bluuebunny/crossref_metadata_2025 huggingface dataset:
Accelerated Nitrogen Loss After Traumatic Injury Is Not Attenuated by Achievement of Energy Balance
Authors: Frankenfield David C. , Smith J Stanley , Cooney Robert N.
Published: May 2008

Background: We wanted to determine if achievement of energy balance decreases myofibrillar protein catabolism and nitrogen loss during posttraumatic catabolic illness. Methods: Surgical intensive care unit of a level I trauma center in a university medical center. Trauma patients expected to be mechanically ventilated for at least 4 days were randomly assigned to one of three parenteral feeding groups: (1) nonprotein calorie group: dextrose and lipid intake equal to measured energy expenditure; (2) total calorie group: dextrose, lipid, and protein intake equal to measured energy expenditure; and (3) hypocaloric group: dextrose and lipid intake equal to 50% of measured energy expenditure. Target protein intake for all groups was 1.7 g/kg body wt. On day 4 of nutrition support, a 24‐hour balance study was conducted. Urine urea and total nitrogen production, 3‐methylhistidine excretion, energy expenditure, and substrate utilization were measured. Results: Despite significant differences in nonprotein and total calorie balance among the groups, nitrogen loss, nitrogen balance, and catabolic rate were not significantly different. Nitrogen loss correlated with catabolic rate but not with energy expenditure or energy balance. Catabolic rate was associated with energy expenditure but not with energy balance. Nitrogen loss was positively correlated with the percentage of nonprotein energy expenditure met by nonprotein calorie intake. Conclusions: Achievement of energy balance (nonprotein or total energy) failed to decrease catabolic rate or nitrogen loss acutely in multiple trauma patients. Provision of caloric intake equal to energy expenditure does not seem necessary during the acute phase of posttraumatic catabolic illness. (Journal of Parenteral and Enteral Nutrition 21:324–329, 1997)
The Effects of Short‐Term Parenteral Nutrition on Human Liver Protein and Amino Acid Metabolism During Laparoscopic Surgery
Authors: Barle H. , Nyberg B. , Andersson K. , Essén P. , McNurlan M.A. , Wernerman Jan , Garlick Peter J.
Published: May 2008

Background:This study was undertaken to elucidate the specific effects of short‐term artificial nutrition on human liver protein metabolism.Methods:Thirty patients undergoing elective laparoscopic cholecystectomy were studied: a control group (n = 16) and a group that received total parenteral nutrition (TPN; n = 14). The nutrition consisted of a balanced IV solution of nutrients (17.5 nonprotein kcal/kg body wt, 50% fat, 50% carbohydrates, and 0.1 gN/kg) that was discontinued when the investigation was finished, after a total infusion time of 8.6 ± 1.0 hours. A liver biopsy specimen was taken as soon as possible after surgery was started, for the determination of the free hepatic amino acid concentrations. In 16 of the patients, L‐[2H5]phenylalanine was given by IV to determine the fractional synthesis rate of total liver protein in a second liver biopsy specimen taken approximately 30 minutes later. Results: The fractional synthesis rate of total liver protein was 15.2% ± 4.7%/d in the TPN group (n = 7), which was not different from that of the control group (17.7% ± 3.8%/d, n = 9). However, the free hepatic concentrations of alanine (p <.05) and the essential amino acids increased (p <.001) in the TPN group, whereas the total hepatic amino acid concentrations were comparable between the groups.Conclusion:Thus short‐term TPN induced specific changes of the free hepatic amino acid concentrations, whereas total liver protein synthesis remained unaffected by the nutrition.(Journal of Parenteral and Enteral Nutrition21:330–335, 1997)
Outcome of Cancer Patients Receiving Home Parenteral Nutrition
Authors: Cozzaglio Luca , Balzola Franco , Cosentino Francesco , Decicco Marcello , Fellagara Paolo , Gaggiotti Giorgio , Gallitelli Livia , Giacosa Attilio , Orban Andrea , Fadda Maurizio , Gavazzi Cecilia , Pirovano Federica , Bozzetti Federico ,   THE ITALIAN SOCIETY OF PARENTERAL AND ENTERAL NUTRITION (S.I.N.P.E.)
Published: May 2008

Background: Indication for home parenteral nutrition (HPN) in cancer patients is controversial because intestinal failure and malnutrition are often only two of the many problems found in such patients that may deserve priority of treatment. Methods: This was a retrospective study of 75 cancer patients from nine institutions included in the Italian HPN Registry. The patients had a mean weight loss of 12.5%, serum albumin of 3.1 g/dL, lymphocyte count of 1150/mm3, and serum total iron‐binding capacity of 190 μg/dL. The main indication for HPN was intestinal obstruction (66%); 72% of the patients had metastatic disease. A series of demographic, oncologic, and nutritional characteristics were analyzed in an attempt to predict a possible benefit of HPN. Results: A total of 9897 days of HPN were delivered to 75 cancer patients, for a median of 4 months (range 1 to 15 months) per patient. Sixty‐nine patients died while receiving HPN, five had a remission of their intestinal failure, and one chose to stop the treatment. Complications related to parenteral nutrition were as follows: 19 cases of sepsis, 6 catheter occlusions, 4 catheter dislocations, and 2 metabolic imbalances. HPN preserved nutritional status and slightly improved weight, lymphocyte count, serum albumin, and Karnofsky performance status in patients who survived >3 months. Quality of life during HPN was judged by the clinicians to have improved in only 9% of those who survived <3 months, but in 68% of the patients who survived for >3 months. Karnofsky performance status >50 at the start of HPN was correlated with longer survival (p =.02). Conclusions: Our study demonstrated a positive effect of HPN on nutritional status and quality of life in patients who survived >3 months and suggests that HPN should be avoided when Karnofsky performance status is <50. (Journal of Parenteral and Enteral Nutrition 21:339–342, 1997)
Stimulation of Gallbladder Emptying by Intravenous Lipids
Authors: Priori Patrizia , Pezzilli R. , Panuccio D. , Nardi R. , Gullo L.
Published: May 2008

Background: Few studies have dealt with the effect of IV administration of lipids on gallbladder emptying, and the results have been conflicting. Methods: Five healthy volunteers, three women and two men, aged 26 to 54 years, (mean, 29 years) were studied. Gallbladder emptying was assessed by means of real‐time ultrasonography. Results: In all subjects, the infusion of a 10% fat emulsion (Intralipid; Kabivitrum, Stockholm) over 3 hours caused a reduction in gallbladder volume. This effect was statistically significant at about 80 minutes of lipid infusion and became progressively more marked as the infusion progressed, reaching a reduction of approximately 30% during the third hour of infusion. A significant relationship (p <.001) was found between the concentration of serum triglycerides and the degree of gallbladder volume decrease. In control studies, infusion of physiologic saline containing glycerol, the excipient of Intralipid, caused no significant changes in gallbladder volume. Conclusions: The results indicate that IV infusion of lipids is able to stimulate significantly contraction of human gallbladder. (Journal of Parenteral and Enteral Nutrition 21:350–352, 1997)
Sodium Butyrate Inhibits Carcinoma Development in a 1,2‐Dimethylhydrazine‐Induced Rat Colon Cancer
Authors: Medina V. , Afonso J.J. , Alvarez‐Arguelles H. , Hernández C. , González F.
Published: May 2008

Background: Butyric acid is one of the most important by‐products of dietary fiber degradation. It is an important trophic agent for the intestinal mucosa under different experimental conditions. Data obtained from several in vitro studies strongly suggest that butyrate can be a potential therapeutic agent in controlling the growth of some cancer cells. However, to date, in vivo animal studies have failed to show conclusive results. Methods: We evaluated the effects of intracecal administration of butyrate in an experimental model of colonic carcinogenesis induced by 1,2‐dimethylhydrazine (DMH), administered at the site where it is naturally produced, the cecum. We studied the incidence of colon tumors and their main histologic features. Results: Direct application of sodium butyrate significantly decreased the total number of tumors and the incidence of malignancies and carcinoma in the colon. Conclusions: Butyrate may inhibit the growth of tumors induced by DMH. (Journal of Parenteral and Enteral Nutrition 22: 14–17, 1998)
Role of Nutrition Support During Induction Chemoradiation Therapy in Esophageal Cancer
Authors: Sikora Sadiq S. , Ribeiro Ulysses , Kane John M. , Landreneau Rodney J. , Lembersky Barry , Posner Mitchell C.
Published: May 2008

Background: Preoperative chemoradiation therapy (CRT) potentially benefits a subgroup of patients with esophageal cancer. The ability to administer aggressive CRT may depend on the initial nutritional status and the ability to sustain nutrition during therapy. Parenteral nutrition support during CRT may lead to complications that limit its usefulness and negate any potential benefit. Methods: Data were analyzed to evaluate the role of parenteral nutrition support (PNS) in patients receiving CRT. Forty‐five consecutive patients with locoregional esophageal cancer, enrolled in a phase I/II trial of induction CRT, were analyzed. On the basis of the nutrition support received, two groups were defmed as follows: group I (with PNS, n = 30) and group II (without PNS, n = 15). Results were compared in terms of chemotherapy (CT) dose tolerated, morbidity of CRT, response rates, and surgical outcome in groups with and without PNS. Results: The two groups were comparable for demographic data, stage and site of disease, and performance status. There was no significant difference between the groups in the nutritional parameters (weight and serum albumin) before and after CRT. Group I patients received significantly more (% of total calculated dose) CT compared with group II (5‐fluorouracil [5‐FU], 86.4% vs 68.8%, p =.02; cisplatin [CDDP], 90.8% vs 78.2%, p =.05; and interferon α‐2b [IFN‐α], 95.4% vs 79.8%, P =.05, in groups I and II, respectively). Major (grade III/ IV) adverse effects of CT were hematologic (group I, 93.3% vs group II, 86.6%, p =.59) and gastrointestinal (group I, 56.67% vs group II, 33.3%, p =.2). Postsurgical staging revealed complete response in 10 (22%) and a major response in 23 (51%) patients, although the response rates were similar in the two groups (group I, 76.6% vs group II, 66.6%, p =.8). Surgical morbidity (51.8% vs 61.5%, p =.73), mortality (7.4% vs 7.6%, p = 1.00), and hospital stay (22.5 vs 19.6 days, p = 63) were also similar in the two groups. Conclusions: PNS can be provided to these patients without an increased risk of CRT or resection‐related morbidity. Although early and prolonged PNS facilitates administration of complete CRT doses, no benefit is derived from the administration of more CRT in the present regimen. The utility of PNS in this setting is unclear and, until further clarified, should not be applied routinely to this cohort of patients. (Journal of Parenteral and Enteral Nutrition 22:18–21, 1997)
Do We Still Need to Collect Stool? Evaluation of Visualized Fatty Acid Absorption: Experimental Studies Using Rats
Authors: Chiba Toshio , Ohi Ryoji
Published: May 2008

Background: Short‐gut syndrome is likely to impair enteric fat utilization. This study was undertaken to develop a clinical test of lipid absorption without fecal collection. Methods: The absorption of enterally fed radioactive long‐chain fatty acid, β‐methyl‐p‐(123I)‐iodophenylpentadecanoic acid was investigated with continuous chyle collection in rats. The changes in excretion and time‐dependent biodistribution of radioactivity of the enterally fed agent were assessed in normal control animals. Similarly, sequential urinary excretion and biodistribution were studied along with scintigraphy using sham‐operated and short‐gut animals. Results: Approximately 64% of the enterally fed radioactivity was recovered in the collected chyle (24 hours). A comparison of normal control, sham‐operated, and short‐gut animals showed significantly less urinary and greater fecal excretions of radioactivity in short‐gut animals. With the use of sequential scintigraphy, the small intestine, whole‐body soft tissues, and urinary bladder were well visualized in sham‐operated animals, whereas the large intestine and feces were demonstrated earlier in short‐gut animals. Conclusions: Our results suggest that enteral feeding of the agent might be feasible for determining lipid absorption from the the dynamic changes of radioactivity in visualized abdominal organs and in urine. (Journal of Parenteral and Enteral Nutrition 22:22–26, 1998)
Physiologic Response to a Protein, Carbohydrate, Fat Meal in Patients With Human Immunodeficiency Virus Who Underwent Small Intestinal Enteropathy as Characterized by a Kinetic Model of D‐Xylose Absorption
Authors: Carlson Stephen J. , Deutsch John C. , Craig Robert M.
Published: May 2008

Purpose: Small intestinal human immunodeficiency virus enteropathy is characterized by profound absorptive dysfunction unrelated to histology or pathogens. Frequently, an attempt is made to compensate for this intestinal failure by supplementing nutrient intake with nourishing liquid meals. It is not known how the diminished absorptive function in these patients will respond to this intake. With the use of a D‐xylose kinetic model of absorption, we determined the absorptive response of patients with small intestinal enteropathy to an isotonic liquid feeding. Methods: Seven male patients with acquired immunodeficiency syndrome (AIDS), diarrhea, weight loss, and no detectable pathogens (stool studies and duodenal biopsy) were enrolled. After an overnight fast, the patients were studied on three separate days. On day 1, the patients received 15 g oral D‐xylose. On day 2, 10 g IV D‐xylose was given. On day 3, 15 g oral D‐xylose was again given along with 250 mL of a liquid polymeric isotonic diet. Serum and urine collections were obtained to calculate the kinetic rate constants and extent of D‐xylose absorption. Results: Mean values for the rate constant for absorption of D‐xylose, K a, (0.26/h; N > 0.65) and the rate constant for nonabsorptive loss, K 0, (2.47/h; N < 0.353) were very abnormal before the meal. Mean K 0 improved (decreased to 0.66), but K a and bioavailability, F, did not have a statistically significant change after the meal. The improvement in mean K 0 with the meal was much more pronounced in the five subjects with high K 0 values before the meal (without meal 3.22; with meal 0.67; p <.05). Conclusions: (1) An isotonic liquid polymeric diet leads to less nonabsorptive loss of D‐xylose, but does not affect the extent of D‐xylose absorption in this group as a whole. This is probably due to the meal slowing gastric emptying. (2) Improvement in nonabsorptive loss with a meal is most pronounced when there is excessive nonabsorptive loss, K 0, without a meal. (3) Improvement in nonabsorptive losses with a meal might predict which patients will benefit from antimotility agents and continued feedings vs those requiring IV hyperalimentation (Journal of Parenteral and Enteral Nutrition 22:27–30, 1998)
Glycyl‐L‐Glutamine‐Enriched Total Parenteral Nutrition Maintains Small Intestine Gut‐Associated Lymphoid Tissue and Upper Respiratory Tract Immunity
Authors: Li Jian , King Brock K. , Janu Peter G. , Renegar Kathryn B. , Kudsk Kenneth A.
Published: May 2008

Background: IV administration of a total parenteral nutrition (TPN) solution results in small intestinal gut‐associated lymphoid tissue (GALT) atrophy, lowers small intestinal immunoglobulin A (IgA) levels, and impairs upper respiratory tract secretory IgA‐mediated mucosal immunity; isonitrogenous supplementation of TPN with 2% glutamine attenuates these changes. This experiment examines whether a 2% glycyl‐L‐glutamine‐enriched TPN solution reverses IV TPN‐induced changes as effectively as L‐glutamine. Methods: Male Institute of Cancer Research (ICR) mice underwent intranasal inoculation with H1N1 influenza virus to establish immunity. After 3 weeks, mice were randomized to chow, IV feeding of a TPN solution, glutamine‐enriched TPN, or glycyl‐L‐glutamine‐enriched TPN. After 4 days of feeding, mice were challenged intranasally with influenza virus and killed at 40 hours to determine viral shedding from the respiratory tract; normal convalescent mice do not shed virus because they possess intact IgA‐mediated mechanisms. Lymphocytes were isolated from Peyer's patches, the intraepithelial layer, and lamina propria to determine cell yields. Results: Total lymphocyte yield in the Peyer's patches, the intraepithelial layer, and lamina propria decreased with TPN but remained normal with glutamine and glycyl‐L‐glutamine. Upon challenge, 70% of the mice in the TPN group shed virus in nasal secretions, whereas only 20% of the glutamine‐treated group, 18% of glycyl‐L‐glutamine group and none of the Chow group were virus positive. Conclusions: L‐Glutamine and glycyl‐L‐glutamine have similar effects on IV administered TPN‐associated (GALT) atrophy and decreased upper respiratory tract immunity. (Journal of Parenteral and Enteral Nutrition 22:31–36, 1998)
Review: Host Defense‐A Role for the Amino Acid Taurine?
Authors: Stapleton Philip P. , O'Flaherty Lean , Redmond H. Paul , Bouchier‐Hayes David J.
Published: May 2008

Taurine (2‐aminoethane sulphonic acid), a ubiquitous β‐amino acid is conditionally essential in man. It is not utilized in protein synthesis but found free or in some simple peptides. Derived from methionine and cysteine metabolism, taurine is known to play a pivotal role in numerous physiological functions. Some of the roles with which taurine has been associated include osmoregulation, antioxidation, detoxification and stimulation of glycolysis and glycogenesis. Intracellular taurine is maintained at high concentrations in a variety of cell types and alteration of cell taurine levels is difficult. The role of taurine within the cell appears to be determined by the cell type. Recent research has determined a regulatory role for taurinechloramine, the product formed by the reaction between taurine and neutrophil derived hypochlorous acid on macrophage function. Plasma taurine levels are also high, although decreases are observed in response to surgical injury and numerous pathological conditions including cancer and sepsis. Supplementary taurine replenishes decreased plasma taurine. Although commonly used as a dietary supplement in the Far East, the potential advantages of dietary taurine supplementation have not as yet been fully recognized in the Western World; this is an area which could prove to be beneficial in the clinical arena.(Journal of Parenteral and Enteral Nutrition22:42–48, 1998)
Early Postoperative Glucose Control Predicts Nosocomial Infection Rate in Diabetic Patients
Authors: Pomposelli James J. , Baxter John K. , Babineau Timothy J. , Pomfret Elizabeth A. , Driscoll David F. , Forse R. Armour , Bistrian Bruce R.
Published: May 2008

Objectives: To determine the relationship between perioperative glucose control and postoperative nosocomial infection rate in 100 consecutive diabetic patients undergoing elective surgery. Design and Patients: One hundred initially uninfected diabetic patients undergoing elective surgery were prospectively monitored for perioperative glucose control and postoperative nosocomial infection rate. Glucose control was determined by the attending surgeon or diabetologist. Setting: A large tertiary care hospital that serves as the in‐patient facility for a local diabetes center. Main Outcome Measures: All patients were screened for infection preoperatively. Only initially uninfected patients were enrolled, and all patients received perioperative antibiotic coverage. Perioperative glucose control and postoperative nosocomial infection rate were monitored prospectively. APACHE II scores were determined on all patients. Patients were stratified into two groups: those with relatively “good” perioperative glucose control (all values ≤220 mg/dL) and those with “poor” control (at least one value >220 mg/dL). Contingency tables were generated, comparing nosocomial infection rates vs perioperative glucose control. Correlation coefficients between APACHE II score and maximum and mean glucose values were also determined. Results: A serum glucose >220 mg/dL on postoperative day one (POD 1) was a sensitive (87.5%) but relatively nonspecific (33.3%) predictor of the later development of postoperative nosocomial infection. In patients with hyperglycemia (>220 mg/dL) on POD 1, the infection rate was 2.7 times that observed (31.3% vs 11.5%) in diabetic patients with all serum glucose values <220 mg/dL. When minor infection of the urinary tract was excluded, the relative risk for “serious” postoperative infection increased to 5.7 when any POD 1 blood glucose level was >220 mg/dL. On the basis of correlation coefficients between serum glucose values and APACHE II score, only 18% of the variance in the highest serum glucose could be explained by disease severity alone. Conclusions: We conclude that diabetic patients undergoing major cardiovascular or abdominal surgery have an increased risk of infection that is further exacerbated by early postoperative hyperglycemia. The high rate of nosocomial infection observed in diabetic patients with poor glucose control suggests that hyperglycemia itself may be an independent risk factor for the development of infection. Efforts to improve perioperative glucose homeostasis in diabetic patients may reduce the incidence of nosocomial infection and thereby improve outcome. (Journal of Parenteral and Enteral Nutrition 22:77–81, 1998)
Comparison of Total Parenteral Nutrition and an Oral, Semielemental Diet on Body Composition, Physical Function, and Nutrition‐Related Costs in Patients With Malabsorption due to Acquired Immunodeficiency Syndrome
Authors: Kotler Donald P. , Fogleman Laura , Tierney Anita R.
Published: May 2008

Background: The nutrition management of patients with malabsorption syndromes due to acquired immunodeficiency syndrome (AIDS) is problematic. The aim of this study was to compare the effects of total parenteral nutrition (TPN) and an oral, semielemental diet (SED) on body weight, body composition, quality of life, survival, and medical costs in AIDS patients with malabsorption. Methods: This was a prospective, randomized, open‐label study performed in outpatients. Twenty‐three AIDS subjects (TPN group, 12; SED group, 11) with cryptosporidiosis, microsporidiosis, or malabsorption of unknown cause were randomized and followed. Subjects were prescribed equivalent amounts of formulas of similar composition for 3 months. Monthly estimations of caloric intake, body weight, body composition by bioimpedance analysis, and quality of life were recorded. Nutritional variables were analyzed by repeated‐measures analysis of covariance, with the baseline measure as the covariate. Nutrition‐related medical costs, survival, and indices of absorptive and immune function were compared, Results: Subjects had lost an average of 1.5 and 1.0 kg body wt/mo for TPN and SED during the 6 months before study entry (p < not significant). The TPN group consumed more total calories than the SED group (p <.05). Weight change during therapy was significantly different from pretreatment in both groups (p <.01 for TPN, p =.023 for SED). The TPN group gained more weight than the SED group (p =.057) and significantly more fat (p =.02), but the changes in body cell mass were similar in the two groups. Changes in weight and body composition correlated with caloric intake but not the mode of feeding. The SED group scored significantly better than the TPN group on a physical functioning subscale of quality of life (p <.01). Survival was similar in the two groups. TPN therapy cost almost four times more than SED. Peripheral blood CD4+ lymphocyte numbers were unaffected by either therapy. Intestinal function was not affected by either therapy. Conclusions: An oral SED may reverse weight loss and wasting in AIDS patients with malabsorption. (Journal of Parenteral and Enteral Nutrition 22:120–126, 1998)
Effects of Insulin‐Like Growth Factor 1 on Neutrophil and Monocyte Functions in Normal and Septic States
Authors: Balteskard Lise , Unneberg Kjetil , Halvorsen Dag , Hansen John‐Bjarne , Revhaug Arthur
Published: May 2008

Background: Insulin‐like growth factor 1 (IGF‐1) mediates anabolic actions in catabolic states and also influences the immune system. Endogenous IGF‐1 production is suppressed in sepsis; replacement therapy is therefore a natural approach to obtain the protein anabolic and potentially immune‐stimulating effects of IGF‐1. Methods: Twenty‐two piglets were randomized to three groups: an IGF‐1 group (n = 8) receiving a continuous infusion of 1.3 mg/h of IGF‐1, a nontreated septic control group (n = 8), and a nonseptic control group (n = 6) receiving saline. Phagocytosis and respiratory burst in porcine neutrophils were evaluated by flow cytometry (FCM); tumor necrosis factor (TNF) levels were measured in serum during the septic period. In addition, human neutrophils and monocytes were primed in vitro with IGF‐1 and subsequently were stimulated with phorbol myristate acetate (PMA) or Escherichia coli; phagocytosis and respiratory burst were evaluated by FCM. Results: Under nonseptic conditions, pretreatment with IGF‐1 suppressed the ability of neutrophils to ingest bacteria (ie, the level of phagocytosis) 43.4% ± 2.7% (IGF‐1‐treated) vs 55.8% ± 3.4% (nontreated septic controls) and 57.3% ± 3.34% (nonseptic controls) (p =.01). When challenged by live E. coli infusion, phagocytosis increased in the IGF‐1 group to the levels of the nontreated group. The respiratory burst showed a convincing priming effect of IGF‐1. After 4 hours of sepsis, the mean fluorescence intensity was 63.1 ± 6.9 in the IGF‐1 group and 40.7 ± 3.0 in nontreated septic controls. The serum levels of TNF‐α in the nontreated septic control group were twice those in the IGF‐1‐treated group, ie, 65.7 ± 13.1 pg/mL in the nontreated septic controls and 31.5 ± 7.5 pg/mL in the IGF‐1 group (p =.03). In vitro priming of human neutrophils and monocytes with IGF‐1 and subsequent stimulation with PMA or E. coli demonstrated that IGF‐1 enhanced both phagocytosis and respiratory burst. Conclusions: IGF‐1 serves as a priming agent for biologic functions of leukocytes. (Journal of Parenteral and Enteral Nutrition 22:127–135, 1998)
Fecal Short‐Chain Fatty Acids Predict Digestive Disorders in Premature Infants
Authors: Szylit O. , Maurage C. , Gasqui P. , Popot F. , Favre A. , Gold F. , Borderon J.C.
Published: May 2008

Background: Excretion of fecal short‐chain volatile fatty acids (SCFAs) may indicate changes in colonic or colonocyte metabolism. The aim of this study was to detect the existence of an average fecal SCFA profile and to define which changes were associated with clinical events that occurred during the survey period. Methods: SCFA profiles of 185 stool samples collected from 46 fed preterm neonates (mean birth weight, 1920 g; mean gestational age, 32.8 weeks) were evaluated and their association with digestive disorders or therapy was explored. Results: Total SCFA concentration increased from 0 to 80 μmol/g feces wet weight over the first 20 days of life. A basic SCFA profile revealed the existence of a highly sensitive period between the second and the third week of life. In the absence of any digestive problem (n = 15), the butyric acid (C4) ratio increased from 7% to 24%. Phototherapy (n = 13) enhanced the SCFA concentration but decreased the ratios of C4 and minor acids. Digestive disorders reported included abdominal distention (n = 6) or bleeding (n = 8). Only in the case of bleeding was the SCFA profile changed by an enhancement of C4 by >50%. Antibiotic therapy (n = 3) suppressed SCFA production. Conclusions: This study supports a hypothesis that changes in the SCFA profile could offer a noninvasive method to anticipate functional modifications of the gastrointestinal tract before the first clinical signs of pathologic events, including necrotizing enterocolitis. (Journal of Parenteral and Enteral Nutrition 22:136–141, 1998)
Arginine, Fish Oil, and Donor‐Specific Transfusions Independently Improve Cardiac Allograft Survival in Rats Given Subtherapeutic Doses of Cyclosporin
Authors: Alexander J. Wesley , Levy Adam , Custer David , Valente John F. , Babcock George , Ogle Cora K. , Schroeder Timothy J.
Published: May 2008

Background: Dietary supplementation with a fish oil and arginine‐enriched immunoenhancing diet (Impact; Sandoz Nutrition, Minneapolis, MN) in a rat cardiac allograft model using donor‐specific transfusion (DST) and cyclosporin (CsA) resulted in significant prolongation of cardiac allograft survival with many animals developing long‐term tolerance. This study was done to determine whether arginine or fish oil was the active ingredient. Methods: A standard AIN‐76A diet was modified to include either 10% fish oil, 2% arginine, or 5% arginine with or without fish oil. Diets were fed to Lewis strain rats that received Ax C9935 Irish (ACI) heterotopic cardiac allografts beginning on day 1 and continuing indefinitely. A DST (1.0 mL ACI whole blood) was given with 10 mg/kg CsA on day 1 relative to transplant and 2.5 mg/kg/ d on days 0 to 6. Groups of animals receiving AIN‐76A diet fortified with 2% glycine and animals receiving a DST or DST/CsA and regular laboratory chow served as controls. Results: Mean survival times ± SEM in days were as follows: untreated, 7.1 ± 0.4; CsA/ 2% glycine, 8.5 ± 0.6; DST only, 9.6 ± 1.1; DST/CsA, 26.6 ± 6.4; CsA/2% arginine, 25.5 ± 3.9; DST/CsA/2% arginine, 68.7 ± 8.9; DST/CsA/5% arginine, 90.1 ± 31.1; CsA/fish oil, 73.6 ± 26.1; and DST/CsA/fish oil/5% arginine, 90.1 ± 31.1. The effect of arginine was slightly dose dependent and was seen best in combination with DST, but the effect of fish oil was not enhanced by DST. Conclusions: Both fish oil and arginine dietary supplementation significantly improved allograft survival but through different mechanisms (DST vs non‐DST dependent). (Journal of Parenteral and Enteral Nutrition 22:152–155, 1998)
Preoperative Oral Supplement With Immunonutrients in Cancer Patients
Authors: Mccarter Martin D. , Gentilini Oreste D. , Gomez Maureen E. , Daly John M.
Published: May 2008

Background: Early postoperative enteral nutrition with immune‐enhancing supplements has helped to restore immune function and reduce infectious complications in patients with cancer undergoing major gastrointestinal operations. The aim of this study was to evaluate the effectiveness of similar supplements (containing arginine and arginine plus omega‐3 fatty acids) given preoperatively for 1 week before cancer surgery. Methods: In this randomized, double‐blinded study, patients scheduled to undergo elective resection of upper gastrointestinal tumors were given one of three different oral liquid supplemental diets (control, arginine, arginine plus omega‐3 fatty acids) to be taken each day for 7 days before surgery. Blood samples were obtained upon enrollment, on the morning of surgery, and on postoperative day 1 for analysis of immunologic function. Results: Mean serum ornithine (a metabolite of arginine) levels were significantly higher compared with controls, but no significant increase in mean serum arginine levels was noted on the morning of surgery for those patients who received arginine as part of the supplement. In conjunction with these findings, there were no differences among groups in mean lymphocyte mitogenesis, mean peripheral blood mononuclear cell production of cytokines, or clinical outcomes. Conclusions: Use of oral liquid supplements in this fashion did not improve lymphocyte proliferation or monocyte functions in patients with cancer undergoing major surgery. (Journal of Parenteral and Enteral Nutrition 22 :206–211, 1998)
Maximal Parenteral Glucose Oxidation in Hypermetabolic Young Children: A Stable Isotope Study
Authors: Sheridan Robert L. , Yu Yong‐Ming , Prelack Kathy , Young Vernon R. , Burke John F. , Tompkins Ronald G.
Published: May 2008

Background: During periods in which nutrition support of critically ill young children must be parenteral, glucose infusions are administered at up to 10 or more mg · kg−1 · min−1 to meet predicted energy needs. However, data in adults suggest that such high glucose loads exceed the ability to oxidize glucose in the hormonal milieu that characterizes critical illness. The purpose of this study was to determine if these high glucose loads are oxidized by critically ill young children. Methods: Ten young children with serious burns were enrolled in a stable isotope study of glucose metabolism. These five boys and five girls were an average age of 5.2 years (range, 1 to 11 years), weight of 18.4 kg (range, 10 to 31 kg) and burn size of 51.6% of the body surface (range, 35% to 86%). During clinically required episodes of parenteral nutrition support, we used the [13C6]glucose tracer to assess the efficacy of glucose oxidation at both 5 and 8 mg · kg−1 · min−1. Serum glucose was recorded and indirect calorimetry was performed. Results: The fraction of exogenous glucose oxidation fell from 59% ± 5% to 47% ± 5% (p <.05). Although there was a significantly increased level of total glucose oxidation (3.2 to 3.8 mg · kg−1 · min−1), this increment (29% ± 9%) was accompanied by a significant decrease in the efficiency of energy production, because the bulk of the additional glucose above 5 mg · kg−1 · min−1 was not being oxidized. Plasma glucose concentration did not change (145 ± 4 vs 137 ± 4 mg/dL, p <.01) and whole‐body expired gas respiratory quotients remained consistent with a mixed fuel oxidation, implying that there exists an increased rate of exogenous glucose uptake by tissues in nonoxidative pathways. Conclusions: Maximum glucose oxidation in severely burned children occurs at intakes approximating 5 mg · kg−1 · min−1. Exogenous glucose in excess of this amount enters nonoxidative pathways and is unlikely to improve energy balance. Clinical markers such as serum glucose levels or expired respiratory quotient may not detect inefficient glucose utilization. (Journal of Parenteral and Enteral Nutrition 22:212–216, 1998)
Glutamine Enhances Gut Glutathione Production
Authors: Cao Yihong , Feng Zuliang , Hoos Annie , Klimberg V. Suzanne
Published: May 2008

Background: The gastrointestinal tract is recognized as having important metabolic functions. This study examined gut glutathione (GSH) extraction and the effect of supplemental oral glutamine (GLN) on gut GSH fractional release. Methods: Healthy female Fisher‐344 rats weighing approximately 150 to 200 g were pair‐fed chow and supplemented by gavage with 1 g/ kg/d GLN or an isonitrogenous amount of Freamine (McGaw, St Louis, MO). Rats were sacrificed at 6 weeks. Arterial and portal blood was assayed for GLN and GSH content. The gut GLN and GSH extractions were calculated. Results: The gut GLN fractional uptake was increased by approximately 50%, and there was a near threefold increase in gut GSH fractional release in the GLNsupplemented group. Conclusions: The discovery of gut's role as a major producer of GSH may give insight into why feeding via the gut rather than by the venous route is so important. Supplemental oral GLN further enhances GLN extraction as well as GSH fractional release in the gut. (Journal of Parenteral and Enteral Nutrition 22:224–227, 1998)
Percutaneous Endoscopic Gastrostomy for Nutrition Support in Pregnancy Associated With Hyperemesis Gravidarum and Anorexia Nervosa
Authors: Godil Aslam , Chen Yang K.
Published: May 2008

Background: Pregnant women with hyperemesis gravidarum (HEG) or anorexia nervosa are at high risk of developing malnutrition and adverse fetal outcome. Providing adequate nutrition support is the mainstay of therapy in these patients. Because of potential complications associated with total parenteral nutrition (TPN), enteral nutrition support is the preferred route. Methods: We describe the first two reported cases of percutaneous endoscopic gastrostomy (PEG) placement in two conscious pregnant women who could not tolerate oral feedings because of severe anorexia nervosa and HEG, respectively. Results: PEG was placed safely and provided adequate enteral nutrition in both patients, resulting in favorable maternal and fetal outcomes. Conclusions: Our observation is the first demonstration that PEG may be a safe and effective alternative to TPN in selected pregnant women with HEG or anorexia nervosa who have failed conventional treatment. (Journal of Parenteral and Enteral Nutrition 22:238–241, 1998)
The Route of Nutrition Support Affects the Early Phase of Wound Healing
Authors: Kiyama Teruo , Witte Maria B. , Thornton Frank J. , Barbul Adrian
Published: May 2008

Background : Nutrition support via the enteral route has been shown to be superior to parenteral administration in maintaining immune function, decreasing septic complications, and increasing survival after severe trauma and surgical injury. Whether the route of nutrition support affects wound healing, another important determinant of outcome following injury, is not known. Methods: Forty‐nine Sprague‐Dawley rats, 290 to 360 g body wt, underwent identical surgical manipulation consisting of central venous catheterization, fashioning of gastrostomy and dorsal skin incision, and placement of polyvinyl alcohol sponges into subcutaneous pockets. Identical infusates of 25% dextrose, 4.25% amino acids, and vitamins were given, half the animals receiving the infusion via the gastrostomy and the other half via the venous catheter. Animals were killed on day 5, 7, or 10. Wound breaking strength, sponge hydroxyproline content (an index of wound collagen deposition), and types I and III collagen gene expression were measured. Results: There were no nutritional differences between the two groups in terms of energy intake, body weight gain, and plasma levels of albumin, total protein, or urea nitrogen. On day 5 wound breaking strength was significantly higher in the enterally supported group (89.3 ± 90.7 vs 64.9 ± 40.2 g for the parenteral group, p <.05). This was paralleled by enhanced wound collagen accumulation (182 ± 19 vs 132 ± 13 μg, p <.05). Gene expression of type I, but not type III, collagen also was increased in the enterally fed group. There were no differences noted between the two groups in wound healing parameters 7 and 10 days after injury. Conclusions: The data demonstrate that the route of nutrition administration can influence wound healing. The beneficial effect of the enteral feeding route is limited to the early phases of healing. (Journal of Parenteral and Enteral Nutrition 22:276–279, 1998)
Effects of Soybean Oil and Fish Oil Emulsions on Glucose and Lipid Metabolism in Streptozotocin‐Induced Diabetic Rats Receiving Total Parenteral Nutrition
Authors: Ling Yeh Sung , Chen Tasi Jui , Jao Chen Wei
Published: May 2008

Background: This study was designed to investigate the effects of fat emulsions with different fatty acid composition on plasma glucose and lipid metabolism in diabetic rats receiving total parenteral nutrition (TPN). Methods: Diabetes was induced in rats with streptozotocin (STZ), and the rats were fed rat chow ad libitum for 6 weeks to achieve a chronic diabetic state. Control and diabetic rats were each divided into two TPN groups. The basal solutions of the two TPN groups were isonitrogenous and identical in nutrients composition except for the fat emulsion, which was made of soybean oil (SO) or fish oil (FO). The TPN control rats (C‐SO and C‐FO) and diabetic rats (DM‐SO and DM‐FO) received solutions with 37.5% of the non‐protein energy provided as fat at an energy level of 30 kcal/100 g body wt/d. Results: The results demonstrated that hyperglycemia and hypertriglyceridemia were induced by STZ in diabetic rats. There was no change in plasma glucose and insulin concentrations before and after TPN infusion in the TPN control groups, whereas plasma glucose as well as triglyceride (TG) and nonesterified fatty acid (NEFA) levels decreased significantly after TPN administration in the diabetic groups. No difference in the concentrations of plasma glucose, TGs, NEFAs, and insulin were observed between the two diabetic groups. Conclusions: These results suggest that compared with soybean oil, TPN with fish oil emulsion did not lead to lower plasma concentrations of TGs and NEFAs in STZ‐induced diabetic rats. Also, no difference in plasma glucose and insulin levels between the two groups was observed. (Journal of Parenteral and Enteral Nutrition 22:297–301, 1998)
A Randomized, Controlled, Single‐Blind Trial of Nutritional Supplementation After Acute Stroke
Authors: Gariballa Salah E. , Parker Stuart G. , Taub Nick , Castleden C. Mark
Published: May 2008

Background: Although stroke patients who do not have difficulty swallowing may be at risk of undernutrition and worsening nutritional status during hospitalization, optimum methods for nutrition intervention in stroke patients have not been established. Aim: To examine the feasibility of enteral sip feeding as an effective nutrition intervention after acute stroke. Methods: Forty‐two acute ischemic stroke inpatients with impaired nutritional status who did not have difficulty swallowing within 1 week after the stroke were entered into a single‐blind, randomized, controlled, prospective study of enteral sip feeding. Twenty‐one patients were randomized to receive daily oral food supplements for 4 weeks in addition to the hospital food, and 21 patients received only the hospital food for the same period. Main outcome measures were energy and protein intakes during the intervention period, change in nutritional status, disability, infective complications, length of stay, and mortality during hospitalization and at 3 months. Results: Two patients, one from each group, were lost to follow‐up immediately after randomization. Twenty patients received oral nutritional supplmentation. The energy intake was significantly greater in the supplemented group: 1807 ± 318 υs 1084 ± 343 kcal/d (mean ± SD; p <.0001) (estimated treatment effect, 723 kcal/d; 95% confidence interval [CI], 498 to 947), as was protein intake: 65.1 ± 13.8 vs 44.1 ± 12.8 g/d (p <.001) (estimated treatment effect, 21.0 g/d; 95% CI, 11.7 to 30.3). There also were significant differences between the two groups in the changes in serum albumin and serum iron concentrations between randomization and at follow‐up. There was a trend to lower mortality at 3 months in the supplemented group with two deaths (10%) compared with seven deaths (35%) in the control group (p =.127, relative risk, 0.29; 95% CI, 0.07 to 1.21). Conclusions: This study suggests that enteral sip feeding is effective in improving nutritional intake and status in stroke patients who do not have swallowing difficulties. There also may be some beneficial effects on clinical outcome, but larger studies are required to confirm this observation and define more precisely the magnitude of any favorable effects. (Journal of Parenteral and Enteral Nutrition 22:315–319, 1998)
Epidermal Growth Factor and Human Growth Hormone Induce Two Sodium‐Dependent Arginine Transport Systems After Massive Enterectomy
Authors: Iannoli Pasquale , Miller Jen‐nie H. , Sax Harry C.
Published: May 2008

Background: A combination of epidermal growth factor (EGF) and human growth hormone (hGH) after massive enterectomy induces a 400% increase in arginine transport in the remnant distal small intestine. The kinetic mechanism (s) responsible for enhanced arginine transport under these conditions is unknown. Methods: New Zealand White rabbits underwent 70% midjejunoileal resection. After a 1‐week recovery period, animals received hGH (0.2 mg/kg/d IM), EGF (1.5 μg/kg/h SC), hGH + EGF, or vehicle (equal volume) for 7 days. Transport of tritiated arginine into brush border membrane vesicles prepared from distal remnant small intestinal mucosa was quantified in the presence and absence of a sodium gradient over a range of arginine concentrations (25 to 5000 μmol/L). Results: Eadie‐Hofstee transformation of the kinetic data demonstrates two sodium‐dependent arginine transport systems, comprising a high‐capacity, low‐affinity system and a low‐capacity, high‐affinity system. A combination of EGF and hGH significantly upregulates both the high‐capacity (685%) and low‐capacity (350%) maximum transport velocity (Vmax). Additionally, EGF alone significantly upregulates V max by 200% in the low‐capacity system. There were no significant changes in transport affinity (Km) in either system. Conclusions: There are two quiescent sodium‐dependent arginine transport systems in the distal small intestine. A combination of EGF and hGH after massive enterectomy increase arginine transport by V max upregulation in both the high‐capacity/low‐affinity and lowcapacity/high‐affinity systems. (Journal of Parenteral and Enteral Nutrition 22:326–330, 1998)
The Reliability of Muscle Function Analysis Using Different Methods of Stimulation
Authors: Brooks Stephanie D. , Gerstman B. Burt , Sucher Kathryn P. , Kearns Patrick J.
Published: May 2008

Background: The purpose of our study was to determine the reliability of nonvolitional muscle function analysis (MFA) by determining the day‐to‐day and within‐day reliability of conventional electrical stimulation and a newer, magneto‐electrical stimulation method, using standard laboratory methodology. Methods: Ten healthy, human immunodeficiency virus‐negative adult men volunteered as subjects. MFA consisted of measuring the maximal relaxation rate, for magneto‐electrical stimulation at 1 Hz and conventional electrical stimulation at 20 Hz, and force‐frequency ratios using conventional electrical stimulation at 10 Hz:20 Hz and 10 Hz:50 Hz. Within‐day and day‐to‐day reliability were determined by calculating the coefficient of variation (CV) for all subjects. Results: Maximal relaxation rate using magneto‐electrical stimulation had a significantly lower CV compared with the other nonvolitional MFA methods (p =.002). Conclusions: Maximal relaxation rate using magneto‐electrical stimulation was more reliable and technically easier than the other muscle function parameters examined. However, the day‐to‐day CV of muscle function parameters is larger than traditional nutrition assessment techniques. Development within the field should strive to improve testing techniques so that the reliability of MFA will allow definition of a range of normal values against which an individual's value can be compared. Until this is available, the precision and reliability of MFA restrict its use to research and population studies. (Journal of Parenteral and Enteral Nutrition 22:331–334, 1998)