ISSN:0148-6071    

DOI:10.1177/0148607193017003199

出版商:SAGE Publications    

年代:1993

数据来源: WILEY

摘要:

An economic analysis accompanied a multicenter Department of Veterans Affairs randomized, controlled trial of perioperative total parenteral nutrition (TPN). The cost of providing TPN for an average of 16.15 days before and after surgery was $2405, more than half of which ($1025) included costs of purchasing, preparing, and delivering the TPN solution itself; lipid solutions accounted for another $181, additional nursing care for $843, and miscellaneous costs for $356. Prolonged hospital stay added another $764 per patient to the $2405 cost of providing TPN, bringing the total to $3169. The incremental costs attributed to perioperative TPN were highest ($3921) for the patients least likely to benefit, that is, those who were less malnourished and at low risk of nutrition‐related complications. Incremental costs were lowest ($3071) for high‐risk patients. On the basis of the hospital‐based method of administering TPN that was used in the clinical trial, perioperative TPN did not result in decreased costs for any subgroup of patients. (Journal of Parenteral and Enteral Nutrition17:201–209, 1993)

ISSN:0148-6071    

DOI:10.1177/0148607193017003201

出版商:SAGE Publications    

年代:1993

数据来源: WILEY

摘要:

The preservation of colonic mucosal mass requires the presence of feces; thus, colonic hypoplasia develops with enteral feeding. Fermentable soy fiber may maintain fecal bulk and prevent mucosal atrophy. We therefore compared the effects of Enrich (containing soy fiber) with Ensure (fiber‐free) on mucosal mass, fecal bile acids, and cell proliferation in the rat. Sprague‐Dawley rats (n = 20) were randomized into groups receiving either standard rat food, Enrich, or Ensure. After 4 weeks, rats were weighed and killed at intervals after administration of vincristine sulfate (1 mg/kg intraperitoneally), which was given to induce metaphase arrest within the intestinal crypts and to allow calculation of crypt cell production rate. Fecal free bile acids and neutral steroids were analyzed using gas‐liquid chromatography and gas‐liquid chromatography mass spectrometry. Nucleic acid concentrations in the small and large intestine and crypt cell production rate in the small bowel were unaffected by diet. In the proximal large bowel, both enteral diets produced a marked reduction in crypt cell production rate to values only 5% to 7.5% of control values (p<.001). In the midcolon of rats fed Ensure, there was a similar reduction, but this hypoplastic effect was completely prevented by Enrich. Without an elevation in the lithocolic acid to deoxycholic acid ratio, secondary bile acid concentrations were increased in rats receiving Enrich (p<.05 to.01) but not in those receiving Ensure. Thus, fermentable soy fiber diets may prevent the midcolonic mucosal hypoplasia induced by enteral feeding. (Journal of Parenteral and Enteral Nutrition17:210–213, 1993)

ISSN:0148-6071    

DOI:10.1177/0148607193017003210

出版商:SAGE Publications    

年代:1993

数据来源: WILEY

摘要:

A syndrome of bone pain and fractures has been described in patients receiving long‐term support from parenteral nutrition containing large quantities of aluminum or vitamin D2. Whether this same syndrome occurs in patients supported by current therapeutic regimens is controversial. In this study, bone health was longitudinally evaluated over 7 to 61 months in 14 subjects maintained on long‐term parenteral nutrition. The parameters of bone health evaluated included bone mass as measured by single and dual photon absorptiometry and quantitative histomorphometry of bone biopsies. There was a striking heterogeneity in baseline measures of bone health. Mean bone density of parenteral nutrition patients was significantly below expected values on entry into the study at both the distal radius (zscore = ‐0.76 ± 0.27) and the lumbar spine (z score = ‐1.17 ± 0.27). Mean areal density at the forearm was less severely depressed (z score = ‐0.62 ± 0.34). The longitudinal changes in bone density and morphology were heterogeneous, with some subjects showing deterioration, others improvement, and still others no change. We conclude that patients already established on parenteral nutrition frequently have osteopenia. The group as a whole did not demonstrate normalization of the osteopenia, but our results also suggest that current parenteral nutrition formulations low in aluminum and vitamin D2 do not necessarily cause worsening of bone health. The etiology of this clinical syndrome merits additional study. (Journal of Parenteral and Enteral Nutrition17:214–219, 1993)

ISSN:0148-6071    

DOI:10.1177/0148607193017003214

出版商:SAGE Publications    

年代:1993

数据来源: WILEY

摘要:

The purpose of this trial was to test the hypothesis that vitamin A adequacy may decrease the incidence of bronchopulmonary dysplasia (BPD) in very‐low‐birth‐weight infants. Serum vitamin A levels were measured and the effects of two regimens of vitamin A supplementation on the incidence of BPD were compared. There were 24 infants in each of two groups with a mean birth weight less than 1000 g, a mean gestational age of 27 weeks, and similar sexual and racial mixes. In group I, vitamin A levels were measured after 1 week of parenteral nutrition and, if low, the infant was given a 2000‐IU supplement intramuscularly three times a week, beginning on the 10th to 14th day of life. In group II, the same supplementation was begun on the second to fourth day of life. In both groups, when enteral feedings reached 60 kcal/kg per day, 2500 IU/d vitamin A was given orally. The incidence of oxygen support at 28 days was similar in both groups, although in group II there was a trend toward less vigorous ventilatory support. χ2analysis showed that a significantly smaller proportion of infants in group II had BPD at 36 weeks' gestational age than in group I. Length of neonatal intensive care unit stay was significantly reduced from 81 to 60 days. We conclude that vitamin A supplementation should be administered early to small, premature infants who are at risk for BPD and that monitoring of plasma levels is essential. (Journal of Parenteral and Enteral Nutrition17:220–225, 1993)

ISSN:0148-6071    

DOI:10.1177/0148607193017003220

出版商:SAGE Publications    

年代:1993

数据来源: WILEY

摘要:

Sepsis is a major complication of total parenteral nutrition (TPN). Impaired immunity has been suggested as being responsible for TPN‐related sepsis, but it is unknown how the immune system is affected by TPN. We recently found that administration of lipid‐free TPN resulted in an increase in prostaglandin Ez (PGE2) release by stimulated splenic macrophages. This observation suggested that TPN may impair immunity through the prominent immunosuppressive effects of PGE2. In the present study, we tested the hypothesis that addition of glucagon to TPN solution may protect against the immunosuppresive effect of TPN by modifying PGE2secretion. Adult, male Sprague‐Dawley rats (n = 18) underwent jugular vein cannulation: group 1 (n = 7) received intravenous saline and chow ad libitum; group 2 (n = 6) received TPN (80 mL/24 h); and group 3 (n = 5) received TPN (80 mL/24 h) plus glucagon (100 μg/24 h). After 10 days, spleens were removed and splenic macrophages were isolated and cultured for 24 h in plain M199 medium (nonstimulated) or in medium containingEscherichia colilipopolysaccharide (5 μg/mL) (stimulated). PGE2release was determined by enzyme‐linked immunosorbent assay. There were no differences in PGE2release between the groups of nonstimulated cells, but when stimulated with lipopolysaccharide, the macrophages from the TPN rats (group 2) released more PGE2(81.68 ± 25.99 ng/2.5 x 106cells) than the control group (16.04 ± 3.26 ng/2.5 × 106 cells). The release of PGE2was normalized in the TPN animals treated with glucagon (15.71 ± 3.33 ng/2.5 x 106cells). This difference was significant, withp<.05 by Tukey's test after analysis of variance. The results confirm that TPN may be immunosuppressive through the release of PGE2by stimulated splenic macrophages. Addition of glucagon appears to prevent this adverse effect of TPN. We hypothesize that this may take place by changes in lipid metabolism mediated by glucagon. (Journal of Parenteral and Enteral Nutrition17:226–230, 1993)

ISSN:0148-6071    

DOI:10.1177/0148607193017003226

出版商:SAGE Publications    

年代:1993

数据来源: WILEY

ISSN:0148-6071    

DOI:10.1177/014860719301700307

出版商:SAGE Publications    

年代:1993

数据来源: WILEY

摘要:

The effect of adding fiber to liquid formula diets on gastrointestinal transit is still controversial. Different fiber types (solublevsinsoluble) and different methodology of transit time measurements yielded variable results. Factors affecting transit include colonic fermentation, neural, and hormonal factors. We have therefore compared the effects of a standardized normal diet and two liquid formula diets with and without supplementation of a soluble fiber (21 g/L) on orocecal transit time measured by the hydrogen lactulose breath test, colonic transit time measured by radiopaque markers with an abdominal x‐ray, bowel movements, stool consistency, and cholecystokinin release in 12 healthy male volunteers. The diets were consumed in a randomized order, each one for 7 days. The addition of soluble fiber did not affect orocecal transit time. Colonic transit time, however, was significantly prolonged (55 h) with fiber supplementation compared with the liquid diet (39 h) and the self‐selected diet (30 h) (p<.01). Stool frequency and consistency was not significantly affected. During administration of both liquid diets, fasting cholecystokinin concentrations were significantly elevated compared with the concentrations found with a self‐selected diet (p<.05). The fasting cholecystokinin concentration correlated significantly with the increase of segmental (right colon) colonic transit time (p=.02). The prolongation of colonic transit time in liquid diet‐fed volunteers might be caused by the combined effect of increased colonic fermentation and high basal cholecystokinin concentrations. (Journal of Parenteral and Enteral Nutrition17:231–235, 1993)

ISSN:0148-6071    

DOI:10.1177/0148607193017003231

出版商:SAGE Publications    

年代:1993

数据来源: WILEY

摘要:

This study was designed to determine whether alanyl glutamine‐containing total parenteral nutrition (TPN) can restore the impaired adaptive process of the remaining intestine, observed with administration of conventional TPN, after massive small‐bowel resection. Seventy‐four male Sprague‐Dawley rats weighing 250 g were randomly divided into seven groups. Group I rats (n = 10) were killed after overnight fasting. Group II animals (n = 32) underwent massive small bowel resection (85%) with preservation of the first 15 cm of jejunum. Group III animals (n = 32) were also submitted to massive small‐bowel resection with preservation of 15 cm of terminal ileum. Three different TPN solutions were prepared. Solution A was a conventional formulation that did not contain glutamine. Solution B contained 1.88 times the amino acid concentration of solution A. Solution C was prepared by adding alanyl glutamine (2 g/100 mL) to solution A. Solutions B and C were isonitrogenous and isocaloric. Each solution was infused to groups II and III, which were subdivided into groups IIA (n = 10), IIB (n = 11), IIC (n = 11), IIIA (n = 10), IIIB (n = 11), and IIIC (n = 11). After 1 week of TPN (270 kcal/kg per day), the experimental animals were killed and the intestine was taken for examination. Final body weight did not differ significantly among the groups, and there was no difference in nitrogen balance among the animals that received solution B or C. Mucosal wet weight, protein, RNA, maltase, and sucrase in duodenum, remaining jejunum, and remaining ileum of animals receiving solution C (groups IIC and IIIC) significantly increased (p<.05) compared with animals receiving solution A or B (groups IIA, IIB, IIIA, and IIIB). Villus height in the duodenum and remaining jejunum of animals receiving solution C (groups IIC and IIIC) was significantly increased (p<.05) compared with animals receiving solution A or B (groups IIA, IIB, IIIA, and IIIB). Mucosal DNA content of group IIC was significantly increased (p<.05) compared with groups IIA and IIB. Diamine oxidase activity in the duodenum was significantly increased in group IIIC animals compared with groups IIA, IIB, and IIC. These results strongly suggest that, after massive resection, adaptation of the remaining intestine, whether jejunal or ileal segment, can be promoted by administration of alanyl glutamine‐enriched TPN. (Journal of Parenteral and Enteral Nutrition17:236–242, 1993)

ISSN:0148-6071    

DOI:10.1177/0148607193017003236

出版商:SAGE Publications    

年代:1993

数据来源: WILEY

摘要:

A frequent mechanical problem encountered with small‐bore feeding tubes is lumenal obstruction of the tube. A number of studies have described methods to prevent tube occlusion and restore patency once the tube becomes occluded. It has been observed that most intact protein formulas will clot when acidified to a pH of less than 5.0. This study evaluated the question of whether gastric feeding tubes occlude more frequently when they are used for checking gastric residuals by aspirating acidic gastric juices into the tube than when gastric residuals are not checked. Patients who were fed intragastrically via a small‐bore feeding tube with intact protein formulas were divided into two groups. Gastric residuals were checked in group A patients every 4 hours, whereas no residuals were checked in group B patients. Fifteen patients in group A were followed for a total of 138 patient days and 13 patients in group B were followed for 154 patient days. Ten occlusive episodes occurred in the group A patients, whereas only one occlusive episode occurred in the group B patients. This difference was statistically significant (p =.0171). We concluded that small‐bore feeding tubes occlude more frequently when used to aspirate gastric residuals. (Journal of Parenteral and Enteral Nutrition17:243–246, 1993)

ISSN:0148-6071    

DOI:10.1177/0148607193017003243

出版商:SAGE Publications    

年代:1993

数据来源: WILEY