Comparative evaluation of fecal fat excretion induced by orlistat and chitosan

OBJECTIVE: To compare the effects of chitosan and orlistat on fecal fat excretion. RESEARCH METHODS AND PROCEDURE: A randomized, open-label, two-period sequential design study was used. A total of 12 healthy adult volunteers within 20% of their ideal body weight entered a 7-day run-in diet period before being randomized to orlistat (120 mg) or chitosan (890 mg) three times daily for 7 days. Subjects then crossed over treatment regimens for an additional 7-day period. Subjects followed a standardized diet (2500 kcal/d, 30% as fat) for the entire 21-day study. Feces were collected on days 4 to 7 of the run-in period (baseline) and during the two treatment periods. Mean daily fecal fat excretion was measured at baseline and during each treatment regimen. RESULTS: Mean baseline fecal fat excretion for all subjects was 1.36 +/- 0.45 g/d. During orlistat treatment, mean fecal fat excretion significantly increased from baseline (+16.13 +/- 7.27 g/d; p < 0.001). No significant effect was observed with chitosan (+0.27 +/- 1.02 g/d; p = 0.379). Fecal fat excretion was significantly greater with orlistat than with chitosan (p < 0.001; 95% confidence intervals: 11.73; 20.00 g/d). DISCUSSION: This study provides additional evidence of the inhibitory effect of orlistat on dietary fat absorption. Chitosan, however, has no effect on fecal fat excretion.     

Increased stool frequency occurs when finely processed pea hull fiber is added to usual foods consumed by elderly residents in long-term care

Dietary fiber fortification of food offers a preventative strategy that is a less invasive alternative to laxatives and enemas in the management of constipation in elderly individuals. To determine if a moderate increase in fiber provided in foods would increase bowel movement frequency among elderly institutionalized residents, data were collected on the same elderly residents (n=114) before and during a 6-week intervention. The intervention consisted of adding finely processed pea hull fiber (1-3 g/serving) to 3 to 4 foods each day. Laxative and enema use was monitored. Mean number of bowel movements/month increased from 18.7+/-9.4 to 20.1+/-9.6 (n=114, P=.034), and in 17 residents with low baseline frequency, the increase was highly significant (8.8+/-1.0 to 12.6+/-3.8 bowel movements/month, P=.001). With treatment, prune-based laxative administration decreased (P<.001). Thus, addition of a moderate amount of finely processed fiber to foods results in increased bowel frequency in institutionalized elderly individuals.     

The effects of acute clostridium difficile diarrhea on fecal nitrogen content in adult hospitalized patients

Clostridium difficile diarrhea (CDD) is a frequent cause of hospital-associated infectious diarrhea and a common reason for nutritional consultation. Limited data are available on fecal nitrogen losses during infectious diarrhea in adults. Eleven patients with acute CDD were studied for stool volume and fecal nitrogen. The mean stool output was 630 +/- 110 g/day and fecal nitrogen 2.5 +/- 0.3 g per 24 hour period (mean +/- SEM). Fecal nitrogen loss was increased from the predicted 12.0 mg/kg BW/day to 38.0 +/- 5.9 mg/kg BW/day. Fecal nitrogen loss in CDD can be an important source of nitrogen loss and should be measured in nitrogen balance studies in such patients.     

Effects of dietary arabinogalactan on gastrointestinal and blood parameters in healthy human subjects

OBJECTIVES: Arabinogalactan (AG) is a non-digestible soluble dietary fiber that resists hydrolytic enzyme action and enters the large bowel intact where it is fermented by resident microflora. To determine whether AG has similar physiological properties to other soluble dietary fibers, we examined the effect of 15 and 30 g per day of a commercially available AG from Western Larch on several gastrointestinal and blood parameters. METHODS: Gastrointestinal parameters included fecal microflora, fecal enzyme activity, fecal short-chain fatty acids, fecal pH, fecal weight, transit time and bowel frequency. Blood parameters included total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, Apo-A1, Apo-B, glucose and insulin. The study consisted of two three-week diet treatments with no washout period. Participants (n=20, 11 males, 9 females) consumed their usual diet in addition to 15 or 30 g AG in a beverage sweetened with aspartame as compared to their usual diet with the control beverage. RESULTS: Significant increases in total fecal anaerobes were observed with 15 g (p=0.01) and 30 g AG (p=0.001). A significant increase (p=0.02) in Lactobacillus spp. was observed when subjects consumed AG for a total of six weeks regardless of dose. There were no significant changes in other microflora, fecal enzyme activity, transit time, frequency, fecal weight, fecal pH and short-chain fatty acids. Fecal ammonia levels decreased with 15 g (p=0.001) and 30 g (p=0.002) AG. No significant changes in blood lipids or blood insulin were observed. CONCLUSIONS: These data suggest that dietary AG is easily incorporated into the diet, well tolerated in subjects and has some positive effects on fecal chemistry.     

Whole-grain rye and wheat foods and markers of bowel health in overweight middle-aged men

BACKGROUND: Whole-grain cereal foods including rye have been identified as providing significant health benefits that do not occur when refined-cereal foods are ingested. OBJECTIVES: Foods (90 g) containing whole-grain rye flour and whole-grain wheat flour were compared with low-fiber refined-cereal foods for their effects on markers of bowel health and the metabolic markers insulin and glucose. DESIGN: Three 4-wk interventions were undertaken in a randomized crossover design with 28 overweight men aged 40-65 y who had no history of bowel disease. Against a background intake of 14 g dietary fiber (DF), the men were fed low-fiber cereal grain foods providing 5 g DF for a total of 19 g DF/d. High-fiber wheat foods provided 18 g DF, and high-fiber rye foods provided 18 g DF, both giving a total of 32 g DF/d. Fecal samples (48-h) and fasting and postprandial blood samples were collected at the end of each period and assayed. RESULTS: Both high-fiber rye and wheat foods increased fecal output by 33-36% (P = 0.004) and reduced fecal beta-glucuronidase activity by 29% (P = 0.027). Postprandial plasma insulin was decreased by 46-49% (P = 0.0001) and postprandial plasma glucose by 16-19% (P = 0.0005). Rye foods were associated with significantly (P = 0.0001) increased plasma enterolactone (47% and 71%) and fecal butyrate (26% and 36%), relative to wheat and low-fiber options, respectively. CONCLUSIONS: High-fiber rye and wheat food consumption improved several markers of bowel and metabolic health relative to that of low-fiber food. Fiber from rye appears more effective than that from wheat in overall improvement of biomarkers of bowel health.     

Improvement in protein absorption with a small-peptide-based diet in patients with high jejunostomy.

We compared urinary and fecal excretions of fluid, electrolytes, and nutrients in six patients with a high jejunostomy during three randomized consecutive 3-day periods of total enteral nutrition with three diets differing only by the degree of hydrolysis of the protein moiety: whole proteins, their hydrolysate (63% nitrogen as small peptides with < 1000 M), and the two mixed together. Daily nitrogen absorption was significantly enhanced with the small-peptide and mixed diets (14.3 +/- 3.4 and 13.1 +/- 2 g, respectively) compared with the whole protein diet (10.9 +/- 2.4 g, p = 0.012). Concomitantly, blood urea nitrogen and urinary urea excretion increased with the small-peptide diet. Apparent absorption of fat and calories, fecal weight, and urinary and fecal excretions of sodium, potassium, calcium, and magnesium remained unchanged. We conclude that a small-peptide-based diet may be beneficial in patients with short-bowel syndrome.     

Soy-polysaccharide fiber: effect on diarrhea in tube-fed, head-injured patients

In a randomized, double-blind, crossover study the effect of tube-feeding with soy-polysaccharide fiber (SPF) vs without SPF on stool weight (SW), stool consistency (SC), fecal nitrogen (FN), and incidence of diarrhea (ID) was compared in nine head-injured subjects; associations with feeding volume, albumin level, and medications were also examined. Subjects with and without SPF had (mean +/- SEM) SW of 245 +/- 47 and 277 +/- 49 g/d, SC of 2.17 +/- 0.01 and 2.52 +/- 0.13 (3 is watery) (p less than 0.01), FN of 1.35 +/- 0.45 and 1.36 +/- 0.33 g/d, and ID of 33% and 44%, respectively. Significant treatment X treatment-sequence interaction nullified results for SW and SC. Neither FN nor ID were affected by SPF. The condition of all variables tended to improve over time. Certain medications and SPF were predictive of SW and SC; albumin and tube-feeding volume were not. SPF-containing tube feedings did not seem to have an effect on bowel function in these well-nourished head-injured patients.     

Stearic acid is well absorbed from short- and long-acyl-chain triacylglycerol in an acute test meal

OBJECTIVE: Absorption of stearic acid from natural oils has been shown to be efficient, but it is claimed to be lower from short- and long-acyl-chain triacylyglycerol molecules (Salatrim). The aim was to measure the apparent absorption of stearic acid from Salatrim fat in an acute test meal. DESIGN: Double-blind crossover study. SUBJECTS: Ten healthy male volunteers, of whom eight completed the study. METHODS: The subjects were studied on two occasions after consumption of a single high-fat meal either without (control) or with 30 g of Salatrim. Fecal samples were collected for 96 h after the meal and the fat was extracted for analysis of the content and composition of free and esterified long-chain fatty acids. RESULTS: Baseline fecal fat was 5.6+/-2.6 g/day increasing to 10.4+/-4.9 g/day after addition of Salatrim (P=0.001). During the whole collection period, the baseline fecal free and esterified fatty acids were 2.6+/-2.3 and 0.8+/-0.7 g, respectively. After Salatrim meal the corresponding figures increased to 5.9+/-3.6 g (P=0.001) and 1.5 (+/-1.2) g (P=0.003), respectively. The total fecal stearic acid after control meal was 0.97+/-0.9 g. Consumption of Salatrim with 16.7+/-0.5 g of stearic acid increased the content to 3.12+/-1.6 g (P<0.001), with apparent absorption of 87%. CONCLUSIONS: The apparent absorption of stearic acid does not differ from its absorption from natural fats. The status of Salatrim as a low-energy fat substitute needs to be re-evaluated. SPONSORSHIP: University of Turku.     

Effect of increasing levels of hard wheat fiber on fecal weight, minerals and steroids and gastrointestinal transit time in healthy young women

Hard red wheat bran (HRWB) baked in a yeast-leavened bread was fed to 36 healthy young college women consuming a basal diet of traditional foods, which contained 15 +/- 3 g/d dietary fiber (DF). Three levels of HRWB were added supplying, respectively, 5.7, 17.1 and 28.5 g/d DF; an additional treatment group did not receive any HRWB. Fecal collections were carried out in the last 5 d of treatment. Fecal wet weight, fecal dry weight and fecal ash increased significantly for each increase in HRWB (P less than 0.05). Fecal dry matter percent changed significantly only at the highest level of HRWB (P less than 0.05). After accounting for the minerals in the HRWB, there was an increased fecal loss of Ca, but not of Zn, Cu, Fe or Mg compared to the women fed no HRWB. HRWB at a level of 17.2 g/d induced faster transit times (TT) than no HRWB and 66 g/d HRWB induced faster TT than either 17.2 or 39.6 g/d HRWB (P less than 0.05). Total daily fecal steroids were not altered by changes in HRWB. Daily total bile acid excretion increased significantly (P less than 0.05) at the two higher levels of HRWB due primarily to higher excretion of chenodeoxycholic acid.     

A new approach to characterize whole-gut transit in infants with use of a nonabsorbable intestinal marker

To characterize mouth to anus transit of intestinal contents, polyethylene glycol (PEG) was given as an intestinal marker to 11 healthy infants, and daily fecal collections were analyzed for PEG concentration per unit of dry stool weight for 9-15 d. Fecal PEG excretion followed first-order kinetics. Thus, half-life (t1/2) and volume of distribution (Vd) of PEG in the gut could be computed for each of seven infants who received continuous daily PEG doses and t1/2 only for four infants who received a single PEG dose. t1/2 of PEG in the gut was 0.99 +/- 0.48 d (means +/- SD). Vd for PEG in the gut was 18.74 +/- 15.38 g of fecal dry weight. We propose that whole-gut transit be expressed in terms of t1/2 and Vd of intestinal contents because these may better characterize the changes in intestinal transit that occur with disease or dietary modifications.     

Decreasing dietary sodium while following a self-selected potassium-rich diet reduces blood pressure

Reducing dietary sodium reduces blood pressure (BP), a major risk factor for cardiovascular disease, but few studies have specifically examined the effect on BP of altering dietary sodium in the context of a high potassium diet. This randomized, crossover study compared BP values in volunteer subjects self-selecting food intake and consuming low levels of sodium (Na+; 50 mmol/d) with those consuming high levels of sodium (> or =120 mmol/d), in the context of a diet rich in potassium (K+). Sodium supplementation (NaSp) produced the difference in Na+ intake. Subjects (n = 108; 64 women, 44 men; 16 on antihypertensive therapy) had a mean age of 47.0 +/- 10.1 y. Subjects were given dietary advice to achieve a low sodium (LS) diet with high potassium intake (50 mmol Na+/d, >80 mmol K+/d) and were allocated to NaSp (120 mmol Na+/d) or placebo treatment for 4 wk before crossover. The LS diet decreased urinary Na+ from baseline, 138.7 +/- 5.3 mmol/d to 57.8 +/- 3.8 mmol/d (P < 0.001). The NaSp treatment returned urinary Na+ to baseline levels 142.4 +/- 3.7 mmol/d. Urinary K+ increased from baseline, 78.6 +/- 2.3 to 86.6 +/- 2.1 mmol/d with the LS diet and to 87.1 +/- 2.1 mmol/d with NaSp treatment (P < 0.001). The LS diet reduced home systolic blood pressure (SBP) by 2.5 +/- 0.8 mm Hg (P = 0.004), compared with the NaSp treatment. Hence, reducing Na+ intake from 140 to 60 mmol/d significantly decreased home SBP in subjects dwelling in a community setting who consumed a self-selected K+-rich diet, and this dietary modification could assist in lowering blood pressure in the general population.     

Effect of chronic ingestion of a fermented dairy product containing Lactobacillus acidophilus and Bifidobacterium bifidum on metabolic activities of the colonic flora in humans

Nine healthy volunteers were studied before, during, and after ingesting a fermented dairy product containing Lactobacillus acidophilus, Bifidobacterium bifidum, and mesophilic cultures (Streptococcus lactis and S cremoris) for 3 wk. Hydrogen and methane productions and fecal beta-galactosidase and beta-glucosidase activities were measured as indicators of fermentation capacity of the colonic flora. Fecal concentrations of nitroreductase, azoreductase, and beta-glucuronidase, which may be implicated in colonic carcinogenesis, were also assessed. Hydrogen and methane productions, fecal beta-galactosidase, beta-glucuronidase, and azoreductase activities did not change over three 3-wk periods whereas fecal beta-glucosidase activity increased (42 +/- 6, 91 +/- 12, and 40 +/- 6 IU/g N, P less than 0.01) and nitroreductase decreased (0.87 +/- 0.13, 0.54 +/- 0.11, and 0.57 +/- 0.08 IU/g N, P less than 0.05).     

Food intake and electrolyte status of ultramarathoners competing in extreme heat

OBJECTIVE: To relate changes in laboratory indices to dietary intake during extremely prolonged running and to determine if dietary intake influences the ability of runners to finish an 160 km trail race. METHODS: We monitored intake and serum chemistries of 26 runners competing in an 160 km foot race in temperatures which peaked at 38 degrees C. Blood was drawn pre-, mid- and post-race. Dietary intake and incidence of gastrointestinal distress or changes in mental status were determined by interview with runners approximately every 13 km. Twenty-three runners completed at least 88 kms and, of these 23 runners, 13 finished 160 km in a mean time of 26.2 +/- 3.6 hours. RESULTS: Finishers ingested nearly 30,000 J, 19.4 +/- 8.1 L of fluid and 16.4 +/- 9.5 g of sodium (Na). Sodium and fluid intake per hour was estimated to be 0.6 g/hour and 0.7 L/hour, respectively. Electrolyte intake during the first half of the race was similar between those that finished the race and those that did not. Finishers ingested fluid at a greater rate than non-finishers (p = 0.01) and tended to meet their caloric needs more closely than did non-finishers (p = 0.09). Body weight was unchanged over time (ANOVA, p = 0.52). Serum Na concentration tended to fall from 143 to 140 mEq/L during the race (p = 0.06), and was inversely correlated with weight loss (p = 0.009). Serum Na concentration was lower mid-race in runners experiencing changes in mental status than in runners without changes (p = 0.04). Fluid intake was inversely correlated with serum Na concentrations (p = 0.04). Most of the runners experienced nausea or vomiting; these symptoms were not related to serum sodium concentration. Hyponatremia (<135 mEq/L) was seen in one runner at 88 kms, but resolved by 160 km. Urinary sodium excretion decreased (p = 0.002) as serum aldosterone concentration increased pre- to post-race (p < 0.001). From start to finish of the race plasma volume increased by 12%. CONCLUSIONS: Food and fluid was ingested at a greater rate than described previously. Runners consumed adequate fluid to maintain body weight although dietary sodium fell far short of the recommended 1 g/hour. The rate of fluid intake was greater in finishers than in non-finishers, and finishers tended to more nearly meet their energy needs. Maintenance of body mass despite large exercise energy expenditures in extreme heat is consistent with fluid overload during a running event lasting more than 24 hours in hot and humid conditions.     

Effects of a 3-mo consumption of short-chain fructo-oligosaccharides on parameters of colorectal carcinogenesis in patients with or without small or large colorectal adenomas

Intervention studies of colorectal adenoma recurrence have demonstrated the need for surrogate markers of the cancer risk. Short-chain fructo-oligosaccharides (sc-FOS) have protective actions on colon carcinogenesis in animal models. We investigated differences in biological markers between adenoma and adenoma-free subjects, before and after 3 mo of daily intake of 10 g sc-FOS, within a multicenter study. After a full colonoscopy, 3 groups were studied at baseline and after 3 mo: 26 subjects with small colorectal adenoma(s), 18 with large adenoma(s), and 30 with no adenoma. At baseline, the mean fecal butyrate concentration was significantly lower in the adenoma groups than in the adenoma-free group (12.01 +/- 5.08 vs. 17.28 +/- 7.34 mmol/g dry weight) but was significantly increased in that group after 3-mo ingestion of sc-FOS (15.7 +/- 8.0 mmol/g; P = 0.02). In subjects without adenoma, sc-FOS ingestion was associated with a decrease in fecal lithocholic acid (P = 0.02) and an increase in cholic acid (P = 0.02), chenodeoxycholic acid (P = 0.04), total primary bile acids (P = 0.03), and ursodeoxycholic acid (P = 0.05). Fecal pH, blood parameters, and crypt cell proliferation were not significantly modified by sc-FOS ingestion in either group. In subjects with and without adenoma, sc-FOS affects some aspects of the colonic environment, which may be involved in prevention of colorectal neoplasia.     

Fructooligosaccharides and fiber partially prevent the alterations in fecal microbiota and short-chain fatty acid concentrations caused by standard enteral formula in healthy humans

The intestinal microbiota are important during enteral tube feeding because they exert colonization resistance and produce SCFAs. However, the effect of the enteral formula composition on major bacterial groups of the microbiota has not been clearly defined. The aim of this study was to investigate the effect of enteral formulas with and without prebiotic fructooligosaccharides (FOS) and fiber on the fecal microbiota and SCFAs. Healthy subjects (n = 10; 4 men, 6 women) consumed both a standard enteral formula and one containing FOS (5.1 g/L) and fiber (8.9 g/L) as a sole source of nutrition for 14 d in a randomized, double-blind, crossover trial with a 6-wk washout phase. Fecal samples were collected at the start and end of each formula phase, and were analyzed for major bacterial groups and SCFA concentrations using fluorescent in situ hybridization and GLC, respectively. Although there were reductions in total fecal bacteria due to both formula treatments, concentrations were higher after the FOS/fiber formula period compared with the standard formula period (11.2 +/- 0.2 vs. 11.0 +/- 0.2 log(10) cells/g, P = 0.005). The FOS/fiber formula increased bifidobacteria (P = 0.004) and reduced clostridia (P = 0.006). Compared with the standard formula, the FOS/fiber formula resulted in higher concentrations of total SCFA (332.4 +/- 133.8 vs. 220.1 +/- 124.5 micromol/g, P = 0.022), acetate (219.6 +/- 96.3 vs. 136.8 +/- 74.5 micromol/g, P = 0.034) and propionate (58.4 +/- 37.4 vs. 35.6 +/- 25.5 micromol/g, P = 0.02). This study demonstrates that standard enteral formula leads to adverse alterations to the fecal microbiota and SCFA concentrations in healthy subjects, and these alterations are partially prevented by fortification of the formula with FOS and fiber.     

Influence of refined cellulose on human bowel function and calcium and magnesium balance

The effect of cellulose purified from wood pulp on wet and dry stool weights, gastrointestinal transit time (TT), frequency of defecation, and calcium and magnesium balances was tested. Seven healthy women consumed a low fiber diet of constant composition (percentage of total kcal: 23% protein, 30% fat, 47% carbohydrate) and the same metabolically controlled diet to which 16 g of refined cellulose (Solka Floc) was added. Each diet was consumed for approximately one month. The neutral detergent fiber contents of the two diets were 9.5 and 23.5 g, respectively. Cellulose consumption significantly increased mean daily wet stool weight from 74.6 +/- 23.4 (SD) to 130.5 +/- 29.4 g, mean daily dry fecal weight from 19.1 +/- 4.2 to 39.5 +/- 7.7 g, and frequency of defecatin from 0.85 +/- 0.2 to 1.10 +/- 0.29/day. Cellulose effectively shortened TT of two subjects with initially slow TT (7 days), but mean TT of all subjects was not significantly affected when fiber was added to the diet. Fecal excretions of calcium and magnesium were significantly greater when the diet containing cellulose was fed, and only calcium balance was significantly more negative. These results suggest that moderate levels of refined cellulose adversely increased fecal losses of calcium and magnesium. All other indices of bowel function remained within normal ranges.     

The medical management of intestinal failure: methods to reduce the severity

A new definition of intestinal failure is of reduced intestinal absorption so that macronutrient and/or water and electrolyte supplements are needed to maintain health or growth. Severe intestinal failure is when parenteral nutrition and/or fluid are needed and mild intestinal failure is when oral supplements or dietary modification suffice. Treatment aims to reduce the severity of intestinal failure. In the peri-operative period avoiding the administration of excessive amounts of intravenous saline (9 g NaCl/l) may prevent a prolonged ileus. Patients with intermittent bowel obstruction may be managed with a liquid or low-residue diet. Patients with a distal bowel enterocutaneous fistula may be managed with an enteral feed absorbed by the proximal small bowel while no oral intake may be needed for a proximal bowel enterocutaneous fistula. Patients undergoing high-dose chemotherapy can usually tolerate jejunal feeding. Rotating antibiotic courses may reduce small bowel bacterial overgrowth in patients with chronic intestinal pseudoobstruction. Restricting oral hypotonic fluids, sipping a glucose-saline solution (Na concentration of 90-120 mmol/l) and taking anti-diarrhoeal or anti-secretory drugs, reduces the high output from a jejunostomy. This treatment allows most patients with a jejunostomy and > 1 m functioning jejunum remaining to manage without parenteral support. Patients with a short bowel and a colon should consume a diet high in polysaccharides, as these compounds are fermented in the colon, and low in oxalate, as 25% of the oxalate will develop as calcium oxalate renal stones. Growth factors normally produced by the colon (e.g. glucagon-like peptide-2) to induce structural jejunal adaptation have been given in high doses to patients with a jejunostomy and do marginally increase the daily energy absorption.     

Effects of immediate postoperative enteral nutrition on body composition, muscle function, and wound healing

Thirty-two patients undergoing bowel resection were randomized to receive either immediate postoperative nasojejunal feeding with full strength Osmolite solution for 56 hours (n = 16) or routine postoperative hypocaloric fluids and gradual reintroduction of diet (n = 16). Body composition changes were measured at 14 days after operation with in vivo neutron activation analysis, the wound healing response by subcutaneous implantation of Gortex tubes, and muscle function by grip strength, maximum ventilatory volume, and stimulation of the ulnar nerve at the wrist. Postoperative fatigue up to 3 months after operation was assessed using a 10-point analogue. Successful immediate enteral nutrition was established in 12 of the 16 patients. Enterally fed patients had a mean daily caloric intake of 1179 +/- 388 kcal/d (mean +/- SD) over the first 4 postoperative days compared with 382 +/- 71 kcal/d for the controls (p less than 0.0001). The amount of hydroxyproline accumulating in the Gortex tubes was also significantly greater (2.5 +/- 1.1 nmol/g tube vs 1.5 +/- 0.8 nmol/g tube; p less than 0.02). However, the amount and composition of the weight lost was not significantly different. Muscle function was not preserved, and postoperative fatigue occurred to an equal extent in both groups. Complications were similar in both groups, except for a preponderance of bowel obstructions in the controls. The time to passage of first flatus and first bowel motion, although shorter in the fed group, did not reach significance (p = 0.07). We conclude that immediate enteral nutrition is feasible and results in an improved wound healing response.(ABSTRACT TRUNCATED AT 250 WORDS)     

Self-administered subcutaneous fluid infusion at home in the management of fluid depletion and hypomagnesaemia in gastro-intestinal disease

BACKGROUND AND AIMS: In short bowel fistula and some other gastrointestinal (GI) diseases, salt, water and magnesium (Mg) balance may continue negative despite oral treatment, even in patients with adequate nutritional status. This study describes the use of self-administered subcutaneous fluid infusions (HSCF) to treat this problem. PATIENTS & METHODS: HSCF was administered to patients with GI failure and adequate macro-nutrient status (BMI) when GI salt, water and magnesium balance continued negative despite optimal diet, drug and supplemental treatment. Mg depletion was confirmed using the Mg load test. Patients were taught to self-administer 0.5-1.0 l 0.9% saline +/-0.5 l 5% dextrose +/-2-4 mmol MgSO4 subcutaneously by gravity drip during 6-12 h overnight, 3-7 days/week. Water and Na balance were assessed (weight, serum creatinine, urea, Na) at baseline and at 1 and 3 months of treatment, but also monitored carefully during the first few days of treatment. Serum Mg was measured at baseline and at 2 and 4 weeks. RESULTS: In 10 patients (mean age 65.3+/-13.5 years) Na and water balance was rapidly restored. At baseline, 1 and 3 months, serum biochemical results were: Eight patients received 8-28 mmol MgSO4/week in the infused fluid. Serum Mg [0.7-1.0 mmol] at baseline, 2 and 4 weeks was 0.49+/-0.06, 0.79+/-0.18, 0.83+/-0.10 mmol/l (P=0.002). Tolerance was good; transient oedema developed in 2 patients, resolved by reducing infusion dose. No patient developed hypokalaemia. CONCLUSIONS: Subcutaneous self-administered fluid infusion at home (HSCF) is an easily managed, safe and effective method of restoring and maintaining water, salt and Mg balance in patients with large GI fluid losses but adequate macronutrient status, particularly in the frail or elderly in whom home parenteral nutrition may be difficult.     

Increased birthweight after prenatal dietary supplementation of rural African women

Birthweight data from 197 rural Gambian women who received an energy-dense prenatal dietary supplement over a 4-y period (net intake = 430 kcal/d) was compared with data from 182 women from 4 baseline years. Preintervention birthweights averaged 2944 +/- 43 (SEM) g when women were in positive energy balance during the dry harvest season (pregnancy weight gain greater than 1200 g/mo). Birthweights decreased to 2808 +/- 41 g (p less than 0.01) in the wet season when food shortages and agricultural work caused negative energy balance (weight gain less than 500 g/mo). There were no detectable secular trends in the baseline data. Supplementation was ineffective during the dry season but highly effective during the wet season: +225 +/- 56 g, p less than 0.001 (unadjusted) or +200 +/- 53 g, p less than 0.001 (adjusted for sex, season, and parity) by between-child multiple regression analysis; +231 +/- 65 g, p less than 0.001 by within-mother analysis. The proportion of low-birthweight babies (less than 2501 g) decreased from 23.7-7.5%, p less than 0.002. The observed threshold effect emphasizes the importance of selective targeting of interventions to truly at-risk groups.