bluuebunny/crossref_metadata_2025 huggingface dataset:
Medium‐Chain, Triglyceride‐Containing Lipid Emulsions Increase Human Neutrophil β 2 Integrin Expression, Adhesion, and Degranulation
Authors: Wanten Geert J. A. , Geijtenbeek Theo B. H. , Raymakers Reinier A. P. , van Kooyk Yvette , Roos Dirk , Jansen Jan B. M. J. , Naber Anton H. J.
Published: May 2008

Background: To test the hypothesis that lipid emulsions with different triglyceride structures have distinct immunomodulatory properties, we analyzed human neutrophil adhesion and degranulation after lipid incubation. Methods: Neutrophils, isolated from the blood of 10 healthy volunteers, were incubated in medium or physiologic (2.5 mmol/L) emulsions containing long‐chain (LCT), medium‐chain (MCT), mixed LCT/MCT, or structured (SL) triglycerides. Expression of adhesion molecules and degranulation markers was evaluated by flow cytometry. Also, functional adhesion was investigated by means of a flow cytometric assay using fluorescent beads coated with the integrin ligand intercellular adhesion molecule (ICAM)‐1. Results: Although LCT and SL had no effect, LCT/MCT significantly increased expression of the β2 integrins lymphocyte‐function‐associated antigen 1 (+18%), macrophage antigen 1 (+387%), p150,95 (+82%), and αDβ2 (+230%). Degranulation marker expression for azurophilic (CD63, +210%) and specific granules (CD66b, +370%) also significantly increased, whereas L‐selectin (CD62L, ‐70%) decreased. The effects of LCT/MCT were mimicked by the MCT emulsion. ICAM‐1 adhesion (% beads bound) was increased by LCT/MCT (34% ± 4%), whereas LCT (19% ± 3%) and SL (20% ± 2%) had no effect compared with medium (17% ± 3%). Conclusions: LCT/MCT and MCT, contrary to LCT and SL emulsions, increased neutrophil β2 integrin expression, adhesion, and degranulation. Apart from other emulsion constituents, triglyceride chain length might therefore be a key feature in the interaction of lipid emulsions and the phagocyte immune system. (Journal of Parenteral and Enteral Nutrition 24:228–233, 2000)
Renal Function and Urinary Excretion of Electrolytes in Patients Receiving Cyclic Parenteral Nutrition
Authors: Boncompain‐Gérard Michèle , Robert Dominique , Fouque Denis , Hadj‐Aïssa Aoumeur
Published: May 2008

Background: Long‐term parenteral nutrition (LTPN) has been shown to induce renal impairment and bone demineralization. However, the mechanism of both injuries has not been clarified. Methods: This prospective study was performed in 16 patients with short bowel syndrome, aged 28 to 63 years, who had received LTPN for 31 ± 7 months. Urinary excretion of electrolytes were measured before (diurnal, 12 hours) and during (nocturnal, 12 hours) parenteral nutrition. Glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) were measured in the morning after the nutritional bag supply. Results: Mean GFR was 86 ± 7 mL/min/1.73 m2 and ERPF was 412 ± 31 mL/min/1.73 m2. Decreased GFR was present in 9 patients. There was no relation between renal function and age or the duration of LTPN. Urine volume and excretion of urea, creatinine, sodium, magnesium, and phosphate but not potassium increased significantly in nocturnal urine compared with diurnal urine. On the basis on 24‐hour calciuria, 7 patients were normocalciuric (NCa) whereas 9 were hypercalciuric (HCa). Both had excessive nocturnal calciuria, but only the HCa group had diurnal hypercalciuria, the calcium supply being identical. Bone mineral density (BMD) was slightly, although not significantly, higher in NCa group, but in all patients BMD correlated significantly with calciuria. Serum parathyroid hormone and vitamin D were not different in the two groups. Conclusions: In patients receiving LTPN, renal function is frequently impaired, by a mechanism which remains unclear. In nocturnal cyclic mode of nutrition, urinary volume and electrolyte excretion occurred predominantly during the infusion, but some patients have diurnal hypercalciuria. In these patients a defect in renal calcium reabsorption or more likely the inability of bone to retain the infused calcium may be responsible for bone demineralization. (Journal of Parenteral and Enteral Nutrition 24:234–239, 2000)
Malnutrition Impairs CD11b/CD18 Expression on Circulating Polymorphonuclear Neutrophils and Subsequent Exudation into Inflammatory Sites in the Early Phase of Glycogen‐Induced Murine Peritonitis
Authors: Ikeda Shigeo , Saito Hideaki , Inoue Tomomi , Fukatsu Kazuhiko , Han Ilsoo , Furukawa Satoshi , Matsuda Takeaki , Hidemura Akio
Published: May 2008

Background: The effects of malnutrition on polymorphonuclear neutrophil (PMN) exudation are not well understood. The purpose of this study was to examine the effects of short‐term dietary restriction on adhesion molecule expression on circulating PMNs and PMN exudation into the inflamed site in a glycogen‐induced peritonitis model. Methods: Twelve mice were randomly assigned to one of two groups. The ad libitum and diet‐restricted groups received mouse chow ad libitum (estimated consumption: 132 g/kg per day) and 33 g/kg per day, respectively, for 7 days. Then, 2 mL of a 1% glycogen solution was intraperitoneally administered to all mice. After 4 hours, the animals were killed. Whole blood was drawn by cardiac puncture. Peritoneal exudative cells were harvested by lavaging the peritoneal cavity. Expressions of CD11b, CD18, and CD62L were measured by flow cytometry. Results: Dietary restriction did not affect the numbers of circulating leukocytes, PMNs, or monocytes. However, CD11b and CD18 expressions on circulating PMNs were significantly lower in the diet‐restricted than in the ad libitum group. In contrast, CD62L expression on circulating PMNs was not affected by dietary restriction. The number of exudative PMNs was significantly lower in the diet‐restricted group than in the ad libitum group. The expressions of CD11b, CD18 and CD62L on exudative PMNs were unaffected by dietary restriction. There was a significant positive correlation between exudative PMN numbers and CD18 expression on circulating PMNs. Conclusions: Severe dietary restriction in our murine model decreased β2 integrin expression on circulating PMNs and inhibited PMN exudation into inflamed sites in the early phase of inflammation. These events may increase susceptibility to bacterial infection. Nutritional replenishment may improve host defense in part by enhancing PMN adhesion molecule expression. (Journal of Parenteral and Enteral Nutrition 24:276–279, 2000)
Arginine Supplementation Is Well Tolerated but Does Not Enhance Mitogen‐Induced Lymphocyte Proliferation in Elderly Nursing Home Residents with Pressure Ulcers
Authors: Langkamp‐Henken Bobbi , Herrlinger‐Garcia Kelli A. , Stechmiller Joyce K. , Nickerson‐Troy Julia A. , Lewis Brandon , Moffatt Laura
Published: May 2008

Background: Immune function declines with age, increasing risk for infection and delaying wound healing. Arginine enhances immune function and healing of standardized wounds in healthy elderly persons. The purpose of this study was to determine what level of arginine supplementation was orally and metabolically tolerated and effective in enhancing immune function in elderly persons with pressure ulcers. Methods: Residents with one or more pressure ulcers were recruited from two local nursing homes. Subjects were randomized to receive 0 g (n = 10; age, 82 ± 3 years), 8.5 g (n = 11; 81 ± 3 years), or 17 g (n = 11; 87 ± 2 years) of supplemental arginine each day for 4 weeks. Oral tolerance, ie, absence of nausea, vomiting, abdominal distention, or diarrhea, was assessed daily. Metabolic tolerance was assessed weekly by evaluating serum electrolytes. Lymphocyte proliferation to phytohemagglutinin and interleukin 2 production were measured at baseline and after 4 weeks of supplementation as indicators of immune function. Results: Supplemental arginine significantly increased plasma arginine levels and was orally and metabolically tolerated with no complaints of abdominal distress or no clinically relevant changes in electrolyte levels among groups. Lymphocyte proliferation and interleukin 2 production were significantly different between nursing homes. When data from nursing homes were considered individually, arginine supplementation did not enhance the proliferative response. In subjects from nursing home 2 only, there was a 38% and 75% decrease (p <.05) in lymphocyte proliferation with 8.5 and 17 g of supplemental arginine, respectively. Interleukin 2 production was no different among supplementation groups. Conclusions: Pharmacologic doses of arginine were well tolerated but did not enhance lymphocyte proliferation or interleukin 2 production in nursing home residents with pressure ulcers. Clinical Relevancy: Enteral formulas supplemented with pharmacologic levels of arginine are frequently administered to elderly persons. This study demonstrates that the very old can tolerate these nitrogen loads if baseline renal function is normal and fluid intake is encouraged. Further research needs to be completed investigating the effect of arginine supplementation on immune function in this population before recommending arginine use. (Journal of Parenteral and Enteral Nutrition 24:280–287, 2000)
Cytokine‐Driven Inflammatory Response Is Associated with the Hypermetabolism of AIDS Patients with Opportunistic Infections
Authors: Garcia‐Lorda Pilar , Serrano Pilar , Jiménez‐Expósito María Jesús , Fraile Julia , Bulló Mónica , Alonso Carlos , Bonada Anna , Viciana Pompeyo , García Luna Pedro P. , Salas‐Salvadó Jordi
Published: May 2008

Background: To assess a possible role of systemic inflammation in the resting metabolic response in AIDS patients with active secondary infections. Methods: Fifty‐two patients with AIDS‐defined criteria and concomitant active infections and 19 healthy subjects were studied. Measurements were as follows: body composition assessed by bioelectrical impedance; resting energy expenditure (REE) by 30‐minute indirect calorimetry; cytokine concentrations (IL‐6, IFNα, TNFα, sTNF‐R1) by ELISA; C‐reactive protein (CRP), erythrocyte sedimentation rate, fibrinogen, and nutritional parameters by standard techniques. Results: REE adjusted for fat‐free mass (REEFFM) was significantly increased in AIDS patients despite 39% of them not being hypermetabolic. The patients were undernourished and were found to have increased levels of acute‐phase proteins and increased concentrations of IL‐6 and sTNF‐R1 relative to controls. REE parameters were positively related to CRP, ESR, ferritin, IL‐6, and sTNF‐R1 and negatively related to albumin, prealbumin, and transferrin. CRP was an independent predictor of REEFFM in AIDS patients and explained 25% of its variability. Patients with severe inflammation (CRP ≥ 37 mg/dL) were significantly hypermetabolic with respect to patients without inflammation (CRP < 6 mg/dL) and had higher levels of IL‐6 and sTNF‐R1 and lower levels of albumin and prealbumin. Although no significant differences were observed with respect to the infection type, patients with tuberculosis and Pneumocystis carinii infections had higher resting metabolic and inflammatory responses, whereas patients with recurrent bacterial pneumonia were normometabolic and had lower levels of inflammatory markers. Conclusions: Resting hypermetabolism observed in AIDS patients with concurrent active infections is related to the presence and severity of systemic cytokine‐driven inflammatory response, which could reflect the type of secondary infection. (Journal of Parenteral and Enteral Nutrition 24:317–322, 2000)
The Medical and Financial Costs Associated with Termination of a Nutrition Support Nurse
Authors: Goldstein Marjorie , Braitman Leonard E. , Levine Gary M.
Published: May 2008

Background: Cost‐containment pressures have adversely affected hospital nutrition support team staffing. We determined the effect of termination of a nutrition support nurse responsible for patients receiving total parenteral nutrition (TPN) on quality assurance and financial indicators. Methods: A retrospective review of all 1,093 patients receiving TPN from fiscal year (FY) 1992 through FY 1998 in a tertiary care community hospital. We documented the changes in care during years when the nutrition support nurse position was staffed, terminated, and restored. Indicators studied included inappropriate TPN, central venous line sepsis, TPN wastage, and estimates of preventable costs. Results: When the nurse was present, 8.6% of TPN patients had a functional gastrointestinal (GI) tract and inappropriately received TPN compared with 12.1% when the nurse was absent, a risk difference of 3.5% points (95% confidence interval [CI], ‐.06 to 8.3; p =.069). Risk of TPN‐associated line sepsis increased from 8.8% of patients when the nurse was present to 13.2% when the nurse was absent, a difference of 4.4% points (95% CI, 0.06 to 9.2; p =.028). In the absence of the nurse, 26.3% of TPN patients had preventable charges us 17.5% when the nurse was present (p <.0001). Total preventable charges were higher in the years without a nurse (p <.003). Total preventable costs increased by $38,148 to $194,285 (depending on the estimate for sepsis) in the year after termination. Reinstatement of the nurse resulted in a decrease in costs between $34,485 and $156,654. Conclusions: Adequate staffing of a nutrition support team reduced inappropriate TPN and complications of TPN. Financial savings of the same order of magnitude as the nurse's compensation accompany substantial decreases in patient morbidity. (Journal of Parenteral and Enteral Nutrition 24:323–327, 2000)
Lipid Peroxide and Hydrogen Peroxide Formation in Parenteral Nutrition Solutions Containing Multivitamins
Authors: Silvers Karen M. , Darlow Brian A. , Winterbourn Christine C.
Published: May 2008

Background: Infusion of parenteral solutions containing peroxides may be detrimental to premature infants. Intralipid frequently contains lipid peroxides and undergoes further peroxidation when exposed to light. Peroxidation is inhibited by ascorbate, and we have proposed that administration of peroxides could be minimized by mixing multivitamins with the Intralipid. In contrast, others have reported that multivitamins generate peroxides and have advised against mixing them with lipid. Our objective was to assess whether light‐dependent reactions in parenteral solutions containing MVI Pediatric (MVIP) generate hydrogen peroxide and establish whether addition of multivitamins to Intralipid is beneficial or detrimental. Results: We were unable to make accurate peroxide measurements in MVIP using the ferrous oxidation of xylenol orange (FOX) assay, even though others have used it for this purpose, because of interference by ascorbate. Therefore oxygen release on adding catalase was measured to assay for hydrogen peroxide. Freshly reconstituted solutions contained 250 to 500 μmol/L hydrogen peroxide, and this increased dramatically in ambient light. This is presumably due to light‐dependent, riboflavin‐catalyzed reduction of oxygen by ascorbic acid. The rate of peroxide generation was less for MVIP diluted in Intralipid than in dextrose solution. Conclusions: Taken together with our previous findings, we conclude that multivitamins protect Intralipid against lipid peroxidation, but light‐dependent hydrogen peroxide production and ascorbate loss occur. These latter changes are less than for multivitamins in other total parenteral nutrition solutions, so there is an advantage in mixing multivitamins with Intralipid. However, prevention of ascorbate loss and hydrogen peroxide formation in any multivitamin solution requires protection of the delivery system from light. (Journal of Parenteral and Enteral Nutrition 25:14–17, 2001)
Reliable Bioelectrical Impedance Analysis Estimate of Fat‐free Mass in Liver, Lung, and Heart Transplant Patients
Authors: Kyle Ursula G. , Genton Laurence , Mentha Gilles , Nicod Laurent , Slosman Daniel O. , Pichard Claude
Published: May 2008

Background: Bioelectrical impedance analysis (BIA) can be valuable in evaluating the fat‐free (FFM) and fat masses (FM) in patients, provided that the BIA equation is valid in the subjects studied. The purpose of the clinical evaluation was to evaluate the applicability of a single BIA equation to predict FFM in pre‐ and posttransplant patients and to compare FFM and FM in transplant patients with healthy controls. Methods: Pre‐ and posttransplant liver, lung, and heart patients (159 men, 86 women) were measured by two methods—50‐kHz BIA‐derived FFM (FFMBIA) by Xitron instrument and DXA‐derived FFM (FFMDXA) by Hologic QDR‐4500 instrument—and compared with healthy controls (196 men, 129 women), aged 20 to 79 years. Results: The high correlation coefficient (r =.974), small bias (0.3 ± 2.3 kg), and small SEE (2.3 kg) suggest that BIA using the GENEVA equation is able to predict FFM in pre‐ and posttransplant patients. The study shows that the lower weight seen in transplant men and women than in controls was due to lower FFM, which was partially offset by higher FM in men but not in women. Furthermore, the higher weights in posttransplant than in pretransplant patients were due to higher FM and % FM that was confirmed by lower FFM/FM ratio in posttransplant patients. Conclusions: Single 50‐kHz frequency BIA permits measurement of FFM in pre‐ and posttransplant patients. (journal of Parenteral and Enteral Nutrition 25:45–51, 2001)
Liquid Enteral Diets Induce Bacterial Translocation by Increasing Cecal Flora without Changing Intestinal Motility
Authors: Haskel Yuval , Udassin Raphael , Freund Herbert R. , Zhang Jian M. , Hanani Menachem
Published: May 2008

The aim of this study was to determine the contribution of intestinal motility and cecal bacterial overgrowth to liquid diet‐induced bacterial translocation (BT). Three different commercially available liquid diets were offered to mice for 1 week. BT to the mesenteric lymph nodes (MLN), spleen, and liver were examined as well as cecal bacterial counts and populations, small bowel length and weight, and histopathologic changes in the ileal and jejunal mucosa. In addition, the effect of the various diets on intestinal motility was measured by the transit index of a charcoal mixture introduced into the stomach. The incidence of BT to the mesenteric lymph nodes was significantly and similarly increased (p <.05) in mice fed Vivonex (30%), Ensure (30%), and Osmolite (33%) compared with chow‐fed controls (0%). Compared with chow‐fed controls, all three liquid diets were associated with the development of cecal bacterial overgrowth (p <.01). There were no significant changes in the transit index for the three liquid diet groups compared with the chow‐fed controls. BT to the MLN was induced by all three liquid diets tested, casting some doubts as to their role in preventing BT in clinical use. BT was associated with a statistically significant increase in cecal bacterial count but was not associated with gut motility changes in this model. In fact, no significant changes in intestinal motility were noted in all groups tested. (Journal of Parenteral and Enteral Nutrition 25:60–64, 2001)
Nutrition Assessment and Support of Organ Transplant Recipients
Authors: Hasse Jeanette M.
Published: May 2008

Timely nutrition assessment and intervention in organ transplant recipients may improve outcomes surrounding transplantation. A pretransplant nutrition assessment should include a variety of parameters including physical assessment, history, anthropometric measurements, and laboratory tests. Malnutrition compromises posttransplant survival; prolonged waiting times worsen outcomes when patients are already malnourished. Severe obesity may decrease graft function and survival in kidney transplant recipients. In the pretransplant phase, nutritional goals include optimization of nutritional status and treatment of nutrition‐related symptoms induced by organ failure. Enteral tube feeding is indicated for patients with functional gastrointestinal tracts who are not eating adequately. Parenteral nutrition is rarely needed pretransplant except in cases of intestinal failure. When determining pretransplant nutrient requirements, nutritional status, weight, age, gender, metabolic state, stage and type of organ failure, malabsorption, induced losses, goals, and comorbid conditions must be considered. During the acute posttransplant phase, adequate nutrition is required to help prevent infection, promote wound healing, support metabolic demands, replenish lost stores, and perhaps mediate the immune response. Nutrient recommendations reflect posttransplant metabolic changes. The appropriateness of posttransplant nutrition support depends on the prevalence of malnutrition among patients with a specific type of organ failure and the benefits when nutrition support is given. Organ transplantation complications including rejection, infection, wound healing, renal insufficiency, hyperglycemia, and surgical complications require specific nutritional requirements and therapies. Many potential applications of nutrition in the pre‐ and posttransplant phases exist and require further study.(Journal of Parenteral and Enteral Nutrition25:120–131, 2001)
Drug‐Nutrient Interactions in Transplant Recipients
Authors: Chan Lingtak‐Neander
Published: May 2008

Drug‐nutrient interaction refers to an alteration of kinetics or dynamics of a drug or a nutritional element, or a compromise in nutritional status as a result of the addition of a drug. The potentials for drug—nutrient interaction increase with the number of drugs taken by the patient. Organ transplant recipients are therefore at high risk for drug‐nutrient interactions because multiple medications are used to manage graft rejection, opportunistic infections, and other associated complications. Unrecognized or unmanaged drug‐nutrient interactions in this patient population can have an adverse impact on their outcomes. This paper reviews the importance of recognizing drug‐nutrient interaction when using cyclosporine‐based regimens.(Journal of Parenteral and Enteral Nutrition25:132–141, 2001)
Most Infectious Complications in Parenterally Fed Trauma Patients Are Not Due to Elevated Blood Glucose Levels
Authors: Kudsk Kenneth A. , Laulederkind Anne , Hanna M. Keith
Published: May 2008

Objective: To determine the relationship between hyperglycemia and infectious complications in nutritional studies of trauma patients. Methods: Retrospective review of serum glucose values in two published randomized, prospective studies of patients receiving either enteral or parenteral feeding (trial 1) or isonitrogenous, isocaloric enteral diets (trial 2). Trial 2 also included patients prospectively followed who received little or no enteral feeding. Results: Patients randomized to enteral or parenteral feeding in trial 1 exhibited no significant differences in the highest recorded serum glucose (SG) until the fourth or fifth day after protocol entry. SG tended to be higher in infected than noninfected patients in the first 4 hospital days, but SG was far below values considered to increase the risk for infection (SG > 220 mg/dL). In trial 2, glucose levels tended to be slightly higher in infected than in noninfected patients within the first 5 days reaching statistical significance by day 5. Unfed control patients had similar SG values but significantly more major infectious complications. Conclusions: Patients developing infections had slightly higher SG levels than noninfected patients early in admission, but these SG values were far below levels considered a risk for infective complications. Significant hyperglycemia does not explain differences in infectious complications in critically ill trauma patients randomized to various routes and types of nutrition. (Journal of Parenteral and Enteral Nutrition 25:174–179, 2001)
A Controlled Comparison of Traditional Feeding Tube Verification Methods to a Bedside, Electromagnetic Technique
Authors: Kearns Patrick J. , Donna Chin
Published: May 2008

Background: Benefits of enteral feeding are diminished by aspiration pneumonia and mechanical complications of misplaced feeding tubes. To avoid complications, clinicians determine the location of the tip before feeding. This study compares diagnostic test characteristics of 4 techniques for tip localization. Methods: A prospective, blinded trial was conducted on the wards and critical care units of four acute‐care hospitals. Patients requiring at least 3 days of enteral feeding were studied. Four observers at each institution used a randomly assigned technique to determine a tube's tip location. Methods included auscultation, aspiration with inspection or pH determination of aspirated material, and a recently developed electromagnetic technique. Results were compared with radiographic determination. Success rates were compared using sensitivity, specificity, and likelihood ratios. Results: The 4 methods agreed with the radiograph in (mean, 95% confidence interval): 84 (80 to 88)%, 50 (45 to 55)%, 56 (51 to 61)%, and 76 (72 to 81)% of observations, respectively. Only the electromagnetic method and aspiration identified all tubes located above the diaphragm (negative likelihood ratio 0 and sensitivity 100%). Aspiration was unsuccessful in making a determination in 53% of the observations, whereas the electromagnetic method was successful 90% of the time. (Journal of Parenteral and Enteral Nutrition 25:210–215, 2001)
Nutrient Support in Hematopoietic Cell Transplantation
Authors: Lenssen Polly , Bruemmer Barbara , Aker Saundra N. , McDonald George B.
Published: May 2008

High‐dose cytoreduction and hematopoietic stem cell infusion form the basis for treatment of hematologic cancers, defects or failure of hematopoiesis, and some solid tumors. As an antitumor therapy, allogeneic hematopoietic cell transplantation (HCT) is superior to autologous HCT by induction of a graft‐us‐tumor effect. However, recipients of allografts suffer higher transplant‐related mortality owing to graft‐us‐host disease (GVHD). Nutrition support research must recognize that HCT is a heterogeneous modality whose short and long‐term outcomes are affected by transplant type, preparative regimens, diagnosis, disease stage, age, and nutritional status. The field of HCT will diversify further as lower dose cytoreduction and mixed chimerism grafts allow expansion of the technique to older patients and to other diseases. (journal of Parenteral and Enteral Nutrition 25:219–228, 2001)
Parenteral Structured Triglyceride Emulsion Improves Nitrogen Balance and Is Cleared Faster from the Blood in Moderately Catabolic Patients
Authors: Kruimel Joanna W. , Naber Ton H. , Adam van der Vliet J. , Carneheim Claes , Katan Martijn B. , Jansen Jan B.
Published: May 2008

Background: Most postoperative patients lose net protein mass, which reflects loss of muscle tissue and organ function. Perioperative parenteral nutrition may reduce the loss of protein, but in general, with conventional lipid emulsions a waste of protein still remains. Methods: We compared the effects on nitrogen balance of an emulsion containing structured triglycerides, a new type of synthesized triglycerides, with an emulsion of a physical mixture of medium‐ and long‐chain triglycerides as part of parenteral feeding in moderately catabolic patients. The first 5 days after placement of an aortic prosthesis patients received total parenteral nutrition (TPN) providing 0.2 g of nitrogen per kg body weight per day; energy requirement was calculated using Harris and Benedict's equation, adding 300 kcal per day for activity. Twelve patients were treated with the structured triglyceride emulsion and 13 patients with the emulsion of the physical mixture of medium‐ and long‐chain triglycerides. The design was a randomized, double‐blind parallel study. Results: In the patients who completed the study, the mean cumulative nitrogen balance over the first 5 postoperative days was ‐8 ± 2 g in 10 patients on the structured triglyceride emulsion and ‐21 ± 4 g in 9 patients on the emulsion of the physical mixture of medium‐ and long‐chain triglycerides; the mean difference was 13 g of nitrogen (95% confidence interval 4 to 22, p =.015) in favor of the structured triglyceride emulsion. On the first postoperative day serum triglyceride and plasma medium‐chain free fatty acid levels increased less during infusion of the structured triglyceride emulsion than with the physical mixture emulsion. Conclusions: The parenteral structured triglyceride emulsion improves the nitrogen balance and is cleared faster from the blood, compared with the emulsion of the physical mixture of medium‐ and long‐chain triglycerides, in moderately catabolic patients. (Journal of Parenteral and Enteral Nutrition 25:237–244, 2001)
The Role of Eicosanoids in the Process of Adaptation Following Massive Bowel Resection in the Rat
Authors: Kollman‐Bauerly Kathryn A. , Thomas Deborah L. , Adrian Thomas E. , Lien Eric L. , Vanderhoof Jon A.
Published: May 2008

Background: Long chain polyunsaturated fatty acids (LCPUFAs) such as arachidonic acid (AA) and eicosapentaenoic acid (EPA) stimulate intestinal adaptation. Prostaglandins also enhance intestinal adaptation. The purpose of this study was to determine by which eicosanoid pathway dietary arachidonic acid enhances intestinal adaptation. Cyclo‐oxygenase or lipoxygenase were selectively inhibited to determine whether either of them enhanced or inhibited adaptation. Methods: Sixty Sprague‐Dawley rats were divided into 2 groups, one receiving an 80% small bowel resection and the other receiving a sham operation. Rats were further divided into groups receiving either a placebo, a general lipoxygenase inhibitor (nordihydroguaiaretic acid [NDGA] at 40 mg/kg per day), or a cyclo‐oxygenase‐2 inhibitor (Etodolac at 3 mg/kg per day). Rats were pair‐fed a diet containing 30% kcal from fat, primarily consisting of AA. Results: After 14 days, mucosal mass, protein, DNA, and disaccharidase activity were measured in the remaining small intestine. There was a significant decrease in ileal mucosal mass in rats receiving Etodolac and a significant increase in mucosal mass in the duodenum in rats receiving NDGA (both p <.001). Mucosal DNA, protein, and disaccharidase data showed similar trends. Conclusions: These findings suggest that after small bowel resection, dietary arachidonic acid may facilitate the adaptation process by acting as a substrate for the synthesis of prostaglandins, and not through the derivatives of lipoxygenase such as leukotrienes or thromboxanes. (Journal of Parenteral and Enteral Nutrition 25:275‐281, 2001)
Effect of Tumor Weight and Tube Feeding on TNF‐α and IL‐1β mRNA Expression in the Brain of Mice
Authors: Ozaki Kunihiro , Yoshida Shogo , Ishibashi Nobuya , Kamei Hideki , Muraoka Tatsuya , Shirouzu Kazuo
Published: May 2008

Background: Previous studies have shown that cytokine mRNA expression is elevated in the brains of anorectic, tumor‐bearing rats. The objectives of the current study were as follows: (1) to determine whether a small tumor would result in up‐regulation of tumor necrosis factor (TNF)‐α and interleukin (IL)‐1β mRNA expression in the brain and other tissues of tumor‐bearing mice; and (2) to determine whether hyperalimentation by tube feeding would prevent up‐regulation of cytokine mRNA expression in the brain and other tissues of tumor‐bearing mice. Methods: Male C57BL/6 mice were divided into 4 groups: (1) control mice fed ad libitum (Control); (2) tumor‐bearing mice fed ad libitum (TB); (3) control mice receiving tube feeding (CTF); and (4) tumor‐bearing mice receiving tube feeding (TBTF). Results: TNF‐α and IL‐1β mRNA expression was elevated in the brains of mice with a 1% body weight tumor, relative to the control and CTF groups, without any detectable changes in the other organs. On the other hand, TNF‐α and IL‐1β mRNA expression was elevated in all organs of mice with an 8% body weight tumor, relative to the control and CTF groups. Tube feeding did not change TNF‐α and IL‐1β mRNA expression in mice burdened with either a 1% or 8% body weight tumor. Conclusions: Up‐regulation of cytokine mRNA synthesis occurs earlier in the brain than in other organs, and hyperalimentation does not change cytokine mRNA expression in tumor‐bearing mice. (Journal of Parenteral and Enteral Nutrition 25:317–322, 2001)
Crossing the quality chasm: building a safe nutrition system
Authors: Schneider PJ
Published: May 2008

Recent reports to Congress and the public from the Institute of Medicine underscore concern about the quality of healthcare in America. The nutrition community has focused most of its attention on the report titled The Role of Nutrition in Maintaining Health in the Nation's Elderly, which evaluated nutrition services coverage for the Medicare population. Of equal importance was the recent publication of two reports from the Committee on Quality of Health Care in America: To Err is Human‐‐Building a Safer Health System and Crossing the Quality Chasm‐‐A New Health System for the 21st Century. IV nutrition support was a breakthrough in medical care that has become a standard tool in treating patients who cannot eat for prolonged periods of time. It is also a medical treatment that can result in harm to patients. As problems with patient safety associated with the use of IV nutrition were documented, safer methods to deliver this life‐saving form of treatment were developed and evaluated. Although an interdisciplinary team approach has been shown to be the safest way to administer IV nutrition, this system is costly and not universally used. Alternatives to the interdisciplinary team approach should be evaluated to assure that patients receive optimum nutrition care. The tools that can be used to improve patient safety include self‐assessment of practitioners who routinely use nutrition support in their practice, curricular‐based continuing education programs, board certification in nutrition support practice, and the use of clinical guidelines to assist in making clinical decisions. By developing and promoting these tools, A.S.P.E.N. is committed to building a safe nutrition system so every patient receives optimal nutrition care.
Efficacy and tolerance of gastrostomy feeding in pediatric forms of neuromuscular diseases
Authors: Seguy D , Michaud L , Guimber D , Cuisset JM , Devos P , Turck D , Gottrand F
Published: May 2008

BACKGROUND: Percutaneous endoscopic gastrostomy (PEG) is a simple and reliable method, but there are few data about its use in pediatric forms of neuromuscular diseases (NMD). The aim of this study was to evaluate the nutritional effects and tolerance of gastrostomy feeding in NMD patients. METHODS: Twelve patients with NMD, ranging in age from 1 month to 25.5 years, underwent a gastrostomy placement (PEG, n = 11; surgical gastrostomy, n = 1) between January 1990 and December 2000. Diseases were muscular dystrophies (n = 5), infantile spinal muscular atrophies (n = 3), congenital myopathies (n = 3), and polyradiculoneuritis (n = 1). Height‐for‐age (Z(H/A)), weight‐for‐age (Z(W/A)), and weight‐for‐height (Z(W/H)) z scores were assessed at birth, at the time of gastrostomy placement, after a 6‐month and 1‐year follow‐up, and at the end of follow‐up. Complications that occurred during the gastrostomy feeding period were recorded. Comparisons of z scores at the different times were performed with repeated‐measures analyses of variance. RESULTS: Z(W/A) (p <.05) and Z(W/H) (p <.001) improved in the whole group after gastrostomy. For the 10 patients for whom follow‐up was more than 1 year, Z(W/A) (p <.03) and Z(W/H) (p <.001) increased from the time of gastrostomy to the end of follow‐up. Among 5 patients who had a gastroesophageal reflux diagnosed before gastrostomy placement, 3 had at least 1 episode of pneumonia and 2 died of respiratory distress caused by the worsening of NMD. No other major complication was encountered. CONCLUSIONS: Gastrostomy feeding is well tolerated and results in an improvement of nutritional indices in NMD patients. Special care should be taken in patients with preexisting gastroesophageal reflux.
Heat and life: the ongoing scientific odyssey
Authors: Heymsfield SB
Published: May 2008

The source of body heat has fascinated philosophers and scientists for millennia. Resting heat production is a major component of human energy requirements in health and disease. This review traces through mankind's attempts to understand the nature of resting heat production in humans and animals and its relationships to body mass and composition. Far from being fully understood, the study of heat production is an area of intense research interest bridging the gap between modern biology and physics.
Keratinocyte growth factor stimulates the recovery of epithelial structure and function in a mouse model of total parenteral nutrition
Authors: Yang H , Wildhaber B , Tazuke Y , Teitelbaum DH
Published: May 2008

BACKGROUND: Keratinocyte growth factor (KGF) increases intestinal growth and is expressed by intestinal intraepithelial lymphocytes (IEL). Because total parenteral nutrition (TPN) leads to villus atrophy and a loss of epithelial function, we hypothesized that KGF administration could reverse these changes. METHODS: Mice were randomized into three groups: oral feeding (Control); TPN; or TPN with recombinant human KGF. Mice were killed at 7 days, and the small bowel was harvested for histology, DNA, and protein content analysis. Epithelial cell proliferation was studied by 5‐bromo‐2‐deoxyuridine (BrdU) incorporation, and apoptosis was detected by flow cytometry with Annexin V staining. Epithelial ion transport function was studied by Ussing chambers. Epithelial barrier function was assessed with transepithelial resistance and transmural passage of 3H‐mannitol. Epithelial KGF receptors expression was studied by using reverse transcriptase‐polymerase chain reaction (RT‐PCR) and Western blot. RESULTS: TPN decreased intestinal DNA, protein content, villus height, and crypt cell proliferation. TPN also resulted in an increase in epithelial cell apoptosis. KGF administration significantly stimulated the recovery of mucosal structures including intestinal protein and DNA content, villus height, and crypt cell proliferation, and decreased epithelial apoptosis. KGF also up‐regulate the epithelial KGF receptor expression. Moreover, KGF attenuated the TPN‐induced increase in ion transport and increased the epithelial barrier function. CONCLUSIONS: KGF administration reversed many of the adverse epithelial changes associated with TPN administration. Additionally, KGF up‐regulated epithelial KGF receptor expression. It is possible that KGF may have a therapeutic efficacy in patients who are receiving TPN.
Body cell mass repletion and improved quality of life in HIV‐infected individuals receiving oxandrolone
Authors: Earthman CP , Reid PM , Harper IT , Ravussin E , Howell WH
Published: May 2008

BACKGROUND: The aim of this study was to measure changes in body cell mass (BCM) and quality of life in HIV‐infected individuals undergoing oxandrolone therapy. Previous studies on oxandrolone have neither quantified changes in BCM using criterion methods nor quality of life using an HIV‐specific instrument. METHODS: Twenty‐five HIV‐infected patients (15 with an AIDS diagnosis) on standard antiretroviral and nutrition management were studied before and an average of 18.6 weeks after the initiation of oxandrolone therapy, as prescribed by their primary care physician for the treatment of weight loss. BCM was estimated from intracellular water measured by multiple dilution. Lean soft tissue mass (LTM) was measured by dual‐energy X‐ray absorptiometry. Quality of life was evaluated by the Functional Assessment of HIV Infection (FAHI) questionnaire. RESULTS: Significant gains in body weight (2.6 +/‐ 3.0 kg; p <.0001), BCM (3.6 +/‐ 3.0 kg; p <.0001), and LTM (3.0 +/‐ 2.9 kg; p <.0001) occurred over an average course of 18.6 weeks of treatment. Overall quality of life improved (p =.056) and appetite improved (p =.032), both of which were positively associated with weight gain (p =.040 and p =.022, respectively). CONCLUSIONS: This is the first study involving oxandrolone therapy in HIV infection to document changes in quality of life and BCM, the metabolically active component of lean body mass that reflects nutritional status better than other more global body composition parameters. Nutritional status and quality of life can improve in HIV‐infected individuals receiving a combined therapeutic approach that includes oxandrolone.
Effectiveness of a clinical practice guideline for parenteral nutrition: a 5‐year follow‐up study in a pediatric teaching hospital
Authors: Duggan C , Rizzo C , Cooper A , Klavon S , Fuchs V , Gura K , Richardson D , Collier S , Lo C
Published: May 2008

OBJECTIVE: To determine the effectiveness of a clinical practice guideline (CPG) on the use of parenteral nutrition (PN) at a tertiary care pediatric hospital. METHODS: Review of prospectively collected data on hospital‐wide PN use 2 years before and 5 years after the establishment of the CPG. Effectiveness of the CPG was measured as the percentage of PN courses lasting fewer than 5 days and the number of PN starts per 1000 patient days. RESULTS: During the study period, 5745 PN courses were administered. The mean (SD) number of PN starts per 1000 inpatient days was 8.86 (0.78) before the CPG and 9.54 (2.49) afterwards (p =.28). The percentage courses of PN lasting for fewer than 5 days declined from 26.3% before the CPG to 18.4% afterwards (p <.0001). A multivariate model confirmed that the rate of short‐term PN starts declined after the CPG was issued. The mean (SD) number of PN courses shorter than 5 days in the 2 years before the CPG was 2.33 (0.42) per 1000 patient days versus 1.75 (0.45) in the 5 years after the CPG was instituted (p =.005), which is a 25% decline. The services with the highest volume of PN use showed the most significant decreases in short‐term PN use. A cost savings to the hospital of more than $50,000 may have been realized. CONCLUSIONS: In a large pediatric tertiary care hospital, a CPG was successfully deployed. CPGs can favorably affect the use rates and costs of parenteral nutrition.
Effect of neuromuscular blockade on energy expenditure in patients with severe head injury
Authors: McCall M , Jeejeebhoy K , Pencharz P , Moulton R
Published: May 2008

BACKGROUND: The purpose of this study was to determine the effect of neuromuscular blockade on energy expenditure in severely head‐injured patients; to determine the effects of body temperature, nutrition support, and morphine use on metabolic rate; and to compare measured energy expenditure with values from predictive equations. METHODS: Energy expenditure was measured using indirect calorimetry in 2 groups of ventilated patients‐18 with severe head injury during and after administration of pancuronium bromide and morphine, and second, 14 severely traumatized patients without severe head injury (trauma group) who received morphine without neuromuscular blockade. RESULTS: The mean energy expenditure of head‐injured patients increased significantly once pancuronium was discontinued, ie, from 24.2 +/‐ 3.1 to 28.7 +/‐ 4.6 kcal/kg (p =.002). This effect was independent of other relevant variables such as morphine dose, body temperature, and nutrition support. When compared with the Harris‐Benedict and World Health Organization predictive equations, neuromuscular blockade resulted in a stress factor of only 0.96 and 0.95, respectively, which increased to 1.19 and 1.18, respectively, once blockade was discontinued. Head‐injured patients not on neuromuscular blockade had a significantly greater energy expenditure when compared with the trauma group (p =.02). CONCLUSIONS: Neuromuscular blockade in severely head‐injured patients decreases energy expenditure to basal levels, independent of morphine use, body temperature, and feeding. Levels of hypermetabolism in both the head‐injured and trauma groups were relatively low, at 19% and 5% above predicted values, respectively. This study provides useful information for the management of nutrition support in severely traumatized patients.
Procalcitonin and enteral nutrition tolerance in critically ill patients
Authors: Brown RO , Alexander E , Hanes SD , Wood GC , Kudsk KA , Dickerson RN
Published: May 2008

BACKGROUND: Serum procalcitonin concentrations have been reported to be elevated in patients with bacterial infection. Early enteral nutrition (EN) has been shown to decrease infections in trauma patients. The purpose of this study was to characterize procalcitonin and other serum proteins during EN of trauma patients based on EN tolerance and presence of infection. METHODS: Twenty traumatized patients received a high‐protein enteral formulation within 5 days of injury. Serum for procalcitonin, C‐reactive protein, and prealbumin was analyzed on days 1 and 7 of EN. The procalcitonin/prealbumin and C‐reactive protein/prealbumin ratios were calculated the same days. Patients who were infected during the study were compared with those not infected, and enteral‐tolerant patients were compared with enteral‐intolerant patients using these measurements. RESULTS: In the 20 trauma patients, procalcitonin (10.35 +/‐ 27.87 versus 1.03 +/‐ 1.24 ng/mL, p <.001) and procalcitonin/prealbumin ratio (1.70 +/‐ 4.20 versus 0.18 +/‐ 0.28, p <.01) decreased significantly over the 7‐day period of EN. In the 12 patients who had infection, procalcitonin (16.33 +/‐ 35.31 versus 1.37 +/‐ 1.41 ng/mL, p <.004) and procal‐ citonin/prealbumin ratio (2.74 +/‐ 5.31 versus 0.26 +/‐ 0.33, p <.01) decreased significantly over the 7‐day period of enteral nutrition. There were no significant changes in the measurements for 8 patients without infection. In the 15 patients who were enteral‐tolerant, procalcitonin (12.56 +/‐ 32.84 versus 1.07 +/‐ 1.23 ng/mL, p <.004) and procalcitonin/prealbumin ratio (2.03 +/‐ 4.93 versus 0.20 +/‐ 0.29, p <.01) decreased significantly. CONCLUSION: Procalcitonin serum concentrations decrease significantly during EN in enteral‐tolerant, critically ill patients with infection.
Pulmonary microcrystalline cellulose deposition from intravenous injection of oral medication in a patient receiving parenteral nutrition
Authors: Ott MC , Khoor A , Scolapio JS , Leventhal JP
Published: May 2008

A 50‐year‐old man who had been dependent on home parenteral nutrition (HPN) for 24 years presented with shortness of breath. A computed tomography scan of the lungs revealed a diffuse micronodular parenchymal infiltrate. On bronchoscopy, a crystalloid material was identified. This organic material was determined to be consistent with codeine. The patient had been injecting codeine into his intravenous catheter.