bluuebunny/crossref_metadata_2025 huggingface dataset:
Adverse Metabolic and Microbiological Effects of Tube Feeding in Experimental Canine Obstructive Jaundice
Authors: Chuang Jn‐Haur , Chen Wei‐Jen , Lo Sing‐Kai , Chang Nyuk‐Kong
Published: May 2008

Background: Inadequate oral intake and poor absorption result in malnutrition in obstructive jaundice. Both malnutrition and obstructive jaundice promote bacterial translocation from the gut. This study was designed to test the efficacy of tube feeding in preventing malnutrition and in decreasing the metabolic and microbiological adverse effects in obstructive jaundice. Methods: Forty adult mongrel dogs were studied and were allocated into one of four groups: group I (PO‐control) underwent sham ligation of the common bile duct (CBDL) and was fed ad libitum on Portagen (Mead Johnson, Evansville, IN); group II (PO‐CBDL) underwent CBDL and was ad libitum fed on the same formula; group III (FEG‐control) underwent sham CBDL and received forced esophagogastric feeding (FEG) with Portagen; and group IV (FEG‐CBDL) underwent CBDL and received FEG. All the animals underwent insertion of a F‐12 feeding tube to the stomach from an esophagotomy wound on day 1 and the tube was used for continuous enteral feeding with Portagen over 4 h/d from day 2 until day 13 in groups III and IV. Fourteen days later, blood samplings were done and a laparotomy was performed to obtain liver, mesenteric lymph nodes (MLN), and terminal ileum for quantitative bacterial culture. Bacterial translocation to MLN and liver was represented by log10 CFU/g of tissue in this study. Results: Both group II and IV animals with CBDL significantly lost body weight (p =.0001) and had a lower level of prealbumin (p =.0054). A significant increase in bacterial translocation to MLN and to liver occurred in groups II and IV (p =.0017 and.0268, respectively). Intestinal bacterial population was also higher in these two groups than in the other two controls (p = 0.0028). An increase in plasma ammonia level was found in dogs with CBDL (p =.0002) and in dogs with FEG (p =.003), compared with their respective controls. Three among 13 dogs in group IV died and no mortality occurred in the other groups (p =.223). Conclusions: Tube feeding fails to improve malnutrition in obstructive jaundice and is associated with intestinal bacterial overgrowth, promoting bacterial translocation to MLN and liver, precipitating liver dysfunction and consequently a higher mortality. (Journal of Parenteral and Enteral Nutrition 21:036–040, 1997)
Serum Albumin Is Predictive of 30‐Day Survival After Percutaneous Endoscopic Gastrostomy
Authors: Friedenberg Frank , Jensen Georgina , Gujral Navjyot , Braitman Leonard E. , Levine Gary M.
Published: May 2008

Background: Percutaneous endoscopic gastrostomy (PEG) tubes have been used since 1980 in patients who require prolonged enteral feeding. Purpose: To identify factors associated with poor survival (defmed as survival <30 days) post‐PEG. Methods : We assessed a cohort of 64 patients consecutively referred for a percutaneous endoscopic gastrostomy tube in a single, tertiary care hospital. Prior to PEG tube placement, we evaluated relevant clinical variables in each patient to determine their effect on 30‐day mortality. Results: Of the cohort, 43 of 64 (67.2%) survived at least 30 days after tube placement. One death was attributable to tube placement. Bivariate analyses showed that 30‐day survival correlated directly with serum albumin (r =.253; p =.049) and inversely with creatinine (r = —0.255; p =.042). Using multivariable logistic regression analysis, only albumin was identified as an independent predictor of 30‐day survival (p =.044). Eighty‐three percent of patients with a serum albumin ≥3.0 g/dL survived 30 days compared with 58% with an albumin <3.0, a difference of 25% (95% CI, ‐2% to 54%; p =.07). Conclusions: In conclusion, serum albumin appears to be a predictor of early survival in individuals undergoing percutaneous endoscopic gastrostomy tube placement. (Journal of Parenteral and Enteral Nutrition 21: 72–74, 1997)
Immunologic Effects of Acute Hyperglycemia in Nondiabetic Rats
Authors: Kwoun Moon O. , Pei Ra Ling  , Lydon Erin , Imrich Amy , Zhensheng Qu  , Palombo John , Bistrian Bruce R.
Published: May 2008

Background: This study was designed to determine the consequences of acute hyperglycemia on the immune function of peripheral neutrophils, peritoneal macrophages, and alveolar macrophages in nondiabetic rats. Methods: The animals were randomly divided into nonsurgical (normal) and surgical groups. The postoperative rats were further divided into normoglycemic (control) and hyperglycemic (glucose) groups. The hyperglycemic condition was maintained by constant infusion of glucose to raise plasma glucose concentration to 300 mg/ dL for 3 hours. The immune cells were then harvested to determine their phagocytic and oxidative capacities via flow cytometry. Results: The results showed that hyperglycemia significantly decreased the respiratory burst of alveolar macrophages (p <.05). In contrast, hyperglycemia enhanced phagocytosis in these cells (p <.002). There was a significant activation of the respiratory burst in peripheral neutrophils by surgery (p <.002), but no effect of hyperglycemia. Conclusions: We conclude that hyperglycemia itself can influence immune function in some phagocytic cells, which may be an important factor in postsurgical infection. (Journal of Parenteral and Enteral Nutrition 21:91–95, 1997)
Effects of Extra‐Carbohydrate Supplementation in the Late Evening on Energy Expenditure and Substrate Oxidation in Patients With Liver Cirrhosis
Authors: Chang Wei‐Kuo , Chao You‐Chen , Tang Hung‐Shang , Lang Hui‐Fen , Hsu Chung‐Te
Published: May 2008

Background: The purpose of this study was to demonstrate the effects of extra‐carbohydrate supplementation before bedtime on energy metabolism and substrate oxidation in patients with liver cirrhosis. Methods: Sixteen cirrhotic patients and eight control subjects were included in this study. To compare the effect of energy metabolism and substrate oxidation with or without a bedtime snack, indirect calorimetry was assessed at 7 to 8 AM after overnight fasting, following either dinner (6 PM) or a bedtime snack (11 PM) the evening before. The bedtime snack contained about 50 g of carbohydrate. The energy expenditure and substrate oxidation were calculated from the indirect calorimetry measurement and 24‐hour urinary nitrogen excretion. Results: In those who fasted since dinner, the respiratory quotient (RQ) was significantly lower in cirrhotic patients than in control subjects. Also, the energy utilized by cirrhotic patients was derived primarily from fat oxidation (58%), whereas the main energy source for controls was carbohydrate (55%). An extra‐carbohydrate supplement before bedtime did not influence the indirect calorimetry measurement in the controls, but there were significant increases in both RQ and carbon dioxide production (VCO2) in cirrhotic patients. The extra‐carbohydrate supplementation did not significantly change the absolute resting energy expenditure utilization in control subjects; however, the utilization of carbohydrate significantly increased with a decrease in fat and protein oxidation in the cirrhotic patients. Conclusions: These preliminary data suggest that extra‐carbohydrate supplementation before bedtime can shorten nocturnal fasting with a more economic fuel utilization and effectively diminish fat and protein oxidation in cirrhotic patients. (Journal of Parenteral and Enteral Nutrition 21:96–99, 1997)
Effects of Small‐Peptide and Whole‐Protein Enteral Feedings on Serum Proteins and Diarrhea in Critically III Patients: A Randomized Trial
Authors: Heimburger Douglas C. , Geels Wilma J. , Bilbrey Jodie , Redden David T. , Keeney Carolyn
Published: May 2008

Background: It has been proposed that enteral feeding formulas containing small peptides are more efficacious and better tolerated than whole‐protein formulas in critically ill patients. Methods: Intensive care unit patients were stratified with regard to treatment with antibiotics and serum albumin and randomized to treatment with a small‐peptide enteral diet or an isoenergetic, isonitrogenous whole‐protein diet for 10 days. To assess efficacy, we measured serum prealbumin and fibronectin, and to assess tolerance, we monitored the incidence of diarrhea. A protocol was followed to ascertain all causes of diarrhea (defined as >200 g stool or ≥3 liquid stools on 2 consecutive days). Results: Fifty subjects completed the trial. Serum prealbumin and fibronectin increased between 21% and 36% in both groups, but the increase was significant only in the small‐peptide group. The change in fibronectin between days 5 and 10 was significantly greater in the small‐peptide group (p =.02). Diarrhea occurred in 10 subjects (17.8% of days) receiving small‐peptide feeding and 4 subjects (7.5% of days) receiving whole‐protein feeding (p =.07 for incidence and 0.03 for prevalence), but the difference was explained by the coincidental use of more diarrhea‐causing medications in the former. Only one case of diarrhea could be attributed to tube feeding. Conclusions: During 10 days of feeding, the small‐peptide diet produced slightly greater increases in serum rapid‐synthesis proteins than did the whole‐protein diet, especially between days 5 and 10. The clinical implications of this difference between the diets are unknown. Both small‐peptide and whole‐protein diets were well tolerated. (Journal of Parenteyal and Enteral Nutrition 21:162–167, 1997)
Glutamine‐Enriched Enteral Diet Enhances Bacterial Clearance in Protracted Bacterial Peritonitis, Regardless of Glutamine Form‡
Authors: Furukawa Satoshi , Saito Hideahi , Inaba Tsuyoshi , Lin Ming‐Tsan , Inoue Tomomi , Naka Shuji , Fukatsu Kazuhiko , Hashiguchi Yojiro , Han Ilsoo , Matsuda Takeaki , Ikeda Shigeo , Muto Tetsuichiro
Published: May 2008

Background: The effects of glutamine (Gln)‐enriched enteral diets on bacterial clearance were investigated in a rat protracted peritonitis model. The effects of the Gln form, peptide‐based vs free amino acid‐based, were also compared. Methods: Twenty‐three rats underwent gastrostomy. An osmotic pump was implanted in the peritoneal cavity. The rats received a continuous intragastric infusion of one of three diets: Gln‐depleted (Gln 0), Gln‐enriched with the Gln in free amino acid form (Gln F), or Gln‐enriched with the Gln in oligopeptide form (Gln P). The three formulas were isocaloric and isonitrogenous. The pumps delivered a continuous infusion ofEscherichia coli, starting at 48 hours after implantation, for 24 hours. Then, the animals were killed. Results: Bacterial numbers in peritoneal lavaged fluid (PLF) and the liver were significantly lower in the Gln P and Gln F groups than in the Gln 0 group. The bacterial number in PLF correlated with that in the liver. Neither the number nor the population of peritoneal exudative cells differed among groups. Plasma levels of proline, alanine and citrulline were significantly higher in the Gln P and Gln F groups than in the Gln 0 group. Both Gln supplemented groups showed significantly greater villous height, crypt depth, and numbers of mitoses per crypt in the small intestine than the Gln 0 group. Conclusions: Supplemental Gln enhances peritoneal and hepatic bacterial clearance, regardless of Gln form. Gln‐enriched may be more beneficial than Gln‐depleted enteral diets in peritonitis. (Journal of Parenteral and Enteral Nutrition 21:208–214, 1997)
Subcutaneously Implanted Enteral Nutrition Port
Authors: Maruyama Michio , Ebuchi Masakazu , Sugano Norihide , Takamatsu Susumu , Kudo Toshihumi
Published: May 2008

Background: Patients who have undergone esophagectomy with extensive lymph node dissection under thoracolapalotomy for advanced esophageal carcinomas frequently need long‐term nutrition support because of their inadequate oral intake. We have used tube enterostomy feeding for these patients not only immediately after the operations but also at home to prevent the development of malnutrition. Patients who receive long‐term tube enterostomy feeding often suffer from skin problems around the enteral nutrition catheters. Once the catheter is removed, the patient with anticipated malnutrition is subsequently unable to receive beneficial enteral nutrition. We have developed a new enteral access system that is placed subcutaneously. This subcutaneously implanted enteral nutrition port makes possible intermittent and long‐term enteral nutrition support not only for the postoperative period but also for home care. Methods: This system consists of the port (Infuse‐a‐Port, SMAP15 Snaplock Macro‐Port Venous Access System; Strato Medical Co) and the enteral nutrition tube (Enteral Tube 8F, 75 cm; Zeon Co). This system was applied to seven patients who had undergone esophagectomy. The port was placed on the lower chest subcutaneously, and the catheter was placed through the gastric tube and duodenum up to the jejunum. After the operation, a 20‐gauge port needle was placed, and enteral nutrition formula (Enterued; Termo Co) was started with the enteral nutrition pump. Results: No complications (eg, infection of skin, obstruction of tube) were observed from the postoperative period through the home care stage. The observation period for this implanted system ranged from 2 to 12 months. The patients were able to avoid the malnutrition anticipated after the extensive operations and continued to receive nutrition support safely and effectively at home. Conclusion: This new nutrition support system is safe and efficient for patients who anticipate long‐term enteral nutrition support. A subcutaneously implanted enteral nutrition port makes possible intermittent and long‐term nutrition support without patient discomfort and inconvenience. (journal of Parenteral and Enteral Nutrition 21:238–240, 1997)
Insulin‐Like Growth Factor 1 Stimulates Protein Synthesis and Inhibits Protein Breakdown in Muscle From Burned Rats
Authors: Fang Cheng‐Hui , Bing Guo Li  , Wang Jing Jing , Fischer Josef E. , Hasselgren Per‐Olof
Published: May 2008

Background: Bum injury is associated with substantial whole‐body protein loss, reflecting mainly a catabolic response in skeletal muscle. Recent studies suggest that treatment with insulin‐like growth factor 1 (IGF‐1) may reverse the catabolic response to burn injury, but the effects of IGF‐1 on muscle protein synthesis and breakdown rates after bum injury are not known. We tested the hypothesis that IGF‐1 blunts the catabolic response in skeletal muscle after burn injury by stimulating protein synthesis and inhibiting protein breakdown and that this effect of IGF‐1 is caused by a direct effect on muscle tissue. Methods: Intact extensor digitorum longus muscles from burned, sham‐burned, and untreated rats were incubated in the absence or presence of different concentrations of IGF‐1. Total and myofibrillar protein breakdown rates were measured as net release of tyrosine and 3‐methylhistidine, respectively. Protein synthesis rates were determined by measuring the incorporation of (U‐14C)‐phenylalanine into protein. Results: IGF‐1 stimulated protein synthesis and inhibited protein breakdown in a dose‐dependent fashion in muscles from burned and unburned rats. The maximal effect of IGF‐1 on protein synthesis was seen at a hormone concentration of 100 ng/mL, whereas protein breakdown was further inhibited when the hormone concentration was increased to 1 μg/mL. Ubiquitin messenger RNA (mRNA) levels were reduced by IGF‐1 in incubated muscles, suggesting that IGF‐1 may inhibit ubiquitin‐dependent protein breakdown. Conclusions: These results suggest that the anabolic effects of IGF‐1 after burn may reflect inhibited protein breakdown and stimulated protein synthesis in skeletal muscle and that this response may be caused by a direct effect of IGF‐1 on muscle tissue. (journal of Parenteral and Enteral Nutrition 21:245–251, 1997)
Effects of Intravenously Infused Fish Oil on Platelet Fatty Acid Phospholipid Composition and on Platelet Function in Postoperative Trauma
Authors: Roulet Michel , Frascarolo Philippe , Pilet Marianne , Chapuis Germain
Published: May 2008

Background: The aim of this study was to assess the short‐term effect of IV infusion of fish oil emulsion on the fatty acid profiles of platelet phosphatidylcholine and phosphatidylethanolamine and on platelet function in postoperative patients. Methods: Over a 7‐day period, 10 patients received a 20% soybean fat emulsion with an added 10% marine fish oil emulsion, whereas 9 controls received only 20% soybean fat emulsion. Results: By comparison with controls, in patients receiving fish oil, (1) a large increase in eicosapentaenoic acid (20:5n‐3) was observed in both platelet phosphatidylcholine (1.55% ±0.17% vs 0.38% ± 0.06% by weight, p <.01) and phosphatidylethanolamine (2.21% ± 0.18% vs 0.66% ± 0.08% by weight, p<.01); (2) eicosapentaenoic acid (20:5n‐3)/arachidonic acid (20:4n‐6) ratios doubled in both platelet phosphatidylcholine (p <.01) and phosphatidylethanolamine (p <.05); (3) with collagen as aggregating factor, maximal reaction speed decreased (p <.02) and latency increased (p <.002); and (4) no toxic effect, in particular no increase of postoperative bleeding and no perturbation of hepatic and renal function, was observed during the fish oil infusion. Conclusions: A short‐term IV infusion of fish oil clearly modifies the platelet composition and changes some parameters of platelet function. (Journal of Parenteral and Enteral Nutrition 21:296–301, 1997)
Collaborative JPEN‐Clinical Nutrition Scientific Publications Role of intestinal bacteria in nutrient metabolism
Authors: Cummings J.H. , Macfarlane G.T.
Published: May 2008

The human large intestine contains a microbiota, the components of which are generically complex and metabolically diverse. Its primary function is to salvage energy from carbohydrate not digested in the upper gut. This is achieved through fermentation and absorption of the major products, short chain fatty acids (SCFA), which represent 40–50% of the available energy of the carbohydrate. The principal SCFA, acetate, propionate and butyrate, are metabolized by the colonic epithelium (butyrate), liver (propionate) and muscle (acetate). Intestinal bacteria also have a role in the synthesis of vitamins B and K and the metabolism of bile acids, other sterols and xenobiotics.

The colonic microflora are also responsive to diet. In the presence of fermentable carbohydrate substrates such as non‐starch polysaccharides, resistant starch and oligosaccharides, bacteria grow and actively synthesize protein. The amount of protein synthesis and turnover within the large intestine is difficult to determine, but around 15 g biomass is excreted in faeces each day containing 1 g bacterial‐N. Whether bacterially synthesized amino acids are ever absorbed from the colon remains unclear.

Finally, individual colonic micro‐organisms such as sulphate‐reducing bacteria, bifidobacteria and clostridia, respond selectively to specific dietary components in a way that may be important to health.
Elemental Diet‐Induced Bacterial Translocation Associated With Systemic and Intestinal Immune Suppression
Authors: Xu Dazhong , Lu Qi , Deitch Edwin A.
Published: May 2008

Background: Elemental diets can lead to a loss of intestinal barrier function, promote bacterial translocation, and impair host immune defenses. The purpose of this study was to determine the effects of IV and orally administered total parenteral nutrition (TPN) solution on systemic and intestinal immunity and to establish whether supplemental cellulose fiber could improve the impaired immune response. Methods: The incidence of bacterial translocation and immune function was quantitated by measuring organ weights, immune cell population levels, and the mitogenic response of lymphocytes from the spleen, mesenteric lymph nodes and Peyer's patches of rats receiving parenteral or enteral TPN solution, with and without fiber supplementation. Results: Parenteral and enterally administered TPN solution promoted bacterial translocation to the mesenteric lymph nodes, reduced immune cell population levels, and decreased the lymphocyte mitogenic response to T‐ and B‐cell mitogens. Supplemental cellulose fiber reduced the incidence of diet‐induced bacterial translocation from 84% to 31% (p <.01) and improved immune cell function. To more closely examine the relationship between bacterial translocation and impaired lymphocyte mitogenic activity, rats receiving TPN orally or IV were separated into two groups based on whether or not bacterial translocation occurred. Rats in which fiber prevented bacterial translocation had normal mitogenic responses, whereas the subgroup of rats in which fiber failed to prevent bacterial translocation had profound decreases in their lymphocyte mitogenic responses. Conclusions: Both parenteral and enteral elemental diets induced bacterial translocation and impaired systemic and intestinal immune function. Fiber supplementation was effective in reducing elemental diet‐induced bacterial translocation and significantly prevented diet‐induced impairment of lymphocyte function. (Journal of Parenteral and Enteral Nutrition 22:37–41, 1998)
A Pharmacokinetic Study of Peritoneal Absorption of Glucose and Alanine in Rats: Nutritional Implications
Authors: Morán J.M. , Mahedero G. , Salas J. , Ribeiro J.M. , Mariñõ E. , Vinagre L.M.
Published: May 2008

Background: The aim of this work was to study the serum bioavailability of glucose and alanine after bolus injection into the peritoneal cavity in Wistar rats and to determine the influence of their metabolism on the rate of absorption of these nutrients. Methods: A group of animals (n = 14) was infused intraperitoneally (IP) or IV with 2 μCi of nonmetabolizable L‐[1‐14C]glucose diluted in 5 mL of 5% D‐glucose/250 g body wt, after which plasma radioactivity was determined. A second group of animals (n = 14) received, either IP or IV, 3 μCi of nonmetabolizable D‐[U‐14C]alanine diluted in 2 mL of an iso‐osmolar L‐amino acid solution/250 g body wt, after which both plasma radioactivity and L‐alanine concentration were determined. The constants of absorption from peritoneal cavity (K a) and elimination from plasma (K e) and the serum absolute bioavailability BA a) after 8 h were calculated assuming a bicompartment pharmacokinetic model. Results: L‐glucose: K a = 3.05 ± 0.97 h−1; K e = 0.40 ± 0.12 h−1; BA a = 94% ± 4%. D‐alanine: K a = 1.08 ± 0.40 h−1; K e = 0.11 ± 0.06 h−1; BA a = 90% ± 11%. L alanine: K a = 1.75 ± 0.273 h−1; K e = 0.02 ± 0.01 h−1; BA a = 99% ± 1%. No hyperglycemia, hypoglycemia, or glycosuria appeared in any case. Conclusions: The absorption rate from peritoneal cavity is nearly 10‐fold higher than the elimination rate from plasma for the three substrates. Eight hours after IP injection an abso lute bioavailability almost as high as after IV injection (ie, close to 100%) was achieved. The metabolism of the nutrients seems to help the peritoneal absorption, as L‐alanine is better absorbec then D‐alanine. These results show that upon IP injection the stud ied nutrients are almost completely absorbed in a short period of time without hyperglycemia or neoglucogenesis and so sug gest that their administration may be a feasible approach to feed ing patients receiving peritoneal dialysis. This model could be applied to other compounds, such as peptides and disaccharides (Journal of Parenteral and Enteral Nutrition 22:72–76, 1998)
Is Vitamin K1 Supplementation Necessary in Long‐Term Parenteral Nutrition?
Authors: Chambrier Cécile , Leclercq Michel , Saudin François , Vignal Bruno , Bryssine Sylvie , Guillaumont Marc , Bouletreal Paul
Published: May 2008

Background: IV lipid emulsions contain vitamin K in substantial quantities and in 1989, we therefore stopped supplying vitamin K1 to patients receiving home parenteral nutrition (HPN). Methods: Nine patients (group I) receiving HPN before 1989 (10 mg IV vitamin K1 supplementation weekly until 1989, which was discontinued thereafter) and six patients with an initial low plasma vitamin K1 concentration (related to their malabsorption) (group II) receiving HPN after 1989 were studied. Pro‐thrombin time (PT), plasma vitamin K1 concentration, and vitamin K1 content in lipid emulsions were measured throughout the period of HPN. Results: All lipid emulsions, except for Eurolip 20% and Clinoleic 20% (Baxter SA, Maurepas, France) contained vitamin K1, with concentration ranges from 179 ± 39 to 353 ± 78 ng/L. Group I patients had an initial high plasma vitamin K1 concentration due to the vitamin K1 supplementation. After this supplementation was discontinued, plasma vitamin K1 decreased and remained in normal ranges with a normal PT. Throughout the HPN period after 1989, patients received 255 ± 104 μg of vitamin K1 weekly through lipid emulsions. The PT and plasma vitamin K1 concentrations in group II patients were restored by lipid emulsions, which contained 418 ± 143 μg/wk of vitamin K1. Conclusions: In patients receiving IV lipids (except for Eurolip and Clinoleic), a normal vitamin K1 status can be maintained during long‐term HPN without vitamin K1 supplementation. However, vitamin K supplementation cannot be abandoned until the vitamin K content of emulsions is standardized by manufacturers. A weekly supply of 250 to 400 μg of vitamin K1 is enough to maintain and even restore a normal vitamin K1 status in HPN. (Journal of Parenteral and Enteral Nutrition 22: 87–90, 1998)
Neither Intact nor Hydrolyzed Soy Proteins Elicit Intestinal Inflammation in Neonatal Piglets
Authors: Mccracken Barbara A. , Zijlstra Ruurd T. , Donovan Sharon M. , Odle Jack , Lien Eric L. , Gaskins H. Rex
Published: May 2008

Background: Efficacy of feeding hydrolyzed soy proteins to infants intolerant to cow milk proteins has not been determined fully. This study compared growth and intestinal responses of neonatal piglets fed formulas with hydrolyzed soy protein to piglets fed formulas with intact soy or cow milk (casein‐whey) proteins. Methods: Piglets (n = 40, day 2 postpartum) were fed commercial milk replacer until day 7 postpartum (designated day 0) and then were assigned randomly to casein‐whey (CW) or soy (intact, SI; hydrolyzed, SH) formulas to evaluate intestinal responses on days 0, 2, 5, and 10. Results: Average daily gain was higher for CW (121 g/d; p <.05) compared with SI piglets (85 g/d); SH pig weight gain was intermediate (109 g/d). Villus height‐to‐crypt depth ratio in proximal jejunum was lower (p <.05) on day 2 than day 0 in soy‐fed pigs and lower (p <.05) on day 5 than day 0 in CW pigs. Mucosal mast cells were generally higher in CW pigs compared with soy‐fed pigs. Villus goblet cell numbers in the midjejunum of SH‐fed piglets were lower (p <.05) on day 5 compared with day 0. On day 5, crypt goblet cell numbers were higher (p <.05) in the midjejunum of CW‐fed piglets compared with SH‐fed piglets with numbers intermediate for SI‐fed piglets. Intestinal differences were not detected among dietary treatments for major histocompatibility complex class I and II gene expression, tissue concentrations of prostaglandin E2, or CD8− T‐cell numbers. Conclusions: Hydrolyzed soy proteins do not elicit intestinal inflammatory responses in piglets and may be viable alternatives to milk and intact soy proteins for feeding infants. (Journal of Parenteral and Enteral Nutrition 22:91–97, 1998)
The Anabolic Effects of IGF‐1 in Skeletal Muscle After Burn Injury Are not Caused by Increased Cell Volume
Authors: Fang Cheng‐Hui , Li Bing Guo , James J. Howard , Fischer Josef E. , Hasselgren Per‐Olof
Published: May 2008

Background: In a recent report, insulin‐like growth factor 1 (IGF‐1) stimulated protein synthesis and inhibited protein breakdown in skeletal muscle after burn injury. The mechanism of the anabolic effects of IGF‐1 in skeletal muscle is not known. We tested the hypotheses that IGF‐1 stimulates protein synthesis and inhibits protein breakdown in skeletal muscle secondary to cell swelling and that cell swelling in itself induces an anabolic response in muscle tissue. Methods: Extensor digitorum longus muscles from control and burned rats were incubated in the absence or presence of 1 μg/mL of IGF‐1. Protein synthesis and breakdown rates were determined by measuring incorporation of 14C‐phenylalanine into protein and net release of tyrosine, respectively. Cell volume was measured by determining wet and dry weight and by using 3H‐mannitol as an extracellular marker. Results: IGF‐1 stimulated protein synthesis and inhibited protein breakdown in muscles from nonburned and burned rats without influencing cell volume. Incubating muscles in hypo‐osmotic medium increased cell volume by 17% and inhibited protein breakdown by 14% but did not influence protein synthesis. Conclusions: The anabolic effects of IGF‐1 in skeletal muscle are not caused by increased cell volume. The results differ from those reported previously in liver cells in which the anabolic effects of IGF‐1 were associated with cell swelling. The role of changes in cell volume in the regulation of protein metabolism may be different in skeletal muscle than in other tissues. (Journal of Parenteral and Enteral Nutrition 22:115–119, 1998)
A Valid and Reliable Tool to Quantify Stool Output in Tube‐Fed Patients
Authors: Guenter Peggi A. , Sweed Margot R.
Published: May 2008

A major problem in determining whether diarrhea exists in tube‐fed patients is the quantification of stool output. On the basis of this need a stool output assessment tool was developed and tested for validity and reliability. Interrater reliability and construct validity were determined by using staff nurses' and principal investigators' observations. Observers blindly rated the bowel movement (BM) on size and consistency and on whether the BM was thought to represent “diarrhea.” Interrater reliability was found to be significant. Stool output scores were determined by using a 24‐hour output form that assessed stool size, consistency, and frequency. Content validity was established as well as concurrent and construct validity. (Journal of Parenteral and Enteral Nutrition 22:147–151, 1998)
Grains or Veins: Is Enteral Nutrition Really Better Than Parenteral Nutrition? A Look at the Evidence
Authors: Lipman Timothy O.
Published: May 2008

Background: Enteral nutrition is said to be better than parenteral nutrition for providing nutrition support to humans. Purpose: To assess the literature documenting the assertions that enteral nutrition is superior to parenteral nutrition with respect to cost, safety, physiology, intestinal structure and function, bacterial translocation, and outcome. Data identification: Sources included MEDLINE search, personal files, and references from human comparative studies of enteral vs parenteral nutrition. Study selection: The goal was to include all human studies directly addressing questions of comparative efficacy of enteral and parenteral nutrition. Emphasis was given to prospective randomized controlled studies where available. Retrospective comparisons were not included. Data extraction: An attempt was made to briefly summarize methodology and findings of relevant studies. No general attempt was made to assess quality of individual studies. Results of data synthesis: Enteral nutrition appears to be less expensive than parenteral nutrition, but new economic analyses are needed given the newer aggressive access techniques for enteral nutrition. Enteral nutrition is associated with meaningful morbidity and mortality. The little comparative data existent suggest no differences in safety. Comparative studies of physiology and metabolism as well as comparative and noncomparative studies of intestinal function and structure do not support putative advantages of enteral nutrition. There is no evidence that enteral nutrition prevents bacterial translocation in humans. Enteral nutrition probably reduces septic morbidity compared with parenteral nutrition in abdominal trauma. Otherwise, there is no evidence that enteral nutrition consistently improves patient outcome compared with parenteral nutrition. Conclusions: With the exception of decreased cost and probable reduced septic morbidity in acute abdominal trauma, the available literature does not support the thesis that enteral nutrition is better than parenteral nutrition in humans. (Journal of Parenteral and Enteral Nutrition 22:167–182, 1998)
Glutamine Protects Intestinal Epithelial Cells: Role of Inducible HSP70
Authors: Robinson Malcolm K.
Published: May 2008

In this in vitro study, the authors test the premise that glutamine (Gln) protects intestinal epithelial cells under conditions of stress via induction of heat shock proteins. Gln (0–20 mM) or its non‐metabolizable analogue, 6‐diazo‐5‐oxo‐L‐norleucine (DON, 0400 μM), was added for 2 hours to IEC‐18 cells that had previously been grown for two days to near confluence in Gln‐free and serum‐free culture media (Dulbecco's modified Eagle's medium). Induction of heat shock protein 70 (HSP70) under these conditions was assessed by Western blots using the monoclonal antibody C92, which recognizes only the inducible form of HSP70. HSP70 mRNA abundance was assessed with Northern blot analysis using a cDNA probe specific for inducible HSP70. Radiolabeled cells (51Cr) treated with Gln or DON were subsequently exposed to heat (49°C for 30–240 minutes) or an oxidant, monochloramine (NH2Cl, 2 μM), and cell injury was quantitated by calculating the percent of 51Cr release. Finally, Gln or DON was added to cells cultured in quercetin, a known inhibitor of HSP70 production. The cells were then analyzed for HSP70 induction, HSP70 mRNA abundance, and cellular protection from heat and oxidation.

Gln added to IEC‐18 cells induced an increase in HSP70 and HSP70 mRNA in a concentration‐dependent manner. Gln administration caused a statistically significant 50% and 65% reduction in cytolysis of cells exposed to lethal heat and oxidation, respectively. The non‐metabolizable analogue of Gln, DON, also induced an increase in HSP70 and HSP mRNA but less than that induced by Gln. DON caused a statistically significant 35% and 25% reduction in cytolysis of cells exposed to lethal heat and oxidation. This suggests that the observed effects of Gln are mediated by both metabolic and non‐metabolic mechanisms. Incubation of cells with quercetin prior to Gln and DON administration not only blocked HSP70 protein and mRNA induction but abrogated the protective effects of Gln and DON on cells exposed to lethal heat and oxidation. The authors conclude that Gln protects intestinal epithelial cells from heat and oxidation via mechanisms which are in part mediated by HSP70 induction.
Metabolic Effects of Adjuvant Recombinant Human Growth Hormone in Patients With Continuing Sepsis Receiving Parenteral Nutrition
Authors: Bettany G.E.A. , Camacho‐Hubner C. , Obeid O. , Halliday D. , Powell‐Tuck J.
Published: May 2008

Background: Adjuvant growth hormone is advocated for treating the catabolism of prolonged sepsis not corrected by parenteral nutrition alone. Methods: An open study was performed in which eight patients whose postabsorptive resting energy expenditure was persistently elevated by a mean of 19% as a result of continuing sepsis were randomized to receive 0.03 or 0.06 mg/kg recombinant human growth hormone (rhGH) each evening for 7 days adjuvant to total parenteral nutrition. Plasma concentrations of growth hormone, insulin, insulin‐like growth factors 1 and 2 (IGF‐1 and ‐2) and their binding proteins IGFBP‐1 and ‐3 were measured before and after rhGH, and their relationship with rates of whole‐body protein turnover was determined in the morning in the postabsorptive state by using L‐[1‐13C]leucine. Results and Conclusions: Before rhGH, the patients were hyperinsulinemic (mean, 44.4 mU/L) but had growth hormone levels within the normal range (< 10 mU/L). After the seventh dose of rhGH, nocturnal growth hormone concentrations rose to a mean of 35.3 ± 26.1 and 61.3 ± 21.05 mU/L for the low and higher dose groups, respectively. Morning IGF‐1 concentrations showed a small increase during treatment, rising from a mean of 241.3 ± 99.0 to 301.7 ± 167.3 ng/mL for the low‐dose group and from 214.5 ± 74.6 to 294.1 ± 116.9 ng/mL for the higher‐dose group. IGF‐2 increased slightly by 89 ± 39 and 75 ± 49 ng/mL for the low and higher doses, respectively. IGFBP‐1 and ‐3 and insulin did not change. The balance between nitrogen input and urinary urea nitrogen increased after rhGH by a mean of 5.3 g/d with no differences between the two dosage groups (4.74 ± 1.56 g/d for the higher dose, 5.94 ± 3.70 g/d for the lower). No significant changes were observed in whole‐body protein turnover after a 1‐week course of rhGH. (Journal of Parenteral and Enteral Nutrition 22:199–205, 1998)
The Influence of Intravenous Infusions of Glucose and Amino Acids on Pancreatic Enzyme and Mucosal Protein Synthesis in Human Subjects
Authors: O'Keefe Stephen J. D. , Lemmer Eric R. , Ogden Janice M. , Winter Trevor
Published: May 2008

Background: Animal studies have shown that the synthesis and secretion of pancreatic enzymes and the turnover of mucosal proteins is strongly influenced by diet. Methods: To determine whether the absorbed products of digestion are responsible for these changes, we investigated in groups of five healthy volunteers, the effects of IV infusions of amino acids (0.08 g/kg/h) and glucose (0.3 g/kg/h) on pancreatic enzyme and mucosal protein synthesis. Proteins were labeled in vivo by a 4‐hours IV infusion of 14 C‐leucine and the enteric infusion of 3H‐leucine tracer, during simultaneous cholecystokinin stimulation and duodenal collection of secreted pancreatic enzymes. Labeling of mucosal proteins was measured by endoscopic biopsy. Results: The amino acid infusions elevated plasma amino acid levels, and the glucose infusions increased both glucose and insulin concentrations. The rates for amylase and trypsin secretion were significantly lower during the first 2 hours of glucose infusion and the rate of synthesis of trypsin was delayed by IV amino acid infusions from 52.1 ± 4.1 to 77.6 ± 8.5 minutes. Mucosal protein turnover rates were unaffected. 3H‐labeling via the enteral route showed similar enzyme synthesis rates but variable mucosal incorporation rates. Conclusions: IV nutrients do not appear to stimulate the synthesis of pancreatic and mucosal proteins in human subjects. (Journal of Parenteral and Enteral Nutrition 22:253–258, 1998)
Role of Arachidonic Acid in the Regulation of the Inflammatory Response in TNF‐α‐treated Rats
Authors: Ling Pei‐Ra , Boyce Patricia , Bistrian Bruce R.
Published: May 2008

Background: This study examined whether adding arachidonic acid (AA) to a fish oil diet would alter certain of the anti‐inflammatory effects of fish oil in response to tumor necrosis factor (TNF) infusion in rats. Methods: AA was given at 0.08 wt% of diet for 6 weeks. The total fat in each diet provided 20% of dietary energy. Four groups were pair‐fed sunflower oil (S), S+AA, fish oil (F), or F+AA for 6 weeks. At the end of feeding, each animal received TNF‐α (20 μg/kg) infusion for 3 hours. After 1 hour of TNF infusion, a euglycemic and hyperinsulinemic clamp (10 mU/min per kilogram of insulin) was used to determine the actions of insulin. The insulin‐stimulated glucose utilization in liver, muscle, and fat was determined by using 14C‐deoxyglucose. The plasma glucose, insulin, and corticosterone levels were determined at basal, 60 minutes, and the end of the experiment (180 minutes). The fatty acid composition of plasma phospholipids also was determined. Results: Fish oil significantly increased w‐3 fatty acids in phospholipids in both F and F+AA and decreased AA in F, compared with S. AA significantly restored the level of AA and reduced the increase of ω‐3 fatty acids in phospholipids in F+AA compared with F, but had no impact on fatty acid composition when added to S. Corticosterone level was significantly lower with fish oil feeding but higher in both F and S containing AA compared with F and S, respectively. The highest glucose uptake in tissues was in F, followed by F+AA, and then S and S+AA. Conclusions: These results suggest that fish oil is anti‐inflammatory principally through a reduction in the AA content of phospholipids. (Journal of Parenteral and Enteral Nutrition 22:268–275, 1998)
Plasma Leptin Levels in Trauma Patients: Effect of Adjuvant Recombinant Human Growth Hormone in Intravenously Fed Multiple Trauma Patients
Authors: Jeevanandam Malayappa , Begay Carmen K. , Petersen Scott R.
Published: May 2008

Background: Leptin, the newly discovered ob gene product, is synthesized primarily in adipose tissue and circulates to all parts of the body. Injury elicits significant metabolic changes, and it is not known how these changes affect the circulating leptin levels. Methods: Plasma leptin levels were measured in postabsorptive normal subjects (n = 14, 5 men and 9 women) and severely injured (injury severity score [ISS], 34 ± 2), hypermetabolic (resting energy expenditure [REE]/basal energy expenditure [BEE], 1.31 ± 0.04), adult (39 ± 4 years; n = 28, 18 men and 10 women) trauma patients within 48 to 60 hours after injury when they were receiving no nitrogen or calories. The nutritional influence on plasma leptin in these patients was monitored during the subsequent 7 days of total parenteral nutrition (TPN). During TPN the patients were randomized to receive or not to receive recombinant human growth hormone (rhGH) supplementation (0.15 mg/kg/d). Results: Trauma significantly lowered plasma leptin levels, both in women (56%) and in men (68%). Gender dimorphism in plasma leptin levels was seen in normal subjects and in both fasted and fed trauma patients, and in all cases female patients had significantly higher levels. Body mass index showed significantly positive correlations with plasma leptin both in normal and injured subjects. One day of TPN restored normal levels of leptin, both in men and women. Adjuvant rhGH treatment did not show any significant changes over that seen with TPN alone. Conclusions: Decreased plasma leptin levels seen due to trauma may be partly related to the fasting conditions, because 1 day of refeeding restored normalcy. Leptin metabolism in trauma patients seemed to be not altered during rhGH supplementation, suggesting a relatively minor metabolic role of leptin. (Journal of Parenteral and Enteral Nutrition 22:340–346, 1998)
The Thermodilution Technique for Measuring Resting Energy Expenditure Does Not Agree With Indirect Calorimetry for the Critically III Patient
Authors: Ogawa Angela M. , Shikora Scott A. , Burke Linda M. , Heetderks‐Cox Jane E. , Bergren Carl T. , Muskat Peter C.
Published: May 2008

Background: The complications associated with overfeeding critically ill patients are well documented. Indirect calorimetry is touted as the gold standard for measuring resting energy expenditure (REE). Unfortunately, the device is expensive, and many centers do not have this technology. The thermodilution technique for measuring cardiac output and calculating REE using the Fick equation has been reported to be an acceptable alternative. This study compared these techniques in a critically ill population. Methods: Forty consecutive patients with indwelling Swan—Ganz catheters in the surgical intensive care unit were prospectively studied while under the consultative care of the nutrition support service. REE was determined in all patients by both techniques within a 2‐hour period. An error of 5% (approximately ±100 kcal/d) between the two methods was deemed acceptable for clinical use. Results: Mean values for REE were 1928 ± 558 vs 1898 ± 518 kcal/d for the indirect calorimetry and thermodilution methods, respectively, and were not significantly different. However, there was great variation between the two techniques for the majority of patients such that REE determinations did not agree (t = 6.8; p <.0005). In 70% of the patients, REE determinations differed by ≥20% and in 10% of the patients by 50%. Additionally, the greater the difference between the two methods, the more the thermodilution method tended to overestimate REE. Conclusions: When compared with indirect calorimetry in a critically ill population, the thermodilution method demonstrated an intersubject variability that is unacceptable for clinical use. (Journal of Parenteral and Enteral Nutrition 22:347–351, 1998)
Effect of Long‐Term Oral Glutamine Supplements on Small Intestinal Permeability in Patients With Crohn's Disease
Authors: Hond Elly Den , Hiele Martin , Peeters Marc , Ghoos Yvo , Rutgeerts Paul
Published: May 2008

Background: Glutamine is a major fuel and an important nitrogen source for the small intestinal cell. It plays a key role in maintaining mucosal cell integrity and gut barrier function. Increased permeability may be a factor in the pathogenesis of Crohn's disease and may be an interesting parameter in the follow‐up of the disease. Therefore, the aim of this study was to examine whether oral glutamine supplements are able to restore an increased intestinal permeability in patients with Crohn's disease. Methods: The inclusion criteria for the study were Crohn's disease and a disturbed small intestinal permeability for 51Cr‐EDTA. Of 38 patients screened, 18 had an increased permeability (6 hours urinary excretion >1.1% of label recovered in urine). Fourteen patients were included in the study and were randomized to receive either oral glutamine (7 g three times per day; n = 7) or placebo (7 g glycine three times per day; n = 7) in addition to their normal treatment during a 4‐week period. The study was performed in a double‐blind manner. Results: Baseline permeability (mean ± SD) was 2.32% ± 0.77% dose in the glutamine group and 2.29% ± 0.67% dose in the placebo group. Permeability did not change significantly after glutamine (3.26% ± 2.15% dose) or after placebo (2.27% ± 1.32% dose). There was no significant effect on plasma glutamine, plasma glutamate, plasma ammonium, Crohn's disease activity index, C‐reactive protein, or nutritional status. Conclusions: Oral glutamine supplements, in the dose administered, do not seem to restore impaired permeability in patients with Crohn's disease. (Journal of Parenteral and Enteral Nutrition 23:7–11, 1999)
Role of Intestinal Mucus on the Uptake of Latex Beads by Peyer's Patches and on Their Transport to Mesenteric Lymph Nodes in Rats
Authors: Khan Jesmine , Iiboshi Yasuhiko , Cui Li , Wasa Masafumi , Okada Akira
Published: May 2008

Background: The effects of N‐acetylcysteine (NAC) as a mucolytic agent on the uptake of fluorescent polystyrene microparticles by Peyer's patches, on intestinal permeability, and on subsequent transport to mesenteric lymph nodes (MLNs) were investigated to establish the role of mucus gel layer in this process. Methods: Twenty rats were divided into two groups: control (n = 10) and NAC (n = 10). Fluorescent polystyrene latex beads of 3.2 ± 0.2 μm in diameter were used as a probe for measuring the previously mentioned parameters. The solution of latex beads (0.1 mL) was injected into a 2‐cm length of ileal loop containing Peyer's patches, with 0.1 mL of saline (control group) or with 0.1 mL of NAC solution (NAC group) within 10 cm proximal from the ileocaecal valve. Intestinal loops, portal blood, and neighboring MLNs were taken within 1 hour of injection. Intestinal sections were stained by periodic acid‐Schiff reagent. Peyer's patches and MLNs were analyzed for the count of particles by image analysis using a confocal laser scanning microscope. Results: Morphologically, periodic acid‐Schiff positive uniform mucus gel was present in front of Peyer's patches of the control group, and mucus gel layer was disrupted and noncontinuous in the NAC group. The number of particles within Peyer's patches and MLNs in the NAC group was significantly higher than that in the control group (p <.001). Intestinal permeability of latex beads in the NAC group was significantly higher than that in the control group (p <.001). Conclusions: These data suggest that the mucus gel layer located in front of Peyer's patches is one of the important factors for the uptake of noxious macromolecules, and this in turn plays a major role on small intestinal permeability and subsequent translocation to MLNs. (Journal of Parenteral and Enteral Nutrition 23:19–23, 1999)