bluuebunny/crossref_metadata_2025 huggingface dataset:
A randomized trial of endoscopic and fluoroscopic placement of postpyloric feeding tubes in critically ill patients
Authors: Foote JA , Kemmeter PR , Prichard PA , Baker RS , Paauw JD , Gawel JC , Davis AT
Published: May 2008

BACKGROUND: Early postpyloric feeding is considered the accepted method of nutrition support in critically ill patients. Endoscopic and fluoroscopic techniques are associated with the highest percentage of successful placement. The purpose of this study was to compare endoscopic vs fluoroscopic placement of postpyloric feeding tubes in critically ill patients. METHODS: This is a randomized prospective clinical trial. Forty‐three patients were randomized to receive feeding tubes by endoscopic or fluoroscopic technique. All procedures were performed at the bedside in the critical care unit. A soft small‐bore nonweighted feeding tube was used in all cases. Successful placement was confirmed by either an abdominal x‐ray for endoscopic technique or a fluoroscopic radiograph for fluoroscopic technique. RESULTS: Postpyloric feeding tubes were successfully placed in 41 of 43 patients (95%). The success rate using endoscopic technique was 96% (25 of 26), whereas the rate using fluoroscopy was 94% (16 of 17). The average time of successful placement was 15.2 +/‐ 2.9 (mean +/‐ SEM) minutes for endoscopic placement and 16.2 +/‐ 3.2 minutes for fluoroscopic placement, which was not statistically significant (p >.05). CONCLUSIONS: Endoscopic and fluoroscopic placement of postpyloric feeding tubes can safely and accurately be performed at the bedside in critically ill patients. Our results showed no significant difference in the success rate or time of placement between endoscopic vs fluoroscopic placement of postpyloric feeding tubes.
3–0 methylglucose uptake as a marker of nutrient absorption and bowel length in pediatric patients
Authors: Sigalet DL , Martin GR , Meddings JB
Published: May 2008

BACKGROUND: Inert carbohydrate probes are commonly used to assess intestinal permeability; we have previously shown that the actively transported moiety 3–0 methylglucose (3–0 MG) is a useful marker of intestinal surface area and nutrient absorption in animal models of short bowel syndrome (SBS). This study examines the correlation of 3–0 MG absorption with nutrient absorption, bowel length, and the tolerance of enteral feeds in pediatric patients. METHODS: Fifteen children (1 month to 15 years in age) were studied after intestinal surgery. All had a stoma, 2 were > 1 year of age, the remainder had surgical intervention as a neonate or within the first month of life. Eight had SBS (50% expected bowel length for age). Bowel length was measured intraoperatively. Nutrient absorption was quantified with a 48‐hour bowel study, measuring fat, protein, and carbohydrate output directly. 3–0 MG absorption and intestinal permeability were quantified using a solution containing 30 mg/mL 3–0 MG, 20 mg/mL mannitol and 30 mg/mL lactulose (osmolarity 352, given at 1 mL/kg via feeding tube). Subsequent urine production was collected for 8 hours, and probe recovery measured using HPLC. RESULTS: 3–0 MG absorption was significantly correlated with nutrient absorption. The correlation with protein absorption was r2 =.59, fat r2 =.62 and carbohydrate r2 =.56. The correlation between 3–0 MG absorption and bowel length was r2 =.58. 3–0 MG absorption was significantly lower in SBS patients vs patients with normal bowel length (15.8 +/‐ 6.7 vs 30.5 +/‐ 10.2%). 3–0 MG absorption also correlated with the ability to tolerate enteral feeds (r2 =.38; p <.03 for all comparisons). CONCLUSIONS: 3–0 MG may be a useful marker of nutrient absorption and bowel length in pediatric patients with short bowel syndrome. The simplicity and reproducibility of the method make it an attractive option for following patient outcomes. Further studies are suggested to determine the utility of these markers in directing the clinical management of patients.
Synergistic anti‐inflammatory activity of omega‐3 lipid and rofecoxib pretreatment on macrophage proinflammatory cytokine production occurs via divergent NF‐kappaB activation
Authors: Babcock TA , Helton WS , Anwar KN , Zhao YY , Espat NJ
Published: May 2008

Omega‐3 lipid pretreatment significantly decreases TNF‐alpha production in LPS‐stimulated Mphis; however, this response is only a partial inhibition, suggesting that other nonsubstrate‐ (lipid) dependent mechanisms are involved. The cyclooxygenase (COX)‐2 enzyme is principally responsible for lipid metabolism; thus, a selective COX‐2 inhibitor (Rofecoxib) would clarify if it is an omega‐3 lipid direct effect or a COX‐2 enzyme‐associated modulated reduction in TNF‐alpha. Moreover, potential synergy between omega‐3 lipids and selective COX‐2 inhibition is postulated. HYPOTHESIS: Through divergent regulatory mechanisms, omega‐3 lipids in combination with Rofecoxib will synergistically decrease the LPS‐stimulated Mphi inflammatory response. METHODS: RAW 264.7 cells were pretreated with omega‐3 lipids, Rofecoxib, or combination treatment and then washed and exposed to LPS. Supernatants were collected for ELISA, total proteins were obtained to determine COX‐2 protein expression by Western blot, and nuclear extracts were isolated to determine NF‐kappaB activation by electromobility shift assay. RESULTS: TNF‐alpha and PGE2 production was significantly decreased with omega‐3 and Rofecoxib pretreatment, and with combination treatment a further decrease in TNF‐alpha production was observed. COX‐2 protein expression was demonstrated to increase in omega‐3, Rofecoxib, and combination groups stimulated with LPS. No alteration in NF‐kappaB activation was observed with Rofecoxib or combination pretreatment compared with LPS‐stimulated control cells. Repletion of prostaglandin (PGE2) in the Mphi model significantly decreased TNF‐alpha in all groups. CONCLUSIONS: Omega‐3 lipids and Rofecoxib independently decrease TNF‐alpha and PGE2 production in LPS‐stimulated Mphi, yet in combination a synergistic reduction in TNF‐alpha production is observed. Although the anti‐inflammatory effects observed from omega‐3 lipids are known to occur partially through decreasing NF‐kappaB activation, we demonstrated that Rofecoxib or even a combination of omega‐3 and Rofecoxib does not alter NF‐kappaB activation, as seen with omega‐3 lipids alone. These data support that combination treatment may result in decreased Mphi inflammation, yet this occurs via divergent mechanisms.
Validation of 2 approaches to predicting resting metabolic rate in critically ill patients
Authors: Frankenfield D , Smith JS , Cooney RN
Published: May 2008

BACKGROUND: Indirect calorimetry is the criterion method for determining resting metabolic rate for nutrition support in critically ill patients. However, calculation equations are more commonly used. In the current study we tested the validity of 2 such calculation systems. METHODS: Indirect calorimetry was performed with an open‐circuit device in mechanically ventilated surgical, trauma, and medical patients at rest. Feedings were not stopped for the measurements. Two predictive equations by Ireton‐Jones and 3 versions of a multivariate equation developed at our institution (referred to as Penn State equations) were then used to estimate resting metabolic rate. These estimates were compared on a percentage basis with the measured value of resting metabolic rate. Estimated resting metabolic rate within 10% of measured was considered accurate, whereas estimations >15% different from measured were considered large errors. RESULTS: Forty‐seven subjects were measured. A larger percentage of subjects were estimated accurately by the Penn State equations (72% in the best equation) than by the Ireton‐Jones equations (60% in the best equation; not significant). The incidence of errors >15% of measured was significantly lower in the Penn State equation (11% of subjects) compared with the Ireton‐Jones equation (32% of subjects) (p <.05). CONCLUSIONS: The Penn State equation for resting metabolic rate in mechanically ventilated intensive care patients receiving nutrition support appears to be a valid clinical tool for determining energy goals in the absence of or as a supplement to indirect calorimetry. The Ireton‐Jones equation performed less well, especially in that a higher number of large errors occurred.
Assessment of the longitudinal changes in bone mineral density in patients receiving home parenteral nutrition
Authors: Haderslev KV , Tjellesen L , Haderslev PH , Staun M
Published: May 2008

BACKGROUND: Low bone mineral density (BMD) is commonly reported in patients receiving home parenteral nutrition (HPN), but it remains unclear whether or not an accelerated bone loss occurs during HPN therapy. We evaluated the spinal, hip, and forearm bone mass density longitudinally in a cohort of 75 patients receiving HPN. METHODS: A total of 943 regional dual‐energy x‐ray absorptiometry scans, 335 spinal, 318 hip, and 290 forearm, obtained between 1995 and 2003 in 75 patients receiving HPN, were used for the analysis of the annual changes in BMD. The average (SD) number of scans per patients was 4.4 (2.9), and follow‐up time was 4.1 (1.9) years. Diagnoses were Crohn's disease (n = 35) and other conditions (non‐Crohn's diseases; n = 40). Data were analyzed using a linear random coefficient model. RESULTS: There was a statistically significant overall decline over time in spinal, hip, and forearm BMD, corresponding roughly to a 1% annual loss (p <.005); however, the loss was not significantly larger than that of age and sex‐matched healthy subjects. In Crohn's disease patients, model estimates of spinal and hip BMD on the initiation of HPN therapy were significantly reduced compared with normal, whereas values were not significantly reduced in non‐Crohn's disease patients. CONCLUSIONS: With the current protocols for HPN treatment, the annual decline in BMD is moderate and not significantly larger than in age‐ and sex‐matched healthy subjects. A considerable part of the metabolic bone disease in these patients is related to the underlying disease for which the HPN was indicated.
Enteral nutrition and cardiovascular medications in the pediatric intensive care unit
Authors: King W , Petrillo T , Pettignano R
Published: May 2008

BACKGROUND: Enteral nutrition has multiple benefits for critically ill patients. However, the administration of enteral nutrition to patients requiring medications for cardiovascular support is controversial secondary to concerns of altered splanchnic perfusion. The objective of this study is to evaluate the tolerance of enteral nutrition in pediatric patients receiving cardiovascular medications. METHODS: This was a retrospective chart review of patients admitted to the pediatric intensive care unit at Children's Healthcare of Atlanta at Egleston in a 1‐year period. Patients were eligible for the study if they received enteral nutrition during or within 24 hours of requiring continuous infusion of dopamine, dobutamine, epinephrine, norepinephrine, or neosynephrine. RESULTS: Fifty‐five admissions (52 patients) met study criteria. Patients ranged in age from 1 month to 20 years old. Although a large number (71%) of patients experienced at least 1 feeding interruption, the majority (70%) of reasons cited for stopping or slowing feedings were not related to gastrointestinal (GI) tolerance. Only 29% of patients had feedings held for perceived intolerance. Vomiting was the most often‐cited reason for these interruptions. Constipation was reported in 36% of patients but cited only 4 times as a reason for feeding interruption. Four patients exhibited evidence of GI bleeding. This bleeding was considered clinically insignificant in 2 patients and appeared unrelated to enteral feedings in the others. CONCLUSIONS: This study suggests that many pediatric patients receiving cardiovascular medications tolerate enteral nutrition without adverse events. Further prospective studies are needed to determine whether enteral nutrition can consistently benefit these critically ill pediatric patients.
The glucose transporter families SGLT and GLUT: molecular basis of normal and aberrant function
Authors: Scheepers A , Joost HG , Schurmann A
Published: May 2008

Glucose enters eucaryotic cells via 2 different types of membrane associated carrier proteins, the Na+‐coupled glucose transporters (SGLT) and glucose transporter facilitators (GLUT). Three members of the SGLT family function as sugar transporters (SGLT1 and SGLT2) or sensors (SGLT3). The human GLUT family consists of 14 members, of which 11 have been shown to catalyze sugar transport. The individual isotypes exhibit different substrate specificity, kinetic characteristics, and expression profiles, thereby allowing a tissue‐specific adaptation of glucose uptake through regulation of their gene expression. Furthermore, some transporters (eg, GLUT4 and GLUT8) are regulated by their subcellular distribution. In addition to catalyzing glucose entry into cells, some isotypes (eg, GLUT2) seem to be involved in the mechanisms of glucosensing of pancreatic beta‐cells, neuronal, or other cells, thereby playing a major role in the hormonal and neural control. Targeted disruption in mice has helped to elucidate the physiologic function of some isotypes (GLUT1, GLUT2, GLUT4). Furthermore, several congenital defects of sugar metabolism are caused by aberrant transporter genes (eg, the glucose‐galactose malabsorption syndrome, SGLT1; the glucose transporter 1 deficiency syndrome; and the Fanconi‐Bickel syndrome, GLUT2). In addition, a malfunction of glucose transporter expression or regulation (GLUT4) appears to contribute to the insulin resistance syndrome.
Serum Levels of Interleukin‐6 and C‐Reactive Protein Correlate With Body Mass Index Across the Broad Range of Obesity
Authors: Khaodhiar Lalita , Ling Pei‐Ra , Blackburn George L. , Bistrian Bruce R.
Published: May 2008

Background: It has been noted that elevated inflammatory markers, such as tumor necrosis factor‐α (TNF), soluble TNF receptor II (sTNF‐RII), interleukin 6 (IL‐6) and C‐reactive protein (CRP), are characteristically found in the serum in obese patients. In this study, we examined the correlation of these markers with BMI in nonobese, obese, and morbidly obese individuals to explore this relationship across the broad range of obesity. Methods: A total of 9 nonobese, including normal and overweight (body mass index [BMI] <30 kg/m2) and 41 obese (BMI≥ 30 kg/m2) adults were included in this study. Among obese subjects, 11 subjects were grade I or II obese (BMI ≥30 and <40 kg/m2), and 30 subjects were morbidly obese (grade III obese, BMI≥ 40 kg/m2). Serum levels of glucose, insulin, TNF, sTNF‐RII, IL‐6, and CRP were measured. Results: Obese subjects (BMI ≥30 kg/m2) had significantly higher serum levels of TNF, sTNF‐RII, IL‐6, and CRP compared with nonobese subjects. Serum levels of sTNF‐RII, IL‐6, and CRP, but not TNF, were positively correlated with BMI in obese subjects. However, in morbidly obese subjects, only the serum concentrations of IL‐6 and CRP remained correlated with BMI, primarily because of this relationship in men. Conclusions: The present results support evidence that obesity represents an inflammatory state. In morbid obesity, the correlation of only IL‐6 and CRP with BMI, particularly in males, suggests that IL‐6 may be secreted in an endocrine manner in proportion to the expansion of fat mass particularly in the abdominal region, with a corresponding increase in hepatic production of CRP.
Immune Function Is Impaired With a Mini Nutritional Assessment Score Indicative of Malnutrition in Nursing Home Elders With Pressure Ulcers
Authors: Hudgens Jan , Langkamp‐Henken Bobbi , Stechmiller Joyce K. , Herrlinger‐Garcia Kelli A. , Nieves Carmelo
Published: May 2008

Background: Malnutrition is prevalent in elders with pressure ulcers and is associated with increased morbidity and mortality. This study compared nutritional status, assessed by the Mini Nutrition Assessment (MNA), to immune function in nursing home elders with pressure ulcers. Methods: Nutritional status was assessed in nursing home residents (>65 years) with a stage II or more severe pressure ulcer. Subjects were classified as well nourished, at risk of malnutrition, or malnourished according to MNA score. Blood was drawn to assess whole blood mitogen‐induced lymphocyte proliferation and neutrophil respiratory burst. Delayed‐type hypersensitivity to 3 antigens was measured. MNA status was compared with immune parameters using the Kruskall‐Wallis test. Results: Of the 24 subjects (23 men, 1 woman) who completed the study protocol, only 4 (17%) were classified as well nourished, whereas 7 (29%) were at risk and 13 (54%) were malnourished according to MNA score. Whole blood lymphocyte proliferation was significantly lower in the malnourished vs at risk subjects with both pokeweed (median [25th,75th percentile], 0.6 [0.3, 0.9] vs 1.8 [1.2, 2.1] disintegrations per minute [dpm]/cell, p< .05); and concanavalin A (1.7 [0.9, 2.0] vs 2.8 [2.6, 3.9] dpm/cell, p < .05) mitogens. Neutrophil respiratory burst normalized to a young control was significantly lower in malnourished subjects vs well‐nourished subjects (0.8 [0.5, 0.9] vs 1.4 [1.0, 1.7], p < .05). Total induration to 3 skin‐test antigens was 13.4± 4.6, 3.5 ± 2.6, and 3.8 ± 1.8 (mean ± SEM) for well‐nourished, at risk, and malnourished, respectively (p = .059). Conclusions: Immune function is impaired with an MNA score indicative of malnutrition in nursing home elders with pressure ulcers.
The C‐Terminal Heptapeptide of Bombesin Reduces the Deleterious Effect of Total Parenteral Nutrition (TPN) on Gut‐Associated Lymphoid Tissue (GALT) Mass but Not Intestinal Immunoglobulin A In Vivo
Authors: Genton Laurence , Reese Shannon R. , Ikeda Shigeo , Le Tho C. , Kudsk Kenneth A.
Published: May 2008

Background: Bombesin, the amphibian analog of mammalian gastrin‐releasing peptide, reverses total parenteral nutrition (TPN)–induced atrophy of gut‐associated lymphoid tissue and increases intestinal and respiratory immunoglobulin A (IgA) levels. Structure‐activity studies suggested that the biologically active portion of bombesin is a C‐terminal heptapeptide (7AA). This study investigates the effect of 7AA on lymphocytes counts of the Peyer's patches (PP), the lamina propria (LP) and the intraepithelial layer (IE). Methods: Forty‐eight male mice were randomized to receive chow (n = 13), TPN only (n = 9), TPN + 15 μg 7AA 3 times per day (n = 13) or TPN + 150 μg 7AA 3 times per day (n = 13). After 5 days of feeding, PP, LP, and IE lymphocytes were determined. Intestinal IgA levels were measured with ELISA. Groups were compared with ANOVA. Results: All TPN‐fed mice lost more weight than mice fed chow (p < .04). Lymphocyte counts in PP, LP, and IE were significantly lower in the TPN group than in the 3 other groups but did not differ between the groups fed chow, TPN + 15 μg 7AA 3 times per day, or TPN + 150 μg 7AA 3 times per day. Intestinal IgA levels were higher in chow‐fed mice (148.4± 16.9) than in mice fed TPN (98.4 ± 14.0, p = .008), TPN + 15 μg 7AA 3 times per day (96.9 ± 7.7, p = .003) or TPN + 150 μg 7AA 3 times per day (87.3 ± 6.7, p = .001). Conclusions: The C‐terminal heptapeptide of bombesin prevented the TPN‐induced decrease in intestinal lymphocyte populations but not the reduction in intestinal IgA levels.
Standard Equations Are Not Accurate in Assessing Resting Energy Expenditure in Patients With Amyotrophic Lateral Sclerosis
Authors: Sherman Michael S. , Pillai Ajay , Jackson Ann , Heiman‐Patterson Terry
Published: May 2008

Objective: To assess the utility of standard equations for calculating caloric requirements in patients with amyotrophic lateral sclerosis (ALS). Background: Malnutrition substantially increases the risk of death in ALS. Weight loss can be stabilized and survival prolonged with early gastrostomy feeding. However the use of standard nutrition equations has not been validated in this population. We therefore compared measured caloric expenditure to 2 predictive equations in patients with varying stages of ALS. Methods: Thirty‐four patients were studied. Caloric expenditure and respiratory quotient (R) were measured using indirect calorimetry. Results were compared with the Harris‐Benedict equation. Results: The prediction error for the Harris‐Benedict equation was 18.6 + 14.9%. Limits of agreement showed this equation could overestimate caloric expenditure by 591 kcal/d and underestimate requirements by 677 kcal/d. R was >0.86 in 11 patients, suggesting overfeeding, and <0.8 in 15 patients, suggesting underfeeding. The difference between predicted and measured caloric expenditure did not correlate with disease severity, disease duration, or body mass index. Mechanically ventilated patients had higher than predicted energy expenditure. Conclusions: We found that standard equations used to calculate energy expenditure were not valid for patients with ALS. Moreover, the majority of our patients were either overfed or underfed. As underfeeding can cause diaphragm impairment, and over‐feeding can increase ventilatory load, indirect calorimetry should be considered in ALS patients to determine optimal caloric requirement.
Glucose in Parenteral Nutrition: A Survey of US Medical Centers
Authors: Schloerb Paul R.
Published: May 2008

Background: A previous report suggested that glucose administration in total parenteral nutrition (TPN) should not exceed 4 mg/kg/min with a respiratory quotient (RQ) >1.0. This rate would not be exceeded, in most patients, with a TPN glucose concentration of 15%. Our previous survey of hospitals, 7 years ago, of TPN composition revealed use of excessive glucose. Our purpose was to reevaluate glucose usage in TPN. Methods: A subset of data from 45 hospitals participating in Novation's Medication Use Evaluation program, “Parenteral Nutrition for Adults and Neonates” study, was analyzed to document glucose administration in TPN. Results: Data of 629 adult patients from 44 hospitals receiving TPN were analyzed. Of these, 30 hospitals with 478 patients had 100 patients (15.9% of the total) with TPN glucose infusion rates> 4 mg/kg/min, whereas 27 hospitals, or 61%, had average TPN glucose concentrations above 15%. This could be associated with an RQ >1.0, implying increased net lipogenesis. Conclusions: The majority of hospitals surveyed were found, as in a previous survey, to be using amounts of glucose in TPN which would be expected to be associated with an RQ >1.0, implying increased net lipogenesis.
Hepatic de Novo Lipogenesis in Stable Low‐Birth‐Weight Infants During Exclusive Breast Milk Feedings and During Parenteral Nutrition
Authors: Garg Meena , Bassilian Sara , Bell Cynthia , Lee Samuel , Lee W. N. Paul
Published: May 2008

Background: Low‐birth‐weight (LBW) infants have high energy requirements and are dependent on high fat intake to maintain adequate postnatal growth. Fat energy is transported in plasma as triglycerides, which are either derived from the diet or from de novo lipogenesis (DNL). It is our hypothesis that DNL plays an important physiologic role in adapting to exclusive breast milk (EBM) feeding or to parenteral nutrition (PN). Methods: We studied hepatic de novo lipogenesis in 14 LBW (<34‐week gestation) appropriate for gestational age and receiving either EBM feedings or full PN support. Stable isotope tracer [2‐13C] acetate was administered for 72 hours to achieve an estimated 10% enrichment of daily fat intake. Fatty acids were extracted from plasma for gas chromatography–mass spectrometry analyses. Results: Percent new synthesis of palmitate was 13.1% ± 2.5% in the EBM group and 14.9%± 0.7% in the PN group (NS), stearate was 11.1% ± 2.7% in the EBM group and 10.6% ± 14% in the PN group (NS) and cholesterol was 12.7% ± 2.1% in the EBM group and 17.4% ± 4.6% in the PN group (NS) after 72 hours of tracer administration (mean ± SEM). The plasma lipid fatty acid composition in palmitate, oleate, and stearate with intake of 3.6 ± 0.6 g/kg/d of IV lipids (ILs) was similar to EBM‐feeding infants taking 6.3 ± 0.13 g/kg/d of fat. Conclusions: De novo lipogenesis is active in stable LBW infants maintaining standard postnatal growth. Hepatic DNL permits newborn infants to meet the fat energy needs of peripheral tissues for growth and storage and to maintain plasma fatty acid composition in adaptation to different dietary fat intake.
Changes in Serum Insulin‐Like Growth Factors, Not Leptin, Are Associated With Postnatal Weight Gain in Preterm Neonates
Authors: Lo Hui‐Chen , Tsao Lon‐Yen , Hsu Wen‐Yin , Chi Chiu‐Yen , Tsai Fu‐Ann
Published: May 2008

Background: Serum concentrations of conventional nutrition‐related proteins, such as albumin, prealbumin, transferrin, and retinol‐binding protein, are usually inconsistent with changes in anthropometric measurements in the postnatal period. The aim of this study was to evaluate how reliable growth hormone (GH), insulin‐like growth factors (IGFs), IGF‐binding proteins (IGFBPs), and leptin, the proteins known to be involved in the regulation of growth, are in reflecting postnatal growth and nutritional status in preterm neonates. Methods: Blood samples and anthropometric measurements were collected from 55 preterm neonates (chronological age 30.4 ± 2.8 weeks) for 4 continuous weeks (weeks 0 to 3). Results: After adjusting for chronological age, body weights and serum IGF‐II concentrations were significantly greater and serum transferrin concentrations were significantly lower in weeks 2 and 3 than in week 0 (repeated‐measures analysis of variance (ANOVA) and Bonferroni test, p < .05). Forward stepwise multivariate regression analysis showed that change in total IGF‐I (week 0 to week 3) was a positive predictor, and changes in insulin and prealbumin were negative predictors of postnatal weight gain. In addition, daily fat intake was a positive predictor of postnatal length increases, and changes in prealbumin, insulin, and GH were negative predictors of postnatal changes in the ponderal index (weight × length–3). Changes in GH and IGFBP‐2 were negative predictors of changes in head circumference and triceps skinfold thickness, respectively. Conclusions: Serial measurements of serum IGF‐I and IGF‐II may be useful adjuncts to anthropometric measurements for monitoring postnatal growth and nutritional status in preterm neonates.
Body Mass Index and Agreement Between Bioimpedance and Anthropometry Estimates of Body Compartments in Anorexia Nervosa
Authors: Piccoli Antonio , Codognotto Marta , Di Pascoli Lorenza , Boffo Gina , Caregaro Lorenza
Published: May 2008

Background: In 74 women with anorexia nervosa (body mass index [BMI] 10–17.5 kg/m2), a progressive disagreement between anthropometry and bioelectrical impedance analysis (BIA) estimates of fat (FM) and fat‐free mass (FFM) was documented with a BMI <15 kg/m2. Below this threshold, an abnormal body composition was detected with vector BIA independent on body weight (useful tool at the bedside). Both anthropometry and BIA are used for body composition assessment. We evaluated the agreement between their estimates of FFM and FM in extremely lean subjects with anorexia nervosa. Methods: Observational study in 74 women (age 15–45 years; BMI 10.0–17.5 kg/m2) with anorexia nervosa. Anthropometry FM and FFM were estimated by skinfold thicknesses. Whole‐body impedance vector components, resistance (R) and reactance (Xc), were measured at the same time (BIA‐101 analyzer, 50‐kHz frequency; Akern/RJL Systems, Clinton Twp., MI). BIA estimates of FFM and FM were obtained with Sun's equations (BMI 14–39 kg/m2). Vector BIA was performed with the RXc graph method. The frequency of disagreement between anthropometry and BIA was evaluated as a function of increasing BMI (receiver operating characteristic curve). Results: The correlation coefficient between methods was 0.80–0.90. The BMI cutoff value of 15 kg/m2 predicted disagreement of FM and FFM in patients with a BMI<15 kg/m2. In the RXc graph, the distribution of vectors from patients with disagreement was significantly shifted out of the right border of the reference tolerance ellipses. Conclusions: Anthropometry and BIA equations should not be used in anorexic patients with a BMI <15 kg/m2. The distribution of vectors from patients with disagreement of methods was shifted out of the right border of the reference tolerance ellipses and was superposed to vectors from patients with a BMI <15 kg/m2. The identified impedance pattern for anorexia could be useful for feedback in individual patient refeeding (vector back into the 75% reference ellipse).
Quality of Life in Adult Home Parenteral Nutrition Patients
Authors: Winkler Marion F.
Published: May 2008

Background: Home parenteral nutrition (HPN) is life‐sustaining therapy in some disease states. Patients, however, report alterations in physical, psychologic, and social function that negatively affect perceived quality of life (QOL). Many generic tools have been used to evaluate QOL during HPN, but there is no gold standard measurement. QOL improvement can only result from identifying and addressing patient‐specific problems. The purpose of this study was to identify the tools used by others to measure QOL in adults receiving long‐term HPN and to identify factors that affect QOL in this population. Methods: An electronic search of CINAHL, MEDLINE, and Health and Psychosocial Instruments databases was conducted to identify studies of HPN and QOL in adults. Results: Thirty‐four publications on HPN and QOL were identified. Twenty‐four studies of HPN and QOL were included in this review; 10 papers were review articles or editorials. QOL was worse in HPN patients compared with healthy populations. Impaired QOL was associated with decreased physical, psychologic, and social function. Depression, drug dependency, sleep disturbance, frequent urination, fear of therapy‐related complications, and inability to eat negatively affected QOL. Conclusions: Use of different QOL instruments, scales, and lifestyle domains limited comparison among studies. QOL is poor in patients receiving HPN and worse in the presence of depression and narcotic dependency. The technical aspects of HPN administration interfere with routine activities. It is difficult to determine whether HPN itself or the impact of the disease affected QOL. Development of an HPN‐specific QOL tool may help in this differentiation.
Effect of Feeding‐Tube Properties on Residual Volume Measurements in Tube‐Fed Patients
Authors: Metheny Norma A. , Stewart Jena , Nuetzel Gretel , Oliver Dana , Clouse Ray E.
Published: May 2008

Background: The effect of feeding tube size and port configuration on the ability to measure gastric residual volume (GRV) is poorly understood. In addition, there is confusion about the need to measure GRVs during feedings into the small bowel. This study sought to (1) compare the volume of gastric contents obtained from small‐diameter feeding tubes and large‐diameter sump tubes concurrently positioned in the stomach and (2) describe the distribution of GRVs during small‐bowel feedings. Methods: For the first objective, GRV measurements were made from 10‐Fr tubes (n = 645) and 14‐Fr or 18‐Fr sump tubes (n = 645) concurrently present in 62 critically ill patients. Sixty‐milliliter syringes were used to measure GRVs from the 10‐Fr tubes; the fluid was returned to the stomach and measurements were repeated from the large‐diameter sump tubes. To address the second research objective, 890 GRV measurements were made from 14‐Fr or 18‐Fr gastric sump tubes (not connected to suction) in 75 critically ill patients who were receiving small‐bowel feedings. Results: When GRVs were >50 mL, a linear regression equation indicated that volumes obtained from the large‐diameter sump tubes were about 1.5 times greater than those obtained from the small‐diameter tubes concurrently present in the stomach, p< .001. Gastric volumes ≥100 mL were found in 11.6% of the 890 measurements made in patients receiving small‐bowel feedings; volumes ≥150 mL were found in 5.4% of the measurements. Conclusions: The findings suggest that GRVs obtained from large‐diameter sump tubes are about 1.5 times greater than those obtained from 10‐Fr tubes. Large GRVs occur in at least 5% of patients receiving postpyloric feedings.
Economic Analysis of Home vs Hospital‐Based Parenteral Nutrition in Ontario, Canada
Authors: Marshall John K. , Gadowsky Shannon L. , Childs Anne , Armstrong David
Published: May 2008

Background: Advances in technology and infrastructure have facilitated transfer of complex services from acute care hospitals to the home. This increases the burden on community resources but may provide net savings to the health care system. We undertook a retrospective cohort study of patients transferred from hospital to home while receiving home parenteral nutrition (PN) to assess their costs of care. Methods: A detailed review of medical records was undertaken for all patients managed by the Hamilton Health Sciences Home PN Program between 1996 and 2001 whose PN was initiated in hospital. Mean per diem direct medical costs were estimated from the perspective of the provincial Ministry of Health for 3 periods: the last 2 weeks before discharge and the first month after discharge. Costs were compared among time intervals and among patients subgroups defined by age and underlying disease. Results: Twenty‐nine eligible subjects were identified. Common indications for PN included malignancy (n = 12), inflammatory bowel disease (n = 6), and intestinal ischemia (n = 4). Mean per diem costs in the last week of hospitalization were higher than those in the first month after discharge ($567 vs $405, p < .0001). Acute care resources accounted for <10% of the overall costs on home PN. The estimated monthly savings per patient maintained on home PN were $4860 (95% confidence interval $2700–$7000). Savings were even greater among patients with underlying malignancy and advanced age. Conclusions: Home PN is cost saving when compared with hospital‐based PN. Neither age nor underlying malignancy should pose a barrier to receipt of home PN.
Severe Obesity: A Growing Health Concern A.S.P.E.N. Should Not Ignore
Authors: Shikora Scott A.
Published: May 2008

The definition of malnutrition in the published standards of the American Society of Parenteral and Enteral Nutrition (A.S.P.E.N.) is any derangement in the normal nutrition status and includes overnutrition, commonly referred to as obesity. The incidence of obesity is increasing and reaching epidemic proportions in the United States and even worldwide. This has significant financial impact as our society spends billions of dollars on fad diets, commercial weight‐loss programs, nutrition and dietary supplements, prescription and over‐the‐counter medications, and health clubs. Another approximately $100 billion are spent to treat the medical consequences of obesity. Currently, for those patients with intractable morbid obesity, defined as having a body mass index >40 kg/m2, surgery offers the only option for achieving meaningful and sustainable weight loss. The resultant weight loss dramatically improves health and decreases the cost of health care for these patients. Years of refinement in technology and the introduction of safer and less invasive procedures have dramatically reduced the short‐term morbidities and long‐term metabolic consequences of these procedures. This address will review the field of weight loss (bariatric) surgery and will offer a compelling request for A.S.P.E.N. to include obesity in its fabric.
Parenteral Nutrition as a Risk Factor for Central Venous Catheter–Related Infection
Authors: Beghetto Mariur G. , Victorino Josué , Teixeira Luciana , de Azevedo Mirela J.
Published: May 2008

Background: The role of parenteral nutrition (PN) therapy as an independent risk factor for central venous catheter (CVC)–related infection in nonselected adult patients is not well established. The aim of this study was to evaluate PN as a risk factor for central venous catheter–related infection in nonselected adult patients in a general university hospital. Methods: Patients using central venous catheters, exposed or nonexposed to PN, were prospectively followed for development of central venous catheter–related infection. Results: One hundred fifty‐three patients were studied; 28 developed central venous catheter–related infection. Patients with central venous catheter–related infection presented higher frequency of PN use than patients without infection (60.7 vs 34.4%; p = .010). Multivariate Cox analysis showed that PN (relative risk (RR) = 3.30; 95% confidence interval [CI], 1.30–8.34; p = .012) was the only risk factor for central venous catheter–related infection. Malnutrition (RR = 0.45; 95% CI, 0.15–1.34; p = .152), days of hospitalization before central venous catheter insertion (RR = 1.00; 95% CI, 0.98–1.02; p = .801), and sustained hyperglycemia (RR = 0.49; 95% CI, 0.98–1.21; p = .091) were not significant in the model. Multiple logistic regression revealed that mal‐nutrition (odds ratio [OR] = 8.05; 95% CI, 1.85–35.03; p = .005), central venous catheter indication for surgical‐related pathology (OR = 7.26; 95% CI, 2.51–21.04; p < .001), sustained hyperglycemia (OR = 4.34; 95% CI, 1.79–10.52; p = .001), and days of hospitalization before central venous catheter insertion (OR = 1.04; 95% CI, 1.01–1.07; p = .004) were associated with PN use after adjustment for Assessment Score Intervention System score (OR = 0.33; 95% CI, 0.14–0.80; p = .014). Conclusions: PN therapy is an independent risk factor for central venous catheter–related infection in nonselected hospitalized adult patients.
5‐Fluorouracil Infusion Reduces Gut‐Associated Lymphoid Tissue Cell Number and Mucosal Immunoglobulin A Levels
Authors: Nagayoshi Hidetoshi , Fukatsu Kazuhiko , Ueno Chikara , Hara Etsuko , Maeshima Yoshinori , Omata Jiro , Hiraide Hoshio , Mochizuki Hidetaka
Published: May 2008

Background: Anticancer drugs have been demonstrated to affect gut mucosal morphology and cause gastrointestinal symptoms. We hypothesized that even small doses of 5‐fluorouracil (5‐FU) would reduce gut‐associated lymphoid tissue (GALT) mass and function. Methods: Mice underwent IV cannulation and received continuous infusion of normal saline or 10 mg/kg of 5‐FU for 5 days. GALT cell numbers, phenotypes, and mucosal immunoglobulin A (IgA) levels were measured. Results: During the infusion, there were no significant differences in food intake or body weight change between the 2 groups. Cell yields from the intraepithelial space and lamina propria of the small intestine were lower in the 5‐FU than the control group. The lamina propria CD4/CD8 ratio was reduced in the 5‐FU compared with the control group. Intestinal and respiratory tract IgA levels were lower in the 5‐FU than in the control group. Conclusions: A small dose of 5‐FU reduces GALT cell number and mucosal IgA levels, regardless of food intake.
Line Sepsis in Home Parenteral Nutrition Patients: Are There Socioeconomic Risk Factors? A Canadian Study
Authors: Chang Albert , Enns Robert , Saqui Olivia , Chatur Nazira , Whittaker Scott , Allard Johane P.
Published: May 2008

Background: Line sepsis complicates home parenteral nutrition (HPN). This study examined nonmedical risk factors that may contribute to line sepsis and compared 2 HPN programs with different administrative structures (Ontario and British Columbia [BC]) in terms of line sepsis and patient satisfaction. Methods: A survey was developed to evaluate possible correlation between line sepsis and (1) patients' perceptions of HPN care, (2) family support, (3) community support, and (4) socioeconomic status. Data were analyzed by categorizing into high‐ and low‐risk groups using a cutoff point. A second method analyzed the incidences of line sepsis as a continuous variable. Results: Sixty‐eight patients responded to the survey: 33 from Ontario (62%), 35 from BC (44%). Community agency, socioeconomic and educational status were not significant in determining line sepsis. Patients who had (1) medication or blood work done through the catheter, (2) a higher number of dependents, or (3) had a trained family member involved in HPN were in the high‐risk category for line sepsis, in addition to patients who were part‐time students or receiving social assistance. When comparing the provinces, there was no difference in line sepsis. However, significant differences between the provinces include (1) BC patients rate their level of care lower; (2) Ontario patients rely more on family members for HPN; and (3) Ontario patients have more community support. Conclusions: Line sepsis may be increased by some nonmedical risk factors. However, when comparing the 2 programs, rates of line sepsis were not influenced by different administrative structures.
Effect of Parenteral Nutrition on Nutrition Status After Bariatric Surgery for Morbid Obesity
Authors: Olmos M. A. Martínez , Vázquez M. J. Martínez , Gorría M. J. Morales , González P. Parada , Martínez I. Otero , Chimeno I. Maruri , González E. Pena , Bobo M. T. Inaraja , Núñez J. E. Casal
Published: May 2008

Background: To evaluate the influence of nutrition support (parenteral nutrition [PN] vs no parenteral nutrition [nPN]) on nutrition outcome, complications, and hospital stay after bariatric surgery (BS). Methods: Sixty‐seven consecutive BS patients (17 gastric bypass and 50 biliopancreatic diversion). The first 38 received PN and the next 29 did not (nPN) during the fasting postoperative (PO) period. In both groups, after fasting, a progressive oral diet was introduced. Data related to nutrition status, perioperative complications, and postsurgical hospital stay were compared. Results: Sixty‐seven patients (58 women), mean age 39.4 ± 11.0 years, body mass index (BMI) 50.7 ± 6.1 kg/m2, were included. Thirty‐eight patients received PN during 8.7± 2.6 days. Ingestion was initiated at a median 8 PO days in PN vs 6.5 PO days in nPN (p < .04). No significant differences between groups were found in age, final fasting serum albumin (SA), and 30 days postoperative SA, with a similar weight loss. Nonsignificant differences were found in non–catheter‐related infectious complications, being mainly urinary tract infections. Catheter‐related infections were present in 21.1% in the PN group and 13.8% in the nPN (p= .33). Median hospital stay after surgery was 14 ± 10 days in PN and 12± 10 days in nPN (p = .003). Conclusions: (1) Nutrition status after BS PO and 30 days postsurgery was no different between PN and nPN. (2) Postsurgery hospital stay was significantly decreased in the nPN group, without a greater incidence of complications. (3) According to nutrition outcome, PN seems unnecessary at the perioperative period in BS unless there are other postsurgical complications.
The Role of Arginine in Infection and Sepsis
Authors: Luiking Yvette C. , Poeze Martijn , Ramsay Graham , Deutz Nicolaas E. P.
Published: May 2008

Sepsis is a systemic response to an infection, with high morbidity and mortality rates. Metabolic changes during infection and sepsis could be related to changes in metabolism of the amino acid L‐arginine. In sepsis, protein breakdown is increased, which is a key process to maintain arginine delivery because both endogenous de novo arginine production from citrulline and food intake are reduced. Argi‐nine catabolism, on the other hand, is markedly increased by enhanced use of arginine via the arginase and nitric oxide pathways. As a result, lowered plasma arginine levels are usually found. Arginine may therefore be considered as an essential amino acid in sepsis, and supplementation could be beneficial in sepsis by improving microcirculation and protein anabolism. L‐Arginine supplementation in a hyperdynamic pig model of sepsis prohibits the increase in pulmonary arterial blood pressure, improves muscle and liver protein metabolism, and restores the intestinal motility pattern. Arguments raised against arginine supplementation are mainly pointed at stimulating nitric oxide (NO) production, with concerns about toxicity of increased NO and hemodynamic instability with refractory hypotension. NO synthase inhibition, however, increased mortality. Arginine supplementation in septic patients has transient effects on hemodynamics when supplied as a bolus but seems without hemodynamic side effects when supplied continuously.
Interactions Between Fatty Acids and Arginine Metabolism: Implications for the Design of Immune‐Enhancing Diets
Authors: Bansal Vishal , Syres Kimberly M. , Makarenkova Valeryia , Brannon Ryan , Matta Benjamin , Harbrecht Brian G. , Ochoa Juan B.
Published: May 2008

Background: Trauma increases the enzyme arginase, thus depleting arginine necessary for producing nitric oxide. Arginine and ω‐3 fatty acids are components in immune‐enhancing diets. These diets decrease infections in surgical patients, perhaps by preventing arginine deficiency. This study examines whether ω‐3 fatty acids alter the metabolic fate of arginine. Thus, we hypothesized there could be differential effects of varying prostaglandins on regulation of arginase. Methods: Prostaglandins PGE1, PGE2, and PGE3 were tested using RAW 264.7 cells cultured in the presence of these prostaglandins for 24 hours. IL‐13 (10 ng/mL) was added 24 hours later to induce arginase I. NO production was induced by adding LPS (2 μg/mL) to the cultures after another 24 hours. Results: Arginase activity (nmol/min/mg) was induced by all prostaglandins but significantly more by PGE1 (466.05 ± 30.25) and PGE2 (248.45 ± 15.05) than PGE3 (139.87 ± 19.88; p<.002) when co‐cultured with IL‐13. Western blots correlated the increase in arginase I expression. Nitrate levels (μM) were inversely proportional to activity with PGE3 having the highest production (3.89 ± 0.19) and PGE2 and PGE1 with the lowest (2.75 ± 0.49 and 1.54 ± 0.19, respectively). Inhibition of arginase I using nor‐hydroxyarginine increased and equalized nitrate levels. Conclusions: Different prostaglandins significantly alter the metabolism of arginine. Prostaglandins from ω‐6 fatty acids increases arginase I expression. By decreasing arginase I expression, prostaglandins from ω‐3 fatty acids may increase available arginine. The specific combinations of dietary fatty acids and arginine should be considered when tailoring dietary regimens. (Journal of Parenteral and Enteral Nutrition 29:S75–S80, 2005)
Control of Systemic and Local Inflammation with Transforming Growth Factor β Containing Formulas
Authors: Fell John M.E.
Published: May 2008

Enteral nutrition therapy with liquid diet has been shown to be effective in achieving clinical remission in intestinal Crohn's disease. The mechanism of action of this therapy, however, is still poorly understood. As part of our assessment of the action of 3 related polymeric enteral therapies, we have used a variety of techniques to document the histological and cytokine responses, in the mucosa and, systemically, to these treatments. The feeds studied (AL110, Modulen IBD and ACD004 [Nestle, Vevey, Switzerland]) all have casein as the protein source, are lactose free and are rich in transforming growth factor β (TGF‐β). They have all been shown to induce clinical remission associated with mucosal healing. In the case of Modulen IBD, as well as mucosal macroscopic and histological healing there was a fall in mucosal proinflammatory cytokines: interleukin‐1 mRNA in colonic and ileal, interleukin‐8 mRNA in the colon and interferon 7 mRNA in the ileum, but a rise in the regulatory cytokine TGF‐β mRNA in the ileum. These results indicate that these formulas are influencing the disease process itself, and thus suggest that the clinical remission achieved is a result of a reduction in inflammation, rather than a consequence of some other nutrition effect.