bluuebunny/crossref_metadata_2025 huggingface dataset:
Metabolic Effect of Short‐Term Total Parenteral Nutrition Highly Enriched With Leucine or Valine in Rats Recovering From Severe Trauma
Authors: Mori Eigo , Hasebe Masaharu , Kobayashi Kunio
Published: May 2008

The metabolic impact of infusing a large amount of leucine (Leu) or valine (Val) was examined with regard to the corrective effect of total parenteral nutrition (TPN). Rats recovering from severe sepsis received either Leu‐ or Valenriched TPN solution for 30 hours. The in vivo behavior of the amino acids administered was explored by a pulse injection of 14 C‐labeled Leu or Val. The recovery of 14CO2 from Leu increased by 64% in the septic rats of Leu‐TPN group (41% of dose; p <.01), as compared with control rats receiving the same TPN solution, whereas no significant rise in the 14CO2 recovery from Val occurred in the septic rats given Val‐TPN (45% of dose) in comparison with the corresponding controls. The enhancement of Leu catabolism to CO2 in the Leu‐TPN group was compatible with the alterations of urinary nitrogen excretion, plasma Leu level, and metabolite contents of liver and muscle. The only difference in metabolite levels observed between the two TPN groups was in hepatic total adenine nucleotides. Plasma amino acid levels were largely unaffected by infusion of these TPN solutions highly enriched with branched‐chain amino acids (45%), except for an approximately threefold elevation of the Val level in Val‐TPN rats. Thus, when administered in a large quantity during such short‐term TPN, Leu can exert its metabolic effect without causing an imbalance in plasma amino acids under severe catabolic conditions. (Journal of Parenteral and Enteral Nutrition 16: 236–240, 1992)
Effects of Pectin and Cellulose on Fat Absorption After Massive Small‐Bowel Resection in Weanling Rats
Authors: Toki Akira , Todani Takuji , Watanabe Yasuhiro , Uemura Sadashige , Sato Yasuhisa , Morotomi Yoshiki
Published: May 2008

The effects of pectin and cellulose on fat absorption after massive small‐bowel resection were studied in rats. Weanling Wistar rats underwent 80% resection of the small intestine with gastrostomy, and fat emulsion labeled with 14C‐linoleate was given via a gastrostomy tube for the fat absorption test on the 10th postoperative day. They were classified into three groups by diet as follows: E group, a fiber‐free, chemically defined diet (CDD); EP group, CDD with 2% pectin; and EC group, CDD with 2% cellulose. The cumulative and hourly output of 14C in the expired air, the absorption rate of 14C in the intestine, and the metabolic utilization rate of 14C were calculated. The cumulative 14CO2 output was significantly lower in the EC group than in the E and EP groups. However, there was no significant difference in the 14CO2 output between the E and EP groups. The highest hourly 14CO2 output in the E and EP groups was observed during the first 2 hours. However, in the EC group, this fluctuated at low levels. No significant difference in the 1‐14C‐linoleate absorption rate was observed between the E and EP groups, whereas it was significantly lower in the EC group than in the E and EP groups. The metabolic utilization rate of 1‐14C‐linoleate showed no significant difference among the three groups. These data suggest that an addition of pectin to CDD does not impair small intestinal absorption of 1‐14C‐linoleate after massive small‐bowel resection, and an addition of cellulose decreases absorption of 1‐14C‐linoleate. (Journal of Parenteral and Enteral Nutrition 16: 255–258, 1992)
Subcutaneous Jejunostomy
Authors: Bozzetti Federico , Bignami Paola , Cozzaglio Luca
Published: May 2008

When the surgeon must obviate to an impending obstruction because of an unresectable tumor of the supramesocolic space and an intestinal bypass is not feasible, a jejunostomy is usually indicated. We describe a new method to provide enteral nutrition via a subcutaneous jejunostomy without any external device, which can be used only when the patient is at risk for developing an obstruction or dysphagia. The feeding tube is inserted into the jejunum and then connected to a Port‐a‐Cath lodged in a subcutaneous pocket. Subsequently, the nutrition can be delivered via a Huber needle inserted in the port, or, to minimize the need for strict aseptic surveillance, the tube can be exteriorized from the pocket and used as the usual tube jejunostomy. This procedure allows placing a precautionary jejunostomy without distortion of the body‐image. (Journal of Parenteral and Enteral Nutrition 16: 286–288, 1992)
Absence of Hypermetabolism After Operation in the Newborn Infant
Authors: Shanbhogue Ragu L.K. , Lloyd David A.
Published: May 2008

This study was designed to assess the effect of operative stress on resting energy expenditure (REE) in the newborn infant. In 13 neonates who had an uncomplicated abdominal, thoracic, or spinal operation, REE was measured both preoperatively and on the third postoperative day. The mean preoperative REE of 43.19 ± 7.95 kcal/kg per day was not significantly different from the mean postoperative REE of 41.70 ± 7.94 kcal/kg per day. Sixteen neonates had REE measured on the first, second, and seventh postoperative days. The mean postoperative REE values of 43.12 ± 6.92, 42.41 ± 7.58, and 46.33 ± 6.89 kcal/kg per day at 1, 2, and 7 days, respectively, were not significantly different from the preoperative REE. There was no significant difference in oxygen consumption, carbon dioxide production, and respiratory quotient between the preoperative and postoperative groups. In this study, an uncomplicated operation did not increase REE in the neonate. (Journal of Parenteral and Enteral Nutrition 16:333–336, 1992)
Adaptation to a Fish Oil Diet Before Inducing Sepsis in Rats Prevents Fatty Infiltration of the Liver
Authors: Lanza‐Jacoby Susan , Smythe Cynthia , Phetteplace Hope , Tabares Alma
Published: May 2008

Hypertriglyceridemia and fatty liver are common lipid abnormalities associated with Gram‐negative sepsis. Fish oils have been shown to have beneficial effects in reducing plasma triglycerides (TG). This study was designed to investigate whether fish oils would prevent the elevation of plasma TG and the accumulation of liver lipids during sepsis. One group of rats was fed a 10% menhaden oil diet and the other group was fed a 10% corn oil diet for 14 days. On the 14th day, sepsis was induced by injecting the rats with 8 x 107 live Escherichia coli colonies/100 g of body weight and the rats were fasted for 22 hours. The liver composition of total lipids and TG in the septic rats prefed the fish oil was lower than in the septic rats prefed the corn oil. In the rats adapted to the corn oil diet, lipids accumulated in the livers of the septic rats in comparison with the control rats. Hepatocytes isolated from the septic rats adapted to the corn oil diet showed an increased esterification of [1‐14C]palmitate into TG and phospholipids than hepatocytes from the control rats. Feeding the fish oil diet instead of the corn oil diet before inducing sepsis reduced TG, cholesterol, and phospholipid synthesis by 58%, 79%, and 71%, respectively. The rise in TG synthesis in the septic rats prefed the corn oil diet was associated with an 89% increase in the activity of phosphatidate phosphohydrolase. There was no significant difference in the activities of glycerol‐3‐phosphate acyltransferase and phosphatidate phosphohydrolase between control and septic rats. The glycerol‐3‐phosphate acyltransferase activity was lower in the livers of septic rats prefed fish oil than in the septic rats prefed corn oil. The hypertriglyceridemia of sepsis was not ameliorated by prefeeding the fish oil diet. The fish oil had a significant effect on the activity of lipoprotein lipase in peripheral tissues from both control and septic rats. The activities of lipoprotein lipase were depressed in the retroperitoneal fat pads and heart from the septic rats fed fish oil in comparison with their controls. The data from this study indicate that a fish oil diet will prevent the sepsis‐induced fatty liver. (Journal of Parenteral and Enteral Nutrition 16:353–358, 1992)
Plasma Polyunsaturated Fatty Acids in Liver Cirrhosis With or Without Chronic Hepatic Encephalopathy: A Preliminary Study
Authors: Cabré Eduard , Periago José L. , González Juana , González‐Huix Ferrán , Abad‐Lacruz Agueda , Gil Angel , Sánchez‐Medina Fermín , Esteve‐Comas María , Fernández‐Bañares Fernando , Planas Ramón , Gassull Miguel A.
Published: May 2008

Fatty acid levels (from C14:0 to C22:6n3) in plasma lipid fractions were prospectively studied in 11 cirrhotic patients with chronic hepatic encephalopathy and compared with those in 23 cirrhotic patients without chronic hepatic encephalopathy with similar age, sex distribution, and liver and nutritional status, and in 11 age‐ and sex‐matched, healthy subjects. Plasma lipid fractions were separated by thin‐layer chromatography and fatty acids were identified by capillary column gas‐liquid chromatography. Total n6 polyunsaturated fatty acid plasma levels were lower in cirrhotic patients—with and without chronic hepatic encephalopathy—than in control subjects. In addition, arachidonic acid levels, both in total lipids and fractions, were lower in patients with than in those without chronic encephalopathy. On the other hand, a selective decrease of plasma docosahexaenoic acid (a major component of neuronal membranes) was observed in those patients with chronic encephalopathy as compared with both control and cirrhotic subjects without chronic encephalopathy. These findings may be due to various mechanisms. Differences in long‐chain polyunsaturated fatty acid content in fish‐ and meat‐restricted diets partly may account for these findings. However, it could be speculated that polyunsaturated fatty acid biosynthesis may be reduced further in patients with chronic hepatic encephalopathy because of either a decrease in portal essential fatty acid extraction in the postabsorptive phase due to portal‐systemic shunting or to the effect of protein‐restricted diets. Furthermore, the finding of low plasma docosahexaenoic acid in these patients raises the possibility that this deficiency might be an additional pathogenic factor in chronic hepatic encephalopathy. (Journal of Parenteral and Enteral Nutrition 16:359–363, 1992)
Feeding Jejunostomy for Post Operative Nutritional Support M. CARMON, D. SEROR, R. UDASSIN, ET AL. Clinical Nutrition 10:298–301, 1991
Authors: Bell Stacey J. , Borlase Bradley C.
Published: May 2008

The authors describe their experience using jejunostomy tubes placed during a primary surgical procedure in 19 adult patients during a 2‐year period. All but one patient underwent a laparotomy (the one exception had a thoracotomy) for gastrointestinal cancer, peptic ulcer disease, or trauma. Large‐bore (16 or 18 French) red rubber catheters were used for feeding jejunostomies. Patients were fed according to a standard protocol that included (1) use of commercially available formulas, (2) infusion pumps, (3) liberal use of antidiarrheal agents, and (4) initiation of feeding on the second postoperative day. Patients were fed by tube for a mean of 22 days and received a mean of 1850 calories with 62 g of protein per day. Feeding tubes remained in place (insertion to removal) for an average of 59 days. Seven of the 19 patients had the tubes removed during hospitalization; for the remaining patients, tubes were removed after discharge. After removal of the tube, the tract closed spontaneously and uneventfully in all patients.

No mortality was associated with feeding tube insertion. One patient developed intestinal obstruction believed to be due to angulation of the bowel caused by the jejunostomy tube; the obstruction resolved after removal of the tube. Another patient exhibited paralytic ileus that necessitated discontinuation of the formula; upon resolution of the ileus, administration of the formula resumed. Five patients (26%) developed diarrhea, and two patients had clogged feeding tubes (one had the tube removed and a new tube was inserted under fluoroscopy). Four patients (21%) had inadvertent removal of their tubes, and all tubes were immediately reinserted. Three patients required home enteral support; one experienced a minor skin irritation at the catheter site that resolved by replacement with a larger feeding tube.

In conclusion, the authors have successfully employed enteral feeding in the hospital setting with low morbidity. They selected jejunostomy feeding tubes rather than gastrostomy tubes for patients requiring prolonged enteral nutrition support because of the reduced risk of aspiration of gastric contents.
Use of Triple‐Lumen Subclavian Catheters for Administration of Total Parenteral Nutrition
Authors: Clark‐Christoff Nena , Watters Virginia A. , Sparks Wanet , Snyder Phyllis , Grant John P.
Published: May 2008

This study evaluated the safety of triple vs single‐lumen catheters in intravenous nutrition. Patients who were judged likely to benefit from a triple‐lumen catheter were randomized to receive either a single‐lumen catheter, with additional peripheral or central venous access as needed, or a triple‐lumen catheter. All patients were at increased risk of catheter‐related infection because of one or more of the following conditions: >60 years of age, breakdown of skin integrity, severe underlying illness, diagnosis of acute pancreatitis, recent head or neck surgery, or presence of a preexisting infection. Patients were excluded who had neutropenia, were immuno‐suppressed, had body burns >40%, or had contaminated wounds in the subclavicular area. Of 204 patients entered between June 1989 and November 1991, 177 completed the required ≥7 days of therapy. Seventy‐eight of these patients were randomized to a single‐lumen catheter and 99 to a triple‐lumen catheter. Catheters were inserted and maintained by the Nutrition Support Team. Dressings were monitored daily and changed weekly using a bio‐occlusive dressing. When parameters were met for a possible septic episode, simultaneous peripheral and central catheter blood cultures were obtained using the Isolator method. Catheter‐related sepsis was considered present if the colony count from a central catheter lumen was ≥5 times that of the peripheral blood. The incidence of catheter‐related sepsis for single‐lumen catheters was 2.6% (2 of 78) compared with 13.1% for triple‐lumen catheters (13 of 99) (p <.01). No correlation was found with the number of insertion attempts, catheter days, or patient's age. We conclude that triple‐lumen catheters should not be routinely used for intravenous nutrition because of an increased risk for central catheter‐related sepsis. (Journal of Parenteral and Enteral Nutrition 16: 403–407, 1992)
Intravenous Glutamine Fails To Improve Gut Morphology After Radiation Injury
Authors: Scott Thomas Edward , Ross Moellman Jeffrey
Published: May 2008

Male Sprague‐Dawley rats housed in individual metabolic cages received total parenteral nutrients via chronic indwelling internal jugular catheters to determine whether supplementing parenteral nutrition with glutamine would accelerate recovery of small‐bowel morphology after abdominal radiation. After recovering from catheter insertion for 3 days they received either 1000 cGy gamma radiation to the abdomen only or no radiation and immediately thereafter received iso‐nitrogenous and isocaloric intravenous solutions containing either 0% or 2% glutamine at 1.58 mL/h for the next 5 days. Intestinal segments were then assayed for whole‐bowel deoxyribose nucleic acid content and villus height. Irradiation caused a 40% decrement in these parameters, which were not restored by glutamine supplementation. Therefore, intravenous glutamine supplementation failed to accelerate recovery of small‐bowel morphology in this model of combined surgical and radiation injury. (Journal of Parenteral and Enteral Nutrition 16:440–444, 1992)
Early Postprandial Energy Expenditure and Macronutrient Use After a Mixed Meal in Cirrhotic Patients
Authors: Riggio Oliviero , Merli Manuela , Romiti Adriana , Pinto Giorgio , Fanella Rita , Attili Adolfo Francesco , Capocaccia Livio
Published: May 2008

The effect of meal ingestion (9 kcal/kg of body weight, 53% carbohydrate, 30% fat, 17% protein, as a liquid formula) on energy expenditure and oxidation rate of carbohydrate, fat, and protein was assessed by indirect calorimetry and urinary nitrogen excretion before and for 3 hours after eating in stable cirrhotic patients and control subjects of comparable age. Postprandial modifications of substrate and hormone levels were also studied. Compared with basal values, the mean ± SD resting energy expenditure during the first 3 hours after meal ingestion increased similarly in cirrhotic patients (+0.32 ± 0.12 kcal/min) and control subjects (+0.31 ± 0.08 kcal/min). Dietary induced thermogenesis was equivalent to 10% of the energy contained in the meal in both groups. Before eating, the carbohydrate oxidation rate was lower and fat oxidation higher in cirrhotic patients than in the control subjects. After eating, glucose oxidation increased whereas fat and protein oxidation rates were reduced in both groups. As a consequence the amount of fat oxidized in the postprandial period remained higher in cirrhotic patients than in the control subjects. After meal ingestion, serum glucose levels increased whereas plasma free fatty acid and glycerol levels decreased in both groups. The substrates, however, remained significantly higher in cirrhotic patients than in control subjects, despite the higher postprandial insulin increment in the patients group, thus suggesting the presence of insulin resistance. Because the postprandial glucose oxidation rate was normal, the low insulin‐mediated glucose uptake observed in cirrhotic patients seems to reflect a defect in the nonoxidative disposal of the glucose ingested. These alterations in endogenous and exogenous nutrient use may account for the wasting in energy stores frequently observed in cirrhotic patients. (Journal of Parenteral and Enteral Nutrition 16:445–450, 1992)
Different Effects of Long‐Chain and Medium‐Chain Triglycerides on Glucose Oxidation During Total Parenteral Nutrition
Authors: Sato Nobuaki , Matsubara Youichi , Yoshikawa Keiji , Muto Terukazu
Published: May 2008

This study was undertaken to clarify differences in the effects of lipid emulsions containing either long‐chain or medium‐chain triglycerides (MCT) on glucose metabolism during total parenteral nutrition (TPN). Glucose kinetics were assessed in beagle dogs using primed, constant infusions of [14C]‐ and [6‐3H]glucose. The rate of appearance of glucose, the percent of VCO2 derived from the oxidation of glucose, the rate of glucose oxidation, and the percent of glucose uptake oxidized were measured at the end of 72 hours of each of the two TPN regimens, ie, TPN in which soybean oil served as long‐chain triglyceride comprising 40% of nonprotein calories (L‐TPN), and TPN in which tricaprylin emulsion served as MCT (M‐TPN). Glucose intake was 5.9 ± 0.5 mg/kg per minute in L‐TPN and 5.8 ± 0.2 mg/kg per minute in M‐TPN. There was no significant difference in the rate of glucose appearance between L‐TPN and M‐TPN. The rate of glucose oxidation was higher with M‐TPN than with L‐TPN (p <.05). Not only the percent of VCO2 derived from the oxidation of glucose but also the percent of glucose uptake oxidized tended to be higher during M‐TPN than during L‐TPN. These findings suggest that the glucose metabolism of dogs receiving L‐TPN is different from that of dogs receiving M‐TPN. (Journal of Parenteral and Enteral Nutrition 16:451–454, 1992)
Long‐Term Central Venous Access vs Other Home Therapies: Complications in Patients With Acquired Immunodeficiency Syndrome
Authors: Mukau Leslie , Talamini Mark A. , Sitzmann James V. , Cartland Burns R. , Mcguire Mary E.
Published: May 2008

One hundred and forty silicone catheters were inserted in 127 patients for long‐term intravenous access with a cumulative follow‐up time of 21,125 catheter‐days (58 patient‐years). Fifty‐six patients had acquired immunodeficiency syndrome (AIDS); 44 were not AIDS patients and were receiving ambulatory home parenteral nutrition, whereas the remaining 27 did not have AIDS and were receiving home antibiotic therapy. Patients had a mean of 1.1 catheters inserted, and the rate of Hickman catheter‐related sepsis was 0.18 per 100 catheter days or 0.6 septic episodes per patient year of treatment. Catheter‐related sepsis was higher in AIDS patients (p <.01) and in patients receiving parenteral nutrition (p <.05) compared with those receiving antibiotic therapy. Prior catheter infection and AIDS were the most significant predictors of catheter infection (p <.01). Staphylococcus aureus was the most commonly isolated pathogen (61%) in AIDS patients. Fever (p <.001) and relative leukocytosis (p <.02) were the most common signs of infection. Only 14 infected catheters (37.8%) were salvaged by antibiotic therapy after the initial infection episode, and 6 of these catheters (42.9%) had recurrent multiple infections. In addition, inflammatory bowel disease was found to be a risk factor for venous thrombosis (p =.018). We conclude that because immunocompromised patients have a high risk of infection, catheter‐related sepsis in these patients should be treated by catheter removal and antibiotics. (Journal of Parenteral and Enteral Nutrition 16:455–459, 1992)
Review: Experimental and Clinical Applications of Molecular Cell Biology in Nutrition and Metabolism
Authors: Yuman Fong  , Moldawer Lyle L. , Lowry Stephen F.
Published: May 2008

Rapid advances in molecular biology have yielded important new techniques for understanding the cellular mechanisms of normal homeostasis and disease. In particular, molecular laboratory methodologies have become important investigative tools for nutritional studies. Detection techniques for specific DNAs, RNAs, and proteins allow direct examination of cellular regulation of protein expression in health and illness. Construction of transgeneic models by recent techniques of inserting foreign genes into experimental animals has provided novel models for studies of cellular metabolism. In addition, molecular biology has had impact on clinical nutrition and therapy. Molecular techniques not only allow for early diagnosis of many inborn genetic errors of metabolism, recombinant technology has also provided for large‐scale production of proteins and hormones of potential therapeutic value. The possibility for direct gene therapies is also nearing reality. Hence, understanding the language of molecular biology and the recent developments in this field is not only of research interest, but is also of clinical relevance.(Journal of Parenteral and Enteral Nutrition 16:477–486, 1992)
Lecithin Increases Plasma Free Choline and Decreases Hepatic Steatosis in Long‐Term Total Parenteral Nutrition Patients A. L. BUCHMAN, M. DUBIN, D. JENDEN, ET AL Gastroenterology 102:1363–1370, 1992
Authors: Demetriou Achilles A.
Published: May 2008

Several investigators, including the authors, have demonstrated that patients receiving long‐term total parenteral nutrition (TPN) have low plasma choline levels.1–3 In the present study, 15 patients who were receiving home TPN were randomly chosen from a group of long‐term TPN patients found to have low levels of plasma free choline on initial screening.3

The patients received TPN for 7.0 ± 1.1 years (range, 1.5 to 12.5 years). Their TPN consisted of 2 to 3 liters of 15% to 25% dextrose solution with 3.5% to 4.25% amino acids, electrolytes, trace elements, and vitamins. Patients received 20.1 ± 2.2 kcal/kg per day actual body weight. Parenteral lipid supplied was 22 ± 5% of daily intravenous caloric intake (Intralipid 20%, Kabi‐Vitrum, Alameda, CA).

Patients received either lecithin supplementation (20 g/12 hours in 2.5 tablespoons of soybean oil‐based liquid) or placebo (2.5 tablespoons of oil) for 6 weeks in a double‐blind fashion. Patients were evaluated at baseline and at 2 and 6 weeks. Laboratory measurements included plasma and red blood cell free choline, plasma and red blood cell phospholipid‐bound choline, transaminases, alkaline phosphatase, bilirubin, cholesterol, high and low density lipoproteins, carnitine (total and free), and methionine. Free and phospholipid‐bound choline levels were measured in bottles of Intralipid. Liver imaging was carried out by computed tomography (CT) scanning. Limited noncontrast CT scans of the liver and spleen were performed at 120 kV, 120 mA with a 3.0‐second scan time. Multiple representative sections were examined and a mean CT number in Hounsfield units was determined by two methods, determination of the mean absolute liver CT number and the liver spleen differential, obtained by subtracting the average spleen CT number from the average liver CT number to correct for interscan variability. Data were analyzed statistically by comparing percent changes in blood tests at 2 and 6 weeks and absolute changes in Hounsfield units.

The full 6‐week study was completed in 10 of the 15 patients. Eight of 15 subjects had fatty livers at baseline. Lecithin supplementation led to an increase in plasma free choline of 53.4% ± 15.4% at 2 weeks (p <.04), whereas the placebo group had no change at 2 weeks. A significant (p <.02) decrease in liver fat, indicated by the change in Hounsfield units was seen at 2 weeks in the lecithin‐supplemented group (7.5 ± 1.7 units). No significant changes were seen in the placebo group.

The authors concluded that hepatic steatosis in many patients receiving long‐term TPN is caused by plasma free choline deficiency and may be reversed with lecithin supplementation.
Defining and Reporting Diarrhea in Tube‐Fed Patients—What a Mess! D. Z. BLISS, P. A. GUENTER, R. G. SETTLE American Journal of Clinical Nutrition 55:753–759, 1992
Authors: Heimburger Douglas C.
Published: May 2008

The purpose of this study is to document the effect that various definitions of diarrhea have on its reported incidence in tube‐fed patients. Following a group of 29 patients who were tube‐fed for at least 5 days (median duration of feeding, 13 days), the investigators prospectively monitored the occurrence of diarrhea according to each of eight definitions: ≥1, ≥2, ≥3, ≥4 liquid stools/ day; ≥3 stools/day; ≥4 stools/day; ≥4 stools/day for 2 days; and ≥5 stools/day. None of the definitions incorporated measurements of either stool weights or volumes. Because treatment with antibiotics and the presence of hypoalbuminemia have been associated with diarrhea in some reports, the investigators took those into account. Sixty‐six percent of the patients (19 patients) were treated with antibiotics and only 7% (2 patients) had serum albumin levels <26 g/L; the mean serum albumin level of the remaining 27 patients was 34 g/L. Only 10% (3 patients) were in critical care units. Because duration of monitoring would be expected to correlate positively with incidence, and is often not reported in studies of tube‐feeding‐associated diarrhea, the authors reported both the incidence of diarrhea and the percent of days with diarrhea. It is also noteworthy that 31% (9 patients) of the patients received kaolin‐pectin for treatment of diarrhea, which probably affected the percent of days with diarrhea.

The more lenient definitions of diarrhea resulted in higher incidence rates and higher percentages of days with diarrhea. The most lenient definition (≥1 liquid stool/day) was associated with an incidence rate of 72%, and 26% of days with diarrhea, whereas the most rigorous definitions (≥4 liquid stools/day and ≥5 stools/day) resulted in 21% incidence and 1.7% of days with diarrhea. The number of days patients were monitored correlated positively with the incidence of diarrhea, but very weakly with the percent of days with diarrhea. Thus, the use of percent of days with diarrhea as the method of reporting reduced the effect of varying durations of monitoring. Antibiotic treatment correlated positively with percent of days with diarrhea, but not with incidence. Serum albumin levels did not correlate with diarrhea, but this may have been caused by the largely normal albumin levels in this population.
Substrate Efficacy in Early Nutrition Support of Critically Ill Multiple Trauma Victims
Authors: Jeevanandam Malayappa , Shamos Raymond F. , Petersen Scott R.
Published: May 2008

The metabolic consequences of excessive nutrition support in patients have been increasingly recognized in recent years. Time‐dependent optimal nutrition support is desired for an early and uncomplicated recovery after severe injury or illness. Metabolic effects of adding balanced amino acids to glucose infusion during total parenteral nutrition were investigated in 18 patients after major trauma (injury severity score 32 ± 2). Two studies were conducted on each subject, one in the early “flow” phase of injury (40–60 hours postinjury) in the basal state without any dietary intake and then after 4 to 6 days of intravenous nutrition provided solely as glucose (24 ± 2 kcal/kg per day, 80% resting energy expenditure, n = 8) or isocaloric glucose (28 ± 3 kcal/kg per day) with amino acids (275 ± 28 mg of nitrogen per kilogram per day, n = 10). Whole‐body fuel substrate kinetics were studied for energy metabolism (indirect calorimetry), protein kinetics (primed‐constant infusion of 15N glycine), and lipid mobilization (two‐stage infusion of 10% glycerol). Injury‐induced hypoaminoacidemia was equally modulated whether the glucose‐based nutrition had amino acids or not. The negative nitrogen balance is reduced similarly in both groups. Protein breakdown rate is significantly (p =.025) decreased in both groups and it is more so (30% us 18%) in patients receiving total parenteral nutrition. Intravenous nutrition could not stimulate protein synthesis. Whole‐body lipolysis rate as well as net fat oxidation rate are suppressed more when glucose alone is given, and this also results in less reesterification. Provision of intravenous glucose alone, not to exceed the resting energy expenditure, seems to be superior to isocaloric glucose with amino acids during this early catabolic flow phase of injury because the injured body could not assimilate this exogenous amino acid. (Journal of Parenteral and Enteral Nutrition 16:511–520, 1992)
Continuous Compared With Intermittent Tube Feeding in the Elderly
Authors: Ciocon Jerry O. , Galindo‐Ciocon Daisy J. , Tiessen Charlotte , Galindo Diana
Published: May 2008

The methods of continuous (C) and intermittent (I) nasogastric tube feedings in 60 patients, 54 men and 6 women, with a mean age of 72 ± 9 years were compared in terms of number of complications, staff time used, and caloric intake. Patients were randomly assigned between these two methods and followed for 7 days. Diarrhea, aspiration pneumonia, clogged tubes, and self‐extubation were observed in both groups. Diarrhea was significantly more frequent (96% of 30 patients) in the I group than the C group (66% of 30 patients) (p <.008). Furthermore, diarrhea was more prolonged (4 days or more) in 64% of 30 patients in the I group than the C group (4 days or more) in 58% of 30 patients (p <.02). However, clogged tubes occurred 3 times more often in the C group (p <.01). Self‐extubation and aspiration pneumonia tend to be more frequent in the I group but the difference was not significant. The average time used by staff nurses in the maintenance of NGT feedings was not significantly longer in the I group (48.45 ± 11 min/patient per day) than the C group (46.46 ± 11 min/ patient per day). In the C group the mean calories recommended were 2248 ± 36 kcal/day but the actual caloric intake was only 1465 ± 281 kcal/day, a deficiency of 783 ± 291 kcal/day. The recommended calorie count for the I group was 2021 ± 5 kcal/ day but the amount delivered was only 1226 ± 254 kcal/day, which resulted in a deficit of 795 ± 259 kcal/day. This difference in calories recommended and actually delivered in the C and I groups was not significant. (Journal of Parenteral and Enteral Nutrition 16:525–528, 1992)
Variability of the Harris‐Benedict Equation in Recently Published Textbooks
Authors: Van Way Charles W.
Published: May 2008

The Harris‐Benedict equation, as cited in a selection of textbooks of medicine, surgery, and nutrition, was compared with the original monograph published by the Carnegie Foundation. A significant amount of variation was found in published versions of this equation. Of 24 published versions, eight were sufficiently variant to produce errors of 7% to 55% in calculations of nutrition requirements. The error is usually in the constant term for one of the two Harris‐Benedict equations. Either the constant term for men is increased to a value approximately the same as for women, or the constant term for women is reduced to be approximately equal to that for men. The primary reason appears to be the lack of availability in medical libraries of the original Carnegie Foundation publication by Harris and Benedict. (Journal of Parenteral and Enteral Nutrition 16:566–568, 1992)
Review: How Amino Acids Get Into Cells: Mechanisms, Models, Menus, and Mediators
Authors: Souba Wiley W. , Pacitti Anthony J.
Published: May 2008

The bloodstream provides a readily available pool of amino acids, which can be taken up by all cells of the body to support the myriad of biochemical reactions that are essential for life. The transport of amino acids into the cytoplasm occurs via functionally and biochemically distinct amino acid transport systems that have been defined on the basis of their amino acid selectivities and physico‐chemical properties. Each system presumably relates to a discrete putative membrane‐bound transporter protein that resides within the cell membrane and functions to translocate the amino acid from the extracellular environment into the cytoplasm. Many of these transporters require sodium for maximal activity. The sodium‐dependent model presented is consistent with “preferred random” kinetics, with sodium binding preferentially before the amino acid. The transporter acts as an enzyme that catalyzes the movement of its bound amino acid (and sodium) into the cell. In this review, the authors provide a conceptual view of the mechanism of carrier‐mediated amino acid transport as well as an overview of the various models that can be used in the laboratory to study this process. In addition, the known agencies that accomplish transport and their regulation by nutrition, hormones, and other mediators of critical illness are discussed. (Journal of Parenteral and Enteral Nutrition 16:569–578, 1992)
Placement of a Duodenal Feeding Tube via Gastrostoma With Fiberoptic Bronchoscope
Authors: Lee Tai‐Shion , Wu Yaw
Published: May 2008

We report a case of esophageal disruption that required a duodenal feeding tube. Because of collapse of the gastric outlet secondary to severe emaciation, several attempts to place a tube into the duodenum via gastrostoma had ended in failure. We finally were able to accomplish it with the aid of a fiberoptic bronchoscope and a Swan‐Ganz catheter. The procedure is described and discussed. (Journal of Parenteral and Enteral Nutrition 16:579–580, 1992)
Fat Elimination in Acute Renal Failure: Long‐Chain vs Medium‐Chain Triglycerides W. DRUML, M. FISHER, S. SERTL, ET AL American Journal of Clinical Nutrition 55:468–472, 1992
Authors: Hamaoui E.
Published: May 2008

This study compared the metabolism of intravenously infused fat in patients with acute renal failure (ARF) vs that in healthy control subjects, using either a long‐chain triglycerides (LCT) emulsion or a 50:50 mixture of LCT and medium‐chain triglycerides (MCT). The test subjects consisted of seven medical intensive care unit patients who had developed ARF due to various causes (sepsis in two; postoperative pancreatitis, vascular surgery, acute interstitial nephritis, poststreptococcal nephritis, and drugs in one each). These patients were considered otherwise clinically stable and were all close to ideal body weight (109 ± 3% ideal body weight). Prior to this study, the patients had been on parenteral nutrition, which provided 130% of resting energy expenditure and consisted of amino acids (15%), glucose (55%), and LCT lipids (30%). The control subjects were six healthy volunteers of somewhat younger age (32 ± 7 years vs 51.9 ± 4.4 years in the study group) and similar weight (103 ± 5% ideal body weight) and had been on a mixed oral diet providing an average of 8800 kJ/d, 80 g protein, and 35% of calories as fat. Fat clearance and hydrolysis were studied using a two‐stage constant infusion of the fat emulsion, infusing 0.75 g fat per kilogram of body weight per hour for 90 minutes, then 1.25 g fat per kilogram of body weight per hour for the next 90 minutes. The emulsions compared were Intralipid 10% (Kabi‐Vitrum, Stockholm, Sweden) as the LCT product and Lipofundin‐MCT 10% (Braun, Melsungen, Germany) as the 50:50 mixture of LCT and MCT. The infusions were administered after a 12‐hour break in nutrition support and at least 20 hours after the last dialysis in the test patients, and after a 12‐hour overnight fast in the controls.

Triglyceride clearance was markedly reduced in ARF (0.53 ± 0.10 vs 1.55 ± 0.30 mL per kilogram body weight per minute) during LCT infusion and showed no improvement with MCT (0.59 ± 0.12 vs 1.93 ± 0.34 mL per kilogram body weight per minute). Elimination half‐lives were accordingly prolonged more than three times in patients with ARF as compared to controls. In both groups, triglyceride hydrolysis, as reflected by the rise in plasma free fatty acids, was higher with MCT than with LCT, but the difference was blunted in patients with ARF. Plasma glucose and lactate levels were not affected by either one of the fat infusions in the controls. In contrast, patients with ARF had significantly higher baseline glucose levels, which rose further (p <.05) with both fat infusions; similarly, their plasma lactate levels started out slightly higher and rose further with both fat infusions. The authors concluded that fat clearance is reduced in ARF and that this impairment is not alleviated by use of MCT.
Early Parenteral Nutrition in Patients Unconscious Because of Acute Drug Poisoning
Authors: Kolacinski Zbigniew
Published: May 2008

The author studied the clinical and laboratory effects of early parenteral nutrition (EPN) in patients who were comatose as a result of acute drug poisoning. All patients were unconscious at the time of admission and entry into the study and received our usual conservative therapy for the first 24 hours. Alternate patients received an EPN solution containing amino acids and glucose. Volume, composition, and caloric content of the EPN solution were calculated separately for each patient according to weight and height nomograms. It was found that the group receiving EPN (n = 46) normalized their nitrogen balance sooner and demonstrated a consistent decrease in their creatine Phosphokinase level. Serum amino acid values in patients treated with EPN did not change significantly during the treatment trial. The control group (n = 40) demonstrated a significantly lower serum amino acid concentration on the third day of treatment (p <.001), had significantly more pneumonias (p <.05), and their hospitalization time was significantly longer (.01 < p <.05) than the EPN group. There were significantly fewer instances of disseminated intravascular coagulation in the group receiving EPN (p <.05).
Intestinal Absorption of Immunologically Intact Macromolecules in Germfree Colostrum‐Deprived Piglets Maintained on Total Parenteral Nutrition
Authors: Mehrazar Karim , Gilman‐Sachs Alice , Berm Kim Yoon
Published: May 2008

We have compared the neonatal absorption of anti‐bovine γ‐globulin (BGG) antibody supplied in colostrum or saline in three groups of piglets born and maintained under different environmental conditions to determine the effect of these conditions on the cessation of intestinal absorption of macromolecules (anti‐BGG antibody), termed “closure.” An enzyme‐linked immunosorbent assay was used to estimate the concentration of anti‐BGG antibody in sera from each group of piglets. Three stages of macromolecular absorption through the piglet's intestine could be detected. The first stage is a nonselective massive absorption of macromolecules (in milligram levels) that lasts up to 3 days in germfree (GF) colostrum‐deprived or conventional colostrum‐fed piglets but up to 5 days in GF piglets maintained on total parenteral nutrition. In this stage, absorption was significantly (r =.05) higher in piglets fed anti‐BGG serum with colostrum than in piglets fed antiBGG serum without colostrum on GF day 0 (31.28% vs 15.59%) and GF‐total parenteral nutrition day 3 (3.08% vs 0.11%). Thus, whenever there was the ability to absorb a massive amount of macromolecules, the sow colostrum had an enhancing affect. Although there was a minor effect of environmental or orally received stimuli in delaying closure, absorption of macromolecules decreased in all piglets maintained either parenterally or enterally after day 3. Thus, intestinal closure to massive absorption of macromolecules in piglets is primarily time (age)‐dependent. The second stage is a selective absorption of immunoglobulins in much smaller quantities (microgram levels), inasmuch as absorption of 0.02% to 0.1% was determined in all 5‐day‐old piglets. The third stage of intestinal absorption is that observed at adult levels (nanogram levels or less). In the piglet, this is achieved by 3 weeks after birth. (Journal of Parenteral and Enteral Nutrition 17:8–15, 1993)
Changes in Plasma and Erythrocyte Fatty Acids in Patients Fed Enteral Formulas Containing Different Fats
Authors: Adams Steve , Yeh Yu‐Yan , Jensen Gordon L.
Published: May 2008

Critically ill hospital patients were fed enteral formulas containing different fat substrates. Seven patients received formula X, which contained 28 g of structured triglycerides and menhaden oil to provide 7.6 g of medium‐chain fatty acids, 2.5 g linoleic acid, 1.3 g eicosapentaenoic acid, and 0.4 g docosahexaenoic acid per 1000 mL of formula. Six patients received formula Y consisting of 36.8 g of medium‐chain triglycerides and corn and soy oils providing 14.3 g medium‐chain fatty acids and 11.7 g linoleic acid per 1000 mL. Feeding of formula X increased plasma total phospholipid levels of eicosapentaenoic acid on days 7 and 14 and docosahexaenoic acid levels on day 14. Plasma levels of linoleic acid were reduced in formula‐X‐fed in comparison to formula‐Y‐fed patients, whereas arachidonic acid was maintained in both groups during feeding. As a result of these changes, the patients receiving formula X had decreased ratios of arachidonic acid:eicosapentaenoic acid in plasma. Formula Y feeding did not alter eicosapentaenoic acid and docosahexaenoic acid levels in the plasma. In the erythrocyte, formula X feeding resulted in a threefold increase in eicosapentaenoic acid from mean baseline levels of 0.4 ± 0.4% to a mean value of 1.2 ± 0.9% at day 7. The formula X feeding decreased linoleic acid levels on days 7 and 14, whereas levels of arachidonic acid and docosahexaenoic acid remained constant. Formula Y feeding did not affect any of the parameters measured for erythrocytes. The ability to alter plasma and erythrocyte levels of n‐3 fatty acids and plasma arachidonic acid:eicosapentaenoic acid ratios may have important implications for patients at risk for sepsis. (Journal of Parenteral and Enteral Nutrition 17:30–34, 1993)
Glutamine Enhancement of Structure and Function in Transplanted Small Intestine in the Rat
Authors: Frankel Wendy L. , Zhang Wei , Afonso Juan , Klurfeld David M. , Don Sidney H. , Laitin Elissa , Deaton David , Furth Emma Elizabeth , Pietra Giuseppe G. , Naji Ali , Rombeau John L.
Published: May 2008

Total parenteral nutrition is required by all patients in need of small bowel transplantation. Untoward side effects of total parenteral nutrition include atrophy and hypofunction of the small intestine. Glutamine, the preferred fuel for the enterocyte, is presumably present in insufficient amounts in diets given to patients with intestinal dysfunction. In a rat model of total parenteral nutrition and small bowel transplantation, this study investigated the following: (1) whether glutamine improves graft structure and function, (2) the optimal route of glutamine delivery (intravenous vs direct infusion into the graft), and (3) the effect of glutamine on ultrastructure of the graft enterocyte. Lewis rats underwent small bowel transplantation as a Thiry‐Vella graft and received total parenteral nutrition for 14 days while assigned to one of four infusion groups: 2% intravenous glutamine; 2% intravenous isonitrogenous mixture, nonessential amino acids (control); 2% glutamine into the graft; or 2% nonessential amino acids into the graft (control). Graft mucosal villous height, villous surface area, crypt depth, weight, protein, deoxyribonucleic acid content, glucose absorption, and enterocyte ultrastructure were then evaluated. Infusion of glutamine directly into the graft significantly increased mucosal villous height (p =.045), surface area (p =.029), and glucose absorption (p =.004) when compared with controls. Intravenous glutamine infusion significantly increased mucosal villous height (p =.002), surface area (p =.001), weight (p =.005), and glucose absorption (p =.04) when compared with controls. Most enterotrophic and functional benefits of glutamine were not significantly different between intravenous infusions and direct administration into the graft. Intravenous glutamine maintained normal enterocyte ultrastructure of the graft when compared with intravenous combined nonessential amino acids. These results indicate that glutamine supplementation improves structure and function in a rat model of total parenteral nutrition and small bowel transplantation. (Journal of Parenteral and Enteral Nutrition 17:47–55, 1993)
Stability of Fat‐Soluble Vitamins A (Retinol Palmitate), E (Tocopherol Acetate), and K1 (Phylloquinone) in Total Parenteral Nutrition at Home
Authors: Billion‐Rey F. , Guillaumont M. , Frederich A. , Aulagner G.
Published: May 2008

Our purpose was to extend previous studies of the stability of vitamins A (retinol palmitate), E (tocopherol acetate), and K1 (phylloquinone) to total parenteral nutrition at‐home (TPNH) admixtures. First, stability over 20 days was tested. Experimental conditions included presence or absence of lipids, presence or absence of trace elements, and storage in a glass bottle or in a single or multi‐layer plastic bag (ethylene vinyl acetate, polyvinyl chloride, Stedim 5, and Stedim 6). The 20‐day storage studies were conducted at 4°C or at ambient air temperature. The second part of the study consisted of exposing to natural light TPNH admixtures with or without lipids, but with trace elements, in the same containers (except polyvinyl chloride). Finally, a clinical situation of TPNH was simulated with a TPNH admixture prepared 11 days before the test in a Stedim 6 plastic bag and stored at 4°C in total darkness. For vitamins A, E, and K1, we observed good stability for 20 days; the final concentrations ranged from 75% to 100% of initial concentrations whatever the conditions studied. It appears that there is no significant difference of action between all containers and that the presence or absence of lipids and trace elements in admixtures stored at 4°C or ambient temperature makes no difference. With exposure to sunlight, vitamin losses were 100% at 3 hours for vitamin A and 50% for vitamin K1; vitamin E concentrations were unchanged after 12 hours of experiment. The presence of lipids or type of container did not appear to enhance protection from direct sunlight. Finally, we showed that, under standardized conditions of preparation, storage, and administration of TPNH such as those used in the pharmaceutical department of Debrousse Hospital, the amounts of vitamins A, E, and K1 that were administered to patients adequately corresponded to the amounts of vitamins prescribed and added to TPN admixtures. (Journal of Parenteral and Enteral Nutrition 17:56–60, 1993)