bluuebunny/crossref_metadata_2025 huggingface dataset:
Resting energy expenditure in children with cyanotic and noncyanotic congenital heart disease before and after open heart surgery
Authors: Avitzur Y , Singer P , Dagan O , Kozer E , Abramovitch D , Dinari G , Shamir R
Published: May 2008

BACKGROUND: Failure to thrive is a common problem in children with congenital heart disease (CHD). Resting energy expenditure (REE) in cyanotic and noncyanotic children with CHD before and after open heart surgery has hardly been investigated. METHODS: Twenty‐nine children younger than 3 years of age with CHD (14 cyanotic and 15 noncyanotic CHD) who were referred for open heart surgery were enrolled. Data on dietary intake, anthropometric measurements, and indirect calorimetry parameters were measured 24 hours before the surgery, (day ‐1), and on day 5 after surgery. The measured REE was compared with the Schofield and World Health Organization (WHO) REE prediction equations. RESULTS: The mean +/‐ SD measured REE was similar in the cyanotic and noncyanotic children before and after surgery (before surgery: 57 +/‐ 13 and 58 +/‐ 9 kcal/kg per day, respectively; 5 days after surgery: 59 +/‐ 10 and 62 +/‐ 10 kcal/kg per day, respectively). Oxygen consumption (VO2) and carbon dioxide production (VCO2) did not change significantly before and after surgery and were similar in both groups. The measured REE for all children on day ‐1 and day 5 was similar to the calculated REE using the Schofield equation but was significantly different from the calculated REE using the WHO equation (p <.01). CONCLUSIONS: Significant changes in REE, VCO2, and VO2 were not observed before and 5 days after open heart surgery in children with CHD. These parameters (REE, VCO2, and VO2) were also similar in children with cyanotic versus noncyanotic CHD. The Schofield equation is more accurate than the WHO equation in predicting energy needs of children with CHD, but measurement of REE is preferred over calculation of REE.
Effect of an 8‐month treatment with omega‐3 fatty acids (eicosapentaenoic and docosahexaenoic) in patients with cystic fibrosis
Authors: De Vizia B , Raia V , Spano C , Pavlidis C , Coruzzo A , Alessio M
Published: May 2008

BACKGROUND: Supplementation of the diet with eicosapentaenoic acid and docosahexaenoic acid, the main long‐chain omega‐3 fatty acids in cell membranes, may have beneficial effects in patients with cystic fibrosis. METHODS: A prospective study involving 30 patients and 20 control subjects was carried out; eicosapentaenoic plus docosahexaenoic acid was equal to 1.3% of caloric intake in the cystic fibrosis patients. Our present study included the evaluation of eicosapentaenoic and docosahexaenoic acid incorporation into erythrocyte membranes and biological and clinical effects in response to long‐term (8 months) supplementation with fish oil as a source of eicosapentaenoic and docosahexaenoic acids in patients with cystic fibrosis. RESULTS: Baseline erythrocyte membrane fatty acids showed low levels of linoleic acid and eicosapentaenoic acid and mild elevation of 18:3n6, but similar docosahexanoic acid and other fatty acids in cystic fibrosis patients compared with controls. Fish oil supplementation led to a 1.7‐fold (p <.05) and 1.3‐fold (not significant) increase of eicosapentaenoic acid in erythrocyte membrane phospholipids after 4 and 8 months of supplementation, respectively, and to a 1.67‐fold (p <.05) and 1.38‐fold (p <.05) increase of docosahexanoic acid, respectively. Along with these changes, there was a progressive decrease of arachidonic acid (from 8.51 to 6.67 g/100 fatty acids at 4 months and 4.83 g/100 fatty acids at 8 months; p <.05) and an increase of linoleic acid (p <.05) in membrane phospholipids. Analysis of inflammatory markers showed a significant decrease of serum immunoglobulin G (IgG) and of alpha‐1 antitrypsin (p <.05) concentrations. Pulmonary function testing showed mild but significant improvement of forced expiratory volume (FEV)‐1 from 61% +/‐ 19% to 57% +/‐ 19% of predicted values (p <.05). The number of days of antibiotic therapy during the study period was markedly lower compared with the preceding 8‐month period (392 versus 721 days; p <.05). CONCLUSION: Long‐term eicosapentaenoic plus docosahexanoic acid supplementation (8 months) has positive effects, such as decreasing inflammation, in cystic fibrosis.
Effects of particle size on blood clearance and tissue uptake of lipid emulsions with different triglyceride compositions
Authors: Qi K , Al‐Haideri M , Seo T , Carpentier YA , Deckelbaum RJ
Published: May 2008

BACKGROUND: Particle size of IV lipid emulsions affects the catabolism of long‐chain triglyceride (LCT) emulsions, but little is known about its effect on the catabolism of medium‐chain triglyceride (MCT)‐ and fish oil (FO)‐containing emulsions. METHODS: Large (VLDL size), intermediate, and small (IDL size) emulsions with different triglyceride (TG) compositions were labeled with [3H]cholesteryl oleoyl ether: LCT (triolein 100%), MCT:LCT (trioctanoin:triolein 50%:50%), MCT:LCT:FO (trioctanoin:triolein:triDHA 50%:40%:10%), and FO (triDHA 100%). Emulsions (0.4 mg TG/mouse) were injected into C57BL/6J mice, and blood clearance and tissue uptake of emulsion particles were determined. RESULTS: Large emulsion particles had 2‐ to 3‐fold faster fractional catabolic rates (FCR) compared with small particles with the same TG content. There was 1.5‐ to 2.0‐fold higher FCR of large FO‐containing emulsions (FO and MCT:LCT:FO) compared with large LCT and MCT:LCT emulsions, whereas effects of FO on FCR in small emulsions were not observed. Large FO‐containing emulsions were taken up more by adipose tissue compared with small particles with concomitant decreases in hepatic uptake. Preinjection of heparin reduced heart and adipose uptakes of FO and MCT:LCT:FO emulsions with increased uptake by liver, suggesting a role of lipoprotein lipase in catabolism of FO‐containing emulsions. CONCLUSIONS: In a mouse model, FO addition to large emulsions increased blood clearance and changed organ delivery. In contrast, there was no or little effect when particle size became smaller. We hypothesize that in humans, FO addition to lipid emulsions can help target emulsion delivery to certain extrahepatic tissues, a factor that may be of use for delivering specific fatty acids, or even drugs, to specific organs.
Nutrition support in the critical care setting: current practice in canadian ICUs‐‐opportunities for improvement?
Authors: Heyland DK , Schroter‐Noppe D , Drover JW , Jain M , Keefe L , Dhaliwal R , Day A
Published: May 2008

BACKGROUND: The purpose of this project was to describe current nutrition support practice in the critical care setting and to identify interventions to target for quality improvement initiatives. METHODS: We conducted a cross‐sectional national survey of dietitians working in intensive care units (ICUs) across Canada to document various aspects of nutrition support practice. RESULTS: Of the 79 dietitians sent study materials, 66 responded (83%). Sixteen of 66 sites (24.2%) reported the presence of a nutrition support team, and 35 of 66 (53%) used a standard enteral feeding protocol. Dietitians retrospectively abstracted data from charts of all patients in the ICU on April 18, 2001. Of 702 patients, 313 (44.6%) received enteral nutrition only, 50 (7.1%) received parenteral nutrition only, 60 (8.5%) received both, and 279 (39.7%) received no form of nutrition support. Enteral nutrition was initiated on 1.6 days (median) after admission to ICU; 10.7% of patients were initiated on day 1. Of those receiving any form of nutrition support, on average, patients received 58% of their prescribed amounts of calories and protein over the first 12 days in the ICU. Of all days on enteral feeds, patients received feeds into the small bowel on 381 of 2321 (16.4%) days. The mean head of the bed elevation for all patients was 30 degrees. Controlling for differences in patient characteristics, site factors contributing the most successful application of nutrition support included the amount of funded dietitians per ICU bed, size of ICU, and the fact that the ICU was located in an academic setting. CONCLUSIONS: A significant number of critically ill patients did not receive any form of nutrition support for the study period. Those that did receive nutrition support did not meet their prescribed energy or protein needs, especially earlier in the course of their illness. Significant opportunities to improve provision of nutrition support to critically ill patients exist.
Noncompliance with body weight measurement in tertiary care teaching hospitals
Authors: Jensen GL , Friedmann JM , Henry DK , Skipper A , Beiler E , Porter C , Boyd‐Kantoff D
Published: May 2008

BACKGROUND: Body weight provides vital information for patient care; therefore, measurement at hospital admission should be standard practice. Our objective was to test compliance with this standard. METHODS: This was a study of 300 patients, aged > or = 18 years, admitted to general medicine and surgery services of 3 tertiary care teaching hospitals in Nashville, Chicago, and San Francisco. At 24 to 36 hours after admission, participants were queried as to whether they had been weighed, and if not, they were asked whether they had been questioned by nursing personnel about their weight. Subjects were then weighed by research personnel using identical protocol at all 3 institutions. Any admission body weight documented by nursing was noted. RESULTS: Compliance was similar at all 3 institutions, with only 197 (65.7%) of patients reporting being weighed. There were 213 (71.0%) patients who had a weight documented in the nursing record. Of those who had not been weighed, 69 (67.0%) indicated that they had been queried about their weight. Comparison of documented weights in the nursing records with those measured by research personnel revealed that 55 (25.9%) differed by > or = 5 pounds (2.27 kg). Those who had a documented weight in the nursing record but were not weighed by nursing personnel were also more likely to deviate from the weight measured by research personnel by > or = 5 pounds (2.27 kg) in comparison with those who had been weighed by nursing personnel (42.8% versus 21.8%, respectively, p <.0147). CONCLUSION: Overall compliance with weight measurement is poor. Recorded weights are often inaccurate.
Alanyl‐glutamine‐supplemented parenteral nutrition prevents intestinal ischemia‐reperfusion injury in rats
Authors: Tazuke Y , Wasa M , Shimizu Y , Wang HS , Okada A
Published: May 2008

BACKGROUND: Intestinal ischemia‐reperfusion (I/R) injury plays an important role in the pathogenesis of systemic inflammation and multiple‐organ failure. We studied whether glutamine, the primary fuel of the small intestine, prevents intestinal mucosal damage after intestinal I/R in rats. METHODS: Rats were randomly divided into 4 groups: a sham‐standard amino acid (SAA) group (n = 8); a sham‐glutamine (Gln) group (n = 8); an I/R‐SAA group (n = 10); and an I/R‐Gln group (n = 9). Alanyl‐glutamine solution was produced by replacing 36% of the total amino acid nitrogen with Gln. The superior mesenteric artery was ligated. After 60 minutes of ischemia, reperfusion was initiated and infusion was started. After 24‐hour reperfusion, the intestinal segment was removed for morphological and biochemical analysis, and blood samples were drawn from the portal vein. Fluorescein isothiocyanate‐conjugated dextran 70,000 (FITC‐dextran) was infused into the duodenum 2 hours before animal death. RESULTS: In the I/R‐SAA group, extensive epithelial sloughing and mucosal ulceration of villous tips were observed, whereas these findings did not occur in the I/R‐Gln group. Mucosal wet weight, DNA, and protein content decreased significantly in the I/R‐SAA group compared with the sham‐SAA group and increased significantly in the I/R‐Gln group compared with the I/R‐SAA group. Plasma FITC‐dextran significantly increased in the I/R‐SAA group compared with the sham‐SAA group, but the plasma level in the I/R‐Gln group was comparable with that of each sham group. Mucosal glutaminase activity significantly increased in both the I/R‐SAA and I/R‐Gln groups compared with the sham‐SAA and sham‐Gln groups, respectively. CONCLUSIONS: Alanyl‐glutamine protects against morphologic and functional mucosal injury after intestinal I/R in rats.
Serum paracetamol concentration: an alternative to X‐rays to determine feeding tube location in the critically ill
Authors: Berger MM , Werner D , Revelly JP , Cayeux MC , Tappy L , Bachmann C , Chiolero RL
Published: May 2008

BACKGROUND: Placement of enteral feeding tubes is an important clinical issue. Previous studies suggest that paracetamol absorption is very fast after jejunal administration. The aim was to determine whether paracetamol serum concentration measured by immunoassay can determine the tip position of the feeding tube. METHODS: Thirty‐three critically ill patients requiring enteral nutrition with either gastric or post‐pyloric feeding tubes were enrolled prospectively in the surgical intensive care unit of a university hospital. Paracetamol was administered in the feeding tube (15 mg/kg) after a baseline blood sample (T0). Thereafter, 8 blood samples were taken between 2.5 and 240 minutes. Paracetamol was analyzed using an automated homogenous immunoassay. RESULTS: The patients did not differ with respect to age or severity of disease. Peak paracetamol concentrations were significantly higher after post‐pyloric administration with 42.6 +/‐ 13.5 versus 20.5 +/‐ 7.5 mg/L (p <.0001). Time‐to‐peak paracetamol concentration was significantly shorter with post‐pyloric tubes (median, 5 versus 60 minutes; p <.0001). The receiver operating characteristic (ROC) curves showed the highest sensitivity and specificity at 5 minutes with 94.1% and 100%, respectively, for discriminating between gastric and post‐pyloric location. CONCLUSIONS: Because of paracetamol's rapid absorption after jejunal administration, the test seems to be a safe and inexpensive alternative to X‐ray control for assessment of the enteral feeding tube location. Its value in clinical practice remains to be established.
Glutamine infusion during ischemia is detrimental in a murine gut ischemia/reperfusion model
Authors: Fukatsu K , Ueno C , Hashiguchi Y , Hara E , Kinoshita M , Mochizuki H , Hiraide H
Published: May 2008

BACKGROUND: Gut ischemia/reperfusion (I/R) frequently occurs in clinical settings as a result of disproportionate splanchnic hypoperfusion during shock. Glutamine (GLN) supplementation of total parenteral nutrition (TPN) before gut I/R improves survival after gut I/R compared with standard TPN. However, it is unknown whether GLN treatment after the occurrence of the insult is beneficial or not. The aims of this study were to examine effects of GLN infusion during gut ischemia on survival, myeloid cell (neutrophils + monocytes) activation, and vascular permeability in organs. METHODS: Male Institute of Cancer Research (ICR) mice were randomized to control and GLN groups. After IV cannulation, mice underwent 90 (experiments 1 and 2) or 60 (experiment 3) minutes of gut I/R. Control mice received normal saline infusion at 1 mL/h for 60 minutes during ischemia, whereas the GLN group was given 3% GLN solution. In experiment 1, survival rates were monitored for 72 hours (n = 25). In experiment 2, peripheral blood was obtained at 2 or 4 hours after reperfusion (n = 17). Reactive oxygen intermediate (ROI) production by myeloid cells was determined by flow cytometry using dihydrorhodamine 123 with or without phorbol myristate acetate stimulation. Expression of CD11a and CD11b on myeloid cells was also measured. Myeloperoxidase (MPO) activity in the lung was evaluated. In experiment 3, vascular permeability in organs was measured using Evans blue at 2 or 4 hours. RESULTS: In experiment 1, survival time in the GLN group was significantly reduced compared with the control group (p =.02, log‐rank test). The survival rates were 92% (12/13) and 42% (5/12) for the control and GLN groups at 12 hours (p =.01) and 38% (5/13) and 0% (0/12) at 48 hours (p =.02), respectively. In experiment 2, ROI production was significantly higher in the GLN group than in the control group after PMA stimulation both at 2 and 4 hours. CD11b expression was significantly higher in the GLN group than in the control group at 4 hours. There was no difference in pulmonary MPO activity at either time point. In experiment 3, GLN infusion significantly increased hepatic vascular permeability compared with saline infusion at 4 hours. CONCLUSIONS: GLN infusion during ischemia is detrimental for survival after gut I/R. A possible mechanism is excessive priming of myeloid cells caused by GLN infusion. Timing of GLN administration is critical for outcome after gut ischemic insult.
Safety and metabolic tolerance of a concentrated long‐chain triglyceride lipid emulsion in critically ill septic and trauma patients
Authors: Garcia‐de‐Lorenzo A , Lopez‐Martinez J , Planas M , Chacon P , Montejo JC , Bonet A , Ortiz‐Leyba C , Sanchez‐Segura JM , Ordonez J , Acosta J , Grau T , Jimenez FJ
Published: May 2008

BACKGROUND: A concentrated fat emulsion (Intralipid 30%) with a phospholipid/triglyceride ratio of 0.04 was tested for clinical tolerance and metabolic effects in the short‐term parenteral nutrition of septic and trauma critically ill patients and compared with Intralipid 20% (phospholipid/triglyceride ratio of 0.06). METHODS: This was a prospective, randomized, multicenter study in the intensive care units in 10 university hospitals, including 90 adult patients in 2 groups: 55 septic and 35 trauma patients. Patients in each group were randomly divided into 2 subgroups according to the fat emulsions administered (1.4 g/kg per day) as part of the calories for at least 6 days of continuous total parenteral nutrition (TPN). One subgroup was treated with 30% long‐chain triglycerides (phospholipid/ triglyceride ratio: 0.04) and the other with 20% long‐chain triglycerides (phospholipid/triglyceride ratio: 0.06). The parenteral nutrition formula was isocaloric and isonitrogenous with 0.25 g of nitrogen/kg per day and 40% of the nonprotein calories as fat. Clinical tolerance was assessed during the study. At baseline and after 3 and 6 days of TPN, the following biochemical parameters were measured: prealbumin, retinol‐binding protein, serum albumin, hematologic, hepatic and renal function variables, triglycerides, phospholipids, total and free cholesterol, nonesterified cholesterol, nonesterified fatty acids, and lipoproteins. RESULTS: At baseline, no differences in age, gender, severity of the condition [Acute Physiology and Chronic Health Evaluation (APACHE II) score], or clinical chemistry were found between the subgroups. The levels of plasma proteins studied and the renal, hematologic, or hepatic function variables did not vary during the study period. Total cholesterol increased significantly, owing to esterified cholesterol, with 20% long‐chain triglyceride in septic patients (baseline: 2.1 +/‐ 0.8 mmol/L, day 6: 2.8 +/‐ 0.6 mmol/L, p =.026). In septic patients receiving 20% long‐chain triglycerides, plasma triglycerides had a similar behavior (baseline: 1.4 +/‐ 0.6 mmol/L, day 3: 2.2 +/‐ 0.8 mmol/L, p <.05). The very‐low‐density lipoprotein content of cholesterol, triglycerides, and phospholipids showed a tendency to decrease in septic patients treated with 30% long‐chain triglycerides (NS). None of the emulsions induced the synthesis of lipoprotein X. CONCLUSIONS: Our results indicate that while both fat emulsions used in the TPN of critically ill patients are clinically safe, the 30% long‐chain triglyceride fat emulsion with a phospholipid/triglyceride ratio of 0.04 causes fewer lipid metabolic disturbances.
Arginine supplementation enhances peritoneal macrophage phagocytic activity in rats with gut‐derived sepsis
Authors: Wang YY , Shang HF , Lai YN , Yeh SL
Published: May 2008

BACKGROUND: Previous reports have shown that arginine (Arg) enhances phagocytic activity of macrophages and is required for macrophage‐mediated toxicity toward tumor cells. Few studies have addressed the importance of Arg supplementation on macrophage and neutrophil function after infection and sepsis. This study examined the effect of Arg‐supplemented diets before and Arg‐enriched total parenteral nutrition (TPN) after sepsis or both on the phagocytic activity of peritoneal macrophages and blood polymorphonuclear cells in rats with gut‐derived sepsis. METHODS: Male Wistar rats were assigned to 4 groups. Groups 1 and 2 were fed a semipurified diet, while groups 3 and 4 had part of the casein replaced with 2% of total calories as Arg. After the experimental diets were administered for 10 days, sepsis was induced by cecal ligation and puncture (CLP); at the same time, an internal jugular vein was cannulated. All rats were maintained on TPN for 3 days. Groups 1 and 3 were infused with conventional TPN, while groups 2 and 4 were supplemented with Arg, replacing 10% of total amino acids in the TPN solution. Survival rates were recorded for 3 days after CLP, and all surviving rats were killed 3 days after CLP to examine their immune responses. RESULTS: Aerobic and anaerobic bacteria colony counts in peritoneal lavage fluid were significantly reduced, and the phagocytic activity of peritoneal macrophages was enhanced in groups 3 and 4 but not in the other 2 groups. There were no significant differences in the phagocytic activities of blood polymorphonuclear cells and survival rates among the 4 groups. CONCLUSIONS: Enteral Arg supplementation before sepsis significantly enhanced peritoneal macrophage phagocytic activity and reduced total bacterial counts in peritoneal lavage fluid. Arg administered before and after CLP seemed to have a synergistic effect on enhancing phagocytic activity and on bacterial clearance. However, IV Arg administration after CLP had no favorable effects on phagocytic activity or survival rates in rats with gut‐derived sepsis.
Efficacy of voluntary nasogastric tube feeding in female inpatients with anorexia nervosa
Authors: Zuercher JN , Cumella EJ , Woods BK , Eberly M , Carr JK
Published: May 2008

BACKGROUND: This investigation assesses the efficacy of a voluntary nasogastric tube feeding protocol on the weight gain of patients with anorexia nervosa, tube feeding's effect on recovery from the psychologic aspects of anorexia, patient satisfaction with treatment, and medical complications. METHODS: The study included a nonrandomized retrospective review of 381 female inpatients with a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnosis of anorexia nervosa, both subtypes. A total of 155 patients received tube feeding and oral refeeding; 226 received oral refeeding alone. Recovery from the psychologic aspects of anorexia was measured by the change in Eating Disorder Inventory‐2 scores between admission and discharge. Patient satisfaction with treatment was measured with a patient satisfaction questionnaire completed at discharge. Repeated measures and multivariate analyses were performed. RESULTS: When severity‐of‐illness and caloric intake differences between patients with and without tube feeding were controlled, patients who received tube feeding gained significantly more weight per treatment week than those who received oral kilocalories alone. Patients who received tube feeding for at least one‐half their length of stay gained 1 kg/week versus 0.77 kg/week for patients receiving oral refeeding alone. Tube‐fed patients evidenced no differences in recovery from anorexia's psychologic aspects, satisfaction with treatment, or medical complication frequency. CONCLUSIONS: In residential psychiatric treatment settings in which intensive therapeutic interventions and appropriate medical monitoring can manage potential psychologic and medical risks, tube feeding's weight gain benefits may be a viable and safe option in treating anorexia.
Nocturnal branched‐chain amino acid administration improves protein metabolism in patients with liver cirrhosis: comparison with daytime administration
Authors: Fukushima H , Miwa Y , Ida E , Kuriyama S , Toda K , Shimomura Y , Sugiyama A , Sugihara J , Tomita E , Moriwaki H
Published: May 2008

BACKGROUND: In an attempt to optimize oral branched‐chain amino acid (BCAA) administration to improve serum albumin in cirrhotic patients, we compared the effects of nocturnal and daytime BCAA administration on protein metabolism in cirrhotic patients. METHODS: Twelve cirrhotic patients were enrolled in a short‐term study. Patients were administered either conventional daytime BCAA granule or nocturnal BCAA for a week, and metabolic analyses were performed, followed by a crossover study in the next week. Another 12 patients, who showed no improvement of serum albumin level with previous daytime BCAA administration, were randomly assigned to either a nocturnal or a daytime BCAA administration group in a long‐term study. RESULTS: Low Fischer's ratio, reduced respiratory quotient, and low serum albumin were observed at entry in cirrhotic patients. Whereas daytime BCAA administration improved nitrogen balance and Fischer's ratio, these 2 were further significantly improved after nocturnal BCAA administration. There were no changes in parameters of energy metabolism throughout the study. In the 3‐month follow‐up, a significant increase in serum albumin was observed in patients administered nocturnal BCAA but not in those administered daytime BCAA. CONCLUSIONS: Nocturnal BCAA administration improved serum albumin in cirrhotic patients who showed no improvement in serum albumin level with daytime BCAA administration. This effect could be partly caused by the improved protein sparing with this administration method.
Influence of glutamine‐supplemented Caco‐2 cells on cytokine production of mononuclear cells
Authors: Aosasa S , Wells‐Byrum D , Alexander JW , Ogle CK
Published: May 2008

BACKGROUND: Caco‐2 cells, cultured with mononuclear cells, were used as an in vitro model of human intestinal cell function. This study shows the effect of glutamine (Gln) supplementation on the production of tumor necrosis factor alpha, interleukin‐10 (IL‐10), and interleukin‐6 (IL‐6). METHODS: Confluent Caco‐2 cells were cultured in media with Gln at 0 mmol/L, 4 mmol/L, or 10 mmol/L +/‐ 1 microg/mL lipopolysaccharide (LPS), treated with fluorescein isothiocyanate‐ (FITC‐) conjugated intercellular adhesion molecule‐1 (ICAM‐1) mononuclear antibody, and assessed for ICAM‐1 expression levels via flow cytometry. Confluent Caco‐2 cells alone in apical inserts, or mononuclear cells (MNCs) alone in basal chambers of transwells, were cultured in media with 0 mmol/L, 4 mmol/L, or 10 mmol/L Gln. Supernatants were taken to assess cytokine and endotoxin levels. Confluent Caco‐2 cells in apical inserts of transwells were cultured in media containing Gln at 0 mmol/L, 4 mmol/L, or 10 mmol/L, whereas MNCs were cultured in the basal chamber in media containing Gln at 4 mmol/L +/‐ LPS. Supernatants were collected to determine cytokine levels in each chamber. RESULTS: With Gln supplementation of the media at 10 mmol/L, enterocytes displayed a decrease in ICAM‐1 expression. MNCs showed a decrease in tumor necrosis factor alpha and IL‐6 production and an increase in IL‐10 production when incubated with Caco‐2 cells in media supplemented with Gln at 10 mmol/L. CONCLUSIONS: Although cytokine production by Caco‐2 or mononuclear cells incubated alone was not influenced by the Gln concentration of the media, cultured together, Gln levels affected cytokine production by mononuclear cells, which suggests that Caco‐2 cells produce mediators in Gln‐rich conditions that can influence mononuclear cell cytokine production.
Improving nutritional screening of hospitalized patients: the role of prealbumin
Authors: Robinson MK , Trujillo EB , Mogensen KM , Rounds J , McManus K , Jacobs DO
Published: May 2008

BACKGROUND: Limited resources prevent hospitals from having all patients formally evaluated by a nutrition expert. Thus, hospitals rely on nutrition‐screening tools to identify malnourished patients. The purpose of this study was to determine the effectiveness of a nutrition‐screening protocol, prealbumin (PAB), retinol binding protein (RBP), and albumin (ALB) in identifying malnourished hospitalized patients. METHODS: A nutrition screening protocol was prospectively used in medical and surgical patients and consisted of a nurse administering a questionnaire to patients and requesting formal evaluation by a registered dietitian (RD) only if nutritional issues were identified. Patients also had ALB, PAB, and RBP drawn, which were used to both screen and identify the malnourished. PAB, RBP, and ALB were compared as predictors of RD classification of patient nutritional status. RESULTS: The nutrition‐screening protocol classified 104 of 320 patients (33%) as malnourished. However, 43% of the patients were not deemed at nutritional risk according to this protocol and therefore did not receive RD assessment. PAB was a significant predictor of RD‐determined nutritional status (p <.05), whereas RBP and ALB were not. PAB screening/assessment identified 50% (162/320) of the patients as being malnourished. Notably, 50% of the patients (71 of 142) who were not evaluated by an RD were identified as malnourished using PAB criteria. The nutrition‐screening protocol took 1.2 days longer to determine malnourishment compared with PAB (p =.0021). CONCLUSIONS: Use of screening questionnaires may miss or delay identification of malnourished patients. PAB screening/assessment may improve identification of those patients requiring nutrition intervention and thus enhance the care of hospitalized individuals.
Oral glutamine (AES‐14) supplementation inhibits PI‐3k/Akt signaling in experimental breast cancer
Authors: Todorova VK , Harms SA , Luo S , Kaufmann Y , Babb KB , Klimberg VS
Published: May 2008

BACKGROUND: 7,12‐dimethylbenz [a] anthracene (DMBA) administration to pubertal rats causes breast tumors and inhibits glutathione (GSH) production. Our previous results have established that oral glutamine (GLN) supplementation significantly reduced tumor development, restored the depressed GSH production, and caused a significant decrease in the circulating levels of insulinlike growth factor‐1 (IGF‐1). The present study was designed to investigate the involvement of the IGF‐1‐activated phosphatidylinositol 3 kinase (PI‐3K)/Akt apoptotic signaling pathway. MATERIALS AND METHODS: Forty female Sprague‐Dawley rats were randomly divided into 4 groups: DMBA+GLN (n = 16), DMBA+water (n = 8), Oil+GLN (n = 8) and Oil+water (n = 8). At the age of 50 days, rats received a single dose of 100 mg/kg DMBA (n = 24) or sesame oil (n = 16) and were gavaged with a GLN suspension formulation (AES‐14) or water for the duration of the entire experiment. The animals were killed 11 weeks after the DMBA application, and the levels of IGF‐1, IGF‐1 receptor (IGF‐IR), Akt, Bcl‐2 and Bad in tumorous and nontumorous breast tissue samples were measured by Western blot analysis. RESULTS: GLN supplementation resulted in a significant decrease in the levels of IGF‐1, IGF‐IR, Akt, and Bcl‐2 in nontumorous samples. At the same time, the levels of pro‐apoptotic protein Bad were significantly elevated. The samples collected from tumor tissues showed lower levels of IGF‐1, Akt, Bcl‐2, Bad, and IGF‐IR in comparison with nontumorous tissues. CONCLUSIONS: GLN supplementation inhibited the PI‐3K/Akt pathway that is thought to be important in increasing cell survival during tumorigenesis. These results are in agreement with our hypothesis that GLN counteracts the effects of DMBA and blocks carcinogenesis in vivo.
Effect of glutamine on the initiation and promotion phases of DMBA‐induced mammary tumor development
Authors: Kaufmann Y , Kornbluth J , Feng Z , Fahr M , Schaefer RF , Klimberg VS
Published: May 2008

BACKGROUND: Oral glutamine (GLN) has been shown to up‐regulate tissue glutathione (GSH), augment natural killer (NK) cell activity, and prevent tumor growth in an implantable breast cancer model (MTF‐7). We hypothesized that dietary GLN would likewise antagonize the induction or promotion of tumor formation by 7,12‐dimethylbenz[a]anthracene (DMBA) via up‐regulation of GSH or augmentation of NK activity. METHODS: At age 55 days, 81 Sprague‐Dawley rats were gavaged with a one‐time dose of 80 mg/kg DMBA, time 0. Rats were randomized into 3 groups (GLN+DMBA, Freamine [FA]+DMBA, water (H2O)+DMBA), pair‐fed chow, and gavaged with 1.0 g/kg/day GLN or isonitrogenous amount of FA or H2O for the indicated times: PreFed (‐1 to + 16 weeks), Short‐Fed (‐1 to + 1 weeks) and PostFed (+ 1 to +16 weeks). After 16 weeks, rats were killed and examined for mammary tumors, blood was assayed for GLN and GSH content, and spleens were assayed for NK cytotoxicity. RESULTS: Over the 4‐month study period, there was no significant difference in tumorigenesis between FA and H2O groups, regardless of timing of feeding and amino acid diet, except GLN. In Pre‐ and PostFed GLN groups, there was no significant difference between groups, but there were significant decreases in tumorigenesis in GLN groups compared with either FA or H2O groups. However, in the Short‐Fed group, there was no significant difference in tumorigenesis from the GLN, FA, or H2O groups. CONCLUSIONS: Continuously supplemented GLN significantly reduced DMBA‐induced breast cancer growth when compared with the non‐GLN‐supplemented and Short‐Fed supplemental GLN groups. Furthermore, GLN appears to have its primary effect on promotion and not initiation of tumor formation. This decreased tumor formation was associated with significantly higher arterial GLN and GSH levels and NK activity at killing in the GLN+DMBA group. Protein in the presentation of FA did not promote or prevent tumor growth. These data indicate that GLN may be useful in the chemoprevention of breast cancer.
Influence of tacrolimus and short‐duration prednisone on bone mineral density following liver transplantation
Authors: Scolapio JS , DeArment J , Hurley DL , Romano M , Harnois D , Weigand SD
Published: May 2008

BACKGROUND: Osteoporosis is a known complication of chronic prednisone use. Patients with end stage liver disease (ESLD) are prone to develop osteopenia and osteoporosis, and additional bone loss may occur with the use of immunosuppression agents after orthotopic liver transplant (OLT). The aim of this study was to determine the effect of tacrolimus (FK506) and short‐duration (4 month) prednisone immunosuppression therapy on bone mineral density (BMD) after OLT of patients with cirrhotic ESLD. METHODS: Forty‐nine patients with cirrhotic ESLD (26 men, 23 women; median age 54 years) had dual energy x‐ray absorptiometry preformed at baseline and 4 and 12 months after OLT. Immunosuppression therapy after OLT included a standard transplant protocol of daily tacrolimus to maintain plasma levels between 0.2 to 0.5 ng/mL and daily oral prednisone tapered over 4 months. BMD was measured at the lumbar spine (L‐BMD) and left hip (hip BMD) and reported as raw density (g/cm2) and T score (standard deviations from gender‐matched young healthy subjects). Results represent total hip measurements. Two‐sided paired t test and analysis of variance methods were used for statistical comparisons. RESULTS: Significant improvement in L‐BMD was seen at 4 and 12 months. Hip BMD declined at 4 months but was stable thereafter between 4 and 12 months. BMD results did not differ between gender and liver disease types. CONCLUSIONS: Tacrolimus and short‐duration prednisone administration after OLT was not associated with bone loss at the lumbar spine at either 4 or 12 months. Significant bone loss occurred at the hip during the 4 months of prednisone administration after OLT but was stable thereafter. These findings suggest that immunosuppression protocols that use lower doses of prednisone administration over shorter time intervals may help prevent bone loss after OLT.
Hepatic P‐glycoprotein changes with total parenteral nutrition administration
Authors: Tazuke Y , Kiristioglu I , Heidelberger KP , Eisenbraun MD , Teitelbaum DH
Published: May 2008

BACKGROUND: The mechanism(s) responsible for the development of parenteral nutrition‐associated liver disease (PNALD) is unknown. Recently, a number of bile canalicular transport proteins have been identified that transport bile components out of hepatocytes. One group of these genes, multidrug resistance 1 (mdr1) and mdr2, encode P‐glycoproteins. Mice lacking mdr2 expression develop liver disease that appears similar to PNALD. This study investigated the alteration in the expression of these transport proteins during the administration of total parenteral nutrition (TPN). METHODS: Mice received either physiologic saline and standard chow or TPN. Mice were sacrificed on day 7, and hepatic DNA and RNA content, mRNA expression, and levels of mdr1 and mdr2 proteins were measured. RESULTS: TPN administration led to a significant (p <.05) decline in mdr2 mRNA expression and an increase in mdr1 mRNA expression. Mdr2 protein expression declined by 66% in the TPN‐treated group, and mdr1 protein expression significantly increased by 58%. Histology and biochemical parameters showed no evidence of liver injury. Serum bile acid levels were elevated in the TPN group, suggesting the development of early cholestasis. CONCLUSIONS: The decline in mdr2 and rise in mdr1 mRNA and protein expression with TPN administration occurred before the development of liver injury but during an early state of cholestasis. This suggests that alterations in mdr gene expression may be a causative factor in the development of PNALD.
Replacement of long‐chain triglyceride with medium‐chain triglyceride/long‐chain triglyceride lipid emulsion in patients receiving long‐term parenteral nutrition: effects on essential fatty acid status and plasma vitamin K1 levels
Authors: Chambrier C , Bannier E , Lauverjat M , Drai J , Bryssine S , Bouletreau P
Published: May 2008

BACKGROUND: In long‐term parenteral nutrition (LTPN) patients, the use of a 50:50 mixture of medium‐ and long‐chain triglyceride emulsion (MCT/LCT) has been suggested to prevent or correct fatty liver infiltration. However, the use of MCT/LCT lipid emulsion results in a 50% reduction of essential fatty acids and vitamin K1 supply and could induce essential fatty acid and vitamin K1 deficiencies. This study evaluated the effect of a long‐term infusion of MCT/LCT lipid emulsion on plasma fatty acid (FA) and vitamin K1 levels on LTPN patients. METHODS: In a prospective nonrandomized crossover study, we measured plasma phospholipid FA composition by gas chromatography and vitamin K1 levels by high‐performance liquid chromatography in 11 LTPN patients before and after a 4‐month replacement of the usual 20% LCT lipid emulsion (20% Lipoven; Fresenius‐Kabi France, Sevres, France) by a 20% MCT/LCT lipid emulsion (Medialipide B; Braun Medical, Boulogne, France). RESULTS: Patient received LTPN for 46 +/‐ 40 months; IV lipid emulsion was 827 +/‐ 336 mL/week. MCT/LCT lipid substitution did not change most of the essential plasma fatty acid concentrations and did not induce essential fatty acid deficiency. With both lipid emulsions, the triene/tetraene (20:3n‐9/20:4n‐6) ratio remained within the normal ranges. However, with MCT/LCT lipid emulsion, 22:4n‐6 (LCT: 0.50 +/‐ 0.12; MCT/LCT: 0.63 +/‐ 0.11%) and 22:5n‐6 (LCT: 0.32 +/‐ 0.11; MCT/LCT: 0.48 +/‐ 0.15%) increased significantly (p =.022 and 0.011, respectively). Plasma vitamin K1 levels decreased drastically with MCT/LCT lipid emulsion. CONCLUSIONS: An amount of 2.85 +/‐ 1.55 g x kg(‐1) week(‐1) of MCT/LCT lipid emulsion neither induced essential fatty acid deficiency nor improved the fatty acid disturbances usually observed in LTPN patients but did induce a drop in plasma vitamin K1 levels.
A.S.P.E.N. 2003 Research Workshop on using tracers to measure carbohydrate, fat, and amino acid metabolism in humans
Authors: Parks EJ , Matthews DE
Published: May 2008

The 2003 A.S.P.E.N. Research Workshop was held during Nutrition Week on January 18 in San Antonio, Texas. The workshop brought scientists and clinicians from around the world together to discuss the latest developments in methodology to measure substrate use and flux in vivo. Methods presented were designed to track the fate of nutrients that are given orally, enterally, or parentally to humans. Talks presented a variety of approaches to tackle particularly difficult problems of assessing intracellular processes in vivo in living animals and humans. The present paper reviews those various approaches that have been developed using (i) differential administration of tracers across organ beds to define organ‐specific intracellular metabolism without tissue biopsies; (ii) animal models that will tolerate complicated multicatheter placement situations; (iii) methods that take advantage of complicated pathways of metabolism that allow movement of specific portions of a molecule for determining gluconeogenesis; (iv) nuclear magnetic resonance and in vivo magnetic resonance spectroscopy to measure intramolecular distribution of tracers; and (v) the multiple stable isotope approach to follow biosynthetic pathways associated with fatty acid flux in the fed‐state in humans. Improved accessibility of these methods provides much hope for their expanded use in understanding the basic mechanisms of metabolic regulation and the physiologic changes in nutrient use that occur in disease states.
Placement of nasoenteral feeding tubes using external magnetic guidance
Authors: Gabriel SA , Ackermann RJ
Published: May 2008

BACKGROUND: Enteral feeding is preferred over parenteral methods, and feeding into the duodenum is preferred over gastric feeding in certain groups of critically ill patients. However, with current techniques, feeding tubes often coil in the stomach, exposing patients to the risk of aspiration. This study investigated whether a nasoenteral feeding tube can be guided beyond the pyloric sphincter, using external magnetic guidance. METHODS: This is a case series of 288 critically ill patients who needed placement of an enteral feeding tube, carried out in the intensive care units and wards of a university‐affiliated community hospital. A 12‐French polyurethane nasoduodenal feeding tube was modified by placing a small magnet in the distal tip. After inserting the tube through the nares into the esophagus, an external magnet was used to draw the tube tip beyond the pyloric sphincter and further into the duodenum or jejunum. Placement was verified by plain abdominal x‐ray, and the depth of insertion (stomach, proximal duodenum, distal duodenum, or jejunum) was recorded. RESULTS: Three hundred twenty‐nine intubations were performed in 288 patients (mean procedure time 15 minutes). In 293 cases (89.1%), the tube was placed beyond the pyloric sphincter. In 139 insertions (42.2%), the tube tip was in the distal portion of the duodenum or the jejunum. There were no significant complications. CONCLUSIONS: This case series demonstrates that external magnetic guidance achieves transpyloric placement of an enteral feeding tube in 89.1% of cases. This reliable bedside technique is superior to other methods described in the literature.
Older adults receiving home enteral nutrition: enteral regimen, provider involvement, and health care outcomes
Authors: Silver HJ , Wellman NS , Arnold DJ , Livingstone AS , Byers PM
Published: May 2008

BACKGROUND: Home enteral nutrition (HEN) is most frequently prescribed for older adults. Medicare reimbursement policy limits in‐home nursing visits, and in‐home professional nutrition services are restricted to those patients with diabetes or predialysis kidney disease. Most older adults receiving HEN rely on informal (family) caregivers to provide HEN care. The purpose of this study was to apply care process theory to identify and investigate variables related to health care outcomes of HEN in a sample of older adults dependent on informal caregivers. We assessed relationships among patient characteristics, the HEN regimen prescription and adherence, formal provider involvement, and health care outcomes. METHODS: In‐home interviews were conducted with a multiethnic (14 white, 8 Hispanic, 7 African American, 1 Asian) sample of 30 older adults (mean = 68.4 years) during their first 3 months of HEN (mean = 1.83 months). RESULTS: Daily enteral intake averaged 1596 +/‐ 553 kcal. Gastrointestinal complications, occurring in up to 63.3% of patients, interrupted daily infusions. Further, one‐third reported tube clogging or leaking, and one‐third had tube displacement. Water intake was half of calculated need and associated with decreased urination (p =.001). Average weight change was ‐4.35 pounds (p =.001), and 17 patients had body mass indexes (BMIs) <18.5. Women had more complications (p =.004), lower enteral intake (p =.009), and lower BMIs (p =.02). Only 6 patients saw dietitians in follow‐up care. Complications and type of feeding tube were associated with unscheduled health care visits and readmissions (p <.05). CONCLUSION: The efficacy of HEN in older adults (ie, reversal of malnutrition and improvements in health, functionality and quality of life) requires more frequent monitoring, reassessment, and intervention from a highly skilled multidisciplinary team that includes dietitians.
Is nutritional depletion by Nutritional Risk Index associated with increased length of hospital stay? A population‐based study
Authors: Kyle UG , Pirlich M , Schuetz T , Lochs H , Pichard C
Published: May 2008

BACKGROUND: Malnutrition is common at hospital admission and tends to worsen during hospitalization. This controlled population study aimed to determine if serum albumin or moderate and severe nutritional depletion by Nutritional Risk Index (NRI) at hospital admission are associated with increased length of hospital stay (LOS) (and increased hospital cost) in patients admitted to hospitals in 2 European countries. METHODS: Serum albumin levels and recent weight loss were prospectively determined at hospital admission in Geneva (n = 652) and Berlin (n = 621). Patients were classified as no, mild, moderate or severe risk by NRI. Multiple logistic regressions were used to determine the association between albumin and nutritional risk category and LOS. RESULTS: Patients (24%) were at moderate or severe nutritional risk by NRI. Nutritional risk by NRI, adjusted for age, was associated with LOS of 11 days (moderate: odds ratio [OR] 1.9, 95% confidence interval [CI] 1.4 to 2.7, p <.005; severe: OR 2.9, 95% CI 1.6 to 5.3, p <.005). Serum albumin was also significantly associated with increased LOS (p <.001). CONCLUSIONS: The prevalence of nutritional depletion assessed by NRI and albumin was increased with longer LOS. Albumin alone underestimated nutritional risk. Severe nutritional depletion by NRI was significantly associated with LOS > or = 11 days in Geneva and Berlin patients. Nutrition screening should take place at hospital admission to determine nutritional risk and risk for longer LOS.