bluuebunny/crossref_metadata_2025 huggingface dataset:
Arginine Supplementation Improves Histone and Acute‐Phase Protein Synthesis During Gram‐Negative Sepsis in the Rat
Authors: León Pablo , Redmond H. Paul , Stein T. Peter , Jian Shou  , Schluter Margaret D. , Kelly Cathal , Lanza‐Jacoby Susan , Daly John M.
Published: May 2008

Mechanisms of nutrient alteration of hepatic protein synthesis during sepsis are unclear. In vitro, arginine downregulates endotoxin‐stimulated hepatocyte protein synthesis but in vivo effects are unknown. This study evaluated the effects of supplemental arginine or glycine on fibrinogen (acute‐phase protein), histone, albumin, and liver protein synthesis after Gram‐negative sepsis in the rat. Adult rats (225 g, n = 36) were randomized to receive isonitrogenous isocaloric total parenteral nutrition supplemented with 264 mg of N per kilogram per day as either arginine or glycine. On day 5, each group was further randomized to control or sepsis. Sepsis was induced by injection of 8 × 107 Escherichia coli per 100 g body weight, and then a continuous infusion of [1‐14C]leucine was started. The rats were sacrificed 4 hours later. The fractional protein synthesis rates (percent per day) of histone, fibrinogen, albumin, and liver were determined. Supplemental arginine led to significantly increased histone (p < 0.05, analysis of variance) and fibrinogen (p < 0.01, analysis of variance) synthesis in the septic rats compared with all other groups. Histone and albumin synthesis were also significantly increased (p < 0.05) in the arginine‐supplemented control group compared with the glycine‐supplemented control group. Arginine supplementation during sepsis significantly increased (p < 0.05) albumin and liver protein synthesis compared with controls. Histones which are involved in DNA synthesis and are rich in arginine may play a role in the host response to stress and sepsis. These in vivo results appear to contradict hepatocyte‐Kupffer cell coculture studies perhaps because of the hormonal and cytokine responses to nutrient substrate and acute septicemia. (Journal of Parenteral and Enteral Nutrition 15:503–508, 1991)
Risk Factors for Central Venous Catheter‐Related Vascular Erosions
Authors: Mukau Leslie , Talamini Mark A. , Sitzmann James V.
Published: May 2008

Risk factors for superior vena cava perforations following central venous catheterization for total parenteral nutrition were identified in a retrospective study of 1058 catheters in 853 patients; 540 of these catheters were size 16‐gauge (51%) and 518 size 14‐gauge (49%). Of the size 14‐gauge catheters, 274 (53%) were right‐sided and 244 (47%) were left‐sided subclavian catheters. Four patients (0.4%) had superior vena cava perforation. All had left‐sided large bore 14‐gauge catheters. All patients experienced acute symptoms and all had pleural effusions. There was no mortality directly related to vascular erosions. Two risk factors were identified for this complication: (1) catheters originating from the left side (p < 0.05), or (2) large catheters (size 14‐gauge or larger) (p < 0.01). We conclude that large bore or left‐sided central venous catheter placement represents an increased risk of superior vena cava perforation. (Journal of Parenteral and Enteral Nutrition 15:513–516, 1991)
Effects of Fiber‐Containing Liquid Diets on Colonic Structure and Function in the Rat
Authors: Levine Gary M. , Rosenthal Jerome
Published: May 2008

Dietary fiber plays a role in maintaining colonic structure and function. Recently, fiber‐supplemented liquid diets containing primarily soy polysaccharide have been marketed. However, the effects of these diets on the colon, particularly absorptive function, are not well documented. We compared Jevity (containing 1.4% soy polysaccharide) to fiber‐free Osmolite. In addition, we were interested in comparing the effects of soy polysaccharide to that of pectin, which has previously been shown to facilitate adaptation. A 1% pectin‐supplemented rat liquid diet was compared to the liquid diet alone. After 2 weeks of dietary treatment, rats were anesthetized and in vivo colonic absorption measured. Both Jevity and the pectin‐containing diets led to a significantly greater (p < 0.01) basal and butyrate stimulated water absorption as well as 20 mM butyrate absorption compared to their fiber‐free fed controls. After perfusion, rats were killed and parameters of colonic mass measured including mucosal weight, protein, and DNA. The fiber‐containing diets produced a modest, nonsignificantly greater colonic mass compared to their fiber‐free controls. A commercial diet containing soy polysaccharide seems to be equally effective as pectin in maintaining colonic absorptive function. (Journal of Parenteral and Enteral Nutrition 15:526–529, 1991)
M‐Mode and Two‐Dimensional Echocardiography in the Routine Follow‐up of Central Venous Catheters in Children Receiving Total Parenteral Nutrition
Authors: Moukarzel A. , Azancot‐Benisty A. , Brun P. , Vitoux C. , Cezard J.P. , Navarro J.
Published: May 2008

A retrospective study in 38 children (1 day to 7 years) on total parenteral nutrition (TPN) (1 month‐24 months) with a central venous catheter (CVC) evaluated the contribution of two‐dimensional echocardiography (2D) and M‐mode in the follow‐up of CVC location and early diagnosis of related complications. Fifty examinations were performed routinely in 21 patients (group I) and 40 in 17 patients for sepsis of the CVC or clinical suspicion of thrombosis (group II). The tip of the CVC was located in the upper right atrium in 17 cases (45%), superior vena cava in 14 cases (37%), jugular or subclavian vein in 5 cases (13%), and was not visualized in 2 cases (15%). In group I, 2D was normal in 19 cases, and catheter thrombosis suspected in 2 was not confirmed by digital angiography (DA). In group II, 2D was normal in 11 cases. In 6 patients, subxiphoid and suprasternal planes identified superior vena cava thrombus in the right atrium (DA confirmed the diagnosis in 2). In 2 pulmonary embolism occurred (1 case died); the remaining patients were successfully treated by medical therapy and removal of the catheter. Echocardiography is a useful noninvasive technique to control CVC tip location and follow‐up. In this study, the sensitivity of cardiac thrombus detection by echocardiography was 100% and the specificity 93%; this method appeared, therefore, appropriate for early detection of cardiac thrombosis in pediatric patients on TPN. (Journal of Parenteral and Enteral Nutrition 15:551–555, 1991)
Selenium Supplementation in Low‐Birthweight Premature Infants: Relationship to Trace Metals and Antioxidant Enzymes
Authors: Huston Robert K. , Jelen Barbara J. , Vidgoff Jaclyn
Published: May 2008

We attempted to study the effect of selenium supplementation upon trace metal metabolism in low‐birthweight infants <1000 g birthweight. Serum levels of the trace metals copper, zinc, and selenium; and white blood cell glutathione peroxidase (GSH‐Px) and superoxide dismutase (SOD) activities were measured in conjunction with the trace metals when parenteral nutrition (TPN) was begun (sample A), at the initiation of enteral nutrition (sample B), and when TPN was discontinued (sample C). Two randomly selected groups of infants were evaluated: group S received selenium supplementation (1.34 μg/kg per d) in their parenteral nutrition solutions; group C was a control which did not receive selenium supplementation. Selenium levels declined to equally low levels in both groups by sample C, but were significantly higher in group S at sample B. GSH‐Px activities demonstrated a significant increase at sample B in group S and then tended to decrease. In group C, GSH‐Px tended to increase, then decreased significantly by sample C. Both groups received 20 μg/kg per d of copper in TPN, however, serum copper declined significantly at sample B in group S whereas there were no significant changes in group C. There were no significant changes in zinc and SOD levels. There were no significant differences between groups in clinical characteristics or outcome. This study suggests that a dose of supplemental selenium of 1.34 μg/kg per d in TPN is inadequate for low‐birthweight premature infants. Selenium supplementation may also affect copper metabolism. (Journal of Parenteral and Enteral Nutrition 15:556–559, 1991)
Total Parenteral Nutrition Energy Composition Affects Small Intestinal Disaccharidase Activity in the Newborn Miniature Pig
Authors: Shulman Robert J. , Burrin Douglas G.
Published: May 2008

Total parenteral nutrition (TPN) decreases disaccharidase activity in the small intestine of humans and miniature piglets. The possibility, however, that specific components of TPN (eg, the energy mix) will increase disaccharidase activity has largely been unexplored. The identification of such components would be particularly useful in the treatment of premature infants with immature gastrointestinal tracts and patients with small intestinal mucosal disease associated with decreased disaccharidase activity. To determine whether the TPN energy composition affects small intestinal disaccharidase activity, 7‐day‐old miniature piglet littermates were randomized to receive TPN containing either glucose (group G) or glucose and fat (group G/F) as the nonnitrogen energy source(s). The TPN regimens were isonitrogenous and isoenergetic. The piglets were not allowed oral intake during the 7 days they were maintained on TPN. At 14 days of age the piglets were killed and the small intestines analyzed for weight, protein, DNA, and disaccharidase activity. Body weight was similar between groups at both the beginning and end of the study. The TPN regimen did not affect small intestinal weight or protein and DNA content. However, jejunal and ileal sucrase and ileal maltase activities (μmol/min·kg body wt ± SD) were greater in group G than those in group G/F (28 ± 9 vs 19 ± 11, p=0.04; 13 ± 7 vs 7 ± 4, p = 0.037; and 31 ± 8 vs 19 ± 10, p = 0.0088, respectively). No differences in lactase activity were noted between groups. It is concluded that in the absence of oral feedings, a glucose‐based TPN regimen in the newborn miniature piglet increases sucrase and maltase activities more than a glucose/fat‐based regimen. (Journal of Parenteral and Enteral Nutrition 15:560–563, 1991)
The Relationship Between Enteral Formula Contamination and Length of Enteral Delivery Set Usage
Authors: Kohn Carol L.
Published: May 2008

Twenty‐one delivery sets were collected from 21 patients who had received continuous Osmolite feedings over 24 hours. Delivery sets were then taken to the laboratory and hung for an additional 48 hours. In the laboratory, the delivery sets were rinsed with tap water and Osmolite was added every 12 hours. Formula samples were obtained from the delivery sets after they had been used for 24 hours, and every 12 hours during the additional 48 hours in the laboratory. Formula contamination was assessed by determining bacterial counts. Unacceptable contamination was defined as bacterial counts ≥ 105 cfu/mL.

The mean bacterial count was 2.8 × 105 cfu/mL at 24 hours, and all subsequent mean counts increased over time. There were statistically significant differences among the mean log bacterial counts at all time periods (p ≤ 0.0005) except between 36 hours and 48 hours (p = 0.019). Of the 21 delivery sets, 23.8% were unacceptably contaminated at 24 hours, and by 48 hours, 42.9% were unacceptable. These findings suggest that if 105 cfu/mL is used as a criterion, delivery sets should not be used for more than 24 hours in a hospital, and 24‐hour use of delivery sets may even be too long. (Journal of Parenteral and Enteral Nutrition 15:567–571, 1991)
Rhoads lecture. Effect of Infection on Nutrient Requirements
Authors: Scrimshaw Nevin S.
Published: May 2008

All infections, no matter how mild, decrease nutrient intakes and increase nutrient losses even when sub‐clinical. The losses include decreased intestinal absorption, direct loss of nutrients in the gut, internal diversion for metabolic responses to infection and increased basal metabolic rate when fever is present. In this way, infection influences not only protein and energy status but also that of most other nutrients. The clinical importance of these consequences of infection depends on the prior state of the individual, the nature and duration of the infection, and the diet of the individual during the infection, particularly dietary intake during the convalescent period and whether full recovery takes place before another infection occurs. In industrialized countries particular attention must be paid to the nutrition of hospitalized patients inasmuch as they are frequently debilitated by their primary disease, morbidity, and nutritional status. Morbidity and mortality are increased by nosocomial infections to which the poorly nourished individual is more susceptible. (Journal of Parenteral and Enteral Nutrition 15:589–600, 1991)
Changes of Hepatic Morphology During Parenteral Nutrition With Lipid Emulsions Containing LCT or MCT/LCT Quantified by Ultrasound
Authors: Baldermann H. , Wicklmayr M. , Rett K. , Banholzer P. , Dietze G. , Mehnert H.
Published: May 2008

Fatty infiltration of the liver with cholestasis is one of the complications of total parenteral nutrition (TPN). The cause has not yet been determined. It seems probable, however, that these alterations could be prevented when a mixture of medium‐ and long‐chain triglycerides (MCT/LCT) is used as a fat component instead of the application of long‐chain emulsions (LCT) alone. To determine whether this could also be demonstrated morphologically in man, 14 patients needing TPN (25 kcal/kg BW x day, carbohydrate 45%, fat 35%, protein 20%) were examined by ultrasound in order to compare liver size and gray‐scale value before and after 7 days of TPN. Seven of the patients were randomly administered a MCT/LCT emulsion as their fat intake, the other seven were exclusively given LCT. There were no changes in liver size and gray‐scale value in the MCT/LCT‐group, whereas both parameters showed a significant rise in the patients with LCT (size: 10.4 ± 1.4 to 11.5 ± 1.4 cm; gray‐scale value: 9.3 ± 1.0 to 11.6 ± 0.7). These data suggest that TPN, administered with a mixture of MCT/LCT emulsions as fat components, could reduce the risk of hepatic dysfunction such as cholestasis and fatty infiltration of the liver. (Journal of Parenteral and Enteral Nutrition 15:601–603, 1991)
Resting Energy Expenditure in Cancer Patients Before and After Gastrointestinal Surgery
Authors: Fredrix E.W.H.M. , Soeters P.B. , Von Meyenfeldt M.F. , Saris W.H.M.
Published: May 2008

The aim of this study was to assess the impact of surgical trauma on energy metabolism in cancer patients. Therefore, resting energy expenditure (REE) was determined before and after surgery in patients with newly detected gastric and colorectal cancer. Preoperative REE was measured in 104 patients. In 65 of these 104 patients REE was also measured on the seventh or eighth postoperative day. Postoperative REE was significantly higher than preoperative REE (mean ± SD: 1471 ± 238 us 1376 ± 231 kcal; p < 0.001). After surgery 22 patients were hypermetabolic (REE ≥ 115% predicted energy expenditure) compared with seven hypermetabolic patients before surgery. This hypermetabolism in the postoperative state can be explained by the administration of total parenteral nutrition (TPN), by an increased body temperature mainly as a consequence of postoperative complications and by the surgical trauma itself. Patients who received preoperative TPN (n = 12) showed a 10% increase in REE. Thirteen patients suffered from minor and major postoperative complications; postoperative REE in this group was increased by 10%. Forty patients who had undergone uncomplicated surgery showed a slight but significant increase of 3% in REE after operation. We conclude from this study that the increase in REE resulting from surgical trauma itself is modest at the seventh to eighth postoperative day. Therefore, energy requirements for patients undergoing major elective surgical stress are lower than generally presumed. (Journal of Parenteral and Enteral Nutrition 15:604–607, 1991)
The Solubility of Calcium and Phosphorus in Neonatal Total Parenteral Nutrition Solutions
Authors: Dunham Bruce , Marcuard Stefan , Khazanie Prabhaker G. , Meade Glen , Craft Teresa , Nichols Kim
Published: May 2008

Precipitation of calcium phosphate in neonatal total parenteral nutrition (TPN) solutions remains a significant problem. Whereas numerous studies have attempted to establish guidelines for maximum concentrations of various combinations that can be mixed, differences in study design and reliance upon subjective visual assessment severely limit their applicability. The purpose of this study was to quantitatively determine calcium and phosphate compatibility in commonly used neonatal TPN solutions containing a final concentration of either 1 or 2% amino acids. The final dextrose concentration was 10%. Electrolytes, heparin, and pediatric vitamins and trace minerals were also added. Calcium gluconate (10%) and potassium phosphate (mono and dibasic) were added by calibrated micropipetors. Calcium concentrations ranged from 5 to 60 mEq/L and phosphate from 5 to 40 mM/L with a minimum of 84 combinations tested for each amino acid concentration. Calcium concentrations were measured in duplicate for each tested combination. Control solutions containing calcium but no phosphate were included to validate the assay methodology. All samples were stored at room temperature for 23.5 hours and then placed in a water bath at 37°C for 30 minutes to simulate incubator conditions encountered during TPN infusion. Calcium determinations were then repeated and precipitation was judged to have occurred whenever calcium concentrations fell below 90% of the initial measured values. These data allowed plotting a calcium and phosphorus reference curve for TPN solutions containing 1 and 2% amino acids based on quantitative assessment. These reference curves should allow pharmacists to avoid compounding TPN solutions that will precipitate, thus saving considerable cost to the pharmacy and preventing complications. (Journal of Parenteral and Enteral Nutrition 15:608–611, 1991)
Lipid Infusion With Different Triglyceride Cores (Long‐Chain vs Medium‐Chain/Long‐Chain Triglycerides): Effect on Plasma Lipids and Bilirubin Binding in Premature Infants
Authors: Rubin Moshe , Harell Daniella , Naor Nora , Moser Asher , Wielunsky Eliahu , Merlob Paul , Lichtenberg Dov
Published: May 2008

The possible beneficial effects of infusing a lipid emulsion containing 50% by weight of medium‐chain triglycerides (MCT) compared with a standard long‐chain triglyceride (LCT) emulsion were studied in 18 premature neonates (gestational age <34 weeks) requiring parenteral nutrition. The infants were assigned in a double‐blind manner to receive one of the two lipid emulsions over 17 hours a day as a supplemental regimen for total parenteral nutrition. A lipid load of 1 g/kg per day was initiated on the third day of life and was increased at the rate of 1 g/kg per day until a maximal dose of 3 g/kg per day was obtained on the fifth day of life and maintained thereafter. Both bound and unbound bilirubin decreased with both infusion regimens during the study period. Despite a marked increase in plasma free fatty acid levels (260% in the MCT/LCT group compared with 210% in the LCT group), the fraction of unbound (free) bilirubin was significantly lower in the MCT/LCT group (34% vs 13%). Free fatty acid levels, corrected to albumin, were positively correlated to the percentage of free bilirubin only for the LCT lipid infusion. The finding of a significant elevation of plasma cholesterol levels only in the MCT/LCT group is now under investigation. Use of the MCT‐containing emulsion was not associated with a higher frequency of adverse effects than the commonly used LCTcontaining emulsion. It is concluded that the lipid emulsion containing MCT is safe for use as a calorie source in lipid supplementation of total parenteral nutrition in premature infants under the conditions studied and that it is probably preferable in situations in which hyperbilirubinemia limits the use of the conventional LCT emulsion. (Journal of Parenteral and Enteral Nutrition 15:642–646, 1991)
Vitamin E Status of Patients Receiving Long‐Term Parenteral Nutrition: Is Vitamin E Supplementation Adequate?
Authors: Steephen Anita C. , Traber Maret G. , Ito Yasushi , Hornsby Lewis Lynn , Kayden Herbert J. , Shike Moshe
Published: May 2008

Vitamin E status of eight patients receiving total parenteral nutrition (TPN), including 10 IU of all‐racemic α‐tocopheryl acetate daily and Intralipid 20% (500 mL; 12 mg of RRR‐α‐ and 92 mg of RRR‐γ‐tocopherols) two to three times per week for 69 ± 45 (mean ± SD) months was assessed by measuring plasma and adipose tissue tocopherol concentrations. Plasma α‐tocopherols of TPN patients were similar to controls (17.5 ± 6.6 μmol/L vs 22.4 ± 5.1), whereas γ‐tocopherols were significantly reduced (6.0 ± 3.1 vs 11.2 ± 3.6, p < 0.03). The adipose tissue α‐ and γ‐tocopherol/triglycerides (TG) were similar (369 ± 215 nmol/mmol vs 452 ± 228, and 125 ± 102 vs 140 ± 130, respectively), but cholesterol/TG were increased in the TPN patients (7.8 ± 2.5 μmol/mmol vs 5.1 ± 3.5, p < 0.05), suggesting that adipose tissue was relatively TGdepleted and tocopherol/cholesterol measurements better reflect vitamin E status. The mean α‐tocopherol/cholesterol ratios were significantly lower in the TPN patients than the controls (55 ± 36 vs 106 ± 63, p < 0.04). Thus, current vitamin E supplementation of TPN patients seems insufficient for maintenance of adequate tissue stores. (Journal of Parenteral and Enteral Nutrition 15:647–652, 1991)
Malnutrition in Tubefed Nursing Home Patients With Pressure Sores
Authors: Breslow Rosalind A. , Hallfrisch Judith , Goldberg Andrew P.
Published: May 2008

This study compares the nutritional status and dietary intake of 14 tubefed nursing home patients with pressure sores (age: 70 ± 5 years, mean ± SEM) to 12 tubefed patient‐controls without sores (age: 60 ± 7 years). Patients tended to have higher calorie intake (32 ± 3 kcal/kg) than patient‐controls (26 ± 2 kcal/kg, p = 0.11). Protein intake was significantly higher in patients (1.4 ± 0.2 g/kg) than patient‐controls (0.9 ± 0.1 g of protein per kg, p < 0.05). Despite increased calorie and protein intake, biochemical measures of nutritional status were worse in the patients. Serum albumin was lower in patients (33 ± 1 g/L) than in patient‐controls (37 ± 1 g/L, p < 0.05) as was level of hemoglobin (patients: 117 ± 5; patient‐controls: 132 ± 5 g/L, p < 0.05). Patients with stage IV (severe) sores had lower serum cholesterol levels (3.46 ± 0.31 mmol/L, n = 5) than patients with stage II/III (milder) sores (4.58 ± 0.23 mmol/L, n = 9, p < 0.05). Plasma zinc was low in both patients (11.2 ± 0.6 μmol/L) and patient‐controls (11.5 ± 0.7 μmoljL, p = NS). Pressure sore surface area was positively correlated with calorie intake per kilogram of body weight (r = +0.59, p < 0.04) and negatively correlated with body mass index (r = ‐0.70, p < 0.03), hemoglobin (r = ‐0.55, p < 0.07) and serum cholesterol (r = ‐0.57, p < 0.05). Thus, tubefed nursing home patients with pressure sores are malnourished despite receiving a diet high in calories and protein. Their low body weight, hypoalbuminemia, anemia, and hypocholesterolemia suggest greatly increased requirements for calories and protein. Because most of the patients in this malnourished, chronically ill population tolerated tubefeeding well, increased provision of calories and protein via the enteral route seems a potentially achievable goal. (Journal of Parenteral and Enteral Nutrition 15:663–668, 1991)
Bilateral Pleural and Pericardial Effusions Because of Mediastinal Placement of a Central Venous Catheter
Authors: Simmons Timothy C. , Henderson Donald R.
Published: May 2008

Pneumothorax, hydrothorax, hydromediastinum, and cardiac tamponade are uncommon, although not unusual, complications of central venous catheter placement. We report a case of hydromediastinum with bilateral pleural and pericardial effusions, occurring in a patient after placement of a Silastic double‐lumen central venous catheter for hyperalimentation. (Journal of Parenteral and Enteral Nutrition 15:676–679, 1991)
Review: Abnormal Substrate Metabolism and Nutritional Strategies in Cancer Management
Authors: Rossi‐Fanelli Filippo , Cascino Antonia , Muscaritoli Maurizio
Published: May 2008

Impairment of the nutritional state plays a major role in the morbidity and mortality of cancer patients. However, the opportunity of providing artificial nutritional support to these patients is still debated, because of the concern that energy substrates administered to replete the host may concomitantly stimulate tumor growth. A correct nutritional approach to cancer patients should thus be based on a thorough knowledge of both host and tumor metabolic needs and host‐tumor metabolic interactions. Specific modifications of plasma levels of glucogenic, aromatic, sulfur‐containing and branched‐chain amino acids have been demonstrated in cancer patients, indicating a specific influence of the tumor on amino acid metabolism. Little is known about protein metabolism in neoplastic tissue. Interference with tumor growth has been attempted by deprivation of single amino acids with controversial results. Increased gluconeogenesis and insulin resistance are responsible for the two main abnormalities in carbohydrate metabolism in cancer patients, namely increased glucose turnover and impaired glucose tissue disposal. Lipid metabolism is also affected by the neoplasm: soluble factors such as “lipid‐mobilizing factor” lead to increased fat mobilization from adipose tissue; plasma elimination of exogenous triglycerides has also been found to be reduced probably because of a tumor‐related decrease in lipoprotein lipase activity. The differences in glucose and fat utilization between tumor and host should be considered in the nutritional approach to cancer patients. Data in this respect are controversial and have been obtained only in experimental animals. In a recent study comparing the effects of a glucose‐based vs a lipid‐based parenteral nutritional regimen, on tumor growth in man, we showed that a lipid‐based parenteral nutrition reduces, although not significantly, tumor growth rate. Nutritional manipulation of cancer is rapidly moving from theory to reality, offering nutritionists and oncologists a valid tool in cancer patient's care. (Journal of Parenteral and Enteral Nutrition 15:680–683, 1991)
Effect of Restricting Dietary Protein on the Progression of Renal Failure in Patients with Insulin‐Dependent Diabetes Mellitus K. ZELLER, E. WHITTAKER, L. SULLIVAN, P. RASKIN, H.R. JACOBSON N Engl J Med 324:78–84, 1991
Authors: Kearns Patrick J.
Published: May 2008

This report compares the progression of renal failure in type‐I diabetic patients fed either a low or a normal protein diet. In a prospective, randomized, controlled fashion, 47 adult patients were placed either on a 0.6 g/ kg daily protein intake (study) or a greater than 1.0 g/ kg (control) daily protein intake. Dietary phosphorus was maintained between 0.5 and 1.0 g for study patients and greater than 1.0 g for control patients. Renal function was monitored by iothalamate and creatinine clearance measurements at 3‐ to 6‐month intervals. Patients were studied for periods up to 46 months (mean 34.7 months). Study patients had a slower deterioration of renal function with clearance decreasing at 25 to 40% the rate observed in control patients. Proteinuria was reduced by 45% in the study group when compared to the control group (2.9 g/dL vs 5.4 g/dL). The authors conclude that a protein‐phosphorus‐restricted diet can slow progression of renal failure in diabetic patients.
Nutritional and Metabolic Response to Acute Spinal‐Cord Injury
Authors: Kearns Patrick J. , Thompson James D. , Werner Peter C. , Pipp Terrance L. , Wilmot Conal B.
Published: May 2008

The metabolic response to complete spinal cord injury was prospectively studied in 10 patients with Frankel class A spinal cord injury. Weekly excretory and balance studies profile the changes in nitrogen, calcium, and 3‐methylhistidine excretion in relation to body weight and metabolic rate. The initial resting energy expenditures were 10% below what was predicted, and body weight decreased by 10%. Nitrogen excretion paralleled the changes in body weight. Calcium excretion increased for 3 weeks and reached a plateau 150% above baseline. Our results chronicle the magnitude of metabolic response to spinal shock. Comparison with reported values shows this response exceeds that seen in immobilized patients. Nitrogen excretion rose to levels seen in highly stressed patients and must be considered in the management of patients with acute spinal‐cord injury. (Journal of Parenteral and Enteral Nutrition 16:11–15, 1992)
Effects of Various Enteral Feeding Products on Postprandial Blood Glucose Response in Patients With Type I Diabetes
Authors: Peters Anne L. , Davidson Mayer B.
Published: May 2008

These studies were performed to evaluate the postprandial blood glucose responses to a variety of differently formulated enteral feeding products in patients with type I diabetes. Eleven subjects with type I diabetes were evaluated in three studies, all using a Biostator (artificial endocrine pancreas) that delivered a small, basal amount of insulin and measured blood glucose levels. Subjects consumed 20 mL of the assigned formula every 15 minutes for the 240 minutes of the study. Study 1 evaluated the response to each of five products: Glucerna, Enrich, Ensure HN, Pulmocare, and Compleat Modified. When the postprandial blood glucose response to Glucerna was greater than when its research formulation (EN‐8715) had been tested in 1988, studies 2 and 3 were undertaken to assess why this discrepancy occurred. Study 2 compared stored EN‐8715 to Glucerna and study 3 compared frozen and thawed vs nonfrozen EN‐8715, because of a concern that the original product had been frozen during shipping. In study 1 the glucose response (assessed as area under the glucose curve) correlated with the grams of carbohydrate present in the enteral feeding formula (r =.58, p =.002). The presence or absence of fiber, in the form of soy polysaccharide, did not affect the glucose response. Glucerna produced a significantly lower blood glucose response than did Enrich, Ensure HN, or Compleat Modified, although this response was greater than the response to EN‐8715 in 1988. However, in study 2 no differences were found between stored EN‐8715 and Glucerna and in study 3, freezing and thawing was not found to significantly alter the glucose response. Thus, the carbohydrate content of an enteral feeding formula has a significant effect on the level of the postprandial glycemic response. A low‐carbohydrate, high‐fat product, such as Glucerna, can produce an attenuated glucose response compared with products with higher carbohydrate content. However, there is a great deal of variability among individual patient responses to a given enteral feeding product, necessitating accurate blood glucose monitoring in patients fed these products, especially at the initiation of enteral feeding therapy. (Journal of Parenteral and Enteral Nutrition 16:69–74, 1992)
Spontaneous Partial Fracture of the Catheter of a Totally Implantable Subcutaneous Infusion Port
Authors: Inoue Yoshifumi , Nezu Rchiro , Nakai Sumio , Takagi Yoji , Okada Akira
Published: May 2008

A totally implantable subcutaneous infusion port was inserted via the left subclavian vein with peel‐away sheath in a 45‐year‐old male patient receiving home parenteral nutrition. Sixteen months after implantation, the patient noted pain in his left clavicular region during home infusion. This was found to be due to the leakage of infusion fluid resulting from partial fracture of the catheter at the level where the catheter passed between the clavicle and first rib. Because the fracture was partial, the catheter did not embolize to the heart or large vessels. Although subcutaneous infusion ports afford patients greater freedom and the ability to lead a more active life than do external catheters, it is emphasized that there may be the risk of spontaneous catheter fracture in patients using subcutaneous infusion ports. (Journal of Parenteral and Enteral Nutrition 16:75–77, 1992)
Composition of Fat in Enteral Diets Can Influence Outcome in Experimental Peritonitis M. D. PECK, C. K. OGLE, J. W. ALEXANDER Annals of Surgery 214:74–82, 1991
Authors: Sax Harry
Published: May 2008

The potential immunosuppressive effects of lipids high in the n‐6 polyunsaturated fatty acids (PUFA) have led many clinicians to recommend limiting fat intake in stressed patients. Similarly, experimental and clinical evidence has been presented that supports the use of lipid formulations enriched in the marine‐based n‐3 PUFA in these patients.1,2

This paper describes an experimental study designed to address the effect of dietary fat composition on outcome in an animal model of chronic intra‐abdominal sepsis. Guinea pigs underwent gastrostomies and were later implanted with osmotic pumps inoculated with a mixture of Escherichia coli and Staphylococcus aureus. A steady infusion of this synergistic combination of bacteria into the peritoneal cavity resulted in an animal model of chronic intra‐abdominal sepsis. Animals were randomized to one of three dietary groups according to the level of fat intake: 3.5%, 14%, and 56% of total calories. Within each of these groups, fat composition was either high in n‐6 PUFA (100% Microlipid), high in n‐3 PUFA (100% maximum eicosapentaenoic acid [MaxEPA]) or a 50:50 mixture of the two.

Animal survival was not significantly altered by the amount of fat in the diet (Kruskal‐Wallis analysis of variance, p >.1). However, the dietary fat composition had a significant overall effect (p <.05) on the length of survival. Median survival in the 50:50 group was 12.5 days, significantly longer than that in the 100% MaxEPA group (9 days), p =.011), but not significantly longer than that in the 100% Microlipid group (10 days, p =.082).

In another experiment animals were fed a 14% total fat calorie diet. A total of five subgroups were created, with fat ratios (Microlipid/MaxEPA) of 100/0, 25/75, 50/50, 75/25, and 0/100. Survival was greatest in the group of animals given equal amounts of fat types: 18%, 25%, 84%, 42%, and 36% (p =.023, 50:50 group vs all other groups).

No major differences in immunologic parameters among the various groups were noted, except for an increase in lipopolysaccharide‐stimulated prostaglandin E2 production by splenic macrophages in the 100% Microlipid group (p =.03).
Composition of Phospholipid Fatty Acids in Red Blood Cell Membranes of Patients in Intensive Care Units: Effects of Different Intakes of Soybean Oil, Medium‐Chain Triglycerides, and Black‐Currant Seed Oil
Authors: Diboune M. , Ferard G. , Ingenbleek Y. , Tulasne P.A. , Calon B. , Hasselmann M. , Sauder P. , Spielmann D. , Metais P.
Published: May 2008

Fatty acid composition of phospholipids in red blood cell membranes was studied in 32 severely head‐injured or cerebral stroke patients receiving enteral nutrition for 3 weeks. During this study the effects of three diets differing only by their lipid composition were investigated. The daily energy intake of each patient amounted to 2950 kilocalories, of which the lipid fraction represented 45.7%. Diet A contained only soybean oil, diet B consisted of a 50% soybean oil and 50% medium‐chain triglycerides mixture, and diet C was an emulsion of 50% soybean oil, 42.5% medium‐chain triglycerides, and 7.5% black‐currant seed oil. Our results showed no biochemical signs of fatty acid deficiency in red blood cell membranes for the patients at the beginning of the study, after a comparison with a control group of 20 healthy adults. Inhibition of Δ6‐desaturase activity on linoleic acid (C18:2ω6) after diet A was suggested by an increase of linoleic acid without a corresponding increase of dihomo‐γ‐linolenic acid (C20:3ω6). Replacing 50% of soybean oil by with medium‐chain triglycerides (diet B) prevented this enzyme inhibition. Supply of black‐currant seed oil rich in γ‐linolenic (C18:3ω6) and stearidonic (C18:4ω3) acids (diet C) induced significant increases of dihomo‐γ‐linolenic and eicosapentaenoic (C20:5ω3) acids, without influencing arachidonic acid (C20:4ω6) levels. This balance was evaluated through the ratio (C20:3ω6 + C20:5ω3)/C20:4ω6. (Journal of Parenteral and Enteral Nutrition 16:136–141, 1992)
Increased Energy Expenditure After Intravenous Administration of Amino Acids
Authors: Hayashida Yoshihiko , Kido Yoshihiro , Tsujinaka Toshimasa , Abe Yoshio , Kobayashi Mitugu , Nishi Toshio , Ogawa Akitaka , Tanaka Takehiko , Mori Takesada
Published: May 2008

Nutrient‐induced thermogenesis (NIT) after parenteral administration of amino acids (AAs) was investigated in rats and compared with result obtained with intragastric administration. Resting energy expenditure was measured with a new type of open‐circuit indirect calorimeter. The NIT increased shortly after parenteral AAs administration and reached a steady state in 30 minutes. The change in resting energy expenditure (the increment of resting energy expenditure over preinfusion baseline values) showed a significant relationship not only with the amount of infused AAs but also with the AA concentration in the portal vein. Furthermore, the increase in plasma AA concentrations in the portal vein was proportional to the amount of the particular AA infused. This relationship held true over the entire range tested. NIT with parenteral infusion (11% to 12%) was lower than that with intragastric infusion (20% to 23%). Plasma insulin, corticosterone, and glucagon levels increased after both parenteral and intragastric AAs administration, but the two methods did not show any significant differences in hormonal changes. The plasma aminogram of the portal vein after intragastric infusion was compared with that after parenteral infusion. Total plasma AA concentration and the levels of glutamine, lysine, arginine, glutamate, aspartate, and histidine were lower but the level of isoleucine was higher after intragastric infusion. On the basis of these results, it is believed that parenteral administration of AAs can induce thermogenesis, which may be regulated by the intraportal AA concentration. Considering the remarkable decrease in glutamine in the portal vein after intragastric infusion, the cost of intestinal metabolism may predominantly contribute to the NIT resulting from intragastric infusion. (Journal of Parenteral and Enteral Nutrition 16: 142–148, 1992)
Risk of Pulmonary Aspiration Among Patients Receiving Enteral Nutrition Support
Authors: Mullan Helen , Roubenoff Rebecca A. , Roubenoff Ronenn
Published: May 2008

We investigated the prevalence, incidence, and risk factors for pulmonary aspiration in all tube‐fed adult patients over 6 months. Twelve aspiration events occurred among 276 patients (prevalence, 4.4%; 95% confidence interval, 2.2% to 7.6%). The incidence of aspiration was 2.4 per 1000 tube‐feeding days (95% confidence interval, 1.2 to 3.9 per 1000). Despite 17% overall mortality, there was no excess mortality and little morbidity associated with aspiration. The major risk factors for aspiration were patient age (p <.015) and location in the hospital (p <.008): the probability of aspiration in the intensive care units (n = 113) was 0.9% compared with 4.9% on medical or surgical wards (n = 142), 16.7% among patients transferred from the intensive care unit to the ward (n = 18), and 33% among patients transferred from the ward to the intensive care unit (n = 3). Pulmonary aspiration is an uncommon and generally benign event among enterally supported patients. More frequent aspiration among ward than intensive care unit patients suggests that aspiration is not an inevitable consequence of severe illness, but can be prevented with adequate nursing care and pulmonary precautions. The fear of aspiration is not a sufficient cause to withhold enteral nutrition support in acutely ill patients. (Journal of Parenteral and Enteral Nutrition 16:160–164, 1992)
Experimental Study of Hub Contamination: Effect of a New Connection Device: The I System
Authors: Inoue Yoshifumi , Nezu Rchiro , Matsuda Hikaru , Fuj Makoto , Nakai Sumio , Wasa Masafumi , Takagi Yoji , Okada Akira
Published: May 2008

Experimental studies of hub contamination of intravenous catheters were done comparing the standard connection method (Luer‐Lock connector) with a newly invented connection method (I system). Immersion of the connection sites into a bacteria‐containing solution showed no bacterial contamination of the medium in any tubing. The second experiment investigated whether bacterial contamination would occur during a tubing change procedure. A high incidence of bacterial contamination was seen with the Luer‐Lock connector, but no bacterial contamination occurred with the I system. These experiments suggest that the use of Luer‐Lock connectors is associated with a high risk of bacterial contamination during tubing change, but the I system can prevent contamination during tubing change, which cannot be avoided with Luer‐Lock connector. (Journal of Enteral and Parenteral Nutrition 16:178–180, 1992)
Effect of Malnutrition on Aerobic and Anaerobic Performance of Fast‐ and Slow‐Twitch Muscles of Rats
Authors: Nishio Mary L. , Jeejeebhoy Khursheed N.
Published: May 2008

The effect of malnutrition on the functional properties of fast‐ and slow‐twitch muscles from rats was studied using aerobic and anaerobic preparations. A 2‐day fast and hypocaloric feeding to a weight loss of 25% were used as models of malnutrition. Soleus (slow‐twitch) and extensor digitorum longus (EDL) (fast‐twitch) muscles were studied using an in situ preparation with the blood supply intact and an in uitro preparation to which cyanide had been added to render the muscles anaerobic. We found that a 2‐day fast had little effect on the function of muscles stimulated in situ, whereas anaerobic stimulation produced a decrease in force per gram of muscle weight in the soleus, but not in the EDL, compared with control values. Hypocaloric feeding resulted in a slowed relaxation rate, an increased Fs/Fmax ratio, and an upward shift of the force‐frequency curve relative to controls when studied in situ. Under anaerobic conditions, soleus muscles from hypocaloric rats continued to show a slow relaxation rate and demonstrated a loss of force per gram of muscle weight compared with controls, particularly at low stimulation frequencies. EDL muscles from hypocaloric rats had an increased relaxation rate and were able to maintain force with anaerobic stimulation. Soleus and EDL muscles from the fasted and hypocaloric groups had lower activities of phosphofructokinase. We conclude that slow‐twitch muscles from malnourished rats are at a disadvantage when required to function under anaerobic conditions. These findings suggest that muscle performance may be impaired in malnourished patients subjected to hypoxia. (Journal of Parenteral and Enteral Nutrition 16:219–225, 1992)
Thiamine, Riboflavin, Folate, and Vitamin B12 Status of Low Birth Weight Infants Receiving Parenteral and Enteral Nutrition
Authors: Levy Ryna , Herzberg Gene R. , Andrews Wayne L. , Sutradhar Brajendra , Friel James K.
Published: May 2008

Thirty infants were randomly assigned to receive either 3 mL of MVI‐Pediatric supplement (PAR3 group, parenterally fed) or 2 mL (PAR2 group, parenterally fed). For the first week, 100% received total parenteral nutrition (TPN), 50% by the second, and less than 33% by the third. Eighteen control infants received enteral feeds of infant formula. Baseline (before TPN) and subsequent weekly blood samples, dietary data, and 24‐hour urine collections were obtained. The adequacies of thiamine and riboflavin were assessed by the thiamine pyrophosphate effect and erythrocyte glutathione reductase activity, respectively. Urinary thiamine and riboflavin levels were measured by fluorometry. Plasma folate, red blood cell folate, urinary folate, and plasma vitamin B12 concentrations were determined by radioassay. No differences between groups were observed in thiamine pyrophosphate effect, erythrocyte glutathione reductase activity, urinary B1 or Bz, or red blood cell folate levels at any time. Plasma folate differed (p <.05) among the PAR3 group (24 ± 7 ng/mL), and both the PAR2 (13 ± 5 ng/mL) and enterally fed (ENT) groups (16 ± 3 ng/mL) before the initiation of feeds, at week 1 (PAR3 = 32 ± 15 ng/mL; PAR2 = 18 ± 4 ng/mL; ENT = 19 ± 9, ng/mL) and between the PAR3 (30 ± 16 ng/mL) and PAR2 (16 ± 4 ng/ mL) infants at week 2. Plasma vitamin B12 levels differed among the ENT groups (551 ± 287 pg/mL) and both the parenteral groups (PAR2 = 841 ± 405 pg/mL; PAR3 = 924 ± 424 pg/mL) at week 1 and between the ENT (530 ± 238 pg/ mL) and PAR3 (999 ± 425 pg/mL) groups at week 2. From the results of the present study it appears that 2 mL of MVI‐Pediatric supplement is sufficient to meet the thiamine, riboflavin, folate, and vitamin B12 needs of the low birth weight infant receiving short‐term parenteral nutrition. (Journal of Parenteral and Enteral Nutrition 16:241–247, 1992)
Muscle Protein Degradation in Severely Malnourished Patients With Chronic Obstructive Pulmonary Disease Subject to Short‐Term Total Parenteral Nutrition
Authors: Aguilaniu Bernard , Goldstein‐Shapses Sue , Pajon Albert , Levy Patrick , Sarrot Francoise , Leverve Xavier , Page Eric , Askanazi Jeffrey
Published: May 2008

Patients with chronic obstructive pulmonary disease (COPD) often lose weight and muscle mass with progression of the disease. Muscle protein degradation in patients with COPD has never been examined before and during hypercaloric feeding. Eight severely malnourished patients with COPD were examined at home consuming their usual intake, in the hospital after 3 days of a meat‐free regular oral diet (period B), and during a hypercaloric (55 kcal/kg) high‐lipid (55%) parenteral formula (total parenteral nutrition [TPN]). During period B, 8 well‐nourished patients and 10 malnourished cancer patients were used as control groups. Measurements included plasma assays, leg blood flow, leg exchange (of 3‐methylhistidine [3MeH], glucose, lactate, and oxygen) and urinary measures of 3MeH, creatinine, and nitrogen. During period B, net release of 3MeH across the leg in patients with COPD was similar to that in well‐nourished control subjects and cachectic cancer patients. In COPD patients, there was only a transient decrease in leg exchange values of 3MeH with administration of TPN. COPD patients demonstrated a reduction (p <.01) in urinary 3MeH excretion and an increase in nitrogen balance (p <.01) with TPN compared with period B. The decrease in muscle protein degradation with administration of TPN accounts for about 50% of the increase in nitrogen retention in patients with COPD. These data suggest that in severely malnourished patients with COPD the weight loss is not dependent on increased rates of skeletal muscle protein degradation; nevertheless, degradation rates attenuate with a positive nitrogen balance during nutrition repletion. (Journal of Parenteral and Enteral Nutrition 16: 248–254, 1992)