bluuebunny/crossref_metadata_2025 huggingface dataset:
Controlled Trial on Nutrition Supplementation in Outpatients With Symptomatic Alcoholic Cirrhosis
Authors: Hirsch Sandra , Bunout Daniel , De La Maza Pia , Iturriaga Hernan , Petermann Margarita , Icazar Gloria , Gattas Vivian , Ugarte Guillermo
Published: May 2008

A controlled trial on nutrition supplementation in ambulatory patients with decompensated alcoholic liver disease was carried out during 1 year. Fifty‐one patients were studied; 26 were assigned to an experimental group receiving a daily supplement of 1000 kcal and 34 g of proteins given as a casein‐based enteral nutrition product and 25 to a control group receiving one placebo capsule. Patients were examined in a special clinic once a month or more if required. Sixty‐eight percent of patients admitted to alcohol ingestion or had alcohol in urine samples on at least one occasion. Dietary recalls showed a significantly higher protein and caloric intake in case patients subjects (p <.0001). Nine patients died during the study, three case patients and six control patients (p = NS). The frequency of hospitalizations was significantly less in the experimental group. This difference was attributed to a reduction in severe infections. Mid‐arm circumference, serum albumin concentration, and hand grip strength improved earlier in case patients, although both groups had a significant improvement in these parameters. Bilirubin and aspartate aminotransferase decreased and prothrombin time increased significantly in both groups during the study period, without differences between groups. It is concluded that nutrition support decreases nutrition‐associated complications in patients with alcoholic liver disease. (Journal of Parenteral and Enteral Nutrition 17:119–124, 1993)
The Effects of Total Parenteral Nutrition on the Hepatic Handling of Bilirubin in the Rat
Authors: Culebras Jesus M. , Garcia‐Vielba Jesus , Garcia‐Diez Fructuoso , De La Hoz Maria L. , Collado Pilar S. , Gonzalez‐Gallego Javier
Published: May 2008

Disturbances of bilirubin metabolism such as jaundice or pigment gallstone formation occur during total parenteral nutrition (TPN). We have studied the effects of TPN on bile flow and bile acid secretion and on the hepatobiliary transport of bilirubin in rats. Animals on parenteral nutrition for 5 days received 4.8 g of amino acids and 6.9 g of glucose daily. Controls were orally fed animals. Bile flow and bile acid secretion were not significatly modified by TPN. Serum bile acid and alkaline phosphatase levels were significantly increased in TPN animals when compared with the controls (+98% and +38%, respectively), which points to a relative cholestasis in the TPN rats. The biliary excretion of bilirubin monoconjugates and bilirubin diconjugates was significantly increased (+72% and +78%, respectively). This provides evidence for enhanced production of the pigment. Serum concentration of total bilirubin was enhanced in the TPN rats (+240%). The esterified/total bilirubin ratio in serum increased, whereas the bilirubin diconjugates/bilirubin monoconjugates ratio decreased. These facts, together with the minor reduction of hepatic bilirubin UDPglucuronosyltransferase activity (—12%), suggest that hyperbilirubinemia would be a consequence of both cholestasis and increased bilirubin production. The alterations reported here could contribute to the explanation of hyperbilirubinemia and pigment gallstone formation in patients maintained on parenteral nutrition. (Journal of Parenteral and Enteral Nutrition 17:125–129, 1993)
Structured Triglycerides to Postoperative Patients: A Safety and Tolerance Study
Authors: Sandström Rolf , Hyltander Anders , Körner Ulla , Lundholm Kent
Published: May 2008

Long‐chain triglycerides are still the standard in fat emulsions, although medium‐chain triglycerides have been suggested to have metabolic advantages even though pure medium‐chain triglycerides are toxic in large doses. The next generation of fat emulsions may be structured triglycerides, which are assumed to provide a higher oxidation rate, faster clearance from blood, improved nitrogen sparing, and less of a tendency to accumulate in the reticuloendothelial system compared with long‐chain triglyceride emulsions. This study was designed to evaluate the safety and tolerance of structured triglyceride fat emulsion 73403 (Kabi Pharmacia Parenterals, Stockholm, Sweden) compared with that of a standard long‐chain triglyceride emulsion (Intralipid 20%) in postoperative patients requiring total parenteral nutrition after major surgery. The study was randomized and of the double‐blind, parallel group type. Twenty patients were included and treated for 5 to 7 days. Safety and tolerance variables demonstrated no major differences between the study and control groups. Physiologic and biochemical variables suggested that structured lipids were rapidly cleared and metabolized. This study represents the first report of administration of structured triglycerides to postoperative patients. The structured triglyceride emulsion (73403) demonstrated no difference in safety and tolerance compared with Intralipid 20%. Therefore, it will now be possible to follow up with studies on metabolic efficiencies of structured triglycerides in postoperative patients. (Journal of Parenteral and Enteral Nutrition 17:153–157, 1993)
Metabolic Rate and Nitrogen Balance in Patients Receiving Bolus Intermittent Total Parenteral Nutrition Infusion
Authors: Hyltander Anders , Arfvidsson Berndt , Körner Ulla , Sandström Rolf , Lundholm Kent
Published: May 2008

The present study investigated whether infusion principles are significant factors that influence the nutritional efficiency of complete intravenous nutrition. For this purpose, three infusion modalities were evaluated in patients who underwent elective and uncomplicated cholecystectomy. The nutrition regimens were as follow: group 1, sequential infusion of fat plus amino acids at a constant rate over 12 hours during daytime followed by glucose infusion at a constant rate for 12 hours during nighttime; group 2, simultaneous infusion of all substrates at a constant rate over 24 hours; and group 3, simultaneous infusion of all substrates with bolus‐based intermittent infusions during 60 minutes six times per day (24 hours). Nonprotein calories corresponded to 160% of the individually measured resting need and were provided as 60% carbohydrate and 40% fat. Nitrogen was provided as crystalline amino acids in solution at 0.2 g of nitrogen per kilogram per day. All patients were randomized into three comparable groups. Intermittent nutrition (group 3) was associated with a significantly higher thermic effect, which led to a significantly lower although still positive energy balance than either sequential nutrition (group 1) or constant nutrition (group 2). The mean daily nitrogen balance was, however, significantly improved in patients receiving intermittent nutrition, and this was accompanied by much higher plasma insulin levels as well as higher plasma amino acid concentrations. This study demonstrates that all substrates should be given simultaneously and that supplementation of intravenous nutrition in boluses, similar to meal feeding, gave the most pronounced protein accretion when compared with either sequential administration of total parenteral nutrition or administration of all admixtures with constant infusion over 24 hours. The positive effect on nitrogen balance was, however, associated with a higher energy cost. (Journal of Parenteral and Enteral Nutrition 17:158–164, 1993)
Amino Acid Infusions Induce Reversible, Dose‐Related Decreases in Bile Flow in the Isolated Rat Liver
Authors: Shattuck Karen E. , Grinnell Chali D. , Rassin David K.
Published: May 2008

Parenteral infusion of amino acid solutions is known to produce cholestasis in experimental animal models and in the isolated perfused rat liver. To characterize the dose responsiveness and reversibility of amino acid‐induced cholestasis, isolated rat livers were perfused with solutions containing 1.5, 3.0, or 6.0 g of amino acids for 1 hour and allowed to recover for 30 minutes. Perfusion of livers resulted in a rapid, dose‐related decrease in bile flow (p <.0001 at doses of 3.0 and 6.0 g). When the amino acid solution was discontinued, bile flow recovered to near control rates. Infusion of taurocholate reduced the magnitude of the decrease in bile flow associated with amino acid infusion but did not prevent it. Infusion of amino acid solutions was associated with the following changes in bile: (1) dose‐related increases in total free amino acid concentrations; (2) increased osmolarity; (3) increased glucose concentrations; (4) increased potassium concentrations; (5) decreased chloride concentrations; (6) increased oxygen uptake in livers not perfused with added taurocholate; and (7) increased total bile acid concentrations in livers perfused with added taurocholate. Additional investigations are needed to determine whether these associations are attributable to individual amino acids or the total metabolic load of the amino acids. (Journal of Enteral and Parenteral Nutrition 17:171–176, 1993)
Review: Medication Delivery in the Short‐Bowel Syndrome
Authors: McFadden Martin A. , Delegge Mark H. , Kirby Donald F.
Published: May 2008

Technologic advances such as total parenteral nutrition have prolonged the lives of individuals with short‐bowel syndrome who previously would not have survived. However, the day‐to‐day management of these patients presents a significant challenge to those who take care of them. Providing medications on either an acute or chronic basis without the use of their central catheters is a difficult clinical problem. This article reviews the approach and methods of treating short‐bowel patients on the basis of their individual circumstances and physiology. (Journal of Parenteral and Enteral Nutrition17:180–186, 1993)
Nutritional Outcome and Pneumonia in Critical Care Patients Randomized to Gastric versus Jejunal Tube Feedings M. A. MONTECALVO, K. A. STEGER, H. W. FARBER, ET AL Critical Care Medicine 20:1377–1387, 1992
Authors: Demetriou Achilles A.
Published: May 2008

A prospective study was carried out over a 10‐month period to compare nutritional status, gastric colonization, and rates of nosocomial pneumonia in intensive care unit (ICU) patients randomized to either gastric tube feeding or feeding by an endoscopically placed jejunal tube. Sixty‐nine patients were considered eligible for the study. Thirty‐eight patients were enrolled from medical and surgical ICUs at two hospitals and were equally divided into two groups. The groups were similar in age, sex, race, underlying disease, type of surgical procedure, number of days fed, duration of ICU stay, duration of mechanical ventilation, days with fever, and days of antibiotic therapy. The jejunal tube (JT) group had more patients who were in circulatory shock on admission (79%) than the gastric feeding (GT) group (68.4%). Additionally, the JT group had higher Acute Physiology Scores (24.0 vs 21.7) and fewer patients with pneumonia at the time of entry into the study (26.3% us 31.6%). The JT patients received a significantly higher percentage of their daily goal caloric intake (p <.05) and had a significantly greater increase in serum prealbumin concentration (p <.05) than the GT patients. The difference in incidence of diarrhea between the two groups was not statistically significant (JT: 3.3 ± 6.6 days; GT: 1.8 ± 2.9 days). Two patients in the GT group (10.5%) and none in the JT group developed nosocomial pneumonia. In a subset of 12 patients from both groups (JT: n = 5; GT: n = 7), quantitative cultures of the pharynx, stomach, and sputum were carried out. No significant differences in the median levels of colonization with Gram‐negative bacilli were seen between the two groups (at each site); similarly, the numbers of Gram‐positive cocci and Candida species for the two groups were similar at all sites.

The authors concluded that patients fed by JT received a significantly higher proportion of their daily caloric intake, had a significantly greater increase in serum prealbumin concentrations, and had a lower rate of pneumonia than patients fed by continuous GT.
Does Perioperative Total Parenteral Nutrition Reduce Medical Care Costs?
Authors: Eisenberg John M. , Glick Henry A. , Buzby Gordon P. , Kinosian Bruce , Williford William O.
Published: May 2008

An economic analysis accompanied a multicenter Department of Veterans Affairs randomized, controlled trial of perioperative total parenteral nutrition (TPN). The cost of providing TPN for an average of 16.15 days before and after surgery was $2405, more than half of which ($1025) included costs of purchasing, preparing, and delivering the TPN solution itself; lipid solutions accounted for another $181, additional nursing care for $843, and miscellaneous costs for $356. Prolonged hospital stay added another $764 per patient to the $2405 cost of providing TPN, bringing the total to $3169. The incremental costs attributed to perioperative TPN were highest ($3921) for the patients least likely to benefit, that is, those who were less malnourished and at low risk of nutrition‐related complications. Incremental costs were lowest ($3071) for high‐risk patients. On the basis of the hospital‐based method of administering TPN that was used in the clinical trial, perioperative TPN did not result in decreased costs for any subgroup of patients. (Journal of Parenteral and Enteral Nutrition 17:201–209, 1993)
Addition of Glucagon to Lipid‐Free Total Parenteral Nutrition Reduces Production of Prostaglandin E2 by Stimulated Splenic Macrophages
Authors: Zamir Oded , Nussbaum Michael S. , Ogle Cora K. , Higashiguchi Takashi , Rafferty Janice F. , Fischer Josef E.
Published: May 2008

Sepsis is a major complication of total parenteral nutrition (TPN). Impaired immunity has been suggested as being responsible for TPN‐related sepsis, but it is unknown how the immune system is affected by TPN. We recently found that administration of lipid‐free TPN resulted in an increase in prostaglandin Ez (PGE2) release by stimulated splenic macrophages. This observation suggested that TPN may impair immunity through the prominent immunosuppressive effects of PGE2. In the present study, we tested the hypothesis that addition of glucagon to TPN solution may protect against the immunosuppresive effect of TPN by modifying PGE2 secretion. Adult, male Sprague‐Dawley rats (n = 18) underwent jugular vein cannulation: group 1 (n = 7) received intravenous saline and chow ad libitum; group 2 (n = 6) received TPN (80 mL/24 h); and group 3 (n = 5) received TPN (80 mL/24 h) plus glucagon (100 μg/24 h). After 10 days, spleens were removed and splenic macrophages were isolated and cultured for 24 h in plain M199 medium (nonstimulated) or in medium containing Escherichia coli lipopolysaccharide (5 μg/mL) (stimulated). PGE2 release was determined by enzyme‐linked immunosorbent assay. There were no differences in PGE2 release between the groups of nonstimulated cells, but when stimulated with lipopolysaccharide, the macrophages from the TPN rats (group 2) released more PGE2 (81.68 ± 25.99 ng/2.5 x 106 cells) than the control group (16.04 ± 3.26 ng/2.5 × 106 cells). The release of PGE2 was normalized in the TPN animals treated with glucagon (15.71 ± 3.33 ng/2.5 x 106 cells). This difference was significant, with p <.05 by Tukey's test after analysis of variance. The results confirm that TPN may be immunosuppressive through the release of PGE2 by stimulated splenic macrophages. Addition of glucagon appears to prevent this adverse effect of TPN. We hypothesize that this may take place by changes in lipid metabolism mediated by glucagon. (Journal of Parenteral and Enteral Nutrition 17:226–230, 1993)
Review: Intestinal Amino Acid Absorption During Sepsis
Authors: Gardiner Keith , Barbul Adrian
Published: May 2008

Sepsis has been shown to cause a decrease in mesenteric blood flow in association with ultrastructural changes in the small intestine and impaired immune, barrier, and metabolic functions of the gut. These impairments in the structure and function of the gastrointestinal tract may have a detrimental effect on the morbidity and mortality of sepsis. Two recent studies have shown that the ability of the small intestine to absorb amino acids is also impaired during sepsis, but the systemic and cellular mechanisms of this impairment are not known. Release of cytokines induced by systemic bacteria or endotoxin may lead to a reduction in the synthesis of transporter proteins by the enterocyte at a time when there is reduced availability of both luminal (because of anorexia) and circulating (because of reduced mesenteric blood flow) substrates. Future research needs to investigate the systemic and local mediation of the sepsis‐induced reduction in intestinal amino acid absorption and the possibility of correcting the defect by the administration of enteral nutrients, hormones, or drugs. (Journal of Parenteral and Enteral Nutrition 17:277–283, 1993)
Symptomatic Vitamin A and D Deficiencies in an Eight‐Year‐Old With Autism
Authors: Clark Joseph H. , Rhoden Donna K. , Turner Denece S.
Published: May 2008

An 8‐year‐old boy with autism developed a limp and periorbital swelling. He was found to have hypocalcemia and radiographic evidence of rickets. Ophthalmologic examination revealed xerophthalmia and corneal erosions. Serum vitamin A was undetectable and serum 25‐hydroxyvitamin D was decreased. Dietary history revealed a markedly altered intake consisting of only french fried potatoes and water for several years. All biochemical and physical abnormalities reversed with appropriate supplementation. The nutritional content of french fries is reviewed. Feeding dysfunction is an integral part of autism and closer attention should be paid to potential nutritional deficiencies. (Journal of Enteral and Parenteral Nutrition 17:284–286, 1993)
Spontaneous Separation and Migration of a Metal Splice Segment of a Repaired Hickman Catheter
Authors: Burnes Jan U. , Kelly Darlene G.
Published: May 2008

Repairs to the external silicone central venous catheter segment are done to correct mechanical defects caused by natural wear and tear or traumatic catheter injury. The ability to repair a damaged catheter obviates the need for surgical replacement. Complications specific to repaired Hickman catheters have not been reported. We report a case in which the metal piece separated from the replacement segment of a Hickman catheter. This metal piece lodged 1 cm from the catheter entrance to the anterior chest and caused incomplete catheter occlusion. (Journal of Parenteral and Enteral Nutrition 17:287–288, 1993)
Use of Sodium Hydroxide Solution to Clear Partially Occluded Vascular Access Ports
Authors: Ter Borg Frank , Timmer John , De Kam Suze S. , Sauerwein Hans P.
Published: May 2008

Gradual vascular access port or tunneled central venous catheter occlusion during total parenteral nutrition is a common complication of unknown etiology, usually unresponsive to treatment with urokinase, ethanol, or hydrochloric acid. After establishing safety with regard to catheter materials and efficacy in dissolving the occluding substance in vitro, we treated a total of 13 vascular access ports (10 patients) that had occluded gradually during “three‐in‐one” total parental nutrition by slow perfusion with 10 to 20 mL of 0.1 mmol/mL sodium hydroxide solution. We found a mean increase in flow (results are flow rates under gravity‐dependent vascular access port inlet pressure of 1.5 kPa) from 37 μL/s (95% upper confidence limit, 45 μL/s) to 75 μL/s (95% lower confidence limit, 64 μL/s; p <.001). For normal use, a flow of 50 μL/s is sufficient. There were no side effects. Five vascular access ports remained in excellent function during a follow‐up period of 9 months. The others had reocclusions, but the partial reocclusions could be treated successfully. (Journal of Parenteral and Enteral Nutrition 17:289–291, 1993)
Liver Dysfunction and Energy Source: Results of a Randomized Clinical Trial
Authors: Buchmiller Carole E. , Kleiman‐Wexler Rachel L. , Ephgrave Kimberly S. , Booth Brenda , Hensley Carl E.
Published: May 2008

Controversy still exists regarding the role of the carbohydrate:fat ratio on liver function abnormalities associated with the administration of total parenteral nutrition (TPN). We designed a prospective clinical trial comparing standard carbohydrate‐based TPN (8.5% amino acids, 50% dextrose, 7.5% of total calories from lipids) with an isocaloric lipid‐based TPN (8.5% amino acids, 30% dextrose, 40% of total calories from lipids) in 43 patients exclusively receiving TPN ≥ 2 weeks. Energy needs were calculated as basal energy expenditure X 1.5. The mean daily calorie intake for patients who obtained carbohydrate‐based TPN (CHO) was 2227 kcal, whereas the lipid‐based TPN (LIP‐CHO) group achieved a mean of 2310 kcal. Patients with preexisting liver disease were excluded. There was no significant difference in age or diagnosis between the groups. We monitored total bilirubin, direct bilirubin, alkaline phosphatase, γ‐glutamyl transferase, lactic dehydrogenase, serum glutamic oxaloacetic transaminase, and serum glutamic pyruvic transaminase. Initial liver‐associated tests did not vary significantly between groups. Group mean values after 2 weeks of TPN were significantly different for total bilirubin (1.5 mg/dL in the CHO group compared with 0.7 in the LIP‐CHO group, p <.05) and direct bilirubin (0.8 mg/dL in the CHO group compared with 0.3 mg/dL in the mixed substrate group, p <.05). Differences in mean values between groups were also noted for serum glutamic oxaloacetic transaminase, serum glutamic pyruvic transaminase, and lactic dehydrogenase. In conclusion, this prospective trial reveals that the use of a balanced energy source TPN solution prevents the abnormalities in liver‐associated tests commonly associated with TPN. This study differs from previous trials in that overfeeding was avoided in both groups and most liver‐associated tests were within normal limits in patients with mixed calorie source TPN. (Journal of Parenteral and Enteral Nutrition 17:301–306, 1993)
Short‐Chain Fatty Acids, Lactate, and Ammonia in Ileorectal and Ileal Pouch Contents: A Model of Cecal Fermentation
Authors: Nordgaard‐Andersen Inge , Clausen Mette Rye , Mortensen Per Brøbech
Published: May 2008

Fecal concentrations of total short‐chain fatty acids were normal in 16 patients with ileorectal anastomoses (mean ± SEM, 99.7 ± 10.3 mmol/L) and 28 patients with ileal pouch‐anal anastomoses (138.8 ± 8.5 mmol/L) and did not differ from those in 14 healthy noncolectomized controls (130.7 ± 12.6 mmol/L). Acetate:propionate:butyrate:isobutyrate+ valerate+isovalerate ratios were similar in the ileorectum (71:12:12:5%) and in the colorectum (66:14:13:7%) of healthy noncolectomized controls, whereas the concentration of acetate was increased at the expense of the polypeptide‐derived isobutyrate, valerate, and isovalerate in the ileal pouch (77:12:11:1%). Ammonia was accordingly significantly diminished in ileal pouch contents (28.8 ± 3.2 mmol/L us 45.2 ± 4.1 mmol/L in controls) in contrast to concentrations in ileorectal contents (36.2 ± 5.3 mmol/L). Concentrations of lactate were normal and low. Twenty‐four‐hour productions of total short‐chain fatty acids in 16.6% fecal homogenates from both groups of patients were normal. Addition of saccharides (eg, glucose, starch, pectin, ispaghula husk) increased the production of acetate, propionate, and butyrate and decreased the production of ammonia and isobutyrate, valerate, and isovalerate, which was increased in homogenates with albumin added. This pattern of substrate fermentation was similar in homogenates from ileal pouch, ileorectum, and control colorectum. In conclusion, the concentrations of short‐chain fatty acids, lactate, and ammonia indicate that ileorectal fermentation resembles normal colorectal fermentation in noncolectomized healthy individuals, whereas the fermentation in ileal pouch contents seems to be more carbohydrate predominated. Therefore, although the ileorectum and ileal pouch are both positioned close to the incoming small intestinal digesta, the ileal pouch may serve as a more appropriate in vivo model of cecal fermentation than the ileorectum. (Journal of Parenteral and Enteral Nutrition 17:324–331, 1993)
Use of the Soluble Peptide γ‐L‐Glutamyl‐L‐Tyrosine to Provide Tyrosine in Total Parenteral Nutrition in Rats
Authors: Radmacher Paula G. , Hilton Mary A. , Hilton Frederick K. , Duncan Scott D. , Adamkin David H.
Published: May 2008

Limited solubility restricts amounts of tyrosine (Tyr) in amino acid solutions used in total parenteral nutrition (TPN). Excess phenylalanine (Phe) is included in TPN for conversion to Tyr by liver Phe hydroxylase. However, this conversion is limited, especially in infants. We have confirmed that infants receiving TPN have low Tyr concentrations and high Phe/Tyr ratios in plasma compared with published values for enterally fed neonates. Tyr is important in the synthesis of proteins and other biomolecules, including catecholamines in the brain. We tested the soluble peptide γ‐glutamyl‐tyrosine (Glu(Tyr)) as a possible precursor of Tyr in TPN. Groups of five rats were given infusions of TPN containing an amino acid mixture simulating a commercial formulation (group A), TPN in which Glu(Tyr) was substituted for half the Phe in the group A solution) (group B), or saline (group C). Control animals (group C) were fed rodent chow. Blood was sampled at 0 time and daily for 4 days. Brains were collected at 96 hours, and aromatic amino acids in plasma and brains were measured by high‐performance liquid chromatography. Throughout the experiment, plasma of animals in group A had significantly elevated Phe and reduced Tyr concentrations compared with control values; plasma concentrations in groups B and C were similar. In groups A and B, brain Tyr levels were 31% and 63% of control values, respectively. In group B, Glu(Tyr) was not detected in brains. These data suggest that supplementing current TPN mixtures with Glu(Tyr), which is stable in solution, can produce normal plasma Tyr concentrations and Phe/ Tyr ratios and improve the supply of Tyr to the brain. (Journal of Parenteral and Enteral Nutrition 17:337–344, 1993)
The Influence of Parenteral Glutamine and Branched‐Chain Amino Acids on Total Parenteral Nutrition—Induced Atrophy of the Gut
Authors: Platell Cameron , Mccauley Rosalie , Mcculloch Ross , Hall John
Published: May 2008

We tested the hypothesis that the provision of glutamine and branched‐chain amino acids would reverse the gut atrophy that accompanies parenteral nutrition. Three hundred seventy‐five rats were randomized into 15 groups to receive either conventional parenteral nutrition, rat food, glutamine‐enriched parenteral nutrition (0.5% to 2.5%), branched‐chain amino acid‐enriched parenteral nutrition (0.8% to 2.0%), or glutamine plus branched‐chain amino acid‐enriched parenteral nutrition (0.5%/0.4% to 1.25%/1/0%). When compared with effects of conventional parenteral nutrition, the infusion of either glutamine or branched‐chain amino acids partially reversed, in a dose‐dependent manner, atrophy of the small bowel as assessed by gut weight (p <.05), mucosal weight (p <.05), villous height (p <.05), crypt cell production rate (p <.05), and mucosal protein concentration (p <.05). There was no effect on the large bowel. These results suggest that the parenteral infusion of either glutamine or branched‐chain amino acids partially reverses the small‐bowel atrophy that is associated with the infusion of solutions of conventional parenteral nutrients. (Journal of Parenteral and Enteral Nutrition 17:348–354, 1993)
Effect of Arginine‐Enriched Total Parenteral Nutrition on the Host‐Tumor Interaction in Cancer‐Bearing Rats
Authors: Oka Toshinori , Ohwada Katsuo , Nagao Mitsuhiro , Kitazato Kenji
Published: May 2008

By using a transplantable Yoshida sarcoma in a rat total parenteral nutrition model, we measured the effectiveness of an arginine‐enriched amino acid solution (AI‐82) in terms of leucine kinetics and nitrogen balance as indicators of host‐tumor nutrition interaction compared with that of a conventional amino acid solution (Proteamin12). When tumor‐bearing rats received isocaloric total parenteral nutrition solutions for 7 days, AI‐82 significantly improved host nitrogen balance and significantly decreased the tumor‐nitrogen trap throughout the experimental period. Leucine kinetics of whole body and tissues were also determined by a 4‐hour continuous infusion of each total parenteral nutrition solution containing 14C‐leucine. Significantly increased whole‐body leucine oxidation (p <.01) without an increase in leucine release from normal tissues was observed in the AI‐82 group. Total incorporation of 14C‐leucine into whole muscle was significantly elevated (p <.05) without changes in muscle protein degradation in the AI‐82 group. In the whole tumor, AI‐82 tended to decrease total incorporation of 14C‐leucine, but there was no difference in leucine release caused by protein breakdown between the two groups. These findings suggest that AI‐82 can improve the nutritional status of the host over that of the tumor. (Journal of Parenteral and Enteral Nutrition 17:375–383, 1993)
Nutrition Support of a Pregnant Comatose Patient via Percutaneous Endoscopic Gastrostomy
Authors: Koh Maria L. , Lipkin Edward W.
Published: May 2008

A pregnant woman was comatose after a motor vehicle accident at 13 weeks' gestation. The nutritional needs of the patient were supported by tube feedings after percutaneous endoscopic gastrostomy. Clinical management was required for nutrition support, infection, and fetal development. At 37 weeks' gestation, a normal 3640‐g male infant was delivered by cesarean section. This represents the first case report of a successful pregnancy outcome after percutaneous endoscopic gastrostomy for enteral nutrition support of a pregnant comatose patient. (Journal of Parenteral and Enteral Nutrition 17:384–387, 1993)
Accuracy of Urinary Urea Nitrogen for Predicting Total Urinary Nitrogen in Thermally Injured Patients
Authors: Milner Elizabeth A. , Cioffi William G. , Mason Arthur D. , Mcmanus William F. , Pruitt Basil A.
Published: May 2008

Estimations of total urinary nitrogen from measured urinary urea nitrogen are commonly used in calculating nitrogen balance. Recently published studies suggest the urinary urea nitrogen/total urinary nitrogen relationship is inconstant and total urinary nitrogen must be directly measured in burned patients. This study addresses the relationship of urinary urea nitrogen to total urinary nitrogen after thermal injury. Two hundred random 24‐hour urine collections obtained from 45 thermally injured patients (mean burn size 59 ± 28%, mean age 40.5 ± 17.2 years) between 1 and 354 days postburn were analyzed for total urinary nitrogen and urinary urea nitrogen. Regression analysis relating total urinary nitrogen to estimated total urinary nitrogen (urinary urea nitrogen x 1.25) revealed a linear relationship (r =.936, p <.001). The mean urinary urea nitrogen/total urinary nitrogen ratio was 0.77 ± 0.10 and was not significantly correlated with percent burn, age, or postburn day. Mean nitrogen balance calculated from measured urinary urea nitrogen in these patients was ‐5.7 g, and that calculated from measured total urinary nitrogen was ‐6.3 g. This difference, although statistically significant, is of little consequence for clinical use. Contrary to recent reports, we found the urinary urea nitrogen to be sufficiently predictive of total urinary nitrogen for practical application, and do not consider routine total urinary nitrogen measurements necessary for the nutritional care of thermally injured patients. (Journal of Parenteral and Enteral Nutrition 17:414–416, 1993)
Patients Receiving Glutamine‐Supplemented Intravenous Feedings Report an Improvement in Mood
Authors: Young Lorraine S. , Bye Rancy , Scheltinga Marc , Ziegler Thomas R. , Jacobs Danny O. , Wilmore Douglas W.
Published: May 2008

Nutritional effects have traditionally focused on outcomes, such as nitrogen balance, wound healing, or muscle strength. Little emphasis has been placed on how biochemical or physical improvements translate into functional changes as perceived by the patient. Because glutamine (GLN)‐supplemented nutrition promotes protein synthesis and improves nitrogen balance, we assessed the mood of individuals participating in a randomized controlled blinded trial receiving GLN solutions. Patients (n = 23) undergoing marrow transplantation were randomized by the research pharmacist to receive either standard total parenteral nutrition (TPN) (control) or GLN‐containing TPN (40 g of glutamine total). The solutions were isocaloric and isonitrogenous and were administered until the patient was eating 50% of estimated requirements. Before TPN and on admission to the hospital, the patient completed the Profile of Mood States questionnaire, a standardized test quantifying the degree of tension, depression, anger, vigor, fatigue, and confusion. The patient completed the questionnaire again at the end of TPN near discharge. The tests were scored and the change from baseline for each mood for both groups of patients was calculated at the completion of TPN. The scores for vigor in the control group (Δ scores) decreased over the course of hospitalization as would be expected with a serious illness. The group receiving glutamine TPN, however, essentially showed little change in vigor from baseline and the Δ score was significantly different from the control group (Δ vigor score ‐0.85 ± 2.1 in the glutamine group vs ‐5.90 ± 1.7 in the control group; p =.07). The control group exhibited little change in feelings of anger over the course of hospitalization; however, the glutamine TPN group felt significantly less angry at the completion of TPN than the control group (Δ anger score ‐6.2 ± 1.6 in the glutamine group vs ‐0.5 ± 2.5 in the control group; p =.052). There was a trend for the total mood score (all six moods evaluated together) to exhibit improvement (p = 1). The GLN group also was discharged from the hospital sooner and had fewer infectious episodes. This is one of the first studies to illustrate an improvement in patients' psychosocial status associated with a nutrition intervention. GLN may influence patients' feelings of well‐being either directly by affecting central nervous system neurotransmitters or through its effects on the protein status of patients. Psychosocial testing may prove useful in evaluating the functional status of patients receiving nutrition support. (Journal of Parenteral and Enteral Nutrition 17:422–427, 1993)
Plasma Lipoprotein Pattern During Long‐Term Home Parenteral Nutrition With Two Lipid Emulsions
Authors: Richelle M. , Rubin M. , Kulapongse S. , Deckelbaum R.J. , Elwyn D.H. , Carpentier Y.A.
Published: May 2008

Hypertriglyceridemia induced by short‐term lipid infusions causes redistribution of neutral lipid components between endogenous lipoproteins and emulsion particles. To determine whether such redistribution occurs over a long‐term infusion period and affects lipoprotein pattern, we studied seven patients with inflammatory bowel disease who received cyclic home parenteral nutrition for two consecutive periods of 3 months with two different lipid emulsions. During each period, they received in random order either an emulsion composed exclusively of soy‐derived long‐chain triglycerides (LCTs) or another emulsion containing an equal weight:weight mixture of long‐ and medium‐chain triglycerides (MCTs/LCTs). Both emulsions contained 20 triglycerides (TGs) and 1.2 phospholipids. Lipids provided 50 of nonprotein energy. Blood samples were taken once a week, 1 hour before the end of infusion (during) and again after a 6‐ to 8‐h lipid‐free interval (baseline). During infusion, there was a moderate increase of plasma TGs and phospholipids and a slight decrease of plasma esterified cholesterol (CE) and free cholesterol. Most of the plasma TGs increase occurred in the very‐low‐density lipoprotein fraction (containing both emulsion particles and the endogenous very‐low‐density lipoprotein), but there was also an increase of TGs content in low‐density lipoprotein (LDL) and high‐density lipoprotein (HDL) that was more pronounced with MCTs/LCTs. Acquisition by exogenous particles of CE transferred from LDL and HDL was significant for the LCT emulsion only. Although no change was observed in plasma lipid concentration of baseline samples during 3 months of home parenteral nutrition, some modifications were observed in the composition of lipoprotein fractions demonstrating a redistribution of lipid components. TGs transferred to LDL were not efficiently cleared during the 6‐ to 8‐hour lipid‐free interval leading to a slight increase of LDL‐TGs with both LCTs (0.31 to 0.36 mmol/L) and with MCTs/LCTs (0.27 to 0.40 mmol/L). HDL‐CEs tended to decrease, whereas LDL‐CEs tended to increase with LCTs. A substantial increase of the LDL‐CE/HDL‐CE ratio occurred after 3 months of home parenteral nutrition with LCTs (1.76 to 3.81; p <.025) but not with MCTs/LCTs (1.91 to 1.44; not significant). (Journal of Parenteral and Enteral Nutrition 17:432–437, 1993)
Nutrition Support After Total Laryngectomy
Authors: Iovinelli Giorgio , Marsili Ida , Varrassi Giustino
Published: May 2008

This study was performed to evaluate the influence of different nutrition supports (enteralvsparenteral) on nutritional status, postoperative complications, and length of hospitalization in patients undergoing total laryngectomy. Forty‐eight patients were divided at random into two groups and received enteral nutrition support by percutaneous endoscopic gastrostomy with a casein and soy‐based polymeric formula blended with a modular protein (group A) or a balanced formula in total parenteral nutrition given through a subclavian venous catheter (group B). The results show a satisfactory preservation of nutritional status after total laryngectomy and no significant differences in the nutritional parameters between groups fed enterally or parenterally; however, percutaneous endoscopic gastrostomy could avoid many problems related to enteral nutrition support for patients undergoing laryngectomy. This route of administration was well tolerated by all the patients and, moreover, the percutaneous endoscopic gastrostomy‐related complications were clinically less significant than those associated with total parenteral nutrition; this fact could explain the longer hospitalization for group B (34 ± 11vs26 ± 11 days) (p<.05). (Journal of Parenteral and Enteral Nutrition17:445–448, 1993)
A New Technique for Placement of Central Venous Catheters in Small Infants
Authors: Stephenson Terence , Khan Javed
Published: May 2008

The delivery of total parenteral nutrition to premature infants has been a major advance in neonatal intensive care. Ideally, total parenteral nutrition fluids should be given through a central venous catheter, but insertion of such a catheter may be a very difficult procedure in small neonates. We describe a new technique that improves the success rate of central venous catheterization in premature infants. (Journal of Parenteral and Enteral Nutrition 17:479–480, 1993)
The Role of the Imino Transporter Protein in Sepsis‐Impaired Intestinal Proline Absorption
Authors: Gardiner Keith , Barbul Adrian
Published: May 2008

Recently, sepsis has been shown to impair intestinal amino acid absorption in addition to gut metabolic and barrier functions. We investigated intestinal proline absorption in a rabbit model of sepsis. Twelve hours after intraperitoneal injection of lipopolysaccharide, proline uptake by everted jejunal sacs prepared from septic animals (480.4 ± 67.4 nmol per sac per hour) was significantly reduced compared with controls (846.8 ± 73.5 nmol per sac per hour) (p <.001 by t test). We next investigated whether reduced expression of transporter proteins contributed to the impaired intestinal proline uptake during sepsis. The proline (imino) carrier of rabbit jejunum is covalently bound by fluorescein isothiocyanate (FITC) and/or phenylisothiocyanate with irreversible inhibition of proline uptake. This binding and inhibition is prevented by sodium chloride and L‐proline. Single‐cell suspensions of rabbit enterocytes were prepared 12 hours after intraperitoneal injection of lipopolysaccharide/saline or saline alone. Enterocytes were incubated for 30 minutes in tris(hydroxymethyl)aminomethane/ethylenediaminetetraacetate (Tris/EDTA) buffer; buffer with 1 mM phenylisothiocyanate; or buffer with 10 mM proline, 100 mM sodium chloride, and 1 mM phenylisothiocyanate. After incubation with 10 μM FITC in Tris/EDTA buffer for 15 minutes, the percent positivity and fluorescent intensity of FITC binding to enterocytes were determined by using flow cytometry. Sepsis significantly reduced the percentage of enterocytes binding FITC and the fluorescent intensity of FITC binding of proline/sodium chloride‐pretreated or untreated cells. This suggests that sepsis depresses the expression of imino transporters by rabbit enterocytes, which may explain the reduced intestinal proline absorption. (Journal of Parenteral and Enteral Nutrition 17:507–512, 1993)
Limitations of Percutaneous Endoscopic Jejunostomy
Authors: Henderson Joseph M. , Strodel William E. , Gilinsky Norman H.
Published: May 2008

Thirty‐six patients at the University of Kentucky Medical Center underwent percutaneous endoscopic jejunostomy placement between January 1 and December 31, 1989. We retrospectively reviewed their charts for indications and complications of the procedure. Experience and outcome with the initial placement of the percutaneous jejunostomy tube was evaluated. Primary diagnoses at the time of insertion included central nervous system disorders (28), ventilator dependence (5), cancer (2), and gastroparesis (1). The follow‐up period ranged from 2 to 131 days (median 16 days). Tube dysfunction or dislodgment occurred in 31% of patients. Other complications included pulmonary aspiration (11%) and bleeding at the insertion site (3%). The 30‐day mortality rate was 19% with all but one death caused by the severity of the underlying primary illness. It is concluded that problems with the currently performed technique of percutaneous endoscopic jejunostomy, along with tube‐related problems, seriously limit the usefulness of this technique. Improvements in technology, along with routine postprocedure radiographs to allow early detection of malpositioned jejunostomy tubes, may improve the outcome of this procedure. Newer techniques that have a higher success of distal small intestinal placement need to be evaluated. (Journal of Parenteral and Enteral Nutrition 17:546–550, 1993)
Amino Acid Loss and Plasma Concentration During Continuous Hemodiafiltration
Authors: Frankenfield David C. , Badellino Michael M. , Reynolds H. Neal , Wiles Charles E. , Siegel John H. , Goodarzi Shirin
Published: May 2008

Amino acid loss, plasma concentration, and the relationship between amino acid intake and balance during continuous hemodiafiltration (CHD) were investigated in a prospective, nonrandomized study of trauma patients exhibiting the systemic inflammatory response with acute renal failure. Data were compared with those from a group of similar patients who had maintained renal function (control). Both groups received similar amounts of nonprotein calories (3015 ± 753 nonprotein calories per day in the control group vs 3077 ± 1018 nonprotein calories per day in the CHD group) and amino acids (2.24 ± 0.36 g/kg per day in the control group vs 2.19 ± 0.48 g/kg per day in the CHD group) via the parenteral route. Amino acid solutions were either 19% or 45% branched‐chain amino acid enriched. Studies were performed every 12 hours for a maximum of 6 days. Amino acid loss was 2.5 ± 2.3 g/12 h in the control group vs 6.6 ± 2.4 g/12 h in the CHD group (p <.0001). Increasing the dialysate rate from 15 to 30 mL/min increased amino acid loss from 5.7 ± 1.7 to 7.9 ± 2.6 g/12 h (p <.0001). Amino acid loss was unrelated to amino acid intake but was directly related to plasma amino acid concentration, CHD effluent volume, and the efficiency of filtration as measured by the ratio of filtered urea nitrogen to blood urea nitrogen (R 2 =.69). A linear relationship was found between amino acid intake and balance (R 2 =.991). The patterns of plasma amino acid concentrations were consistent with metabolic changes wrought by a combination of sepsis and multiple organ dysfunction and type of amino acid intake but seemed unaffected by increased amino acid loss in CHD effluent. Amino acid losses were 2 to 3 times greater from CHD than from normal kidney. However, CHD amino acid losses may not be clinically significant unless amino acid intake is restricted to levels used typically in traditional hemodialysis. (Journal of Parenteral and Enteral Nutrition 17:551–561, 1993)
Famine, Fiber, Fatty Acids, and Failed Colonic Absorption: Does Fiber Fermentation Ameliorate Diarrhea?
Authors: Roediger William E.W.
Published: May 2008

The salvage function of the colon for absorption of unabsorbed sodium and water from the jejunum and ileum depends upon the metabolic integrity of colonic epithelial cells maintained by luminal short‐chain fatty acids. With the depletion of luminal short‐chain fatty acids under conditions of starvation, metabolic compensation from vascular substrates is incomplete. Loss of luminal short‐chain fatty acids diminishes cell membrane integrity and causes secretion by colonic epithelial cells, leading to starvation diarrhea. Because sodium absorption is dependent upon CO2 production from n‐butyrate, no compensatory absorption occurs during starvation. Under conditions in which luminal short‐chain fatty acids are depleted, dietary fiber is useful as a low osmolality food constituent and for renewal of short‐chain fatty acid levels by bacterial fermentation. The “antisecretory” effect of dietary fiber depends on the degree of the preexisting depletion of short‐chain fatty acids and the methodology used to assess absorptive function. Dietary fiber has not been found harmful in refeeding starvation victims for whom it is an essential food constituent. (Journal of Parenteral and Enteral Nutrition 18:4–8, 1994)
Dicarboxylic Acids and Glucose Utilization in Humans: Effect of Sebacate
Authors: Raguso C.A. , Mingrone G. , Greco A.V. , Tataranni P.A. , De Gaetano A. , Castagneto M.
Published: May 2008

Dicarboxylic acids have been proposed as an alternate lipid energetic substrate for total parenteral nutrition. No data are yet available on the possible effect of dicarboxylic acids on glucose metabolism in humans. Thus, we examined the effect of a continuous intravenous infusion of the sodium salt of the10‐carbon atom alyphatic dicarboxylic acid, sebacate (Sb), on insulin‐dependent glucose metabolism in four control subjects, four patients with insulin‐dependent diabetes mellitus, and four obese subjects. All subjects received a constant 5‐hour infusion of saline or sebacate (6.6 g/h), in a randomized order on two different days. After 3 hours of infusion, a 120‐minute euglycemic, hyperinsulinemic clamp procedure was performed (insulin infusion rate = 40 mU/m2 per minute). Glucose uptake, plasma sebacate, insulin, glucagon, C‐peptide, and ketone bodies were measured. No significant differences in insulinemia were found among groups either during the saline infusion or the sebacate infusion. On the contrary, glucose uptake (molar) was significantly reduced during the sebacate vs the saline day in all three groups: 6.7 ± 0.04 vs 3.7 ± 1.3 in control subjects (p <.001), 4.6 ± 0.4 vs 2.5 ± 1.2 in patients with insulin‐dependent diabetes mellitus (p <.001), and 4.8 ± 0.5 vs 2.7 ± 0.2 mg/kg per minute in obese subjects (p <.001). In conclusion, Sb administration was associated with a glucose‐sparing effect as shown by the reduced glucose uptake in all patients studied. Sebacate did not stimulate insulin secretion, inasmuch as no modification of C‐peptide plasma levels was observed after 3 hours of Sb infusion. In addition, no change in Sb steady‐state levels was observed during hyperinsulinemia, suggesting that insulin does not influence Sb plasma clearance. (Journal of Parenteral and Enteral Nutrition 18:9–13, 1994)