bluuebunny/crossref_metadata_2025 huggingface dataset:
Addition of dietary fiber to liquid formula diets: the pros and cons
Authors: Scheppach W , Burghardt W , Bartram P , Kasper H
Published: May 2008

Dietary fiber defined as nonstarch polysaccharides (NSP) has been added to liquid formula diets in order to approach a more physiological state of nutrition. There are interesting experimental data supporting a role for fiber in artificial enteral feeding: NSP components have been shown to increase fecal bacterial mass, to favor colonic sodium and water absorption, to stimulate colonic crypt proliferation and to delay small intestinal glucose absorption. The number of controlled studies testing the effects of fiber added to liquid formulas is, however, small. Thus, there is no firm basis for the routine use of fiber‐enriched formulas although these products are commercially available and in widespread clinical use. Research in this important field of digestive physiology is encouraged as many experimental data are in favor of supplementing formula diets with fiber.
The Effect of High Lipid Diet on In Vitro Prostaglandin E2 and Thromboxane B2 Production by Splenic Macrophages
Authors: Ogle Cora K. , Tchervenkov Jean , Alexander J. Wesley , Ogle James D. , Palkert Diane , Taylor Ann , Barnwell Sheryl , Warden Glenn D.
Published: May 2008

Feeding animals a diet high in linoleic acid for 7 days had no effect on the in vitro production of PGE2 by unstimulated macrophages. Feeding animals the high linoleic acid diet for 30 days greatly increased the production of PGE2 by macrophages when they were unstimulated, but decreased the production of PGE2 when they were stimulated with LPS. Feeding animals a diet high in linoleic acid for 30 days increased the production of TxB2 by macrophages when they were unstimulated, but decreased the production of TxB2 when they were stimulated. Normal, unstimulated splenic macrophages produced almost 80 times more TxB2 than PGE2. However, when the macrophages were stimulated the ratio decreased to six or less because of a greater increase in PGE2 production. The high linoleic acid diet did not inhibit the antibody dependent cellular cytotoxicity of macrophages. (Journal of Parenteral and Enteral Nutrition 14:250–254, 1990)
Availability of Insulin from Total Parenteral Nutrition Solutions
Authors: Marcuard Stefan P. , Dunham Bruce , Hobbs Alton , Caro José F.
Published: May 2008

Insulin is frequently required in total parenteral nutrition (TPN) solutions to control hyperglycemia. The purpose of this study was to evaluate the recovery of human insulin from standard TPN solutions with and without lipids and from TPN solutions with specialized amino acid formulations and to compare it to the insulin recovery from normal saline.

All solutions were mixed in currently utilized PVC‐free bags (ethylene vinyl acetate) and drained through PVC‐containing tubing. Human insulin (Humulin‐R) was spiked with 125I‐labeled insulin and then added in concentrations of 10, 25, and 50 units to 1‐liter bags containing 39‐g amino acids (10% Freamine‐III; or 6.9% Freamine HBC; or 8% Hepatamine), 257‐g dextrose, electrolytes (Hyperlyte‐R), 1000 units of heparin, MVI‐12, and MTE‐5 Concentrate. Alternate sets of bags contained 125 ml of 20% Intralipid and an appropriate amount of sterile water to keep the final volume at 1 liter. Actual clinical conditions of preparation, storage, and administration were simulated in this in vitro experiment. Multiple samples were collected during the 8‐hr infusion period directly in gamma counter vials. All experiments and assays were done in triplicate.

Our findings indicate that human insulin availability in TPN solutions is much higher (90%‐95%) than the 50% suggested in the literature. Insulin recovery was not appreciably altered by adding lipids or by using Freamine HBC. Insulin recovery from TPN solutions was significantly reduced if they contained Hepatamine (87% and 88%, p<0.05) as compared to Freamine (90% and 94%). In comparison, insulin recovery from normal saline was 65% (p<0.001) and, accordingly, insulin binding to the infusion materials was significantly greater than with TPN solutions. (Journal of Parenteral and Enteral Nutrition 14:262–264, 1990)
Pharmacokinetics of Ampicillin during Parenteral Nutrition
Authors: Koo Winston W.K. , Ke June , Tam Yun K. , Finegan Barry A. , Marriage Barbara
Published: May 2008

Seven healthy volunteers (four males, 20–28 years) were studied to determine the effect of parenteral nutrition (PN) on ampicillin clearance. Each volunteer received intravenous infusions of 1 liter of PN (3.75% amino acid and 10% dextrose) alternating with 1 liter of 10% dextrose (containing all additives as PN except for calcium and phosphorus); and a meal containing similar fluid volume, caloric, protein, and sodium content as the PN solution. Ampicillin (250 mg) was given intravenously 2 hr after commencement of each intravenous solution and 4 hr after the meal. During PN infusion, the mean (±SE) glomerular filtration rate (GFR) as indicated by creatinine clearance was 125 ± 18 ml/min; ampicillin pharmacokinetic data included area under the serum ampicillin concentration‐time curve of 899 ± 118 μg * min/ml, terminal elimination half life of 37 ± 4.3 min, volume of distribution at steady state of 11.9 ± 1.6 liter, total body clearance of 4.7 ± 0.6 ml/min/kg, renal clearance of 3.8 ± 0.5 ml/min/kg, and 82 ± 6.7% of the ampicillin administered was excreted in urine over 10 hr. The results were not significantly altered by different nutrient regimens or the order of infusion of intravenous solutions. We conclude that the use of PN is unlikely to affect the pharmacokinetics of ampicillin provided the renal functions including GFR, remain unchanged. (Journal of Parenteral and Enteral Nutrition 14:279–282, 1990)
Effect of Sepsis and Surgery on Trace Minerals
Authors: Shanbhogue L.K.R. , Paterson N.
Published: May 2008

The purpose of this study was to evaluate effect of infection and surgery on serum iron, zinc, and the copper simultaneously. Twenty patients who had emergency abdominal surgery for acute inflammatory conditions, and 15 controls who had elective abdominal surgery were studied. Preoperatively, serum iron levels were significantly decreased in the septic group compared to controls (p < 0.001). Following surgery and removal of the septic focus, serum iron, ferritin. and zinc levels increased, while serum transferrin levels decreased significantly. Serum copper levels did not show any significant difference. It is concluded that serum iron, transferrin, ferritin, and zinc levels are affected profoundly by septic and the surgical stress. (Journal of Parenteral and Enteral Nutrition 14:287–289, 1990)
Reviews: Special Nutritional Needs of Children with Malignancies: A Review
Authors: Mauer Alvin M. , Burgess Juliene B. , Donaldson Sarah S. , Rickard Karyl A. , Stallings Virginia Ann , Van Eys Jan , Winick Myron
Published: May 2008

Nutrition support for the patient with cancer is an important part of the overall treatment regimen. Nutrition support for the child with cancer poses a special challenge. For the purpose of reviewing the special nutritional needs of children with cancer, a Task Force was formed by the American Academy of Pediatrics to review the current state of knowledge. The work of the Task Force was supported by the Food and Drug Administration through its Liaison Representative, Joginder Chopra, M.D., Staff support from the Academy was provided by Jean D. Lockhart, M.D., This review is prepared from the Task Force Report to the FDA. It is designed to review factors enhancing nutritional risks for the child with cancer and to discuss nutritional intervention strategies and their efficacies. (Journal of Parenteral and Enteral Nutrition 14:315–324,1990)
Nortriptyline Absorption in Short Bowel Syndrome
Authors: Broyles Joyce E. , Brown Rex O. , Self Timothy H. , Frederick Randall C. , Luther R. Wayne
Published: May 2008

Severe short bowel syndrome usually requires a period of parenteral nutrition support until gastrointestinal hypertrophy occurs. Because of the shortened length of the gastrointestinal tract, oral drug therapy can be compromised secondary to decreased absorption. In the case presented, a patient with short bowel syndrome who required parenteral nutrition was able to achieve therapeutic nortriptyline serum concentrations while receiving the drug via the oral route. (Journal of Parenteral and Enteral Nutrition 14:326–327,1990)
Effects of Glutamine‐Enriched Parenteral Nutrition on the Exocrine Pancreas
Authors: Helton W.S. , Jacobs D.O. , Bonner‐Weir S. , Bueno R. , Smith R.J. , Wilmore D.W.
Published: May 2008

Total parenteral nutrition (TPN) is associated with intestinal and pancreatic atrophy and pancreatic exocrine insufficiency. Recent investigations have demonstrated that the addition of glutamine to intravenous feedings attenuates TPN‐associated intestinal atrophy. However, the effect of glutamine‐supplemented intravenous feedings on the pancreas of intact animals is unknown. This study compared the effects of an intravenous infusion of a 2% glutamine‐enriched diet (GLN) with an isonitrogenous, isocaloric diet without glutamine (CONT) on the composition and structure of the exocrine pancreas in laboratory rats with and without a 60% small bowel resection. In nonresected, TPN‐fed animals, pancreatic weight was significantly increased in the GLN group when compared to CONT (645 ± 33 g us 554 ± 20 g, p < 0.05). Nonresected GLN animals also had increased pancreatic DNA (3.82 ± 0.19 mg us 2.91 ± 0.49 mg, p < 0.005) and protein contents (93.0 ± 5.9 mg us 76.6 ± 7.0 mg, p = 0.08) compared to control. Similar significant increases in pancreatic weight, DNA, and protein were observed in intestinally resected animals fed the glutamine diet. When data from CONT and GLN animals were pooled and analyzed together, glutamine significantly increased total pancreatic trypsinogen and lipase contents (p < 0.05). The increase in trysinogen in resected GLN animals was significantly greater than in CONT animals (283 ± 22 us 139 ± 23, p < 0.005). Biochemical and morphometric observations demonstrated that the trophic effects of glutamine on the exocrine pancreas were manifest by acinar hyperplasia and not hypertrophy. Glutamine appears to be an important nutrient for pancreatic exocrine tissue during TPN. The trophic effect of glutamine on the pancreas may have important clinical relevance in reversing or attenuating pancreatic atrophy and insufficiency during intravenous feeding. (Journal of Parenteral and Enteral Nutrition 14:344–352, 1990)
Continuous Enteral Feeding: A Major Cause of Pneumonia among Ventilated Intensive Care Unit Patients
Authors: Jacobs Sydney , Chang René W.S. , Lee Berni , Bartlett Frank W.
Published: May 2008

Continuous enteral feeding is widely practiced in intensive care units (ICU). We found that pneumonia developed in 54% of 24 ventilated patients on continuous enteral feeding for more than 3 days. This appeared to affect only patients with a persistently high morning (7:00 am) gastric pH, with 12 of 13 (92%) patients developing pneumonia. In 11 patients the causative organisms were cultured initially from the stomach, oropharynx and trachea before pneumonia supervened. This effect was distinct from that found with the prophylactic use of antacids or H2‐receptor antagonists. The mortality (46%) of this group of patients was 1.6 times greater than the expected mortality predicted by the Apache II Severity of Disease Classification System. (Journal of Parenteral and Enteral Nutrition 14:353–356, 1990)
Short‐Term Dietary Protein Manipulation Does Not Affect Survival from Intraperitoneal Pseudomonas Infection in Mice
Authors: Clouva‐Molyvdas Phyllis , Peck Michael D. , Alexander J. Wesley
Published: May 2008

Manipulation of dietary protein has a variable effect on immune function and outcome from infections. In this study we investigated the role of different sources of protein at different levels on the susceptibility of mice to infection with Pseudomonas aeruginosa. CF1 mice were pair‐fed diets with 5%, 20%, and 40% protein by weight. At the end of two weeks feeding of the experimental diets, mice were challenged with Ps. aeruginosa intraperitoneally and mortality was recorded over one week. No significant differences in survival among groups fed different levels of protein were seen. Similarly, type of protein used did not affect outcome. We conclude that overall two‐week manipulation of dietary protein did not significantly affect outcome from infection in this model. (Journal of Parenteral and Enteral Nutrition 14:366–370, 1990
Taurine and Cholesterol Supplementation in the Term Infant: Responses of Growth and Metabolism
Authors: Rassin David K. , Räihä Niels C.R. , Minoli Iolanda , Moro Guido
Published: May 2008

The effects of taurine and of cholesterol supplementation to a whey‐protein‐predominant formula fed ad libitum on the growth and biochemical responses of term infants were studied. The responses of these infants were compared to those of infants fed formula without a supplement and infants that were breastfed. These infants were followed for 12 weeks. No effect of cholesterol was observed on any of the measurements and no effect of taurine was observed on any of the biochemical measures with the exception that taurine concentrations in plasma and urine (reduced in infants fed formula alone) were corrected to concentrations observed in breastfed infants. Taurine supplementation had no effect on the rate of weight gain or on linear growth over the complete course of the study. Thus, taurine supplementation of formulas returns plasma and urine concentrations of this amino acid to those found in human milk‐fed infants. However, these data indicate that the supplementation of formulas with taurine has no benefit with respect to growth. (Journal of Parenteral and Enteral Nutrition 14:392–397, 1990)
Effects of Gas Leak Around Endotracheal Tubes on Indirect Calorimetry Measurement
Authors: Dietrich Kenneth A. , Romero Michael D. , Conrad Steven A.
Published: May 2008

The use of uncuffed endotracheal tubes (ETT) in pediatric patients raises concern over the accuracy of indirect calorimetry measurement in the presence of a gas leak around an ETT. We examined the effects of ETT gas leak on respiratory gas measurements in a dog model.

Mongrel dogs (n=12) were sedated, paralyzed, intubated, and placed on mechanical ventilation. Leak was achieved by adjusting cuff volume. Oxygen consumption (VO2), CO2 production (VCO2), respiratory exchange ratio (RER), and resting energy expenditure (REE) were measured at each leak pressure (Pleak). Peak inspiratory pressure (PIP), Pleak, inspiratory and expiratory tidal volume (VTinsp, VTexp), VE, end tidal CO2 (ETCO2), and blood gases were recorded at each leak pressure.

VO2, VCO2, and REE decreased significantly with increasing gas leak. There was a linear relationship between VO2, VCO2, and REE with both TVratio (VTexp/VTinsp) and Pdiff (PIP‐Pleak). Multiple regression equations based on TVratio and Pdiff were obtained which allowed correction of the measurement error in VO2, VCO2, and REE, with correlation coefficients (R 2) of 0.71, 0.75, and 0.73, respectively.

ETT gas leak affects measurements of VO2, VCO2, and REE, but not RER. Measurements made with TVratio > 0.80 required no correction. Measurements made with TVratio > 0.45 could be corrected to actual values in our model with regression equations based on TVratio and Pdiff. We conclude that indirect calorimetry measurements can be useful in the presence of tracheal gas leak around an ETT. (Journal of Parenteral and Enteral Nutrition 14:408–413, 1990)
Bulk Prevents Bacterial Translocation Induced by the Oral Administration of Total Parenteral Nutrition Solution
Authors: Spaeth Georg , Specian Robert D. , Berg Rodney D. , Deitch Edwin A.
Published: May 2008

The effects of a fat and glutamine‐free orally administered total parenteral nutrition (TPN) solution on intestinal mucosal mass, morphology, barrier function, and cecal bacterial population levels were measured in CD‐1 mice. Ileal mucosal protein content decreased by 63% (p < 0.01) in the oral TPN‐fed mice, although they gained weight on this diet. These TPN‐fed mice also exhibited changes in mucosal structure and the normal ecology of their cecal microflora was disrupted leading to overgrowth with Gram‐negative enteric bacilli. These changes in intestinal mucosal mass, morphology, and gut bacterial ecology were associated with an increased incidence of bacterial translocation (BT) (TPN group 70% BT us control group 15% BT: p < 0.01). The administration of cellulose fiber or kaolin (bulk‐forming agents), but not of citrus‐pectin (a fully‐fermentable, nonresidue fiber) reduced the incidence of BT in the TPN‐fed mice to control levels. The beneficial effects of these bulk‐forming agents appeared to be due to their ability to prevent TPN‐induced disruption of the intestinal microflora and alterations in intestinal morphology, even though they did not prevent ileal mucosal protein levels from decreasing. These results suggest that the administration of bulk forming agents will prevent the loss of intestinal barrier function against luminal bacteria that occurs in mice fed an oral TPN solution. (Journal of Parenteral and Enteral Nutrition 14:442–447, 1990)
Percutaneous Endoscopic vs Surgical Gastrostomy
Authors: Jones Mark , Santanello Steven A. , Falcone Robert E.
Published: May 2008

The percutaneous endoscopic gastrostomy (PEG) has replaced the surgical gastrostomy (GT) on our service. We reviewed our data in an effort to determine relative efficacy and cost effectiveness of the two techniques. Thirty‐five patients with PEGs were matched for age and diagnosis with 35 patients with GTs done by the same surgical service. PEGs were done in the endoscopy suite; GTs were done in the operating room: both under local anesthesia. Patients in PEG and GT groups were comparable in sex, diagnosis, and age. The PEG took less time to insert (15.3 vs 25.4 min, p < 0.001). Major postoperative morbidity was similar with 10 systemic complications for each group and 11 deaths for the PEG us 12 deaths for the GT group (at 90 days). Minor morbidity was higher for the PEG group with nine complications vs 1. Estimated cost for PEG was half the cost of GT. Hospital stay for the two groups was similar (36 vs 45 days, p > 0.1), but postop stay for the PEG group tended to be shorter (17 us 24 days, p < 0.08). The PEG is faster and cheaper to insert than the GT, however major morbidity and mortality are the same. (Journal of Parenteral and Enteral Nutrition 14:533–534, 1990)
Role of the Lungs in Maintaining Amino Acid Homeostasis
Authors: Plumley Donald A. , Austgen Thomas R. , Salloum Rabih M. , Souba Wiley W.
Published: May 2008

The relative contributions of skeletal muscle and the pulmonary bed in maintaining amino acid homeostasis were studied. Inasmuch as more than 60% of whole blood amino acid nitrogen is transported as glutamine and alanine, the flux of these two amino acids across the lungs (n = 20) and hindquarter (n = 20) was determined in the postabsorptive adult rat. Both skeletal muscle and the lungs released net amounts of glutamine and alanine in the postabsorptive state. Blood flow to the hindquarter was approximately 16% of cardiac output (3.8 ± 0.3 cc/100 g BW/min), while pulmonary blood flow (cardiac output) was 23.7 ± 1.7 cc/100 g BW/min. Thus, despite a lower glutamine concentration difference across the lungs (—32 ± 6 μmol/liter) compared with the hindquarter (—59 ± 10 pmol/liter (p < 0.01), the lungs released significantly more glutamine (741 ± 142 nmol/100 g BW/min) than the hindquarter (208 ± 39 nmol/100 g BW/min) (p < 0.01) because of the significantly higher pulmonary blood flow. Similarly, the concentration difference for alanine across the lungs was less than that of the hindquarter (‐24 ± 8 μmol/liter us ‐60 ± 12 μmol/liter, p < 0.01) but the lungs released significantly more alanine than the hindquarter (553 ± 159 nmol/100 g BW/min us 221 ± 41 nrnolj100 g BW, p < 0.01. Compositional studies demonstrated that the hindquarter comprises 40% of total body muscle mass in the rat; thus both total skeletal muscle mass and the lungs contribute approximately equally to the maintenance of blood glutamine and alanine levels. The lungs, which are traditionally viewed as an organ of gas exchange, play a central role in maintaining amino acid homeostasis in the postabsorptive state. (Journal of Parenteral and Enteral Nutrition 14:569–573, 1990)
Conventional and Nonconventional Modes of Vancomycin Administration to Decontaminate the Internal Surface of Catheters Colonized with Coagulase‐Negative Staphylococci
Authors: Gaillard Jean‐Louis , Merlino Rosario , Pajot Nathalie , Goulet Olivier , Fauchere Jean‐Louis , Ricour Claude , Veron Michel
Published: May 2008

Using a quantitative in vitro model simulating clinical conditions, we studied the efficacy of conventional and nonconventional 3‐day therapies involving vancomycin for treating the internal surface of catheters colonized with a slime‐producing strain of Staphylococcus epidermidis. When infused for 1 hr every 8 hr through the catheter at the daily dose recommended for a 10‐kg child (450 mg), vancomycin alone reduced bacterial colonization but failed to sterilize the inserts. Vancomycin was more active in combination with netilmicin (25 mg for 1 hr every 8 hr), rifampin (150 mg for 90 min every 12 hr), or fosfomycin (500 mg for 4 hr every 6 hr), but the catheters were inconsistently decontaminated after 3 days of treatment. Two nonconventional modes of antibiotic administration were tested for their capacity to ensure high levels of vancomycin in the catheter lumen over a prolonged time. Vancomycin infused continuously through the catheter at a daily dose of 450 mg had the same poor sterilizing effect as vancomycin administered intermittently. On the contrary, catheters were totally decontaminated when 2.5 mg of vancomycin in a volume of 0.5 ml were injected twice daily into noninfused catheters, confirming that the antibiotic‐lock technique is an approach of great interest to sterilize the internal surface of catheters colonized with staphylococci.(Journal of Parenteral and Enteral Nutrition 14:593–597, 1990)
Comparison of Acute and Chronic Protein‐Energy Malnutrition on Host Antitumor Immune Mechanisms
Authors: Lieberman Michael D. , Reynolds John , Redmond H. Paul , Leon Pablo , Shou Jian , Daly John M.
Published: May 2008

Protein‐calorie malnutrition (PCM) is prevalent in cancer patients. However, the effect of PCM on antitumor immunity is unclear and critically important in an era of improving results with adoptive immunotherapy. This study examined the effect of short‐ and long‐term PCM on tumor‐specific and natural immune effector mechanisms in a murine neuroblastoma (C1300 NRB) model. A/J mice received an isocaloric 2.5% or 24% casein diet for 3 or 8 weeks before innoculation with tumor. Three weeks later lymphocytes from tumor‐bearing mice were harvested for determination of cytotoxic T lymphocyte (CTL) generation and natural killer (NK) cell cytotoxicity. Both 3 and 8 weeks of PCM significantly reduced mean total body weight by 25% (p<0.001) and 41% (p<0.001), respectively, compared with regularly nourished mice. Short‐term PCM did not inhibit CTL or NK cytotoxicity, whereas long‐term PCM significantly diminished CTL generation (p<0.001) but preserved NK cytotoxic function. These results indicate that CTL development against autologous tumor, in contrast to basal NK function, is dependent on host nutritional status. Mean tumor growth, determined by tumor‐weight to carcass‐weight ratio, was unchanged for both short‐and long‐term protein‐energy deprived groups compared with results in regularly nourished mice. These findings suggest that NK function is the predominant effector mechanism inhibiting C1300 NRB growth and that NK tumorcidal capacity is preserved during PCM. (Journal of Parenteral and Enteral Nutrition 15:15–21, 1991)
Metabolic and Immune Effect of Vitamin E Supplementation After Burn
Authors: Kuroiwa Kojiro , Nelson Jeffrey L. , Boyce Steven T. , Alexander J. Wesley , Ogle Cora K. , Inoue Sumio
Published: May 2008

The effect of dietary vitamin E supplementation was studied in burned guinea pigs. Forty‐four guinea pigs bearing a catheter gastrostomy received a 30% total body surface area full thickness flame burn and were given identical enteral diets (175 kcal/kg/day) except for the amount of vitamin E. Groups 1, 2, 3, and 4 received 0, 4 mg/kg/day (approximately equivalent to guinea pig's RDA) 20 or 100 mg/kg/day of vitamin E respectively. After 14 days of enteral feeding, there were no significant differences between groups in the body weights and the weights of carcass, gastrocnemius muscle, liver, and spleen. Resting metabolic expenditure on PBD 3, 6, 9, and 12 was similar in all groups. No statistical differences were seen in ear‐thickness response to 2,4‐dinitrofluorobenzene and lymphocytic proliferative responses to phytohemagglutinin. However, mucosal weight and protein content in group 1 were significantly less compared to groups 2 and 4 (p < 0.05). Anemia was also significantly greater in group 1. Histologic examination of the intestinal wall, however, did not yield any physical differences associated with the addition of vitamin E to the diet. This study suggests that vitamin E supplementation in diets of burned animals may have a beneficial effect on maintenance of intestinal mucosa and erythrocyte counts over a wide‐dose range. (Journal of Parenteral and Enteral Nutrition 15:22–26, 1991)
Thermogenesis from Intravenous Medium‐Chain Triglycerides
Authors: Mascioli Edward A. , Randall Sheldon , Porter Kathaleen A. , Kater Gabrielle , Lopes Sarah , Babayan Vigen K. , Blackburn George L. , Bistrian Bruce R.
Published: May 2008

Eighteen hospitalized patients dependent on total parenteral nutrition (TPN) were randomly enrolled into a prospective study comparing intravenous long‐chain triglycerides (LCT) with a physical mixture of 75% medium‐chain triglycerides (MCT) and 25% LCT. The TPN was given continuously as amino acids and glucose over 5 days with the respective lipid emulsion given intermittently during each day for 10 hr. Indirect calorimetry was measured on each patient before the lipid emulsion was administered in the morning and again 10 hr later near the end of the lipid infusion, on days 1, 3, and 5. Resting energy expenditure, VO2, VCO2, and calculated fat oxidation were shown to increase during MCT infusion but not during LCT administration, (resting energy expenditure 899 ± 37 to 1085 ± 40, compared with 978 ± 23 to 976 ± 39, kcal/m2 body surface area [BSA]/day, respectively, p < 0.0002; V02: 129.9 ± 5.2 to 157.2 ± 5.9, compared with 140.9 ± 3.6 to 141.2 ± 5.9 ml O2/min/m2 BSA, respectively, p < 0.0005; and VCO2: 110.7 ± 4.4 to 127.5 ± 4.3, compared with 118.3 ± 2.8 to 118.0 ± 5.3, ml CO2/min/m2 BSA, respectively, p < 0.0076; calculated fat oxidation 10.7 ± 1.5 to 19.3 ± 2.4, compared with 20.0 ± 2.7 to 20.0 ± 3.6, kcal/m2 BSA/hr, respectively, p < 0.014). Respiratory quotient tended to fall with lipid infusion but did not change statistically. Body temperatures were unaltered by either fat infusion. It is concluded that TPN consisting of MCT causes an increased thermogenesis, most likely through increased fat oxidation, reflective of MCT's property as an obligate fuel. The increased thermogenesis occurs without an increase in body temperature. (Journal of Parenteral and Enteral Nutrition 15:27–31, 1991)
Triacetin: A Potential Parenteral Nutrient
Authors: Bailey J.W. , Haymond M.W. , Miles J.M.
Published: May 2008

Triacetin, the water‐soluble triglyceride of acetate, was infused in mongrel dogs at isocaloric (N=6) or hypercaloric (~1.5 REE, N =7) rates in mongrel dogs for 3 hr. Ketone body and glucose production rates were quantified with [13C2] acetoacetate and [3H]glucose, respectively. Four additional animals were infused with glycerol to serve as controls for the hypercaloric triacetin infusion. Energy expenditure was determined in the isocaloric experiments. Results: no evidence of acute toxicity was observed during triacetin infusion at either rate. Plasma acetate concentrations increased from basal levels to ~1 and ~13 mmol/liter in the isocaloric and hypercaloric experiments, respectively. Plasma lactate and pyruvate concentrations decreased dramatically after 30 min of both isocaloric and hypercaloric triacetin infusions. Glucose production rates did not increase in either group, but glucose clearance decreased significantly in both groups (p<0.05) over the last hour of triacetin infusion. Plasma ketone body concentrations increased from 1.4 to 3.5 and 1.8 to 13.5 μmol/kg·min, respectively, during isocaloric and hypercaloric triacetin infusion. Resting energy expenditure increased from 3.0 ± 0.3 to 4.0 ± 0.5 kcal/kg·hr during isocaloric triacetin infusion (p<0.05). These studies indicate that triacetin can be administered to dogs at high rates without overt toxicity. The decrease in glucose clearance may represent competition between carbohydrate (glucose) and lipid (acetate). Triacetin infusion resulted in significant increases in ketone body production and concentration. These preliminary data indicate that triacetin may have a future role as a parenteral nutrient, and that further studies of its use are warranted. (Journal of Parenteral and Enteral Nutrition 15: 32–36, 1991)
Risks and Benefits of Home Parenteral Nutrition in the Acquired Immunodeficiency Syndrome
Authors: Singer Pierre , Rothkopf Michael M. , Kvetan Vladimir , Kirvelä Olli , Gaare Judith , Askanazi Jeffrey
Published: May 2008

The gastrointestinal tract is a major target of the human immunodeficiency virus. Many AIDS patients have weight loss and/or diarrhea. Parenteral nutrition can be used to treat malnutrition associated with malabsorption. We reviewed retrospectively the clinical course of 22 patients with AIDS and weight loss greater than 10% who received home parenteral nutrition (HPN) for 56.2 patient‐months. Mean weight loss was 21.4%, mean duration of HPN 2.55 months, mean age 37.4 years. Fifteen patients gained weight, six stabilized and two continued to lose weight. Nine patients returned to previous activity. Five died. The rates of catheter‐related sepsis, complications, and metabolic disturbances were 0.12, 0.25, and 0.12/100 catheter days, respectively, results identical to those reported in other patient populations where HPN is commonly applied. We found that HPN induced weight gain and clinical improvement in most patients without higher risks of sepsis than in patients with malignancies. (Journal of Parenteral and Enteral Nutrition 15:75–79, 1991)
A Usage Evaluation of Total Parenteral Nutrition in Pediatric Patients
Authors: Macfarlane K. , Bullock L. , Fitzgerald J.F.
Published: May 2008

Records of 20 consecutive pediatric patients receiving total parenteral nutrition over a 1‐month period were reviewed for appropriateness of nutritional assessment and management. Each patient was monitored until total parenteral nutrition was discontinued or for a maximum of 2 weeks. A total of 124 therapy days were reviewed. Results demonstrated that only 35% of these patients had a nutritional assessment performed prior to initiation of therapy, and only 65% had nutritional goals determined. Nutritional goals were defined as patient‐specific goals for fluid volume (FV), calories, protein, and fat emulsion. Analysis of data demonstrated that goals for FV were met on 62% of therapy days. Of the days on which FV goals were met, goals for calories, protein, and fat emulsion were met on 54%, 59%, and 51% of therapy days, respectively. Baseline serum triglyceride levels were measured in one of 20 patients. Serial laboratory monitoring was adequate, with the exception of hepatic enzymes and serum triglycerides, which were measured in 14 and 9 patients, respectively. Recommendations for pediatric parenteral nutrition therapy are discussed, as well as methods to implement these recommendations. (Journal of Parenteral and Enteral Nutrition 15:85–88, 1991)
Review: Short‐Bowel Syndrome: A Review of the Role of Nutrition Support
Authors: Purdum Preston P. , Kirby Donald F.
Published: May 2008

Advances in long‐term venous access devices and in parenteral nutrition solutions have made it possible for patients with severe short bowel syndrome to survive and to live in our society. The spectrum of this disease is such that some patients may be able to lessen their dependence or even become free from parenteral therapy. This review will discuss the role of nutrition support in the patient with short bowel syndrome. (Journal of Parenteral and Enteral Nutrition 15:93–101, 1991)
Amino Acids Enhance Insulin Resistance to Exogenous Glucose Infusion in Overnight‐Fasted Humans
Authors: Flakoll Paul J. , Kulaylat Mahmoud , Frexes‐Steed Maria , Hill James O. , Abumrad Naji N.
Published: May 2008

The role that amino acids play in regulating exogenous glucose infusion during hyperinsulinemia was examined in overnight‐fasted volunteers. Each study consisted of both a 30‐minute basal period and a 4‐hour experimental period during which insulin was infused at either 0.6, 1.2, 2.5, 5.0, 10, or 20 mU/kg/min with euglycemia maintained. Two protocols were used. In the first (I), subjects were allowed to develop hypoaminoacidemia, and in the second (II), plasma amino acid levels were maintained near basal by frequently monitoring plasma leucine levels in conjunction with exogenous infusion of an L‐amino acid solution. The amount of amino acids infused were 0.85 ± 0.11, 1.53 ± 0.17, 1.97 ± 0.13, 2.18 ± 0.50, 2.78 ± 0.61, and 2.83 ± 0.44 mg/kg/min at escalating insulin doses, respectively. When amino acids were infused, the amount of glucose required to maintain euglycemia was lower at each insulin dose used (4.5 ± 0.3 vs 3.6 ± 0.4*, 7.6 ± 0.5 vs 6.9 ± 0.3, 10.4 ± 1.0 vs 8.7 ± 0.5*, 13.3 ± 0.8 us 10.2 ± 0.4*, 14.7 ± 0.8 vs 11.7 ± 0.6*, and 14.9 ± 0.6 vs 11.8 ± 0.8* mg/kg/min at escalating insulin doses, respectively; * p<0.05). The calculated maximal infusion rates were 15.8 ± 0.6 vs 12.6 ± 0.4 mg/kg/min (protocol I vs II, p<0.001), while the concentrations required to achieve half‐maximal rates were 153 ± 22 and 134 ± 22 μ U/ml (p=ns), respectively. These data indicate that amino acid infusions to attain near basal plasma concentrations during a hyperinsulinemic euglycemic clamp in overnight‐fasted normal volunteers resulted in decreased responsiveness, without altering sensitivity, to insulin's effects on exogenous glucose infusion. This is suggestive of an amino acid‐mediated postreceptor defect. (Journal of Parenteral and Enteral Nutrition 15:123—127, 1991)
Osmotic Load from Glucose Polymers
Authors: Koo Winston W.K. , Poh Debbie , Leong Marlene , Tam Yun K. , Succop Paul , Checkland Elizabeth G.
Published: May 2008

Glucose polymer is a carbohydrate source with variable chain lengths of glucose units which may result in variable osmolality. The osmolality of two commercial glucose polymers was measured in reconstituted powder infant formulas, and the change in osmolality of infant milk formulas at the same increases in energy density (67 kcal/dL to 81 and 97 kcal/ dL) from the use of additional milk powder or glucose polymers was compared. All samples were prepared from powders (to nearest 0.1 mg), and osmolality was measured by freezing point depression. For both glucose polymers the within‐batch variability of the measured osmolality was <3.5%, and between‐batch variability of the measured osmolality was <9.6%. The measured osmolality varies linearly with energy density (p < 0.001) and was highest in infant formula reconstituted from milk powder alone. However, there exist significant differences in the measured osmolality between different glucose polymer preparations. At high energy densities (≥97 kcal/dL), infant milk formulas prepared with milk powder alone or with the addition of certain glucose polymer preparation may have high osmolality (≥450 mosm/kg) and theoretically predispose the infant to complications of hyperosmotic feeds. (Journal of Parenteral and Enteral Nutrition 15:144–147, 1991)
Measurement Reliability and Reactivity Using Repeated Measurements of Resting Energy Expenditure with a Face Mask, Mouthpiece, and Ventilated Canopy
Authors: Isbell Terry R. , Klesges Robert C. , Meyers Andrew W. , Klesges Lisa M.
Published: May 2008

This investigation evaluated the measurement reliability and reactivity of repeated measurements of resting energy expenditure using different methods of data collection. Thirty subjects were randomly assigned to either face mask, mouthpiece/nose clip, or ventilated canopy collection systems for 45 min a day over 3 days. Results indicated that there were no significant differences among data collection systems nor were there any differences either within or between systems over time. Across all three days of measurement, the first 5 min of data collection on all systems were reactive compared to the subsequent 40 min of assessment. Analyses indicated that acceptable reliability coefficients were obtained after 20 min of continuous data collection in the ventilated canopy and after 40 min with the face mask after a 5‐min acclimation period. The results suggest that, following an acclimation period, a single 20‐min assessment of resting energy expenditure in both a face mask and ventilated canopy are stable and reliable. (Journal of Parenteral and Enteral Nutrition 15:165–168, 1991)
Alteration of Whole‐Body Protein Kinetics According to Severity of Surgical Trauma in Patients Receiving Total Parenteral Nutrition
Authors: Tashiro Tsuguhiko , Mashima Yoshiya , Yamamori Hideo , Horibe Kazuo , Nishizawa Masahiko , Okui Katsuji
Published: May 2008

This study was conducted to clarify the mechanisms of body nitrogen losses according to the severity of surgical trauma. Thirteen male patients who underwent operation for esophageal cancer (group E), and 11 men (who underwent gastric or colorectal surgeries (group GC) were studied. The measurement of whole‐body protein turnover, synthesis, and breakdown were made preoperatively on the 3rd and 10th postoperative day with constant infusion of [15 N]glycine during isocaloric and isonitrogenous total parenteral nutrition. Significant increases in the rates of whole‐body protein turnover (flux) and breakdown were seen in group E on the 3rd postoperative day (p < 0.01, p < 0.01, respectively), whereas the increases were not significant in group GC. The rates of whole‐body protein flux and breakdown were significantly greater in group E than group GC (p < 0.01, p < 0.01, respectively). The rate of protein synthesis significantly increased in group E (p < 0.05), but did not alter or slightly decreased in group GC. The rates of whole‐body protein flux and breakdown in group E were still significantly greater on the 10th postoperative day than preoperatively. It was concluded that unchanged or slightly decreased rates of whole‐body protein synthesis with slightly increased breakdown were seen in the group of patients who underwent gastric or colorectal surgery, whereas synthesis increased significantly with a greater increase of breakdown in patients receiving severe surgical procedures, esophagectomy for esophageal cancer. (Journal of Parenteral and Enteral Nutrition 15:169–172, 1991)
Urinary Urea Nitrogen: Too Insensitive for Calculating Nitrogen Balance Studies in Surgical Clinical Nutrition
Authors: Konstantinides Frank N. , Konstantinides Nancy N. , Li John C. , Myaya Mary E. , Cerra Frank B.
Published: May 2008

Urinary urea nitrogen (UUN) has been used as an estimate of total urinary nitrogen (TUN) when calculating nitrogen output for nitrogen balance (NB) studies. UUN is assumed to constitute 80 to 90% of the total nitrogen output; when estimating TUN from UUN, UUN values are multiplied by 1.25 to correct for non‐urea nitrogen components. In order to evaluate the validity of estimating total urinary nitrogen output from measured UUN in a clinical setting, 491 UUN:TUN paired studies were performed on 24‐hour urine collections in general surgical/trauma patients who had measured TUN outputs ranging from 0.04 to 54.0 g/d.

Assessment of 315 NB studies was done to compare NB values of those calculated by using UUN as an estimate of TUN with those calculated from measured TUN. Patients in both studies were subdivided into four stress categories, using TUN/day as the index: < 5 g, 5–10 g, 10–15 g, and > 15 g.

On average, 80 to 90% of TUN is represented by the UUN. However, in our patient population the variability ranged from 12 to 112%. If these UUN values are used as estimates for TUN in calculating NB, variations of up to 12 g/d would result. Application of the correction factor of 1.25 is not consistent in correcting for nonurea nitrogen components in this clinical setting. The use of actual rather than estimated TUN may be a more accurate and appropriate method than UUN when calculating NB. (Journal of Parenteral and Enteral Nutrition 15:189–193, 1991)
Parenteral Drug Products Containing Aluminum as an Ingredient or a Contaminant: Response to Food and Drug Administration Notice of Intent and Request for Information
Authors:   ASCN/A.S.P.E.N. WORKING GROUP ON STANDARDS FOR ALUMINUM CONTENT OF PARENTERAL NUTRITION SOLUTIONS
Published: May 2008

Aluminum remains a significant contaminant of total parenteral nutrition (TPN) solutions and may be elevated in bone, urine, and plasma of infants receiving TPN. Aluminum accumulation in tissues of uremic patients and adult TPN patients has been associated with low‐turnover bone disease. Furthermore, aluminum has also been linked with encephalopathy and anemia in uremic patients and with hepatic cholestasis in experimental animals. Because of the toxic effects of aluminum, the Food and Drug Administration (FDA) recently published a notice of intent to set an upper limit of 25 μg/L for aluminum in large‐volume parenterals and to require manufacturers of small‐volume parenterals, such as calcium and phosphate salts, to measure aluminum content and note this content on the package label. The ASCN/A.S.P.E.N. Working Group on Standards for Aluminum Content of Parenteral Nutrition Solutions supports these intentions and further urges the FDA to require that cumulative aluminum intake in terms of safe, unsafe, and toxic quantities of aluminum per kilogram be made known to physicians and pharmacists preparing the TPN solutions, to ensure that manufacturers use appropriate control procedures in aluminum measurements, and to employ a standard unit of aluminum measurement. (Journal of Parenteral and Enteral Nutrition 15:194–198, 1991)
Successful High‐Dose Calcium Treatment of Aluminum‐Induced Metabolic Bone Disease in Long‐Term Home Parenteral Nutrition
Authors: Lidor Cobi , Schwartz Ivan , Freund Uri , Gazit Dan
Published: May 2008

A patient who developed severe metabolic bone disease is presented. He had received long‐term home parenteral nutrition (HPN) following extensive small bowel resection after mesenteric vein thrombosis. Bone disease caused by aluminum intoxication had components of osteomalacia and low‐turnover osteoporosis. Aluminum was detected at the surface of mineralized bone and was elevated in the serum, resulting in a positive deferoxamine infusion test.

One year of treatment with high doses of calcium (up to 24 mEq per day) significantly diminished the patient's bone pain, increased the serum levels of calcium, abolished aluminum deposits in the mineralized trabecula, improved bone formation, and increased trabecular bone volume as assessed by repeated histomorphometric analysis. (Journal of Parenteral and Enteral Nutrition 15:202–206, 1991)
Reviews: Role of Albumin in Human Physiology and Pathophysiology
Authors: Doweiko John P. , Nompleggi Dominic J.
Published: May 2008

Albumin is one of the major products of hepatic protein synthesis. Although it is a small molecule, it is an important diagnostic and prognostic determinant, as well as a useful therapeutic agent. A review of the evolution and structure of albumin as well as a description of its colloidal and buffering properties is presented. Synthesis, distribution, and catabolism, the major determinants of serum albumin level, are discussed. Emphasis is given to those mechanisms responsible for the regulation of these processes, including the importance of nutritional status on substrate availability, energy supply, and hormonal modulation.(Journal of Parenteral and Enteral Nutrition15:207–211, 1991)
Hormonal and Metabolic Response to Operative Stress in the Neonate
Authors: Schmeling David J. , Coran Arnold G.
Published: May 2008

It is evident from this review that newborns, even those born prematurely, are capable of mounting an endocrine and metabolic response to operative stress. Unfortunately, many of the areas for which a relatively well‐characterized response exists in adults are poorly documented in neonates. As is the case in adults, the response seems to be primarily catabolic in nature because the combined hormonal changes include an increased release of catabolic hormones such as catecholamines, glucagon, and corticosteroids coupled with a suppression of and peripheral resistance to the effects of the primary anabolic hormone, insulin. (Journal of Parenteral and Enteral Nutrition 15:215–238, 1991)
Liver Dysfunction Associated with Long‐Term Total Parenteral Nutrition in Patients with Massive Bowel Resection
Authors: Ito Yasushi , Shils Maurice E.
Published: May 2008

Sixteen patients with massive bowel resection receiving long‐term home total parenteral nutrition (HTPN) for 31 to 145 months were reviewed for evidence of liver disease. Patients were divided into three groups: group 1 with duodenocolostomy (n = 3), group 2 with an estimated 15–43 cm residual small bowel (n = 7), and group 3 with an estimated 55–120 cm residual small bowel (n = 6). Two patients in group 1 developed liver cirrhosis; one was diabetic and died of sepsis and liver failure at the 88th month on HTPN; the other died of lung cancer at the 46th month on HTPN. The third patient, followed for 33 months, had transient severe liver function abnormalities associated with a blood transfusion. In groups 2 and 3, only one patient (with a history of probable liver disease before HTPN) developed biopsy‐proven cirrhosis at the 60th month of HTPN. All four patients with clinically apparent liver disease developed persistent elevation of serum aspartate aminotransferase (AST) early in HTPN. Four other patients (all in group 3) with abnormal AST values in the early phase of HTPN normalized them later; they did not develop clinical liver disease over a mean follow‐up time of 110 months (range, 39–152). None of the remaining eight patients (seven in group 2 and one in group 3) had significant liver function test abnormalities and none developed clinical liver disease over a mean follow‐up period of 72 months (range, 39–120). The higher prevalence of severe liver diseases in patients with duodenocolostomy suggests that a host factor(s) related to the extent of resection may be pathogenetically more important than the composition of TPN formulas, at least as formulated in this program. The development of severe liver disease was not rapid in our series. (Journal of Parenteral and Enteral Nutrition 15:271–276, 1991)