摘要:

Background:The role of IV infusion kinetics to explain nutrition efficiency was investigated in patients after major surgical procedures.Methods:IV nutrition was provided as three different infusion kinetic regimens in a randomized fashion. All patients received nonprotein calories (100% of predicted preoperative REE, 60% D‐glucose, 40% fat) and amino acid nitrogen (0.2 g N/d). Group A: Nutrition was provided by sequential infusion with combined fat and amino acids during daytime and glucose alone during nighttime (“sequential infusion”). Group B: Patients received 24‐hour combined infusion with fat, amino acids, and glucose (all in one mixture) (“continuous infusion”). Group C: Nutrition was provided by bolus infusions during 1 hour followed by 2 hours without any infusion (“bolus infusion”).Results:The daily energy balance was negative in all groups (‐318 ± 25 kcal/d, sequential infusion; ‐368 ± 25 kcal/d continuous infusion; ‐292 ± 20 kcal/d, bolus infusion). Significantly different excretion patterns of nitrogen in urine occurred among the groups despite an almost identical provision of nitrogen. Continuously infused patients retained nitrogen significantly better (‐0.2 ± 0.6 g/d) compared with sequentially (‐3.4 ± 1.0 g/d) and bolus‐infused patients (‐2.8 ± 0.3 g/d) (p<.01), whereas their cumulative urinary glucose excretion was significantly larger. Continuously infused patients were in cumulative nitrogen balance during the entire postoperative period, whereas the other groups were in a significantly negative nitrogen balance. Urinary 3‐methylhistidine excretion was similar in all groups.Conclusions:The breakdown of muscle proteins was not sensitive to alterations in nutrient and substrate supply. Thus improved nitrogen retention reflected entirely improved synthesis. “All‐in‐one” IV nutrition with prolonged infusion periods is at present the most favorable regimen considering both the nutritional efficiency and its metabolic load on the organism after major surgery.(journal of Parenteral and Enteral Nutrition19:333—340, 1995)

ISSN:0148-6071    

DOI:10.1177/0148607195019005333

出版商:SAGE Publications    

年代:1995

数据来源: WILEY

摘要:

Background:We have previously observed a potentiation of the metabolic response to cachectin/tumor necrosis factor (TNF) by total parenteral nutrition (TPN) but not in anorexic orally fed animals. We hypothesized that nutritional status might affect TNF clearance kinetics.Methods:We compared the clearance of a bolus of labeled TNF in TPN‐fed animals given sufficient nutrients to grow called weight‐gaining rats (WGR) with those given 50% of the WGR called weight‐losing rats (WLR) and with orally fed rats (OFR). Data were analyzed using a two‐compartment open system model and by linear systems analysis.Results:The data from both types of analysis indicated that although metabolic clearance was similar, WGR had a slower fractional TNF clearance rate (FCR) as well as a larger volume of distribution than WLR or OFR. Further analysis showed that an increased proportion of the total mass of TNF resided in a plasma‐associated compartment in WGR compared with WLR and OFR. In addition, WGR had reduced uptake of labeled TNF by the kidney.Conclusion:The data suggest that nutrition support influences either the distribution of TNF or the FCR, resulting in a greater retention in the plasma‐associated compartment with intact absolute removal rates. This study has important implications concerning the type of nutrition support provided to the critically ill patient because our data suggest that clinical states with increased circulating TNF levels may be adversely affected by currently available nutritional practices.(journal of ParenteralandEnteralNutrition 19:341–350, 1995)

ISSN:0148-6071    

DOI:10.1177/0148607195019005341

出版商:SAGE Publications    

年代:1995

数据来源: WILEY

摘要:

Background:The purpose of the present study was to evaluate the effect of sodium selenite on skeletal and cardiac muscular function in patients with severe Se deficiency.Methods:Skeletal and cardiac muscular function was investigated in 10 selenium depleted patients on long‐term home parenteral nutrition because of short bowel syndrome. The following examinations were applied: Skeletal muscle biopsy, muscular force test (Kin‐Com dynamometer test), electromyography (EMG) and radionuclide ventriculography. The patients were blindly randomized to intravenous supplementation with selenium 200 μg 5 to 7 times per week or placebo for 4 months. Hereafter the examinations were repeated. The patients randomized to placebo received selenium in an open study for a further 4 months and hereafter their skeletal and cardiac function was reevaluated.Results:Plasma selenium increased to normal levels from median.21 μmol/l (range 0 ‐.69) to 1.25 μmol/l (range.9 ‐ 2.27) following selenium repletion. The muscle biopsies showed only minor abnormalities. The only change after selenium supplementation was a small but statistically significant increase of the mean diameter of fiber type 1. The muscle strength of the quadriceps muscle was unchanged after selenium substitution. EMG did not reveal signs of myopathy. The cardiac function was normal and remained unchanged.Conclusion:Despite severe selenium depletion ten patients on long term home parenteral nutrition had normal cardiac function, and no clinically significant signs of skeletal myopathy. The only change after selenium supplementation was a small but statistically significant increase of the mean diameter of muscle fiber type 1.(Journal of Parenteral and Enteral Nutrition19:351–355, 1995)

ISSN:0148-6071    

DOI:10.1177/0148607195019005351

出版商:SAGE Publications    

年代:1995

数据来源: WILEY

摘要:

Background:The purpose of the study was to evaluate, using meta‐analysis techniques, whether enteral nutrition is effective in inducing clinical remission in active Crohn's disease.Methods:Randomized trials either comparing enteral nutrition with steroids or comparing elemental (amino acid‐based) with nonelemental diets were selected using MEDLINE (1984 to 1994), reference lists from published articles, reviews, and abstracts from major gastrointestinal meetings. Sixteen studies fulfilled the inclusion criteria (four published as abstracts). Crude rates for induction of remission were collected on an intention‐to‐treat basis by three independent observers. Each study was given a quality score, based on predetermined criteria.Results:The pooled odds ratio (OR) for all type of enteral diets compared with steroid therapy was 0.35 (95% CI, 0.23 to 0.53). This result was similar for the best studies (by quality score) combined, for trials using tube feeding combined, and when noncompliant patients were withdrawn. Further subgroup analyses were conducted on the basis of the type of diet administered. Peptide‐based diets were significantly inferior to steroids (pooled OR, 0.32; CI, 0.20 to 0.52). There was a trend to lower remission rate after elemental diets than after steroids (pooled OR, 0.44; CI 0.17 to 1.12). On the other hand, pooled OR for whole protein‐based diets compared with elemental diets was 1.28 (CI, 0.40 to 4.02).Conclusions:Data available to date show that steroids are better than enteral nutrition to induce remission in active Crohn's disease. These results are more evident when peptide‐based diets are administered, but they are not conclusive when either elemental or whole protein‐based diets are used.(journal of Parenteral and Enteral Nutrition19:356–364, 1995)

ISSN:0148-6071    

DOI:10.1177/0148607195019005356

出版商:SAGE Publications    

年代:1995

数据来源: WILEY

摘要:

Background:Enteral nutrition regimens achieve remission from active Crohn's disease at rates comparable to steroids and total parenteral nutrition. Despite their increasing use there has to date been no assessment of patient tolerance or practical difficulties involved.Methods:We investigated 147 treatments with elemental diet in 89 patients and followed this with an anonymous questionnaire.Results:Sip feeding was successfully introduced in 85% with nasogastric feeding being necessary in 22 (15%). Nausea and postural hypotension were common in the first week of treatment but vomiting was only seen in three patients who were sensitive to the formula used. Two patients each had caffeine withdrawal symptoms and hypoglycemia and a further four had food‐related night terrors. Our experience suggests that caution is necessary if this treatment is used in elderly subjects. Although the diets are perceived as being unpalatable, only six patients found taste to be a problem after the first week of treatment. The main problem with long‐term treatment was the large daily volume requirement, which was overcome by increasing the concentration of the feed. Eighty percent of patients responded to the questionnaire, and 65% stated that they would opt for treatment with elemental diet again in the case of a further relapse.Conclusions:Elemental diet seems to be an acceptable and well‐tolerated form of treatment in Crohn's disease.(Journal of Parenteral and Enteral Nutrition19:365–368, 1995)

ISSN:0148-6071    

DOI:10.1177/0148607195019005365

出版商:SAGE Publications    

年代:1995

数据来源: WILEY

摘要:

Background:Prolonged parenteral nutrition with lipid emulsions is essential to provide sufficient energy supply and to avoid essential fatty acid deficiency in preterm infants. However, chronic administration of lipid emulsions may lead to the development of pathological plasma lipid and LP‐X concentrations. The aim of this study was to evaluate the relative importance of the phospholipid‐triglyceride (PL‐TG) ratio and the source of phospholipid in lipid emulsions, with respect to plasma lipid and LP‐X levels.Methods:Rats were infused for 9 days with IV lipid emulsion containing 10% (IL‐10) or 20% (IL‐20) egg lecithin or Lipofundin containing 20% soya lecithin (LF), with PL‐TG ratios of.12,.06, and.075, respectively. Results: LF significantly increased plasma triglyceride concentration(p<.01), whereas the rise in cholesterol levels observed with all emulsions was primarily caused by the increase in low‐density lipoprotein cholesterol concentrations. The plasma phospholipid concentration was increased most by IL‐10 (p<.005). There was a strong correlation between the PL‐TG ratio of emulsions and the developing plasma phospholipid and LP‐X concentrations(r2=.91 and.96, respectively), despite the different origin of phospholipids in the emulsions, suggesting that it is the PL‐TG ratio, rather than the source of phospholipids in lipid emulsions that primarily influences developing plasma lipid and LP‐X concentrations.Conclusion:These results indicate that the administration of lipid emulsions with lower PL‐TG ratios should be considered, to avoid the development of pathological plasma lipoprotein concentrations.(Journal of Parenteral and Enteral Nutrition19:369–372, 1995)

ISSN:0148-6071    

DOI:10.1177/0148607195019005369

出版商:SAGE Publications    

年代:1995

数据来源: WILEY

摘要:

Background:Blood plasma of neonates is less able to inhibit iron induced lipid peroxidation than plasma of older patients. Copper, also a powerful pro‐oxidant, may accumulate in ill babies because of excess intake or decreased excretion. We assessedin vitrothe ability of plasma of neonates to inhibit copper induced peroxidation damage.Methods:Peroxidation of phospholipid liposomes, induced by CuCl2, was measured with a thiobarbituric acid assay. The ability of plasma from venous blood of adults and cord blood of babies to inhibit peroxidation was compared. The levels of the copper binding plasma proteins, albumin and ceruloplasmin, were also measured. Results: Protection against copper induced lipid peroxidation was much higher with adult plasma compared to neonatal plasma. Despite their lower albumin and ceruloplasma levels the protection by the plasma of preterm babies was higher than that of the term babies.Conclusions : At birth, babies have a limited ability to inhibit copper induced oxidative damage in vitro. Postnatal studies are needing to assess the influence of maturation and nutrition on these findings and their relevance in diseases induced by reactive oxygen species.(Journal of Parenteral and Enteral Nutrition19:373–375, 1995)

ISSN:0148-6071    

DOI:10.1177/0148607195019005373

出版商:SAGE Publications    

年代:1995

数据来源: WILEY

摘要:

Background:Because the interrelationship between the parenchymal cell population and the microvasculature is critical in normal organ function, the effects of starvation on rat myocardium were studied morphometrically with respect to the microvasculature.Methods:Morphometric analytical studies were performed on myocardium of adult, female Wistar rats (groups of 5–7 rats) on fasting days 0, 1, 2, 4, 6, 8 and 10. Since cardiac muscle is a tissue with a high level of anisotropy, methods based on the concept of vertical planes were used to describe quantitative alterations in the rat myocardium both at the cellular and ultrastructural level.Results:Morphometric analysis of electromicrographs of myocardium showed an increase in capillary density together with a decrease in capillary lumen cross‐sectional area during starvation (p<.05). There was no significant change in volume fraction of the capillaries but surface density of the myocytes increased significantly (p<.01) and the diffusion distance for oxygen from the capillary lumen to the mitochondrion decreased(P<.01).Conclusions: Malnutrition alters the interrelationship between parenchyma and vascularization in the heart. This leads to a significant decrease of the diffusion distance for metabolites. This decrease of diffusion distance may improve cellular energy supply and offers a relative protection of the metabolism in the malnourished myocyte.(journal of Parenteral and Enteral Nutrition19:376–380, 1995)

ISSN:0148-6071    

DOI:10.1177/0148607195019005376

出版商:SAGE Publications    

年代:1995

数据来源: WILEY

摘要:

Background:It has been proposed, on the basis of animal experiments, that medium‐chain triglycerides (MCT) may exert more favorable effects on whole body metabolism of injured animals than long‐chain triglycerides (LCT). Therefore, the present study was designed to evaluate whether structured triglycerides are associated with increased whole body fat oxidation without promotion of ketogenesis in postoperative patients.Methods:A structured lipid emulsion (73403 Pharmacia, Sweden) containing medium‐ and long‐chain fatty acids, esterified randomly to glycerol in a triglyceride structure, was used. Whole body fat oxidation was determined by indirect calorimetry in the postoperative period. Patients were randomized to receive structured lipids 1 day followed by LCT (Intralipid, Pharmacia) the next day orvice versaduring 6 postoperative days. In part 1 of the study patients received fat at 1.0 g/kg per day in the presence of 80% of the basal requirement of nonprotein calories. In part 2 patients received fat at 1.5 g/kg per day in the presence of 120% of the nonprotein caloric requirement. Amino acids were always provided at 0.15 g N/kg per day.Results:Structured lipids were not associated with any side effects, were rapidly cleared from the plasma compartment, and were rapidly oxidized without any significant hyperlipidemia or ketosis. Provision of structured lipids in the presence of excess of nonprotein calories (part 2) caused a significantly higher whole body fat oxidation (2.4 ± 0.05 g/kg per day) compared with LCT provision (1.9 ± 0.06 g/kg per day) (p<.0001) examined in the same patients.Conclusions:The results demonstrated for the first time in man that provision of structured triglycerides were associated with increased whole body fat oxidation in stressed postoperative patients, which is in line with the original metabolic and biochemical concept for structured triglycerides. The study provided evidence to support that structured lipids may represent a next generation of IV fat emulsions that may be clinically advantageous compared with conventional LCT emulsions in certain clinical conditions.(journal of Parenteral and Enteral Nutrition19:381—386, 1995)

ISSN:0148-6071    

DOI:10.1177/0148607195019005381

出版商:SAGE Publications    

年代:1995

数据来源: WILEY

摘要:

Background:Immunosuppression after severe head injury has been characterized by a depressed CD4 (T‐helper/inducer)‐CD8 (T‐suppressor/cytotoxic) ratio and decreased T‐lymphocyte responsiveness. Some investigators propose that this immunocompromized state is the result of an injury‐associated hypermetabolic response and inadequate nutrient delivery during the immediate postinjury recovery phase. Previous observations from our institution demonstrated a preserved CD4‐CD8 ratio in severe closed‐head injury (CHI) patients receiving early parenteral nutrition (PN). It was unclear whether early PN or other aspects of patient care eliminated the characteristic depression in cellular immunity. The purpose of this study was to further investigate the effect of early PN on the immune function of CHI patients.Methods:Nine patients sustaining severe CHI were prospectively randomized to either early PN (n = 4) at day 1 or delayed PN (n = 5) at day 5. Total nutrient administration was delivered at 2 g of protein/kg per day and 40 nonprotein kcal/kg per day for at least the first 14 days of hospitalization. Analysis for T‐lymphocyte expression of CD4 and CD8 cell surface antigens and interleukin‐6 was performed on days 1, 3, 7, and 14 of hospitalization. T‐lymphocyte activation in response to stimulation by concanavalin A (Con A), phytohemagglutinin (PHA), and pokeweed mitogens (PWM) was also assessed on these days.Results:Significant increases in total CD4 cell counts (2048 ± 194 to 2809 ± 129 vs 1728 ± 347 to 1825 ± 563,p<.05) and CD4% (42.6 ± 4.4% to 56.2 ± 2.6% vs 36.6 ± 6.6% to 36.6 ± 11.3%,p<.05) were observed at day 14 in patients receiving early vs delayed PN. An improved lymphocyte response from baseline to day 14 after Con A stimulation was demonstrated in the early PN group (3850 ± 1596 to 16144 ± 5024 cpm,p<.05). A significant rise in the CD4‐CD8 ratio over baseline to day 14 was also noted in the early PN group (1.43 ± 0.17 to 2.38 ± 0.54,p<.05).Conclusions:The early aggressive nutrition support of CHI patients appears to modify immunologic function by increasing CD4 cells, CD4‐CD8 ratios, and T‐lymphocyte responsiveness to Con A. (Journal of Parenteral and Enteral Nutrition19:387–392, 1995)

ISSN:0148-6071    

DOI:10.1177/0148607195019005387

出版商:SAGE Publications    

年代:1995

数据来源: WILEY