bluuebunny/crossref_metadata_2025 huggingface dataset:
Intralipid‐Based Short‐Term Total Parenteral Nutrition Does Not Impair Small Intestinal Mucosa‐Related Cellular Immune Reactivity in the Healthy Rat
Authors: Gross Thomas , Babst Reto , Juretic Antonio , Herzog Birgit , Stehle Peter , Filgueira Luis , Oberholzer Martin , Gudat Fred , Heberer Michael
Published: May 2008

Background: The lipid component of total parenteral nutrition (TPN) has reportedly been associated with trophic effects on the intestinal mucosa and suppressive effects on the immune system. Methods: We have challenged these hypotheses using a 7‐day TPN rodent model comparing the effects of isocaloric, isonitrogenous lipid‐based (TPN‐lipid, 50% of calories as long‐chain triacylglycerol) and carbohydrate‐based TPN (TPN‐CH, 100% of calories as carbohydrates) on mucosal morphology and immune function. Enterally fed animals were included to establish a baseline for immunologic read‐outs. The study was performed in healthy, metabolically stable animals to avoid interference by septic or trauma‐related stress factors. Results: Both TPN regimens resulted in a significantly smaller weight gain (TPN‐lipid, 29.8 ± 4.0 g; TPN‐CH, 30.3 ± 4.4 g) compared with enterally fed reference animals (49.2 ± 3.2 g; p =.007), with no difference in nitrogen balance between the TPN groups. Mucosal sucrase activity was significantly lower in both TPN groups (TPN‐lipid, 8.8 ± 1.0 × 10−7 katal per gram (kat/g) of protein; CH: 11.9 ± 1.6 × 10−7 kat/g of protein) compared with enteral feeding (17.4 ± 0.9 × 10−7 kat/g of protein; ANOVA: p =.0007). Morphometric analysis of the small intestine revealed no differences between the two TPN groups although a significantly depressed villus height in the TPN‐lipid group could be observed in comparison to enterally fed reference rats (TPN‐lipid, 0.47 ± 0.02; TPN‐CH, 0.50 ± 0.01; enteral, 0.56 ± 0.02 mm; ANOVA: p =.0298). Light and electron microscopy revealed a normal surface architecture in all three groups of rats. Cellular immune reactivity was evaluated using a novel specific immunization protocol: animals were immunized against OVA 4 weeks before TPN. OVA‐induced lymphoproliferative responses and phenotypic data from draining popliteal and mesenteric lymph nodes were evaluated after the different regimens. Results did not differ among the three groups. Conclusions: In healthy rodents, short‐term lipid‐based and carbohydrate‐based TPN regimens lead to limited mucosal atrophy with preserved surface architecture compared with enteral feeding. However, peripheral and mesenteric cellular immune responsiveness after both TPN regimens remained comparable to enterally fed reference animals. Therefore, mesenteric and systemic cellular immune reactivity does not appear to be impaired by lipid‐based or carbohydrate‐based TPN. (Journal of Parenteral and Enteral Nutrition 24:337–344, 2000)
Role of Lipid Emulsions in Cholestasis Associated with Long‐Term Parenteral Nutrition in Children
Authors: Colomb Virginie , Jobert‐Giraud Agathe , Lacaille Florence , Goulet Olivier , Fournet Jean‐Christophe , Ricour Claude
Published: May 2008

Background: In children who depend on long‐term parenteral nutrition (PN), liver disease is a major complication that may lead to end‐stage liver failure requiring liver transplantation. Methods: This retrospective study investigated the influence of lipid emulsions on cholestasis onset in children receiving long‐term total parenteral nutrition (TPN) with lipids. Ten children who presented with a total of 23 episodes of cholestasis, associated in 13 cases with thrombocytopenia, were studied. Results: Changes in the lipid delivery preceded these complications in more than half the cases. The temporary decrease in lipid administration led to normalization of bilirubin in 17 episodes. Conclusions: These data suggest that lipid supply is one of the risk factors for PN‐associated cholestasis. The link between cholestasis and the reticuloendothelial system overload needs to be better understood. Prevention of cholestasis might include the decrease in the lipid load. When cholestasis occurs, lipid supply should be temporarily stopped, especially in the case of associated thrombocytopenia. (Journal of Parenteral and Enteral Nutrition 24:345–350, 2000)
Nasogastric Tube Feeding in Children with Cancer: The Effect of Two Different Formulas on Weight, Body Composition, and Serum Protein Concentrations
Authors: den Broeder Eline , Lippens Robert J. J. , van 't Hof Martin A. , Tolboom Jules J. M. , Sengers Robert C. A. , van den Berg Anneke M. J. , van Houdt Nicole B. M. , Hofman Zandrie , van Staveren Wija A.
Published: May 2008

Background: Treatment of cancer cachexia partly involves the administration of adequate amounts of energy. The aim of this study was to assess the tolerance and efficacy of two equal volumes of tube feeding, one with a standard (1 kcal/mL) and one with a high energy density (1.5 kcal/mL), during the intensive phase of treatment. Methods: Nutritional status was assessed weekly, in 27 children with a solid tumor, by measuring weight, height, midupper arm circumference, biceps and triceps skinfold, and serum proteins. Tolerance was assessed by recording the occurrence of vomiting and by expressing the administered volume as a percentage of the required volume. Results: Both formulas were equally well tolerated, leading to a significantly higher energy intake in the energy‐enriched formula group. In both formula groups, all anthropometric variables increased significantly (range of mean increase, 5.2% to 25.5%; p <.05) during the first 4 weeks of intervention. Between 4 and 10 weeks, variables continued to increase significantly in the energy‐enriched group, resulting in adequate repletion, in contrast to the standard formula group. The concentration of serum proteins, low at initiation of tube feeding, returned to the normal range within 2 to 4 weeks with no significant differences between the two groups. Conclusions: The energy‐enriched formula was more effective in improving the nutritional status of children with cancer during the intensive phase of treatment than the standard formula. Intensive, protocolized administration of an energy‐enriched formula should therefore be initiated as soon as one of the criteria for initiation of tube feeding is met. (Journal of Parenteral and Enteral Nutrition 24:351–360, 2000)
Pancytopenia after Removal of Copper from Total Parenteral Nutrition
Authors: Fuhrman M. Patricia , Herrmann Virginia , Masidonski Patricia , Eby Charles
Published: May 2008

Patients who develop cholestatic jaundice during chronic total parenteral nutrition (TPN) can develop significant hematologic complications due to hypocupremia if copper supplementation is withheld. A 36‐year‐old female with short bowel syndrome developed progressive liver dysfunction 6 months after initiation of TPN. Trace elements were omitted from her TPN because of cholestasis and persistent hyperbilirubinemia. Despite chronic diarrhea, absorption of some dietary copper was anticipated from her oral diet. Fifteen months later, the patient became red cell transfusion dependent, and her neutrophil and platelet counts steadily declined. After 19 months of receiving TPN without trace elements, her serum copper level was 25 μg/dL (normal: 70 to 155 μg/dL). Provision of trace elements for 2 months was associated with increased serum copper, neutrophil and platelet counts and independence from red cell transfusions. When the serum copper level reached 186 μg/dL, copper supplementation was discontinued. Over the next 3 months, serum copper level fell to 10 μg/dL, neutrophil and platelet counts fell precipitously, and red cell transfusions were resumed. Once again, copper, neutrophil and platelet levels promptly rebounded with parenteral copper supplementation. Although anemia and neutropenia are well‐recognized hematologic consequences of copper deficiency, thrombocytopenia rarely has been reported. This is the first report of pancytopenia secondary to TPN‐related copper deficiency in which the association was confirmed when hypocupremia recurred. (Journal of Parenteral and Enteral Nutrition 24:361–366, 2000)
Effects of L‐Arginine on the Proliferation of T Lymphocyte Subpopulations
Authors: Ochoa Juan B. , Strange Jennifer , Kearney Paul , Gellin Gloria , Endean Eric , Fitzpatrick Elizabeth
Published: May 2008

Background:Dietary supplementation of L‐arginine as a mechanism to enhance cellular immune response (T lymphocytes), has slowly gained approval, and appears especially important during critical illness. Despite its clinical use, little is known as to the direct effects of L‐arginine on the different T lymphocyte subpopulations.Methods:Lymphocytes were harvested from spleens of C57 Bl/6 mice, and proliferation was induced with anti‐CD3 in the presence of different concentrations of L‐arginine ranging from 0 to 1000 μmol/L. Flow cytometry was used to evaluate the effect of L‐arginine on T lymphocyte subpopulations. Interleukin‐2 production was measured by ELISA and gene expression by RT‐PCR.Results:L‐Arginine at or greater than 100 μmol/L significantly enhanced anti‐CD3 stimulated T lymphocyte proliferation (p=.01). L‐Arginine was essential for adequate T lymphocyte (CD3+) cellular maturation (p =.01). Proliferation of Helper T cells (CD4+) was not dependent on L‐arginine. In contrast, Cytotoxic T cells (CD8+) showed a dose dependent proliferation in response to L‐arginine (p =.01). Of the CD8+ cells, an increase in the CD45RA negative CD8 positive (memory) T cell subpopulation was observed with the addition of L‐arginine. In addition, the number of cell surface CD8 receptors (CD8R) and CD3 receptors (CD3R) increased in the presence of L‐arginine (p =.01, p =.04). Interleukin‐2 receptor (IL‐2R) expression was not up‐regulated by L‐arginine. L‐Arginine modestly increased IL‐2 production and had pronounced effects on its disappearance from the culture media (p <.0001). Interleukin‐2 mRNA expression was not dependent on L‐arginine.Conclusions:The requirements for L‐arginine for the proliferation of CD3 stimulated T lymphocytes vary widely, and have to be taken into account when studying the mechanism of how L‐arginine enhances cellular proliferation. L‐Arginine may increase cellular proliferation by increasing specific receptor expression and the utilization of interleukin‐2.(Journal of Parenteral and Enteral Nutrition25:23–29, 2001)
Iron Status of Children with Sickle Cell Disease
Authors: Stettler Nicolas , Zemel Babette S. , Kawchak Deborah A. , Ohene‐Frempong Kwaku , Stallings Virginia A.
Published: May 2008

Background: Dietary iron requirements are unclear in children with SS‐type sickle cell disease. Methods: Iron status was assessed in 104 nontransfused African American children (aged 0.5 to 17.6 years) with sickle cell disease who receive no iron supplement. Dietary iron intake was not measured at the time of this study. Results: Serum ferritin was normal or high in all children. Other hematologic and biochemical indicators of iron deficiency were in the normal range in most children. Conclusions: Unlike previous studies, this sample of children and adolescents did not show signs of iron deficiency. (Journal of Parenteral and Enteral Nutrition 25:36–38, 2001)
Small Bowel Segment Reversal Induces Intestinal Hyperplasia but Reduces Whole‐Body Growth in Massive Bowel Resected Rats
Authors: Lo Hui‐Chen , Hsu Ko‐Hau , Wang Shiu‐Fen
Published: May 2008

Background: Surgical reversal of a small bowel segment has been proposed as a means to improve nutritional status in individuals with extensive bowel resection. However, clinical experience remains controversial. The aim of this study was to determine the effects of bowel segment reversal on intestinal adaptation and whole‐body anabolism. Methods: Male Wistar rats underwent a 70% small bowel resection with (REV) or without (CON) reversal of a 5‐cm small bowel segment (5 cm distal to resected segment), or sham‐operation (SHAM). After surgery (day 0), rats were fed with powdered diet from day 2 to day 12. Body weight, nitrogen balance, carcass compositions, and serum concentrations of albumin and insulin‐like growth factor (IGF)‐1 were determined to assess whole‐body anabolism. The composition and architecture of the small intestine were measured to assess the intestinal growth response. Serum concentrations of tumor‐necrosis factor (TNF)‐α and interleukin (IL)‐6 were measured to assess the response of postoperative cytokines. Results: Surgical reversal significantly increased the intestinal protein and DNA contents in the proximal segment compared with surgical resection. REV rats had a significantly slower rate of weight gain and lower serum levels of albumin and IGF‐1, and had significantly greater levels of circulating white blood cells, blood urea nitrogen, and IL‐6 compared with CON and SHAM rats. There were no significant differences in serum concentrations of TNF ‐α and carcass percentages of water, protein, and fat among groups. Conclusions: Small bowel segment reversal stimulates jejunal hyperplasia but the surgical reversal induced‐elevation in serum IL‐6 may eliminate the whole‐body anabolism in massive bowel‐resected rats. (journal of Parenteral and Enteral Nutrition 25:73–80, 2001)
On‐Off Study of Manganese Administration to Adult Patients Undergoing Home Parenteral Nutrition: New Indices of In Vivo Manganese Level
Authors: Takagi Yoji , Okada Akira , Sando Kinya , Wasa Masafumi , Yoshida Hiroshi , Hirabuki Norio
Published: May 2008

Background: Recently, there have been reports that magnetic resonance imaging (MRI) reveals high‐intensity T1‐weighted images (HI) in the basal ganglia (especially in the globus pallidus) of patients receiving total parenteral nutrition (TPN). This finding is presumably due to excess administration of manganese. We investigated the reversibility and reproducibility of these changes by means of an on‐off manganese administration study. We also investigated the temporal relationships between the intensity of T1‐weighted images (MRI intensity) and the whole‐blood and plasma manganese concentrations to evaluate the potential for the MRI intensity to serve as an index of the in vivo manganese level. Methods: Eleven adult patients undergoing home parenteral nutrition received TPN solutions containing manganese (0 or 20 μmol/d) according to an on‐off design. The whole‐blood and plasma manganese concentrations were determined at the same time the brain MRI was performed. Results: Both the whole‐blood manganese concentration and the MRI intensity in the globus pallidus changed in response to the administration and withdrawal of manganese. It took at least 5 months for HI to disappear when manganese was withdrawn, and this change was reversible and reproducible. The whole‐blood manganese concentration showed strong correlations with both the MRI intensity and the T1 value (r = 0.7693, ‐0.7011). The MRI intensity and the T1 value showed a strong correlation (r = ‐0.9051). Conclusions: The whole‐blood manganese concentration, the MRI intensity in the globus pallidus and the T1 value, an objective index of the MRI intensity, may be useful indices of the manganese level in the body. (journal of Parenteral and Enteral Nutrition 25:87–92, 2001)
A New Simple Technique for the Insertion of Cuffed Central Venous Catheters: An Initial Experience
Authors: François Bruno , Roustan Jérôme , Vignon Philippe
Published: May 2008

Background: Although tunneled polyurethane catheters with polyester cuffs are useful when prolonged central venous access is necessary but their insertion still remains challenging at times. We report the first study of a new cuffed polyurethane catheter (Seldicuff) that can be easily inserted using the Seldinger technique without the need of a vein dilator and that incorporates a tunneling needle onto the catheter. A Seldicuff catheter was placed in 15 patients (mean age: 53 ± 11 years) who required prolonged parenteral nutrition. All catheters were inserted into the right subclavian vein. The procedure lasted 6.4 ± 0.8 minutes and no complication directly related to catheter placement was noted. Catheters remained in position for a mean duration of 103 days (range, 58 to 220 days). During this period, no infectious or mechanical complications were observed. Conclusion: These results demonstrate that placement of this novel cuffed catheter is as simple as inserting a conventional central venous catheter. (journal of Parenteral and Enteral Nutrition 25:93–94, 2001)
Manganese Intoxication During Intermittent Parenteral Nutrition: Report of Two Cases
Authors: Masumoto Kouji , Suita Sachiyo , Taguchi Tomoaki , Yamanouchi Takeshi , Nagano Miki , Ogita Keiko , Nakamura Masatoshi , Mihara Futoshi
Published: May 2008

Background and Methods: The administration of trace elements is thought to be needed in patients receiving long‐term parenteral nutrition. Recently, manganese intoxication or deposition was documented in such patients. We report two cases of manganese intoxication during intermittent parenteral nutrition including manganese. Manganese had been administered for 4 years at a frequency of one or two times per week in one case and for 5 years at a frequency of one or two times per month in the other case. Both cases showed mild symptoms with headache and dizziness. One case had mild hepatic dysfunction and the other did not. The whole‐blood manganese level increased in one case, but not in the other case. T1‐weighted magnetic resonance images revealed symmetrical high‐intensity areas in basal ganglia and thalamus in both cases. After the administration of manganese was stopped, these symptoms all disappeared and the magnetic resonance images abnormalities gradually improved in both patients. Mild long‐term manganese intoxication is thus considered to occur regardless of the frequency of using a manganese supplement. Conclusions: Patients should be carefully monitored when receiving long‐term parenteral nutrition including manganese, even when the manganese dose is small and the frequency of receiving a manganese supplement is low. (journal of Parenteral and Enteral Nutrition 25:95–99, 2001)
Protective Role of the L‐Arginine‐Nitric Oxide Synthase Pathway on Preservation Injury after Rat Liver Transplantation
Authors: Geller David A. , Chia Stanley H. , Takahashi Yoshihito , Yagnik Gautam P. , Tsoulfas George , Murase Noriko
Published: May 2008

Background : A major problem complicating liver transplantation is the preservation injury that results from cold storage and subsequent ischemia/reperfusion injury after organ revascularization. The L—arginine—nitric oxide (NO) pathway has been recognized to play critical roles during infection, inflammation, organ injury, and transplant rejection. Recent data indicates that NO synthesis has beneficial effects in several models of liver injury. The purpose of this study is to examine the role of the L—arginine—NO pathway on preservation injury in an experimental model of rat liver transplantation. Methods: Orthotopic liver transplantation was performed in syngeneic (LEW to LEW) rats. Liver preservation injury was determined by measuring serum liver function tests 6 to 48 hours after transplantation. In some experiments, rats received L‐arginine supplementation 0 to 24 hours after transplantation. In other experiments, NO synthase inhibitors (L‐NAME or L‐NIL) were injected at the time of isograft revascularization. Results: L‐Arginine supplementation decreased hepatic transaminase levels at all time points examined (6–48 hours). L‐Arginine produced a significant improvement in liver preservation injury by 12 hours after reperfusion. The NO synthase inhibitor L‐NAME caused a significant increase in liver injury 24 hours after injection. The inducible NO synthase (iNOS)‐specific inhibitor L‐NIL had no significant effect on liver injury. Conclusions: The results show that L‐arginine supplementation and NO synthesis improve hepatic injury and have a protective role in the transplanted liver graft. The protective effect may be mediated by low‐level cNOS‐derived NO. (Journal of Parenteral and Enteral Nutrition 25:142–147, 2001)
Effects of Age, Feeding Regimen, and Glucocorticoids on Catecholamine and Cortisol Excretion in Preterm Infants
Authors: Shulman Robert J. , Heitkemper Margaret , O'Brian Smith E. , Lau Chantal , Schanler Richard J.
Published: May 2008

Background: The sympathoadrenal system is important in maintaining normal physiologic functioning in infants and increased output also can reflect stress. We sought to determine the effects of age, feeding regimen, and glucocorticoids on catecholamine and cortisol excretion in preterm infants and to assess whether a particular strategy of feeding enhanced sympathoadrenal development or was stressful. Methods: Preterm infants (26–30 wk gestation; n = 171) were assigned randomly to begin trophic feedings from day 4 through 14 (trophic group) or to start feedings at day 15 (standard group) with feedings administered either by bolus every 3 hours (bolus) or continuously over 24 hours (continuous). At 10, 28, 40, 50, and 60 days of age, urine was collected continuously for 6 hours for measurement of catecholamines (norepinephrine, epinephrine, dopamine), cortisol, and creatinine. Data were available for 98 infants. Results: Norepinephrine excretion increased with postnatal age. The increase with age was significantly greater in the trophic group compared with that in the standard group. Epinephrine excretion did not change with age, and there were no differences between trophic and standard groups. Dopamine excretion increased with age but was similar between trophic and standard groups (borderline significantly greater in the trophic group). Cortisol excretion increased with age and also was similar between trophic and standard groups. There was no effect on catecholamine or cortisol excretion of bolus vs continuous feedings, antenatal or postnatal corticosteroids, gestational age at birth, age at which full feedings were attained, or use of human milk compared with preterm formula. Conclusions: The greatest determinant of catecholamine and cortisol excretion is postnatal age. Feeding method, type of feeding, and glucocorticoid administration in the amounts customarily used have little significant effect on catecholamine or cortisol excretion. The apparent link between early feeding and norepinephrine (and possibly dopamine) excretion warrants further investigation. (Journal of Parenteral and Enteral Nutrition 25:254‐259, 2001)
Nutritional Effects of Surgical and Medical Treatment for Short Bowel Syndrome
Authors: Sigalet D.L. , Lees G.M. , Aherne F.X. , Fedorak R. , Keelan M. , Thomson A.B.R. , van Aerde J.
Published: May 2008

Background: The choice of treatment options in short bowel syndrome (SBS) is hampered by a lack of comparative studies. This study uses a previously validated juvenile pig model of SBS to compare nontreated controls (C), surgical treatment with either proximal colon interposition (CI) or bowel lengthening (BL), with medical treatment with codeine and cimetidine (M). Methods: Treatment was initiated 6 weeks after resection of 75% of the small bowel, and animals were followed until sacrifice at week 16. Feed intake and weight gain were monitored throughout; in vivo nutrient absorption, in vitro nutrient transport, sodium‐glucose cotransporter activity, and intestinal morphology (gross and microscopic) were examined at the end of treatment. Results: BL and M treatments resulted in improved rates of weight gain; this improvement was associated with improved absorption of dietary fat. The treatments did not affect carbohydrate or protein absorption in vivo. In vitro fatty acid absorption was not increased in any group. Active uptake of glucose was increased in the colon interposition group, but phlorizin binding (reflecting sodium glucose cotransporter activity) did not differ between groups. Gross serosal and microscopic mucosal surface areas increased in all groups; however, there were no significant differences between the treatment groups. Conclusions: These results demonstrate that bowel lengthening and medical treatment improved the rate of weight gain in this model of SBS. This appeared to be due to improvement in the absorption of dietary fat, which was not caused by alterations in in vitro uptake or mucosal surface area, suggesting these treatments have their affects by altering motility or intraluminal digestion. These findings suggest that these treatments are worthy of further study in treating patients (primary pediatric) with SBS. (Journal of Parenteral and Enteral Nutrition 25:330–336, 2001)
Prevention of Dexamethasone‐Induced Lymphocytic Apoptosis in the Intestine and in Peyer Patches by Enteral Nutrition
Authors: Ruiz‐Santana Sergio , López Antonio , Torres Santiago , Rey Agustin , Losada Antonio , Latasa Leonor , Manzano José L. , Díaz‐Chico Bonifacio N.
Published: May 2008

Background: Apoptosis is a programmed cell death, genetically controlled, that can be activated by physiological and pathophysiological events and by the administration of several drugs, including the exogenous administration of corticosteroids. The aim of this study was to develop a rat model of intestinal lymphocytic apoptosis induced by dexamethasone to determine if apoptosis could be prevented by enteral or parenteral nutrition. Methods: Male Sprague‐Dawley rats were used. On day 0, the right internal jugular vein was catheterized for parenteral nutrition, and a silicone tube was inserted into the duodenum for enteral feeding. Animals (n = 6/group) were randomly assigned to one of the following 3 feeding regimens: an immune‐enhancing enteral diet; its placebo (the same formula without immunonutrients); and isocaloric isonitrogenous parenteral nutrition. On the seventh day, 200 μg of dexamethasone or vehicle were administered by IV bolus, and the diets were continued for 1 more day. Intestinal Peyer patches and thymic lymphocytic apoptosis were determined both by flow‐cytometry and immunohistochemistry. Results: A single dexamethasone dose (200 μg/rat) administered to surgically treated rats fasted for 18 hours, 24 hours later, caused massive intestinal and Peyer patches lymphocytic apoptosis (96 ± 2% and 85 ± 5%, respectively; p <.0001 versus vehicle in both kinds of tissue). Lymphocytic apoptosis was reduced to almost indetectable levels in intestinal and lamina propia lymphocytes (from 96 ± 2% to <0.6%; p <.0001). Peyer patches lymphocytic apoptosis was reduced as well (from 85 ± 5% to 15 ± 7.1%; p <.001) in animals prefed the 2 enteral nutrition formulas. Those prefed parenteral nutrition only showed a partial decrease of lymphocytic apoptosis in the intestine (from 96 ± 2% to 53 ± 23%; p <.001). Nutrition had no effect on the dexamethasone‐induced thymus involution. Conclusions: Enteral nutrition prevents intestinal intraepithelial and lamina propia lymphocytic apoptosis due to dexamethasone. These findings support the use of early enteral nutrition in critically ill patients treated with corticosteroids. (journal of Parenteral and Enteral Nutrition 25:338–345, 2001)
Requirements for providing optimal nutrition care: passion, evidence, and compassion‐‐presidential address to the 24th Clinical Congress, January 24, 2000
Authors: Borum PR
Published: May 2008

Harry M. Vars, PhD was a visionary leader of the clinical nutrition community, who in his work and in his professional life, exhibited the qualities of passion, evidence, and compassion that are needed by both individual members and our society to assure that every patient receives optimal nutrition care.
Effects of 2 lipid emulsions (LCT versus MCT/LCT) on the fatty acid composition of plasma phospholipid: a double‐blind randomized trial
Authors: Martin‐Pena G , Culebras JM , De la Hoz‐Perales L , Barro‐Ordovas JP , Catala‐Pizarro R , Ruiz‐Galiana J
Published: May 2008

BACKGROUND: Fatty acids from the diet or from IV fat emulsions are incorporated into the plasma and cell membrane phospholipids and act as substrates in the synthesis of eicosanoids. This study reports the effect of 2 parenteral lipid emulsions in plasma phospholipids fatty acids. METHODS: A total of 83 patients aged 18 to 75 years were randomized to receive long‐chain triglycerides (LCT) or 50/50 mix of long‐ and medium‐chain triglyceride emulsion (LCT/MCT). Blood samples were collected at baseline and at weekly intervals for 28 days. Plasma phospholipid fatty acids were measured by gas chromatography. RESULTS: Patients receiving LCT versus MCT/LCT emulsion have an increase in 18:2n6 and a decrease in 20:4n6 and 22:4n6 after 7, 14, and 21 days of treatment with parenteral nutrition. Phospholipid fatty acids at 15 days of treatment with parenteral nutrition with LCT versus MCT/LCT for 18:2n6 were 17.30% versus 22,90% (p <.05), for 20:4n6 10.44% versus 8.38% (p <.05), and for 22:4n6 0.51% versus 0.40% (p <.05). The 20:4n6 percentage inversely correlated with the percentage of 18:2n6 on days 7, 14, and 21: regression coefficients: ‐7.40 (p <.001), ‐7.39 (p <.001), and 5.70 (p <.001), respectively. CONCLUSIONS: Parenteral lipid emulsions modify fatty acid profiles in plasma phospholipids. MCT/LCT emulsions produce in phospholipids a fatty‐acid profile that is closer to normality than that achieved with LCT emulsions. These changes in phospholipid fatty acids are suggestive of an inhibition of A‐5‐desaturase in patients who received LCT emulsions.
Choline and vitamin B12 deficiencies are interrelated in folate‐replete long‐term total parenteral nutrition patients
Authors: Compher CW , Kinosian BP , Stoner NE , Lentine DC , Buzby GP
Published: May 2008

BACKGROUND: Choline has recently been recognized as an essential nutrient, in part based on deficiency data in long‐term home total parenteral nutrition (TPN) patients. Choline, a methyl donor in the metabolism of homocysteine, is intricately related to folate status, but little is known about choline and vitamin B12 status. Long‐term TPN patients are also subject to vitamin B12 deficiency. OBJECTIVE: The objective of the study was to evaluate any interaction between choline, vitamin B12, and folate in patients with severe malabsorption syndromes, requiring long‐term TPN. DESIGN: Plasma free choline, serum and red blood cell (RBC) folate, serum vitamin B12 methylmalonic acid, B6, and plasma total homocysteine concentrations were assayed by standard methods. Low choline was defined as values that fall 1 to < or =3 and marked low choline concentration as >3 SD below the control mean. RESULTS: Both low choline concentrations (52% were marked low, 33% low, 14% normal) and elevated methylmalonic acid concentrations (47%) were prevalent. Choline concentration was significantly lower and RBC folate higher in patients with elevated methylmalonic acid. Total homocysteine elevations were rare (3 of 21) and mild. CONCLUSIONS: These data suggest a strong interaction between vitamin B12 and choline deficiencies and folate status in this population, which may be due in part to variations in vitamin and choline delivery by TPN. Folate adequacy may increase B12 use for homocysteine metabolism, thus limiting B12 availability for methylmaIonic acid metabolism. Choline use may also increase, and choline deficiency may worsen if choline substitutes when the vitamin B12 side of the homocysteine metabolic pathway cannot be used.
Influence of glycine on intestinal ischemia‐reperfusion injury
Authors: Lee MA , McCauley RD , Kong SE , Hall JC
Published: May 2008

BACKGROUND: It has been reported that glycine may protect donor small intestine against hypothermic ischemia before transplantation. This is consistent with the documented role of glycine as a natural cytoprotectant. OBJECTIVE: Using an in vivo rodent model, we sought to determine whether exposure to a 20% glycine solution reduces the extent of warm ischemia‐reperfusion injury. METHODS: Wistar rats (n = 50) underwent laparotomy. A baseline group did not receive any further intervention. The remaining animals had cannulation of the aorta before the initiation of intestinal ischemia (30 minutes) followed by reperfusion (30 minutes). Using a factorial design, rats were randomized to receive local tissue perfusion with either normal saline or a 20% glycine solution during either the preischemia or the prereperfusion phase. Standardized segments of small intestine were removed at the end of the study period to determine the extent of ischemia‐reperfusion injury. RESULTS: Perfusion with 20% glycine increased mucosal protein content (p <.05), increased mucosal DNA content (p <.05), reduced intestinal myeloperoxidase activity (p <.05), and maintained mucosal glutaminase activity. This was true regardless of whether glycine was administered during the preischemia phase or the prereperfusion phase. CONCLUSIONS: Local perfusion with 20% glycine can diminish warm ischemia‐reperfusion injury to the rat small intestine in an in vivo model. The role of glycine supplementation should be evaluated in situations where hemodynamic instability may be responsible for breakdown in the gut barrier.
Enteral nutrients alter enterocyte function within an in vitro model similar to an acute in vivo rat model during hypoxia
Authors: Kles KA , Turner JR , Tappenden KA
Published: May 2008

BACKGROUND: Early enteral nutrition in patients following traumatic injury is an important intervention. However, after shock‐resuscitation, intestinal hypoperfusion persists despite adequate systemic resuscitation. Our previous in vivo rat studies indicate that hypoperfusion impairs mucosal function in the small intestine. Therefore, the current study sought to improve previous in vitro models by the following means: (1) We used Caco‐2 monolayers stably transfected with the brush‐border sodium‐glucose co‐transporter (SGLT‐1); and (2) we created an environment that mimicked the physiologic enterocyte environment. We hypothesized that hypoxic alterations of epithelial function in an in vitro model are comparable to those of an in vivo rat model. METHODS: After 21 days, monolayers were randomized to receive 24 hours of incubation in a normoxic or hypoxic environment. Cells were further randomized to receive 1 of 4 nutrient treatments: mannitol (an osmotic control), glucose (uses SGLT‐1 and is metabolized), 3‐O‐methylglucose (3‐O‐mg; uses SGLT‐1 and is not metabolized), or fructose (does not use SGLT‐1 but can be metabolized). RESULTS: Transepithelial resistance (p =.007) and short‐circuit current (p =.05) were lower in hypoxic groups. When compared with normoxic groups, hypoxic groups had significantly impaired glucose (p <.001) but not glutamine transport, irrespective of nutrient treatment. Additionally, adenosine triphosphate/adenosine diphosphate ratio was reduced (p =.01) and lactate concentration was increased (p <.001) during hypoxia. CONCLUSIONS: In summary, results from this in vitro study using Caco‐2BBe cells stably transfected with SGLT‐1 correspond to results obtained in the in vivo rat model. Therefore, this is an appropriate in vitro model in which to study cellular alterations caused by the hypoxic small intestine, with the goal of ensuring safe early enteral nutrition following traumatic injury.
Early versus late enteral feeding of mechanically ventilated patients: results of a clinical trial
Authors: Ibrahim EH , Mehringer L , Prentice D , Sherman G , Schaiff R , Fraser V , Kollef MH
Published: May 2008

BACKGROUND: This study sought to compare 2 strategies for the administration of enteral feeding to mechanically ventilated medical patients. METHODS: The prospective, controlled, clinical trial was carried out in a medical intensive care unit (19 beds) in a university‐affiliated, urban teaching hospital. Between May 1999 and December 2000, 150 patients were enrolled. Patients were scheduled to receive their estimated total daily enteral nutritional requirements on either day 1 (early‐feeding group) or day 5 (late‐feeding group) of mechanical ventilation. Patients in the late‐feeding group were also scheduled to receive 20% of their estimated daily enteral nutritional requirements during the first 4 days of mechanical ventilation. RESULTS: Seventy‐five (50%) consecutive eligible patients were entered into the early‐feeding group and 75 (50%) patients were enrolled in the late‐feeding group. During the 5 five days of mechanical ventilation, the total intake of calories (2370 +/‐ 2000 kcal versus 629 +/‐ 575 kcal; p <.001) and protein (93.6 +/‐ 77.2 g versus 26.7 +/‐ 26.6 g; p <.001) were statistically greater for patients in the early‐feeding group. Patients in the early‐feeding group had statistically greater incidences of ventilator‐associated pneumonia (49.3% versus 30.7%; p =.020) and diarrhea associated with Clostridium difficile infection (13.3% versus 4.0%; p =.042). The early‐feeding group also had statistically longer intensive care unit (13.6 +/‐ 14.2 days versus 9.8 +/‐ 7.4 days; p =.043) and hospital lengths of stay (22.9 +/‐ 19.7 days versus 16.7 +/‐ 12.5 days; p =.023) compared with patients in the late‐feeding group. No statistical difference in hospital mortality was observed between patients in the early‐feeding and late‐feeding groups (20.0% versus 26.7%; p =.334). CONCLUSIONS: The administration of more aggressive early enteral nutrition to mechanically ventilated medical patients is associated with greater infectious complications and prolonged lengths of stay in the hospital. Clinicians must balance the potential for complications resulting from early enteral feeding with the expected benefits of such therapy.
Nutritional assessment of serum and hepatic vitamin A levels in patients with cirrhosis
Authors: Ukleja A , Scolapio JS , McConnell JP , Spivey JR , Dickson RC , Nguyen JH , O'Brien PC
Published: May 2008

BACKGROUND: Serum vitamin A (retinol) levels may not correlate with hepatic vitamin A stores in patients with cirrhosis; thus, supplementation of vitamin A based on serum levels may have a detrimental effect. Our aim was to determine whether serum levels correlate with hepatic stores in cirrhotic patients. METHODS: A prospective study of patients with cirrhosis undergoing orthotopic liver transplantation was completed. Serum and hepatic levels of vitamin A were measured by high‐performance liquid chromatography. Statistical analysis was performed using rank sum tests and Spearman rank correlation coefficients. RESULTS: Fifty cirrhotic patients (33 men and 17 women, mean age 53 years) were compared with a control group (25 men and 25 women, mean age 47 years) of liver donors. Median serum levels of retinol were 259 microg/L in controls and 166 microg/L in cirrhotic patients (p <.001). Median hepatic levels of retinol were 25 microg/g in controls and 27.5 +/‐ g/g in cirrhotic patients (p not significant). Total hepatic vitamin A levels (retinol plus retinyl esters) were 471 microg/g in controls and 244 microg/g in cirrhotic patients (p =.028). Serum retinol did not correlate with total hepatic vitamin A stores in cirrhotic patients (rs =.10, p =.332). CONCLUSIONS: Serum retinol and total hepatic vitamin A stores are lower in cirrhotic patients than in controls. However, because levels of serum retinol do not correlate with hepatic vitamin A levels, the decision to prescribe vitamin A replacement for patients with cirrhosis should not be made solely on the basis of serum retinol levels.
Early enteral nutrition‐the unanswered Ws
Authors: Tappenden KA
Published: May 2008

Early enteral nutrition has become a common practice in many intensive care units. Several questions regarding effective and safe implementation of this specialized method of nutrition support exist and are discussed in this editorial.
Evaluation of board certification in nutrition support pharmacy
Authors: Ebiasah RP , Schneider PJ , Pedersen CA , Mirtallo JM
Published: May 2008

BACKGROUND: Credentialing of healthcare professionals is a topic that has received increasing attention. The Board of Pharmaceutical Specialties (BPS) has recognized nutrition support pharmacy as a specialty for more than 10 years. There has recently been concern about the decline in the number of pharmacists seeking board certification or recertification as specialists in nutrition support and changes in the job responsibilities of nutrition support pharmacists. These factors have resulted in a need to evaluate the current system of certification of nutrition support pharmacists. METHODS: A national survey was developed and sent to pharmacist members of the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) and members of the Home Care Section of the American Society of Health‐System Pharmacists (ASHP). The objectives of this study were to describe the activities of nutrition support pharmacists, determine the benefits and barriers to board certification, and assess the current system of certification. RESULTS: Two hundred and fifty‐eight of 486 surveys were returned for an overall response rate of 53%. There has been a decrease in the amount of professional time devoted to nutrition support activities. The most highly ranked benefit to certification was peer recognition. The most highly ranked barrier to certification was the examination cost. CONCLUSIONS: There is satisfaction with the current system; however, alternative methods were supported if the current method cannot sustain itself There is a need to evaluate the cost of the examination and increase marketing efforts to candidates for whom the examination is intended.
Enteral versus parenteral nutrition: the patient's preference
Authors: Scolapio JS , Picco MF , Tarrosa VB
Published: May 2008

BACKGROUND: Given that, in most clinical circumstances, enteral nutrition (nasal gastric tube feeding) may not necessarily be superior to parenteral nutrition (IV feeding), consideration of patient preference should be included in decisions on the method of feeding. OBJECTIVES: To evaluate patient preference for nasal gastric versus IV feeding. METHODS: We administered a written questionnaire to 101 hospitalized oncology patients and 98 outpatients without gastrointestinal illness (controls). Statistical analyses included comparisons of group means with Student t tests, comparisons of proportions with chi2 tests, and logistic regression analysis. RESULTS: Demographic variables of the 2 groups were comparable. In both groups, most individuals preferred IV to tube feeding. Preference for IV or tube feeding was related to patient perception of the comfort of these interventions. In logistic regression analyses, the strongest influences on preference were age and perceived comfort of IV feeding. Older individuals preferred IV to tube feeding. Gender, education level, physician's recommendation, and cost did not influence patient preference. CONCLUSIONS: Most patients prefer IV to nasal gastric feeding. Awareness of this patient preference is helpful in making decisions regarding the method of nutrient delivery.
Kinetics of diethylhexyl‐phthalate extraction From polyvinylchloride‐infusion lines
Authors: Loff S , Kabs F , Subotic U , Schaible T , Reinecke F , Langbein M
Published: May 2008

BACKGROUND: For infusion therapy, polyvinylchloride (PVC)‐infusion lines are commonly used. In this study, we examined the temperature dependency and the dynamics of extraction in the time course of infusion. METHODS: PVC‐infusion lines used on the newborn ICU were perfused with a typical 24‐hour fat infusion. We collected the perfused solution and measured the concentration of DEHP. This procedure was carried out at 27 degrees C and 33 degrees C. In another experiment, we examined the extraction rate in the time course of a 24‐hour infusion. The infusion was collected every 4 hours. RESULTS: We discovered that extraction of DEHP depends highly on the surrounding temperature. Whereas at 27 degrees C, the extraction of DEHP was 422.78 microg/mL, the leaching reached 540.78 microg/mL at 33 degrees C under otherwise identical conditions. This is important because the temperature on a newborn ICU is between 31 and 37 degrees C in an incubator. In the other experiment, we found out that the extraction rate rose from 25.44 microg/mL in the first 4 hours to 478.1 microg/mL after 24 hours. CONCLUSIONS: The result of this study is that the actual daily load of DEHP for a 2‐kg newborn is 30% higher than measured before. The rate of extraction is dependent on the time of contact between solution and tubing. If PVC‐infusion systems are used, solutions should be as cold as possible, and infusion time should be as short as possible.
Omega‐3 fatty acid supplementation increases anti‐inflammatory cytokines and attenuates systemic disease sequelae in experimental pancreatitis
Authors: Foitzik T , Eibl G , Schneider P , Wenger FA , Jacobi CA , Buhr HJ
Published: May 2008

BACKGROUND: The cytokines involved in the systemic inflammatory response in acute pancreatitis (AP) comprise lipid mediators (eg, prostanoids, thromboxanes, leukotrienes) generated from arachidonic acid (AA) and eicosapentaenoic acid (EPA). The AA‐derived mediators are generated from omega‐6‐fatty acid (FA) and have strong proinflammatory effects and the EPA‐derived mediators generated from omega‐3‐fatty acid are less active or even exhibit anti‐inflammatory effects. Basic parenteral nutrition delivers omega‐6‐FA and omega‐3‐FA at a ratio of approximately 7:1. AIM: To investigate whether altering the FA composition by fish oil supplementation (omega‐3‐FA) affects cytokine production and the parameters reflecting systemic disease severity in experimental AP. METHODS: Severe AP was induced in 30 rats by standardized intraductal infusion of bile salt and IV cerulein. Six hours after AP induction, rats were randomized to TPN using commercial solutions with identical amounts of glucose, amino acids, and fat but different FA compositions: group 1 received a soybean‐based fat solution without additional fish oil and group 2 was supplemented with 0.2 g/kg per day fish oil. TPN was continued for 2 days. Serum concentrations of IL‐6 and IL‐10 were measured before and after AP induction and at 24 and 48 hours after starting TPN. Routine cardiorespiratory and renal parameters were monitored to assess the systemic response at the organ level. RESULTS: Animals treated with fish oil had significantly higher IL‐10 values (at 24 hours, 63 +/‐ 7 versus 46 +/‐ 3 pg/mL), produced more urine (28 +/‐ 0.9 versus 21 +/‐ 1.6 mL), and had significantly fewer episodes of respiratory dysfunction (defined as a pO2 < 80 mm Hg or pCO2 > 50 mm Hg for >15 minutes; 29% versus 67%) during the observation period. CONCLUSIONS: Altering eicosanoid mediator precursor availability by infusion of (omega‐3 fatty acid increases anti‐inflammatory cytokines in this model of AP. This together with improved renal and respiratory function suggests that the systemic response to pancreatic injury is attenuated.