摘要:

Plasma fibronectin, which is an α2‐glycoprotein of importance for the immunodefence, has been reported to decrease after starvation and in severely ill patients with cancer. To evaluate the usefulness of fibronectin as an indicator of nutritional repletion, 18 patients with gastrointestinal disorders were studied over a 2‐wk period of total parenteral nutrition (TPN). According to nutritional assessment on admission the patients were divided into well nourished (n = 6) and malnourished (n = 12). For comparison nine patients with anorexia nervosa were also studied over a 3‐wk period of TPN. Before and after TPN fibronectin, albumin, prealbumin, transferrin, and two acute‐phase reactants, haptoglobin and orosomucoid were measured in plasma. The majority of the malnourished patients had an inflammatory reaction in contrast to only a few of the well‐nourished and anorexia nervosa patients. Of the proteins measured, only fibronectin rose significantly in the malnourished patients (malnourished and anorexia nervosa), but not in the well nourished patients during TPN. Our results may indicate the usefulness of fibronectin as an indicator of short‐term TPN in malnourished subjects, irrespective of the presence or absence of inflammatory response. (Journal of Parenteral and Enteral Nutrition 8:000–000, 1984)

ISSN:0148-6071    

DOI:10.1177/0148607184008005493

出版商:SAGE Publications    

年代:1984

数据来源: WILEY

摘要:

Small intestinal absorption was studied in 12 patients receiving enteral nutrition in the immediate postoperative period after colorectal surgery including construction of an ileostomy. Seven patients were given a peptide‐based, low osmolality elementary diet and five patients were given a polymeric diet. Comparisons between the intake and ileal excretion showed on both diets a high utilization of energy, fat, and nitrogen as well as of calcium, phosphorus, magnesium, zinc, and iron. From a nutritional point of view a polymeric diet could thus replace an elementary diet in the immediate postoperative course. (Journal of Parenteral and Enteral Nutrition 8:497–500, 1984).

ISSN:0148-6071    

DOI:10.1177/0148607184008005497

出版商:SAGE Publications    

年代:1984

数据来源: WILEY

摘要:

Empiric amphotericin B therapy was compared to central venous catheter withdrawal in a prospective randomized trial. Of 32 febrile, neutropenic patients with indwelling Broviac catheters and without documented infection, 14 had persistent fever while receiving broad spectrum antibacterial drugs. Six patients were randomized to catheter removal and eight patients received amphotericin B empirically. None of six patients responded to catheter removal and six of eight defervesced after receiving antifungal therapy (p<0.01). Of the six patients in whom catheters were removed, two later became afebrile while on subsequent therapy with amphotericin B. Culture and histologic evaluation of the removed catheters failed to implicate the prosthesis as an infectious source. Central venous catheters in a persistently febrile neutropenic host need not be removed, unless local difficulties or bacteremia with skin commensal organisms occur. Amphotericin B can be infused through a central venous catheter in febrile, neutropenic patients unresponsive to empiric antibacterial drugs, with many patients becoming afebrile as a result of this therapy.(Journalof Parenteral and Enteral Nutrition 8:501–505, 1984)

ISSN:0148-6071    

DOI:10.1177/0148607184008005501

出版商:SAGE Publications    

年代:1984

数据来源: WILEY

摘要:

A prospectively studied series of 1072 patients who received specialized nutritional support are presented to evaluate the patterns of such care in a large nonuniversity teaching center. Age, service, materials used, routes of administration, complications, assessment parameters, duration of treatment, diagnoses, and survival statistics are presented. Such patterns are considered to be of importance to medical scientists, basic researchers, hospital administrators, governmental agencies, and members of the health care insurance industry. (Journal of Parenteral and Enteral Nutrition 8:506–510, 1984)

ISSN:0148-6071    

DOI:10.1177/0148607184008005506

出版商:SAGE Publications    

年代:1984

数据来源: WILEY

摘要:

To assess postoperative progress 43 patients undergoing major abdominal procedures were randomized to be given normal postoperative electrolyte solutions alone or with the addition of 400 ml of essential amino acids. Postoperative measurements confirmed a nitrogen retention significant at 0.1%. Decreased breakdown of muscle was also shown by measuring the upper arm muscle circumference and by following the grip strength. Those treated had no significant muscle loss postoperatively but there was significant loss in those not receiving amino acids. The intravenous cannulae survived equally well in both groups. There was no demonstrable difference in the overall clinical progress. (Journal of Parenteral and Enteral Nutrition 8 :511–514, 1984)

ISSN:0148-6071    

DOI:10.1177/0148607184008005511

出版商:SAGE Publications    

年代:1984

数据来源: WILEY

摘要:

Reference values for the mid‐upper arm muscle area, mid‐upper arm fat area, subscapular skinfold thickness, and sum of triceps and subscapular skinfold thicknesses of American adults were developed from data collected by the National Center for Health Statistics during the first National Health and Nutrition Examination Survey, 1971 to 1974. The reference values were compared to other reference values derived from a similarly conducted cross‐sectional survey of the American population, the Health Examination Survey of 1960 to 1962. These comparisons revealed that (1) arm muscle area and subscapular skinfold thickness of men and arm muscle area of women continuously increase with aging from 18 to 74 yr; (2) arm fat area and sum of skinfold thicknesses of men increase with aging from 18 to 34 yr but stabilize or decrease with further aging; and (3) arm fat area, subscapular skinfold thickness, and sum of skinfold thicknesses of women increase with aging from 18 to 64 yr but decrease thereafter. As these parameters frequently change more than 20% over the period of a single decade, it is important that age be considered in nutritional evaluations based on anthropometric measurements. Changes in these four parameters with successive generations are also frequently large. Consequently, it is imperative that the reference values used in nutritional assessment protocols be updated at regular intervals.(Journalof Parenteral andEnteralNutrition 8:515–522, 1984)

ISSN:0148-6071    

DOI:10.1177/0148607184008005515

出版商:SAGE Publications    

年代:1984

数据来源: WILEY

摘要:

The present study evaluated the sensitivity and specificity of the serum transferrin concentration as a measure of the nutritional state. Serum transferrin was derived from total iron‐binding capacity measurements in 74 patients on 114 occasions and correlated with body composition as measured by multiple isotope dilution. Highly significant correlations (p<0.001) existed between serum transferrin and both the body cell mass and the nutritional state as measured by the Nae/Keratio. However, the 95% confidence limits about both regressions were wide. The false‐positive rate was 60% while the false‐negative rate was 31%. Body composition and transferrin were measured before and after 2 wk of total parenteral nutrition in 34 malnourished patients. Eighteen patients restored body cell mass toward normal after 2 wk of total parenteral nutrition while in 16 patients the body cell mass continued to decrease in size, despite 2 wk of total parenteral nutrition. The changes in serum transferrin were not significant over this period of time in either group, despite significant changes in the nutritional state in both groups. The presence of a statistically significant relationship between the serum transferrin concentration and the nutritional state indicates that the serum transferrin concentration accurately reflects a population's nutritional status, and is therefore useful in epidemiologic surveys. However, because of the large variance of the data, as demonstrated by the wide 95% confidence limits, and because of the poor sensitivity and specificity, in an individual patient it is of little value as a measure of the nutritional status. (Journal of Parenteral and Enteral Nutrition 8:523–528, 1984)

ISSN:0148-6071    

DOI:10.1177/0148607184008005523

出版商:SAGE Publications    

年代:1984

数据来源: WILEY

摘要:

An abnormal lipoprotein (LP), detected in plasma during total parenteral nutrition, has been shown to be similar to LPX observed in cholestasis and in familial lecithin‐cholesterol‐acyl‐transferase (LCAT) deficiency. However, the conditions which facilitate the appearance of LPX during total parenteral nutrition are unclear; potential determining factors could be lipid input, plasma lipid levels, and/or inhibition of LCAT activity. An investigation was conducted on 12 patients receiving total parenteral nutrition for 3 wk by simultaneously evaluating plasma LPX (via a quantitative method) as well as total cholesterol, phospholipids (PL), triglycerides (TG), apolipoprotein B, and LCAT activity. Daily total nonprotein calories (40 kcal/kg body weight) and nitrogen input (250 mg/kg body weight) were fixed in this study. Three 7‐day periods were defined: during periods 1 and 3, lipid emulsion (10 or 20% Intralipid) and glucose were given as nonprotein calories (glucose‐lipid periods); in period 2, glucose was administered alone as the sole source of nonprotein energy (glucose period) so that the total energy input was not modified. During periods 1 and 3, the patients were randomly assigned to receive either 9 g (period 1) and 12 g (period 3) of PL/day for 7 days, or 12 and 9 g of PL/day. By infusing either 10 or 20% Intralipid, TG input was varied concomitantly so that the subjects received 75, 100, or 150 g/day in periods 1 and 3. During the glucose‐lipid periods, plasma LPX was measurable from the 2nd day and increased progressively. Its increment was closely related to a rise in unesterified cholesterol and PL (r = 0.7; p<0.05). These increases in cholesterol and PL were largely incorporated into LPX. In contrast, TG was decreased independently of LPX levels. LPX concentrations were dependent on PL input since the LPX increment was significantly higher when 12 g rather than 9 g of PL were infused daily. TG input had no such effect. LPX was not correlated with either LCAT activity or apolipoprotein B levels which did not yield any significant variation during the entire study. In the glucose period, there was a significant decrease in LPX (half life: 2–4 days), cholesterol, and PL, while TG was increased. Our study suggests that different types of discontinuous total parenteral nutrition can induce varying patterns of the plasma lipid profile. The LPX level and the rise of cholesterol and PL were related to PL input but not to TG input or to inhibition of LCAT activity. The increase of unesterified plasma cholesterol was higher than expected after low cholesterol input, indicating that the excess cholesterol may be partly endogenous in origin. (Journal of Parenteral and Enteral Nutrition 8:529–534, 1984)

ISSN:0148-6071    

DOI:10.1177/0148607184008005529

出版商:SAGE Publications    

年代:1984

数据来源: WILEY

摘要:

The results of monitoring the serum amino acid concentrations during three infusion regimens using a 5:4 mixture of 70% glucose and the synthetic L‐amino acid solution, Synthamin 17 (Travasol) are reported. Twelve stabilized patients received continuous total parenteral nutrition (TPN), eight of whom were subsequently placed on a second regimen of cyclical feeding. A separate group of five patients was infused with amino acids, both with and without simultaneous glucose. The serum amino acid concentrations indicated that the supply of valine, leucine, isoleucine, lysine, and histidine, and the synthesis of taurine from the infused methionine was suboptimal, particularly if the period of TPN was prolonged. The synthesis of tyrosine from phenylalanine appeared to be inversely proportional to the infusion rate of the TPN mixture, in particular the glucose component, resulting in depressed tyrosine and increased phenylalanine concentrations in serum during continuous iv nutrition. Cyclical infusions, on the other hand, permitted the tyrosine and phenylalanine concentrations to return to normal during the noninfusion stage of the cycle. Amino acid measurements enabled us to design an amino acids additive mixture which normalized the serum concentrations in three long‐term home parenteral nutrition patients. As a result of these investigations serum amino acid measurements are used routinely to monitor the efficacy of TPN and accommodate any specific amino acid requirements of individual patients. (Journal of Parenteral and Enteral Nutrition 8: 535–541, 1984)

ISSN:0148-6071    

DOI:10.1177/0148607184008005535

出版商:SAGE Publications    

年代:1984

数据来源: WILEY

摘要:

The selenium status of 13 adult home parenteral nutrition (HPN) patients was evaluated using 12 healthy adult volunteers as controls. Patients had been maintained on HPN for a mean of 36 months and averaged 121 cm of residual small bowel. Prospective diet surveys in patients indicated a mean oral caloric intake of 902 kcal/day. The mean plasma selenium concentrations (μg/g) were 0.044 in patients and 0.117 in controls (p<0.01). The erythrocyte glutathione peroxidase activities, as μmol of NADPH oxidized/g hemoglobin/min, averaged 11.01 in patients and 31.76 in controls (p<0.01). Four patients exhibited myalgic symptomatology suggestive of clinical selenium deficiency. No correlations could be ascertained between plasma selenium levels and glutathione peroxidase activities in either patients or controls. Additionally, in the patient group, no significant correlations could be ascertained between selenium status and oral caloric intake, residual small bowel length, symptomatology suggestive of deficiency or HPN duration. However, since sample size was not large, lack of correlations might best be considered suggestive not conclusive. The data indicate that HPN patients with small bowel resections exhibit suboptimal selenium status and may be at risk of developing clinically evident selenium deficiency. HPN patients should be prophylactically supplemented with selenium regardless of oral intake, duration of HPN, or residual length of resected small bowel. (Journal of Parenteral and Enteral Nutrition 8:542–545, 1984)

ISSN:0148-6071    

DOI:10.1177/0148607184008005542

出版商:SAGE Publications    

年代:1984

数据来源: WILEY