium chain triglyceride (MCT)/LCT (75%/25%) emulsion intermittently over 10 hr at 0.13 g kg−1hr−1for three consecutive days. Patients were given continuous total parenteral nutrition (TPN) comprised of protein, 1.5 g kg−1day−1, and dextrose, 4.5 g kg‐1day‐l. RES function was examined by measuring the clearance rates of intravenously injected TSC while receiving TPN containing only protein and dextrose, and again after three days of fat infusion. Mean (±SEM) clearance rate constants before and after continuous LCT infusion were 0.38 ± 0.09 and 0.41 ± 0.08 min−1, respectively, while those before and after intermittent MCT/LCT infusion were 0.50 ± 0.18 and 0.73 ±‐ 0.24 min−1, respectively. In contrast to intermittent LCT infusion, the administration of continuous LCT or an intermittent MCT/LCT mixture does not impair TSC clearance by the RES. These findings suggest that condensing the daily period of LCT infusion at standard dosage may exceed the rate of metabolic utilization, resulting in increased fat removal and diminished TSC uptake by the RES. The provision of fat principally as MCT or by a continuous mode of administration may enable adequate metabolism of lipid emulsion without RES dysfunction, and so may be of particular benefit in critically ill or septic patients. (Journal of Parenteral and Enteral Nutrition14:467–471, 1990)

ISSN:0148-6071    

DOI:10.1177/0148607190014005467

出版商:SAGE Publications    

年代:1990

数据来源: WILEY

摘要:

Neutrophils from cord blood of healthy term infants were isolated and incubated for 30 min with varying concentrations of intravenous lipid emulsion (ILE) solution (4, 8, 20 mg/ml). In vitro assay of chemotaxis was performed after incubation for 120 min with endotoxin‐activated serum (EAS). Neutrophil random motility was unchanged after ILE incubation yet chemotactic factor (EAS)‐stimulated motility was significantly reduced in a dose‐related pattern. (Journal of Parenteral and Enteral Nutrition14:472–473, 1990)

ISSN:0148-6071    

DOI:10.1177/0148607190014005472

出版商:SAGE Publications    

年代:1990

数据来源: WILEY

摘要:

Clinical suspicion and venographic conformation were used to diagnose 15 cases of superior vena caval obstruction (SVCO) in 107 home parenteral nutrition (HPN) patients over 379 cumulative years of HPN (3.9 cases/100 patient‐years). Patients with SVCO had been on HPN a mean of 51.5 months and had used 6.2 (range 1–50) central catheters, including short‐ and long‐term, before SVCO was diagnosed. The frequency of inflammatory bowel disease (IBD) with SVCO was approximately the same as that in our general HPN population. Positive blood cultures were present immediately preceding the diagnosis of SVCO in 40% (six of 15) of cases. Atypical line placements were noted in two cases. The most common management strategies employed were conversion to enteral feedings in five patients and placement of a new catheter directly into the right atrium by thoracotomy in another five patients. Two of the five with right atrial catheters experienced a postpericardiotomy syndrome (fever, pericardial rub, and pulmonary infiltrates) that responded promptly to indomethacin. The most significant long‐term sequela of SVCO was the need for a left jugular vein to right atrial appendage bypass in one patient with chronic venous congestion from her SVCO. Once the SVCO is confirmed, systemic heparinization provides immediate antithrombotic effect and minimizes the risk of pulmonary embolism. The use of streptokinase may result in rapid thrombolysis. (Journal of Parenteral and Enteral Nutrition14:474–479, 1990)

ISSN:0148-6071    

DOI:10.1177/0148607190014005474

出版商:SAGE Publications    

年代:1990

数据来源: WILEY

摘要:

Patients receiving cytoreductive therapy and bone marrow transplantation (BMT) are known to develop marked protein catabolism. To assess the contribution of whole body protein breakdown, amino acid oxidation and incorporation into proteins, plasma leucine kinetics (1‐13C‐leucine infusion technique) were determined in six patients five times within 14 days before and after cytoreductive therapy (Cyclophosphamide and total body irradiation) and marrow transplantation. Nitrogen balance became negative (—0.20 ± 0.04 g/ Kg/24 hr) after cyclophosphamide (p<0.01) and was ‐0.25 ± 0.05 g/Kg/24 hr 7 days after BMT in spite of total parenteral nutrition.Plasma leucine concentration increased after BMT by 67% (p<0.0015). Leucine plasma appearance was 1.20 ± 0.15 μmol/ kg/min before treatment, it increased slightly and transiently after cyclophosphamide, and increased again from day 5 to day 7 after BMT (p<0.01), suggesting increased protein breakdown. Leucine oxidation increased from 0.27 ± 0.07 before therapy to 0.97 ± 0.16 μmol/kg/min (p<0.02) after cyclophosphamide and BMT. Nonoxidative leucine disappearance rate decreased slightly from 0.92 ± 0.08 to 0.75 ± 0.16 μmol/kg/min after BMT (ns). Leucine metabolic clearance rate decreased from 11.8 ± 1.65 before therapy to 6.9 ± 0.70 ml/kg/min (p<0.02) after cytoreductive therapy. After BMT it increased again to 9.9 ± 1.5 ml/kg/min (p<0.02). The results demonstrate that patients undergoing cytoreductive therapy and bone marrow transplantation develop negative nitrogen balance due to increased protein breakdown associated with increased leucine oxidation and increased metabolic clearance rate. Leucine incorporation into proteins (protein synthesis) was not altered inspite of an increase in plasma leucine concentration. (Journal of Parenteral and Enteral Nutrition14:480–484, 1990)

ISSN:0148-6071    

DOI:10.1177/0148607190014005480

出版商:SAGE Publications    

年代:1990

数据来源: WILEY