bluuebunny/crossref_metadata_2025 huggingface dataset:
Glucose Response to Abrupt Initiation and Discontinuation of Total Parenteral Nutrition
Authors: Krzywda Elizabeth A. , Andris Deborah A. , Whipple Julianne K. , Street Carole C. , Ausman Robert K. , Schulte William J. , Quebbeman Edward J.
Published: May 2008

Plasma glucose was studied during the initiation of total parenteral nutrition (TPN) and the discontinuation of TPN without a tapering schedule. Blood was sampled every 5 minutes for 2 hours after the start of TPN and 1 week later as TPN was discontinued. A total of 14 initiations and 14 discontinuations were studied in 18 patients. Severity of illness in patients ranged from stable condition postoperatively to multiple‐system failure; six patients had diabetes mellitus. The TPN solution was a 3:1 admixture that provided a caloric intake equal to 1.2 times the resting energy expenditure, with 40% fat and 60% carbohydrate calories. An average of 1963 kcal was provided per day (340 g of glucose, 79 g of fat). During the initiation phase, the mean increase in plasma glucose was 60 mg/dL. The increase for diabetic patients was 79 ± 14 mg/dL compared with 52 ± 23 mg/dL for the nondiabetics. During the discontinuation phase, the mean plasma glucose decreased 40 ± 20 mg/dL; two patients with high concentrations of regular insulin (50 and 100 units) showed an increase in plasma glucose when the TPN was stopped. Plasma glucose returned to the preinfusion baseline after discontinuation. During both initiation and discontinuation, plasma glucose showed little change after the first 60 minutes. No clinical symptoms of hypoglycemia were observed. In conclusion, TPN as a 3:1 admixture can be safely started as full nutrition support and stopped abruptly without a tapering schedule. Plasma glucose response is rapid, predictable, and mostly complete within 60 minutes. (Journal of Parenteral and Enteral Nutrition 17:64–67, 1993)
Intermittent Back Pain After Central Venous Catheter Placement
Authors: Rosa Ute W. , Foreman Marilyn , Willsie‐Ediger Sandra
Published: May 2008

We report a case of inadvertent azygos placement of a central venous catheter. The patient experienced ill‐defined back pain associated with total parenteral nutrition infusion. The catheter malposition remained unrecognized and resulted in extensive diagnostic work‐up. Symptoms resolved after the catheter was withdrawn. (Journal of Parenteral and Enteral Nutrition 17:91–93, 1993)
Comparison of Parenteral Nutrition Supplemented With L‐Glutamine or Glutamine Dipeptides
Authors: Jiang Zhu‐Ming , Wang Li‐Jin , Qi Yun , Liu Tong‐Hua , Qiu Min‐Ru , Yang Nai‐Fa , Wilmore Douglas W.
Published: May 2008

Although glutamine is an important fuel used by the intestinal mucosa and other visceral organs, it is not present in any commercially available parenteral amino acid solution. To compare the effects of L‐glutamine with glutamine dipeptides, we studied the effects of each in 8 dogs and 60 Wistar rats. In the dog study, three amino acid solutions were compared: standard commercial amino acid solution (control), alanine‐glutamine dipeptide‐enriched solution (glutamine 3.4%), and glycine‐glutamine dipeptide‐enriched solution (glutamine 3.6%). Arterial and venous samples were collected to compare the effects of the three solutions on skeletal muscle amino acid exchange. In the rat study, two studies were undertaken: group 1 rats underwent only central venous catheterization; group 2 rats underwent central venous catheterization and a 50% intestinal resection. Within each group, three different solutions were infused: standard amino acid solution (control), glutamine‐enriched (1.5% glutamine) solution, or glutamine dipeptide‐enriched (1% glutamine) solution. After 7 days of parenteral nutrition, samples of gut, blood, and muscle were collected for determination of mucosal thickness, villus area, serum amino acid profile, liver and renal function tests, and muscle composition. When glutamine or glutamine‐dipeptide solutions were administered, the dogs showed increasing serum glutamine concentrations and enhanced glutamine uptake across the hind leg muscle. Similarly, both groups of rats demonstrated significant differences in serum glutamine levels, nitrogen balance, intestinal mucosa thickness, and villus area. We conclude that both glutamine and glutamine‐dipeptide infusions increase serum glutamine concentrations and result in regional tissue effects. Both exerted similar metabolic effects with no apparent complications. (Journal of Parenteral and Enteral Nutrition 17:134–141, 1993)
The Effects of Oral RNA and Intraperitoneal Nucleoside‐Nucleotide Administration on Methicillin‐Resistant Staphylococcus aureus Infection in Mice
Authors: Adjei Andrew A. , Takamine Fusae , Yokoyama Hiroomi , Shiokawa Katsuko , Matsumoto Yoko , Asato Liu , Shinjo Sumie , Imamura Teisuke , Yamamoto Shigeru
Published: May 2008

The effects of oral RNA and intraperitoneal nucleoside‐nucleotide mixture administration on methicillin‐resistant Staphylococcus aureus (MRSA) strain 8985N infection were studied in mice. BALB/c mice were fed a nucleic acid‐free diet or nucleic acid‐free diet supplemented with 0.5% or 2.5% ribonucleic acid (RNA) for 30 days. Nucleoside‐nucleotide mixture or saline (control) was intraperitoneally administered daily to these rats except for the 2.5% RNA group, which received saline only. On the 10th day of this treatment, the mice were inoculated intravenously with the viable MRSA organisms. Susceptibility to the MRSA was determined by animal survival and recovery of the MRSA from the organs. The survival rates in the three groups that were administered saline were 29%, 35%, and 40% for nucleic acid‐free diet, 0.5% RNA, and 2.5% RNA groups, respectively, whereas in the two groups that received the nucleoside‐nucleotide mixture the rates were 69% for the nucleic acid‐free diet group and 55% for 0.5% RNA group. The susceptibility of the mice to the MRSA challenge was not affected by dietary RNA, which indicates the ineffectiveness of oral RNA. The combined survival rate in the two nucleoside‐nucleotide groups (64%) was statistically different (p <.01) from that in the three saline groups (34%). There was a greater reduction in viable organism recovery in the kidney and spleen of the surviving mice that had been administered the nucleoside‐nucleotide mixture than in those administered saline. The study showed that intraperitoneal administration of the nucleoside‐nucleotide mixture was effective in increasing the host resistance, whereas oral RNA was not adequate in offering protection to the mice against MRSA infection. (Journal of Parenteral and Enteral Nutrition 17:148–152, 1993)
Alanyl Glutamine‐Enriched Total Parenteral Nutrition Restores Intestinal Adaptation After Either Proximal or Distal Massive Resection in Rats
Authors: Tamada Horacio , Nezu Rhchiro , Matsuo Yoshinobu , Imamura Ikuo , Takagi Yoji , Okada Akira
Published: May 2008

This study was designed to determine whether alanyl glutamine‐containing total parenteral nutrition (TPN) can restore the impaired adaptive process of the remaining intestine, observed with administration of conventional TPN, after massive small‐bowel resection. Seventy‐four male Sprague‐Dawley rats weighing 250 g were randomly divided into seven groups. Group I rats (n = 10) were killed after overnight fasting. Group II animals (n = 32) underwent massive small bowel resection (85%) with preservation of the first 15 cm of jejunum. Group III animals (n = 32) were also submitted to massive small‐bowel resection with preservation of 15 cm of terminal ileum. Three different TPN solutions were prepared. Solution A was a conventional formulation that did not contain glutamine. Solution B contained 1.88 times the amino acid concentration of solution A. Solution C was prepared by adding alanyl glutamine (2 g/100 mL) to solution A. Solutions B and C were isonitrogenous and isocaloric. Each solution was infused to groups II and III, which were subdivided into groups IIA (n = 10), IIB (n = 11), IIC (n = 11), IIIA (n = 10), IIIB (n = 11), and IIIC (n = 11). After 1 week of TPN (270 kcal/kg per day), the experimental animals were killed and the intestine was taken for examination. Final body weight did not differ significantly among the groups, and there was no difference in nitrogen balance among the animals that received solution B or C. Mucosal wet weight, protein, RNA, maltase, and sucrase in duodenum, remaining jejunum, and remaining ileum of animals receiving solution C (groups IIC and IIIC) significantly increased (p <.05) compared with animals receiving solution A or B (groups IIA, IIB, IIIA, and IIIB). Villus height in the duodenum and remaining jejunum of animals receiving solution C (groups IIC and IIIC) was significantly increased (p <.05) compared with animals receiving solution A or B (groups IIA, IIB, IIIA, and IIIB). Mucosal DNA content of group IIC was significantly increased (p <.05) compared with groups IIA and IIB. Diamine oxidase activity in the duodenum was significantly increased in group IIIC animals compared with groups IIA, IIB, and IIC. These results strongly suggest that, after massive resection, adaptation of the remaining intestine, whether jejunal or ileal segment, can be promoted by administration of alanyl glutamine‐enriched TPN. (Journal of Parenteral and Enteral Nutrition 17:236–242, 1993)
Aspirating Gastric Residuals Causes Occlusion of Small‐Bore Feeding Tubes
Authors: Powell Karen S. , Marcuard Stefan P. , Farrior Evelyn S. , Gallagher Margie L.
Published: May 2008

A frequent mechanical problem encountered with small‐bore feeding tubes is lumenal obstruction of the tube. A number of studies have described methods to prevent tube occlusion and restore patency once the tube becomes occluded. It has been observed that most intact protein formulas will clot when acidified to a pH of less than 5.0. This study evaluated the question of whether gastric feeding tubes occlude more frequently when they are used for checking gastric residuals by aspirating acidic gastric juices into the tube than when gastric residuals are not checked. Patients who were fed intragastrically via a small‐bore feeding tube with intact protein formulas were divided into two groups. Gastric residuals were checked in group A patients every 4 hours, whereas no residuals were checked in group B patients. Fifteen patients in group A were followed for a total of 138 patient days and 13 patients in group B were followed for 154 patient days. Ten occlusive episodes occurred in the group A patients, whereas only one occlusive episode occurred in the group B patients. This difference was statistically significant (p =.0171). We concluded that small‐bore feeding tubes occlude more frequently when used to aspirate gastric residuals. (Journal of Parenteral and Enteral Nutrition 17:243–246, 1993)
The Importance of a Source of Sufficient Protein in Postoperative Hypocaloric Partial Parenteral Nutrition Support
Authors: Hwang Tsann‐Long , Mou San‐Chu , Chen Mn‐Fu
Published: May 2008

A comparison of postoperative metabolic and nutritional responses to different hypocaloric parenteral nutrition supports was performed in 42 patients with various gastric lesions. Sixteen patients (group A) received 3000 mL of a 5% glucose in water or glucose in saline infusion per day after surgery (approximately 10 kcal/kg per day). Another 14 patients (group B) received 2000 mL of 5% glucose in water or saline plus 1000 mL of 5% amino acid solution per day (approximately 10 kcal/kg per day and 1 g of protein per kilogram per day). The other 12 patients (group C) received 2000 mL of 5% glucose in water or saline plus 500 mL of 5% amino acid solution and 500 mL of 10% fat emulsion (approximately 20 kcal/kg per day and 0.5 g of protein per kilogram per day). After 7 days of study, all three groups were found to have a decrease in body weight, mid‐arm circumference, triceps skin‐fold, and serum albumin level, and the differences among them were not significant. Groups B and C had significantly less negative mean nitrogen balance than group A (—5.54 ± 0.63 g/ d and ‐6.07 ± 0.49 g/d vs ‐9.20 ± 0.68 g/d). Group B also had a significantly greater increase of transferrin (from 175.5 ± 9.9 mg/dL to 185.4 ± 9.3 mg/dL) than group A and a significantly greater increase in total lymphocyte count (from 956 ± 113 cells/mm3 to 1196 ± 176 cells/mm3) than groups A and C. We concluded that postoperative hypocaloric nutrition support with a sufficient protein source, at least 1 g/kg per day, achieved better nitrogen balance, improved short half‐life of visceral protein levels, and higher total lymphocyte count. (Journal of Parenteral and Enteral Nutrition 17:254–256, 1993)
Intravenous Administration of Nucleosides and a Nucleotide Mixture Diminishes Intestinal Mucosal Atrophy Induced by Total Parenteral Nutrition
Authors: Jima Shohei , Tsujinaka Toshimasa , Kido Yoshihiro , Hayashida Yoshihiko , Ishida Hideki , Homma Taro , Yokoyama Hiroomi , Mori Takesada
Published: May 2008

Total parenteral nutrition (TPN) is associated with atrophic changes in the structure and function of the intestinal mucosa. Because rapidly renewing intestinal mucosal cells may require an external source of purines and pyrimidines for their optimal growth, it can be assumed that supplementation of nucleosides and a nucleotide mixture (OG‐VI) during TPN may prevent the progression of mucosal atrophy by compensating for a relatively insufficient delivery from liver. To test that hypothesis, male Wistar rats receiving TPN for 7 days were divided into four groups according to different TPN solutions. Group C (n = 10) received a standard solution, group O (n = 10) received OG‐VI in addition to the standard solution, and group G (n = 10) received a glutamine‐rich TPN solution containing almost the same amount of calories and nitrogen as the standard solution. Group O+G (n = 10) received OG‐VI in addition to the glutamine‐rich solution. Various parameters were examined on the eighth day in the jejunal and ileal segments. The following significant changes in comparison with group C were observed: total wet weight of the jejunal segment in group O was significantly greater, as was mucosal wet weight of the jejunal and ileal segments in groups O and O+G; protein contents of the ileal segment in group O as well as the DNA content of the jejunal segment in group O increased significantly; and maltase activity of the jejunal segment in group O+G increased, as did the villus height of the jejunal segment in groups O and O+G and the villus height of the ileal segment in group G. Finally, proliferating cell nuclear antigen‐positive cells in crypts of the jejunal segment in group O and group O+G increased significantly. The supplementation of OG‐VI prevented the intestinal mucosal atrophic changes induced by TPN more effectively than did glutamine. The combined effect of OG‐VI and glutamine was observed on the development of brush‐border enzymes. Provision of an external source of purines and pyrimidines therefore has a supportive effect on intestinal mucosal growth during TPN. (Journal of Parenteral and Enteral Nutrition 17:265–270, 1993)
Comparison of Weighted vs Unweighted Enteral Feeding Tubes for Efficacy of Transpyloric Intubation
Authors: Lord Linda M. , Weiser‐Maimone Anne , Pulhamus Marsha , Sax Harry C.
Published: May 2008

Routine transpyloric placement of feeding tubes reduces aspiration in intensive care unit patients. Spontaneous passage eliminates the need for radiologic or endoscopic intervention. It is unclear whether the addition of a weight to the end of the tube or the use of the prokinetic agent metoclopramide in the conventional dose (10 mg) improves spontaneous transpyloric placement. In a randomized, prospective trial, 39 intensive care unit patients (age >2 years) had a total of 50 nasoenteral tubes placed after intravenous metoclopramide (20 mg in adults, 0.2 mg/kg in children). The tubes were 8 French in diameter with either a weighted end or an unweighted bullet tip. Tip position was confirmed radiographically within 4 hours after blinded placement and at 1 and 2 days if spontaneous passage had not occurred. At 4 hours, 36% of the weighted tubes and 84% of the unweighted tubes (p <.002) had passed through the pylorus. At 1 day, 48% of the weighted tubes and 86% of the unweighted tubes (p <.007) had achieved transpyloric position. At 2 days, 56% and 92% of the weighted and unweighted tubes, respectively, had passed through the pylorus (p <.009, χ2). The occurrence of transpyloric passage and the rapidity at which it occurred was significantly greater for the unweighted tube during all time periods. A poststudy trial was conducted to evaluate the effect of the normal dose of metoclopramide (10 mg in adults and 0.1 mg/kg in children) and the transpyloric passage of the unweighted feeding tube. Twenty‐five patients received 10 mg of metoclopramide before the insertion of the unweighted tube. Within a 4‐hour period, 22 (88%) of 25 tubes passed through the pylorus spontaneously. There was no statistical difference between the use of 10 and 20 mg of metoclopramide. The combination of preinsertion metoclopramide and a tapered, unweighted feeding tube achieved transpyloric position in a vast majority of intensive care unit patients, obviating the need for additional intervention. (Journal of Parenteral and Enteral Nutrition 17:271–273, 1993)
Glutamine Peptide Does Not Improve Gut Barrier Function and Mucosal Immunity in Total Parenteral Nutrition
Authors: Spaeth Georg , Gottwald Thomas , Haas Werner , Holmer Matthias
Published: May 2008

In two separate experiments, three groups of 10 (first experiment) and 12 (second experiment) rats each were catheterized for the long term via the right jugular vein and fed one of the following dietary regimens for 7 days while in individual metabolism cages. The rat food control groups were fed powdered rat food. The total parenteral nutrition (TPN) formula for one group was enriched with the stable dipeptide L‐alanyl‐L‐glutamine (ALA‐GLN) equivalent to a 1% or 2% glutamine concentration. For the control TPN groups, the dipeptide was replaced by isonitrogenous amounts of alanine (ALA). In both experiments, bacterial translocation was promoted to a similar extent by the ALA‐GLN and ALA TPN formulas compared with the rat food groups. Bacterial overgrowth in the cecum and intestinal atrophy, quantitated by the mucosal protein content, did not differ between ALA‐GLN and ALA groups. The nitrogen balances of the three groups showed similar values in the second experiment. The secretory immunoglobulin A was measured in washings of the jejunum and ileum (soluble fraction) and in the homogenates of the gut mucosa (insoluble fraction). The secretory immunoglobulin A values of both fractions showed no difference between the ALA and ALA‐GLN groups, irrespective of whether they were normalized for gut segment length or corrected for mucosal protein content. In conclusion from these results, the supplementation of TPN with glutamine does not seem to improve gut barrier function or mucosal immunity in unstressed rats. (Journal of Parenteral and Enteral Nutrition 17:317–323, 1993)
Elemental Diet‐Induced Immune Suppression Is Caused by Both Bacterial and Dietary Factors
Authors: Deitch Edwin A. , Xu Dazhong , Qi Lu , Berg Rodney
Published: May 2008

Because it is unclear whether elemental diet‐induced immune suppression is an indirect effect caused by the translocating bacteria or is directly caused by the elemental diet, we tested whether prevention of diet‐induced bacterial translocation or disruption of the gut microflora ecology would prevent diet‐induced impaired lymphocyte function in a rat elemental diet model. Prevention of diet‐induced bacterial translocation was accomplished by the addition of cellulose fiber or oral antibiotics (penicillin and streptomycin) to the elemental diet feeding regimen. Control groups consisted of rat food‐fed and elemental diet‐fed (4.25% amino acids; 28% glucose) rats. Immune function was quantitated by measuring the mitogen‐induced blastogenic response of peripheral blood or splenic mononuclear cells to the mitogens concanavalin A and phytohemagglutinin. Bacterial translocation from the gut to the mesenteric lymph node and cecal bacterial population levels were measured in all groups. Although the incidence of elemental diet‐induced bacterial translocation was reduced from 100% to 25% (p <.01) by the addition of dietary fiber, fiber did not prevent diet‐induced impaired lymphocyte function. Because fiber supplementation of the elemental diet did not completely prevent diet‐induced intestinal bacterial overgrowth or bacterial translocation, the experiment was repeated in antibiotic‐decontaminated rats. Antibiotic decontamination completely prevented diet‐induced intestinal bacterial overgrowth and bacterial translocation. Although antibiotic decontamination reduced the magnitude of lymphocyte mitogen suppression (p <.05), it was not fully effective in reversing the diet‐induced lymphocyte suppression. These results indicate that elemental diet‐induced lymphocyte blastogenic suppression is related to both bacterial and dietary factors. (Journal of Parenteral and Enteral Nutrition 17:332–336, 1993)
Comparison of Net Protein Utilization of Milk Protein Mild Enzymatic Hydrolysates and Free Amino Acid Mixtures With a Close Pattern in the Rat
Authors: Monchi Mehran , Rérat Alain A.
Published: May 2008

The nutritive value of two nitrogen‐containing mixtures, one formed from small peptides (milk protein mild enzymatic hydrolysates) and the other consisting of a mixture of free amino acids having the same pattern except for glutamine, was measured in rats with and without experimental liver and exogenous pancreas dysfunction. For this purpose, 30 animals (group N) were fitted with an indwelling duodenal catheter; 36 animals (group L) also underwent ligation and resection of the biliopancreatic duct. After a 3‐day recovery period, the animals in each group, divided into three equivalent batches, were given, for 10 days, a protein‐free diet ad libitum and a twice‐daily duodenal infusion (5 mL) of either saline, the small peptides, or the free amino acid mixture. The nitrogen‐containing mixtures provided 0.32 g of nitrogen per day. A blood sample (left side of the heart) was collected 1 hour before (five to six animals per batch) and after (five to six animals per batch) the last infusion for determination of glucose, insulin, and amino acids. After the animals were killed, their carcasses were freeze‐dried, ground, and analyzed for nitrogen content. Under these conditions, the net protein utilization (the gain in body nitrogen in the animals infused with one of the two nitrogen‐containing solutions in comparison with the animals infused with saline only divided by the nitrogen ingested) was calculated. This was found to be greater for the mixtures of small peptides than for the mixtures of free amino acids (group N: p <.001; group L: p <.05) and greater under conditions of normal liver and pancreatic function in comparison with dysfunction (p < 0.005). In the animals with normal hepatopancreatic function, the blood amino acid peaks 1 hour after infusion were higher for certain amino acids (especially arginine, leucine, and tyrosine) when milk protein mild enzymatic hydrolysate solution was infused than when the free amino acid solution was infused; the same was true for the blood insulin levels. It thus appears that under conditions of discontinuous enteral feeding, a mixture of small peptides is of greater nutritive value than a mixture of free amino acids having a close composition, probably because some amino acids from peptides are more rapidly absorbed and may produce greater insulin reaction. (Journal of Parenteral and Enteral Nutrition 17:355–363, 1993)
A Study of the Delayed Hypersensitivity Response in Healthy People in Spain: Spanish National Tables
Authors: Caínzos Miguel , Culebras Jesús M. , Lozano Francisco , Alcaraz Patricio , Balibrea Jose L. , Bouza Emilio , Davila David , Ferreira Vicente , Honorato Jesús , García Rodríguez José A. , Gómez Alonso Alberto , Morales Salvador , Potel Joaquín , Prat Guillermo , Regueiro Benito , Sans Segarra Manuel , Seco Jose L.
Published: May 2008

With a view to creating national tables of the delayed hypersensitivity response, a total of 1476 healthy persons were studied at eight different locations in Spain. For the measurement of delayed cellular immunity response, Multitest IMC was used. Of those examined, 0.7% were anergic, 21.3 were relatively anergic, and 73 were immunocompetent. Of the 766 men, 28 were relatively anergic and 3 were anergic, whereas of the 710 women, 14 were relatively anergic (p <.001) and 8% were anergic (p <.001). The highest incidence of anergy was found in women of over 70 years (p <.001). Tuberculin was the antigen with the most positive responses, 77%, followed by Candida with 58%. Trichophyton and Proteus mirabilis were the antigens least recognized by the Spaniards studied. Major geographical variations were observed, both in the overall index for the delayed hypersensitivity response and in the response to different antigens. Catalonia revealed the highest level of anergy and the Valencia region, the lowest. (Journal of Parenteral and Enteral Nutrition 17:454–457, 1993)
Adhesion of Percutaneously Inserted Silastic Central Venous Lines to the Vein Wall Associated With Malassezia furfur Infection
Authors: Kim Eun H. , Cohen Ronald S. , Ramachandran Pramela , Glasscock Gregory F.
Published: May 2008

Percutaneously inserted Silastic central venous catheters have been used for prolonged infusion of parenteral nutrition in neonates. Malassezia furfur infection has been associated with intravenous fat emulsions infused through central venous lines. In this paper, we report two premature infants whose Silastic catheters were adhered to the vein wall with associated M furfur infection. (Journal of Parenteral and Enternal Nutrition 17:458–460, 1993)
Review: First Choice for Total Parenteral Nutrition: The Peripheral Route
Authors: Payne‐James J. Jason , Khawaja Hamid T.
Published: May 2008

Historically, total parenteral nutrition (TPN) has been administered by the central venous route because of the rapid development of thrombophlebitis when TPN solutions are administered into peripheral veins. The insertion and placement of central venous catheters is, however, associated with morbidity and mortality and is the main cause of TPN‐related complications. By avoiding central venous catheterization, TPN can be made safer. Current awareness about the pathophysiology of peripheral vein thrombophlebitis and the use of a number of techniques that prevent or delay onset of peripheral vein thrombophlebitis mean it is now possible to administer TPN via the peripheral route. These techniques and changes in the practice of TPN in recent years (eg, reduction of caloric loads and use of lipid emulsions) mean peripheral parenteral nutrition is a technique that is now applicable to the majority of hospitalized, nutritionally compromised patients for whom intravenous feeding is anticipated for less than 10 to 14 days. (Journal of Parenteral and Enteral Nutrition 17:468–478, 1993)
Early Changes of Body Composition in Human Immunodeficiency Virus‐Infected Patients: Tetrapolar Body Impedance Analysis Indicates Significant Malnutrition
Authors: Apour Christine S. , Bell Stacey , Bistrian Bruce R. , Forse R. Armour
Published: May 2008

In this study the investigators examined alterations in body composition and the prevalence of diarrhea in HIV‐infected subjects. By using tetrapolar body impedance analysis (RJL‐Akern BIA 109:Data‐input, Frankfurt/Main, Germany), body composition was measured in 533 subjects, including 193 men aged 21 to 70 years, who had tested positive for HIV‐1 antibodies and 340 age‐ and sex‐matched control subjects. HIV‐infected patients were grouped according to the Walter Reed (WR) classification of HIV disease stages.1 Total body water, extracellular mass (ECM), body fat, body cell mass (BCM), and ECM/BCM ratio were determined. Relative to control subjects, the body weight and body mass index (BMI) of WR 3 through WR 5 (n = 85) and WR 6 (n = 83) subjects were significantly decreased (p <.29 and P <.001, respectively), whereas WR 2 (n = 26) subjects exhibited no decline in either body weight or BMI. However, all HIV‐infected subjects, including those classified as WR 2, displayed both a statistically significant decline in BCM and an increase in ECM, resulting in an increased ECM/BCM ratio. The use of tetrapolar impedance detected depletion of lean body mass in clinically asymptomatic HIV patients at the WR 2 stage who had not yet demonstrated alterations in body weight or BMI. Malnutrition can be defined as a state of decreased BCM and increased ECM. The altered ECM/BCM ratio is independent of body weight or BMI. Almost half the WR 2 patients had ECM/BCM ratios greater than those of matched control patients by 1 standard deviation. No significant depletion of fat stores was noted in any group except in the most severe WR 6 HIV patients.

When patients were classified into four diarrheal states in terms of stool evacuation, consistency, duration, and frequency, only the most severe state (patients with either more than 20 diarrheal episodes of more than 3 days duration or permanent diarrhea during the last year) correlated with the degree of malnutrition.
Quality of Life in Long‐Term Total Parenteral Nutrition Patients and Their Family Caregivers
Authors: Smith Carol E.
Published: May 2008

The purpose of this study was to identify individual and family variables associated with patient and caregiver quality of life. Perceived quality of life has been associated with improved outcomes and compliance. Methods included telephone interviews of 178 families, randomly selected from academic, hospital, and infusion agencies across the United States, with 116 follow‐up questionnaires returned. Patients had varied bowel disorders requiring total parenteral nutrition for an average of 4.6 years. Patients were an average of 52.0 years old; caregivers averaged 52.5 years of age. Coded interview data indicated that caregivers assist patients daily (for a mean of 4.2 hours) and provide emotional support. Problems such as loss of friends, loss of employment, and depression were reported in two thirds of the families. Overall low quality of life was associated with length of time on total parenteral nutrition, fewer family coping skills, and inability to get along on income, whereas higher quality of life was associated with higher self‐esteem and quality in the relationship. Preparing families for potential social problems or situations related to depression while also enhancing financial assistance, self‐esteem, quality in the relationship, and coping skills may increase both patient and caregiver quality of life. (Journal of Parenteral and Enteral Nutrition 17:501–506, 1993)
Detrimental Effects of an ω‐3 Fatty Acid‐Enriched Diet on Wound Healing
Authors: Albina J.E. , Gladden P. , Walsh W.R.
Published: May 2008

The ω‐3 fatty acids contained in fish oils have anti‐inflammatory effects with potential beneficial clinical applications. However, these same effects may alter wound healing, a process dependent upon an adequate inflammatory response. The hypothesis that a diet enriched with ω‐3 fatty acids could be detrimental to wound healing was tested in male rats fed complete diets differing only in their fat composition (17% menhaden oil + 3% corn oil vs 20% corn oil by weight) for 21 days before wounding and for 10 or 30 days after wounding (n = 16 per group). The wounding protocol included a dorsal 5‐cm skin incision used for mechanical testing and a 2‐cm incision used for subcutaneous polyvinyl alcohol sponge implantation. At 10 or 30 days postinjury, the 5‐cm skin wounds were harvested and mechanically tested. The sponges were removed at 30 days and analyzed for collagen content. Food consumption and weight gain were the same in the two dietary groups. No differences in the mechanical properties of the wounds were detectable 10 days after injury. At 30 days, however, wounds harvested from rats fed the menhaden oil diet were significantly weaker than those from corn oil‐fed animals. This difference in tensile strength was not explained by differential collagen accumulation, inasmuch as the collagen content of the sponges at 30 days was the same in both groups. Dietary consumption of a diet rich in ω‐3 fatty acids may conspire against the quality of wounds by altering the fibroplastic or maturational phases of the healing response. (Journal of Parenteral and Enteral Nutrition 17:519–521, 1993)
Meconium Passage in Very‐Low‐Birth‐Weight Infants
Authors: Meetze William H. , Palazzolo Valerie L. , Bowling Dan , Behnke Marylou , Burchfield David J. , Neu Josef
Published: May 2008

The timing of the first meconium stool has been considered a marker for proper gastrointestinal functioning in the term infant. There is limited information on the meconium passage patterns of very‐low‐birth‐weight infants of less than 32 weeks' gestation. It is unknown whether feeding practices influence the timing of the first stool in these infants. We retrospectively studied 47 very‐low‐birth‐weight infants with birth weights of 1250 g or less who were previously enrolled in a study of gastrointestinal (GI) priming. Infants whose mothers desired to breast feed (n = 7) were given GI priming with their own mother's milk. The remaining infants had been randomly assigned to receive total parenteral nutrition alone (n = 21) or GI priming with infant formula (n = 19) during the first 14 days of life. We attempted to advance all infants to full enteral nutrition by 21 days of age. There was no statistically significant difference in timing of the first stool among the three groups. The overall median age at first stool was 43 hours, and the 75th percentile was 10 days. The range was 1/2 hour to 27 days. There was no concordance between time of first stool and birth weight within the range studied. There was no concordance between time of first stool and necrotizing enterocolitis, although there was little statistical power to detect this. There was also very little concordance with feeding tolerance. Other than necrotizing enterocolitis, no significant GI disease developed in any of the infants studied. Because meconium passage is delayed past 10 days in 25% of the infants studied and delayed passage does not seem to predict GI disease, there is no rationale for extensive investigation or treatment of delayed meconium passage in very‐low‐birth‐weight infants unless there are other signs of GI disease. (Journal of Parenteral and Enteral Nutrition 17:537–540, 1993)
Nutritional Parameters Observed During 28‐Day Infusion of Recombinant Human Tumor Necrosis Factor‐α
Authors: Hardin Thomas C. , Koeller Jim M. , Klun John G. , Roodman G. David , Von Hoff Daniel D.
Published: May 2008

In conjunction with a Phase I investigation of the antineoplastic activity of recombinant human tumor necrosis factor‐α (TNF‐α), administered as a 28‐day continuous infusion, selected nutritional parameters were evaluated to identify any effect that might be attributed to the TNF infusion. Seven clinically stable men with a variety of tumor types were studied. None had clinical or laboratory evidence of significant malnutrition before entry into the study. Five patients received 10 μg of recombinant human TNF‐α per square meter per day and two patients received 25 μg/m2 per day. Indirect calorimetry assessment of resting energy expenditure, body weight, serum TNF concentration, and laboratory analysis of common nutritional markers (albumin, prealbumin, and triglycerides) were performed at baseline, day 14, day 28, and 2 weeks (day 42) after completion of the infusion. There were no statistically significant differences by analysis of variance observed in any parameter during the study period compared with baseline values and values on day 42. Also, there were no differences between any parameters when stratified by dose administered, although the number of patients studied was small. Measured serum TNF concentrations ranged from 0.02 to 1.56 ng/mL and did not correlate with study day or dose of TNF infused. No correlation was observed between serum TNF concentrations and resting energy expenditure. Although others have reported significant metabolic changes associated with acute administration of TNF in humans and animals, our experience does not support a hypermetabolic state in patients receiving low daily dose, long‐term (28‐day) continuous infusion of recombinant human TNF‐α, a state that may be consistent with many neoplastic conditions. (Journal of Parenteral and Enteral Nutrition 17:541–545, 1993)
Apparent Fiber Digestibility and Fecal Short‐Chain Fatty Acid Concentrations With Ingestion of Two Types of Dietary Fiber
Authors: Fredstrom Susan B. , Lampe Johanna W. , Jung Hans‐Joachim G. , Slavin Joanne L.
Published: May 2008

Short‐chain fatty acids (SCFAs) are products of dietary fiber fermentation. As such, fiber digestibility is thought to be related to SCFA production. The effects of two concentrations of cereal fiber as wheat bran (WB) and vegetable fiber (VF) on fiber digestibility were examined in 34 free‐living volunteers. Five diets consisting of a fiber‐free liquid nutrition supplement and quick breads containing either (1) 0 g of fiber, (2) 10 g of WB, (3) 30 g of WB, (4) 10 g of VF, or (5) 30 g of VF were consumed in random order. Apparent digestibility of neutral detergent fiber (NDF) was determined. Colonic fluid, collected by in vivo dialysis in 9 subjects, was analyzed for SCFAs by gas chromatography. Digestibility of NDF was greater with WB than with VF ingestion in those 9 subjects, but digestibility was not different with ingestion of both fibers when all 34 subjects were considered. No effect of intake level was seen with either WB or VF. Fiber ingestion increased acetate, propionate, and butyrate concentrations above those on the 0 g of fiber diet (43%, 31%, and 90%, respectively; p <.0001). Propionate and butyrate concentrations were greater on WB than VF (p <.01); acetate concentrations were similar with both fibers. No correlation between NDF digestibility and SCFA concentrations was observed. Despite differences in origin, chemistry, particle size, and subject transit time, the WB and VF were similar in NDF fermentability. Molar ratios of specific SCFAs were influenced by type of fiber ingested. (Journal of Parenteral and Enteral Nutrition 18:14–19, 1994)
Dietary Nucleotides Affect Hepatic Growth and Composition in the Weanling Mouse
Authors: Novak Donald A. , Carver Jane D. , Barness Lewis A.
Published: May 2008

The effect of dietary nucleotides upon hepatic growth and composition was examined in weanling mice. For 5 weeks, mice were fed either Purina™ Rat Chow, a nucleotide‐free diet (NT−), a nucleotide‐free diet supplemented with a mixture of five nucleotides (0.21% w/w), (NT+) or a nucleotide‐free diet supplemented with adenosine 5′‐monophosphate (0.0425% w/w) (NTA). Hepatic cholesterol and lipid phosphorous were significantly higher, whereas liver weight (expressed as a percentage of body weight), and glycogen were lower in animals fed NT− vs all other groups. NTA‐fed animals presented a greater contrast to the NT− group than did animals fed the mixture of nucleotides. Liver fatty acid composition and distribution of phospholipid subclasses were not affected by dietary nucleotide supplementation. Dietary nucleotide supplementation in weanling mice affects hepatic growth and composition; adenosine 5′‐monophosphate may play a unique role in these effects. (Journal of Parenteral and Enteral Nutrition 18:62–66, 1994)
Intestinal Placement of pH‐Sensing Nasointestinal Feeding Tubes
Authors: Berry Scott , Orr Marsha , Schoettker Pamela , Lacy Joseph , Davis Crystal , Warshawsky Kathy , Nussbaum Michael , Bower Robert
Published: May 2008

Intestinal access for enteral nutrition can be achieved by spontaneous intestinal nasogastric tube passage or by endoscopic, fluoroscopic, or surgical placement methods. Each of these methods has limitations that may compromise clinical utility. pH‐sensing nasointestinal feeding tubes allow active placement with minimal equipment and expertise; however, this method requires an acidic gastric pH. We sought to determine whether antiulcer regimens used at our institution would preclude intestinal pH‐sensing tube placement. Twenty‐five patients had 25 (81%) successful intestinal placements in 31 attempts. Observed pH values and calculated pH changes were compared within and between successful and unsuccessful groups by using a Student's t test. Initial, lowest, and final pH values did not differ significantly between groups. The pH change initial‐to‐lowest (4.7 ± 0.18 vs 3.6 ± 0.59, p <.03) and lowest‐to‐final (5.0 ± 0.18 vs 3.0 ± 0.47, P <.0001) differed significantly between groups, whereas the pH change initial‐to‐final did not. Cost analysis of endoscopic ($782), fluoroscopic ($341 to $382), spontaneous ($167 to $212), and pH‐sensing ($162) methods revealed 3% to 79% savings when the pH‐sensing placement method was used. We conclude that the antiulcer therapies used in our patient population did not preclude intestinal pH‐sensing tube placement. If the pH changes from initial‐to‐lowest and lowest‐to‐final were greater than 4, successful intestinal placement occurred in 91% of attempts. Finally, the method was cost‐effective at our institution. (Journal of Parenteral and Enteral Nutrition 18:67–70, 1994)
Alteration of Mucosal Immunity After Long‐term Ingestion of an Elemental Diet in Rats
Authors: Serizawa Hiroshi , Miura Soichiro , Tashiro Hirokazu , Imaeda Hiroyuki , Shiozaki Hiroshi , Ohkubo Nobuyuki , Kimura Hiroyuki , Tanaka Shin , Tsuchiya Masaharu
Published: May 2008

The effects of an elemental diet on lymphocyte transport in intestinal lymph and immune responses of gut‐associated lymphoid tissue were investigated in rats. The control animals were fed a conventional diet. After 4 week of feeding, the total calorie intake and body weight gain showed no differences between the two groups. The number and total area of Peyer's patches and the ratio of height of villi to height of crypt showed no significant differences between the two groups. The rate of lymph flow in intestinal lymphatics showed no significant change in treated animals compared with the control rats. However, an elemental diet induced a significant decrease in lymphocyte flux in intestinal lymphatics compared with that in control rats. Lymphocyte subsets in intestinal lymph revealed a significant decrease in CD3‐positive cells, especially CD4‐positive cells in the elemental diet‐treated group. A significant decrease in the number of immunoglobulin A‐containing cells and a decreased CD4/CD8 ratio in T‐cell subsets were observed in the lamina propria of ileal mucosa in the elemental diet‐treated group by morphometric analysis in the immunohistochemical study. Specific antibody‐secreting cells in intestinal lymph were also investigated after rats were intraduodenally primed with cholera toxin and challenged with the same toxin after an interval of 2 weeks. No significant difference was seen between the two groups in any of the numbers of anti‐cholera toxin immunoglobulin‐secreting cells in any immunoglobulin A, immunoglobulin G, or immunoglobulin M class as determined by the enzyme‐linked immunospot assay. These results suggest that the elemental diet we used might have an inhibitory effect on several aspects of the mucosal immunologic system of the gut without significant reduction in its ability to produce specific antibodies. (Journal of Parenteral and Enteral Nutrition 18:141–147, 1994)
Glutamine‐Supplemented Parenteral Nutrition Improves Gut Mucosa Integrity and Function in Endotoxemic Rats
Authors: Chen Kai , Okuma Toshitada , Okamura Kenji , Torigoe Yoshitsugu , Miyauchi Yoshimasa
Published: May 2008

The effects of glutamine‐supplemented parenteral nutrition on protein metabolism, small intestinal mucosal metabolism, morphology, and barrier function were studied in endotoxin‐treated rats. Forty‐six male Wistar rats were randomized to two groups of 23 animals each and received total parenteral nutrition solutions supplemented with either glutamine (GLN group) or glycine (GLY group) at 2% wt/vol. Endotoxemia was induced by continuous intravenous infusion of endotoxin at a dose of 2 mg/kg per day throughout the 4‐day study period. The GLN group had a less‐negative cumulative nitrogen balance (‐14.0 ± 132.8 mg of nitrogen in the GLN group and ‐86.8 ± 161.7 mg of nitrogen in the GLY group, p <.05) and less cumulative excretion of urinary 3‐methylhistidine (2910 ± 593 nmol) than the GLY group (4447 ± 933 nmol, p <.01). Jejunal mucosal glutaminase activity and the arterio‐portal venous blood glutamine concentration differences were significantly higher in the GLN group compared with the GLY group (15.6 ± 2.3 vs 11.1 ± 1.9 μmol/g per minute, p <.05, and 181 ± 52 vs 147 ± 36 nmol/mL, p <.05, respectively). The morphology of the jejunal mucosa in the GLN group was significant for having greater mucosal weight (23.4 ± 3.1 vs 17.6 ± 2.5 mg/cm), villus height (445 ± 75 vs 357 ± 57 μm), crypt depth (197 ± 34 vs 161 ± 28 μm), and wall thickness (751 ± 77 vs 648 ± 102 μm) than the GLY group (p <.05). In the GLN group, the arterio‐portal venous endotoxin difference was less negative (‐31 ± 137 vs ‐480 ± 672 pg/mL), suggesting that the absorption of endotoxin across the gut was partially reversed. We conclude that glutamine supplementation can improve gut metabolism, decrease the extent of mucosal atrophy, and thereby assist in the maintenance of the mucosal barrier function in endotoxemia. (Journal of Parenteral and Enteral Nutrition 18:167–171, 1994)
Anemia and Neutropenia Due to Copper Deficiency in Enteral Nutrition
Authors: Tamura Hirokazu , Hirose Satoru , Watanabe Otsu , Arai Ken‐Ichi , Murakawa Masaya , Matsumura Osamu , Isoda Kazuo
Published: May 2008

Copper deficiency has been regarded a rare complication of total parenteral nutrition. This report describes the first known case of anemia and neutropenia caused by copper deficiency in a patient receiving long‐term enteral nutrition. A 34‐year‐old man presented with bulbar palsy and tetraplegia after an operation for cerebellar hemorrhage on June 7, 1989. Nasopharyngeal tube feeding with a defined‐formula diet (Besvion) was instituted on June 19, 1989. He developed normocytic anemia and neutropenia approximately 19 months after the initiation of the tube feeding. Serum copper and ceruloplasmin levels were markedly below normal. There were anisocytosis and erythrocyte deformities in the peripheral blood smear. Bone marrow aspirates revealed a hypocellular marrow with numerous myeloid and erythroid cells with cytoplasmic vacuoles. Because the amount of copper administered was estimated to be 2.6 to 5.1 μmol/d during the tube feeding, copper deficiency was suspected to be the cause of the hematologic disorders. The patient's daily oral copper intake was increased to 34 μmol/d. His serum copper and ceruloplasmin concentrations reached a normal level after 16 days and 23 days of copper supplementation, respectively. A marked reticulocytosis occurred after 10 days of copper supplementation, and his anemia gradually improved over the next 3 months. His blood neutrophil count also returned to normal within 2 weeks. (Journal of Parenteral and Enteral Nutrition 18:185–189, 1994)
Mucosal Bridge Formation in the Esophagus Caused by Injury From a Nasoenteric Feeding Tube
Authors: Buchman Alan L. , Waring J. Patrick
Published: May 2008

We report the first case of an esophageal mucosal bridge that was caused by a nasoenteric feeding tube or its placement. The mucosal bridge was diagnosed by esophagoscopy and was nearly resolved 3 weeks later after removal of the feeding tube and treatment with histamine antagonists. Although uncommon, esophageal injury may occur in relation to the use of small‐bore nasoenteric feeding tubes and great care should be taken during tube placement and use. (Journal of Parenteral and Enteral Nutrition 18:278–279, 1994)