摘要:

We have tested the response to a primed constant infusion of alanine (2 mg/kg·min infusion, 120 mg/kg prime) on glucose and urea kinetics in overnight fasted volunteers by using primed‐constant infusions of 6,6‐d2‐glucose and15N2‐urea. When no alanine was infused, plateaus in glucose and urea concentration and enrichment were maintained for the final 3 hr of a 4‐hr infusion of tracers. When alanine was infused over the final 2 hr of a second protocol, urea enrichment decreased significantly, indicating an increase in urea production from 4.4 ± 0.31 to 7.0 ± 0.63 μmol/kg·min. This corresponded to a potential increase in gluconeogenesis from alanine of 20%. Nonetheless, the alanine infusion had no significant effect on either the plasma concentration or enrichment of glucose, which means that hepatic glucose output was not affected. We conclude, therefore, that increasing gluconeogenic precursor availability does not stimulate hepatic glucose output in overnight‐fasted man. (Journalof Parenteral and EnteralNutrition11:109–111, 1987)

ISSN:0148-6071    

DOI:10.1177/0148607187011002109

出版商:SAGE Publications    

年代:1987

数据来源: WILEY

摘要:

Branched chain amino acids (BCAA) improve nitrogen balance and end‐organ function in surgical patients, but are untested in marrow transplant recipients. We compared nitrogen balance, urinary 3‐methylhistidine‐to‐creatinine ratio, upper arm anthropometry, serum prealbumin, and day to peripheral engraftment in a randomized, double‐blinded trial between 45% (high‐leucine) and 23% BCAA intravenous solutions in 40 adult leukemia patients for 1 month following allogeneic marrow transplantation. Nutritional support, provided at approximately 30 nonprotein calories/kg and 0.21 g nitrogen/kg ideal weight, did not differ between groups. Despite greater nitrogen loss and muscle breakdown evidenced by increased 3‐methylhistidine‐to‐creatinine ratio and loss of arm muscle area by study end in the 45% BCAA, no statistical differences were observed when nitrogen balance was compared by week and within stress level as defined by organ and infectious complications. It is likely the patients in the 45% BCAA experienced greater metabolic stress by study end. Serum prealbumin and day posttransplant to peripheral engraftment also did not differ between groups. The chances (power) of this study exceeded 85% in detecting a difference in nitrogen balance of 2.5 g during study week 1 and 4.0 g during week 2. The power during week 3 was 77% for detecting a difference of 4.0 g, and it is unlikely that the true difference exceeds this magnitude. Thus, we did not find any evidence that intravenous BCAA‐enriched solutions improved nitrogen balance during the first month after marrow transplantation. (Journalof Parenteral and Enteral Nutrition 11: 112–118, 1987)

ISSN:0148-6071    

DOI:10.1177/0148607187011002112

出版商:SAGE Publications    

年代:1987

数据来源: WILEY

摘要:

The toxic effects of methotrexate administration [20 mg/kg, bolus intraperitoneally (ip)] to rats fed a regular chow diet (n = 10) was compared with results in animals fed an elemental, chemically defined, liquid diet (n = 10) for 7 days. All animals receiving an elemental diet became anorectic and lethargic within 60 hr of methotrexate injection. All animals in this group subsequently developed enteritis and died within 150 hr. There was no clinical evidence of enteritis in rats fed a regular chow diet and mortality as zero in this group (p<0.001). In a second study one group of rats (n = 9) was fed a regular chow diet for 7 days; four groups were fed an elemental, chemically defined, liquid diet (n = 9 per group) for 7 days. At 24 hr and 8 hr prior to, or 24 hr after methotrexate administration, one group was refed a regular chow diet; the fourth group was maintained on an elemental liquid diet throughout the study period. All rats fed a regular chow diet survived following methotrexate injection (20 mg/kg, ip). All rats fed an elemental diet throughout the study period died. Those rats refed a regular diet 24 or 8 hr prior to methotrexate injection demonstrated a significant improvement in survival (100% in the 24‐hr group, 55% in the 8‐hr group). However, those animals refed a regular diet 24 hr after methotrexate injection demonstrated a 100% mortality.A similar study evaluated changes in plasma and bowel methothrexate levels in rats refed either 24 hr or 8 hr prior to 24 hr after methotrexate administration. Serum and bowel tissue methotrexate levels were significantly elevated in rats refed 24 hr after methotrexate injection compared with the other groups.The administration of an elemental, chemically defined liquid diet to rats results in a marked increase in mortality from severe enteritis following methotrexate administration compared with regular chow diet fed animals. These animals demonstrated delayed clearance of methotrexate from serum and from small intestine tissue. This enhanced toxicity is readily reversible by refeeding a regular diet to these animals within 24 hr prior to methotrexate injection. Elemental, chemically defined liquid diets do not afford protection to the gastrointestinal mucosa from the toxic effects of methotrexate. (Journal of Parenteral andEnteralNutrition 11: 119–123, 1987)

ISSN:0148-6071    

DOI:10.1177/0148607187011002119

出版商:SAGE Publications    

年代:1987

数据来源: WILEY

摘要:

Oligosaccharides are potential sources of carbohydrate‐derived energy for use in parenteral nutrition regimens. Clinical studies indicate that although some patients utilize infused oligosaccharides well, many patients do not. These results suggest that oligosaccharides might be useful as a parenteral energy source for selected patients. This report describes a method, suitable for use by nursing staff on the ward, to determine oligosaccharide utilization and identify patients utilizing oligosaccharides well. Oligosaccharides excreted in urine are hydrolyzed enzymaticallly to glucose using α‐glucosidase and α‐amylase, and the glucose released is measured by a test tape method. The results obtained agree well with the acid hydrolysis‐spectrophotometric assay for oligosaccharide excretion used in earlier studies. The method readily identified postsurgical patients utilizing infused oligosaccharides poorly in both prospective and retrospective studies. (Journalof ParenteralandEnteral Nutrition 11:124–128, 1987)

ISSN:0148-6071    

DOI:10.1177/0148607187011002124

出版商:SAGE Publications    

年代:1987

数据来源: WILEY

摘要:

Using a single‐dose [15N]glycine turnover technique, we studied protein metabolism in 15 children with newly diagnosed acute lymphocytic leukemia (ALL). As in our previous study, we observed increased rates of whole body protein synthesis (S) and breakdown (B) in comparison to healthy controls. In eight patients, we assessed basal metabolic rate (BMR). There was a significant linear regression between BMR (kcal/d) (Y) and S (g protein/d) (X): y = 3.7 X + 850 (R = 0.925, p<0.001). There was also a significant linear correlation between BMR, expressed as a percentage of the normal value, and S expressed as a percentage of the mean value in the healthy children (r= 0.79, p<0.05). There were also significant positive correlations between BMR and body weight (r = 0.75, p<0.05) or age (r = 0.83, p<0.05) and between S and weight or age (both, r = 0.86, p<0.01). BMR (kcal/d) also correlated with B (g protein/d) (r = 0.91, p<0.01). Multiple regression analysis revealed that BMR was much more highly related to S than to weight. These data suggest that increased rates of S are closely related to increased energy requirements in patients with ALL. Furthermore, these data provide evidence for the biological relevance of whole body protein kinetics. (JournalofParenteral andEnteral Nutrition 11:129–134, 1987)

ISSN:0148-6071    

DOI:10.1177/0148607187011002129

出版商:SAGE Publications    

年代:1987

数据来源: WILEY

摘要:

We have compared the direction of changes in four plasma transport proteins measured weekly with the direction of nitrogen balance in general surgical patients receiving intravenous nutrition (IVN). Fifty four patients had IVN for 2 weeks, and 15 had IVN for 3 or 4 weeks. Change in plasma prealbumin followed the direction of nitrogen balance in both weeks of IVN in 39 of 54 of the former group, whereas none of the other plasma proteins achieved 50% accuracy. A weekly rise in plasma prealbumin had a sensitivity of 88%, specificity of 70%, positive predictive value of 93%, and negative predictive value of 56% in detecting positive nitrogen balance. Results in the patients who received 3 or 4 weeks of IVN showed an improvement in negative predictive value to 79%. None of the other plasma proteins performed as well. Twelve patients suffered a major complication of their disease or died, following their course of IVN. Nitrogen balance was the best prognostic indicator of these patients, whereas a fall in prealbumin was the best of the plasma proteins, with a sensitivity of 67%, specificity of 79%, positive predictive value of 40%, and negative predictive value of 92% in determining the incidence of complications. Prealbumin was the most suitable plasma protein for use as a dynamic index of nutritional progress in the type of patient seen in this study. (Journal of Parenteral andEnteralNutrition 11: 135–139, 1987)

ISSN:0148-6071    

DOI:10.1177/0148607187011002135

出版商:SAGE Publications    

年代:1987

数据来源: WILEY

摘要:

The effect of nutritional status on the morbidity and mortality of major gastrointestinal surgery for benign disease was studied in 32 patients. Malnutrition was defined as a serum albumin10%, in addition to any two of the following: weight for height, mid‐arm circumference or triceps skin‐fold thickness<10th percentile. The morbidity and mortality in the 17 malnourished patients was 59% and 29%, respectively, compared with 20% and 7% in 15 well‐nourished patients matched for age and operative procedure (p60% requirement) was 11.9 days ± 2.9 (SEM) in well‐nourished patients compared with 30.5 days ± 3.7 in the malnourished group. The longer IONIP in malnourished patients was a consequence of the higher morbidity in this group, thus warranting the consideration of supportive (postoperative) parenteral nutrition in malnourished patients who undergo major gastrointestinal surgery for benign disease. (Journal of Parenteral and Enteral Nutrition 11: 140–143, 1987)

ISSN:0148-6071    

DOI:10.1177/0148607187011002140

出版商:SAGE Publications    

年代:1987

数据来源: WILEY

摘要:

Serum transferrin and prealbumin levels were determined at intervals of 3 to 4 days in 16 patients requiring nutritional support. Caloric and nitrogen intake were measured and nitrogen balance calculated. There were 117 intervals available for analysis. A mean decrease in transferrin of 12.95 mg/ dl was associated with a mean decrease in nitrogen balance of 0.92 g/day, whereas a mean increase in transferrin of 21.04 mg/ dl was associated with a mean increase in nitrogen balance of 1.49 g/day; the correlation between changes in transferrin with changes in nitrogen balance was statistically significant (p = 0.02). Upward and downward changes in prealbumin were also associated with corresponding changes in nitrogen balance, but the changes were not statistically significant. Decreases in transferrin and prealbumin were also associated with a lower caloric intake. Operation caused a significant decrease in prealbumin (p = 0.003) and nitrogen balance (p = 0.05); a decrease in transferrin also occurred, but was not statistically significant. There was a highly significant correlation between serum transferrin and prealbumin (p = 0.001) and also between the interval changes in transferrin and prealbumin (p<0.001). In conclusion, transferrin was found to correlate closely with prealbumin. Changes in transferrin were more significantly related to changes in nitrogen balance, and from the results of this study, measurement of serum transferrin can be recommended as a useful parameter in following the nutritional status of patients receiving nutritional support. (Journalof Parenteral and Enteral Nutrition 11:144–148, 1987)

ISSN:0148-6071    

DOI:10.1177/0148607187011002144

出版商:SAGE Publications    

年代:1987

数据来源: WILEY

摘要:

Two different soy oil emulsions (Intralipid and Soyacal) were studied over a 2‐week period in a random crossover study to determine if there were clinical or biochemical differences between the two preparations when used in patients requiring total parenteral nutrition (TPN). Each fat emulsion was infused randomly over 1 week and then switched to the other. Eighteen adult patients requiring a minimum of 14 days TPN were studied. None of the 26 metabolic parameters evaluated was statistically different between the two groups. Analysis of nutritional status, irrespective of lipid infused, showed that the patients who received 56 kcal/kg/day with 37% of the nonprotein calories from lipids (1.8 ± 0.7 g/kcal/day) were in positive nitrogen balance on 80 of the 101 days studied. No adverse effects could be observed from either lipid emulsion during the short period of TPN used in this study. Both lipid emulsions were efficacious as a caloric source, and no clinical complications or biochemical abnormalities were found from either preparation. (JournalofParenteraland Enteral Nutrition 11:149–151, 1987)

ISSN:0148-6071    

DOI:10.1177/0148607187011002149

出版商:SAGE Publications    

年代:1987

数据来源: WILEY

摘要:

Fat‐based total parenteral nutrition (TPN) has been shown to maintain the host nutritionally equivalent to carbohydrate‐based TPN in a rat model; however, data on body composition have not been obtained. This study compared the effects of a lipid‐based TPN regimen to those of an isocaloric glucose‐based regimen and an oral diet on the composition of the carcass and organs of tumor‐ and nontumor‐bearing rats. Sprague‐Dawley rats implanted with the Walker 256 carcinosarcoma were randomly assigned to either diet A, a glucose‐based TPN regimen; B, a lipid‐based TPN regimen; or C, a purified oral diet. Tumor‐bearing rats infused with diet B had less protein and more fat in their carcasses than those in the other dietary groups. Organs of nontumor‐ and tumor‐bearing rats fed diet B contained less protein and more fat and triglycerides than rats fed either diet A or C. Survival index and hematocrit values were lowest in rats infused with the parenteral lipid diet. These findings indicate an abnormal pathological response to a TPN diet formulated to deliver 67% of nonprotein kilocalories as lipid. (Journalof Parenteral and Enteral Nutrition 11:152–158, 1987)

ISSN:0148-6071    

DOI:10.1177/0148607187011002152

出版商:SAGE Publications    

年代:1987

数据来源: WILEY