ISSN:0148-6071    

DOI:10.1177/0148607193017005401

出版商:SAGE Publications    

年代:1993

数据来源: WILEY

ISSN:0148-6071    

DOI:10.1177/0148607193017005403

出版商:SAGE Publications    

年代:1993

数据来源: WILEY

摘要:

The objective of this validation study was to explore bioelectric impedance analysis (BIA) as a way to assess nutritional status and body composition. The study was done in the outpatient department of the AIDS unit at University Hospital Dijkzigt, Rotterdam, The Netherlands. Eleven clinically stable patients with AIDS were studied. Total body water, body fat, lean body mass, and body cell mass were measured and calculated with multiple dilution techniques and BIA. With linear regression analysis, a strong correlation was found between total body water and lean body mass derived from BIA and multiple dilution techniques (r2=.96 and.98, respectively), and slightly weaker correlation was found for body cell mass and body fat (r2=.88 and.76, respectively). These results suggest that BIA is a suitable method for the assessment of body cell mass in HIV‐infected patients without opportunistic infections. The technique is safe, noninvasive, fast, and inexpensive. (Journal of Parenteral and Enteral Nutrition17:404–406, 1993)

ISSN:0148-6071    

DOI:10.1177/0148607193017005404

出版商:SAGE Publications    

年代:1993

数据来源: WILEY

摘要:

In a paper by Ziegler et al (Ann Intern Med 116:821–828, 1992), total parenteral nutrition supplemented with L‐glutamine (TPN/GLN) was reported beneficial in patients receiving bone marrow transplantation (EMT) for hematologic malignancies. By using a similar protocol, we studied 29 patients with both hematologic malignancies and solid tumors, and with both allogeneic and autologous BMTS. In a double‐blind, randomized approach, patients were given isocaloric, isonitrogenous TPN after BMT until they consumed 50% of their required diet orally. Total body water and extracellular water were measured before and after TPN in 10 patients. Total body water increased in patients receiving standard TPN and decreased significantly in patients receiving TPN/GLN. Length of hospital stay after BMT was significantly (5.8 days) less in patients receiving TPN/GLN. Incidence of positive bacterial cultures, clinical infections, and mortality did not differ significantly between the two groups. When the groups were subdivided into patients with hematologic malignancies and those with solid tumors, there were no significant differences in the above variables associated with TPN/GLN. In 17 of 30 additional hospitalized patients receiving standard TPN, substitution of TPN/GLN did not have discernible clinical or laboratory effects but appeared to be safe. Inclusion of patients with solid tumors and a higher mortality in our patients may have obscured beneficial effects of TPN/GLN observed by others. (Journal of Parenteral and Enteral Nutrition17:407–413, 1993)

ISSN:0148-6071    

DOI:10.1177/0148607193017005407

出版商:SAGE Publications    

年代:1993

数据来源: WILEY

摘要:

Estimations of total urinary nitrogen from measured urinary urea nitrogen are commonly used in calculating nitrogen balance. Recently published studies suggest the urinary urea nitrogen/total urinary nitrogen relationship is inconstant and total urinary nitrogen must be directly measured in burned patients. This study addresses the relationship of urinary urea nitrogen to total urinary nitrogen after thermal injury. Two hundred random 24‐hour urine collections obtained from 45 thermally injured patients (mean burn size 59 ± 28%, mean age 40.5 ± 17.2 years) between 1 and 354 days postburn were analyzed for total urinary nitrogen and urinary urea nitrogen. Regression analysis relating total urinary nitrogen to estimated total urinary nitrogen (urinary urea nitrogen x 1.25) revealed a linear relationship (r=.936,p<.001). The mean urinary urea nitrogen/total urinary nitrogen ratio was 0.77 ± 0.10 and was not significantly correlated with percent burn, age, or postburn day. Mean nitrogen balance calculated from measured urinary urea nitrogen in these patients was ‐5.7 g, and that calculated from measured total urinary nitrogen was ‐6.3 g. This difference, although statistically significant, is of little consequence for clinical use. Contrary to recent reports, we found the urinary urea nitrogen to be sufficiently predictive of total urinary nitrogen for practical application, and do not consider routine total urinary nitrogen measurements necessary for the nutritional care of thermally injured patients. (Journal of Parenteral and Enteral Nutrition17:414–416, 1993)

ISSN:0148-6071    

DOI:10.1177/0148607193017005414

出版商:SAGE Publications    

年代:1993

数据来源: WILEY

摘要:

Total parenteral nutrition (TPN) has been shown to alter the serum concentration of certain gastrointestinal hormones. However, the effects of surgical and nutritional techniques have not been evaluated adequately. This study examined the effects of those techniques on serum gastrin and secretin levels in Fischer 344 rats fed TPN. After aseptic superior vena cava cannulation and a 4‐day postoperative recovery period with ad libitum access to food and water, 18 rats were randomly and equally (n = 6) assigned to either (1) a baseline group, killed after the recovery period; (2) a TPN group fed sufficient nutrients (67% dextrose, 21.7% amino acid, 11.3% fat) and kilocalories (1.45 kcal/mL) for normal growth and development; or (3) an orally fed (OF) group fedad libituma powdered diet isocaloric and isonitrogenous to the TPN solution. Both the TPN and OF groups were fed for 5 days and then killed. Another set of six rats without surgery served as a control (CON) group and had the same diet protocol as the OF group. Serum was analyzed for gastrin and secretin by radioimmunoassay. The OF group had significantly (p<.01) lower gastrin levels than the CON group. Gastrin levels of OF rats were twofold lower (p<.04) than those of the TPN rats and were threefold greater (p<.02) than those of the baseline group. Secretin levels in OF rats were twice as high (p<.02) as those in CON rats. The OF group showed a trend toward significantly (p<.09) higher serum secretin levels when compared with the TPN group. These data indicate that surgery and route of nutrient intake affect gastrointestinal hormone levels. Surgery decreases gastrin and increases secretin, whereas the infusion of TPN tends to normalize these hormone levels in rats. (Journal of Parenteral and Enteral Nutrition17:417–421, 1993)

ISSN:0148-6071    

DOI:10.1177/0148607193017005417

出版商:SAGE Publications    

年代:1993

数据来源: WILEY

摘要:

Nutritional effects have traditionally focused on outcomes, such as nitrogen balance, wound healing, or muscle strength. Little emphasis has been placed on how biochemical or physical improvements translate into functional changes as perceived by the patient. Because glutamine (GLN)‐supplemented nutrition promotes protein synthesis and improves nitrogen balance, we assessed the mood of individuals participating in a randomized controlled blinded trial receiving GLN solutions. Patients (n = 23) undergoing marrow transplantation were randomized by the research pharmacist to receive either standard total parenteral nutrition (TPN) (control) or GLN‐containing TPN (40 g of glutamine total). The solutions were isocaloric and isonitrogenous and were administered until the patient was eating 50% of estimated requirements. Before TPN and on admission to the hospital, the patient completed the Profile of Mood States questionnaire, a standardized test quantifying the degree of tension, depression, anger, vigor, fatigue, and confusion. The patient completed the questionnaire again at the end of TPN near discharge. The tests were scored and the change from baseline for each mood for both groups of patients was calculated at the completion of TPN. The scores for vigor in the control group (Δ scores) decreased over the course of hospitalization as would be expected with a serious illness. The group receiving glutamine TPN, however, essentially showed little change in vigor from baseline and the Δ score was significantly different from the control group (Δ vigor score ‐0.85 ± 2.1 in the glutamine groupvs‐5.90 ± 1.7 in the control group;p=.07). The control group exhibited little change in feelings of anger over the course of hospitalization; however, the glutamine TPN group felt significantly less angry at the completion of TPN than the control group (Δ anger score ‐6.2 ± 1.6 in the glutamine groupvs‐0.5 ± 2.5 in the control group;p=.052). There was a trend for the total mood score (all six moods evaluated together) to exhibit improvement (p= 1). The GLN group also was discharged from the hospital sooner and had fewer infectious episodes. This is one of the first studies to illustrate an improvement in patients' psychosocial status associated with a nutrition intervention. GLN may influence patients' feelings of well‐being either directly by affecting central nervous system neurotransmitters or through its effects on the protein status of patients. Psychosocial testing may prove useful in evaluating the functional status of patients receiving nutrition support. (Journal of Parenteral and Enteral Nutrition17:422–427, 1993)

ISSN:0148-6071    

DOI:10.1177/0148607193017005422

出版商:SAGE Publications    

年代:1993

数据来源: WILEY

摘要:

Low profile, self‐retaining feeding conduits (“buttons”) inserted percutaneously through a mature gastrostomy stoma are ideal for prepyloric feeding. We tested the efficacy of a surgically inserted button (Button, C.R. Bard, Inc) in the jejunum for long‐term postpyloric feeding. Forty‐two aspiration risk patients were prospectively randomized to receive a standard No. 14 French red rubber catheter (n = 21, mean age 68 ± 17 years) or the button (n = 21, mean age 68 ± 18 years). Common indications for jejunal feeding were aphagia due to obtundation (41%) and esophageal dysmotility (41%). All feeding devices were inserted 20 cm distal to the ligament of Treitz via a serosal tunnel (catheter) or double pursestring (button) technique. No patient required reoperation, and cardiopulmonary failure was the most frequent cause of death, occurring in 11 patients (26%). Goal feedings were obtained in 91% of the catheter patients and 100% of the button patients by postoperative day 4.7 ± 1.9 and 4.2 ± 2.2, respectively. At a follow‐up of 43 ± 13 days, 12 (92.3%) of 13 catheter patients and 9 (81.8%) of 11 button patients were receiving goal feedings. Three patients in the catheter group and four patients in the button group had resumed an oral diet. Device‐related complications (dislodgment, occlusion, peritubular leak, or bowel obstruction) and total number of patients with complications were significantly lower in the button group (one [5%]vseight [38%] for device‐related complications and one [5%]vssix [29%] for incidence of complications for the button and catheter groups, respectively). The jejunostomy button appears to be an attractive alternative for selected patients requiring long‐term postpyloric feeding. (Journal of Parenteral and Enteral Nutrition17:428–431, 1993)

ISSN:0148-6071    

DOI:10.1177/0148607193017005428

出版商:SAGE Publications    

年代:1993

数据来源: WILEY

摘要:

Hypertriglyceridemia induced by short‐term lipid infusions causes redistribution of neutral lipid components between endogenous lipoproteins and emulsion particles. To determine whether such redistribution occurs over a long‐term infusion period and affects lipoprotein pattern, we studied seven patients with inflammatory bowel disease who received cyclic home parenteral nutrition for two consecutive periods of 3 months with two different lipid emulsions. During each period, they received in random order either an emulsion composed exclusively of soy‐derived long‐chain triglycerides (LCTs) or another emulsion containing an equal weight:weight mixture of long‐ and medium‐chain triglycerides (MCTs/LCTs). Both emulsions contained 20 triglycerides (TGs) and 1.2 phospholipids. Lipids provided 50 of nonprotein energy. Blood samples were taken once a week, 1 hour before the end of infusion (during) and again after a 6‐ to 8‐h lipid‐free interval (baseline). During infusion, there was a moderate increase of plasma TGs and phospholipids and a slight decrease of plasma esterified cholesterol (CE) and free cholesterol. Most of the plasma TGs increase occurred in the very‐low‐density lipoprotein fraction (containing both emulsion particles and the endogenous very‐low‐density lipoprotein), but there was also an increase of TGs content in low‐density lipoprotein (LDL) and high‐density lipoprotein (HDL) that was more pronounced with MCTs/LCTs. Acquisition by exogenous particles of CE transferred from LDL and HDL was significant for the LCT emulsion only. Although no change was observed in plasma lipid concentration of baseline samples during 3 months of home parenteral nutrition, some modifications were observed in the composition of lipoprotein fractions demonstrating a redistribution of lipid components. TGs transferred to LDL were not efficiently cleared during the 6‐ to 8‐hour lipid‐free interval leading to a slight increase of LDL‐TGs with both LCTs (0.31 to 0.36 mmol/L) and with MCTs/LCTs (0.27 to 0.40 mmol/L). HDL‐CEs tended to decrease, whereas LDL‐CEs tended to increase with LCTs. A substantial increase of the LDL‐CE/HDL‐CE ratio occurred after 3 months of home parenteral nutrition with LCTs (1.76 to 3.81;p<.025) but not with MCTs/LCTs (1.91 to 1.44; not significant). (Journal of Parenteral and Enteral Nutrition17:432–437, 1993)

ISSN:0148-6071    

DOI:10.1177/0148607193017005432

出版商:SAGE Publications    

年代:1993

数据来源: WILEY

摘要:

Thirty‐three current long‐term total parenteral nutrition (TPN) patients (13 men, 20 women) aged 21 to 79 years were prospectively studied to evaluate their change in glomerular filtration rate since beginning TPN. Creatinine clearance (CrCl) from the subject's initial home TPN clinic visit and at present were estimated from standard formulas and compared. The CrCl in 12 patients who had received home TPN for>10 years was estimated retrospectively on a yearly basis. The estimated CrCl as an accurate measure of glomerular filtration rate was confirmed by measuring plasma indium‐111 diethylenetriamine pentaacetic acid clearance. The mean daily intravenous protein intake and days during which nephrotoxic medications were used and number of bacteremic/fungemic episodes were determined for each subject. CrCl declined by 3.5 ± 6.3% per year (p=.004). Twenty‐nine of 33 patients had decreases of 0.6% to 15.4% per year. Tubular function, as determined by the tubular reabsorption of phosphate, was impaired in 52% of the subjects. The intravenous protein load averaged 1.28 ± 0.32 g/kg per day, nephrotoxic drug use averaged 3.4 ± 4.0% of all days on home TPN, and each patient averaged 2.3 episodes of bacteremia or fungemia since home TPN was started (0.5 ± 0.5 episodes per year). When all factors were assessed simultaneously, nephrotoxic drug use, episodes of bacteremia/fungemia, and age accounted for approximately 46% of the variability in CrCl. When bacteremia/fungemia was expressed as a yearly rate, nephrotoxic drug use assumed no role in the glomerular filtration rate determination; infection rate and age alone accounted for 53% of the CrCl variability. We describe a profound decrease in renal function associated with long‐term TPN, most of which is largely unexplained. (Journal of Parenteral and Enteral Nutrition17:438–444, 1993)

ISSN:0148-6071    

DOI:10.1177/0148607193017005438

出版商:SAGE Publications    

年代:1993

数据来源: WILEY