摘要:

Lipid emulsions contain not only triglyceride (TG)‐rich particles but also phospholipid (PL)‐rich particles that are believed to trap free cholesterol and apoprotein E, when they are infused in excess. The present study was designed to evaluate the effects of such abnormal PL‐rich particles on lipid metabolism during a 5‐day infusion in man. Eighteen patients undergoing esophagectomy were evenly randomized to receive intravenously during 5 days 1.75 g·kg−1·d−1long‐chain TG from either a 10% lipid emulsion with a PL/TG weight ratio of 0.12 (group A), a 10% emulsion with a PL/TG weight ratio of 0.06 (group B), or a 20% emulsion with a PL/TG weight ratio of 0.06 (group C). Plasma PL, free cholesterol, and apoprotein E increased progressively in group A (4.1 ± 0.3 mmol/ L, 2.4 ± 0.3 mmol/L, and 0.089 ± 0.012 g/L on day 5, respectively) but not in groups B (2.7 ± 0.3 mmol/L, 1.3 ± 0.2 mmol/ L, and 0.048 ± 0.007 g/L) and C (2.4 ± 0.2 mmol/L, 1.2 ± 0.1 mmol/L, and 0.050 ± 0.006 g/L). Free fatty acids and TGs remained constant and similar in each group postoperatively. After fat infusion had been stopped at the end of the fifth day, the elimination of plasma TGs over the next 4 hours was comparable in the three groups. We conclude that excess egg PLs induce alterations of plasma lipids even within a few days. (Journal of Parenteral and Enteral Nutrition17:107–112,1993)

ISSN:0148-6071    

DOI:10.1177/0148607193017002107

出版商:SAGE Publications    

年代:1993

数据来源: WILEY

摘要:

Previous studies have shown that 1‐hour infusions of neither glucose nor an amino acid mixture alone stimulates muscle protein synthesis in postabsorptive rats (Biosci Rep 1986;6:177–183). We have therefore investigated whether longer periods of infusion are required to initiate responses. The effects of intravenous infusions of various substrates for 6 hours on rates of skeletal muscle protein synthesis in fasted rats were studied. Fractional rates of protein synthesis (ks, the percent of muscle protein renewed each day) and the ribonucleic acid activity (KRNA, the amount of protein synthesis per unit of ribonucleic acid [milligrams of protein per day per milligram of ribonucleic acid]) were measured with a flooding dose of L‐[4‐3H]phenylalanine. Infusion of mixed amino acids (15 mg of nitrogen per hour per rat) increased ksand kRNA by approximately 50% in comparison with saline‐infused rats, but rates of muscle protein synthesis remained below those observed in fed animals. Doubling the infusion rate of amino acids to 30 mg of nitrogen per hour per rat had no additional effect on ks and kRNA, and addition of glucose (0.3 g/h per rat) or glucose plus lipid also had no significant additive effect. However, infusion of glucose alone (0.3 g/h per rat) increased ksand kRNAby 25% when compared with saline‐infused controls. Infusion of the branched‐chain amino acids in the same amounts as present in the amino acid mixture increased ksand kRNA by 20% compared with saline‐infused controls, but the rate remained significantly lower than that obtained by infusion of mixed amino acids. (Journal of Parenteral and Enteral Nutrition17:113–118, 1993)

ISSN:0148-6071    

DOI:10.1177/0148607193017002113

出版商:SAGE Publications    

年代:1993

数据来源: WILEY

摘要:

A controlled trial on nutrition supplementation in ambulatory patients with decompensated alcoholic liver disease was carried out during 1 year. Fifty‐one patients were studied; 26 were assigned to an experimental group receiving a daily supplement of 1000 kcal and 34 g of proteins given as a casein‐based enteral nutrition product and 25 to a control group receiving one placebo capsule. Patients were examined in a special clinic once a month or more if required. Sixty‐eight percent of patients admitted to alcohol ingestion or had alcohol in urine samples on at least one occasion. Dietary recalls showed a significantly higher protein and caloric intake in case patients subjects (p<.0001). Nine patients died during the study, three case patients and six control patients (p= NS). The frequency of hospitalizations was significantly less in the experimental group. This difference was attributed to a reduction in severe infections. Mid‐arm circumference, serum albumin concentration, and hand grip strength improved earlier in case patients, although both groups had a significant improvement in these parameters. Bilirubin and aspartate aminotransferase decreased and prothrombin time increased significantly in both groups during the study period, without differences between groups. It is concluded that nutrition support decreases nutrition‐associated complications in patients with alcoholic liver disease. (Journal of Parenteral and Enteral Nutrition17:119–124, 1993)

ISSN:0148-6071    

DOI:10.1177/0148607193017002119

出版商:SAGE Publications    

年代:1993

数据来源: WILEY

摘要:

Disturbances of bilirubin metabolism such as jaundice or pigment gallstone formation occur during total parenteral nutrition (TPN). We have studied the effects of TPN on bile flow and bile acid secretion and on the hepatobiliary transport of bilirubin in rats. Animals on parenteral nutrition for 5 days received 4.8 g of amino acids and 6.9 g of glucose daily. Controls were orally fed animals. Bile flow and bile acid secretion were not significatly modified by TPN. Serum bile acid and alkaline phosphatase levels were significantly increased in TPN animals when compared with the controls (+98% and +38%, respectively), which points to a relative cholestasis in the TPN rats. The biliary excretion of bilirubin monoconjugates and bilirubin diconjugates was significantly increased (+72% and +78%, respectively). This provides evidence for enhanced production of the pigment. Serum concentration of total bilirubin was enhanced in the TPN rats (+240%). The esterified/total bilirubin ratio in serum increased, whereas the bilirubin diconjugates/bilirubin monoconjugates ratio decreased. These facts, together with the minor reduction of hepatic bilirubin UDPglucuronosyltransferase activity (—12%), suggest that hyperbilirubinemia would be a consequence of both cholestasis and increased bilirubin production. The alterations reported here could contribute to the explanation of hyperbilirubinemia and pigment gallstone formation in patients maintained on parenteral nutrition. (Journal of Parenteral and Enteral Nutrition17:125–129, 1993)

ISSN:0148-6071    

DOI:10.1177/0148607193017002125

出版商:SAGE Publications    

年代:1993

数据来源: WILEY

摘要:

Blood concentrations of gastrin, motilin, insulin, and insulin‐like growth factor‐I were measured sequentially during the first 3 weeks of life in 22 very‐low‐birth‐weight infants (birth weight 1.03 ± 0.24 g; gestational age 28.3 ± 1.9 weeks; mean ± SD) who were in respiratory distress requiring mechanical ventilation and were receiving either total parenteral or enteral feedings. An increase in the blood concentration of motilin beyond the basal measurement was observed in enterally fed infants but not in infants receiving total parenteral nutrition. Motilin and gastrin concentrations were significantly increased in the enterally fed group compared with infants receiving total parenteral nutrition at 2 and 3 weeks and 1 and 3 weeks, respectively. There were no differences in serum insulin or plasma insulin‐like growth factor‐I concentrations between groups after the start of the study. The present data suggest that enteral nutrition in very‐low‐birth‐weight infants is associated with a relative increase in peripheral motilin and gastrin concentrations compared with parenterally fed infants. (Journal of Parenteral and Enteral Nutrition17:130–133, 1993)

ISSN:0148-6071    

DOI:10.1177/0148607193017002130

出版商:SAGE Publications    

年代:1993

数据来源: WILEY

摘要:

Although glutamine is an important fuel used by the intestinal mucosa and other visceral organs, it is not present in any commercially available parenteral amino acid solution. To compare the effects of L‐glutamine with glutamine dipeptides, we studied the effects of each in 8 dogs and 60 Wistar rats. In the dog study, three amino acid solutions were compared: standard commercial amino acid solution (control), alanine‐glutamine dipeptide‐enriched solution (glutamine 3.4%), and glycine‐glutamine dipeptide‐enriched solution (glutamine 3.6%). Arterial and venous samples were collected to compare the effects of the three solutions on skeletal muscle amino acid exchange. In the rat study, two studies were undertaken: group 1 rats underwent only central venous catheterization; group 2 rats underwent central venous catheterization and a 50% intestinal resection. Within each group, three different solutions were infused: standard amino acid solution (control), glutamine‐enriched (1.5% glutamine) solution, or glutamine dipeptide‐enriched (1% glutamine) solution. After 7 days of parenteral nutrition, samples of gut, blood, and muscle were collected for determination of mucosal thickness, villus area, serum amino acid profile, liver and renal function tests, and muscle composition. When glutamine or glutamine‐dipeptide solutions were administered, the dogs showed increasing serum glutamine concentrations and enhanced glutamine uptake across the hind leg muscle. Similarly, both groups of rats demonstrated significant differences in serum glutamine levels, nitrogen balance, intestinal mucosa thickness, and villus area. We conclude that both glutamine and glutamine‐dipeptide infusions increase serum glutamine concentrations and result in regional tissue effects. Both exerted similar metabolic effects with no apparent complications. (Journal of Parenteral and Enteral Nutrition17:134–141, 1993)

ISSN:0148-6071    

DOI:10.1177/0148607193017002134

出版商:SAGE Publications    

年代:1993

数据来源: WILEY

摘要:

Commercially available intravenous lipid emulsions are largely derived from vegetable oils, a natural source of phylloquinone (vitamin K1). We therefore examined the concentration of vitamin K1in two widely used intravenous lipid emulsions by using a previously validated high performance liquid chromatography technique. The vitamin K1concentrations of 10% emulsions of Intralipid and Liposyn II were 30.8 and 13.2 μg/dL, respectively. The concentration of vitamin K1in the 20% emulsions of these products was essentially double that in the 10% emulsions. The coefficients of variation between the vitamin K1content in three different lots of each product were consistently less than 7.0%. The observed concentrations of the vitamin in these lipid emulsions paralleled the predicted content on the basis of the type of vegetable oil(s) used to make the product. The type of vegetable oil used for production therefore seems to be a major determinant of the final vitamin K1content. The vitamin K1contained in these intravenous lipid emulsions is substantial and may have great impact on the vitamin K status of the recipient. (Journal of Parenteral and Enteral Nutrition17:142–144, 1993)

ISSN:0148-6071    

DOI:10.1177/0148607193017002142

出版商:SAGE Publications    

年代:1993

数据来源: WILEY

摘要:

In this preliminary study of peripheral parenteral nutrition, we compared our first nine patients fed by this method with 21 patients fed by total parenteral nutrition during the same period. We found that peripheral parenteral nutrition was as effective as total parenteral nutrition in improving physiologic function (both skeletal and respiratory muscle function). We also found that by using the protocol described here thrombophlebitis was not a significant problem. Additional study is required to ascertain the exact incidence of this and other complications. We would advocate the greater use of peripheral parenteral nutrition in suitable patients and the use of this protocol for its administration. (Journal of Parenteral and Enteral Nutrition17:145–147, 1993)

ISSN:0148-6071    

DOI:10.1177/0148607193017002145

出版商:SAGE Publications    

年代:1993

数据来源: WILEY

摘要:

The effects of oral RNA and intraperitoneal nucleoside‐nucleotide mixture administration on methicillin‐resistantStaphylococcus aureus(MRSA) strain 8985N infection were studied in mice. BALB/c mice were fed a nucleic acid‐free diet or nucleic acid‐free diet supplemented with 0.5% or 2.5% ribonucleic acid (RNA) for 30 days. Nucleoside‐nucleotide mixture or saline (control) was intraperitoneally administered daily to these rats except for the 2.5% RNA group, which received saline only. On the 10th day of this treatment, the mice were inoculated intravenously with the viable MRSA organisms. Susceptibility to the MRSA was determined by animal survival and recovery of the MRSA from the organs. The survival rates in the three groups that were administered saline were 29%, 35%, and 40% for nucleic acid‐free diet, 0.5% RNA, and 2.5% RNA groups, respectively, whereas in the two groups that received the nucleoside‐nucleotide mixture the rates were 69% for the nucleic acid‐free diet group and 55% for 0.5% RNA group. The susceptibility of the mice to the MRSA challenge was not affected by dietary RNA, which indicates the ineffectiveness of oral RNA. The combined survival rate in the two nucleoside‐nucleotide groups (64%) was statistically different (p<.01) from that in the three saline groups (34%). There was a greater reduction in viable organism recovery in the kidney and spleen of the surviving mice that had been administered the nucleoside‐nucleotide mixture than in those administered saline. The study showed that intraperitoneal administration of the nucleoside‐nucleotide mixture was effective in increasing the host resistance, whereas oral RNA was not adequate in offering protection to the mice against MRSA infection. (Journal of Parenteral and Enteral Nutrition17:148–152, 1993)

ISSN:0148-6071    

DOI:10.1177/0148607193017002148

出版商:SAGE Publications    

年代:1993

数据来源: WILEY

摘要:

Long‐chain triglycerides are still the standard in fat emulsions, although medium‐chain triglycerides have been suggested to have metabolic advantages even though pure medium‐chain triglycerides are toxic in large doses. The next generation of fat emulsions may be structured triglycerides, which are assumed to provide a higher oxidation rate, faster clearance from blood, improved nitrogen sparing, and less of a tendency to accumulate in the reticuloendothelial system compared with long‐chain triglyceride emulsions. This study was designed to evaluate the safety and tolerance of structured triglyceride fat emulsion 73403 (Kabi Pharmacia Parenterals, Stockholm, Sweden) compared with that of a standard long‐chain triglyceride emulsion (Intralipid 20%) in postoperative patients requiring total parenteral nutrition after major surgery. The study was randomized and of the double‐blind, parallel group type. Twenty patients were included and treated for 5 to 7 days. Safety and tolerance variables demonstrated no major differences between the study and control groups. Physiologic and biochemical variables suggested that structured lipids were rapidly cleared and metabolized. This study represents the first report of administration of structured triglycerides to postoperative patients. The structured triglyceride emulsion (73403) demonstrated no difference in safety and tolerance compared with Intralipid 20%. Therefore, it will now be possible to follow up with studies on metabolic efficiencies of structured triglycerides in postoperative patients. (Journal of Parenteral and Enteral Nutrition17:153–157, 1993)

ISSN:0148-6071    

DOI:10.1177/0148607193017002153

出版商:SAGE Publications    

年代:1993

数据来源: WILEY