ISSN:0148-6071    

DOI:10.1177/014860719301700401

出版商:SAGE Publications    

年代:1993

数据来源: WILEY

摘要:

A combined body scan technique for measuring total energy expenditure (TEE) from energy intake and changes in energy stores is presented. The TEE of 13 patients with Crohn's disease who required nutrition support over a 14‐day period was measured. They had a mean TEE of 33 kcal/kg per day. The components of the TEE in these 13 patients were also measured. Seventy percent of the TEE was made up by resting metabolic expenditure, 10% by diet‐induced thermogenesis, and the remaining 20% by activity energy expenditure. These patients had a mean activity energy expenditure of 369 kcal/day. The diet‐induced thermogenesis was a mean 12.6% increase on the resting metabolic expenditure. Each percent increase was caused by a mean of 210 kcal of energy in either the intravenous nutrition or the enteral nutrition. There was no difference in diet‐induced thermogenesis between those having enteral nutrition and those receiving intravenous nutrition. Decreased activity was significantly correlated with increased activity of the disease (r =.7, p<.01). This confirms the belief that patients with Crohn's disease require no more energy (ie, 33 kcal/kg per day) than other patients. If the resting metabolic expenditure is increased through illness, then the activity energy expenditure decreases. The combined invivoneutron activation‐dual energy x‐ray absorptiometry technique has allowed for the first time measurements in ward patients with Crohn's disease. The measurements confirm that TEE is not raised and that 30 to 35 kcal/kg per day is sufficient to achieve energy balance in such patients. (Journal of Parenteral and Enteral Nutrition 17:3–7, 1993)

ISSN:0148-6071    

DOI:10.1177/014860719301700103

出版商:SAGE Publications    

年代:1993

数据来源: WILEY

摘要:

We have compared the neonatal absorption of anti‐bovine γ‐globulin (BGG) antibody supplied in colostrum or saline in three groups of piglets born and maintained under different environmental conditions to determine the effect of these conditions on the cessation of intestinal absorption of macromolecules (anti‐BGG antibody), termed “closure.” An enzyme‐linked immunosorbent assay was used to estimate the concentration of anti‐BGG antibody in sera from each group of piglets. Three stages of macromolecular absorption through the piglet's intestine could be detected. The first stage is a nonselective massive absorption of macromolecules (in milligram levels) that lasts up to 3 days in germfree (GF) colostrum‐deprived or conventional colostrum‐fed piglets but up to 5 days in GF piglets maintained on total parenteral nutrition. In this stage, absorption was significantly (r =.05) higher in piglets fed anti‐BGG serum with colostrum than in piglets fed antiBGG serum without colostrum on GF day 0 (31.28%vs15.59%) and GF‐total parenteral nutrition day 3 (3.08%vs0.11%). Thus, whenever there was the ability to absorb a massive amount of macromolecules, the sow colostrum had an enhancing affect. Although there was a minor effect of environmental or orally received stimuli in delaying closure, absorption of macromolecules decreased in all piglets maintained either parenterally or enterally after day 3. Thus, intestinal closure to massive absorption of macromolecules in piglets is primarily time (age)‐dependent. The second stage is a selective absorption of immunoglobulins in much smaller quantities (microgram levels), inasmuch as absorption of 0.02% to 0.1% was determined in all 5‐day‐old piglets. The third stage of intestinal absorption is that observed at adult levels (nanogram levels or less). In the piglet, this is achieved by 3 weeks after birth. (Journal of Parenteral and Enteral Nutrition 17:8–15, 1993)

ISSN:0148-6071    

DOI:10.1177/014860719301700108

出版商:SAGE Publications    

年代:1993

数据来源: WILEY

摘要:

A practical technique to provide central parenteral nutrition to insulin‐taking diabetic patients based on prehospitalization insulin requirements and insulin placed in the central parenteral nutrition was originally presented based on retrospective review. The present article confirms the safety and applicability of this method after a multiyear period of application. Particularly noteworthy are the absence of hypoglycemic episodes, the attainment of reasonable blood glucose control, and the relatively consistent relationship of insulin required in central parenteral nutrition to prehospitalization insulin requirements. (Journal of Parenteral and Enteral Nutrition17:16–19, 1993)

ISSN:0148-6071    

DOI:10.1177/014860719301700116

出版商:SAGE Publications    

年代:1993

数据来源: WILEY

摘要:

There are only a few experimental investigations on the feasibility and potential advantages of intraportal nutrition in animals and only two uncontrolled studies in humans. The purpose of this study was to compare some metabolic variables in patients who received portal or systemic nutrition after elective surgery for colorectal cancer. Twenty patients were randomized to receive postoperatively for a week a hypocaloric, “protein sparing” standard infusion via the portal (catheter in the gastroepiploic vein) (10 patients) or systemic (10 patients) route. We evaluated the basal concentrations of some visceral and acute‐phase proteins and their variations in the first postoperative week and the nitrogen balance. Statistical analysis was performed by the two‐tailed Studentttest. There was no difference in the daily changes of the visceral and acute‐phase proteins after surgery in the two groups of patients, but in the portal group there was a significantly better recovery of the level of total protein, albumin, and cholinesterase at the end of the portal infusionvsthe systemic group (p≤.005,.03, and.02, respectively). In regard to the nitrogen balance, although there was no difference in the overall balance between portal and systemic nutrition, if we separate the acute phase of the injury from the later one we do not see any significant difference in the first period but we do see a highly significant advantage for the portal group during the last 2 days (p≤.0001). These data suggest that short‐term portal nutrition is feasible and safe, with metabolic effects that are at least similar to and possibly better than those of systemic nutrition. (Journal of Parenteral Nutrition 17:20–24, 1993)

ISSN:0148-6071    

DOI:10.1177/014860719301700120

出版商:SAGE Publications    

年代:1993

数据来源: WILEY

ISSN:0148-6071    

DOI:10.1177/0148607193017001011

出版商:SAGE Publications    

年代:1993

数据来源: WILEY

摘要:

The author studied the clinical and laboratory effects of early parenteral nutrition (EPN) in patients who were comatose as a result of acute drug poisoning. All patients were unconscious at the time of admission and entry into the study and received our usual conservative therapy for the first 24 hours. Alternate patients received an EPN solution containing amino acids and glucose. Volume, composition, and caloric content of the EPN solution were calculated separately for each patient according to weight and height nomograms. It was found that the group receiving EPN (n = 46) normalized their nitrogen balance sooner and demonstrated a consistent decrease in their creatine Phosphokinase level. Serum amino acid values in patients treated with EPN did not change significantly during the treatment trial. The control group (n = 40) demonstrated a significantly lower serum amino acid concentration on the third day of treatment (p<.001), had significantly more pneumonias (p<.05), and their hospitalization time was significantly longer (.01

ISSN:0148-6071    

DOI:10.1177/014860719301700102

出版商:SAGE Publications    

年代:1993

数据来源: WILEY

摘要:

Critically ill hospital patients were fed enteral formulas containing different fat substrates. Seven patients received formula X, which contained 28 g of structured triglycerides and menhaden oil to provide 7.6 g of medium‐chain fatty acids, 2.5 g linoleic acid, 1.3 g eicosapentaenoic acid, and 0.4 g docosahexaenoic acid per 1000 mL of formula. Six patients received formula Y consisting of 36.8 g of medium‐chain triglycerides and corn and soy oils providing 14.3 g medium‐chain fatty acids and 11.7 g linoleic acid per 1000 mL. Feeding of formula X increased plasma total phospholipid levels of eicosapentaenoic acid on days 7 and 14 and docosahexaenoic acid levels on day 14. Plasma levels of linoleic acid were reduced in formula‐X‐fed in comparison to formula‐Y‐fed patients, whereas arachidonic acid was maintained in both groups during feeding. As a result of these changes, the patients receiving formula X had decreased ratios of arachidonic acid:eicosapentaenoic acid in plasma. Formula Y feeding did not alter eicosapentaenoic acid and docosahexaenoic acid levels in the plasma. In the erythrocyte, formula X feeding resulted in a threefold increase in eicosapentaenoic acid from mean baseline levels of 0.4 ± 0.4% to a mean value of 1.2 ± 0.9% at day 7. The formula X feeding decreased linoleic acid levels on days 7 and 14, whereas levels of arachidonic acid and docosahexaenoic acid remained constant. Formula Y feeding did not affect any of the parameters measured for erythrocytes. The ability to alter plasma and erythrocyte levels of n‐3 fatty acids and plasma arachidonic acid:eicosapentaenoic acid ratios may have important implications for patients at risk for sepsis. (Journal of Parenteral and Enteral Nutrition 17:30–34, 1993)

ISSN:0148-6071    

DOI:10.1177/014860719301700130

出版商:SAGE Publications    

年代:1993

数据来源: WILEY

摘要:

Available data on the nutritional status of alcoholics is controversial. The present study was conducted to assess the frequency of malnutrition in alcoholic inpatients. The objectives were to (1) compare anthropometric data of hospitalized alcoholic and nonalcoholic patients and (2) evaluate the association between alcoholism and protein‐energy malnutrition. It was a cross‐sectional comparative study including a stratified analysis to control for potential confounding factors. Alcoholics were identified as patients with a score from the Michigan Alcoholism Screening Test ≥8 among patients admitted consecutively to the general wards of a department of internal medicine; they were matched for sex, age, and time of admission with nonalcoholic patients (Michigan Alcoholism Screening Test score ≤4). Nutritional status was assessed using weight, height, midarm circumference, and tricipital skinfold thickness values, which were then used to determine the Quetelet body mass index and the mid‐arm muscle circumference. The study took place in general wards of internal medicine in a 1000‐bed city and teaching hospital in Lausanne, Switzerland. The participants were 93 alcoholic patients and 93 controls aged 20 to 75 years, admitted from September 1, 1988, to March 18, 1989. Alcoholics were characterized by a low rate of severe protein‐energy malnutrition (<5%); their average body weight was normal, similar to the weight of nonalcoholic inpatients, and not greatly influenced by the presence or severity of concomitant liver disease. However, tricipital skinfold thickness was lower in alcoholics than in nonalcoholics (8 mmvs10 mm, p<.05, and 13 mmvs20 mm, p<.01, in men and women, respectively). The association between alcoholism and protein‐energy malnutrition (odds ratio 3.0, 95% confidence interval 1.6–5.7) remained positive when adjusted for smoking, liver disease, or occupational status. In conclusion, alcoholism was associated with poor nutritional status in hospitalized patients, although severe protein‐energy malnutrition was infrequent. The results suggest that alcoholism‐related malnutrition exists irrespective of the social and medical situation of the patient and is mostly related to caloric undernutrition. (Journal of Parenteral and Enteral Nutrition 17:35–40, 1993)

ISSN:0148-6071    

DOI:10.1177/014860719301700135

出版商:SAGE Publications    

年代:1993

数据来源: WILEY

摘要:

Current solution formulations for total parenteral nutrition (TPN) do not contain glutamine (GLN). The purpose of this study was to examine whether GLN supplementation of TPN would improve survival in experimental Escherichia coli peritonitis in Fischer 344 rats (190–210 g). Initial experiments were performed to determine the degree of stress and to evaluate survival after intraperitoneal Ecoliinjection. The E coli colony used was isolated from a culture of human blood. Graded doses were injected intraperitoneally in Fischer 344 rats (190–210 g). The response of white blood cell count, plasma insulin, glucagon, and corticosterone levels, and urinary excretion of vanillylmandelic acid reflected a significant stress response for at least 3 days. Survival was dose‐dependent, with 60% mortality at 3 days after injection of 5 × 105colony forming units of Ecoli/200 g body weight. To determine whether GLN supplementation of TPN would alter survival in this E coli peritonitis model, Fischer 344 rats were randomized to receive TPN containing 4.25% standard amino acids (group STD, n = 38) or the same solution with 1.5% of the amino acid content replaced with L‐GLN (group GLN, n = 38). After 7 days of TPN, 5 × 105 colony forming units of Ecoli/200 g body weight were injected intraperitoneally under direct vision through a small laparotomy. Survival was monitored for 3 days. Surviving rats were killed to determine various nutritional parameters including plasma albumin and GLN concentration, the weight and nitrogen content of the gastrocnemius muscle, and biochemical and histological composition of the small intestine. Group GLN showed significantly improved survival (92.1%) compared with group STD (44.7%). There were no differences in the nutritional status. Mucosal weight, mucosal nitrogen content, villous height, and mucosal thickness, however, were significantly greater in group GLN than in group STD. These data demonstrate that GLN supplementation of TPN significantly improves tolerance to E coli‐induced peritonitis. Several possible mechanisms of action are discussed. (Journal of ParenteralandEnteral Nutrition 17:41–46, 1993)

ISSN:0148-6071    

DOI:10.1177/014860719301700141

出版商:SAGE Publications    

年代:1993

数据来源: WILEY