bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of Growth Hormone and Insulin‐Like Growth Factor 1 (IGF‐1) Treatments on the Nitrogen Metabolism and Hepatic IGF‐1‐Messenger RNA Expression in Postoperative Parenterally Fed Rats
Authors: Inaba Tsuyoshi , Saito Hideaki , Fukushima Ryoji , Hashiguchi Yojiro , Lin Ming‐Tsan , Inoue Tomomi , Fukatsu Kazuhiko , Muto Tetsuichiro , Takenaka Asako , Takahashi Shin‐Ichiro , Noguchi Tadashi
Published: May 2008

Background: Few studies have made direct comparisons of the metabolic effects of growth hormone (GH) and insulin‐like growth factor 1 (IGF‐1). We have assessed the dose‐dependent effects of GH and IGF‐1 treatments on nitrogen metabolism, intestinal structure, and hepatic IGF‐1‐messenger RNA (mRNA) expression in postoperative parenterally fed rats. Methods: Rats were maintained on total parenteral nutrition (TPN) for 3 days after gastrectomy. GH (0.4 or 0.8 IU/kg/d) or IGF‐1 (1, 2, or 4 mg/kg/d) was infused throughout the experimental period. Anabolic effects of GH and IGF‐1 were assessed by body weight change, nitrogen excretion, and whole‐body protein turnover. Organ weights, intestinal structure, plasma IGF‐1 levels and hepatic IGF‐1‐mRNA contents were also determined. Results: Both GH and IGF‐1 attenuated body weight loss and nitrogen excretion and increased whole‐body protein synthesis and spleen weight. These observations suggest that the anabolic effects of 1 mg/kg/d of IGF‐1 were equivalent to those of 0.66 IU/kg/d of GH. IGF‐1, but not GH, reduced atrophy of the intestinal mucosa. GH treatment increased hepatic IGF‐1‐mRNA and the plasma IGF‐1 level, whereas IGF‐1 treatment increased the plasma IGF‐1 level with no change in the hepatic IGF‐1‐mRNA content. Conclusions: Administration of GH or IGF‐1 attenuates catabolism after surgery. The anabolic effects of 1 mg/kg/d of IGF‐1 are equivalent to those of 0.66 IU/kg/d of GH. IGF‐1 reduces intestinal mucosal atrophy. GH increases hepatic IGF‐1‐mRNA and the plasma IGF‐1 level. (Journal of Parenteral and Enteral Nutrition 20:325–331, 1996)
Erythromycin Facilitates Postpyloric Placement of Nasoduodenal Feeding Tubes in Intensive Care Unit Patients: Randomized, Double‐Blinded, Placebo‐Controlled Trial
Authors: Kalliafas Stavros , Choban Patricia S. , Ziegler Daniel , Drago Stefano , Baum Louis Flano
Published: May 2008

Background: To determine whether administration of erythrornycin (E) could facilitate passage of a nasoenteric feeding tube into the duodenum for postpyloric feedings, this randomized, double‐blind, placebo‐controlled trial was performed. Methods: Fifty‐seven patients were accrued from the surgical intensive care units (ICUs) of a tertiary‐care university hospital. Patients enrolled were categorized as to the presence or absence of diabetes mellitus (DM). Those patients without DM were then subdivided into those with normal or depressed mental status. The three groups, normal (NMS), depressed mental status (DMS), or diabetes mellitus (DM), were then randomized independently to receive either E or placebo (P), followed by blind placement of a feeding tube. Tube placement was verified by an abdominal radiograph. Results: Overall, the rate of postpyloric placement was 61% (19/31) in the E group, significantly better than 35% (9/26) in the P group (p <.05). In patients with NMS, the success rate with E was improved (64%, 9/14) compared with that with P (9%, 1/11) (p <.0005). In the DMS group, there was a 50% success rate (6/ 12) with E versus 63% (5/8) with P (not significant [NS]). In the DM group, 80% (4/5) of the patients had placement of the tube in the duodenum with E and 43% (3/7) with P (NS). Conclusions: These data suggest that, overall, E is effective in facilitating placement of a nasoenteric feeding tube into the duodenum in ICU patients. It is clearly beneficial in those patients with normal mental status and may be useful in patients with diabetes mellitus. (journal of Parenteral and Enteral Nutrition 20:385–388, 1996)
Creation of a Specialized Nutrition Support Outcomes Research Consortium: If Not Now, When?
Authors: August David Allen
Published: May 2008

Background: There is a compelling need to determine the benefits of sophisticated, costly, and potentially hazardous nutrition support interventions. The clinical efficacy and cost effectiveness of specialized nutrition support must be quantitatively defined. Creation of a national outcomes research consortium to study the use of specialized nutrition support can meet these objectives. Methods: Nutrition support and outcomes research literature were reviewed to develop a model for the application of outcomes research methods to clinical, professional, administrative, and financial problems currently challenging the discipline of nutrition support. Results: A multi‐institutional nutrition support outcomes research consortium involving creation of a large, practice‐based data base is proposed. Relevant clinical, administrative, methodologic, and implementation issues are discussed. Conclusions: A multi‐institutional nutrition support outcomes research consortium offers the means to collect rigorous data that can be used to improve patient outcomes, improve the cost‐effectiveness of nutrition support, establish a firm scientific basis for the discipline of nutrition support, and assist nutrition support clinicians in the cost‐cutting climate that currently characterizes health care in the United States. Given the timeliness of these objectives and the human, professional, and financial costs of not achieving them in a timely fashion, it is fair to ask of a nutrition support outcomes research consortium, “If not now, when?” Uournal of Parenteral and Enteral Nutrition 20:394–400, 1996)
Effect of Low‐ and High‐Fat, Peptide‐Based Diets on Body Composition and Disease Activity in Adolescents With Active Crohn's Disease
Authors: Khoshoo Vikram , Reifen Ram , Neuman Manuela G. , Griffiths Anne , Pencharz Paul B.
Published: May 2008

Background: The effect of nasogastric feeding with high‐ and low‐fat, peptide‐based diets on body composition and disease activity was studied in adolescents with active Crohn's disease. Methods: Fourteen patients with active Crohn's disease (12 to 17 years) were fed exclusively through nasogastric feedings with two isocaloric, isonitrogenous, peptide‐based diets, either with low‐ or high‐fat content, for 3 weeks each in a randomized manner then were “crossed over” to the other diet for another 3 weeks of feeding. At the end of each 3‐week period, urine and stools were collected for 72 hours for measuring energy absorption and nitrogen utilization (n = 6). Weight, height, triceps skin folds, fat free body mass, and disease activity were also monitored (n = 14). Results: There was no difference in any parameter of energy absorption or nitrogen utilization between the two formulas irrespective of the order in which they were administered. The changes in nutritional parameters were also comparable with both formulas. There was a significant increase in weight, fat free body mass and triceps skinfold thickness during both the 3‐week periods of feeding (p <.05). This was accompanied by a significant reduction in the pediatric Crohn's disease activity index (p <.05). Conclusions: Peptide‐based diets may be useful in restoring the fat free body mass and improving the disease activity in patients with Crohn's disease. A high fat (high medium‐chain triglycerides) diet did not offer any nutritional advantage over a similar but low‐fat diet. The improvement in disease activity during feeding with a low‐fat diet was comparable to that with a high‐fat diet. The improvement in disease activity seems to be associated with improvement in lean body mass irrespective of the type of diet used to achieve it. (Journal of Parenteral and Enteral Nutrition 20:401–405, 1996)
Comparison of the Safety of Early Enteral vs Parenteral Nutrition in Mild Acute Pancreatitis
Authors: McClave Stephen A. , Greene Lisa M. , Snider Harvy L. , Makk Laszlo J.K. , Cheadle William G. , Owens Nancy A. , Dukes Larry G. , Goldsmith Linda J.
Published: May 2008

Background: This prospective study was designed to compare the safety, efficacy, cost, and impact on patient outcome of early total enteral nutrition (TEN) vs total parenteral nutrition (TPN) in acute pancreatitis. Methods: Patients admitted with acute pancreatitis or an acute flare of chronic pancreatitis, characterized by abdominal pain and elevated serum amylase and lipase, were randomized to receive either isocaloric and isonitrogenous TEN (via a nasojejunal feeding tube placed endoscopically) or TPN (via a central or peripheral line) started within 48 hours of admission. Results: Thirty patients were studied over 32 admissions (TEN given on 16 and TPN on 16) for acute pancreatitis. There were no differences on admission in mean age, Ranson criteria, multiple organ failure score (MOF), or APACHE III score between TEN and TPN groups. Although slower to approach goal feeding over the first 72 hours of admission, TEN patients received 71.3% goal calories by day 4 vs 85.2% for TPN patients (not significant). There were no deaths and no differences between groups in serial pain scores, days to normalization of amylase, days to diet by mouth, serum albumin levels, or percent nosocomial infection. However, the mean cost of TPN per patient was over four times greater than that for TEN ($3294 vs $761, respectively, p <.001). Mean serial Ranson criteria, APACHE III, and MOF scores recorded every 2 to 3 days decreased in the TEN group, whereas those in the TPN group increased. Only the difference in the third Ranson criteria (mean 6.3 days after admission) for the TEN and TPN groups (0.5 vs 2.8, respectively) reached statistical significance (p =.002). Stress‐induced hyperglycemia was worse in the TPN group, as serum glucose levels increased significantly over the first 5 days of hospitalization (p <.02), whereas those in the TEN group showed no significant change. An exacerbation of pancreatitis, occurring in one TEN patient when the nasojejunal tube was dislodged into the stomach, resolved after placement back in the jejunum. Three patients who became asymptomatic and normalized amylase on TEN flared upon advancing to diet by mouth. Conclusions: TEN for acute pancreatitis is as safe and effective, but is significantly less costly than TPN. Compared with TPN, TEN may promote more rapid resolution of the toxicity and stress response to pancreatitis. TEN via jejunal feeding should be used preferentially in this disease setting. (Journal of Parenteral and Enteral Nutrition 21:014–020, 1997)
Neurologic Disorders Due to Brain Manganese Deposition in a Jaundiced Patient Receiving Long‐Term Parenteral Nutrition
Authors: Alves G. , Thiebot J. , Tracqui A. , Delangre T. , Guedon C. , Lerebours E.
Published: May 2008

Background: Neurologic and radiologic disorders have been reported in patients receiving long‐term parenteral nutrition (PN). On the basis of elevated serum manganese levels, some of these abnormalities have been attributed to manganese intoxication. Alterations of the basal ganglia signal intensity on T1‐weighted magnetic resonance images (MRIs) have been previously reported, but the precise nature of these alterations remains controversial although the deposition of manganese has been suggested in patients with chronic hepatic encephalopathy due to liver failure. Methods: We report the case of a patient who was receiving PN and exhibited a chronic cholestasis. Neurologic disorders appeared after several months of PN, when a hypersignal in the basal ganglia and white matter was found on T1‐weighted MRIs of the brain in association with elevated serum and manganese levels. Results: Elevated autopsic concentrations of manganese were found in the radiologic abnormal cerebral areas. Conclusion: Our observation is the first demonstration of a relationship between high intracerebral manganese levels, radiologic abnormalities, and neurologic disorders during long‐term PN. Moreover, serum manganese levels are not a good indicator of cerebral levels. In fact, in our patient, serum manganese levels returned to normal, whereas those of cerebral manganese remained increased. (Journal of Parenteral and Enteral Nutrition 21:041–045, 1997)
Skeletal Muscle Weakness and Dysphagia Caused by Acid Maltase Deficiency: Nutritional Consequences of Coincident Celiac Sprue
Authors: King Timothy S. , Anderson Janice R. , Wraight E. Philip , Hunter John O. , Cox Timothy M.
Published: May 2008

Background: A 30‐year‐old woman with celiac sprue had progressive weight loss, myalgia, limb‐girdle weakness, and dysphagia. Methods and Results: Barium swallow showed an atonic esophagus, and scintigraphic study confirmed esophageal dysmotility. Skeletal muscle biopsy showed characteristic appearances of acid maltase deficiency, which was confirmed by a reduction of leukocyte acid α‐glucosidase activity. Conclusions: Nutritional factors may have accelerated the presentation of the lysosomal storage disorder. This is the first reported case of dysphagia caused by esophageal motor weakness in acid maltase deficiency. (Journal of Parenteral and Enteral Nutrition 21:046–049, 1997)
Skin Necrosis: An Unusual Complication of Hyperphosphatemia During Total Parenteral Nutrition Therapy
Authors: Janigan David T. , Perey Bernard , Marrie Thomas J. , Chiasson Patrick M. , Hirsch David
Published: May 2008

Background:. Hyperphosphatemia complicated by calcification of subcutaneous arteries and skin infarcts are very rarely reported in the absence of chronic renal failure (CRF). We describe identical lesions in an obese woman with sepsis. Hyperphosphatemia resulted from an unintended excess of phosphate in her total parenteral nutrition (TPN) formulations. She did not have CRF or hyperparathyroidism. Methods: The patient's records during 37 weeks of hospitalization 12 years ago and, subsequently, her outpatient records were reviewed. Results: During a 7‐week period, the total elemental phosphorus infused daily, as divalent phosphate, ranged from 1.8 to 4.2 g, median 3.1, over triple the normal daily requirement. This excess was unintended. This occurred before the current practice of pharmacist‐monitoring of TPN formulations, and possibly resulted from misinterpretation of a revised formulation sheet, newly introduced to the nursing units at the start of that period. Serum phosphorus increased to 3.02 mmol/L (normal 0.76 to 1.46 mmol/L). She developed calcification of subcutaneous arteries, which was complicated by widespread infarcts of the anatomically related skin and subcutis, apparently the result of hypoperfusion of these vessels during an episode of septic shock. The infarcts were heralded by unusual, blotchy skin discolorations. Conclusions: This report, illustrating a startling cutaneous complication associated with apparent misinterpretation of TPN formulations, demonstrates a pathogenetic relationship between hyperphosphatemia, calcification of subcutaneous arteries, and necrosis of the skin and subcutis in the absence of CRF and hyperparathyroidism and introduces a new differential diagnosis for unusual skin lesions appearing during TPN therapy. (Journal of Parenteral and Enteral Nutrition 21:050–052, 1997)
Bedside Placement of pH‐Guided Transpyloric Small Bowel Feeding Tubes in Critically III Infants and Small Children
Authors: Dimand Robert J. , Veereman‐Wauters Gigi , Braner Dana A.V.
Published: May 2008

Background and Methods: The small bowel of critically ill infants and small children was cannulated using a soft feeding tube with a pH sensor at the distal tip. By monitoring pH, the tubes were guided through the stomach into the small bowel. Results: Successful placements were performed in 36 of 37 (97%) attempts in 29 critically ill patients whose age was 7.9 ± 6.3 months and weight was 5.9 ± 2.6 kg. Continuous jejunal feedings were administered for 3.7 ± 3.1 weeks without difficulties or complications in all but one patient. Conclusion: pH‐guided jejunal tube placement provides a safe, easy bedside alternative to fluoroscopic, endoscopic or surgical placement in critically ill infants and small children. (journal of Parenteral and Enteral Nutrition 21:112–114, 1997)
Insulin‐Like Growth Factor 1 Has Beneficial Effects, Whereas Growth Hormone Has Limited Effects on Postoperative Protein Metabolism, Gut Integrity, and Splenic Weight in Rats With Chronic Mild Liver Injury
Authors: Inaba Tsuyoshi , Saito Hideaki , Fukushima Ryoji , Hashiguchi Yojiro , Lin Miing‐Tsan , Inoue Tomomi , Fukatsu Kazuhiko , Muto Tetsuichiro , Oka Teruaki , Takenaka Asako , Takahashi Shin‐Ichiro , Noguchi Tadashi
Published: May 2008

Background: Both growth hormone (GH) and insulin‐like growth factor 1 (IGF‐1) improve protein metabolism after surgical insult in subjects without liver disease. However, these effects in chronic liver injury, in which the GH‐IGF‐1 axis is impaired, have not been investigated. We examined the anabolic effects of GH and IGF‐1 after gastrectomy in rats with chronic mild liver injury. Methods: Rats with chronic mild liver injury induced by thioacetamide were used. After gastrectomy, the rats were randomized into vehicle control, GH, and IGF‐1 groups. In the latter two groups, 0.8 IU/kg/d of GH or 4 mg/kg/d of IGF‐1 was infused for 72 hours. Anabolic effects were assessed by body weight change, 3‐methylhistidine (3‐MH) excretion, nitrogen excretion, and whole‐body protein turnover. Organ weights, plasma levels of glucose, insulin, and IGF‐1, tissue IGF‐1 levels, hepatic messenger RNA (mRNA) content, and intestinal structure were also determined. Results: Both GH and IGF‐1 decreased nitrogen excretion. IGF‐1, but not GH, increased postoperative body weight, whole‐body protein turnover, and splenic weight. IGF‐1 reduced atrophy of the intestinal mucosa. GH treatment increased hepatic IGF‐1‐mRNA and the plasma IGF‐1 level, whereas IGF‐1 treatment increased the plasma IGF‐1 level with no change in the hepatic IGF‐1‐mRNA content. There were no significant differences in plasma glucose or insulin levels among the three groups. Neither GH nor IGF‐1 affected the gastrocnemius muscle IGF‐1 level. Conclusions: IGF‐1 has beneficial effects, whereas GH has only limited effects on postoperative protein metabolism, gut integrity, and splenic weight in chronic mild liver injury. (Journal of Parenteral and Enteral Nutrition 21:55–62, 1997)
Lipids in Total Parenteral Nutrition Solutions Differentially Modify Lipids in Piglet Intestinal Brush Border and Microsomal Membranes
Authors: Van Aerde John E. , Keelan Monika , Clandinin M. Thomas , Thomson Alan B.R.
Published: May 2008

Background: Fats in the diet modify the lipid composition and function of the intestinal brush border membrane (BBM) as well as the enterocyte microsomal membrane (EMM). Methods: This study was undertaken in pigs to establish the effect of 3 weeks of total parenteral nutrition (TPN) on the fatty acids in the major phospholipids, (phosphatidylcholine [PC] and phosphatidylethenolamine [PE]) in the jejunal and ileal BBM and EMM. Results: In a comparison of 21‐day‐old milk‐fed piglets and newborn animals, there were differences in the major fatty acids (palmitic, 16:0; stearic, 18:0; oleic, 18:1ω9, and linoleic acid, 18:2ω6) in PC and PE in BBM and EMM. Age‐matched (3‐week‐old) animals fed a lipid‐free glucose‐containing TPN solution had different membrane fatty acids than did milk‐fed piglets, or animals given a soybean oil‐containing TPN solution for 21 days. Substituting fish oil or fish oil plus soybean oil altered BBM and EMM fatty acids, compared with the soybean oil‐based TPN solutions. These changes varied between the class of phospholipids (PC vs PE), between intestinal site (jejunum vs ileum), and between the type of membrane (BBM νs EMM). Conclusions: The jejunum and ileum have distinctive control mechanisms for varying their membrane lipids in response to TPN. There is some postmicrosomal modification of lipids between the EMM and BBM. It remains to be established whether the lipid content of the membranes of other organs, and therefore their function, is modified by the lipid composition of parenterally infused lipids. (JPEN 21:063–071, 1997)
Role of Glutamine in Bacterial Transcytosis and Epithelial Cell Injury
Authors: Panigrahi Pinaki , Gewolb Ira H. , Bamford Penelope , Horvath Karoly
Published: May 2008

Background: L‐Glutamine is the principal energy source for small intestinal enterocytes. Diminution of intestinal function, mucosal atrophy, and increased bacterial translocation have been noted during total parenteral nutrition (TPN). In a rat model of glutamine starvation, we previously showed that luminal glutamine is essential for optimal intestinal function. In this study, we examined the effect of apical νs basolateral glutamine on bacterial translocation in a Caco‐2 cell culture system and bacteria‐induced tissue injury in a weanling rabbit ileal loop model. Methods : Caco‐2 cells were grown in a transwell system. After confluence, apical and basolateral chambers received defined media, and glutamine deprivation was carried out over a 4‐ to 48‐hour period. Escherichia coli transcytosis and structure/function studies were then performed. In a second series of experiments, the effect of intraluminal glutamine supplementation was evaluated in an E. coli‐induced tissue injury model in weanling rabbit ileal loops. Results: Expression of disaccharidases, glucoamylase, and Na+/K+‐adenosine 5′‐triphosphatase (ATPase) were significantly reduced when cells were deprived of glutamine from the apical side, and there was increased bacterial translocation across the monolayer. Transepithelial epithelial resistance (TEER) across the monolayer was also reduced in the glutamine‐free cultures. Glutamine replenishment over 24 to 48 hours restored the original functions. Basolateral deprivation had a smaller effect on the Caco‐2 cells. Typical necrotic mucosal injury caused by E. coli in the ileal loops was blocked by co‐infiltration of the loops with glutamine. Conclusions: This study demonstrates for the first time that the supply of glutamine from the apical side is of critical importance for maintaining optimal structure and function of the enterocytes. The effects are not acute or energy related. These observations have important clinical implications in the management of patients under critical care, including premature infants and patients receiving TPN, for whom lack of glutamine from the luminal side could produce mucosal dysfunction, resulting ultimately in severe atrophic/necrotic complications. (Journal of Parenteral and Enteral Nutrition 21:75–80, 1997)
Cyclic vs Continuous Enteral Feeding With ω‐3 and γ‐Linolenic Fatty Acids: Effects on Modulation of Phospholipid Fatty Acids in Rat Lung and Liver Immune Cells
Authors: Palombo John D. , Demichele Stephen J. , Lydon Erin , Bistrian Bruce R.
Published: May 2008

Background: Arachidonic acid (AA) present in lung and liver immune cell phospholipids is the precursor of eicosanoids that promote neutrophil margination, leading to tissue injury and inflammation. Administration of novel enteral formulations low in linoleic acid (LA) and containing eicosapentaenoic acid (EPA) from fish oil and γ‐linolenic acid (GLA) from borage oil displaces AA and promotes cell formation of eicosanoids with reduced inflammatory potential. The present study was undertaken to determine whether or not short‐term provision of enteral diets containing GLA, EPA, or both in a cyclic fashion modulated the fatty acid composition of rat alveolar macrophage (AM) and liver Kupffer and endothelial (K&E) cell phospholipids in vivo to the extent achieved during continuous feeding. Methods: Rats were isocalorically fed through a gastrostomy catheter for 3 or 6 days with high‐fat, low‐carbohydrate diets that were enriched with either LA (diet A), EPA (diet B), or EPA + GLA (diet C). The rats were randomized by infusion modality, ie, continuous vs cyclic (14 hours feeding with 10 hours fasting daily) feeding. AM and K&E were isolated and phospholipid fatty acid profiles were determined by gas chromatography. Results: The dietary effects on AM and K&E cell phospholipid fatty acids for a given feeding period were not significantly influenced by the infusion modality. AM and K&E cells from rats receiving either diet B or diet C for 3 days had significantly lower AA and LA and higher EPA and dihomo‐GLA (DHGLA), respectively, than rats given diet A regardless of the infusion modality. The mole % of EPA and DHGLA in K&E cells were higher after 6 vs 3 days of cyclic feeding with diet C. Using the eicosanoid precursor ratio (EPA+ DHGLA/AA), the potential for generation of AA‐derived eicosanoids was lower in rats given diet B or C vs diet A regardless of infusion modality. Discussion: Given the rapid changes in lung and liver immune cell phospholipid fatty acids, short‐term provision of EPA and GLA‐enriched diets cyclically or continuously may prove clinically relevant for modulating the fatty acid composition and potential eicosanoid formation by these cells. (Journal of Parenteral and Enteral Nutrition 21:123–132, 1997)
Accuracy of 30‐Minute Indirect Calorimetry Studies in Predicting 24‐Hour Energy Expenditure in Mechanically Ventilated, Critically Ill Patients
Authors: Smyrnios Nicholas A. , Curley Frederick J. , Shaker K. Gem
Published: May 2008

Background: There is no consensus regarding the optimal duration of measurement or time of day to perform indirect calorimetry (IC). Energy expenditure (EE) varies at different times of day and with different activity levels. We sought to assess the variability of EE in mechanically ventilated patients over a 24‐hour period and the accuracy of 30‐minute IC studies in predicting the 24‐hour energy expenditure (EE24). Methods: The study was a prospective comparison between the resting EE obtained by 30‐minute measurement of IC and EE values obtained from 24‐hour measurements. Tests were performed in the Medical Intensive Care Unit (MICU) of a tertiary care, university hospital. Oxygen consumption (VO2) and carbon dioxide production (VCO2) were measured for 24 hours in eight ventilated patients. Measurements were made every 3 minutes and used to calculate 30‐minute and 24‐hour oxygen consumption values. EE24 was calculated using the modified Weir equation. Each 30‐minute interval was compared with the value obtained from the 24‐hour measurement. Results: Three hundred forty‐one of 384 30‐minute intervals remained for analysis. Average EE24 measured was 1490 ± 486 kcal/d. Average EE24 predicted by extrapolation from 30‐minute studies was 1501 ± 503 kcal/d, with a mean difference of 0 ± 209 kcal/d from the measured 24‐hour values (range: ‐1068 to + 585 kcal/d). Thirty‐minute studies were within 20% of 24‐hour measurements for 89% of intervals. The difference between 24‐hour and 30‐minute studies correlated with changes in minute ventilation (VE), heart rate, systolic blood pressure, and breath rate from their 24‐hour means (p <.001). The mean error of EE estimate was greatest between 3 and 11 PM (p <.001). Conclusions: We conclude the following: (1) EE in MICU patients is variable; (2) 30‐minute IC studies predict measured EE24 acceptably well for clinical purposes; and (3) accuracy is maximized if a 30‐minute study is performed between 11 PM and 3 PM, and when VE, heart rate, systolic blood pressure, and breath rate are near the day's average. (Journal of Payenteral and Enteral Nutrition 21:168–174,1997)
Does the Route of Feeding Modify Gut Barrier Function and Clinical Outcome in Patients After Major Upper Gastrointestinal Surgery?
Authors: Reynolds John V. , Kanwar Sunjay , Welsh Fenella K.S. , Windsor Alastair C.J. , Murchan Peter , Barclay G. Robin , Guillou Pierre J.
Published: May 2008

Background: Direct experimental evidence suggests that total enteral nutrition (TEN) reduces septic morbidity compared with bowel rest and total parenteral nutrition (TPN) and that mucosal support and maintenance of gut barrier function is a key mechanism. This effect is supported indirectly by clinical studies, but this question has not previously been investigated directly in the postoperative patient. This study examined the hypothesis that early enteral feeding after major upper gastrointestinal surgery may modulate gut barrier function and decrease the risk of major infective complications compared with bowel rest and parenteral nutrition. Methods: A randomized clinical trial of 67 patients (TPN = 34; TEN = 33) fed postoperatively for 7 days was performed. Thirty‐day major morbidity and mortality were monitored. Intestinal permeability was measured using the lactulose/mannitol test preoperatively and on postoperative days 1 and 7. Systemic anti‐endotoxin core immunoglobulin G and M antibodies and serum albumin and C‐reactive protein were quantified at these time points. Results: No clinical benefit was observed in patients fed enterally compared with the parenterally fed group. Intestinal permeability was increased on the 1st postoperative day in association with evidence of endotoxin exposure. By day 7, enteral feeding compared with parenteral feeding had failed to significantly influence any of the gut barrier or systemic parameters. Conclusions: This randomized controlled trial of TEN vs TPN after major upper gastrointestinal surgery failed to show a clinical benefit for the enteral route. Moreover, enteral nutrition did not modulate gut barrier function postoperatively. (Journal of Parenteral and Enteral Nutrition 21:196–201, 1997)
Early Postoperative Enteral Nutrition Improves Peripheral Protein Kinetics in Upper Gastrointestinal Cancer Patients Undergoing Complete Resection: A Randomized Trial
Authors: Harrison Lawrence E. , Hochwald Steven N. , Heslin Martin J. , Berman Russell , Burt Michael , Brennan Murray F.
Published: May 2008

Background: Patients with upper gastrointestinal (GI) tract malignancies are at risk for malnutrition and postoperative morbidity and mortality. We examined the protein kinetic effects of early enteral feeding in this population and compared it with results in patients receiving IV fluid. Methods: Twenty‐nine patients undergoing resection of an upper GI tract malignancy were prospectively randomized to either enteral feeding starting on postoperative day (POD) 1 via a jejunostomy tube (FEED, n = 12) or IV fluid (IVF, n = 17). On POD5, all patients underwent a protein metabolic study using [3H]phenylalanine to determine forearm skeletal muscle (nmol phenylalanine/100 g/min) protein net balance. Free fatty acids (FFA, mEq/dL) and insulin levels (mU/mL) were measured. Results: Protein net balance was significantly less negative in the FEED group compared with the IVF group (‐1.4 ± 0.8 vs ‐ 5.0 ± 1.4, p <.05). Respiratory quotient was significantly increased in patients receiving enteral feeding (0.85 ± 0.02 vs 0.78 ± 0.02 FEED vs IVF, p <.05). FFA levels were significantly decreased in the FEED group (0.36 ± 0.04 vs 0.85 ± 0.07, p <.05). Insulin levels were significantly elevated in the FEED group (19.8 ± 4.5 vs 9.3 ± 0.8, p <.05). Insulin levels correlated with amino acid fluxes. Conclusions: Postoperative enteral nutrition in upper GI cancer patients results in an improvement in protein kinetic net balance and amino acid flux across peripheral tissue. In addition, insulin levels are elevated, and this elevation correlates with amino fluxes across the forearm. By improving peripheral protein kinetics, early postoperative enteral nutrition may potentially contribute to a decrease in postoperative morbidity and mortality in upper gastrointestinal cancer patients. (Journal of Parenteral and Enteral Nutrition 21:202–207, 1997)
Effect of Medium‐Chain Triglyceride Emulsion in Total Parenteral Nutrition on Experimental Hepatic Metastasis in the Rat
Authors: Ohkawa Akira , Sato Nobuaki , Hatakeyama Katsuyoshi
Published: May 2008

Background: This study evaluated the effect of total parenteral nutrition (TPN) regimens containing a medium‐chain triglyceride (MCT) emulsion on tumor metastasis. Methods: Tumor metastasis development was assessed by the number of metastatic foci on the liver surface in rats inoculated with ACL‐15 tumor cells via the portal vein. Rats received one of the following TPN regimens: TPN containing an MCT emulsion (group M), in which tricaprylin emulsion served as the MCT and comprised 50% of nonprotein calories (NPC); TPN containing a long‐chain triglyceride (LCT) emulsion (group L), in which soybean oil served as the LCT and comprised 50% of NPC; and TPN without lipid emulsion (group G), in which dextrose comprised 100% of NPC. Results: The number of metastatic foci was greatest in rats receiving TPN containing the MCT emulsion on day 11 after tumor cell inoculation and either 11 days of TPN or 2 days of TPN followed by 9 days standard rat chow. Conclusions: TPN containing MCT emulsion increases liver metastasis early in its administration. (Journal of Parenteral and Enteral Nutrition 21:220–223, 1997)
Triglyceride Hydrolysis of Soy Oil vs Fish Oil Emulsions
Authors: Oliveira Fernanda L.C. , Rumsey Steven C. , Schlotzer Ewald , Hansen Inge , Carpentier Yvon A. , Deckelbaum Richard J.
Published: May 2008

Background: Fish oil triglycerides (TG) are being considered for use in IV lipid emulsions, but the characteristics of their lipase‐mediated clearance from plasma are largely unknown. Methods: We compared the in vitro hydrolysis of soy oil long‐chain triglyceride emulsions (LCT) and fish oil emulsions (ω‐3) using lipoprotein (LPL) and hepatic (HL) lipases. ω‐3 emulsions contained 18% and 28% of total TG fatty acid as eicosapentaenoic acid (EPA) and docosahexanoic acid (DHA), respectively. Results: Under conditions of maximal hydrolysis, total free fatty acid (FFA) release was two‐ to threefold greater with LCT compared with ω‐3 emulsions. Also, EPA and DHA together contributed proportionally much less than other fatty acids (<20%) to FFA released from ω‐3 emulsions. In mixtures of LCT emulsion with ω‐3 emulsions, the presence of >20% of w‐3 particles substantially inhibited LCT emulsion hydrolysis (by up to 50%). Conclusions: Our results suggest that, during infusion of ω‐3 emulsions, EPA and DHA may enter cells as TG or partial glycerides within emulsion particles and not as FFA and that coinfusion of ω‐3 emulsion with LCT emulsion at low w‐3:LCT emulsion ratios (up to 20% of total triglyceride as w‐3) will not substantially inhibit LCT hydrolysis. (Journal of Parenteral and Enteral Nutrition 21:224–229, 1997)
A Prospective Survey for Central Line Skin‐Site Colonization by the Pathogen Malassezia furfur Among Hospitalized Adults Receiving Total Parenteral Nutrition
Authors: Jatoi Aminah , Hanjosten Karen , Ross Elizabeth , Mason Joel B.
Published: May 2008

Background: Over 50 case reports suggest that Malassezia furfur is an emerging systemic pathogen in neonates who receive IV lipid emulsions. Because isolation of this fungus requires special culture techniques, which are not routinely used, the authors of many case reports of M. furfur infections in adults question whether infections caused by this organism are being underdiagnosed in older patients. Methods: Catheter insertion site colonization rates in adults receiving total parenteral nutrition (TPN) were prospectively evaluated in 149 hospitalized patients with 928 cultures handled specifically for M. furfur detection. Positive control samples consisted of M. furfur cultures in neonates and in adults, who had not been enrolled in the study, and of a separate positive culture obtained from a skin site inoculated with M. furfuy Results: M. furfur was not cultured from any of the 928 study samples (95% confidence interval [CI] ‐0.4% to +0.4%). Conclusions: These results suggest that M.,furfur is less of a threat to hospitalized adults receiving TPN than has been otherwise postulated. These data do not support the inclusion of special cultures for M. furfur in routine skin‐site surveillance programs among hospitalized adults receiving TPN. (Journal of Parenteral and Enteral Nutrition 21:230–232, 1997)
Pentoxifylline and Thalidomide Fail to Reduce Hepatic Steatosis During Total Parenteral Nutrition and Bowel Rest in the Rat
Authors: Vromen Amos , Spira Ram M. , Bercovier Herve , Berry Elliot , Freund Herbert R.
Published: May 2008

Background: We suggested that the continuous translocation of endotoxin from Gram‐negative bacterial overgrowth during bowel rest and total parenteral nutrition (TPN) causes the release of tumor necrosis factor (TNF), resulting in liver damage and hepatic dysfunction. Because TPN‐induced hepatic steatosis was significantly reduced by the monoclonal antibodies against TNF, we attempted a more clinically applicable approach using pentoxifylline and thalidomide. Methods: A control group (group I) fed rat chow and four groups of rats receiving TPN were studied. Group II received TPN only; group III, TPN and 100 mg/kg/d pentoxifylline; group IV, TPN and 200 mg/kg/d pentoxifylline; and group V, TPN and 5 mg/kg/d thalidomide. On day 7, total liver fat was determined. Results: Bowel rest and TPN resulted in a significant (p <.0005) increase in liver fat content that was unaltered by either pentoxifylline or thalidomide. Conclusions: Our results show no role for pentoxifylline or thalidomide in reducing TPN‐associated hepatic steatosis. (journal of Parenteral and Enteral Nutrition 21:233–234, 1997)
Long‐Term Central Venous Access Through the Ovarian Vein
Authors: Chang Michael Y. , Morris Jon B.
Published: May 2008

This is a case report of a patient, totally dependent on parenteral nutrition, with thrombosis of the superior vena cava and infrarenal inferior vena cava. The ovarian vein was the most accessible route for placement of a long‐term indwelling catheter. We describe a technique of central venous access via the ovarian vein through a lower midline laparotomy. (journal of Parenteral and Enteral Nutrition 21:235–237, 1997)
Effect of a Fish Oil Structured Lipid‐Based Diet on Prostaglandin Release From Mononuclear Cells in Cancer Patients After Surgery
Authors: Swails Wendy S. , Kenler Andrew S. , Driscoll David F. , Demichele Stephen J. , Babineau Timothy J. , Utsunamiya Tohru , Chavali Sambasiva , Forse R. Armour , Bistrian Bruce R.
Published: May 2008

Background: The authors compared the effect on eicosanoid production (prostaglandin E2 [PGE2], 6‐keto PGF1α, and thromboxane B2) from peripheral blood mononuclear cells (PBMC) of feeding an enteral diet containing a fish oil/mediumchain triglyceride structured lipid (FOSL‐HN) vs an isonitrogenous, isocaloric formula (O‐HN) in patients undergoing major abdominal surgery for upper gastrointestinal malignancies. A previous study, which used the same formulas and experimental design, suggested improved renal and liver function as well as a reduced number of gastrointestinal and infectious complications with the use of fish oil structured lipids. This study sought to investigate the potential mechanism for these effects by assessing eicosanoid production from PBMC with the two diets. Methods: This prospective, blinded, randomized trial was conducted in 20 patients who were jejunally fed either FOSL‐HN or O‐HN for 7 days. Serum chemistries, hematology, urinalysis, gastrointestinal complications, liver and renal function, and eicosanoid production from isolated PBMC, either unstimulated or stimulated with endotoxin, were measured at endotoxin baseline and on day 7. Comparisons were made in 10 and 8 evaluable patients based a priori on the ability to reach a tube feeding rate of >40 mL/h. Results: Patients receiving FOSL‐HN experienced no untoward side effects compared with patients given O‐HN and demonstrated the same general trend toward improved hepatic, renal and immune function found in the previous study. There was a significant reduction in PGE2 (p <.03) and 6‐keto PGF1α (p <.01) production from PBMC with endotoxin stimulation in patients receiving FOSL‐HN. Conclusions: The results of early enteral feeding with FOSL‐HN after surgery in this follow‐up study provide further support to claims of safety, tolerance, and improved physiologic function. There was an associated reduction in eicosanoid production from PBMCs, which is presumed to be the principal mechanism for these effects. (journal of Parenteral and Enteral Nutrition 21:266–274, 1997)
pH and Concentrations of Pepsin and Trypsin in Feeding Tube Aspirates as Predictors of Tube Placement
Authors: Metheny Norma A. , Stewart Barbara J. , Smith Lisa , Hua Yan  , Diebold Marilyn , Clouse Ray E.
Published: May 2008

Background : The purpose of this study was to determine the extent to which pepsin and trypsin concentrations in feeding tube aspirates, in addition to pH, contribute to predicting feeding tube position. Methods: Aspirates from 742 feeding tubes (nasogastric, n = 343; nasointestinal, n = 399) were tested for pH and enzyme concentrations. Also tested were aspirates from two feeding tubes inadvertently positioned into the lung (one in the pleural space and one in the tracheobronchial tree) and 146 samples of tracheobronchial and pleural fluids collected by other methods. Enzyme assays were conducted in a research laboratory. Results of the pH and enzyme tests were compared with radiologic reports of tube location. Results: Gastric fluid had a mean low pH (4.06), a high mean pepsin concentration (349.1 μg/mL), and a low mean trypsin concentration (19.3 μg/mL). In contrast, intestinal fluid had a mean high pH (7.40), a high mean trypsin concentration (143.0 μg/mL), and a low mean pepsin concentration (24.2 μg/mL). Respiratory samples also had a high mean pH (7.89) but contained little or no pepsin or trypsin. Using a logistic regression equation with all three variables to differentiate between respiratory and gastrointestinal placement, it was possible to correctly classify 100% of the respiratory cases and 93.4% of the gastrointestinal cases. Another equation used to differentiate between gastric and intestinal sites was able to classify correctly 91.2% of the gastric cases and 91.5% of the intestinal cases. Conclusions: The results clearly indicate that laboratory‐determined enzyme concentrations in feeding tube aspirates are helpful in predicting tube location. Thus, it is desirable that inexpensive, simple bedside tests be developed so that they can be used in conjunction with pH measurements to help predict tube position. (journal of Parenteral and Enteral Nutrition 21:279–285, 1997)
Changes in Adipose Tissue Composition in Malnourished Patients Before and After Liver Transplantation: A Carbon‐13 Magnetic Resonance Spectroscopy and Gas‐Liquid Chromatography Study
Authors: Hasse Jeanette
Published: May 2008

The purpose of this study was to assess the fatty acid profile of adipose tissue in malnourished patients with chronic liver disease before and after liver transplantation using carbon‐13 magnetic resonance spectroscopy (13C MRS), a noninvasive, in vivo technique. Twenty‐two patients with histologically proven cirrhosis undergoing liver transplantation were evaluated before and eight weeks after transplantation. An equal number of healthy, matched controls were also evaluated. Body weight, body mass index, triceps skinfold thickness, and mid‐upper arm circumference were determined. Fasting blood samples were analyzed for blood count, biochemical profile, lipid concentrations, glucose levels, liver function tests, and coagulation. Patients were nutritionally assessed using objective and clinical indicators. 13C MR spectra were obtained from the subcutaneous adipose tissue of the thigh from all subjects. In addition, adipose tissue samples were obtained from 11 of the liver transplant recipients (all with cholestatic liver disease) at the time of transplantation and from 4 control subjects during hernia repair. Profiles of individual fatty acids were analyzed from these samples by gas‐liquid chromatography (GLC). Pretransplant patients with cholestatic liver diseases had lower serum high‐density lipoprotein concentrations and higher levels of serum total and low‐density lipoprotein cholesterol compared with patients with other types of liver failure. Based on anthropometric measurements, patients with cirrhosis had depleted fat and muscle stores compared with the healthy controls. However, there were no differences in percentages of saturated, polyunsaturated, or monounsaturated fatty acids in subcutaneous fatty tissue between pretransplant patients and controls based on 13C MRS results. GLC evaluation of fatty tissue samples obtained at time of surgery confirmed these results and, in addition, identified differences in individual fatty acids between the control and cirrhotic patients. The percentage of n‐3 fatty acids was 0.84% ± 0.07% in patients with cirrhosis and 1.36% ± 0.13% in the healthy, control patients. After transplantation, liver function tests improved. Body mass, body fat, and muscle stores increased significantly by the eighth posttransplant week, reaching levels similar to the control group. Finally, after transplantation there was an increase in saturated fatty acid levels (21.0% ± 2.8% pretransplant vs 25.5% ± 1.2% posttransplant) and a decrease in unsaturated fatty acid levels (78.4% ± 2.8% pretransplant vs 74.5% ± 1.2% posttransplant) in adipose tissue.
Effect of an Elemental vs a Complex Diet on L‐Citrulline Production From L‐Arginine in Rat Isolated Enterocytes
Authors: Guihot Gwénaële , Blachier François , Colomb Virginie , Morel Marie‐Thérèse , Raynal Pierre , Corriol Odile , Ricour Claude , Duée Pierre‐Henri
Published: May 2008

Backgyound: L‐Arginine and L‐glutamine are highly metabolized by intestinal cells, leading to various metabolites, including L‐citrulline, which is required for optimal growth. Elemental diets, used in clinical practice to treat growth failure and malnutrition, are very different from complex diets normally consumed. The aim of the present study was to assess the effects of an elemental diet compared with a complex diet on L‐arginine metabolism in rat isolated enterocytes and its modulation by L‐glutamine. Methods: Rats were fed the elemental diet (group ED) or the control diet (group C) for 14 days. Villus enterocytes then were isolated, and metabolic capacities or enzyme activities were assessed. Results: The incubation of enterocytes isolated from group C with 0.1 mmol/LL‐[U‐14C]‐arginine led to the production of 125 ± 25 pmol L‐citrulline/106 cells per 30 minutes. This production showed a twofold increase in the presence of 2 mmol/L L‐glutamine. In group ED, L‐citrulline synthesis from L‐arginine was markedly lower in the absence or in the presence of L‐glutamine. This coincided with lower carbamoylphosphate synthase I activity and carbamoylphosphate (CP) content of enterocytes. Other L‐arginine andLglutamine metabolic pathways were not affected. Similar results were obtained when the elemental diet was administered continuously through a gastric catheter or fed by mouth. Conclusions: L‐Glutamine favors the synthesis of L‐citrulline from L‐arginine in isolated enterocytes, probably via an increase in CP production. Changing the diet composition, from a complex to an elemental diet, results in an alteration of the enterocyte capacity to synthesize L‐citrulline from L‐arginine, irrespective of the rhythm of delivery. (Journal of Parenteral and Enteral Nutrition 21:316–323, 1997)