ISSN:0148-6071    

DOI:10.1177/014860719501900293

出版商:SAGE Publications    

年代:1995

数据来源: WILEY

摘要:

Background:Previous studies using indirect calorimetry in Crohn's disease have suggested that with weight loss there is a proportionally greater decrease in body fat along with a sparing of lean mass. This study analyzed body composition (compared with that of controls) by direct methods in a group of 30 patients with active Crohn's disease and further evaluated the effects of nutrition support on body composition.Methods:Total body protein was assessed by neutron activation, fat was assessed by dual energy x‐ray absorptiometry, water was assessed by bioelectric impedance analysis, and potassium was assessed by γ‐ray technique. These measurements were repeated in patients with Crohn's disease after 3 weeks of enteral nutrition by feeding tube that provided 35 nonprotein kcal/kg of ideal body weight.Results:Compared with age‐ and sex‐matched controls, patients had lost (on average) 11.3 kg (16%) of body weight (p<.0005), including 5.1 kg (30%) of fat (p<.0005), 2.2 kg (19%) of protein (p<.025), 3.7 kg (10%) of water (p= NS), and 24.9 g (21%) of total body potassium (p<.01). After enteral feeding, body weight increased by 1.9 ± 0.3 kg (p<.0005). Weight gain was accompanied by an increase in body protein (0.3 ± 0.1 kg), fat (0.3 ± 0.1 kg), and water (1.1 ± 0.4 kg) (allp<.025), and by a nonsignificant increase in total body potassium. The weight gain of approximately 2 kg consisted of 65% water, 18% fat, and 18% protein, thus comprising a normal proportion of body composition.Conclusions:Reduced body weight in patients with Crohn's disease compared with that in controls was due to less fat tissue. With modest nutritional repletion, proportionate gains in all body compartments are possible. (Journal of Parenteral and Enteral Nutrition19:95–99, 1995)

ISSN:0148-6071    

DOI:10.1177/014860719501900295

出版商:SAGE Publications    

年代:1995

数据来源: WILEY

摘要:

Background:The role of fiber in postresection adaptation is poorly understood. We examined the significance of short‐chain fatty acids produced by intracolonic fiber fermentation during colonic adaptation.Methods:Rats underwent one of three surgeries: control laparotomy, cecal resection, or cecal resection with placement of perfusion catheter. Rats of each surgical group were randomly assigned to receive treatment regimens of standard fiber diet (with or without fermentation‐suppressing antibiotics), fiber‐free diet, or diet plus intracolonic perfusion of short‐chain fatty acids. Adaptation parameters of mucosal weight, mucosal DNA and protein content, water absorption, and butyrate absorption were measured.Results:Compared with controls, postresection rats that were fed fiber had 65% greater basal and 112% greater butyrate‐stimulated water absorption as well as 140% greater butyrate absorption. Fiber‐fed rats exhibited significantly greater colonic weight and colonic mucosal protein after cecal resection. These changes were absent in postresection rats fed a fiber‐free diet. Inhibition of fermentation by neomycin and metronidazole added to a standard fiber diet also prevented postresection adaptation. All adaptive changes were restored when the cecal‐resection rats that were fed the fiber diet with antibiotics received an intracolonic infusion of short‐chain fatty acids. Adaptation did not occur when short‐chain fatty acids were infused into colons of postresection rats that were fed a fiber‐free diet.Conclusions:Cecal resection leads to significant functional and structural changes in the adapting residual colon. Fermentation of dietary fiber by colonic flora to short‐chain fatty acids is necessary, but it alone is not sufficient to mediate adaptation. (Journal of Parenteral and Enteral Nutrition19:100–106, 1995)

ISSN:0148-6071    

DOI:10.1177/0148607195019002100

出版商:SAGE Publications    

年代:1995

数据来源: WILEY

摘要:

Background:Fasting and other catabolic states are characterized by reductions in the rate of protein synthesis. Most studies have investigated tissues such as skeletal muscle or liver, but impairments in the biochemistry of cardiovascular tissues also contribute to enhanced morbidity. The objectives of the present study were (1) to determine the response of protein synthesis in the heart and lung of young rats to overnight fasting; and (2) to determine whether protein synthesis could be ameliorated or modulated by refeeding or provision of enteral or parenteral nutrition.Methods:Fractional rates of protein synthesis (ie, the percentage of tissue protein renewed each day,ks) were measuredin vivoin the ventricular muscle and lungs of young male Wistar rats (body weight, 100 to 130 g) with a “flooding” dose of L‐[43H]phenylalanine. Rats were fedad libitumor fasted overnight. Fasted rats were subjected to various treatments.Results:When nutrient supply in fasted rats recommenced by refeeding for 1 hour, there were small but significant increases in the rates of ventricular protein synthesis, although the infusion of amino acids and glucose for 1 hour had no significant effect. Increases in ventricularkswere also obtained when amino acids were infused for 6 hours. Infusion of glucose alone for 6 hours did not cause a significant increase in ventricularks.The effect of infusing a mixture of glucose plus amino acids for 6 hours was similar to the effects of amino acids alone. In all instances, ventricularksin rats infused with amino acid for 6 hours did not attain rates observed in fed rats.kswas reduced in the lung after overnight fasting but was unresponsive to refeeding or to acute or chronic provision of amino acids and glucose by either IV or oral routes. Measurements also suggested that changes in neither insulin nor glucagonper sewere responsible for the amino acid‐induced increases in heart protein synthesis. However, acute treatment of rats with anti‐insulin serum reduced rates of ventricularksbelow values observed in fed rats. Anti‐insulin serum also increased lungksConclusions:It was concluded that rates of heart protein synthesis could be increased by the chronic provision (ie, 6 hours) of nutrients by oral or IV routes. In contrast, the lung was insensitive to these treatments. The observations have important implications for clinical situations, which are characterized by diminished cardiopulmonary protein synthesis. (Journal of Parenteral and Enteral Nutrition19:107–113, 1995)

ISSN:0148-6071    

DOI:10.1177/0148607195019002107

出版商:SAGE Publications    

年代:1995

数据来源: WILEY

摘要:

Background:Intravenous iron supplements are not routinely administered to very‐low‐birth‐weight newborns receiving total parenteral nutrition because of the possible increased risk of infection and because iron needs may be met with blood transfusions.Methods:To assess the benefits of a prudent IV iron supplement (200 to 250 μg/kg/d), 26 very‐low‐birth‐weight newborns (birth weight, 1005 ± 302 g; gestational age, 28 ± 2.3 weeks; mean ± SD) were randomly allocated to receive total parenteral nutrition without iron (No‐Iron) or with iron supplied as iron dextran (Iron). These newborns were followed at baseline (2 to 3 days after birth) and at weeks 1 to 4 thereafter. At each sampling time, urine samples, fecal samples (rarely), unused total parenteral nutrition solutions, blood products, and a blood sample (1 mL) were collected.Results:There were no differences between the two groups in anthropometric measurements, hematologic or biochemical parameters, number or amount of blood transfusions (2.3 ± 1.9), amount of blood removed for diagnostic purposes (44 ± 16 mL), or number of septic events (n = 16). There was no difference between the groups for the total iron excreted; however, the Iron group retained more iron. Iron balance was negative for all but 10 newborns (No‐Iron, 3; Iron, 7) throughout the study.Conclusions:A total iron intake of 400 μg/kg/d, half of which was provided by IV iron, is not sufficient to maintain iron balance or to meet fetal accretion rates (1000 μg/kg/d) in very‐low‐birth‐weight newborns receiving total parenteral nutrition. Furthermore, endogenous iron from blood transfusions does not provide an adequate supply of iron. (Journal of Parenteral and Enteral Nutrition19:114–118, 1995)

ISSN:0148-6071    

DOI:10.1177/0148607195019002114

出版商:SAGE Publications    

年代:1995

数据来源: WILEY

摘要:

Background:The effects of insulin‐like growth factor‐I (IGF‐I) on gut metabolism, structure, and barrier function as well as its general anabolic effects were investigated in septic rats.Methods:Thirty‐three male Wistar rats that underwent cecal ligation were randomly divided into one of the following two groups: (1) received only total parenteral nutrition(control group) or (2) received total parenteral nutrition with IGF‐I (IGF group) at a dose of 4 mg/kg/d for 3 days.Results:During the 3‐day period, the body weight of rats in the IGF group increased significantly over that of rats in the control group (17.1 ± 2.6vs5.8 ± 4.6 g,p<.01). The total and free IGF‐I plasma concentrations were significantly higher in the IGF group than in the control group. The cumulative nitrogen balance was significantly more positive for the IGF group (423.9 ± 24.3 mg of nitrogen) than for the control group (290.8 ± 26.0 mg of nitrogen). The weights of thymus, spleen, and kidneys were significantly increased in the IGF group compared with weights in the control group. Treatment with IGF‐I improved the gut mucosal weight in all regions of the gut examined, including duodenum, jejunum, ileum, and colon. Histologic and biochemical analyses of the jejunum showed greater villus height and crypt depth and higher mucosal DNA and protein content in the IGF group. The arterial concentration of endotoxin was not significantly different between the two groups, whereas its level in portal blood was significantly lower in the IGF group (23.2 ± 9.9 pg/mL) than in the control group (95.5 ± 37.9 pg/mL), an indication that IGF‐I treatment decreased the amount of endotoxin that traversed the gut barrier.Conclusions:These results indicate that IGF‐I can improve gut metabolism and reduce mucosal atrophy and that it may play a role in maintaining the gut barrier function in sepsis.(Journal of Parenteral and Enteral Nutrition19:119–124, 1995)

ISSN:0148-6071    

DOI:10.1177/0148607195019002119

出版商:SAGE Publications    

年代:1995

数据来源: WILEY

摘要:

Background: Plasma triglyceride analyses to evaluate the clearance of IV fat emulsion are necessary in patients receiving parenteral nutrition. Enzymatic kits for triglyceride analysis measure the glycerol that is hydrolyzed from triglyceride. This study investigates the effect of fat emulsion free glycerol on plasma triglyceride determination. Methods: Venous blood from fasting volunteers (n = 10) was drawn into tubes containing EDTA and was centrifuged to separate the plasma. An IV fat emulsion containing 2.25% glycerol was added to plasma samples to create serial dilutions ranging from 0.049% to 0.245% fmal lipid concentration. Total triglyceride and free glycerol concentrations were determined in each dilution and control sample. The free glycerol concentration was subtracted from the total triglyceride concentration to yield a true triglyceride value. Results: Increasing concentrations of fat emulsion added to donor plasma produced increases in total triglyceride and free glycerol concentrations. The increase in free glycerol concentration produced significant concentration‐related differences between total and true triglyceride concentrations.Conclusions:The total triglyceride level overestimated the true triglyceride concentration due to fat emulsion free glycerol. To assure reliable triglyceride results in patients receiving fat emulsion, blanking for free glycerol should be considered. (Journal of Parenteral and Enteral Nutrition19:125–126, 1995)

ISSN:0148-6071    

DOI:10.1177/0148607195019002125

出版商:SAGE Publications    

年代:1995

数据来源: WILEY

摘要:

Background:Fasting is associated with significant structural, functional, and metabolic alterations in the intestinal mucosa. Before abdominal surgery, patients are usually fasted the night before surgery or for a longer period of time if chronic illness is present. The splanchnic organs may experience varying degrees of ischemia/reperfusion as blood vessels are occluded during the various manipulations.Methods:To study whether fasting alters intestinal reperfusion injury, rats were fasted for 0 to 2 days, and the mesenteric artery was occluded for 30 minutes and then reperfused for 1 hour. Mucosal atrophy was quantitated by measuring jejunal villus height and crypt depth, and mucosal injury was quantitated by measuring jejunal villus width to villus height and mucosal integrity. To determine whether any effect of fasting on reperfusion injury was due to the absence of luminal nutrients or to a systemic nutrient deficiency, rats were fed parenterally for 7 days before ischemia/reperfusion.Results:A 1‐day fast produced significant mucosal atrophy. Reperfusion in the O‐day and 1‐day fasted animals produced mucosal injury and additional mucosal atrophy. After a 2‐day fast, there was no mucosal injury or mucosal atrophy other than that produced by fasting alone. Parenteral feeding before ischemia/reperfusion did not prevent ischemia/reperfusion induced mucosal atrophy and injury.Conclusions:The protective effect of a 2‐day fast before intestinal ischemia/reperfusion cannot be attributed to the physical and chemical absence of food within the intestinal lumen. (Journal of Parenteral and Enteral Nutrition19:127–132, 1995)

ISSN:0148-6071    

DOI:10.1177/0148607195019002127

出版商:SAGE Publications    

年代:1995

数据来源: WILEY

摘要:

Background:The establishment of reliable central venous access is essential in the management of patients with major complications, including pneumothorax and hemopneumothorax. Although peripherally inserted central catheters (PICCS) offer advantages over traditional central venous approaches, PICC lines are associated with a number of insertion and maintenance problems, including clotting and catheter fracture. These complications often result in catheter removal before completion of prescribed therapy.Methods:We conducted a retrospective descriptive study in a convenience sample of 322 consecutively placed PICC lines. Study variables included size of catheter, tip placement, infused solutions, patient diagnosis, and unit of line placement. The rationale for line discontinuance as well as for complication rates is described.Results:Complication rates for infection and central venous thrombosis were less than 1%. Phlebitis occurred in 9.7% of patients, and catheter fracture occurred in 9.7% of patients. Two distinct clusters of phlebitis, early and late development, were observed. Early phlebitis is attributable to the mechanics of insertion, and late phlebitis is attributable to chemical and patient‐specific causes. Catheter fractures were primarily related to tearing of the catheter during insertion or traction on the catheter‐hub junction (51.6%).Conclusions:The majority of published data about PICC lines is in the area of chemotherapy or antibiotic infusion. Our study supports the use of PICC lines in patients receiving a variety of solutions, primarily parenteral nutrition. With an experienced, team approach to catheter placement and maintenance, PICC lines provide reliable, cost‐effective venous access and reduce many of the complications of central venous access in a variety of clinical settings. (Journal of Parenteral and Enteral Nutrition19:133–136, 1995)

ISSN:0148-6071    

DOI:10.1177/0148607195019002133

出版商:SAGE Publications    

年代:1995

数据来源: WILEY

摘要:

Background:The addition of an anabolic stimulant during intensive nutrition therapy in trauma patients seems to be a reasonable adjuvant for minimizing muscle‐mass erosion. The plasma free amino acid pattern is the mirror of the net amino acid metabolism, and we have measured the progressive changes resulting from recombinant human growth hormone therapy in trauma victims during nutritional repletion in the early catabolic flow phase of injury.Methods:In 20 severely injured (injury severity scale = 31 ± 2), highly catabolic, and hypermetabolic adult multiple‐trauma patients, we have measured the fasting (day 0) plasma amino acid levels (48 to 60 hours after injury before starting the nutrition therapy) and their progressive changes during 7 days of IV nutrition support (total parenteral nutrition, 1.1 × resting energy expenditure calories, 250 mg of nitrogen per kilogram per day) with or without adjuvant recombinant human growth hormone. Group H (n = 10) randomly received daily recombinant human growth hormone (0.15 mg of Somatropin per kilogram per day) and Group C (n = 10) received the vehicle of infusion.Results:Hypoaminoacidemia of trauma is normalized by infusion of recombinant human growth hormone, which indicates its anabolic nature, and this is confirmed in the cumulative nitrogen balance (‐281 ± 139 mg of nitrogen per kilogram per 7 days compared with ‐809 ± 151 mg of nitrogen per kilogram per 7 days without recombinant human growth hormone;p≤.005). This improved nitrogen retention is also reflected in the significantly low blood urea nitrogen levels in the recombinant human growth hormone group, which represents the efficient utilization of the infused amino acids for synthesis of proteins. Elevated plasma insulin‐like growth factor‐1 levels in Group H compared with those in Group C may also account for this altered amino acid metabolism. Conclusions: Recombinant human growth hormone treatment in combination with conventional total parenteral nutrition in the immediate posttraumatic period improved nitrogen metabolism and normalized the plasma free amino acid levels. (Journal of Parenteral and Enteral Nutrition19:137–144, 1995)

ISSN:0148-6071    

DOI:10.1177/0148607195019002137

出版商:SAGE Publications    

年代:1995

数据来源: WILEY