bluuebunny/crossref_metadata_2025 huggingface dataset:
Prospective Study on the Efficacy of Branched‐Chain Amino Acids in Septic Patients
Authors: Jiménez Jiménez F.J. , Ortiz Leyba C. , Morales Méndez S. , Barros Pérez M. , Munoz Garcia J.
Published: May 2008

The metabolic response to sepsis is characterized by increased proteolysis and gluconeogenesis, reduced protein synthesis, and negative nitrogen balance. The effects of a solution with a high proportion of branched‐chain amino acids (BCAA) on the nutritional state of septic patients were evaluated. Eighty patients with peritonitis were divided into two groups of 40 patients; group 1 was administered a solution with 22.5% BCAA and group 2 with 45% BCAA. The following parameters were evaluated: anthropometrics, creatinine/height index, urinary 3‐methylhistidine, nitrogen balance, stress index, albumin, prealbumin, transferrin, retinol binding protein, lymphocytes, delayed cutaneous sensitivity tests, studies of hepatic function, and plasma aminogram. In group 2 a more positive nitrogen balance, a greater drop in the stress index, a rise in plasma prealbumin and retinol binding protein levels, an increase in the creatinine/height index, and a more marked fall in the urinary excretion of 3‐methylhistidine were found. When solutions with a high BCAA content were administered, there was an increase in the plasma concentrations of these amino acids in the BCAA/aromatic amino acid quotient and a decrease in the aromatic amino acids. Plasma concentrations of leucine and valine achieved very high, potentially toxic, levels at 15 days when solutions with high BCAA content were used. It is concluded that solutions with BCAA are advisable for use in the septic patient in the increased protein catabolic phase, where positive nitrogen balance, a reduction in muscle protein catabolism, and faster recovery of muscle and visceral protein were obtained. (Journal of Parenteral and Enteral Nutrition 15:252–261, 1991)
Dietary Fiber and Total Enteral Nutrition: Fermentative Assessment of Five Fiber Supplements
Authors: McBurney Michael I. , Thompson Lilian U.
Published: May 2008

Total enteral nutrition (TEN) formulas supplemented with dietary fiber, typically soy polysaccharide, are in widespread clinical use. Five commercially available dietary fiber supplements obtained from fruits (apple, grapefruit, orange, prune, tomato) were examined for potential use in TEN formulas. In uitro fermentations of 0, 4, 8, 12, and 24 hours' duration with human fecal microbiota from three different donors were conducted to assess colonic fermentative effects. Short‐chain fatty acid and hydrogen productions differed significantly with fiber source. The most rapid fermentation rate was with tomato followed by orange, grapefruit, apple, and finally prune fiber. Such differences in fermentability should be considered when fiber sources are selected to supplement TEN formulas. (Journal of Parenteral and Enteral Nutrition 15:267–270, 1991)
Dietary Manipulation of Methotrexate‐Induced Enterocolitis
Authors: Jian Shou  , Lieberman Michael D. , Hofmann Kurt , Leon Pablo , Redmond H. Paul , Davies Helen , Daly John M.
Published: May 2008

Administration of chemotherapy is limited by host toxicity, which is often manifested by severe enterocolitis. This study evaluated the effects of a liquid, elemental, chemically defined diet (ED) supplemented with 2% glutamine (Glu‐ED) compared with a polypeptide diet (PPD) on the morbidity and mortality after methotrexate (MTX) administration. Fischer 344 rats (n=80) were fed either a regular rat chow diet (RD), a 2% glycine supplemented elemental diet (Gly‐ED), a 2% glutamine‐supplemented elemental diet (GLU‐ED), and a glycine‐supplemented polypeptide diet(Gly‐PPD) for 7 days prior to administration of MTX (20 mg/kg, ip). After 72 hours, eight rats per group were killed; portal vein and vena cava blood, mesenteric lymph nodes (MLN), liver, small intestine, and cecum were sampled for bacterial culture. Remaining animals were followed to calculate survival.

One hundred percent of the Gly‐PPD and 25% of the Glu‐ED animals survived compared with 0% of the Gly‐ED animals. Our data showed that ED resulted in an increased quantity of intestinal Gram‐negative bacteria and diminished intestinal mucosal height and mucosal DNA/protein content. The polypeptide diet prevented intestinal mucosal atrophy, avoided MTX‐induced enterocolitis and significantly improved animal survival compared with an elemental diet with or without glutamine supplementation. (Journal of Parenteral and Enteral Nutrition 15 :307–312, 1991)
Clinically Significant Pneumatosis Intestinalis with Postoperative Enteral Feedings by Needle Catheter Jejunostomy: An Unusual Complication
Authors: Smith C. Daniel , Sarr Michael G.
Published: May 2008

We evaluated the incidence of clinically significant pneumatosis intestinalis and intestinal necrosis with the use of needle catheter jejunostomy in 217 consecutive patients who had undergone complicated abdominal operations or selected bariatric procedures. The needle catheter jejunostomy was used to deliver immediate postoperative nutrition, maintenance, and replacement fluids, and selected medications. In this group, no serious complications requiring surgical intervention were related to the use of needle catheter jejunostomies. Clinically significant pneumatosis intestinalis was encountered in two of 217 patients (1%). With the needle catheter jejunostomy in place, both patients improved rapidly when enteral feedings were discontinued and parenteral antibiotics were administered. None of the 217 patients developed ischemic intestinal necrosis. We conclude that 1) clinically significant pneumatosis is a rare complication of enteric feeding via needle catheter jejunostomy when the intrajejunal feeding is begun with a diluted, hypoosmolar solution with stepwise increases in osmolality, and 2) patients who do develop clinically significant pneumatosis (n=2) seem to respond rapidly to a temporary stoppage of enteral feedings and administration of parenteral antibiotics. (Journal of Parenteral and Enteral Nutrition 15:328–331, 1991)
Accessible Pool and System Parameters: Assumptions and Models
Authors: Cobelli Claudio , Saccomani Maria Pia
Published: May 2008

Quantitative assessment of substrate metabolism from in vivo tracer kinetic data requires a model of the system, i.e., a hypothesis on the structure and functioning of the system. Some fundamentals of modeling important for studying intermediary metabolism in the steady state will be discussed. Accessible pool and system parameters are defined. Although the calculation of accessible pool parameters is structure‐free, that of system parameters requires the use of noncompartmental or compartmental structures. Assumptions, bases for choice, and relative merits of these two modeling strategies are discussed. Glucose and leucine metabolism serve as prototypes to illustrate the theoretical points. (Journal of Parenteral and Enteral Nutrition 15:45S‐50S, 1991)
Role of Basal Insulin in the Regulation of Protein Kinetics and Energy Metabolism in Septic Patients
Authors: Zhang Xiao‐Jun , Kunkel Kelly R. , Jahoor Farook , Wolfe Robert R.
Published: May 2008

We have investigated the role of basal insulin concentration on leucine kinetics (determined by means of 1‐[13C]leucine) and energy metabolism (determined by indirect calorimetry) in eight septic patients by reducing insulin (and glucagon) secretion by somatostatin infusion. Basal glucagon concentration was elevated (744 ± 381 pg/mL), and insulin concentration was normal (10 ± 4 μU/mL). Basal resting energy expenditure (REE) was 151 ± 8% that of predicted basal energy expenditure, and leucine appearance (Ra), oxidation, and nonoxidative disposal rates were all elevated above the normal ranges. Somatostatin infusion reduced insulin concentration by 52% and glucagon concentration by 64%. This resulted in a significant increase in the rate of leucine oxidation from 0.96 ± 0.08 to 1.18 ± 0.14 μmol/kg/min (p < 0.01), and nonoxidative leucine disposal decreased from 2.95 ± 0.18 to 2.67 ± 0.17 μmol/kg/min (p < 0.01). Somatostatin infusion also caused significant increases in REE and fat oxidation from 1310 ± 100 to 1505 ± 128 kcal/m2/day (p < 0.05) and from 1.72 ± 0.24 to 2.41 ± 0.41 mg/kg/min, respectively, and a slight decrease of carbohydrate oxidation from 1.51 ± 0.49 to 1.31 ± 0.49 mg/kg/min. These metabolic responses can be attributed to the reduction in insulin concentration, because they are in the opposite direction of changes that would occur as a consequence of a reduction in glucagon concentration. We conclude that the basal insulin plays an important role in attenuating net protein loss and energy expenditure. (Journal of Parenteral and Enteral Nutrition 15:394–399, 1991)
A Prospective Study of Outcome from Protein‐Energy Malnutrition in Nursing Home Residents
Authors: Thomas David R. , Verdery Roy B. , Gardner Lucy , Kant Ashima , Lindsay Jennifer
Published: May 2008

To study recovery from protein‐energy malnutrition in patients newly admitted to a chronic care facility, biochemical and anthropomorphic malnutrition indicators were measured prospectively over a 2‐month period. Subjects were observed for a mean of 76 ± 18 days after admission. Factors which might affect nutritional status including method of feeding, energy prescribed, use of supplemental feedings, assistance in eating, and amount of diet consumed were recorded. Confounding variables including illness, mental status, functional status, or prescription drugs were evaluated for their impact. On the basis of an empiric nutrition score, 54% of newly admitted residents were malnourished. Improvement in nutritional score occurred in 63% of malnourished patients remaining in the facility whereas 37% remained malnourished. Two related factors, percentage of diet consumed and degree of assistance required in eating, were important differences in the outcome of patients remaining malnourished. Interventional studies to determine whether outcome can be improved by more aggressive feeding methods or by feeding teams need to be undertaken. (Journal of Parenteral and Enteral Nutrition 15:400–404, 1991)
Effects of Enteral Fat Emulsion on Fat Absorption in Obstructive Jaundiced Rats
Authors: Sato Yasuhisa , Todani Takuji , Toki Akira , Watanabe Yasuhiro , Uemura Sadashige , Morotomi Yoshiki
Published: May 2008

The effects of fat emulsion given enterally on fat absorption were studied with obstructive jaundiced rats (J group) as compared with jaundice‐free rats (C group). The J and C groups were subdivided into JE and CE groups using emulsified fat for the fat absorption test, and JU and CU groups using unemulsified fat. Rats in all groups were fed for 7 days with regular rat chow. After fasting for 12 hours, 14C‐labeled fat emulsion was infused to the JE and CE, and 14C‐labeled unemulsified fat to the JU and CU groups through a gastrostomy for the absorption test. The hourly and cumulative output of 14CO2 by respiration, absorption rate of 14C‐labeled fat in the intestine, and metabolic oxidation rate of the absorbed fat were determined during an 8‐hour period after the gastroenteral administration of emulsified or unemulsified fat. The peak of hourly output was seen after the first 2 hours in the CE, JE, and CU groups, following which a remarkable decline was seen in the CE and CU groups. However, a more gentle descent in the JE, and fluctuation at a low level in the JU group were observed. The cumulative output in the JE was 61 % of that in the CE, while the output in the JU was 16% of that in the CU group. The absorption rate in the JE was 81 % of that in the CE group, while the rate in the JU was 22% of that in the Cu group. These results show that the emulsified fat is more readily absorbed from the intestine even in jaundiced rats than the unemulsified fat and suggest that a fat module composed of fine emulsified fat may be effective in patients with insufficient excretion of bile acid. (Journal of Parenteral and Enteral Nutrition 15:408–411, 1991)
Continuous Infusion of Insulin in Hyperglycemic Low‐Birth Weight Infants Receiving Parenteral Nutrition with and without Lipid Emulsion
Authors: Kanarek Keith S. , Santeiro Maria L. , Malone John I.
Published: May 2008

The efficiency of a continuous infusion of insulin in improving glucose tolerance was compared in two groups of very low‐birth weight infants (mean ± SEM birth weights 757 ± 40 vs 828 ± 80 g and gestational ages 27.6 ± 0.7 vs. 27.2 ± 0.5 weeks) receiving total parenteral nutrition with and without the addition of lipid emulsion to the nutrition regimen. The mean ± SEM cumulative doses of insulin (0.87 ± 0.1 vs 1.15 ± 0.3 U/kg) and hours required to decrease the blood glucose level to 120 mg/dL (9.1 ± 0.8 vs 9.5 ± 1.0 hours) were similar. Insulin was delivered with a syringe pump used for other routine purposes in the neonatal intensive care unit. Continuous intravenous insulin infusion is an effective, inexpensive, safe method for maintaining glucose homeostasis in low‐birth weight infants who develop hyperglycemia as a consequence of total parenteral nutrition. (Journal of Parenteral and Enteral Nutrition 15:417–420, 1991)
Effect of Total Parenteral Nutrition with Xylitol on Protein and Energy Metabolism in Thermally Injured Rats
Authors: Karlstad Michael D. , Demichele Stephen J. , Bistrian Bruce R. , Blackburn George L.
Published: May 2008

The use of xylitol as an alternative carbohydrate calorie source in total parenteral nutrition may offer unique pharmacologic and nutritional properties in the therapy of the thermally injured. Male Sprague‐Dawley rats (250 g) received a 15‐second dorsal scald injury (25–30% BSA) and were parenterally fed isovolemic diets (60 ml/day) that provided 200 kcal/kg/d, 9.68 g of amino acids/kg/d, and 23.5% nonprotein calories (NPC) as fat for 3 days. The balance of NPC were provided as dextrose (Dex) or 50% xylitol:50% dextrose (Xyl/ Dex). Rectus muscle and liver fractional protein synthetic rates (FSR, %/day), whole body leucine appearance (Flux), oxidation (OX), protein breakdown (PB), and synthesis (PS) were estimated using a 4‐hour iv infusion of [1‐14 C]leucine on day 3. Mean values (±SE) for leucine kinetics (μmol leucine/hr/100 g), cumulative nitrogen balance (mg N) and plasma insulin concentration (Table I). (μU/mL). The partial replacement of dextrose calories with xylitol did not significantly alter whole body and tissue leucine kinetics, daily and cumulative nitrogen balance, insulin concentration, and energy expenditure (indirect calorimetry). These data indicate that xylitol may be useful as an alternative carbohydrate calorie source in parenteral nutrition to avoid possible deleterious side effects of glucose overfeeding in the critically ill but did not improve protein metabolism under the conditions of this study. (Journal of Parenteral and Enteral Nutrition 15:445–449, 1991)
Clenbuterol Treatment Increases Muscle Mass and Protein Content of Tumor‐Bearing Rats Maintained on Total Parenteral Nutrition
Authors: Chance William T. , Cao Lequn , Zhang Fu‐Sheng , Foley‐Nelson Teri , Fischer Josef E.
Published: May 2008

Treatment of tumor‐bearing (TB) and control rats with the anabolic beta‐2 agonist drug clenbuterol (CLE) for 14 days reduced food intake for 4 days initially. Feeding was increased in anorectic TB rats, however, during the last 7 days of drug administration. Since minimal muscle savings were observed in chow‐fed TB rats treated with CLE, the anabolic effects of this drug were investigated in a second experiment on TB rats maintained on total parenteral nutrition (TPN). Sixteen days after the subcutaneous transplantation of methylcholanthrene‐induced sarcomas rats was begun on a 2‐week schedule of TPN. One group of these rats was treated daily for 14 days with CLE, while the remaining rats received injections of saline. Additional groups of TB and nonTB rats were maintained on rat chow for this period and treated with saline. Although TB rats maintained on rat chow or TPN and treated with saline exhibited significantly decreased gastrocnemius muscle weight and protein content, treatment of TB‐TPN rats with clenbuterol normalized muscle mass and increased muscle protein content significantly and increased plasma concentrations of branched‐chain amino acids. These results indicate that although nutritional support of TB organisms does not result in protein repletion, the addition of an anabolic drug renders the nutritional support highly efficacious. (Journal of Parenteral and Enteral Nutrition 15:530–535, 1991)
In Vitro Assessment of Vancomycin HCl Compatibility after Coinfusion with a Specialized Amino Acid Formulation
Authors: Martins A. Melanie , Mcdougal Albert , Hamilton Don , Igwemezie Linus , Mcerlane Keith
Published: May 2008

Vancomycin usage at British Columbia's Children's Hospital has increased substantially in the Special Care Nursery as a consequence of a study demonstrating a reduced morbidity and mortality in neonates with necrotizing enterocolitis when treated with vancomycin and cefotaxime. The inability to place more than one peripheral intravenous access necessitates interruption of parenteral nutrition to infuse vancomycin, resulting in a reduction of the planned daily intake of these neonates. This is clinically significant with the administration of vancomycin because of the long administration period required for this drug (60 minutes). This study was designed to assess the physical and chemical stability of vancomycin with a standard neonatal parenteral nutrition solution, Vamin A, when coadministered through the same intravenous line. To simulate the actual clinical setting, the dose of vancomycin and the infusion rate of Vamin A were chosen to represent those commonly used in a 1‐kg neonate. Physical compatibility was assessed using effluent obtained after coinfusion of vancomycin with parenteral nutrition solution. Duplicate samples were visually checked for color changes and precipitate. High‐pressure liquid chromatography (HPLC) and pH testing were used to assess chemical compatibility of vancomycin. The results of physical compatibility revealed no color change or precipitate. No changes in pH were observed. HPLC determination confirmed that there were no significant time‐dependent changes in vancomycin stability. The samples were studied over 24 hours to determine the rate of degradation of vancomycin, if any, under various temperature conditions. The concentrations were not significantly different from each other at the different temperatures studied. Thus, there was no apparent change in the concentration of vancomycin in the presence of Vamin A. The results support the findings observed in other studies, which indicate that vancomycin is compatible when coinfused with Vamin A parenteral nutrition solution. It is concluded that vancomycin can be safely coinfused via four‐way stopcock with Vamin A in those neonates in whom no other intravenous access can be obtained. The benefits of coinfusion include (1) maintenance of planned daily intake for the neonate, (2) a decrease in nonnutrient fluid intake, and (3) a decrease in nursing time for line manipulation. (Journal of Parenteral and Enteral Nutrition 15:536–539, 1991)
Insulin Sensitivity in Septic Cancer‐Bearing Patients
Authors: Sauerwein H.P. , Pesola G.R. , Godfried M.H. , Levinson M.R. , Jeevanandam M. , Brennan M.F.
Published: May 2008

Resistance to insulin's effect on glucose metabolism is a well‐documented phenomenon. The magnitude of resistance to insulin's antilipolytic action is usually less than the resistance to insulin's action on glucose metabolism. In sepsis, resistance to the antilipolytic effect of insulin may be more prominent than resistance to insulin's action on glucose metabolism. Therefore, free fatty acid (FFA) turnover, FFA concentration, glucose tissue uptake, and endogenous glucose production were measured in nine septic cancer‐bearing patients and six healthy volunteers during a constant glucose load at two different insulin concentrations. During infusion of glucose alone, plasma insulin concentration in patients and control subjects were, respectively 33 ± 7 mU/L and 23 ± 4 mU/L. When plasma glucose was clamped at the low normal range these values were, respectively, 85 ± 17 mU/L and 28 ± 5 mU/L (p < 0.05). Glucose tissue uptake and endogenous glucose production were not significantly different in patients and control subjects in both parts of the study. FFA turnover and FFA concentrations were significantly higher in the patients compared with the control subjects (p < 0.001) in both parts of the study. It is concluded that in septic cancer‐bearing patients, resistance to insulin's effect on FFA turnover is more pronounced than resistance to its inhibiting effect on endogenous glucose production and its stimulating effect on glucose tissue uptake. (Journal of Parenteral Nutrition 15:653–658, 1991)
Lipomatous Hypertrophy of the Cardiac Interatrial Septum: An Unusual Complication in Long‐Term Home Parenteral Nutrition in Adult Patients
Authors: Beau P. , Michel P. , Coisne D. , Morichau‐Beauchant M.
Published: May 2008

The aim of this study was to report unusual echocardiographic findings in patients on long‐term home parenteral nutrition suggesting lipomatous hypertrophy of the cardiac interatrial septum. Seven patients (two women and five men, mean age 58 years) were prospectively evaluated by two‐dimensional echocardiography before and during home parenteral nutrition for severe short‐bowel syndrome. Parenteral caloric intake was 33 ± 4 kcal/kg per day (mean ± SD), with a mean supply of lipid emulsion of 1 g/kg per day. The first echocardiography, performed before initiation of home parenteral nutrition, was normal in the seven patients. The second echocardiography, performed 5 to 43 months (mean 20 months) later, revealed a significant increase of the thickness of the atrial septum in all patients (+8.3 ± 3.6 mm; p < 0.01), consistent with the diagnosis of lipomatous hypertrophy in four patients, and moderate fat accumulation in two others. The septum thickness measured after the nutritional support period was significantly correlated (p < 0.05) with the total amount of nutrient and lipid infused. Cardiac nuclear magnetic resonance imaging was performed in two patients; it suggested the adipose nature of interatrial septum deposit. None of the patients developed clinical or electrocardiographic symptoms during the period of nutrition. We suggest that patients undergoing long‐term home parenteral nutrition be screened for this new and unusual cardiac abnormality. Whether the latter might have clinical consequences in these patients remains to be determined. (Journal of Parenteral and Enteral Nutrition 15:659–662, 1991)
Diet and Cimetidine Induce Comparable Changes in Theophylline Metabolism in Normal Subjects K.E. ANDERSON, R.B. MCCLEERY, E.S. VESELL, F.F. VICKERS, A. KAPPAS Hepatology 13:941–946, 1991
Authors: Demetriou Achilles A.
Published: May 2008

This study examines the effects of diet and cimetidine on theophylline metabolism in 12 men. Subjects, all nonsmokers within 15% of their ideal body weight, were 23 to 26 years of age and had no unusual dietary habits. Energy needs were calculated using the Harris‐Benedict equation. Subjects were placed either on a high‐protein, low‐carbohydrate diet (44% of total calories as protein, 35% as carbohydrate, and 21% as fat) or a low‐protein, high‐carbohydrate diet (10% of total calories as protein, 70% as carbohydrate, and 20% as fat) for 15 days on each diet. The order of the dietary periods was reversed in one half of the subjects, and there was a 24‐day washout period between the two dietary periods. Cimetidine (800 mg/d at bedtime) was administered on days 10 to 15 of each dietary period. Aminophylline (3 mg of theophylline base/kg body weight) was administered intravenously as a bolus over 20 to 30 minutes on days 8 and 15 of each dietary period. Blood was withdrawn before and at 1, 2, 4, 6, 8, 12, and 24 hours after the end of the infusion for determination of theophylline plasma levels by high‐pressure liquid chromatography. Theophylline metabolism was studied under four experimental conditions in all 12 subjects. Thus, the effect of: (1) diet change (changing from a high‐progein to a high‐carbohydrate diet), (2) diet change during concurrent cimetidine administration, (3) cimetidine during a high‐protein diet, and (4) the combination of cimetidine and the opposite change in diet (from high carbohydrate to high protein) were examined.

Diet change (high protein to high carbohydrate) reduced mean theophylline clearance by 30 ± 10% (p < 0.012). Diet change (high protein to high carbohydrate) during concurrent cimetidine administration, resulted in 23 ± 9% reduction in theophylline clearance (p < 0.016). During a high‐protein diet, cimetidine decreased mean theophylline clearance by 37 ± 5% (p < 0.0009). During a high‐carbohydrate diet, cimetidine decreased theophylline clearance by 30 ± 5% (p < 0.0014). Depending on the direction of change in the protein/carbohydrate ratio, the effects of diet and cimetidine were either additive (theophylline clearance was slower during a high‐carbohydrate diet and cimetidine administration) or counteractive (an increase in the protein/carbohydrate ratio partially counteracts the inhibitory effect of cimetidine).

The authors conclude that diet and drugs can have similar effects on hepatic drug metabolism rates in humans. Therefore, during treatment with a drug having a narrow therapeutic index, it would be important to consider not only potential drug‐drug interactions but also drug‐diet interactions. Such interactions could result in either subtherapeutic or excessive drug levels.
Effect of Short‐Chain Fatty Acids on Colonic Function and Structure
Authors: Friedel David , Levine Gary M.
Published: May 2008

Short‐chain fatty acids (SCFA), fermentation products of fiber, are believed to play a role in intestinal adaptation. Although the administration of fiber or the infusion of SCFA has been shown to cause colonic growth, studies have been done primarily in enterally fed animals. In addition, the effects of SCFA on absorptive function have not been determined. Adult male rats were maintained on total parenteral nutrition (TPN) and, in addition, received either 150 mmol/L of saline or 150 mmol/L of SCFA mixture (60:25:15, acetate:propionate:butyrate) into the proximal colon. One week later, the in vivo absorption of water, electrolytes, and 20 mmol/ L of butyrate was measured. After the rats were killed, parameters of colonic mass were determined. SCFA infusion into the colon had no significant effect on absorptive function. However, significantly greater mucosal height (p <.01) and mucosal DNA (p <.05), were observed. Although SCFA has a modest effect on colonic structure, they do not influence absorptive function in TPN rats. (Journal of Parenteral and Enteral Nutrition 16:1–4, 1992)
Glucose Metabolism and Thermogenesis During Glucose and Insulin Infusion in Severely Underweight Patients
Authors: Gallen Ian W. , Macdonald Ian A. , Allison Simon P.
Published: May 2008

This study investigates the effects of gross loss of body weight on glucose disposal (GD), storage (GS), oxidation (GO), and the thermogenic response (TR) during hyperinsulinemic euglycemic glucose infusion in 9 underweight but nourished patients (UP) and in 3 of the patients after weight gain (WGP). In UP, baseline metabolic rate (MR) was 4.1 ± 0.2 kJ/min and respiratory exchange ratio (RER) 0.97 ± 0.02. During the final 30 minutes of hyperinsulinemia MR rose by 0.32 ± 0.07 kJ/min (p <.01) and RER rose to 1.09 ± 0.03 (p <.01). GD was 61 ± 3 μmol/kg per minute, GO 35 ± 1 μmol/ kg per minute, and GS 26 ± 4 μmol/kg per minute. The energy cost of glucose storage as glycogen was 0.15 kJ/min, and as lipid was 0.2 kJ/min. In WGP baseline MR was 4.5 ± 0.4 kJ/ min and RER was 0.91 ± 0.03. During hyperinsulinemia MR rose by 0.63 ± 0.2 kJ/min, RER rose to 0.93 ± 0.02, GD was 53 ± 4 μmol/kg per minute, GO was 30 ± 3 μmol/kg per minute, and GS was 23 ± 1 μmol/kg per minute. The energy cost for this glucose storage was 0.22 kJ/min.

Therefore, during hyperinsulinemia in UP, GD, and TR are similar, but GO is greater and GS is less than previously reported in healthy subjects. However, this TR is entirely accounted for by the energy cost of glucose storage with no evidence of facultative thermogenesis. In WGP, all responses were similar to those in healthy subjects, and the TR was in excess of that required of the energy cost of glucose storage. (Journal of Parenteral and Enteral Nutrition 16:5–10, 1992)
Effect of Short‐Chain Fatty Acids on the Human Colonic Mucosa in Vitro
Authors: Scheppach W. , Bartram P. , Richter A. , Richter F. , Liepold H. , Dusel G. , Hofstetter G. , Rüthlein J. , Kasper H.
Published: May 2008

Fermentable dietary fiber components are known to stimulate colonic crypt proliferation. As these compounds are rapidly degraded to short‐chain fatty acids (SCFAs) by the anaerobic microflora, the hypothesis was tested that this trophic effect of fiber may be mediated by SCFAs. Biopsies were taken from normal cecal mucosa of 45 individuals during routine colonoscopy. They were incubated for 3 hours with sodium salts of SCFAs at physiological concentrations (three SCFAs = acetate 60 mmol/L + propionate 25 mmol/L + butyrate 10 mmol/L; acetate 60 mmol/L; propionate 25 mmol/ L; butyrate 10 mmol/L) or equimolar NaCl (control). Cell proliferation was measured autoradiographically by subsequent pulse labeling with [3H]thymidine (1 hour). The labeling index (number of labeled cells divided by the total number of cells) was computed for the crypt as a whole and for five equal crypt compartments (compartment 1 = crypt base, compartment 5 = crypt surface). Cecal crypt proliferation was raised significantly in all incubation experiments with SCFAs. Butyrate (10 mmol/ L, increase +89%) and propionate (25 mmol/L, +70%) were as effective in stimulating proliferation as the combination of three SCFAs (+103%), although the effect of acetate (+31%) was minor. Increasing the butyrate concentration to 25 mmol/ L or 60 mmol/L did not result in a further increase of cell labeling. SCFAs stimulated proliferation in the basal three crypt compartments only. An expansion of the proliferative zone to compartments 4 and 5 was not observed. SCFAs, especially butyrate and propionate, are luminal trophic factors for the cecal epithelium. This finding emphasizes the view of a symbiosis between the host and the anaerobic microflora in the large gut. In long‐term artificial enteral nutrition and in the management of the short‐bowel syndrome, it may be desirable to avoid colonic atrophy by supplementing liquid formula diets with carbohydrates, that are fermented to SCFAs in the colon. (Journal of Parenteral and Enteral Nutrition 16:43–48, 1992)
Concurrent Administration of Albumin With Total Parenteral Nutrition in Sick Newborn Infants
Authors: Kanarek Keith S. , Williams Paul R. , Blair Clifford
Published: May 2008

The effects of concurrent administration of albumin with total parenteral nutrition were studied in 12 premature newborns (birth weight 1.26 ± 0.1 kg [mean ± SEM] and gestational age 30 ± 0.8 weeks [mean ± SEM]) compared with a control group of 12 premature newborns (birth weight 1.17 ± 0.2 kg and gestational age 29 ± 0.1 weeks) who received total parenteral nutrition. All newborns had a plasma albumin level below 3 g/dL and were in cardiorespiratory distress requiring assisted ventilation. Albumin supplementation of total parenteral nutrition resulted in a sustained increase in serum albumin concentration as well as increased mean arterial blood pressures in the study group. Slow albumin infusion had no observed effect on the severity of respiratory distress. Study group infants regained birth weight earlier than control group infants. These data suggest that the concurrent administration of albumin may be clinically beneficial in critically ill newborn infants. (Journal of Parenteral and Enteral Nutrition 16:49–53, 1992)
Platelet Glutathione Peroxidase Activity in Long‐Term Total Parenteral Nutrition With and Without Selenium Supplementation
Authors: Sando Kinya , Hoki Masanori , Nezu Rchiro , Takagi Yoji , Okada Akira
Published: May 2008

Selenium (Se) is not routinely included in total parenteral nutrition (TPN) solution; thus, patients receiving long‐term TPN may be at risk of Se deficiency, which may cause fatal cardiomyopathy. Platelet glutathione peroxidase (GSH‐Px) activity, as well as Se levels and GSH‐Px activity in plasma and erythrocytes during prolonged TPN, was measured in six patients with chronic gastrointestinal disease. During the time course of TPN, Se administration was discontinued for 12 weeks, and then resupplemented for another 12 weeks. Before the study period, all Se indices had been maintained within the normal range. After discontinuation of Se supplementation, a significant decrease in platelet GSH‐Px activity was observed after 1 week (from 64 ± 7 [mean ± SD] to 39 ± 5 U/g of protein). After resupplementation, it increased after 1 week (from 44 ± 9 to 65 ± 10 U/g of protein). Plasma Se indices significantly changed within 3 weeks after withdrawal and reintroduction of Se (Se: from 136 ± 28 to 75 ± 14 and from 61 ± 22 to 125 ± 33 μg/L; GSH‐Px: from 236 ± 50 to 140 ± 36 and from 128 ± 32 to 220 ± 64 U/L). Erythrocyte Se indices showed no significant changes during the study period. The results demonstrate that platelet GSH‐Px activity is the most sensitive index of Se status in TPN patients. (Journal of Parenteral and Enteral Nutrition 16:54–58, 1992)
The Prognostic Inflammatory and Nutritional Index in Traumatized Patients Receiving Enteral Nutrition Support K. L. VEHE, R. O. BROWN, D. A. KUHL, ET AL Journal of The American College of Nutrition 10:355–363, 1991
Authors: Claxton Betty
Published: May 2008

This study examines the value of the Prognostic Inflammatory and Nutritional Index (PINI), first proposed by Ingenbleek and Carpentier in 1985,1 as a clinical assessment tool in critically ill traumatized patients. The PINI combines measurements of serum C‐reactive protein (CRP), α1‐acid glycoprotein (AAG), prealbumin (PA), and albumin (ALB) concentrations to produce a single score. The hypothesis is that this assessment system will be more complete because it takes into account changes in inflammatory response markers and, therefore, may be superior to other predictive indices.

This study included 15 critically ill trauma patients receiving enteral nutrition support. Patients were placed on a nutritionally complete formula providing 1.4 g of protein/kg per day and 32 kcal/kg per day 8 ± 3 days after injury and were maintained on this diet for 19 ± 8 days. The PINI decreased significantly (p <.05) from 186 ± 202 at baseline to 116 ± 86 on day 4 and 27 ± 40 on day 14. Nitrogen balance increased significantly during the same time period. Serum CRP concentration decreased significantly, whereas serum PA and ALB concentrations increased significantly and AAG concentration did not change. A statistically significant positive correlation was noted between the PINI and CRP concentration (r =.72, P =.0001) and a statistically significant negative correlation was noted between PINI and PA (r = 51, p =.0018).

This study demonstrates that the decline in PINI noted in this group of enterally fed patients is largely due to the decline in the serum CRP concentration. It is speculated that the large impact of the serum CRP concentration on the PINI, demonstrated here and in a previous study,2 could allow use of serum CRP measurements alone as a prognostic indicator in this group of critically ill patients.
The Dipeptide Alanyl‐Glutamine Prevents Intestinal Mucosal Atrophy in Parenterally Fed Rats
Authors: Tamada Horacio , Nezu Rchiro , Imamura Ikuo , Matsuo Yoshinobu , Takagi Yoji , Kamata Shinkichi , Okada Akira
Published: May 2008

This study was performed to determine whether the addition of alanyl‐glutamine (Ala‐Gln) can prevent intestinal mucosal atrophy induced by standard solution of total parenteral nutrition (S‐TPN). Forty‐one male Sprague‐Dawley rats weighing 250 g were randomly divided into four groups: group I was killed after overnight fasting; group II received S‐TPN. The other groups received S‐TPN supplemented with amino acids other than glutamine (group III) or supplemented with Ala‐Gln 2 g/100 mL (group IV); both solutions were isocaloric and isonitrogenous. After 1 week of TPN the rats were killed, and the duodenum, proximal jejunum, mid‐small bowel, and distal ileum were obtained for morphologic and functional analysis.

Weight gain did not differ significantly among these four groups, and there was no difference in nitrogen balance between groups III and IV. Serum glutamine in group IV (102.8 ± 13.3 μmol/dL) was significantly increased (p <.05) compared with groups I, II, and III (66.2 ± 3.9, 55.7 ± 7.8, and 61.3 ± 10.8 μmol/dL, respectively). Mucosal wet weight, protein, RNA, sucrase, and maltase of group IV were significantly increased (p <.05) compared with groups II and III. Villus height was significantly increased (p <.05) in the jejunum of group IV rats compared with groups II and III, but not in any other segments of the intestine. No significant changes were observed in crypt depth among all groups. Diamine oxidase in groups II, III, and IV was significantly decreased (p <.05) compared with group I in all segments except for the ileum. Significant decreases (p <.05) in mucosal weight, RNA content, maltase, sucrase, and diamine oxidase activity were observed in groups II and III compared with group I. These results provide further evidence that administration of S‐TPN solution results in significant mucosal atrophy. The results also indicate that the specific addition of Ala‐Gln to S‐TPN may preserve or enhance intestinal mucosal cellularity and function. Thus, alanyl‐glutamine, the stable form of glutamine, may be a suitable form for inclusion in TPN formulas. (Journal of Parenteral and Enteral Nutrition 16:110–116, 1992)
Influence of N‐Acetylglutamine or Glutamine Infusion on Plasma Amino Acid Concentrations During the Early Phase of Small‐Bowel Adaptation in the Dog
Authors: Gouttebel M.C. , Astre C. , Briand D. , Saint‐Aubert B. , Girardot P.M. , Joyeux H.
Published: May 2008

Glutamine is a nonessential neutral amino acid that is widely consumed by the intestinal tract in catabolic states. We have followed up the plasma amino acid profile after extensive small‐bowel resection in dogs receiving total parenteral nutrition (TPN) with or without glutamine (GLN) or N‐ acetylglutamine (aGLN) supplementation. Animals were divided into four groups according to the type of surgery (enterectomy or transection) and nutrition (TPN, TPN with aGLN, or TPN with GLN). Plasma GLN levels decreased in group I (enterectomy and TPN) on day 2 (p =.03) and significantly increased on postoperative days in groups III (enterectomy and TPN with aGLN) and IV (enterectomy and TPN with GLN). A significant increase of plasma GLN was observed in groups III and IV compared with group I on days 6 and 8 (p =.03 and p =.01). Plasma alanine decreased in groups with bowel resection, whereas no change was observed in the control group (transection) and the decrease of plasma alanine was significantly less pronounced in groups III and IV compared with group I. The increase of crypt depth and villous height was more pronounced in groups III and IV. These results suggest that GLN is a required substrate for mucosal growth and function, which could improve the intestinal adaptation encountered after enterectomy. (Journal of Parenteral and Enteral Nutrition 16: 117–121, 1992)
Thrombosed Central Venous Catheters: Restoring Function With 6‐Hour Urokinase Infusion After Failure of Bolus Urokinase
Authors: Haire William D. , Lieberman Robert P.
Published: May 2008

Nineteen central venous catheters with radio‐graphically proven thrombotic occlusion failed to have function restored with a mean of 1.6 5000‐unit boluses of urokinase per catheter. Catheters then underwent a 6‐hour infusion of urokinase at 40,000 units per hour followed by repeat contrast injection and evaluation of function. Reduction in thrombus size occurred in all but one patient. Catheter function was restored in 15 patients. In two patients, thrombus dissolved but catheters remained occluded because of tip malposition. In the remaining two patients, catheter function was restored with an additional 6‐hour infusion. No adverse reactions to the infusion were seen. After infusion catheters continued to function normally for a mean of 36.2 days. Five catheters rethrombosed, two of which responded to urokinase bolus instillation. Thrombosed catheters failing standard intracatheter bolus urokinase are generally salvaged with a 6‐hour infusion of low‐dose urokinase.(Journal of Parenteral and Enteral Nutrition 16:129–132, 1992)
Breakage of an Embolized Intravascular Catheter Fragment: A Complication of Nonsurgical Transvenous Retrieval
Authors: Bauch Terry D. , Stoughton Thomas L. , Pearl William
Published: May 2008

The use of permanently implantable central venous catheters may be complicated by catheter fracture and embolism. Nonsurgical retrieval of embolized catheter fragments is well established, and complications are rarely noted. We report a case in which the retrieval technique led to further fracture of a silicone rubber (Silastic) catheter and embolization to the lung. Silastic catheters may be prone to this complication, and appropriate caution during recovery of such catheter fragments is recommended. (Journal of Parenteral and Enteral Nutrition 16:175—177, 1992)
Measuring Body Fat: Calibrating the Rulers. Intermethod Comparisons in 389 Normal Caucasian Subjects R. N. PIERSON, JR, J. WANG, S. B. HEYMSFIELD, ET AL American Journal of Physiology 261 (Endocrinology and Metabolism 24):E103‐E108, 1991
Authors: Goldstein Richard E.
Published: May 2008

In this study from Columbia University, 389 (156 men and 233 women) healthy white subjects ranging from 19 to 94 years, with body mass index ranging from 15 to 35 kg/m2, had their body fat measured using eight different methods. These methods included anthropometric assessments as defined by Durnin and Womersley1 and Steinkamp et al,2 underwater weighing, total body potassium, dual‐photon absorptiometry, total body water, total body electrical conductivity, and bioelectric impedance analysis. All subjects were studied after an overnight fast. Statistical analysis of the data utilized repeated‐measures analysis of variance to test the hypothesis that the eight methods yielded the same average percent of body fat. Pearson correlation coefficients were calculated for each pair of body fat measurements. Linear regression equations were calculated for each pair of methods and for each method using age as an independent variable. The reliability of the methods was calculated using the intraclass correlation coefficient; the coefficient of variation of each method was also calculated.

Table I summarizes the coefficients of variation and reliability intraclass correlations for the eight methods tested. It is important to note the low coefficients of variation in dual‐photon absorptiometry and underwater weighing and the high coefficient of variation using total body potassium. Table II summarizes the average percent body fat measurements for men and women using the various methods. Of note is that the use of bioelectric impedance analysis and total body electrical conductivity consistently resulted in the lowest values for percent body fat, whereas the use of total body potassium and anthropometric measurements, as defined by Steinkamp et al,2 consistently resulted in the highest values for percent body fat. Additional data presented by the authors demonstrate correlations between percent body fat, measured by the different methods, and the linear regression equations of percent fat with age. The investigators conclude their data presentation with a full‐page table of intermethod linear regression equations for men and women. The purpose of this table is to serve as a type of Rosetta stone. It provides the slopes and intercepts (and standard estimate of the error and r 2 values) to be used to translate results obtained using one method to those that would be expected using any of the other methods according to the general formula y = mx + b.
Use of Residual Volume as a Marker for Enteral Feeding Intolerance: Prospective Blinded Comparison With Physical Examination and Radiographic Findings
Authors: Mcclave Stephen A. , Snider Harvy L. , Lowen Cynthia C. , Mclaughlin Arthur J. , Greene Lisa M. , Mccombs Ricky J. , Rodgers Linda , Wright Richard A. , Roy Thomas M. , Schumer Mary P. , Pfeifer Michael A.
Published: May 2008

High gastric residual volumes (RVs) are a frequent cause for cessation of total enteral nutrition (TEN). This study was designed to determine the RV that indicates intolerance or inadequate gastric emptying and to compare the RV findings in a blinded fashion with those findings obtained on physical examination and radiography. Twenty healthy normal volunteers (HNV), 8 stable patients with gastrostomy tubes (GTP), and 10 critically ill patients (CIP) were evaluated prospectively for 8 hours while receiving TEN. No subjects were clearly intolerant (ie, vomiting, aspiration). Of the total RVs recorded, 13.1% were ≥150 mL in the CIP group, whereas only 2.4% of the RVs were ≥150 mL in the HNV group. None of the RVs in the GTP group were ≥150 mL. Objective scores on physical examination failed to correlate with RV (p =.397), as did objective scores on radiography (p =.742). However, objective scores on physical examination were significantly related to scores on radiography (p =.016). Abnormal physical examination findings were found in 4 out of 11 patients (GTP + CIP) with RVs <100 mL and in 6 out of 7 with RVs ≥100 mL. Abnormal radiographic results were found in 6 out of 11 patients with RVs < 100 mL, in 7 out of 7 patients with RVs ≥100 mL, and in 4 out of 20 HNVs. There was no difference in RVs obtained from the supine or right lateral decubitus positions. Patients with gastrostomy tubes had lower RVs than did those with nasogastric tubes. Patients receiving higher infusion rates had higher RVs. Low RVs did not seem to guarantee tolerance and adequate gut motility because abnormalities still appeared on physical examination and radiography. A single high RV should not cause automatic cessation of TEN because it did occur in some cases in a setting with normal radiographic and physical examination results, where subsequent RVs were shown to decrease. An RV ≥200 mL obtained from a nasogastric tube (or ≥100 mL obtained from a gastrostomy tube) should raise concern about intolerance, but feedings may continue as physical examination, radiographs, and RV are monitored closely. (Journal of Parenteral and Enteral Nutrition 16:99—105, 1992)
Interaction of Protein and Zinc Malnutrition With the Murine Response to Infection
Authors: Peck Michael D. , Alexander J. Wesley
Published: May 2008

Malnutrition increases the host's susceptibility to infection. However, the mechanisms are not well understood. This study examined the interaction of protein and zinc underfeeding in mice before challenge with an intracellular pathogen, Salmonella typhimurium. C3H/HeN mice (n = 68) were weighed and placed on one of four diets: 20% ovalbumin with adequate zinc (20% NL), 20% ovalbumin without zinc (20% LO), 1% ovalbumin with zinc (1% NL), and 1% ovalbumin without zinc (1% LO). At the end of 6 weeks they were again weighed and then challenged with 104 S. typhimurium intraperitoneally. Mortality was recorded over the next 2 weeks. Although weight loss was markedly affected by protein malnutrition (two‐way analysis of variance: p =.0001), there was no independent effect by zinc (p =.3459). Similarly, protein malnutrition alone affected mortality rates (χ2: p =.0001), whereas zinc had no independent effect (p =.7166). However, both protein and zinc underfeeding shortened the length of survival (Mann‐Whitney U test: p <.001). We conclude that protein malnutrition is the dominant factor influencing weight loss and mortality in this model. However, zinc malnutrition does shorten the length of survival and may contribute to the global immunosuppression noted in malnourished subjects. (Journal of Parenteral and Enteral Nutrition 16:232–235, 1992)