bluuebunny/crossref_metadata_2025 huggingface dataset:
Hyperemesis Gravidarum and Fetal Outcome
Authors: Paauw James D. , Bierling Sandra , Cook Curtis R. , Davis Alan T.
Published: May 2008

Background: Hyperemesis gravidarum (HG) is reported in 0.5–2% of all pregnancies. The purpose of this research was to evaluate the relationship of maternal HG, neonatal birth weight, and birth outcomes. Methods: This is a prospective cohort study of 45 patients diagnosed, by Fairweather's criteria, with HG compared with 306 non‐HG control pregnant patients with singleton pregnancies. Sociodemographic and clinical data were obtained from the pregnant patients. Neonatal data were also collected, including indicators of neonatal wellness. Results: Significantly higher incidences of being nonwhite (33% vs 16%; p < .05) and of attaining post–high school education (60% vs 38%) were noted in the HG group, relative to controls. Mothers in the control group experienced greater gestational weight gain, 14.9 ± 0.3 kg (mean± SEM) relative to mothers in the HG group (10.6 ± 1.3 kg). Infants from HG pregnancies manifested significantly lower birth weight (3.23± 0.09 kg vs 3.52 ± 0.03 kg), younger gestational age (38.4 ± 0.3 weeks vs 39.7 ± 0.1 weeks), and a greater length of hospital stay (2.9 ± 0.5 days vs 1.8 ± 0.1 day), relative to infants from the control group. After undergoing multivariate analysis, HG was a significant predictor of decreased gestational age and increased hospital length of stay. Conclusions: Infants born of women who had HG are more likely to experience decreased gestational age and increased length of hospital stay. Efficacy of early and aggressive treatment of HG, including nutrition support, in minimizing these outcomes needs to be studied.
Nutrition and Immunological Status in Long‐Term Follow Up of Children with Short Bowel Syndrome
Authors: González Horacio F. , Pérez Néstor B. , Malpeli Agustina , Martínez María I. , Del Buono Beatriz , Viteri Fernando E.
Published: May 2008

Background: Little is known about the long‐term evolution, nutrition status, growth, and eventual deficiencies of patients with short bowel syndrome (SBS) adapted to oral feeding after parenteral nutrition (PN). Because there are not absolute criteria for weaning from parenteral or enteral nutrition to oral feeding, new nutrient deficiencies may develop. Subtle nutrition deficits could induce subclinical immune deficiencies; therefore, we studied long‐term growth, nutrition status, and the state of the immune system in 10 patients with SBS after weaning PN for at least 2 years. Methods: Ten children with SBS (3–12 years old; mean, 7.4 years) who had not received PN for at least 2 years were studied. Anthropometric measurements, hemoglobin values, and indicators of iron, zinc, copper, folate and vitamin B12 nutrition status were evaluated, along with immunoglobulins, lymphocyte subpopulations, and polymorphonuclear candidicidal activity. Results: Weight‐for‐height was normal in 8 children; height‐for‐age was low in 5 children whose SBS was established early in life. Fat body mass was also low in 5 subjects. Four children presented macrocytosis, 2 with anemia. Low serum levels of vitamin B12 (1 child), folates (4 children), and ferritin (2 children) were observed. Diminished candidicidal activity (4 children) was the only remarkable immunological abnormality. Conclusion: Many biologic and growth deficiencies are frequently seen in patients with SBS, even in children adapted to enteral feeding. This finding and the existence of previously unreported decreased candidicidal activity in some patients with SBS deserve long‐term clinical and biologic follow up.
Hypoleptinemia in Gastric Cancer Patients: Relation to Body Fat Mass, Insulin, and Growth Hormone
Authors: Huang Qi , Zhang Xin , Jiang Zhi‐Wei , Liu Bi‐Zhu , Li Ning , Li Jie‐Shou
Published: May 2008

Background: It remains elusive whether there are other causes besides body fat mass wasting contributing to decreased leptin level in cancer cachexia patients. This study attempts to explore possible factors influencing leptin levels in patients with gastric cancer. Methods: Hormones levels (including leptin, insulin, growth hormone (GH), insulin‐like growth factor I, glucagons, and cortisol), acute phase reactant, and body composition were measured in 88 gastric cancer patients and 24 healthy controls. All patients were divided into weight‐loss (48 patients) or nonweight‐loss (40 patients) groups and cachexia (body mass index <18; 13 patients) or noncachexia (75 patients) groups. The detection was repeated 3 months after radical surgery in 16 patients. Results: Compared with the controls, leptin levels decreased in gastric cancer patients with and without weight loss (p < .001 and p = .003, respectively), even when the percentage of fat mass was adjusted (p = .004 and 0.018, respectively). GH and insulin levels also changed significantly. Similar results were also found in patients with and without cachexia. Multivariate regression analysis showed that the percentages of fat mass (standardized coefficient [SC] = 0.631, p < .001), GH (SC = –0.244, p = .005) and insulin (SC = 0.201, p = .020) were significantly correlated with leptin. In the 16 patients who underwent radical surgery, leptin levels remained low and no significant changes in the other hormones were detected.Conclusions: Our results showed that low leptin levels in gastric cancer patients depended not only on the percentage of fat mass, but also on GH and insulin levels. Chronic high GH and low insulin levels may inhibit the leptin secretion.
Intestinal Growth in Parenterally‐Fed Rats Induced by the Combined Effects of Glucagon‐like Peptide 2 and Epidermal Growth Factor
Authors: Kitchen Paul A. , Goodlad Robert A. , FitzGerald Anthony J. , Mandir Nikki , Ghatei Mohammed A. , Bloom Stephen R. , Berlanga‐Acosta Jorge , Playford Raymond J. , Forbes Alastair , Walters Julian R.F.
Published: May 2008

Background: Parenteral nutrition and the absence of luminal feeding result in impaired intestinal growth and differentiation of enterocytes. Glucagon‐like peptide 2 (GLP‐2) and epidermal growth factor (EGF) have each been shown to have trophic effects on the intestine, and thus have the potential to benefit patients fed parenterally, such as those with intestinal failure from short bowel syndrome. We report studies aimed to determine whether there may be synergistic effects of these 2 peptides. Methods: Rats were established on parenteral nutrition (PN) and infused for 6 days with GLP‐2 (20 μg/d), EGF (20 μg/d), or GLP‐2 + EGF (20 μg/d of each). These groups were compared with untreated PN‐fed and orally‐fed controls. Tissue was obtained from small intestine and colon to determine growth, proliferation, and representative gene expression. Results: Small intestinal weight was increased by 75%, 43%, and 116% in the GLP‐2, EGF, and GLP‐2 + EGF groups, respectively, compared with PN controls (all p < .001). Cell proliferation increased with GLP‐2, EGF, and GLP‐2 + EGF in proximal small intestine by factors of 2.3, 1.7, and 3.4 respectively (p < .001). A synergistic effect on villous and crypt area was observed in the proximal small intestine when GLP‐2 and EGF were combined (p < .05). GLP‐2 had no effect in the colon, unlike EGF. Further studies showed GLP‐2 + EGF significantly increased expression in distal small intestine of transcripts for the bile acid transport protein IBABP (p < .05) and showed a significant correlation between the expression of IBABP and the transcription factor HNF‐4. Conclusions: Both GLP‐2 and EGF upregulate growth of the small intestine, and this is augmented when GLP‐2 and EGF are combined. These findings may lead to improved treatment of patients receiving PN.
A 45‐Year Obsession and Passionate Pursuit of Optimal Nutrition Support: Puppies, Pediatrics, Surgery, Geriatrics, Home TPN, A.S.P.E.N., Et Cetera
Authors: Dudrick Stanley J.
Published: May 2008

A candid account of the many innovations, fundamental developments and discoveries in the evolution and successful clinical application of parenteral nutrition; and its subsequent stimulus to providing optimal nutrition support, to the founding of A.S.P.E.N., and to inducing changes in the way medicine is practiced today.
Noninvasive Verification of Nasogastric Tube Placement Using a Magnet‐Tracking System: A Pilot Study in Healthy Subjects
Authors: Bercik Premysl , Schlageter Vincent , Mauro Marina , Rawlinson John , Kucera Pavel , Armstrong David
Published: May 2008

Background: Fluoroscopic verification of nasogastric (NG) feeding tube placement is inconvenient and involves radiation exposure. We tested whether the position of an NG tube can be assessed reliably by a recently introduced magnet‐tracking system. Methods: A small permanent magnet was attached at the end of an NG tube and its position was monitored using an external sensor array connected to a computer. NG tube trajectory, spontaneous movements of the magnet, and its position relative to the lower esophageal sphincter (LES) and xiphisternum were assessed in 22 healthy subjects and compared with esophageal manometry. In 12 subjects, localization of the magnet was also compared with fluoroscopy. Results: Magnet‐tracking displayed NG tube tip movement reproducibly as it moved vertically in the esophagus and then laterally into the stomach. Compared with manometry, the accuracy and sensitivity of magnet tracking for localization of the NG tube tip, above or below the diaphragm, were 100%. Compared with fluoroscopy, the accuracy of NG tube localization by magnet tracking was 100%. With the magnet in the stomach, but not in the esophagus or LES, low amplitude displacements at a frequency of 3 per minute, consistent with gastric slow wave activity, were observed. Conclusions: Magnet tracking allows accurate, real‐time, 3‐dimensional localization of an NG tube with respect to anatomic landmarks. Recorded motor patterns are indicative of the position of the NG tube. Magnet tracking may be a useful tool for bedside placement of nasogastric and enteral feeding tubes.
Epidermal Growth Factor and/or Growth Hormone Induce Differential, Side‐Specific Signal Transduction Protein Phosphorylation in Enterocytes
Authors: Avissar Nelly E. , Toia Liana , Sax Harry C.
Published: May 2008

Background: Epidermal growth factor (EGF) plus growth hormone (GH) enhances luminal glutamine transport into rabbit and human intestinal cells. Our objective was to screen for activation status of signal proteins in C2BBe1 cells (enterocyte‐like cell line) in response to side‐specific EGF or GH treatment and to investigate the dependence of EGF receptor (EGFR) phosphorylation status on its tyrosine kinase. Methods: C2BBe1 cells on Transwells were treated for 15 minutes on either the basolateral or apical‐side with EGF or GH. Lysates underwent Kinetworks phospho site‐screen‐2.1 analysis (duplicate experiments). In addition, lysates from cells treated as above with or without tyrphostin AG1478 (a specific EGFR tyrosine kinase inhibitor) underwent Western blot analysis for total EGFR and EGFR phosphorylated on tyrosine 1173, 1086 or 1068 (4–7 experiments). Results: Kinetworks phospho‐screening demonstrated a broad range of interactions dependent on both side of exposure and protein studied. From this screen, it appears that ErbB2, Met, and insulin receptor (R)/insulin‐like growth factor 1 R are not involved in the growth factors signals. For EGFR phosphorylation, basolateral, but not apical, EGF was a strong activator. Synergism was seen, but only with apical EGF plus basolateral GH. All EGFR phosphorylations were EGFR tyrosine kinase dependent. In contradistinction, apical EGF phosphorylated FAK and MAPKs. Conclusions: Kinetworks phosphoprotein screens can suggest pathways involved in side‐specific and synergistic interaction between EGF and GH. For EGFR, synergism by EGF + GH was noticed only with Ap EGF plus Bl GH and was EGFR tyrosine kinase dependent. Adaptive intestinal responses due to enterally administrated EGF might be accelerated by the availability of parenteral GH.
Dietary Restriction Compromises Resistance to Gut Ischemia‐Reperfusion, Despite Reduction in Circulating Leukocyte Activation
Authors: Ueno Chikara , Fukatsu Kazuhiko , Maeshima Yoshinori , Moriya Tomoyuki , Shinto Eiji , Hara Etsuko , Nagayoshi Hidetoshi , Hiraide Hoshio , Mochizuki Hidetaka
Published: May 2008

Background: Gut ischemia‐reperfusion (gut I/R) accompanying severe surgical insults leads to neutrophil‐mediated injury and is regarded as a triggering event in early multiple‐organ failure. Our previous study demonstrated dietary restriction to down‐regulate leukocyte activation. Therefore, we hypothesized dietary restriction might be beneficial in terms of surviving I/R. We also evaluated leukocyte activation and the level of organ glutathione, an antioxidative substance. Methods: Institute of Cancer Research mice received chow, 170 (ad libitum), 119 (MR: mild restriction) or 68 (SR: severe restriction) g/kg per day for 7 days. Exp. 1: The mice (n = 59) underwent 15 or 45 minutes of gut ischemia and survival was observed. Exp. 2: The mice (n = 73) were killed before or 60 or 120 minutes after 15‐minute ischemia. Reactive oxygen intermediate (ROI) production by circulating myeloid cells and CD11b expression was determined. Some mice were assessed for nuclear factor κ B (NFκB) activation. Glutathione levels were measured in some of the small intestine and liver samples from each group. Results: Dietary restriction decreased survival. Circulating myeloid cell priming and activation, in terms of ROI production and CD11b expression, were enhanced in the ad libitum group but not in the restricted groups. NFκB was activated only in the ad libitum group. Gut and hepatic glutathione levels were lower in the SR than in the ad libitum group. Dietary restriction caused histologic damages in gut, liver, and lung 120 minutes after reperfusion. Conclusions: Dietary restriction blunts leukocyte priming and activation after gut ischemic insult but worsens the outcome by, at least in part, decreasing antioxidative activities. Clinically, nutrition replenishment may be required to improve the outcome of gut hypoperfusion.
The Impact of a Normoglycemic Management Protocol on Clinical Outcomes in the Trauma Intensive Care Unit
Authors: Collier Bryan , Diaz Jose , Forbes Rachel , Morris John , May Addison , Guy Jeffrey , Ozdas Asli , Dupont William , Miller Richard , Jensen Gordon
Published: May 2008

Background: The purpose of this study was to determine if protocol‐driven normoglycemic management in trauma patients affected glucose control, ventilator‐associated pneumonia, surgical‐site infection, and inpatient mortality. Methods: A prospective, consecutive‐series, historically controlled study design evaluated protocol‐driven normoglycemic management among trauma patients at Vanderbilt University Medical Center. Those mechanically ventilated ≥24 hours and ≥15 years of age were included. A glycemic‐control protocol required insulin infusion therapy for glucose >110 mg/dL. Control patients included those who met criteria, were admitted the year preceding protocol implementation, and had hyperglycemia treated at the physician's discretion. Results: Eight hundred eighteen patients met study criteria; 383 were managed without protocol; 435 underwent protocol. The protocol group had lower glucose levels 7 of 14 days measured. After admission, both groups had mean daily glucose levels <150 mg/dL. No difference in pneumonia (31.6% vs 34.5%; p = .413), surgical infection (5.0% vs 5.7%; p = .645) or mortality (12.3% vs 13.1%; p = .722) occurred between groups. If one episode of blood glucose level was ≥150 mg/dL (n = 638; 78.0%), outcomes were worse: higher daily glucose levels for 14 days after admission (p < .001), pneumonia rates (35.9% vs 23.3%; p = .002), and mortality (14.6% vs 6.1%; p = .002). One or more days of glucose ≥150 mg/dL had a 2‐ to 3‐fold increase in the odds of death. Protocol use in these patients was not associated with outcome improvement. Conclusions: Protocol‐driven management decreased glucose levels 7 of 14 days after admission without outcome change. One or more glucose levels ≥150 mg/dL were associated with worse outcome.
Effects of a High‐Fiber Diet on Hepatocyte Apoptosis and Liver Regeneration After Partial Hepatectomy in Rats With Fatty Liver
Authors: Lai Hong‐Shiee , Lin Wen‐His , Chen Pey‐Rong , Wu Hsiu‐Chuan , Lee Po‐Huang , Chen Wei‐Jao
Published: May 2008

Background: The morbidity and mortality that accompany fatty liver may occur as a result of increased apoptosis of hepatocytes and decreased liver regeneration. We determined the effects of a high‐fiber diet on hepatocyte apoptosis and liver regeneration after partial hepatectomy in rats with fatty liver. Methods: Fatty liver was induced in male Wistar rats weighing around 200 g through feeding of a high‐fat diet for 4 weeks. The rats were then randomly assigned to 3 groups that received a high‐fat diet, a normal diet, or a high‐fiber diet for another 4 weeks. Partial hepatectomy (around 70%) was performed, and rats were killed 6, 24, 48, or 72 hours after hepatectomy. We then measured (1) the ratio of remnant liver weight to body weight and assessed the histology of the remnant liver as indicators of fatty liver, (2) caspase‐3 activity and in situ cell death detection of DNA fragmentation as indicators of apoptosis, and (3) 5‐bromo‐2‐deoxyuridine (BrdU) activity and (4) ornithine decarboxylase (ODC) contents in remnant livers as markers of regeneration. Results: We found that (1) a high‐fat diet for 4 weeks can markedly induce fatty liver, (2) apoptosis of hepatocytes is greater in fatty liver than in normal liver (98 ± 19 vs 36 ± 7) at 6 hours after partial hepatectomy (p< .05), (3) the capacity of liver regeneration decreases significantly (BrdU index: 30 ± 5 vs 12 ± 3, and ODC contents: 604± 48 vs 390 ± 42 mg/dL) in fatty liver 24 hours after partial hepatectomy (p < .05), (4) a normal diet can partially reverse the effects of fatty liver; (5) a high‐fiber diet can significantly reverse the effects of fatty liver (p < .05). Conclusions: A high‐fiber diet can reverse the negative effects of fatty liver on apoptosis and regenerative capacity after partial hepatectomy.
Medical and Psychosocial Experiences of Family Caregivers With Children Fed Enterally at Home
Authors: Enrione Evelyn B. , Thomlison Barbara , Rubin Aviva
Published: May 2008

Background: Pediatric home enteral nutrition (HEN) studies that evaluate the psychosocial aspects of caregiving are limited. Overlooking the psychosocial needs of the caregiver may result in negative outcomes such as lack of adherence to the HEN regimen. This study determined whether caregivers report psychosocial situations more frequent and difficult to manage than medical situations. Methods: A questionnaire, which identified 10 psychosocial and 10 medical issues related to pediatric HEN, was mailed to 150 caregivers (37 responded), who rated the statements for frequency and difficulty. Each statement was ranked from most frequent/difficult to least frequent/difficult by mean cross‐product score (frequency × difficulty). To indicate overall burden, a medical total composite score (MTCS) and a psychosocial total composite score (PTCS) were calculated by summing the cross‐products of the respective problems. Paired t tests compared MTCS to PTCS and also the psychosocial frequency means and difficulty means to the same for the medical problems. Results: Of the top 10 problems, 7 were psychosocial, whereas 3 were medical. Caregivers reported incidences of psychosocial problems more frequently (p < .003) than medical problems, and they had more difficulty (p < .001) with the psychosocial situations than with the medical ones. The PTCS was significantly higher (p < .001) than the MTCS. Conclusions: The psychosocial situations were perceived as causing a greater burden and greater difficulty in coping with everyday life. Health professionals need to understand and address the psychosocial difficulties of the caregiver in order to provide support for the caregiver and promote positive growth and development of the child.
The Safety of Percutaneous Endoscopic Gastrostomy Tube Placement in Patients With Existing Ventriculoperitoneal Shunts
Authors: Saalwachter Schulman Alison , Sawyer Robert G.
Published: May 2008

Background: Because the insertion of percutaneous endoscopic gastrostomy tubes (PEG) involves disruption of the gastrointestinal tract with potential peritoneal contamination, patients with indwelling ventriculoperitoneal (VP) shunts could be at increased risk of meningitis, a potentially devastating infection. The safety of PEG placement in the presence of a VP shunt is unclear. Methods: A retrospective chart review was performed that included all adult patients with existing VP shunts requiring PEG placement at a single university medical center over an approximate 9‐year period from July 1995 to March 2004. Results: Thirty‐nine patients who underwent PEG placement 2–564 days after shunt placement were identified. Two patients (5%) subsequently developed meningitis. Cerebrospinal fluid cultures demonstrated Staphylococcus aureus and Enterococcus faecalis. These infections occurred 2 and 15 months after PEG placement, respectively. At the time of PEG placement, 17 patients (44%) were receiving antibiotics for reasons other than operative prophylaxis, and 11 patients (28%) received prophylactic antibiotics. Both infected patients had received antibiotics at the time of PEG placement. Conclusions: These data constitute the largest series of patients with existing VP shunts undergoing PEG placement reported to date. When compared with the published 2%–5% infection rate for patients with VP shunts alone, our data do not suggest an increased risk of infection for patients after PEG placement. As the total number of adult patients requiring a PEG after VP shunt placement is low, multicenter studies should be carried out to better stratify this risk.
Immunopathogenesis of Crohn's Disease
Authors: MacDonald Thomas T. , DiSabatino Antonio , Gordon John N.
Published: May 2008

This review highlights the huge advances made in the understanding of Crohn's disease in the last 15 years. The pathogenic immune response in the gut wall is a highly polarised T helper cell type 1 response, probably directed against antigens of the commensal flora. There is marked over‐expression of pro‐inflammatory cytokines such as tumor necrosis factor (TNF)‐a and increased production of matrix degrading enzymes by fibroblasts and macrophages, which are probably responsible for ulceration and fistula formation. Crohn's disease runs in families and the susceptibility genes identified so far are associated with innate recognition of microbial products (Nod2) or epithelial barrier function (OCTN cation transporter genes and DLG5). Endogenous healing pathways mediated by transforming growth factor (TGF)‐β1 are inhibited because mucosal inflammatory cells express Smad7, the endogenous intracellular inhibitor of TGF‐β signalling. This makes it unlikely that enteral feeds containing TFG‐β are therapeutic by means of direct anti‐inflammatory effects, however TGF‐β may still be involved because it is a well known epithelial motogen and may promote mucosal healing, in synergy with changes in mucosal bacterial populations as a result of the change in the diet.
The Anti‐Inflammatory Effects of Enteral Nutrition
Authors: Sanderson Ian R. , Croft Nicholas M.
Published: May 2008

Enteral nutrition has a positive effect on growth in children with active Crohn's disease. The question arises: is this is due only to improved nutrition? Enteral formulas may also directly reduce inflammation, lowering the expression of cytokines like interleukin (IL)‐6 that inhibit growth. Four lines of evidence support the hypothesis that enteral formulas directly lessen inflammation: enteral nutrition directly affects the inflamed intestine; changes in inflammatory markers precede repletion of nutrition status; molecular pathways exist linking changes in luminal contents to the expression of class II MHC genes in intestinal epithelium in animal studies; and enteral formulas have a direct effect on cytokine expression by intestinal epithelial cells.
Milk Casein‐Based Diet Containing TGF‐β Controls the Inflammatory Reaction in the HLA‐B27 Transgenic Rat Model
Authors: Schiffrin Eduardo J. , Yousfi Mimoun El , Faure Magali , Combaret Lydia , Donnet Anne , Blum Stephanie , Obled Christiane , Breuillé Denis
Published: May 2008

Background: A casein‐based formula containing TGF‐β has been successfully used in adolescents during acute episodes of Crohn's disease. The role played by this molecule requires confirmation. We have examined the capacity of a TGF‐β containing diet to control the intestinal inflammation in HLA‐B27 transgenic rats, and compared its effects with a similar diet devoid of TGF‐β. Methods: Three groups of rats were studied. HLA‐B27/hβ2M transgenic rats were fed with a casein‐based rat‐adapted diet containing TGF‐β or a control casein‐based diet without TGF‐β. Fischer control animals were fed the latter. Body weight, dietary intake, tissue weights, fecal samples, leukocyte counts, and acute phase response were analyzed. Intestinal inflammation was assessed by histology, myeloperoxidase, and mRNA expression of cytokines. MUC2 protein expression was assessed by immunohistochemistry. Breakdown of muscle protein was examined. Results: The test diet improved diarrhea increasing the fecal dry matter and the colonic inflammation as shown by a lower inflammatory score (2.43 ± 1.13 vs 4.42 ± 0.53, p <.05), lower mucosal thickness (431.25 ± 72.29 vs 508.57 ± 81.32 ?m, p =.08) and decreased IFN7 mRNA expression. MUC2 protein expression was increased in HLA rats fed the TGF‐β diet compared with HLA rats fed the control diet, but restitution to normal pattern was not observed. The test diet also decreased leukocytosis and the acute phase response and improved the muscle catabolic response. Conclusion: The TGF‐β containing diet has a beneficial effect in an animal model of intestinal inflammation. Our observations support a potential role for dietary TGF‐β in the restoration of immune homeostasis.
The Use of Enteral Nutrition in the Management of Crohn's Disease in Adults
Authors: Dray X. , Marteau Phillipe
Published: May 2008

Crohn's disease is a chronic, relapsing disease and none of the treatments developed so far can cure it. Artificial nutrition is effective to both treat malnutrition when present and induce remission. However, striking advances in anti‐inflammatory and immunomodulating therapies (including infliximab) and low compliance to treatment in the first trials have limited its place in the management of adults to drug‐resistant patients. Randomized controlled trials show that artificial nutrition is effective in >50% of the cases in this selected population. Significant progress has recently been made to improve the palatability (and thus acceptability) of some enteral solutions, which can be consumed by the oral route and as pharmaconutrition. We reviewed the literature on enteral nutrition in adults with Crohn's disease. We present herein the results of the studies performed with antioxidants, glutamine, short‐chain fatty acids, prebiotics, pro‐biotics, low microparticle diets, and a TGFβ2 enriched formulation.
Semi‐Elemental Formula or Polymeric Formula: Is There a Better Choice for Enteral Nutrition in Acute Pancreatitis? Randomized Comparative Study
Authors: Tiengou Laurent‐Eric , Gloro Romain , Pouzoulet Julien , Bouhier Karine , Read Marie‐Hélène , Arnaud‐Battandier Franck , Plaze Jean‐Marie , Blaizot Xavier , Dao Thông , Piquet Marie‐Astrid
Published: May 2008

Background: Jejunal nutrition is recommended during acute pancreatitis. The use of semi‐elemental formulas presents several theoretical advantages over polymeric formulas, but their clinical value has been poorly documented. Our aim was to evaluate in patients with acute pancreatitis the effect of enteral nutrition by a semi‐elemental formula compared with a polymeric formula. Methods: A randomized prospective pilot study, stratified according to severity, was performed in 30 consecutive patients with acute pancreatitis requiring jejunal nutrition. The semi‐elemental group received 35 kcal/kg/d of Peptamen (n = 15), and the polymeric group received the same quantity of Sondalis‐Iso (n = 15). Tolerance was evaluated after 7 days of enteral nutrition (D7) on visual analog scale (VAS), stool frequency, and 24‐hour steatorrhea/creatorrhea. Outcome was evaluated by weight loss, length of hospital stay, and infection rate. Results: Results were calculated as mean ± SEM, t‐test, or χ2. Patients of the 2 groups were comparable in terms of age, gender, and severity. Tolerance was good in both groups (semi‐elemental vs polymeric: VAS, 7.4 ± 0.6 vs 7.1 ± 0.6, not significant (NS); number of stools per 24 hours, 1.7 ± 0.4 vs 1.8 ± 0.4, NS). Steatorrhea and creatorrhea were lower than normal in both groups. In semi‐elemental group, the length of hospital stay was shorter (23 ± 2 vs 27 ± 1, p = .006) and weight loss was less marked (1 ± 1 vs 2 ± 0, p = .01). One patient in semi‐elemental group and 3 patients in polymeric group developed an infection (NS). Conclusions: Semi‐elemental and polymeric nutrition are very well tolerated in patients with acute pancreatitis. Nutrition with a semi‐elemental formula supports the hypothesis of a more favorable clinical course than nutrition with a polymeric formula, but this conclusion needs to be established in larger adequately powered clinical trials.
Liver and Skeletal Muscle Lipids Have Differing Fatty Acid Profiles in Short‐Gut Rats Fed via Parenteral Nutrition
Authors: McCowen Karen C. , Ling Pei‐Ra , Ollero Mario , Maykel Justin A. , Blanco Paola G. , Bistrian Bruce R.
Published: May 2008

Background: In short‐gut rats, we showed marked abnormalities in plasma lipid fatty acids using parenteral nutrition (PN) with lipid vs sham surgery rats. This suggests that either sensing or metabolism of parenteral lipid is abnormal in malabsorption. The goal of this study was to determine fatty acid profiles in skeletal muscle and liver in short‐gut rats treated with PN compared with sham rats. Methods: Sprague‐Dawley rats underwent laparotomy and massive small bowel resection (or sham surgery). Rats (n = 32, 16 sham, 16 short gut) were randomly assigned to PN with lipid or fat‐free PN. After 5 days, weight loss was similar in all groups, and mixed hindlimb skeletal muscle and liver were biopsied. Results: We found marked differences between liver and skeletal muscle. In livers of short‐gut animals, 22:4ω6, 22:5ω6, and 22:6ω3 were higher (all p < .05) than in sham. In skeletal muscle, short gut had no effect on fatty acid profiles. In liver, fat‐free PN led to significant increases in 20:3ω6, 22:4ω6, 22:5ω6, 20:3ω9, 20:5ω3, 22:6ω3, and triene/tetraene ratio (all p < .05) compared with feeding PN with lipid, irrespective of short gut. In muscle, levels of the distal long‐chain fatty acid metabolites and triene/tetraene ratio were minimally affected by nutrition. Serum glucose and insulin concentrations were similar in all 4 groups. Conclusions: Both the presence of short gut and type of PN led to increases in distal metabolites of fatty acids onω :3 and ω:6 pathway in liver phospholipids but not in skeletal muscle during short‐term PN feeding in rats.
Curcumin, An Atoxic Antioxidant and Natural NFκB, Cyclooxygenase‐2, Lipooxygenase, and Inducible Nitric Oxide Synthase Inhibitor: A Shield Against Acute and Chronic Diseases
Authors: Bengmark Stig
Published: May 2008

Background: The world suffers a tsunami of chronic diseases, and a typhoon of acute illnesses, many of which are associated with the inappropriate or exaggerated activation of genes involved in inflammation. Finding therapeutic agents which can modulate the inflammatory reaction is the highest priority in medical research today. Drugs developed by the pharmaceutical industry have thus far been associated with toxicity and side effects, which is why natural substances are of increasing interest. Methods: A literature search (PubMed) showed almost 1500 papers dealing with curcumin, most from recent years. All available abstracts were read. Approximately 300 full papers were reviewed. Results: Curcumin, a component of turmeric, has been shown to be non‐toxic, to have antioxidant activity, and to inhibit such mediators of inflammation as NFκB, cyclooxygenase‐2 (COX‐2), lipooxygenase (LOX), and inducible nitric oxide synthase (iNOS). Significant preventive and/or curative effects have been observed in experimental animal models of a number of diseases, including arteriosclerosis, cancer, diabetes, respiratory, hepatic, pancreatic, intestinal and gastric diseases, neurodegenerative and eye diseases. Conclusions: Turmeric, an approved food additive, or its component curcumin, has shown surprisingly beneficial effects in experimental studies of acute and chronic diseases characterized by an exaggerated inflammatory reaction. There is ample evidence to support its clinical use, both as a prevention and a treatment. Several natural substances have greater antioxidant effects than conventional vitamins, including various polyphenols, flavonoids and curcumenoids. Natural substances are worth further exploration both experimentally and clinically.
Safety of an Immune‐Enhancing Nutrition Supplement in Cirrhotic Patients With History of Encephalopathy
Authors: Abou‐Assi Souheil G. , Mihas Anastasios A. , Gavis Edith A. , Gilles HoChong S. , Haselbush Amy , Levy James R. , Habib Adil , Heuman Douglas M.
Published: May 2008

Malnutrition in advanced cirrhosis may worsen liver function and increase susceptibility to infections. Immune‐enhancing nutrition supplements (IENS) may be of value, but their safety in patients with decompensated cirrhosis and history of encephalopathy is unknown. We assessed the safety of Impact Recover (Novartis, St. Louis Park, MN), an orally palatable IENS, in 12 men with hepatic cirrhosis of Child‐Turcotte‐Pugh (CTP) class B or C, ages 40–60. On day 0, patients were evaluated serially for 6 hours after ingestion of 2 packets of Impact Recover. Despite a transient doubling of the blood ammonia, no cognitive abnormalities were noted on clinical assessment or psychometric testing. Subsequently, patients were instructed to ingest 3 packets per day of Impact Recover for 56 days, after which supplements were stopped. Patients were evaluated in a fasting state on days 0 (baseline), 56 (end of treatment), and 112 (follow‐up). One patient was transplanted on day 21, and another died after an urgent cholecystectomy on day 30. The remaining 10 patients completed the study. Mean value of CTP score was 9 (range, 7–11) and mean value of model for end‐stage liver disease (MELD) score was 14 (7–21), and there was no change after 8 weeks of IENS. Only 1 experienced transient worsening of encephalopathy after omitting lactulose. Performances on psychometric tests did not change. Transferrin levels increased rapidly with IENS, then returned toward baseline after IENS was stopped. Fasting insulin and peptide YY (PYY) levels also increased, but fasting glucose and hemoglobin A1C did not change. Trends in other nutrition and immune parameters did not reach significance. We conclude that acute and chronic administration of Impact Recover was well tolerated in cirrhotic patients with controlled encephalopathy. Further studies are justified to assess potential efficacy of long‐term IENS in preventing infection and slowing progression in advanced cirrhosis.
Lack of Enteral Nutrition Delays Nuclear Factor Kappa B Activation in Peritoneal Exudative Cells in a Murine Glycogen‐Induced Peritonitis Model
Authors: Ueno Chikara , Fukatsu Kazuhiko , Kang Woodae , Maeshima Yoshinori , Nagayoshi Hidetoshi , Omata Jiro , Saito Hideaki , Hiraide Hoshio , Mochizuki Hidetaka
Published: May 2008

Background: Early enteral nutrition is associated with a lower incidence of intraabdominal abscess in severely injured patients than parenteral nutrition (PN). We explored the underlying mechanisms by examining the influence of nutrition route on nuclear factor κB (NFκB) activation in peritoneal exudative cells (PECs) and peritoneal cytokine levels. Methods: Thirty male Institute Cancer Research mice were randomized to chow (n = 10), IV PN (n = 10), or intragastric (IG) PN (n = 10) and fed for 5 days. PECs were harvested at 2 or 4 hours after intraperitoneal injection of 2 mL of 1% glycogen. Intranuclear NFκB activity in PECs was examined by laser scanning cytometry. Cytokine (tumor necrosis factor‐α [TNF‐α], macrophage inflammatory protein‐2 [MIP‐2], interleukin‐10 [IL‐10]) levels in peritoneal lavaged fluid were determined by enzyme‐linked immunosorbent assay. Results: Intranuclear NFκB at 2 hours was significantly higher in the chow and IG‐PN groups than in the IV‐PN group. TNF‐α and IL‐10 levels of the chow group were significantly higher than those of IV‐PN mice at 2 hours, whereas those of IG‐PN mice were midway between those of the chow and IV‐PN groups. MIP‐2 was significantly higher in the chow group than in the IG‐PN and IV‐PN mice at 2 hours. TNF‐α levels correlated positively with intranuclear NFκB activity in PECs. Conclusions: Enteral nutrition may improve peritoneal defense by preserving early NFκB activation in PECs and cytokine responses.
Liver Failure Is Uncommon in Adults Receiving Long‐Term Parenteral Nutrition
Authors: Salvino Richard , Ghanta Ravi , Seidner Douglas L. , Mascha Edward , Xu Yaomin , Steiger Ezra
Published: May 2008

Background: Abnormal liver enzymes and endstage liver disease are reported to occur in 25%–100% and 15%–40% of adult patients receiving long‐term parenteral nutrition (PN), respectively. The purpose of this historic cohort study was to investigate the incidence of and possible factors leading to the development of liver disease in our large home PN population. Methods: All patients on home PN for at least 6 months from July 1991 through June 2002 were eligible. Patients were excluded if they had active malignancy, underlying liver disease, or exposure to a hepatotoxin. The presence of PN‐associated liver disease was only considered if test results were elevated on more than 1 occasion over at least 6 or more months. The severity of liver‐associated enzymes was based on the degree of elevation and was stratified as mild (<2 times normal), moderate (2–5 times normal), and severe (>5 times normal). Severe liver dysfunction was defined as having all of the following criteria: total bilirubin >3 mg/dL; albumin<3.2 g/dL; and prothrombin time >3 seconds prolonged. A cumulative logit model was used to compare age, gender, underlying disease, PN indication, and PN formulas in patients with normal vs abnormal laboratory test results. Results: Two hundred eight patients received PN for more than 6 months, 36 had exclusion criteria, and 10 could not be analyzed, because of incomplete laboratory test results, leaving 162 in the study group. The average PN duration was 2.14 ± 2.19 years (maximum, 10.28 years). Abnormal liver tests occurred in 154 patients, with most having a moderate elevation of alkaline phosphatase or aspartate aminotransferase; severe liver dysfunction occurred in 7 patients; 1 patient had completely normal liver enzymes. On average, patients received a PN formula that was high in amino acids (1.45 ± 0.65 g/kg/d), modest in energy (24.7 ± 13.4 kcal/kg/d), and in most cases with enough lipid emulsion to meet essential fatty acid requirements (0.28 ± 0.25 g/kg/d). Only female gender was found to be associated with a greater likelihood of liver failure (p = .02). There was a trend toward a greater amount of total calories, dextrose calories, and duration of PN exposure leading to the development of severe liver dysfunction. Conclusions: When long‐term PN is given with a modest amount of total energy and a minimal amount of lipid emulsion, abnormal liver enzymes are common, but severe liver dysfunction is unusual.
A New Graduated Dosing Regimen for Phosphorus Replacement in Patients Receiving Nutrition Support
Authors: Brown Kaleb A. , Dickerson Roland N. , Morgan Laurie M. , Alexander Kathryn H. , Minard Gayle , Brown Rex O.
Published: May 2008

Background: Hypophosphatemia is a common metabolic complication in patients receiving specialized nutrition support. We changed our previously reported dosing algorithm because the low dose no longer appeared to be effective at increasing serum phosphorus concentrations. The purpose of this study was to evaluate the safety and efficacy of a revised weight‐based phosphorus‐dosing algorithm in critically ill trauma patients receiving specialized nutrition support. Methods: Seventy‐nine adult trauma patients with hypophosphatemia (serum phosphorus concentration ≤0.96 mmol/L) receiving nutrition support received an IV dose of phosphorus on day 1 according to the serum concentration of phosphorus: 0.73–0.96 mmol/L (0.32 mmol/kg, low dose), 0.51–0.72 mmol/L (0.64 mmol/kg, moderate dose), and ≤0.5 mmol/L (1 mmol/kg, high dose). The IV phosphorus bolus dose was administered at 7.5 mmol/hour. Generally, patients with a serum potassium concentration <4 mmol/L received potassium phosphate and patients with a serum potassium concentration ≥4 mmol/L received sodium phosphate. Patients who still had hypophosphatemia on day 2 were dosed using the new dosing algorithm by the nutrition support service according to that day's serum concentration of phosphorus, or empirically by the trauma service. Results: Of the 79 patients studied, 57 were male and 22 were female with a mean age of 44.8 ± 20.6 years. Mean Injury Severity Scores and APACHE‐II scores were 27.1 ± 11.6 and 15.2 ± 6.8, respectively. There was no difference in baseline characteristics among the 3 dosing groups. Of the 79 patients, 34 received the low dose, 30 received the moderate dose, and 15 received the high dose of phosphorous. Mean serum phosphorous concentrations on day 2 were significantly increased in the moderate‐dosed group (0.64 ± 0.06 to 0.77 ± 0.22 mmol/L, p < .05) and high‐dosed group (0.38 ± 0.06 to 0.93 ± 0.32 mmol/L, p < .01), respectively, when compared with day 1. Mean serum phosphorus concentrations were normal in all 3 groups on day 3. Serum concentrations of magnesium, sodium, and potassium, as well as arterial pH, were stable across the study. Mean concentrations of ionized calcium were not significantly different in any of the 3 dosing groups across the study period. Conclusions: This weight‐based phosphorus‐dosing algorithm is safe for use in critically ill patients receiving nutrition support. The moderateand severe‐dose regimens effectively increase serum phosphorus concentrations.
Problems Experienced by Patients Receiving Parenteral Nutrition at Home: Results of an Open Interview Study
Authors: Huisman‐de Waal Getty , Naber Ton , Schoonhoven Lisette , Persoon Anke , Sauerwein Hans , van Achterberg Theo
Published: May 2008

Background: Home parenteral nutrition (HPN) is offered to patients who are unable to absorb sufficient nourishment from normal oral food intake or tube feeding. Major causes include severe motility disorders and limited resorption surface in the small intestine. HPN is a lifesaving therapy but has severe consequences on daily life. The aim of this study was to make an inventory of the problems experienced by patients receiving HPN. Methods: Open interviews were held with 48 patients from the 2 major centers for HPN in the Netherlands, centered around the question: Which 3 HPN problems have the most severe impact on your daily life? Data were analyzed using content analysis. Results: The respondents mentioned 7 central problems: negative emotions, physical problems, social limitations, dependence on others, incapability, complications, and patient‐care provider problems. In addition, practical problems were mentioned: sleeping problems, financial problems, and the “hospital atmosphere” at home. The latter issues formed less of a problem for the patients. Conclusion: The main underlying elements in the lives of many HPN patients appeared to be loss, longing, and grief. In contrast, a smaller proportion of the patients expressed that they had clearly adapted to life with HPN. By means of the HPN, they were still alive and enjoying all the things they could still do.
Retraction: The Influence of Early Supplementation of Parenteral Nutrition on Quality of Life and Body Composition in Patients With Advanced Cancer
Authors: Shang Edward , Weiss Christel , Post Stefan , Kaehler Georg
Published: May 2008

The authors of the above article have requested its withdrawal, notifying the Journal that the clinical trials described in the article were not conducted as written in the article. The Editor‐in‐Chief, the American Society for Parenteral and Enteral Nutrition, and the Publisher have determined to retract the article.
The Use of a Handheld Calorimetry Unit to Estimate Energy Expenditure During Different Physiological Conditions
Authors: Rubenbauer Justine R. , Johannsen Darcy L. , Baier Shawn M. , Litchfield Ruth , Flakoll Paul J.
Published: May 2008

Background: Accurately determining rates of energy expenditure (EE) under free‐living conditions is important in understanding the mechanisms involved in the development and prevention of obesity. Metabolic carts are not portable enough for most free‐living situations. The purpose of this study was to compare a portable, handheld indirect calorimetry device (HealtheTech Incorporated, Golden, CO) to a metabolic cart (Physio‐Dyne Instrument Corporation, Quogue, NY) during 3 different physiologic states. Methods: EE was measured by both the handheld calorimeter (5–10 minutes) and the metabolic cart (15–20 minutes) in 20 healthy subjects (18–35 years of age). Measurements were made during 3 physiologic states: (1) postabsorptive rest (REE), (2) postprandial rest (fed energy expenditure, FEE), and (3) while walking in place (activity energy expenditure, AEE). Results: There were no significant differences between the means of the cart vs the handheld device for REE (mean± SE; kcal/d; 1552 ± 64 vs 1551 ± 63), FEE (1875± 99 vs 1825 ± 86), and AEE (3333 ± 218 vs 3489 ± 152). The range over which the techniques were tested was 1300–5000 kcal/d. The agreement between the 2 methods was excellent for REE (0.80, p < .0001), FEE (0.89, p < .0001), and AEE (0.75, p < .0002). Conclusions: Compared with the metabolic cart, the handheld device provided similar estimates of energy expenditure during resting, postprandial, and physically active states. This suggests that portable indirect calorimetry devices can provide reliable and valuable information in free‐living research situations for which maximal energy expenditure is <5000 kcal/d.