bluuebunny/crossref_metadata_2025 huggingface dataset:
Hepatic de novo Lipogenesis after Liver Transplantation
Authors: Minehira Kaori , Novel‐Chaté Valérie , Schwarz Jean‐Marc , Gillet Michel , Darioli Roger , Chioléro René , Tappy Luc
Published: May 2008

Background: The liver can synthesize fatty acids from carbohydrate (de novo lipogenesis [DNL]).We hypothesized that stimulation of this process may be involved in the development of obesity and dyslipidemia, 2 conditions frequently encountered after liver transplantation. Methods: Hepatic fractional DNL and glucose metabolism were measured in 2 groups of 5 patients (age 36.8 ± [SD] 14.9 years, BMI 26.3 ± 5.3 kg/m2) 1 to 5 years after liver transplantation and 8 healthy subjects (age 28.1 ± 5.3 years, BMI 27.2 ± 4.5 kg/m2). Subjects were studied while receiving an isoenergetic nutrition (based on 1.1 × their basal energy expenditure) as hourly oral liquid formula during 10 hours. Their hepatic DNL was measured by infusing 1‐13C acetate and measuring tracer incorporation in VLDL‐palmitate. Their glucose metabolism was assessed by means of 6,6‐2H2 glucose and indirect calorimetry. Results: Two liver transplant recipients and 4 healthy subjects were obese, as defined by a BMI > 27 kg/m2. Fractional hepatic DNL was not different in the 2 groups of subjects: liver transplant recipients 3.1 ± 1.7% vs 3.2 ± 2.1% in healthy subjects. In both groups, DNL increased in proportion to BMI. When both groups were analyzed together, BMI was positively correlated with DNL (DNL = 0.28 x BMI ‐ 4.28, r 2 =.445, p <.05). Whole body glucose turnover was 15.0 ± 4.4 μmol/kg per minute in liver transplant recipients and 15.8 ± 4.1 μmol/kg per minute in healthy subjects (NS). Net carbohydrate oxidation tended to be lower in liver transplant recipients (8.1 ± 2.6 μmol/kg per minute) than in healthy subjects (10.4 ± 2.4 μmol/kg per minute; NS). Net nonoxidative glucose disposal (4.0 ± 2.7 in liver transplant recipients vs 1.9 ± 1.8 in healthy subjects, NS) and energy expenditure (0.065 ± 0.01 vs 0.065 ± 0.01 kJ/kg per minute) were similar in both groups. Conclusions: These results indicate that fractional hepatic DNL is not altered by liver transplantation during near continuous nutrition. The disposal of orally administered carbohydrate is also essentially unchanged. This strongly argues against a role of hepatic DNL in the pathogenesis of obesity and dyslipidemia after liver transplantation. (Journal of Parenteral and Enteral Nutrition 25:229–236, 2001)
Luminal Nutrients Exacerbate Intestinal Hypoxia in the Hypoperfused Jejunum
Authors: Kles K.A. , Wallig M.A. , Tappenden K.A.
Published: May 2008

Background: Provision of enteral nutrients shortly after traumatic injury has become the preferred method of nutrition support provided to patients. However, traumatic shock results in splanchnic hypoperfusion, which may cause persistent intestinal hypoxia. This study tested the hypothesis that delivery of enteral nutrients to the hypoperfused jejunum increases oxidative demand beyond that available, thereby exacerbating intestinal hypoxia. Methods: Wistar‐Furth rats (186 ± 4 g; n = 24) were randomized to receive intestinal hypoxia (superior mesenteric artery occlusion) or serve as normoxic controls (sham laparotomy). Within the jejunum of each rat, 4 6‐cm loops were randomized to receive luminal perfusions with 1 of 4 substrates: mannitol (an osmotic control); glucose (undergoes active transport via the sodium‐glucose co‐transporter [SGLT‐1] and is metabolized); 3‐o‐methylglucose (3‐o‐mg; uses SGLT‐1 but is not metabolized); or fructose (does not use SGLT‐1 but is metabolized). After in situ perfusions, jejunal tissue was removed for analysis of nutrient transport and barrier function in modified Ussing chambers. Tissue homogenate was used to determine concentration of ATP, lactate, pyruvate, and protein. Also, jejunal tissue was stained with hematoxylin and eosin for qualitative analysis of ischemia and necrosis. Results: Transmural resistance was lower (p <.001) in the hypoxia groups, irrespective of substrate, indicating increased mucosal permeability. When compared with the normoxic controls, glucose transport was impaired (p <.001) in the hypoxic groups; however, glutamine transport was unaffected. The degree of intestinal hypoxia, assessed by jejunal lactate concentration, was higher (p <.001) in the glucose and fructose groups, than the control mannitol and 3‐o‐mg groups. Conclusions: The observation that 3‐o‐mg did not differ from the mannitol control indicates that SGLT‐1 activation alone does not exacerbate hypoxia. Rather, these results indicate that provision of metabolizable nutrients to the hypoperfused intestine exacerbate hypoxia and potentially lead to intestinal ischemia. Although early enteral nutrition is an important intervention after trauma, care must be taken to ensure intestinal perfusion is adequate to allow for nutrient metabolism and prevent further compromise. (Journal of Parenteral and Enteral Nutrition 25:246–253, 2001)
Effects of Glutamine‐Supplemented Total Parenteral Nutrition on Cytokine Production and T Cell Population in Septic Rats
Authors: Sung Ling Yeh  , Chiu Li Yeh  , Ming Tsan Lin  , Ping Nan Lo  , Wei Jao Chen
Published: May 2008

Background: This study was designed to investigate the effects of total parenteral nutrition (TPN) enriched with glutamine (GLN) on in vivo cytokine production and cellular immune response in early and late septic stages of rats. Methods: Male Wistar rats were divided into 2 experimental groups and received TPN solution at an energy level of 270 kcal/kg body weight. The TPN solutions were isonitrogenous and identical in nutrients composition except for differences in amino acid content. One group received 2% GLN, whereas the other group received glycine (Gly) instead. TPN was maintained for 5 or 6 days according to the sacrifice schedule of the rats. On day 5, sepsis was induced by cecal ligation and puncture (CLP). Respective groups of rats were sacrificed 2, 4, 6, and 24 hours after CLP. Results: Sepsis resulted in a negative nitrogen balance in both groups, and nitrogen loss was significantly lower in the GLN than the Gly group. Interleukin (IL)‐2 and interferon (IFN)‐γ in most of the samples collected at various time points were not detectable in plasma or peritoneal lavage fluid. No differences in plasma IL‐6 and TNF‐α concentrations were observed between the GLN and Gly groups. Also, there were no significant differences in IL‐1β, IL‐6, and TNF‐α concentrations in peritoneal lavage fluid between the 2 groups at various time points. The CD4+/CD8+ ratio was significantly higher in the GLN group than in the Gly group only at 4 hours after CLP, and no difference was observed at 24 hours after CLP. Conclusions: TPN preinfused with a GLN‐supplemented solution had a beneficial effect in ameliorating the extent of negative nitrogen balance in septic rats. However, parenterally administered GLN did not reduce the production of inflammatory mediators systemically or at the site of injury, and the influence on enhancing cellular immunity was not obvious. (Journal of Parenteral and Enteral Nutrition 25:269–274, 2001)
Effects of Tyrosine Kinase Signaling Inhibition on Survival After Cecal Ligation and Puncture in Diet‐Restricted Mice
Authors: Kang Woodae , Saito Hideaki , Fukatsu Kazuhiko , Hidemura Akio , Koyama Hiroyuki , Sakamoto Tetsuya , Maekawa Kazuhiko
Published: May 2008

Background: Malnutrition impairs host immunity, resulting in high mortality and morbidity due to infections. Phosphorylation of protein tyrosine kinase (PTK) is a key step in the signaling of many cellular functions, including immune cell functions. Malnutrition may affect this signaling in response to surgical insults. The aim of this study was to examine the effects of PTK inhibition on mortality in ad libitum and in diet‐restricted mice after cecal ligation and puncture (CLP). Moreover, tyrosine phosphorylation of peritoneal cells from these animals was evaluated. Methods: Survival study: Mice (n = 45) received chow, 146 g/kg per day (ad libitum) or 36.5 g/kg per day (diet‐restricted), for 7 days. Two hours before CLP, one‐half the mice in each group were given a tyrosine kinase inhibitor, AG 556 (3.0 mg/kg i.p.), and the others received vehicle. Survival was observed up to 7 days after CLP. Effects of AG 556 on survival with a lesser degree of malnutrition (chow 73 g/kg per day) were also examined (n = 41). Measurement of tyrosine phosphorylation: mice (n = 20) were assigned to the ad libitum and diet‐restricted (chow 36.5 g/kg per day) groups. Peritoneal cells were harvested either before or 2 hours after glycogen injection. Glycogen treatment elicits polymorphonuclear neutrophil influx into the peritoneal cavity. The cells were incubated with or without N‐formyl‐methionyl‐leucyl‐phenylalanine (fMLP). Tyrosine phosphorylation in the cells was examined using flow cytometry, laser scanning cytometry, and Western blotting. Results: Diet restriction significantly reduced survival compared with the ad libitum group. AG 556 treatment decreased the survival of ad libitum, but not in diet‐restricted mice in both survival experiments. Stimulation of peritoneal cells with fMLP increased tyrosine phosphorylation in the ad libitum group (23% increase before glycogen and 18% after glycogen), but not in the diet‐restricted group (‐9% before glycogen and 3% after glycogen). Conclusions: Inhibition of tyrosine kinase signaling impairs the ability of a well‐nourished host to survive CLP—induced sepsis, while having no effects on survival in diet‐restricted mice. Peritoneal cells from diet‐restricted animals are unable to increase PTK phosphorylation in response to stimulation, which may be the mechanism underlying impaired host defense during malnutrition. (journal of Parenteral and Enteral Nutrition 25:291–298, 2001)
Early Enteral Nutrition in Critically III Patients With a High‐Protein Diet Enriched with Arginine, Fiber, and Antioxidants Compared With a Standard High‐Protein Diet. The Effect on Nosocomial Infections and Outcome
Authors: Caparrós Tomás , Lopez Jorge , Grau Teodoro
Published: May 2008

Background: This study was designed to evaluate the effects of a high‐protein formula enriched with arginine, fiber, and antioxidants compared with a standard high‐protein formula in early enteral nutrition in critically ill patients. Methods: For this study, 220 patients were enrolled in a prospective, multicenter, single‐blind, randomized trial in 15 Spanish intensive care units (ICUs). The primary endpoints were the incidence density rates of nosocomial infections, ICU and hospital length of stay, ICU and in‐hospital mortality, and mortality at 6‐month follow‐up. Results: The patients in the control and study groups had similar baseline characteristics. The study group had a lower incidence of catheter‐related sepsis (0.4 episodes/1000 ICU days) than the control group (5.5 episodes/1000 ICU days), with a relative risk (RR) of 0.07 (95% confidence interval [CI] 0.01 to 0.54, p <.001). There were no differences in the incidence of ventilator‐associated pneumonia, surgical infection, bacteremia, or urinary tract infections between the 2 groups. ICU mortality (16% in the study group versus 21% in the control group; RR 1.5, CI 95% 0.7 to 2.9) and in‐hospital mortality (21% in the study group versus 30% in the control group; RR 1.6, CI 95% 0.9 to 3) were similar without differences in survival at 6‐month follow‐up (75% in the study group versus 68% in the control group, p =.15). Patients in the study group who were treated for 2 or more days showed a strong trend for better survival at 6‐month follow‐up (76% in the study group versus 67% in the control group, p =.06). Medical patients treated with the study diet had better survival than medical patients in the control group (76% in the study group versus 59% in the control group, p <.05). Conclusions: Critically ill patients fed a high‐protein diet enriched with arginine, fiber, and antioxidants had a significantly lower catheter‐related sepsis rate than patients fed a standard high‐protein diet. There were no differences in mortality or ICU and hospital length of stay. The subgroup of patients fed the study diet for >2 days showed a trend toward decreased mortality. (Journal of Parenteral and Enteral Nutrition 25:299–309, 2001)
Human Neutrophil Membrane Fluidity After Exposure to Structurally Different Lipid Emulsions
Authors: Wanten Geert J. , Naber Anton H.J.
Published: May 2008

Background: We have previously reported that medium‐chain triglyceride (MCT)‐containing lipid emulsions, contrary to long‐chain triglyceride (LCT) emulsions, activate human neutrophils. This activation might result from functional alterations in cellular membranes induced by MCT. Membrane fluidity is such a feature with known clinical implications and can be assessed by fluorescence polarization measurements. This study was performed to investigate whether exposure to various emulsions distinctively influences neutrophil membrane fluidity. Methods: Neutrophils from 8 volunteers were incubated in medium or physiologic 2.5 mmol/L emulsions containing LCT, mixed LCT/MCT, or structured lipids (SL). Subsequently, the cells were washed and anisotropy, ie, the reciprocal of fluidity, was measured using the fluorescent probes 1,6‐diphenyl‐1,3,5‐hexatriene (DPH) and trimethyl‐ammonium (TMA)‐DPH. Results: Compared with nonlipid‐exposed neutrophils, LCT/ MCT and, to a lesser degree, SL decreased fluorescence anisotropy and thus increased membrane fluidity, which was measured by DPH anisotropy, whereas LCT had no effect. Similar results were obtained with the more polar probe TMA‐DPH. Conclusions: These data suggest that the neutrophil‐activating effect of MCT‐containing emulsions may, at least in part, be mediated by an effect on cellular membrane fluidity. (Journal of Parenteral and Enteral Nutrition 25:352–355, 2001)
Comparison of standard and immune‐enhancing oral formulas in asymptomatic HIV‐infected persons: a multicenter randomized controlled clinical trial
Authors: Keithley JK , Swanson B , Zeller JM , Sha BE , Cohen M , Hershow R , Novak R
Published: May 2008

BACKGROUND: Both standard and immune‐enhancing oral formulas are widely used to forestall HIV wasting and to promote immune function. However, there is little scientific evidence to support the differential effects of these formulas in asymptomatic HIV disease. The aim of this study was to compare the effects of an immune‐enhancing oral formula and a standard oral formula on nutrition and immune measures in asymptomatic HIV‐infected persons. A secondary aim was to evaluate the feasibility of maintaining a diverse sample of outpatients on a long‐term oral formula protocol. METHODS: In this multicenter controlled nonblinded study, 90 asymptomatic HIV‐infected persons with CD4 cell counts between 275 and 550 cells/mm3 were randomized to a control group; a standard oral formula group (Ensure Plus); or an immune‐enhancing oral formula group (Advera). All groups received basic nutrition counseling. Participants were evaluated on nutrition, immune, and feasibility measures at 3‐month intervals during the 12‐month study period. Differences in nutrition and immune measures among the 3 groups were analyzed using the Kruskal‐Wallis and Wilcoxon tests. Wilcoxon tests and correlation coefficients were used to analyze feasibility data. RESULTS: Sixty‐six outpatients completed the 12‐month study protocol. Among the 3 groups, there were no significant differences with respect to body weight, bioelectrical impedance analysis (BIA)‐derived body cell and fat mass, daily caloric intake, and serum albumin at any of the study visits. Moreover, absolute CD4+ T lymphocytes and percentages did not significantly differ at any time point among the 3 groups. Acceptability and tolerance of the formulas were high for both the standard and immune‐enhancing oral formula groups. CONCLUSIONS: Within the context and limitations of this study, standard and immune‐enhancing oral formulas consumed daily for 1 year had no differential effects on nutrition or immune parameters in asymptomatic HIV‐infected persons.
Cardiomyopathy in association with selenium deficiency: a case report
Authors: Yusuf SW , Rehman Q , Casscells W
Published: May 2008

A 46‐year‐old man developed “dilated cardiomyopathy” probably caused by selenium deficiency while on total parenteral nutrition (TPN). This development emphasizes the role of considering selenium deficiency as a reversible cause of unexplained cardiomyopathy in impaired nutritional state.
Local antibiotic lock for the treatment of infections related to central catheters in parenteral nutrition in children
Authors: Cuntz D , Michaud L , Guimber D , Husson MO , Gottrand F , Turck D
Published: May 2008

BACKGROUND: Central venous catheter‐related (CVC) infections represent the most common complication of parenteral nutrition. These infections are usually treated by means of long‐term systemic antibiotic treatment. The objective of this study was to determine the efficacy of combining a local antibiotic lock with a short systemic double antibiotic to treat CVC‐related staphylococci infections. METHODS: Any child with coagulase‐negative staphylococci or Staphylococcus aureus septicemia, confirmed by a positive blood culture, was included in the study. A double antibiotic systemic treatment composed of amikacin and teicoplanin was started and continued for 5 days. The antibiotic treatment was combined from the first day (D0) with a local teicoplanin lock, which was left for 12 hours a day in the catheter for 15 days. Parenteral nutrition was continued on a nocturnal cyclic mode during antibiotic treatment. The efficacy of the treatment was evaluated by clinical (body temperature), biologic [C‐reactive protein levels (CRP)], and bacteriologic (blood culture) measures. RESULTS: Twenty CVC‐related infection episodes in 13 patients were analyzed for the study. In the initial biologic test, CRP varied from 2 to 130 mg/L (mean 43 mg/L). After 3 days of treatment, CRP varied from 2 to 61 mg/L (mean 12 mg/L). The median time until normalization of temperature and CRP levels after the beginning of antibiotic treatment was 3.2 days (range 1 to 14 days) and 6.2 days (range 2 to 19 days), respectively. All blood cultures were negative for infection 48 hours after stopping the treatment. Only 1 therapeutic failure was observed during the treatment. The patient had persistent signs of clinical septicemia that required removal of the CVC. Two catheter‐related infection recurrences were observed in the month after termination of the local antibiotic lock, which also required removal of the CVC. The central venous catheter was maintained in the other cases. CONCLUSIONS: Teicoplanin antibiotic locks, combined with a short conventional systemic antibiotic treatment and continuation of cyclic parenteral nutrition, seem effective and well‐tolerated treatments for CVC infections.
Efficacy of antibiotic‐lock technique with teicoplanin in staphylococcus epidermidis catheter‐related sepsis during long‐term parenteral nutrition
Authors: Guedon C , Nouvellon M , Lalaude O , Lerebours E
Published: May 2008

BACKGROUND: The antibiotic‐lock technique has been suggested to treat catheter‐related sepsis in parenteral nutrition and to avoid catheter removal. METHODS: To determine the incidence of catheter‐related sepsis, the bacteria involved, and the efficacy of the antibiotic‐lock technique with teicoplanin, all patients (n = 263) undergoing parenteral nutrition from January 1997 to December 1999 in one center, with patients at the hospital (n = 209) and at home (54) were retrospectively studied. The antibiotic‐lock technique with teicoplanin was systematically used in all suspected infections and maintained in staphylococcus epidermidis (SE) infections. RESULTS: A total of 21 of 263 patients had 34 infections (0.11/patient per year): 12 of 209 hospitalized and 9 of 54 home patients. A total of 10 of 34 infections were due to non‐SE, and the catheter was immediately removed. The other 24 of 34 infections were due to SE; in 5 of 24, the catheter was removed after 48 hours of the antibiotic‐lock technique because of persistent fever or thrombosis. A total of 5 of 12 patients had 2 or more infections on the same catheter. The antibiotic‐lock technique prevented short‐term catheter removal in these cases, but a second infection occurred within a median of 50 days. In 4 of 5 cases, a third infection occurred in a mean delay of 90 days so that the catheter was removed. In 3 of 5 patients, bacteria was analyzed with pulsed field gel electrophoresis, which showed that recurrent infections were due to the same strain in all cases. CONCLUSIONS: In this study, the incidence of catheter‐related sepsis was low and mostly related to SE. Our results do not support the use of the teicoplanin antibiotic‐lock technique in SE infections.
Accuracy of bioelectrical impedance spectroscopy in measuring changes in body composition during severe weight loss
Authors: Cox‐Reijven PL , van Kreel B , Soeters PB
Published: May 2008

BACKGROUND: Bioelectrical impedance spectroscopy (BIS) is an attractive method for measuring body composition because it is noninvasive, simple, and cheap. The effect of obesity on the accuracy of impedance measurements has been recognized for some time, but no conclusive explanations or ways to correct the measurement errors have been published. We studied the effect of the composition of weight loss on the accuracy of BIS to measure changes in body fluid volumes during severe weight loss. Within subjects the effect of variable losses of fat mass was studied. METHODS: In 10 morbidly obese female subjects who underwent gastric reduction surgery, changes in total body water (TBW) and extracellular water (ECW) were monitored for 1 year by deuterium (Deu) and bromide (Br) dilution and by BIS. Measurements were performed before the operation and after 2 weeks, 3 months, and 1 year. Extrapolated resistance values of extracellular (Recw) and intracellular water (Ricw) were used in mixture equations for calculating the corresponding fluid volumes. RESULTS: After 1 year, weight decreased by 53 kg, TBW (Deu) loss was 8.7 L, and ECW (Br) loss was 4.3 L. Comparison of BIS with reference methods for measuring all possible changes over 6 time‐intervals revealed a mean overestimation of TBW (2.4 L, SD = 2.9) and ECW (0.74 L, SD = 2.6) losses by BIS. Overestimation increased significantly with increasing fat losses, expressed as percentage fat of the weight loss and as change in triceps skinfolds. Measured changes in Recw and Ricw were less than expected for an ideal agreement between dilution methods and mixture equations. CONCLUSIONS: BIS with the use of mixture equations overestimates fluid losses during weight loss. The error is associated with the amount of fat loss. The large contribution of the factor weight in the mixture equations is likely to be responsible. The assumptions of mixture theory are not valid in obesity.
Qualitative manipulation of amino acid supply during total parenteral nutrition in surgical patients
Authors: Berard MP , Pelletier A , Ollivier JM , Gentil B , Cynober L
Published: May 2008

We investigated whether a qualitative manipulation of amino acid mixture could improve the nutritional status of patients undergoing surgery. Patients received total parenteral nutrition for 2 consecutive 5‐day periods. Energy and nitrogen supplies were calculated using a modified Harris‐Benedict equation, with an energy‐to‐nitrogen ratio of 125 kcal/g nitrogen (N). The mean kilocalorie lipids‐to‐glucose ratio was 35% to 65%. There were 6 patients in the control group and 7 patients in the experimental group. The control group received the same standard amino acid solution (Vintene, Baxter‐Clintec, Maurepas, France) for the entire 10 days. The experimental group received the standard solution during the first 5 days but was switched to a more individualized solution during the last 5 days. The second solution was determined from a linear regression performed on day 3 comparing rate of infusion of each amino acid and its plasma variations after 3 hours of infusion with basal values. Amino acids were defined as oversupplied or undersupplied when not within the 95% confidence interval (above or below the curve, respectively). Daily nitrogen balance and urinary excretion of 3‐methylhistidine were measured from day 1 to day 10 in all patients. For the patients in whom these measures were made, amino acid variations except those of lysine (11 of 12), ornithine (6 of 12), alanine (5 of 12), arginine (5 of 12), and glutamate (5 of 12) were within the 95% confidence interval. During the second 5‐day period, imbalances persisted in the control group but were almost gone in the experimental group. Daily nitrogen balance was not significantly different between groups. However, when expressed as a mean over each period, nitrogen balance was significantly higher during the second period in the experimental group than in the control group: 4.5+/‐0.8 g N/d versus 0.2+/‐0.7 g N/d, p <.01. The ratio of urinary 3‐methylhistidine to creatinine decreased from day 1 to day 10 in both groups. These findings suggest that the relationship between rate of infusion and plasma amino acid variation may offer a rational basis for choosing the most appropriate amino acid mixture for catabolic patients. An appropriate mixture would limit plasma amino acid imbalances and improve nitrogen retention. This therapy must now be tested in a larger population of patients.
Short‐term efficacy of enteral nutrition in the treatment of active Crohn's disease: a randomized, controlled trial comparing nutrient formulas
Authors: Sakurai T , Matsui T , Yao T , Takagi Y , Hirai F , Aoyagi K , Okada M
Published: May 2008

BACKGROUND: The optimal dietary fat content to induce clinical remission in active Crohn's disease has been the subject of controversy. We therefore performed a prospective, randomized, controlled study to compare the effects of nutrient formulas differing in the amount of medium‐chain triglycerides (MCT). METHODS: Thirty‐six patients with active Crohn's disease whose Crohn's disease activity index (CDAI) was > or =150 were included in the study. A formula with 3.4 g of fat per 2000‐kcal dose was used as the nutrient formula with a low‐fat content (ED group), and a formula with 55.6 g of fat per 2000‐kcal dose was used as the nutrient formula with a high amount of MCT (TL group). RESULTS: The rate of short‐term remission induction at 6 weeks was 67% in the ED group and 72% in the TL group (p = NS). Therapy markedly reduced the high CDAI and van Hees activity index in both groups, with no significant difference in the pattern of the time‐course changes. C‐reactive protein levels, erythrocyte sedimentation rate, and low serum albumin and plasma prealbumin levels normalized over the course of therapy, with no significant difference between the 2 groups. The assessment of fatty acid fractions revealed that the triene/tetraene ratio began to increase at 2 weeks in the ED group. The serum levels of linoleic acid, an omega‐6 fatty acid, almost always varied within the normal range during the treatment period in the TL group, but in the ED group, levels began to decrease significantly at 2 weeks. The levels of linolenic acid, an omega‐3 fatty acid, decreased in both groups. CONCLUSIONS: Both nutrient formulas induced clinical remission in about two‐thirds of patients. The results of the present study suggest that it is not necessary to restrict the amount of MCT when given in liquid form to patients with active Crohn's disease.
Short‐chain fatty acids and total parenteral nutrition affect intestinal gene expression
Authors: Drozdowski LA , Dixon WT , McBurney MI , Thomson AB
Published: May 2008

BACKGROUND: The supplementation of total parenteral nutrition (TPN) formulas with short‐chain fatty acids (SCFAs) increases glucose uptake and the expression of glucose transporters in parenterally fed animals. Several signals may be involved in intestinal adaptation; however, increased messenger RNA (mRNA) levels for proglucagon and several early‐response genes, including c‐myc and c‐fos, are seen in animals receiving SCFA‐supplemented TPN. Although the effects of a mixture of SCFAs are well documented, the relative contribution of individual SCFAs is unknown. Butyrate is a preferred fuel of colonocytes, with documented effects on cellular proliferation and gene expression. Accordingly, this study was undertaken to determine the relative role of butyrate in initiating an adaptive response in nonresected rats receiving TPN. METHODS: Animals received standard TPN for 66 hours, followed by 6 hours of either standard TPN, TPN supplemented with a mixture of SCFAs (acetate, propionate, and butyrate, 60 mmol/L total), or TPN supplemented with butyrate alone (9 mmol/L). An oral control group was fed an elemental diet, similar in macronutrient content to the TPN, so that all animals received the same amount of energy daily. RESULTS: SCFAs increased ileal glucose transporter 2 (GLUT2) mRNA expression compared with the orally fed group. SCFAs also increased proglucagon mRNA expression compared with the TPN group. No changes in Na+K(+)‐adenosine triphosphatase or early‐response gene expression were found in this study. CONCLUSIONS: In a rat model of TPN, the use of 9 mmol/L butyrate did not have the same effect on GLUT2 and proglucagon expression as a 60‐mmol/L mixture of SCFAs. This suggests that the effect of a mixture of SCFAs on intestinal gene expression is not butyrate specific.
Home parenteral nutrition: does affiliation with a national support and educational organization improve patient outcomes?
Authors: Smith CE , Curtas S , Werkowitch M , Kleinbeck SV , Howard L
Published: May 2008

BACKGROUND: For patients receiving home parenteral nutrition (HPN), catheter‐related bloodstream infection (CRBSI) and reactive depression may significantly impact quality‐of‐life. This study evaluated the influence of patient affiliation with a national organization promoting HPN education and peer support on these outcome variables. METHODS: Using a case‐control design, we compared 2 groups of affiliated patients with nonaffiliated controls, who were matched for diagnosis, HPN duration, sex, and age. Group 1 data were obtained from patients in large HPN medical practice programs. Group 2 data were obtained from patients in small medical practices with a small number of HPN patients. All participants were evaluated by structured interviews every 6 months over 18 months. RESULTS: In both data collection groups, affiliated patients (A) had significantly higher (mean +/‐ SD) quality‐of‐life scores compared with nonaffiliated patients (NA): (Gr 1: A, 19.8 +/‐ 4.7 versus NA, 17.6 +/‐ 5.6, p =.05; Gr 2: A, 20.4 +/‐ 5.2 versus NA, 17.3 +/‐ 4.8, p =.05). Affiliated patients also had lower depression scores (Gr 1: A, 10.9 +/‐ 10.4 versus NA, 20.4 +/‐ 13.6, p =.01; Gr 2: A, 12.5 +/‐ 9.6 versus NA, 18.5 +/‐ 10.8, p =.03) and a lower incidence of catheter‐related infections (Gr 1: A, 0.10 +/‐ 0.3 versus NA, 0.60 +/‐ 0.55, p =.01; Gr 2: A, 0.27 +/‐ 0.55 versus NA, 0.71 +/‐ 0.64, p =.02) than nonaffiliated patients. CONCLUSIONS: Affiliation with an organization that provides ongoing HPN education and peer support was associated with significantly better HPN outcomes. Alternative explanations are discussed in relation to limitations of the case‐control design.
Total parenteral nutrition supplementation with glutamine improves survival after gut ischemia/reperfusion
Authors: Ikeda S , Zarzaur BL , Johnson CD , Fukatsu K , Kudsk KA
Published: May 2008

BACKGROUND: Total parenteral nutrition (TPN) alters gut cytokines and mucosal immunity and increases intercellular adhesion molecule‐1 (ICAM‐1) expression, gut neutrophil levels, and mortality after gut ischemia. Supplementation of TPN with glutamine partially supports mucosal immunity by preserving respiratory and intestinal IgA levels, maintaining the proper IgA‐stimulating cytokine milieu within the intestine, and reducing intestinal ICAM‐1 expression and neutrophil accumulation. This work investigates whether glutamine supplementation of TPN affects mortality in mice after gut ischemic insult. METHODS: Thirty‐eight mice were randomized to receive chow, TPN, or 2% glutamine‐supplemented TPN (GLN‐TPN) for 5 days. After feeding their respective diets, gut ischemia/reperfusion (I/R) was induced with superior mesenteric artery occlusion for 30 minutes followed by resuscitation with 1 mL saline. Survival was recorded until 72 hours after reperfusion. RESULTS: Survival time was significantly reduced in the TPN‐fed mice compared with both chow‐fed and GLN‐TPN‐fed mice (p <.05). Survival at 72 hours after reperfusion was also significantly lower in the TPN‐fed mice than in the chow‐fed and GLN‐TPN‐fed mice (p <.05) CONCLUSIONS: Glutamine supplementation of TPN significantly improves survival after gut I/R, suggesting modulation of the inflammatory response or improved gut tolerance to low‐flow states.
The calorie conundrum
Authors: Koretz RL
Published: May 2008

We have begun to recognize that the infusion of excessive amounts of nutrients in nutritional support programs is harmful. The question we must now address is what constitutes “excessive”?
A comparison of the effect of elemental and immune‐enhancing polymeric jejunal feeding on exocrine pancreatic function
Authors: Duerksen DR , Bector S , Parry D , Yaffe C , Vajcner A , Lipschitz J
Published: May 2008

BACKGROUND: There are few studies examining the effect of jejunal feeding on pancreatic exocrine output. The purpose of this study was to compare the effects of jejunal feeding with an elemental formula (EF) and with a polymeric immune‐enhancing formula (PIEF) on pancreatic exocrine function. METHODS: Patients undergoing a partial pancreatectomy had a jejunal feeding tube inserted and a pancreatic stent exteriorized, facilitating collection of pancreatic secretions. Postoperatively, patients underwent a secretin‐stimulation test to document adequate pancreatic reserve. Patients were then randomized to receive jejunal feeding with EF or with PIEF for a 24‐hour period, followed by a washout period of feeding with dextrose, and subsequent jejunal feeding with EF or PIEF. RESULTS: The secretin‐stimulation test demonstrated significant pancreatic reserve in all patients. There was a mild increase in pancreatic exocrine secretion with jejunal feeding with EF and PIEF compared with baseline and with dextrose. There was increased bicarbonate secretion with EF compared with PIEF, but there were no other significant differences in pancreatic exocrine function. CONCLUSIONS: In this model of partial pancreatectomy, there was no significant difference in pancreatic exocrine output when use of an EF was compared with use of a PIEF for jejunal feeding. Further clinical studies are needed to determine the potential role of PIEF in pancreatic disease.
Mucosal immunity preservation with bombesin or glutamine is not dependent on mucosal addressin cell adhesion molecule‐1 expression
Authors: Zarzaur BL , Ikeda S , Johnson CD , Le T , Sacks G , Kudsk KA
Published: May 2008

BACKGROUND: Mucosal addressin cell adhesion molecule‐1 (MAdCAM‐1) is an adhesion molecule that directs naive T and B cells into Peyer's patches for sensitization and distribution to intestinal and extraintestinal sites. With no enteral stimulation, its expression drops rapidly in association with reduced Peyer's patch cell populations and increases rapidly with reinstitution of enteral feeding. Because both glutamine (GLN) and bombesin (BBS) preserve mucosal immunity, this study examined whether they preserve MAdCAM‐1 expression. METHODS: In 2 separate experiments, animals were randomized to IV cannulation with chow, total parenteral nutrition (TPN), and (experiment 1) 15 microg/kg BBS 3 times per day or (experiment 2) an isocaloric, isonitrogenous 2% GLN‐supplemented solution. After 5 days of feeding, MAdCAM‐1 expression in Peyer's patches, spleen, and intestine was measured using a dual radiolabeled monoclonal antibody technique. RESULTS: MAdCAM‐1 expression was not significantly improved from TPN levels either with BBS or GLN supplementation. Levels of MAdCAM‐1 expression remained unchanged in non‐Peyer's patch sites. CONCLUSIONS: Although MAdCAM‐1 is considered the gateway molecule for cell entry into mucosal immunity, this does not seem to be the mechanism for mucosal immunity preservation in nonenterally fed mice receiving bombesin or glutamine.
Relative influence of glucose and insulin on peripheral amino acid metabolism in severely burned patients
Authors: Gore DC , Wolf SE , Herndon DN , Wolfe RR
Published: May 2008

BACKGROUND: Protein catabolism and glucose intolerance are prominent in critically injured patients. The objective of this study was to assess if glucose or insulin availability influences the extent of protein catabolism in hypermetabolic patients. METHODS: Amino acid net balance from the leg was quantitated in 6 severe burn victims. Furthermore, whole body and leg protein kinetics were assessed with 2H5 phenylalanine and 15N alanine. Measurements were obtained after a 9‐hour fast, during an IV glucose infusion (30 micromol/kg per minute), and during a hyperinsulinemic (500 mIU/kg per minute) euglycemic clamp. RESULTS: Compared with fasting values, the administration of glucose resulted in a significantly increased efflux of amino acids from the leg. In contrast, insulin administration significantly decreased the cumulative net efflux of amino acids. During hyperinsulinemia, isotopic measurements demonstrated a significant decrease in alanine appearance and an increase in phenylalanine disappearance into the leg. CONCLUSIONS: These findings demonstrate that in critically injured patients, acute hyperglycemia increases muscle catabolism despite an endogenous insulin response. In contrast, exogenous insulin given in sufficient amount impedes muscle protein loss. The mechanism for this anabolic effect of insulin may vary between different amino acids.
Preoperative albumin and surgical site identify surgical risk for major postoperative complications
Authors: Kudsk KA , Tolley EA , DeWitt RC , Janu PG , Blackwell AP , Yeary S , King BK
Published: May 2008

BACKGROUND: Although malnutrition contributes to morbidity, studies of pre‐ and postoperative nutrition often include well‐nourished patients unlikely to benefit from therapy and usually do not stratify by the site of surgical pathology. This study evaluates whether perceived preoperative markers of nutritional status recorded in charts correlates with postoperative complications and resource use in patients who receive no preoperative nutrition support and reinterprets the results of several conflicting randomized, prospective studies in this context. METHODS: This is a retrospective cohort study of 526 surgical patients who had preoperative serum albumin levels measured and were undergoing elective esophageal, gastric, pancreaticoduodenal, or colon surgery between 1992 and 1996 who could have received preoperative nutrition but did not. RESULTS: Most medical records contained inadequate analysis of preoperative nutritional status, but preoperative albumin correlated inversely with complications, length of stay, postoperative stay, intensive care unit (ICU) stay, mortality, and resumption of oral intake. Patients undergoing esophageal or pancreatic procedures sustained a significantly higher complication rate at most albumin levels, whereas colonic surgery resulted in lower complication rates at the same albumin levels. Resource use (eg, length of stay and ICU stay) related to these complication rates; esophageal and pancreatic procedures used the most resources and colon procedures used the fewest at most albumin levels. This lack of appreciation for nutritional risk and operative site can explain discrepancies in outcome noted in several randomized, prospective nutritional studies and must be applied to the design and implementation of new studies. CONCLUSIONS: Elective, non‐emergent esophageal and pancreatic procedures performed in patients who could have had surgery delayed for preoperative nutrition, but did not, result in higher risk than colon surgery at any given level of serum albumin below 3.25 g/dL. Patient populations in trials should be stratified by operative site and by markers of nutritional status. Degree of hypoalbuminemia and other potential markers of nutritional status may explain many of the discrepancies between trials of nutrition support. Preexisting hypoalbuminemia in patients undergoing elective surgery remains underappreciated, unrecognized, and untreated in many hospitalized patients.
Is serum albumin an independent predictor of survival in patients with breast cancer?
Authors: Lis CG , Grutsch JF , Vashi PG , Lammersfeld CA
Published: May 2008

BACKGROUND: The medical literature shows several examples of an inverse relationship between serum albumin levels and survival in patients with advanced cancer. METHODS: We investigated the effect of baseline serum levels on 180 consecutively treated patients who were diagnosed with breast cancer from March 1993 to December 1999 at our institution. We investigated the effect of low levels of serum albumin (<3.5 g/dL) using univariate and the multivariate Cox regression model. RESULTS: Demographically, the median age of these patients was 51 years of age, with a range of 28 to 88 years. In this series, 28 patients have died and 9 have developed a recurrence of tumor. The patient distribution by tumor stage was 53, stage 1; 47, stage 2A; 29, stage 2B; 11, stage 3; 13, stage 4A; and 21, stage 4B. In this cohort, the overall 5‐year survival was 69%. The Cox regression analysis found that normal levels of albumin (>3.5 g/dL) reduced the risk of death by 72% (p =.0033). Only tumor stage had a larger impact on survival (p <.0000). Other factors achieving statistical significance were overexpression of the HER2/Neu antigen (p =.0167) and breast antigen (p =.0116). CONCLUSION: Univariate statistical analysis found that low levels of serum albumin adversely affected survival by a statistically significant level for all stages of breast cancer. We found that a baseline serum albumin level was a powerful prognostic variable, which accounted for 7.35% of the variation in patient survival time.
Serum and hepatic vitamin E assessment in cirrhotics before transplantation
Authors: Ukleja A , Scolapio JS , McConnell JP , Dickson RC , Nguyen JH , O'Brien PC
Published: May 2008

BACKGROUND: Hepatic vitamin E may have a protective effect against hepatocyte injury; therefore, vitamin E replacement or supplementation may be beneficial in patients with cirrhosis. However, serum vitamin E may not correlate with hepatic vitamin E stores, making decisions regarding treatment difficult based on serum levels alone. The specific aims of this study were to determine hepatic concentrations of vitamin E and to determine whether serum levels of vitamin E correlate with hepatic vitamin E stores in cirrhotics. METHODS: A prospective study of cirrhotics undergoing orthotopic liver transplantation (OLT) was completed. Serum and hepatic levels of vitamin E were measured by high‐performance liquid chromatography. Statistical analysis was performed using rank sum tests and Spearman's rank correlation coefficient. RESULTS: Fifty cirrhotics (33 males, 17 females; mean age of 53 years) were studied. The control group (25 males, 25 females; mean age of 47 years) consisted of the liver donors. The median serum levels of vitamin E in controls and cirrhotics were 5.95 and 7.8 mg/L, respectively (p =.009). The median hepatic levels (0.10 mg/g) in the control and cirrhotic groups were similar (p =.037). There was a significant correlation between serum and hepatic vitamin E levels in cirrhotics (R = 0.335; p =.017). CONCLUSIONS: A positive correlation exists between serum and hepatic concentrations of vitamin E in cirrhotics, therefore making serum vitamin E levels a useful reference for treatment using exogenous vitamin E.
The chicken soup paradigm and nutrition support: rethinking terminology
Authors: Lipman TO
Published: May 2008

The language used to describe the provision of artificial nutrition needs to be rethought and probably changed.
Glutamine preserves cardiomyocyte viability and enhances recovery of contractile function after ischemia‐reperfusion injury
Authors: Wischmeyer PE , Vanden Hoek TL , Li C , Shao Z , Ren H , Riehm J , Becker LB
Published: May 2008

BACKGROUND: Glutamine has been shown to protect against cellular injury in in vitro gut epithelial cells and in vivo in the septic rat. Glutamine's effect on the cardiomyocyte has not been explored. We tested the hypothesis that glutamine can enhance heat shock protein 72 (HSP 72) expression, attenuate intracellular oxidant generation, and protect cardiomyocytes against ischemia/reperfusion (I/R) injury. METHODS: Chicken cardiomyocytes were supplemented with glutamine (10 mmol/L) or were controls (0 mmol/L). Cells underwent I/R, and HSP 72 content was evaluated using Western blotting. Reactive oxygen species generation was quantified through 2′‐7′‐dichlorofluorescin diacetate oxidation. Cell viability was quantified using propidium iodide staining. Return of contractile function was analyzed through phase contrast microscopy. RESULTS: Glutamine significantly increased cardiomyocyte HSP 72 expression and markedly reduced cell death after I/R injury. Glutamine did not significantly decrease intracellular oxidant generation. Contractile function returned in all glutamine‐treated cells versus none of the control cells postreperfusion. CONCLUSIONS: Glutamine significantly increases cardiomyocytes survival and recovery of contractile function after I/R injury. This protection is associated with enhanced HSP 72 expression. These observations suggest that glutamine may prove beneficial as a protective therapy in patients at risk for cardiac ischemia and reperfusion injury, such as patients undergoing procedures requiring cardiopulmonary bypass and patients with coronary artery disease.
Serum leptin levels in acute protein deprivation
Authors: Stapleton PP , Barden CB , McCarter MD , Mackrell PJ , Freeman TA , Naama HA , Daly JM
Published: May 2008

BACKGROUND: Protein energy malnutrition (PEM) induces a host neuroendocrine response, reflected by significant elevations in circulating glucocorticoid levels and associated with metabolic and immune dysfunction. Leptin regulates food intake and body mass and has a significant impact on the hypothalamic‐pituitary‐adrenal axis (HPA). We hypothesized that leptin may be altered by and may play an important role in regulating the effects of PEM. METHODS: Female Balb/c mice were used. In experiment 1, mice were pair‐fed either a protein‐free (0% casein) or control (24% casein) diet for 7 days. In experiment 2, mice were implanted with either a placebo or corticosterone‐releasing pellet and fed the control diet for 7 days. In experiment 3, adrenalectomized mice were pair‐fed either the protein‐free or control diet for 7 days. Serum corticosterone and leptin levels were measured in all experiments. RESULTS: PEM caused significant reductions in food intake, body weight, and total body fat, but not lean body mass. Serum corticosterone and leptin levels were significantly greater in mice fed the protein‐free diet. Subcutaneous implantation of a corticosterone pellet in mice fed the control diet resulted in a significantly elevated serum leptin level compared with placebo‐implanted controls. Bilateral adrenalectomy partially blunted the increased serum leptin in PEM. CONCLUSIONS: Leptin may be an important mediator of weight loss and decreased food intake in PEM. Elevated serum leptin in PEM may be secondary to elevated serum corticosterone, with other factors inherent in the host response to protein restriction also contributing to elevated serum leptin.