bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevention of Cancer Cachexia by Pyrrolidine Dithiocarbamate (PDTC) in Colon 26 Tumor‐Bearing Mice
Authors: Nai Yong‐Jun , Jiang Zhi‐Wei , Wang Zhi‐Ming , Li Ning , Li Jie‐Shou
Published: May 2008

Background:The precise mechanism of cancer cachexia is not fully elucidated. This study was aimed to assess the effect of pyrrolidine dithiocarbamate (PDTC, an inhibitor of NFκB) on interleukin (IL)‐6 synthesis and cachexia in colon 26 tumor‐bearing mice.Methods:Murine colon 26 adenocarcinoma cells were inoculated subcutaneously in male BALB/c mice to induce cachexia. Saline and various doses of PDTC (10, 50, or 100 mg/kg/d) were given intraperitoneally daily from 7 days after tumor inoculation to killing. Body weight, food intake, and tumor volume were monitored daily. Serum and tumor tissue levels of IL‐6, serum biochemical indicator, and activity of NFκB in tumor tissue were investigated in all mice.Results:Significant tissue wasting was observed in all tumor‐bearing mice. By day 16, carcass weights of untreated tumor‐bearing mice were about 71.3% of healthy controls (p< .01), and the weights of gastrocnemius muscle and epididymal fat were lowered by 42.4% and 70.4% (p< .01), respectively. Furthermore, tumor‐bearing caused a significant decrease of serum albumin, glucose, and triglyceride (p< .01) and increase of IL‐6 (p< .01) in serum and tumor tissues. Administration of PDTC dose dependently inhibited the NFκB activation in tumor tissues, inhibited IL‐6 synthesis of the tumor cells, and attenuated the wasting of carcass weight, gastrocnemius muscle, and epididymal fat. Tumor growth was inhibited by PDTC with 100 mg/kg (p< .05). No differences of food intake were found between groups (p> .05).Conclusions:These results suggest that PDTC, an inhibitor of NFκB, can attenuate the development of cachexia in colon 26 tumor‐bearing mice through inhibition of IL‐6 synthesis regulated by NFκB.
Pharmacologic Levels of Dietary Arginine in CB6F1 Mice Increase Serum Ammonia in the Healthy State and Serum Nitrite in Endotoxemia
Authors: Nieves Carmelo , Sitren Harry S. , Herrlinger‐Garcia Kelli A. , Langkamp‐Henken Bobbi
Published: May 2008

Background: Therapeutic or pharmacologic doses of arginine are used to enhance blood flow and immune function despite the lack of dose‐response studies and the potential for adverse effects. This study determined the optimal level of oral arginine supplementation required to elevate serum arginine concentrations yet limit adverse effects in healthy and endotoxemic mice. Methods: Male CB6F1 mice were fed one of the following diets: The standard AIN93G (3 g arginine/100 g of protein) or this diet modified to provide 10 g, 20 g, or 30 g arginine/100 g of protein. On day 14, mice were injected with lipopolysaccharide (endotoxemic) or saline (healthy) and 4 hours later were exsanguinated. Results: Weight gain was reduced 50% in the group fed the 30 g arginine vs standard diet. Serum arginine, ornithine, citrulline, histidine, lysine, serine, threonine, tyrosine, and phenylalanine were greater and glutamate levels were lower in healthy supplemented mice; lipopolysaccharide treatment negated these changes. Serum ammonia concentration was 52% greater in healthy mice fed the 30 g arginine vs standard diet. Serum nitrite and urea were unaffected by supplementation in healthy mice. Serum nitrite was 37% greater in endotoxemic mice fed 30 g vs 10 g arginine, and serum urea was 27% greater in mice fed 20 g or 30 g vs 10 g arginine. Conclusions: Changes in serum arginine or its metabolites were observed with all of the modified diets; however, a 30‐g arginine diet was associated with an initial impairment of growth and potential adverse effects.
Estimation of Body Fat Mass Using Dual‐Energy X‐Ray Absorptiometry, Bioelectric Impedance Analysis, and Anthropometry in HIV‐Positive Male Subjects Receiving Highly Active Antiretroviral Therapy
Authors: Aghdassi Elaheh , Arendt Bianca , Salit Irving E. , Allard Johane P.
Published: May 2008

Background:The purpose of this pilot study was to compare estimates of percentage body fat mass (FM) by bioelectric impedance analysis (BIA) and skinfold measurements (SF) with estimates obtained from dual‐energy x‐ray absorptiometry (DEXA) in 47 HIV‐infected male subjects receiving highly active antiretroviral therapy (HAART). As different patterns of abdominal fat accumulation might affect the body FM estimation, correlation and agreement of these methods were also compared in patients with waist to hip ratio (WHR)≤ 0.9 and >0.9.Methods:Body FM was estimated by BIA and by measuring skinfold thickness at biceps, triceps, and subscapular area, and was compared with DEXA as the reference method using pairedt‐test.Results:Estimates by SF were significantly higher and by BIA were significantly lower compared with DEXA for all subjects. This relationship persisted only in those with WHR >0.9. Both BIA and SF correlated significantly with DEXA, but they did not agree. However, both techniques showed a small intermethod bias, and the precision was within the acceptable range. This relationship persisted in those with WHR >0.9. In comparison with measurement by BIA, SF showed poorer agreement (larger bias and error).Conclusion:For population studies and perhaps to monitor changes over time for intervention studies, the bias for both BIA and SF methods is relatively small and errors and precisions are within the acceptable range when compared with DEXA, and thus all 3 techniques can be used for routine monitoring of total body FM in male subjects with HIV infection.
An Antioxidative Nutrient‐Rich Enteral Diet Attenuates Lethal Activity and Oxidative Stress Induced by Lipopolysaccharide in Mice
Authors: Abe Shizuko , Tanaka Yoshiaki , Fujise Nobuaki , Nakamura Tsuyoshi , Masunaga Hiroaki , Nagasawa Takashi , Yagi Minoru
Published: May 2008

Background: Oxidative stress is related to various diseases, such as diabetes, cancer, inflammatory disease, and arteriosclerosis. The aim of this study is to evaluate enhancement effect in serum antioxidant capacity obtained from an antioxidative nutrient‐rich enteral diet (AO diet). We also investigated the ability of the AO diet to attenuate lethality, the production of oxidized products, the production of inflammatory cytokines, and liver injury using lipopolysaccharide (LPS)‐injected mice. LPS mice were used as a model to represent critically ill patients that have experienced a septicemia. Methods: The AO diet contained polyphenol and enhanced vitamin C, vitamin E, and trace elements. Total antioxidant activities of the control enteral diet (Control diet) and the AO diet were measured by 1,1‐diphenyl‐2‐picrylhydrazyl (DPPH) and 2,2′‐azinobis‐(3‐ethylbenzthiazoline sulphonic acid; ABTS) radical‐scavenging activities. Male BALB/c mice were fed either of these diets for 7 days and were injected with 5 mg/kg LPS. The survival of mice was monitored from day 0 to day 8. To evaluate oxidative stress, inflammation, and liver injury, blood and liver samples were collected, and tumor necrosis factor‐α (TNF‐α), interleukin‐6, thiobarbituric acid‐reactive substances (TBARS), protein carbonyl contents, aspartate aminotransferase, alanine aminotransferase, and radical‐scavenging activities were measured. Results: The survival rate of mice receiving the AO diet or the Control diet was 73.9% and 33.3%. In the AO diet group, levels of serum TNF‐α, serum protein carbonyl contents, plasma, and liver TBARS were significantly lower than in the Control diet group. DPPH and ABTS radical‐scavenging activities of the AO diet itself were significantly higher than that of the Control diet, and serum activities in the AO diet group were also higher. Conclusions: The antioxidative nutrient supplementation of an enteral diet may be useful and offer relief from septic symptoms.
Diethylhexylphthalate Extracted by Typical Newborn Lipid Emulsions From Polyvinylchloride Infusion Systems Causes Significant Changes in Histology of Rabbit Liver
Authors: Loff P. D. Steffan , Subotic Ulrike , Oulmi‐Kagermann Jasmina , Kränzlin Bettina , Reinecke Maria‐Franziska , Staude Christiane
Published: May 2008

Background: Looking for a candidate substance inducing hepatobiliary dysfunction under parenteral nutrition (PN) in newborns, we recently discovered that newborn infusions extract large amounts of the plasticizer diethylhexylphthalate (DEHP) from commonly used polyvinylchloride (PVC) infusion lines. This plasticizer is well known to be genotoxic and teratogenic in animals and to cause changes in various organs and enzyme systems even in humans. The aim of this study was to examine the effect of DEHP, extracted in the same way and in the same amount as in newborns, on livers of young rabbits. Methods: Prepubertal rabbits received lipid emulsion through central IV lines continuously for 3 weeks either via PVC or polyethylene (PE) infusion systems. Livers were examined after 1 and 3 weeks by light and electron microscopy. Results: By light microscopy, hydropic degeneration, single‐cell necrosis, fibrosis, and bile duct proliferation were observed more in the PVC group. Electron microscopy revealed multiple nuclear changes, clusters and atypical forms of peroxisomes, proliferation of smooth endoplasmic reticulum, increased deposition of lipofuscin, and a mild perisinusoidal fibrosis only in the PVC group. These changes, which are generally regarded as reaction upon a toxic stimulus, could be exclusively attributed to DEHP. Conclusions: This investigation proved that DEHP produces toxin‐like changes in livers of young rabbits in the same dose, duration, and method of administration as in newborn infants. For this reason, it is likely that DEHP is the substance that causes hepatobiliary dysfunction in newborns under PN. Possible modes of action of DEHP are proposed.
Glutathione Decreased Parenteral Nutrition–Induced Hepatocyte Injury in Infant Rabbits
Authors: Hong Li , Wu Jiang , Cai Wei
Published: May 2008

Background: This study was designed to explore the mechanisms in parenteral nutrition (PN)‐associated hepatic dysfunction, and the possible effectiveness of glutathione (GSH) to alleviate this injury. Methods: Thirty 1‐week‐old New Zealand rabbits were divided into 3 groups: 10 in the control group (maternal fed); 10 in the PN group (PN for 10 days); and 10 in the GSH + PN group (PN plus glutathione for 10 days). At the end of the study, blood biochemistry analysis and liver histologic examination were performed by light and electronic microscope; malondialdehyde (MDA) content of liver tissues and apoptotic hepatocytes were also measured. Results: Direct bilirubin and bile acid in the PN group were significantly higher than that in the control group and in the GSH + PN group (p < .05, for both). In the PN group, there were some cholestatic or steatotic changes. In the GSH + PN group, histologic changes were reduced compared with the PN group. The electron microscopy appearances were in agreement with the histologic findings. MDA value was higher in the PN group than in the control group and in the GSH + PN group (p < .05, respectively). Terminal deoxynucleotidyl transferase mediated nick end labeling (TUNEL) assays showed that the rate of apoptotic hepatocytes in the PN group was the highest and the control group was the lowest among 3 groups (comparison between groups, p < .01, individually.) Conclusions: The study showed that PN can induce hepatic dysfunction in infant rabbits. GSH can effectively reduce this injury. The study implies that oxidative stress and apoptosis contribute to PN‐associated hepatic dysfunction.
Treatment of Moderate to Severe Acute Hypocalcemia in Critically Ill Trauma Patients
Authors: Dickerson Roland N. , Morgan Laurie M. , Croce Martin A. , Minard Gayle , Brown Rex O.
Published: May 2008

Background: Our recent data indicate that 21% of critically ill, adult, multiple‐trauma patients receiving specialized nutrition support experience hypocalcemia. However, evidence‐based methods for the treatment of moderate to severe acute hypocalcemia (ionized calcium concentration [iCa]<1 mmol/L) are lacking. Methods: The efficacy of an infusion of 4 g of calcium gluconate was evaluated in 20 critically ill, adult, multiple‐trauma patients with moderate to severe hypocalcemia (iCa <1 mmol/L). The calcium gluconate was infused at a rate of 1 g/h in a small volume admixture. A serum iCa determination was obtained on the following day. Results: Calcium gluconate infusion significantly increased serum iCa from 0.90 ± 0.08 mmol/L to 1.16 ± 0.11 mmol/L (p < .001) on the following day. This dosage regimen was successful for achieving a serum iCa >1 mmol/L for 19 of 20 (95%) hypocalcemic patients and achieved a concentration >1.12 mmol/L in 14 (70%) of the patients. Two patients developed mild hypercalcemia (iCa of 1.34 mmol/L and 1.38 mmol/L) postinfusion. Conclusions: A short‐term infusion of 4 g of intravenous (IV) calcium gluconate for the treatment of moderate to severe hypocalcemia appears to be a promising regimen for critically ill, adult, multiple‐trauma patients.
Use of Ethanol Lock Therapy to Reduce the Incidence of Catheter‐Related Bloodstream Infections in Home Parenteral Nutrition Patients
Authors: Opilla Marianne T. , Kirby Donald F. , Edmond Michael B.
Published: May 2008

Background: Catheter‐related bloodstream infection (CRBSI) is a serious complication for home parenteral nutrition (HPN) patients. To reduce the incidence of infection in frequently infected HPN patients, prophylactic ethanol lock therapy (ELT) was initiated. Methods: Nine patients were selected as candidates for ELT because of their history of recurrent CRBSI. Diagnosis of CRBSI was determined by symptoms correlating with positive peripheral and access device blood cultures. Medical‐grade ethyl alcohol 25%–70% was instilled into the central venous access device and allowed to dwell for 2–4 hours. The incidence of CRBSI and catheter changes was compared before and after initiation of ELT. Results: Nine patients experienced 81 CRBSIs (8.3 per 1000 catheter‐days) before starting ELT vs 9 infections (2.7 per 1000 catheter‐days: relative risk [RR], 0.325; confidence interval [CI] 95%, 0.17–0.64) after ELT. Catheter changes were also reduced from 69 (7.0 per 1000 days) before ELT to 1 (0.3 per 1000 days: RR, 0.043; CI 95%, 0.01–0.25) after ELT. No significant adverse effects were noted, although some patients complained of transient dizziness and nausea. Conclusions: ELT shows promise in reducing the incidence of CRBSI in the frequently infected HPN population. Further studies are warranted.
Is There a Difference in Metabolic Outcome Between Different Enteral Formulas?
Authors: Kagansky Michael , Rimon Ephraim
Published: May 2008

Background: Despite appropriate enteral nutrition, many elderly patients do not reach a good metabolic outcome. Two nutrition formulas are commonly used in Israel with no evidence‐based medicine to indicate preference of one over the other. Methods: We describe a 2‐month observational study of patients fed by 1 of the 2 formulas. The first (Osmolite, Abbott Company, Abbott Park, IL) is without fiber, and the second (Easy Fiber, Easyline Company Givataim, Israel) in addition to containing fiber is also richer in protein, vitamins, and minerals. The formula was selected by the primary care physician before enrollment in the study and was not influenced by the investigators. Routine blood tests as well as body weight were monitored at the start of enteral feeding and during the 2 months following as part of the regular follow‐up. Results: Fifty‐seven patients were fed with the regular formula and 77 with the enriched one. No statistically significant differences were noted between the groups during the follow‐up period, in body weight, cholesterol levels, total lymphocyte count, renal function tests, or electrolyte balance. However, in the enriched formula group there was a significant decrease in glucose (p < .05), and increase in albumin (p < .05) and hemoglobin (p = .01) levels. Conclusions: Enteral feeding with enriched formula appears to improve albumin and hemoglobin levels as well as diabetic control, thus it may be more appropriate than the nonfiber diet for use in long‐term care patients.
American Society of Parenteral and Enteral Nutrition Presidential Address: Food for Thought: It's More Than Nutrition
Authors: Winkler Marion F.
Published: May 2008

Three issues were highlighted in the 30th Presidential Address to the society: (1) A.S.P.E.N.'s unique interdisciplinary structure; (2) support of the A.S.P.E.N. Rhoads Research Foundation; and (3) the meaning of food from the perspective of the patient who is receiving life‐sustaining home enteral or parenteral nutrition. A.S.P.E.N., founded as a multidisciplinary society in the 1970s has evolved into an interdisciplinary society with an expanded and diverse membership of health care professionals and scientists with overlapping interests in clinical nutrition and metabolism. A.S.P.E.N. envisions an environment in which every patient receives safe, efficacious, and high quality patient care. The society is committed to advancing the science and practice of nutrition support therapy. In support of this direction, the A.S.P.E.N. Rhoads Research Foundation exists to fund research grants, promote evidence‐based practice, and foster training and mentorship in nutrition and metabolic research. The scientific advances and technologic innovations that have enabled our profession to provide enteral and parenteral nutrition to patients has caused practitioners to forget that the meaning of food extends beyond nutrient value. Some individuals receiving long term enteral nutrition or home parenteral nutrition have expressed feelings of anger, anxiety, and depression resulting from the inability to eat normally, from losses of independence, and control of body functions. The ritual of eating may be altered when the enteral or intravenous feedings provide nourishment and, for some, the loss of the eating function is a distressing experience, especially given the cultural focus on social gatherings and meals. The emotional meaning attributed to food, and changes in food preferences and eating behaviors, may become a source of conflict for individuals who have substantial dietary restrictions, or for those individuals dependent on enteral or parenteral nutrition therapy. The value of food intake on social patterns, self‐esteem, pleasure, and enjoyment, may impact quality of life. While nutrition support can provide the basic need for nutrients, its impact on human needs associated with food requires further investigation.
The Route of Administration (Enteral or Parenteral) Affects the Conversion of Isotopically Labeled L‐[2‐15N]Glutamine Into Citrulline and Arginine in Humans
Authors: Ligthart‐Melis Gerdien C. , van de Poll Marcel C. G. , Dejong Cornelis H. C. , Boelens Petra G. , Deutz Nicolaas E. P. , van Leeuwen Paul A. M.
Published: May 2008

Background: Glutamine exhibits numerous beneficial effects in experimental and clinical studies. It has been suggested that these effects may be partly mediated by the conversion of glutamine into citrulline and arginine. The intestinal metabolism of glutamine appears to be crucial in this pathway. The present study was designed to establish the effect of the feeding route, enteral or parenteral, on the conversion of exogenously administered glutamine into citrulline and arginine at an organ level in humans, with a focus on gut metabolism. Methods: Sixteen patients undergoing upper gastrointestinal surgery received an IV or enteral (EN) infusion of l‐[2‐15N]glutamine. Blood was sampled from a radial artery and from the portal and right renal vein. Amino acid concentrations and enrichments were measured, and net fluxes of [15N]‐labeled substrates across the portal drained viscera (PDV) and kidneys were calculated from arteriovenous differences and plasma flow. Results: Arterial [15N]glutamine enrichments were significantly lower during enteral tracer infusion (tracer‐to‐tracee ratio [labeled vs unlabeled substrate, TTR%] IV: 6.66 ± 0.35 vs EN: 3.04 ± 0.45; p < .01), reflecting first‐pass intestinal metabolism of glutamine during absorption. Compared with IV administration, enteral administration of the glutamine tracer resulted in a significantly higher intestinal fractional extraction of [15N]glutamine (IV: 0.15 ± 0.03 vs EN: 0.44 ± 0.08 μmol/kg/h; p < .01). Furthermore, enteral administration of the glutamine tracer resulted in higher arterial enrichments of [15N]citrulline (TTR% IV: 5.52 ± 0.44 vs EN: 8.81 ± 1.1; p = .02), and both routes of administration generated a significant enrichment of [15N]arginine (TTR% IV: 1.43 ± 0.12 vs EN: 1.68 ± 0.18). This was accompanied by intestinal release of [15N]citrulline across the PDV, which was higher with enteral glutamine (IV: 0.38 ± 0.07 vs EN: 0.72 ± 0.11 μmol/kg/h; p = .02), and subsequent [15N]arginine release in both groups. Conclusions: In humans, the gut preferably takes up enterally administered glutamine compared with intravenously provided glutamine. The route of administration, enteral or IV, affects the quantitative conversion of glutamine into citrulline and subsequent renal arginine synthesis in humans.
Effects of Lymphotoxin β Receptor Blockade on Intestinal Mucosal Immunity
Authors: Kang Woodae , Kudsk Kenneth A. , Sano Yoshifumi , Lan Jinggang , Yang‐Xin Fu , Gomez F. Enrique , Maeshima Yoshinori
Published: May 2008

Background: Mucosal addressin cellular adhesion molecule‐1 (MAdCAM‐1) directs lymphocyte migration into gut‐associated lymphoid tissue (GALT) through Peyer's patches (PPs). Parenteral nutrition (PN) impairs mucosal immunity by reducing PPs MAdCAM‐1 expression, T and B cells in GALT, and intestinal and respiratory immunoglobulin (Ig) A levels. We previously showed that PN reduces lymphotoxin β receptor blockade (LTβR) in PPs and intestine, and that stimulation with LTβR agonist antibodies reverses these defects. To confirm that LTβR regulates transcription of MAdCAM‐1 message and more fully understand the effects of LTβR on MAdCAM‐1 function within the mucosal immune system, we studied the effect of LTβR blockade with a chimeric LTβR Ig‐fusion protein on MAdCAM‐1 mRNA levels, PP lymphocyte mass and IgA levels in the intestinal and respiratory tracts. Methods: Mice were cannulated and killed 3 days after receiving chow + control Ig, chow + LTβR‐Ig fusion protein (100 μg IV), or PN + control Ig. The PPs of half of the animals were processed for lymphocyte count, and the other half were processed for complementary DNA and subsequent polymerase chain reaction (PCR). mRNA levels of MAdCAM‐1 were determined by real‐time PCR; intestinal and respiratory IgA levels were measured by ELISA. Results: PN significantly reduced PP lymphocyte mass, MAdCAM‐1 mRNA, and intestinal IgA. As anticipated, LTβR blockade significantly decreased PP cells and MAdCAM‐1 mRNA, but not intestinal IgA because chow feeding was maintained. Both LTβR blockade and PN decreased nasal IgA, but not significantly. Conclusions: LTβR blockade in chow animals significantly reduces transcription of MAdCAM‐1 gene and PPs lymphocyte mass. These data implicate inadequate LTβR signaling as a major mechanism for decreased GALT cells with lack of enteral stimulation, and further establish the role of LTβR in the mucosal immune system.
Effect of Thiol‐Containing Molecule Cysteamine on the Induction of Inducible Nitric Oxide Synthase in Hepatocytes
Authors: Ozaki Takashi , Kaibori Masaki , Matsui Kosuke , Tokuhara Katsuji , Tanaka Hironori , Kamiyama Yasuo , Nishizawa Mikio , Ito Seiji , Okumura Tadayoshi
Published: May 2008

Background: Cysteamine, which is a known antioxidant and anti‐inflammatory agent, is believed to be a key regulator of essential metabolic pathways in organisms. Cysteamine has beneficial effects in liver damaged by a variety of insults. During liver injury, inducible nitric oxide synthase (iNOS) is induced by lipopolysaccharide or proinflammatory cytokines, leading to excessive nitric oxide (NO) production. Accumulated evidence indicates that NO is an important factor associated with hepatic dysfunction. We examined whether cysteamine influences the induction of iNOS in hepatocytes. Methods: Primary cultured rat hepatocytes were treated with interleukin (IL)‐1β in the presence and absence of cysteamine. NO production, iNOS induction, and iNOS signal were analyzed. Results: IL‐1β stimulated the inhibitory protein κB (IκB)/nuclear factor κB (NFκB) pathway, resulting in the activation of NFκB (nuclear translocation and DNA binding), which was followed by the induction of iNOS and NO production. The addition of IL‐1β and cysteamine (1–4 mmol/L) markedly inhibited NO production, with a maximal effect at 4 mmol/L (80%–90% inhibition). Cysteamine also decreased the levels of iNOS protein and mRNA. Transfection experiments revealed that cysteamine decreased the transactivation activity of the iNOS promoter. An electrophoretic mobility shift assay demonstrated that cysteamine inhibited the activation of NFκB. Furthermore, cysteamine decreased the mRNA levels of the NFκB subunit p65 but increased those of the inhibitory protein IκB. Conclusions: These findings suggest that cysteamine inhibits iNOS induction at the step of NFκB activation. Further study is necessary to define the molecular basis of this effect of cysteamine on the regulation of NFκB and its pharmacologic implications.
Subjective Global Assessment in the Clinical Setting
Authors: Baccaro Fernando , Moreno Jose Balza , Borlenghi Cecilia , Aquino Leonardo , Armesto Graciela , Plaza Gabriel , Zapata Sandra
Published: May 2008

Background: Our goal was nutrition assessment in hospitalized patients of an internal medicine service. Methods: Ours was a longitudinal, prospective, and observational study. Four hundred twelve patients participated in this study using the Subjective Global Assessment (SGA). We used χ2 for univariate and logistic regression. Results: Of 412 patients, 47.6% presented with malnutrition: 38.8% with moderate malnutrition (group B), and 8.58% with severe malnutrition (group C). Malnutrition was related to male patients older than 65 years, oncologic and infectious diseases, and length of hospitalization. Conclusions: Malnutrition incidence in an internal medical service is high. There is remarkable lack of interest in hospitalized patients' nutrition state. Results show similarities to other studies from Latin America.
Feeding the Open Abdomen
Authors: Collier Bryan , Guillamondegui Oscar , Cotton Bryan , Donahue Rafe , Conrad Andrew , Groh Kate , Richman Jill , Vogel Todd , Miller Richard , Diaz Jose
Published: May 2008

Background: The purpose of this study was to determine if early enteral nutrition improves outcome for trauma patients with an open abdomen (OA). Methods: Retrospective review was used to identify 78 patients who required an OA for ≥4 hospital days, survived, and had available nutrition data. Demographic data and nutrition data comprising enteral nutrition initiation day and daily % target goal were collected. Patients were divided into 2 groups: early enteral feeding (EEN), initiated ≤4 days within celiotomy; and late enteral feeding (LEN; >4 days). Outcomes included infectious complications, early closure of the abdominal cavity (<8 days from original celiotomy), and fistula formation. Results: Fifty‐three of 78 (68%) patients were men, with a mean age of 35 years; 74% had blunt trauma. Forty‐three of 78 (55%) patients had EEN, whereas 35 of 78 (45%) had LEN. There was no difference with respect to demographics, injury severity, or infectious complication rates. Thirty‐two of 43 (74%) patients with EEN had early closure of the abdominal cavity, whereas 17 of 35 (49%) patients with late feeding had early closure (p = .02). Four of 43 (9%) patients with EEN demonstrated fistula formation, whereas 9 of 35 (26%) patients with late feeding formed fistulae (p = .05). The EEN group had lower hospital charges (p = .04) by more than $50,000. Conclusions: EEN in the OA was associated with (1) earlier primary abdominal closure, (2) lower fistula rate, (3) lower hospital charges.
Advanced Glycation and Lipoxidation End Products–Amplifiers of Inflammation: The Role of Food
Authors: Bengmark Stig
Published: May 2008

Background: High levels of glycated and lipoxidated proteins and peptides in the body are repeatedly associated with chronic diseases. These molecules are strongly associated with activation of a specific receptor called RAGE and a long‐lasting exaggerated level of inflammation in the body. Methods: PubMed reports over 5000 papers plus >13,500 articles about the related HbA1c, most of them published in the past 5 years. Most of the available abstracts have been read and approximately 800 full papers have been studied. Results: RAGE, a member of the immunoglobulin superfamily of cell surface molecules and receptor for advanced glycation end products, known since 1992, functions as a master switch, induces sustained activation of nuclear factor κB (NFκB), suppresses a series of endogenous autoregulatory functions, and converts long‐lasting proinflammatory signals into sustained cellular dysfunction and disease. Its activation is associated with high levels of dysfunctioning proteins in body fluids and tissues, and is strongly associated with a series of diseases from allergy and Alzheimers to rheumatoid arthritis and urogenital disorders. Heat treatment, irradiation, and ionization of foods increase the content of dysfunctioning molecules. Conclusions: More than half of the studies are performed in diabetes and chronic renal diseases; there are few studies in other diseases. Most of our knowledge is based on animal studies and in vitro studies. These effects are worth further exploration both experimentally and clinically. An avoidance of foods rich in deranged proteins and peptides, and the consumption of antioxidants, especially polyphenols, seem to counteract such a development.
Parenteral Nutrition Does Not Stimulate Tumor Proliferation in Malnourished Gastric Cancer Patients
Authors: Pacelli Fabio , Bossola Maurizio , Teodori Laura , Trinca Maria Luisa , Tortorelli Antonio , Rosa Fausto , Doglietto Giovan Battista
Published: May 2008

Background: The present study evaluated the effects of preoperative parenteral nutrition (PN) on tumor cell proliferation in malnourished gastric cancer patients. Methods: Twenty malnourished patients affected by gastric cancer were randomized to receive the standard hospital oral diet (control group) or the standard hospital oral diet plus PN (PN group; 0.2 g/kg/d of nitrogen and 30 nonprotein kcal/kg/d). Samples of tumor tissue and surrounding health mucosa were taken by endoscopic biopsies and from the operative specimen, immediately after resection. Tissues were sent for histologic examination and prepared for flow cytometry and for the measurement of the uptake of bromodeoxyuridine (BduR) by cells after in vitro exposure to the agent. The BduR uptake is largely used to assess the proportion of cells actively synthesizing DNA and is one of the principle methods used to measure tumor proliferation. Results: In the PN group, the mean percentage of tumor cells incorporating BduR was 2.51%± 1.7% in the endoscopic samples and 1.52% ± 0.8% in the operative specimens (p = .2). In the normal mucosa, the mean percentage of cells incorporating BduR was 2.24% ± 1.8% and 1.13%± 1.1%, respectively (p = .1). In the control group, the percentage of cells incorporating BduR in the normal mucosa was 1.26% ± 1.1% at endoscopy and 0.41% ± 0.3% at surgery (p = .2), whereas the percentage of cells incorporating BduR in the tumor tissue was 1.41% ± 1.2% at endoscopy and 0.48% ± 0.6% at surgery (p = .2). The percentage of S‐phase cells documented by flow cytometry in the PN group was: in the tumor, 6.6% ± 2.9% in the endoscopic samples and 5.7% ± 2.5% in the operative specimens (p = .6); in the normal mucosa, 5.8% ± 2.5% at endoscopy and 5.4% ± 0.9% at surgery (p = .7). In the control group, the percentage of proliferating cells measured by flow cytometry was 4.9% ± 3.2% in the normal mucosa taken by endoscopic biopsy and 5.3% ± 1.4% in the normal mucosa taken from the operative specimens (p = .8), whereas it was 11.4% ± 7.2% in the tumor taken with endoscopic biopsy and 9.7% ± 4% in the tumor tissue taken from the surgical specimens (p = .7). Conclusions: The present study suggests that PN does not stimulate tumor proliferation in malnourished patients affected by gastric cancer.
Influence of Fiber on Glycemic Index of Enteral Nutrition
Authors: Visek Jakub , Zourek Michal , Lacigova Silvie , Rusavy Zdenek
Published: May 2008

Background: Enteral nutrition is indicated in patients with malnutrition due to inadequate peroral intake. A number of these patients have diabetes mellitus or impaired glucose tolerance. The aim of the study was to evaluate the influence of fiber‐enriched enteral nutrition on postprandial glycemia and insulinemia. Methods: Ten healthy volunteers consumed the following solutions: A. 50 g of glucose, B. enteral formula containing 50 g of saccharides, and C. enteral formula containing 50 g of saccharides enriched with 2.3 g of fiber/100 mL. Postprandial glycemia and insulinemia were measured in time period after administration of specified nutrition. Time courses of glycemia and insulinemia were used for calculation of areas under the curve (AUC). The glycemic (GlyI) and insulinemic (InsI) indices of the nutrition were subsequently derived from AUC. Every measurement was performed 3 times for given type of nutrition. Results: Results are presented as median and interquartile range. GlyI of enteral nutrition was 85.76 (82.71–87.82), GlyI of enteral nutrition with fiber was 84.61 (80.31–94.39). InsI of enteral nutrition was 114.15 (106.55–137.71); InsI of enteral nutrition with fiber was 104.10 (96.71–127.96). The GlyI and InsI results did not differ significantly. Addition of fiber into enteral nutrition did not influence postprandial glycemia in comparison with common enteral nutrition. Conclusions: Added fiber in polymerous enteral nutrition does not influence postprandial glycemia compared with polymerous enteral nutrition without fiber.
Parenteral Nutrition Prolongs the Survival of Patients Associated With Malignant Gastrointestinal Obstruction
Authors: Fan Bo‐Guang
Published: May 2008

Background: Many patients with advanced cancers have associated gastrointestinal (GI) obstruction. Parenteral nutrition (PN) is indicated in patients with a dysfunctional GI tract, but the role of PN in patients' survival is still controversial. The present study was retrospectively conducted to verify if there are any long‐term survivors living for more than 1 year after initiation of PN without food or drink in patients with malignant GI tract obstruction resulting from advanced cancers. Methods: One hundred fifteen adult patients with malignant GI obstruction were identified over a 6‐year period at a palliative‐care setting. Their median age was 51 years (range, 31–74 years), and 62 (54%) were women and 53 men (46%). All selected patients had malignant GI tract obstruction and started PN treatment after cessation of energy intake to time of death. Survival expectancy as a criterion was analyzed in all patients. Results: The median time from initiation of PN to death was 6.5 months. Eleven patients survived ≥1 year and 2 patients have been alive for almost 4 years later after cessation of energy intake. Conclusions: PN can be expected to obtain a longer survival for the patient with GI tract obstruction caused by advanced cancer.
Colonic Energy Salvage in Chronic Pancreatic Exocrine Insufficiency
Authors: Owira P. M. O. , Winter T. A.
Published: May 2008

Background: Chronic pancreatic exocrine insufficiency results in maldigestion. As a result, increased amounts of undigested nutrients reach the colon, providing more substrate for bacterial fermentation to produce short‐chain fatty acids, which could therefore provide additional energy supplement. Methods: This study aimed to assess carbohydrate malabsorption in patients with chronic pancreatic exocrine insufficiency after ingestion of a standard diet and to calculate energy salvaged by colonic bacterial metabolism. A 72‐hour stool collection was done on 10 adult patients receiving a 3‐day standard diet containing 100 g fat, 329 g carbohydrate, and 154 g protein, and short‐chain fatty acids, fat, carbohydrate, and nitrogen excretion were assessed. A breath hydrogen test after ingestion of 200 g (dry weight) cooked maize meal (test meal) and 10 g oral inulin (standard), respectively, was subsequently done on the patients and 15 healthy adult controls. Results: Breath hydrogen production after ingestion of maize meal and inulin, respectively, and calculated carbohydrate malabsorption were significantly greater in patients (21.4% ± 17%) than in controls (10.2 ± 1.4%; p < .05). Patients malabsorbed 70.4 g/d (281.6 kcal) carbohydrate in the standard diet. Total carbohydrate loss in stool amounted to 8.1 g/d (2.4%), and 62.3 g/d (19%) was hence salvaged as short‐chain fatty acids for energy provision. Colonic bacterial fermentation therefore converted 88.5% of malabsorbed carbohydrate to short‐chain fatty acids, 92.8% of which was absorbed and 7.2% excreted. This suggests that 10.2% of energy expenditure/requirement in these patients is derived from salvage of malabsorbed carbohydrate. Conclusions: Colonic bacterial metabolism is a significant source of energy salvage in patients with pancreatic enzyme deficiency.
Thromboembolism in Infants and Children With Gastrointestinal Failure Receiving Long‐Term Parenteral Nutrition
Authors: Kakzanov Vered , Monagle Paul , Chan Anthony K. C.
Published: May 2008

Thromboembolism is an established complication of long‐term parenteral nutrition (PN) administration which requires central venous lines in the pediatric population. Predisposing factors that increase the risk of thrombosis, as well as prophylaxis and treatment guidelines in this specific population, are not clearly defined. We performed a computerized search of PubMed, OVID databases, and pertinent articles from reference lists of related review papers. This review summarizes currently available data on the rates of thromboembolism in the pediatric population receiving long‐term PN and concludes that control of factors such as location of catheter, duration of nutrition support, and prophylaxis with heparin or anticoagulants may reduce the rates of thrombosis in this patient population, although most data on the matter are inconclusive.
Hepatic and Thymic Alterations in Newborn Offspring of Malnourished Rat Dams
Authors: Schuler Sandra Lúcia , Gurmini Jocemara , Cecílio William Augusto Casteleins , de Azevedo Marina Luise Viola , Olandoski Márcia , de Noronha Lúcia
Published: May 2008

Background: Protein‐energy malnutrition encompasses a group of conditions resulting from a lack of both protein and calories. It affects immune function and the gastrointestinal tract. Animal model studies of the effect of malnutrition during pregnancy and lactation have shown changes in the body weight of dams, with consequences for the pups. Methods: Sixty healthy adult Wistar rats were mated for breeding. Pregnant dams (n = 19) were separated and randomly divided into 2 groups: normally nourished (NG; n = 10) and malnourished (MG; n = 9). The authors measured the average amount of feed eaten by the dams in the NG group in 24 hours and offered half this amount to the MG dams until delivery, after which both groups had an adequate amount of feed. Offspring were killed after birth and after lactation. Morphometric liver parameters were measured, and the tissue microarray method was performed manually to carry out histopathological and immunohistochemical analysis of thymuses from the offspring. Results: Body weight, body length, and intestine length measured after birth were statistically lower (P < .05) in the MG group offspring than in the NG group offspring but recovered after lactation. Histological comparison of pups' livers revealed minimal differences. However, morphometric evaluation showed significant differences. Slides exposed to antivimentin and anti‐CD45 RO stained positively in both groups, but the samples from the NG group were more heavily stained. Conclusions: Malnutrition in dams causes alterations in the liver, thymus, and other internal organs of newborn offspring. Significant changes in thymuses were found using human monoclonal antibodies that cross‐react with rat proteins, a novel finding in the literature.
A Comparison Between Ventilation Modes: How Does Activity Level Affect Energy Expenditure Estimates?
Authors: Hoher Jorge A. , Teixeira Paulo José Zimermann , Hertz Felipe , da S. Moreira José
Published: May 2008

Background: An appropriate diet is essential to avoid complications of overfeeding or underfeeding in mechanically ventilated intensive care unit (ICU) patients. The paucity of consistent comparative data on energy expenditure for each ventilation mode complicates diet prescription. This study evaluates caloric requirements by comparing estimated and measured energy expenditure values for 2 ventilation modes. Methods: The energy expenditure of 100 ICU patients on assisted or controlled mechanical ventilation was measured by indirect calorimetry for 20 minutes. Values were calculated for a 24‐hour period and compared with Harris‐Benedict estimates multiplied by an injury factor and either multiplied or not by a 10% activity factor. Results: The mean Harris‐Benedict estimate was 1858.87± 488.67 kcal/24 h when multiplied by an injury factor and a 10% activity factor. The mean energy expenditure values measured by indirect calorimetry were 1712.76 ± 491.95 kcal/24 h for controlled and 1867.33± 542.67 kcal/24 h for assisted ventilation. The mean total energy expenditure for assisted ventilation was 10.71% greater than the mean for controlled ventilation (P < .001). For controlled ventilation, Harris‐Benedict results overestimated indirect calorimetry values by 141.10± 10 kcal/24 h (8.2%, P = .012) when multiplied by injury and activity factors, and underestimated values by 44.28 ± 28 kcal/24 h (2.6%, P = .399) when the equation was calculated without the activity factor. For assisted ventilation, Harris‐Benedict results underestimated indirect calorimetry values by 198.84 ± 84 kcal/24 h (10.7%, P = .001) when not multiplied by the activity factor and by 13.46 kcal/24 h (0.75%) when the activity factor was used, but differences were not statistically significant (P = .829). Conclusions: Results suggest that a 10% activity factor should be adopted only for assisted ventilation because multiplication by an activity factor may lead to overfeeding of patients on controlled ventilation.
Nutrition Support in the Critically Ill: A Physician Survey
Authors: Behara Ami Shah , Peterson Sarah J. , Chen Yimin , Butsch John , Lateef Omar , Komanduri Srinadh
Published: May 2008

Background: Current clinical practice guidelines delineate optimal nutrition management in the intensive care unit (ICU) patient. In light of these existing data, the authors identify current physician perceptions of nutrition in critical illness, preferences relating to initiation of feeding, and management practices specific to nutrition after initiation of feeding in the ICU patient. Methods: The authors electronically distributed a 12‐question survey to attending physicians, fellows, and residents who routinely admit patients to medical and surgical ICUs. Results: On a scale ranging from 1 to 5 (1 = low, 5 = high), the attending physician's mean rating for importance of nutrition in the ICU was 4.60, the rating for comfort level with the nutrition support at the authors' institution was 3.70, and the rating for the physician's own understanding of nutrition support in critically ill patients was 3.33. Attending physicians, fellows, and residents reported waiting an average of 2.43, 1.79, and 2.63 days, respectively, before addressing nutrition status in an ICU patient. Fifty‐two percent of attending physicians chose parenteral nutrition as the preferred route of nutrition support in a patient with necrotizing pancreatitis. If a patient experiences enteral feeding intolerance, physicians most commonly would stop tube feeds. There was no significant difference in responses to any of the survey questions between attending physicians, fellows, and residents. Conclusions: This study demonstrates a substantial discordance in physician perceptions and practice patterns regarding initiation and management of nutrition in ICU patients, indicating an urgent need for nutrition‐related education at all levels of training.
ω‐3 Fatty Acids–Supplemented Parenteral Nutrition Decreases Hyperinflammatory Response and Attenuates Systemic Disease Sequelae in Severe Acute Pancreatitis: A Randomized and Controlled Study
Authors: Wang Xinying , Li Weiqin , Li Ning , Li Jieshou
Published: May 2008

Background: The objective of this study was to investigate whether altering the fatty acid (FA) profile by ω‐3 FA supplementation affects inflammatory response and systemic disease sequelae in severe acute pancreatitis. Methods: Forty severe acute pancreatitis patients were enrolled and randomly assigned to receive parenteral nutrition (PN) for 5 days in a double‐blind manner. Patients received PN with identical amounts of amino acids (1.25 g/kg/d), glucose (3 g/kg/d), and fat (1 g/kg/d) but different lipid compositions: the control group received a soybean oil (SO; Lipovenos 20%; Fresenius, Germany)–based fat solution and the ω‐3 FA group was supplemented with 0.15 ‐ 0.2 g/kg/d fish oil (FO; Omegaven 10%; Fresenius, Germany). Serum concentrations of eicosapentaenoic acid (EPA), interleukin‐6, C‐reactive protein (CRP), white blood cell count, and routine respiratory and renal parameters were measured before PN, and again on day 6 after starting PN. Outcomes such as infection morbidity, mortality, intensive care unit time, and length of hospital stay were recorded. Results: Patients treated with FO had a significantly higher EPA concentration (P < .01), lower CRP level (P < .05), and better oxygenation index (P < .05) after 5 days of PN. Moreover, the number of days of continuous renal replacement therapy (CRRT) in the ω‐3 FAs group was significantly less than that in the control group (P < .05). Conclusions: PN supplemented with ω‐3 FAs diminishes the hyperinflammatory response by the EPA increase and the proinflammatory cytokine decrease in severe acute pancreatitis. This, together with improved respiratory function and shortened CRRT time, suggests that the systemic response to pancreatic and organ injury is attenuated.