摘要:

Growth failure is the most common extraintestinal manifestation of Crohn's disease in childhood, occurring in up to 50% to 88% of affected patients. Previous studies have shown malnutrition to be the most likely cause of the decrease in height and weight velocities in these children. The purpose of this study was to determine the effect of an intermittent defined formula diet on growth and disease activity in children with Crohn's disease and growth failure. Six Tanner stage I‐II patients, mean age 13.6 years with height less than the 5th percentile or height velocity less than the 3rd percentile were enrolled in a 1‐year prospective study. An isotonic, hydrolyzed whey, medium‐chain triglyceride formula was given by nocturnal nasogastric infusion at a caloric equivalent of 50th percentile for age, as the exclusive nutrient source 1 out of 4 months during a 1‐year period. A 2‐week exclusion diet and a 2‐week low‐residue diet followed the defined formula diet before resuming the regular diet for 2 months. Patients served as their individual control based on observations of at least 1 year before the study. Height and weight velocity significantly increased. Prednisone intake significantly decreased, and significant improvement was seen in disease activity, albumin, and somatomedin C. The results indicate that an intermittent defined formula diet can improve growth failure and significantly decrease disease activity in children with Crohn's disease.(Journal of Parenteral and Enteral Nutrition16:499–504, 1992)

ISSN:0148-6071    

DOI:10.1177/0148607192016006499

出版商:SAGE Publications    

年代:1992

数据来源: WILEY

摘要:

The aim of this study was to compare the efficiency of ornithine α‐ketoglutarate (OKG) and glutamine supplementation in an experimental model of denutrition that provides well‐characterized disturbances of amino acid patterns. Male Wistar rats (187 ± 11 g; five in each group) were starved for 3 days and then refed for 7 days with an oral diet (192 kcal kg−1· day−1and 2.25 g of nitrogen kg−1· day−1), supplemented with 0.19 g of nitrogen kg−1· day−1in the form of OKG, glutamine, or casein (control group). Food deprivation induced a fall in most tissue amino acids, with the notable exception of muscle leucine and liver glutamate, which increased by 43% (p<.01), and 11% (p<.05), respectively. The main effect of OKG was seen in the viscera, with a normalization of most amino acid pools (including proline and branched‐chain amino acids) in the small bowel and liver. The main effect of glutamine was observed in the muscle, with a normalization of the glutamine and leucine pools. We conclude that, in this model and with the doses used, OKG and glutamine act in different target tissues, ie, splanchnic areas and muscle, respectively. (Journal of Parenteral and Enteral Nutrition16:505–510, 1992)

ISSN:0148-6071    

DOI:10.1177/0148607192016006505

出版商:SAGE Publications    

年代:1992

数据来源: WILEY

摘要:

The metabolic consequences of excessive nutrition support in patients have been increasingly recognized in recent years. Time‐dependent optimal nutrition support is desired for an early and uncomplicated recovery after severe injury or illness. Metabolic effects of adding balanced amino acids to glucose infusion during total parenteral nutrition were investigated in 18 patients after major trauma (injury severity score 32 ± 2). Two studies were conducted on each subject, one in the early “flow” phase of injury (40–60 hours postinjury) in the basal state without any dietary intake and then after 4 to 6 days of intravenous nutrition provided solely as glucose (24 ± 2 kcal/kg per day, 80% resting energy expenditure, n = 8) or isocaloric glucose (28 ± 3 kcal/kg per day) with amino acids (275 ± 28 mg of nitrogen per kilogram per day, n = 10). Whole‐body fuel substrate kinetics were studied for energy metabolism (indirect calorimetry), protein kinetics (primed‐constant infusion of15N glycine), and lipid mobilization (two‐stage infusion of 10% glycerol). Injury‐induced hypoaminoacidemia was equally modulated whether the glucose‐based nutrition had amino acids or not. The negative nitrogen balance is reduced similarly in both groups. Protein breakdown rate is significantly (p=.025) decreased in both groups and it is more so (30%us18%) in patients receiving total parenteral nutrition. Intravenous nutrition could not stimulate protein synthesis. Whole‐body lipolysis rate as well as net fat oxidation rate are suppressed more when glucose alone is given, and this also results in less reesterification. Provision of intravenous glucose alone, not to exceed the resting energy expenditure, seems to be superior to isocaloric glucose with amino acids during this early catabolic flow phase of injury because the injured body could not assimilate this exogenous amino acid.(Journal of Parenteral and Enteral Nutrition16:511–520, 1992)

ISSN:0148-6071    

DOI:10.1177/0148607192016006511

出版商:SAGE Publications    

年代:1992

数据来源: WILEY

摘要:

The objectives of this study were to investigate the effects of an excess of xylitol on nitrogen balance and glucose metabolism in parenterally fed rats. Female Sprague‐Dawley rats (200–250 g, n = 17) were catheterized for total parenteral nutrition and then randomized into two groups based on subsequent diet. The two diets used were isonitrogenous (1.5 g of nitrogen per kilogram per day) and isocaloric, with half the calories (125 kcal/kg per day) being derived from lipid (125 kcal/kg per day) and the other half from either glucose or xylitol (125 kcal/kg per day). The rats were fed a half‐strength total parenteral nutrition diet for the day after surgery and a full‐strength total parenteral nutrition diet for the following 4 days. Urines were collected daily for the determination of nitrogen balance. On day 5, the rats were given a 7‐ to 8‐hour infusion of 6,6‐d2 glucose (6 mg/h and 2‐d1glucose (12 mg/h). At the conclusion of the isotope infusion period, the rats were killed and blood was collected. Urine output was increased by122% per day in the xylitol‐treated rats, and they excreted 46.5 mmol of xylitol per liter per kilogram per day (7.1 g/kg per day, ∼22.7% of dose). The xylitol group lost weight, had poorer nitrogen balance (341 ± 31vs83 ± 29 mg/kg per day [mean ± standard error of the mean], p<.05), and developed fatty livers. Analysis of the liver fat distribution pattern indicated that the source of the excess hepatic lipid was dietary fat. Substitution of xylitol for glucose had no effect on total glucose appearance as measured with 6,6‐d2glucose (1238 ± 76vs1294 ± 113 mg/kg per day), but the rate of glucose cycling was markedly reduced (1518 ± 101vs764 ± 63 mg/kg per day, p<.05). The adverse effects of xylitol in this study were due to a caloric deficit secondary to a combination of (1) exceeding the renal threshold for xylitol and (2) hepatic steatosis.(Journal of Parenteral and Enteral Nutrition16:521–524, 1992)

ISSN:0148-6071    

DOI:10.1177/0148607192016006521

出版商:SAGE Publications    

年代:1992

数据来源: WILEY

摘要:

The methods of continuous (C) and intermittent (I) nasogastric tube feedings in 60 patients, 54 men and 6 women, with a mean age of 72 ± 9 years were compared in terms of number of complications, staff time used, and caloric intake. Patients were randomly assigned between these two methods and followed for 7 days. Diarrhea, aspiration pneumonia, clogged tubes, and self‐extubation were observed in both groups. Diarrhea was significantly more frequent (96% of 30 patients) in the I group than the C group (66% of 30 patients) (p<.008). Furthermore, diarrhea was more prolonged (4 days or more) in 64% of 30 patients in the I group than the C group (4 days or more) in 58% of 30 patients (p<.02). However, clogged tubes occurred 3 times more often in the C group (p<.01). Self‐extubation and aspiration pneumonia tend to be more frequent in the I group but the difference was not significant. The average time used by staff nurses in the maintenance of NGT feedings was not significantly longer in the I group (48.45 ± 11 min/patient per day) than the C group (46.46 ± 11 min/ patient per day). In the C group the mean calories recommended were 2248 ± 36 kcal/day but the actual caloric intake was only 1465 ± 281 kcal/day, a deficiency of 783 ± 291 kcal/day. The recommended calorie count for the I group was 2021 ± 5 kcal/ day but the amount delivered was only 1226 ± 254 kcal/day, which resulted in a deficit of 795 ± 259 kcal/day. This difference in calories recommended and actually delivered in the C and I groups was not significant. (Journal of Parenteral and Enteral Nutrition16:525–528, 1992)

ISSN:0148-6071    

DOI:10.1177/0148607192016006525

出版商:SAGE Publications    

年代:1992

数据来源: WILEY

摘要:

Overgrowth of Gram‐negative bacteria as a result of total parenteral nutrition (TPN) and bowel rest could be responsible for the release of a variety of hepatotoxic substances such as endotoxin or tumor necrosis factor (TNF) and the ensuing TPN‐associated liver function derangements. Polymyxin B is an effective antimicrobial agent as well as a blocking agent for endotoxin (lipopolysaccharide) activity and TNF production. In the present study we compared the oral and intravenous effects of polymyxin in rats receiving TPN in an attempt to define these two possible mechanisms of action of polymyxin on TPN‐associated hepatic steatosis.Both oral, as well as intravenous polymyxin B, significantly reduced total hepatic fat and triglyceride accumulation in TPN rats, more so in the intravenous group exhibiting close to control levels. Both polymyxin‐treated groups exhibited significantly lower Gram‐negative bacterial counts in the cecum, with the oral group exhibiting a lower count than the IV group. The spontaneous production of TNF by peritoneal macrophages was markedly increased in rats receiving TPN and very close to being undetected in both groups receiving TPN and polymyxin.We believe polymyxin B protects the liver during TPN by both its antimicrobial effect which prevents overgrowth of gut Gram‐negative bacteria and the subsequent translocation of endotoxin, and by its specific antilipopolysaccharide activity which, in the present study, completely abolished hepatic steatosis and TNF production during TPN.(Journal of Parenteral and Enteral Nutrition16:529–532, 1992)

ISSN:0148-6071    

DOI:10.1177/0148607192016006529

出版商:SAGE Publications    

年代:1992

数据来源: WILEY

摘要:

Serum cholesterol‐lowering effects of oat bran‐enriched diets have been indicated in several studies in which oat bran was given several times a day. Concomitant changes in the daily diet, ie, a diminished energy intake or changes in the composition of fats in the diet, also have been reported and used to explain the hypocholesterolemic effect of oats. The present study was designed to replace only the conventional continental breakfast by a single oat bran cereal muesli containing 60 g of oat bran and to measure the effects of this dietetic modification on serum lipids in 13 patients with hypercholesterolemia type IIa. Compared with a 3‐week baseline period, total serum cholesterol (7.38 ± 0.35 mmol/L, mean ± SEM) was reduced by 10.9, 8.4, and 9.7% in the first, second, and third week of oat bran ingestion (p<.01). High‐density lipoprotein and low‐density lipoprotein cholesterol as well as apolipoprotein A1decreased to the same extent (8 to 11%; p<.05) during the oat bran period, whereas a pronounced reduction of 25.8% was seen for apolipoprotein B100(p<.01), which is a major component of low‐density lipoprotein. Dietary data obtained by 3‐day food records at baseline, oat bran, and follow‐up period did not show any differences between the study periods except for dietary fiber, which was increased from 21.9 g/day to 42.4 g/day (p<.002) during the test period because of the daily oat bran intake. On the basis of these results the simple replacement of a conventional continental breakfast by an oat bran cereal muesli can be highly recommended to lower total serum cholesterol and other atherogenic lipid fractions in patients with hyperlipoproteinemia type IIa. (Journal of Parenteral and Enteral Nutrition16:533–537, 1992)

ISSN:0148-6071    

DOI:10.1177/0148607192016006533

出版商:SAGE Publications    

年代:1992

数据来源: WILEY

摘要:

Dietary fiber supplementation may improve gastrointestinal tolerance and decrease diarrhea in patients receiving enteral formula diets. To compare the effects of two dietary fibers on bowel function parameters and short‐chain fatty acid excretion we fed 11 healthy men three defined enteral formula diets in random order for 18 days each. The test diets consisted of a fiber‐free formula and daily intakes of maltodextrin (0 g of fiber), 15 g of total dietary fiber as an enzymatically modified guar gum, and 15 g of total dietary fiber as soy polysaccharide. Data were also collected while subjects consumed self‐selected diets for 5 days. Mean transit time was longer and fecal moisture content was lower on 0 g of fiber and modified guar than on the self‐selected and soy diets. Furthermore, mean transit time was slightly longer and fecal nitrogen excretion greater on modified guar compared with 0 g of fiber. Daily fecal output and frequency of defecation were greater, fecal pH was lower, and fecal butyrate concentrations were higher on the self‐selected diet compared with the enteral formula diets. However, there was no difference in these parameters among the three liquid diets. Thus, despite significant differences in mean transit time, few differences in other parameters of bowel function were observed when healthy subjects consumed enteral formula diets containing 0 g of fiber and 15 g of total dietary fiber as modified guar and soy.(Journal of Parenteral and Enteral Nutrition16:538–544, 1992)

ISSN:0148-6071    

DOI:10.1177/0148607192016006538

出版商:SAGE Publications    

年代:1992

数据来源: WILEY

摘要:

This study examined the short‐term effects of three total parenteral nutrition solutions, each containing a different lipid source, on host and tumor protein metabolism in a rat cancer model. Each diet contained 220 kcal/kg per day, including 2 g of nitrogen/kg per day and 50% of nonprotein calories as either a structured lipid of medium‐chain triglycerides and fish oil, a physical mix of medium‐chain triglycerides and fish oil, or Liposyn II, a long‐chain triglyceride. A 3‐day intravenous feeding infusion began on day 7 after tumor implantation. Tumor growth rate, nitrogen balance, energy expenditure, and plasma albumin, glucose, and free fatty acids were measured, and whole body protein kinetics and fractional synthetic rates in liver, muscle, and tumor tissues were assessed using a constant infusion of14C‐leucine. The results revealed that tumor growth rate was slowed in structured lipid‐fed animals (p=.06, one‐way analysis of variance) with significant increases in rates of tumor protein synthesis and tumor protein breakdown (p<.001, one‐way analysis of variance). Although muscle fractional synthetic rates were significantly decreased in tumor‐bearing animals (p<.05, two‐way analysis of variance), the rates in structured lipid‐fed animals were restored. Nitrogen balance improved significantly in structured lipid‐fed animals. The results demonstrate that the source of lipid in total parenteral nutrition solutions can influence tumor and host protein metabolism, and that a structured lipid composed of medium‐chain triglycerides and fish oil seems to improve protein metabolism in host tissue without stimulating tumor growth.(Journal of Parenteral and Enteral Nutrition16:545–551, 1992)

ISSN:0148-6071    

DOI:10.1177/0148607192016006545

出版商:SAGE Publications    

年代:1992

数据来源: WILEY

摘要:

Enteral nutrition is an effective treatment for catabolic patients with normal intestinal absorption. However, tube‐fed patients are at risk from superinfection. Our study is the first to evaluatein vivothe microbial contamination of solutions staying in the nasogastric tube of cancer patients receiving nutritional preparations. After daily feeding, the tube was rinsed with nonsterile tap water. Tap water staying overnight in the tube was considered as tube‐rinsing solution. Microbial burden of nutritional preparations was determined on the fifth day of enteral nutrition, from opening the first container and throughout feeding. The next day, a sample of the tube‐rinsing solution was cultured. All bacterial species were identified and antibiotic susceptibility pattern was assessed. Thirty‐one cancer patients were included, 12 on the hospital's preparations and 19 on commercial feeding. Seven of the hospital—and none of the commercial—preparations were contaminated. Among the 48 samples collected during feeding, 16 were contaminated, including 10 hospital and 6 commercial preparations. All the 31 tube‐rinsing solutions were contaminated and 102 strains cultured. Their median concentration was 106colony‐forming units/mL (range 10–1010). The strains were 48 Enterobacteriaceae, 20 group D streptococci, 9Candida albicans,9Pseudomonas aeruginosa,and 16 others. Multiple antibiotic resistance was present in 12 of the 102 strains. Lower resistance was present in 33. The predominant microorganism of the tube‐rinsing solution caused a bacterial colonization for three febrile patients. In conclusion, the feeding tube is an important reservoir for multiple antibiotic‐resistant bacteria.(Journal of Parenteral and Enteral Nutrition16:552–557, 1992)

ISSN:0148-6071    

DOI:10.1177/0148607192016006552

出版商:SAGE Publications    

年代:1992

数据来源: WILEY