ISSN:0148-6071    

DOI:10.1177/0148607190014006555

出版商:SAGE Publications    

年代:1990

数据来源: WILEY

摘要:

To study energy and protein balances in elderly patients after surgery, spontaneous energy and protein intake and resting energy expenditure (REE) were measured in 20 elderly female patients with a femoral neck fracture (mean age 81 ± 4, SD, range 74–87 years; weight 53 ± 8, range 42–68 kg) during a 5–6 day period following surgery. REE, measured over 20–40 min by indirect calorimetry using a ventilated canopy, averaged 0.98 ± 0.15 kcal/min on day 3 and decreased to 0.93 ± 0.15 kcal/min on day 8–9 postsurgery (p<0.02). REE was positively correlated with body weight (r = 0.69, p<0.005). Mean REE extrapolated to 24 hr (24‐REE) was 1283 ± 194 kcal/day. Mean daily food energy intake measured over the 5‐day follow‐up period was 1097 ± 333 kcal/day and was positively correlated with 24‐REE (r = 0.50, p<0.05). Daily energy balance was ‐235 ± 351 kcal/day on day 3 (p<0.01 us zero) and —13 ± 392 kcal/day on day 8–9 postsurgery (NS us zero) with a mean over the study period of ‐185 ± 289 kcal/day (p<0.01 us zero). When an extra 100 kcal/day was allowed for the energy cost of physical activity, mean daily energy balance over the 5‐day study period was calculated to be ‐285 ± 289 kcal/day (p<0.01 us zero). Measurements of total 24‐hr urinary nitrogen (N) excretion were obtained in a subgroup of 14 patients. Calculated net protein oxidation was 56.0 ± 19.5 and 61.7 ± 25.6 g/day on day 3 and on day 8–9, respectively. Spontaneous protein intake on the other hand was only 38.1 ± 16.6 on day 3 and 36.9 ± 15.2 g/day on day 8–9 (p<0.01 and p<0.001 us protein oxidation for the two periods, respectively). Net protein balance averaged ‐17.3 ± 22.9 g/day on day 3 and ‐24.3 ± 16.5 g/day on day 8–9. It is concluded that elderly patients with a femoral neck fracture do not adequately adjust their spontaneous food intake to meet their energy and protein needs. The results support the view that such patients would benefit from an oral supplementation above their spontaneous food intake providing an extra 200–300 kcal/day containing 20 g of protein/day.(Journal of Parenteral and Enteral Nutrition14:563–568, 1990)

ISSN:0148-6071    

DOI:10.1177/0148607190014006563

出版商:SAGE Publications    

年代:1990

数据来源: WILEY

摘要:

The relative contributions of skeletal muscle and the pulmonary bed in maintaining amino acid homeostasis were studied. Inasmuch as more than 60% of whole blood amino acid nitrogen is transported as glutamine and alanine, the flux of these two amino acids across the lungs (n = 20) and hindquarter (n = 20) was determined in the postabsorptive adult rat. Both skeletal muscle and the lungs released net amounts of glutamine and alanine in the postabsorptive state. Blood flow to the hindquarter was approximately 16% of cardiac output (3.8 ± 0.3 cc/100 g BW/min), while pulmonary blood flow (cardiac output) was 23.7 ± 1.7 cc/100 g BW/min. Thus, despite a lower glutamine concentration difference across the lungs (—32 ± 6 μmol/liter) compared with the hindquarter (—59 ± 10 pmol/liter (p<0.01), the lungs released significantly more glutamine (741 ± 142 nmol/100 g BW/min) than the hindquarter (208 ± 39 nmol/100 g BW/min) (p<0.01) because of the significantly higher pulmonary blood flow. Similarly, the concentration difference for alanine across the lungs was less than that of the hindquarter (‐24 ± 8 μmol/liter us ‐60 ± 12 μmol/liter, p<0.01) but the lungs released significantly more alanine than the hindquarter (553 ± 159 nmol/100 g BW/min us 221 ± 41 nrnolj100 g BW, p<0.01. Compositional studies demonstrated that the hindquarter comprises 40% of total body muscle mass in the rat; thus both total skeletal muscle mass and the lungs contribute approximately equally to the maintenance of blood glutamine and alanine levels. The lungs, which are traditionally viewed as an organ of gas exchange, play a central role in maintaining amino acid homeostasis in the postabsorptive state.(Journal of Parenteral and Enteral Nutrition14:569–573,1990)

ISSN:0148-6071    

DOI:10.1177/0148607190014006569

出版商:SAGE Publications    

年代:1990

数据来源: WILEY

摘要:

The administration of growth factors may potentially accelerate recovery during critical illness by reducing body protein catabolism, enhancing wound healing, and improving skeletal muscle function. The purpose of this phase 1 study was to evaluate the safety and initial efficacy of a recombinant growth factor, human growth hormone (GH), combined with nutritional support in a critical care unit. Following an initial control week, 11 individuals received GH (10 mg/day) daily for 1–6 consecutive weeks. Near constant nutrient intake was provided via parenteral and/or enteral feedings throughout the study period. Vital signs and other clinical parameters, blood values, and nutrient excretion were monitored daily. GH administration was not associated with clinically significant adverse effects. During the first 2 weeks of study, nitrogen excretion decreased from 1356 ± 157 mmol/day (19.0 ± 2.2 g/ day) during control to 899 ± 107 mmol/day (12.6 ± 1.4 g/day) with growth hormone (p<0.002) in association with markedly reduced urea generation. Significant reductions in potassium excretion (control 100 ± 11 mmol/day us 69 ± 6 with GH; p<0.01) and phosphorus excretion (31 ± 5 mmol/day us 18 ± 3; p<0.025) also occurred during GH. The protein‐conserving effects of GH were sustained during several weeks of treatment. Growth hormone enhanced the efficiency of administered protein and facilitated nitrogen retention without clinically significant adverse effects in this small patient group. Controlled trials are indicated to determine whether use of this anabolic hormone reduces hospitalization time and improves other clinical outcomes in severely injured patients when combined with appropriate nutritional support.(Journal of Parenteral and Enteral Nutrition14:574–581,1990)

ISSN:0148-6071    

DOI:10.1177/0148607190014006574

出版商:SAGE Publications    

年代:1990

数据来源: WILEY

摘要:

An index of undernutrition (IOU) has been developed from a crosssectional study of 200 general surgical patients. The IOU was constructed using a ranking method based upon the relative values of anthropometric measurements (weight loss, mid‐arm muscle area, mid‐arm fat area) and serum protein concentrations (albumin, transferrin). The IOU was derived without reference to the incidence of adverse clinical events and took the form of a boolean cluster.A subsequent prospective longitudinal study evaluated the IOU in 367 general surgical patients at the time of admission to hospital. The results of this study supported the validity of the IOU. There was no association between gender and IOU scores. However, patients with high scores were more likely to be elderly (p<0.02), have cancer (p<0.001), stay in hospital longer (p<0.001), or experience an adverse clinical event after surgery (p<0.001). In accord with other published indices of undernutrition, the association between the extent of undernutrition and the incidence of adverse clinical events was only of moderate diagnostic potential (overall accuracy 68%). This study demonstrates that it is possible to derive an index of protein‐energy undernutrition that is independent of the incidence of adverse clinical events.(Journal of Parenteral and Enteral Nutrition14:582–587, 1990)

ISSN:0148-6071    

DOI:10.1177/0148607190014006582

出版商:SAGE Publications    

年代:1990

数据来源: WILEY

摘要:

We prospectively studied the risk of catheter‐related sepsis (CRS) in 75 critically ill patients who received total parenteral nutrition (TPN) through 158 pulmonary artery catheters (PACs) and 214 triple‐lumen catheters (TLCs). We relied on semiquantitative cultures of the catheter tips, peripheral blood cultures in febrile patients and clinical response to catheter removal to diagnose catheter‐related sepsis. The infection rate was 2.5% (4/158) of PACs and 6.5% (14/214) of TLCs (p=0.124). Colonization rates were 29.1% for PACs and 32% for TLCs. PACs were left in place a significantly shorter length of time than TLCs, 3.1 vs 5.1 days (p<0.005). Guidewire exchanges and subclavian vein insertions were associated with a decreased rate of CRS when compared to new insertions and internal jugular vein insertions, respectively.We conclude that pulmonary artery catheters can be used safely for the delivery of hyperalimentation in critically ill patients with no increased risk for catheter‐related sepsis compared to triple‐lumen catheters. The use of the PAC in this manner allows for the use of a single central venous catheter for the delivery of hyperalimentation and hemodynamic monitoring.(Journal of Parenteral and Enteral Nutrition14:588‐592, 1990)

ISSN:0148-6071    

DOI:10.1177/0148607190014006588

出版商:SAGE Publications    

年代:1990

数据来源: WILEY

摘要:

Using aquantitative in vitromodel simulating clinical conditions, we studied the efficacy of conventional and nonconventional 3‐day therapies involving vancomycin for treating the internal surface of catheters colonized with a slime‐producing strain ofStaphylococcus epidermidis.When infused for 1 hr every 8 hr through the catheter at the daily dose recommended for a 10‐kg child (450 mg), vancomycin alone reduced bacterial colonization but failed to sterilize the inserts. Vancomycin was more active in combination with netilmicin (25 mg for 1 hr every 8 hr), rifampin (150 mg for 90 min every 12 hr), or fosfomycin (500 mg for 4 hr every 6 hr), but the catheters were inconsistently decontaminated after 3 days of treatment. Two nonconventional modes of antibiotic administration were tested for their capacity to ensure high levels of vancomycin in the catheter lumen over a prolonged time. Vancomycin infused continuously through the catheter at a daily dose of 450 mg had the same poor sterilizing effect as vancomycin administered intermittently. On the contrary, catheters were totally decontaminated when 2.5 mg of vancomycin in a volume of 0.5 ml were injected twice daily into noninfused catheters, confirming that the antibiotic‐lock technique is an approach of great interest to sterilize the internal surface of catheters colonized withstaphylococci.(Journal of Parenteral and Enteral Nutrition14:593–597,1990)

ISSN:0148-6071    

DOI:10.1177/0148607190014006593

出版商:SAGE Publications    

年代:1990

数据来源: WILEY

摘要:

Nucleic acid synthesis in tissues of rapid growth is preferentially done using dietary purines and pyrimidines via the salvage pathway. In the case of a low protein intake, dietary nucleotides may be semiessential for cell replication of gut, lymphocytes, and bone marrow, and especially in those intestinal diseases in which the mucosa is altered, dietary nucleotides may have a role in intestinal development. The effect of dietary nucleotides on intestinal weight and length, gut mucosal weight, intestinal protein and DNA contents, and lactase, maltase, and intestinal mucosal activities was assessed in a controlled way. Weanling (21‐day‐old) rats were separated into two groups of 36, each receiving blindly a basal diet containing glucose polymers (C) or a basal diet with lactose as the main carbohydrate (L) for 15 days. Those fed with L developed a syndrome of chronic diarrhea and malnutrition. Ten rats of each group were sacrificed at that time. The rest of the animals of each group were separated into two subgroups. The first was fed with the C diet and the second with the C diet supplemented with 50 mg/100 g of each of the following nucleotides: AMP, GMP, CMP, UMP, and IMP (CN). Thus the subgroups CC, CN, LC, and LN were formed. Rats were sacrificed after 4 weeks and gut separated into three segments corresponding to duodenum, jejunum, and ileum. Analysis of variance was used to compare the effect of diet or segments. DNA and lactase, maltase, and sucrase activities increased in the LN group with respect to LC especially in jejunum and ileum but there were not any differences between CC and CN. After malnutrition recovery, total proteins and DNA were similar in all groups. Dietary nucleotides appear to be modulators of intestinal development after chronic diarrhea and may have important implications in the growth of enterocyte.(Journal of Parenteral and Enteral Nutrition14:598–604,1990)

ISSN:0148-6071    

DOI:10.1177/0148607190014006598

出版商:SAGE Publications    

年代:1990

数据来源: WILEY

摘要:

One of the major clinical manifestations of the acquired immunodeficiency syndrome (AIDS) and AIDS‐related complex (ARC) is the development of cachexia. This most likely results from a multifactorial interplay of poor diet, malabsorption, and altered metabolism. To assess the potential role of nutrient intake in the development or persistence of malnutrition, a detailed analysis was performed of a 72‐hr diet record in clinically stable patients with AIDS (N = 18), ARC (N = 12) and in human immunodeficiency virus (HIV) seropositive controls without significant manifestations of disease (N = 13). Total calorie intake was 39.1 ± 13.2 kcal/kg/day in AIDS patients us 34.6 ± 7.8 kcal/kg/day in ARC patients or 31.9 ± 17.7 kcal/kg/day in HIV seropositive cases (allp= NS). Likewise, mean protein intakes were similar among the groups and exceeded recommended daily dietary allowance (RDA) guidelines. The mean body weight changes from the inception of illness were ‐11 ± 1% in AIDS, ‐6 ± 7% in ARC,us+3 ± 2% in HIV‐seropositive‐only cases(p<0.05 vs AIDS and ARC). Dietary vitamin and mineral analysis revealed that 88% of AIDS, 88% of HIV seropositive, and 89% of ARC patients were ingesting less than 50% RDA for at least one nutrient. The mean number of deficiencies per patient was 1.8 ± 1.3 in AIDS, 3.8 ± 3.5 in ARC, and 2.9 ± 2.5 in HIV‐seropositive‐only cases (p<0.05 AIDSusARC). There were no significant correlations between specific anthropometric measurements and dietary intakes of protein or fat. Absolute numbers of CD4 positive peripheral blood lymphocytes did not correlate with weight loss or dietary protein intake. It is concluded that protein and caloric intake in clinically stable AIDS, ARC, and HIV seropositive patients meets RDA standards and is similar among the groups. These data, in this population of patients, could lend further support to the importance of malabsorption or altered metabolism in the development or persistence of cachexia in AIDS. However, the intake of various vitamins and minerals may be inadequate, potentially leading to further compromise of organ functions.(Journal of Parenteral and Enteral Nutrition14:605–609, 1990)

ISSN:0148-6071    

DOI:10.1177/0148607190014006605

出版商:SAGE Publications    

年代:1990

数据来源: WILEY

摘要:

Chromium (Cr) present as contaminant was analyzed by flameless atomic absorption spectrometry in a variety of commercially produced solutions and additives commonly used in total parenteral nutrition (TPN) formulas. Total Cr likely to be administered unintentionally per day was estimated both by summing the Cr in appropriate volumes of each solution required for preparation of standard TPN formulas and by analyzing complete TPN solutions. Storage of TPN solutions in plastic bags for 14 days did not affect Cr concentrations. The amounts ranged from 2.4 to 8.1 μg/day for a high glucose formula and 2.6 to 10.5 μg for a high lipid formula. Amino acid solutions, especially when containing phosphate, or with phosphate salt additives and with lipid emulsions accounted for approximately 85 to 90% of the Cr found.(Journal of Parenteral and Enteral Nutrition14:610–614, 1990)

ISSN:0148-6071    

DOI:10.1177/0148607190014006610

出版商:SAGE Publications    

年代:1990

数据来源: WILEY