The influence of calorie source on water and sodium balances during intravenous refeeding of malnourished rabbits

34 New Zealand rabbits were starved until a mean weight loss of 15% to 20% was achieved and then were parenterally re-fed with four different total parenteral nutrition (TPN) formulae for 6 days. Regimens were isocaloric (85 kcal/kg/day) and isonitrogenous (0.52 gN/kg/day) with the following formulae: group S-GLU-70 (water 100 ml/kg/day, Na 7 mEq/day and 70 30 % of calories as glucose/lipids, n = 9), group S-GLU-50 (water 100 ml/kg/day, Na 7 mEq/day and 50 50 % of calories as glucose/lipids, n = 9), group L-GLU-30 (water 70 ml/kg/day, no sodium and 30 70 % of calories as glucose/lipids, n = 8) and group L-GLU-50 (water 70 ml/kg/day, no sodium and 50 50 % of calories as glucose/lipids, n = 8). The group S-GLU-70 showed the highest water and sodium balances (p = 0.001 respectively, ANOVA test). Group S-GLU-70 showed also a greater weight gain (p = 0.0001) and, although not statistically significant, the lowest albumin at the end of the TPN. Glucose load appears to be responsible for the rapid weight gain and positive water and sodium balances during TPN in depleted non-stressed animals.     

Extracellular water: sodium bromide dilution estimates compared with other markers in patients with acquired immunodeficiency syndrome

Extracellular fluid and closely related extracellular water (ECW) provide information on nutritional status in health and disease. Although various methods exist for ECW determination, little is known about their comparability in patients with wasting diseases such as acquired immunodeficiency syndrome (AIDS). One practical method, the dilution of sodium bromide (NaBr), is used widely in clinical research, although its relationship to other ECW markers has not been well characterized. The present study sought to compare ECW estimates as determined by NaBr and three other methods in 11 male patients with AIDS (mean +/- SD; age, 44+/-12 years; body weight, 64.5+/-8.8 kg; and height, 172+/-4 cm). ECW volumes were determined from NaBr dilution, total body chlorine (TBCl) by delayed gamma-neutron activation analysis, total body water (TBW) by tritium dilution combined with total body potassium (TBK) by whole body 40K counting, and radioactive sulfate dilution (35SO4). All correlations between the NaBr method and other methods were statistically significant (NaBr vs TBCl [r = .91; p < .001]; vs TBW/TBK [r = .76; p < .01]; and vs 35SO4 [r = .89; p < .001]). As expected from previous studies, ECW (L) derived by NaBr provided a group mean (15.1+/-2.2 L) similar to the TBCl method (15.4+/-1.7 L; p = .32), a significantly smaller ECW than by the TBW/TBK method (18.6+/-3.4 L; p = .0004), and a significantly larger ECW than by 35SO4 method (13.3+/-3.0 L; p = .002). Estimating ECW by NaBr dilution was comparable with other research-based ECW methods and, thus, offers a practical alternative for evaluating ECW in patients with AIDS.     

Gender specific alterations of body composition in patients with inflammatory bowel disease compared with controls.

OBJECTIVE: To assess body hydration and the distribution of the body water compartments in defined populations of patients with inflammatory bowel disease (IBD) compared with those of matched healthy controls. SUBJECTS: Fifty-two patients with IBD at time of diagnosis (20 patients with Crohn's disease (CD-new) and 32 patients with ulcerative colitis (UC-new)), 40 patients with long-standing CD (CD-long) and 2 matched healthy control groups (n = 52 and n = 40) were recruited for the study. METHODS: Total body water (TBW) and extracellular water (ECW) were measured by deuterium oxide and bromide dilution, respectively. Intracellular water (ICW) was calculated as TBW-ECW. In addition, hydration of fat-free mass (FFM) and the ECW:ICW ratio were calculated. FFM, body fat (BF) and % body fat (%BF) were assessed by dual energy X-ray absorptiometry. RESULTS: In female IBD patients, the ECW:ICW ratio was significantly (P < 0.05) higher than in controls (CD-new: 0.89+/-0.11 vs 0.79+/-0.08, P < 0.01; UC-new: 0.85+/-0.15 vs 0.77+/-0.10, P < 0.05; CD-long: 0.86+/-0.14 vs 0.80+/-0.10, P < 0.05). In these female patients, the ICW:FFM ratio was significantly (P < 0.05) lower than in controls. Fluid shifts were especially pronounced in female patients with recently diagnosed CD. In male patients with recently diagnosed UC and in those with long-standing CD, body weight, body mass index, BF and %BF were significantly (P < 0.05) lower than in controls. No differences in body hydration or body water distribution were observed between male patients and controls. CONCLUSIONS: An altered body water distribution and body hydration was observed in female IBD patients, especially in female patients with recently diagnosed CD.     

Effect of weight reduction on the renin-aldosterone axis

Eight normotensive obese subjects participated in an inpatient study designed to determine the effect of a constant sodium intake (150 mEq) on the renin-aldosterone axis during 12 weeks of weight reduction. Two 800-calorie (3,200 kj) ketogenic diets, differing in carbohydrate content (10 g vs 70 g) were used for the study. Supine and upright plasma renin activity (PRA) and serum aldosterone (SA) were determined at the baseline and every 4 weeks. Total body water (TBW) was determined by the tritiated water technique at the baseline and 12 weeks after dieting. Extracellular water (ECW) was determined by 77Br space. Routine serum chemistries were obtained at 2-week intervals. Analysis of variance indicated no significant differences in the PRA and SA between the two diets. At the baseline, while on a self-selected 150 mEq sodium diet, there was a 3- to 4-fold increase in PRA after 2 h of ambulation (supine PRA 0.83 +/- 0.22 increased to 3.41 +/- 0.96 ng/ml/h). After the hypocaloric diets were instituted, the absolute values for PRA in the supine and upright positions declined. However, the magnitude of the postural response (3- to 4-fold increase) remained unchanged during the 12 weeks of weight reduction. There was no decline in the absolute values for supine or upright SA, during the entire study. Weight loss was significant (from 102.56 +/- 6.0 to 81.7 +/- 3.7 kg; P less than .001) and was accompanied by a mean +/- SE reduction in the TBW of 3.01 +/- 0.88 liters (P less than .011).(ABSTRACT TRUNCATED AT 250 WORDS)     

早产儿胃肠外营养相关性胆汁淤积的影响因素分析

目的：分析影响早产儿胃肠外营养（ PN）相关性胆汁淤积的相关因素,为临床干预提供理论依据。方法回顾性分析自2010年1月至2014年4月在佛山市南海区第二人民医院进行PN治疗的146例早产儿相关资料,按照是否发生胆汁淤积分为对照组（未出现胆汁淤积,n＝110例）与观察组（出现胆汁淤积,n＝36例）,比较两组患者出生体重、PN持续时间、禁食时间、住院时间、PN营养液配比、感染、抗生素、机械通气等情况。结果两组患儿出生体重、PN持续时间、禁食时间、糖热卡比、氨基酸热卡比、脂肪乳酸热卡比、奶热卡比、总热卡比较差异有统计学意义（ t值分别为5．469、12．921、14．802、8．156、9．217、10．108、19．982、14．698,均P＜0．05）;感染发生率及机械通气率比较差异有统计学意义（χ2值分别为4．105、4．891,均P＜0．05）。多重逐步进入Logistic分析,结果表明PN持续时间长（OR＝2．147,95％CI：1．040～3．807）,禁食时间长（OR＝2．751,95％CI：1．970～4．408）、高葡萄糖热卡比（OR＝2．433,95％CI：1．583～3．901）、高脂肪乳热卡比（OR＝2．907,95％CI：2．072～5．833）、高氨基酸热卡比（OR＝2．779,95％CI：2．018～4．540）、机械通气（OR＝1．511,95％CI：1．067～3．908）及感染（OR＝1．275,95％CI：1．021～3．460）是早产儿胃肠外营养相关性胆汁淤积的危险性因素,而高出生体重（OR＝0．672,95％CI：0．070～0．759）则为保护性因素。结论早产儿胆汁淤积危害患儿的生命健康,临床医师在对早产儿进行PN时应控制早产儿感染、机械通气的使用、早日开奶,减少PN持续时间,且注意PN营养液的合理配比。     

Glucose clearance is delayed after hyperglycemia in healthy elderly men

Delayed glucose clearance after hyperglycemia may contribute to insulin resistance. Rates of glucose and insulin decay were measured after 3 h of sustained hyperglycemia (10 mmol/L) in 8 healthy older men (66 +/- 2 y) and were compared with those of 8 younger men (22 +/- 1 y). Fractional glucose clearance rates were calculated by regression analysis. Insulin decay was estimated from insulin levels through 30 min postinfusion. Abdominal adiposity was estimated from waist-to-hip ratios. Body weight and basal plasma glucose, insulin and C-peptide concentrations did not differ between groups. Fat mass, abdominal adiposity, fasting serum triglycerides and total cholesterol, although normal, were higher (P < 0.05) in the older group. The elderly group experienced lower glucose clearance rates (1.9 +/- 0.2 vs. 2.9 +/- 0.1%/min, P < 0.002) and higher plasma insulin after hyperglycemia (P < 0.03). Glucose and insulin decay correlated with glucose infusion rates (r = 0.88, P < 0.0002 and r = 0.51, P < 0.05). Delayed glucose clearance was associated with greater abdominal adiposity (r = -0.56, P < 0.03), higher serum triglycerides (r = -0.73, P < 0.003) and elevated serum cholesterol (r = -0.56, P < 0.04). In conclusion, modest increases in abdominal adiposity and circulating lipids are associated with abnormal glucose clearance in clinically healthy older men; this may be a precursor to the development of insulin resistance and related complications that arise from prolonged postprandial hyperglycemia.     

Human extracellular water volume can be measured using the stable isotope Na234SO4

The volume of human extracellular water (ECW) may be estimated from the sulfate space (SS). Although it may better approximate ECW volume than the bromide space, a common alternative, SS measurement is limited by the need to administer a radioactive substance, sodium [35S]sulfate. In this paper, we demonstrate the measurement of the SS using the stable isotope, sodium [34S]sulfate. Eight healthy nonobese men ingested 0.50-0.78 mg (3.47-5.42 micromol) Na234SO4/kg body weight and 30 mg NaBr/kg body weight. Sulfate concentrations and 34SO4 enrichments were measured by electrospray tandem mass spectrometry before and during the 5 h after tracer administration. SS was calculated by linear extrapolation of the natural logarithm of serum 34SO4 concentrations obtained at h 2, 3 and 4 compared with h 3, 4 and 5. The SS obtained using values between h 3 and 5 (187 +/- 17 mL/kg) was similar to published determinations using intravenous or oral radiosulfate, and was 80% of the simultaneously measured corrected bromide space (234 +/- 10 mL/kg, P = 0.01). Oral sodium [34S]sulfate administration is a suitable technique for measuring ECW and avoids radiation exposure.     

Evaluation of between-methods agreement of extracellular water measurements in adults and children

BACKGROUND: Extracellular water (ECW), a relevant molecular level component for clinical assessment, is commonly obtained by 2 methods that rely on assumptions that may not be possible to test at the time the measurements are made. OBJECTIVE: The aim of the current study was to evaluate the degree of agreement between ECW assessment by the sodium bromide dilution (ECW(NaBr)) and total body potassium (TBK; whole-body (40)K counting) to total body water (TBW; isotope dilution) methods (ECW(TBK-TBW)) in an ethnically mixed group of children and adults. DESIGN: ECW was measured with the ECW(NaBr) and ECW(TBK-TBW) methods in 526 white and African American males and females (86 nonobese children, 193 nonobese adults, and 247 obese adults). Fat mass was assessed with dual-energy X-ray absorptiometry. Multiple regression analysis was used to examine the variables related to between-ECW method differences. RESULTS: Significant but generally small group mean (+/-SD) differences in ECW were found in the obese adults (1.28 +/- 2.54 kg) and children (-0.71 +/- 1.78 kg). The magnitude of the differences was related to mean ECW in obese adults, children, and nonobese adults, and the relations between these variables were modified by sex for nonobese adults. ECW differences were also dependent on age, weight, sex, and race or on interactions between these variables. CONCLUSIONS: Overall, although good between-method agreement was found across the 3 groups, the degree of agreement varied according to subject characteristics, particularly at the extremes of ECW and body weight. We advance a possible mechanism that may link subject characteristics with the degree of agreement between ECW measurement methods and their underlying assumptions.     

Oral chromium picolinate improves carbohydrate and lipid metabolism and enhances skeletal muscle Glut-4 translocation in obese,hyperinsulinemic (JCR-LA corpulent) rats

Human studies suggest that chromium picolinate (CrPic) decreases insulin levels and improves glucose disposal in obese and type 2 diabetic populations. To evaluate whether CrPic may aid in treatment of the insulin resistance syndrome, we assessed its effects in JCR:LA-corpulent rats, a model of this syndrome. Male lean and obese hyperinsulinemic rats were randomly assigned to receive oral CrPic [80 microg/(kg. d); n = 5 or 6, respectively) in water or to control conditions (water, n = 5). After 3 mo, a 120-min intraperitoneal glucose tolerance test (IPGTT) and a 30-min insulin tolerance test were performed. Obese rats administered CrPic had significantly lower fasting insulin levels (1848 +/- 102 vs. 2688 +/- 234 pmol/L; P < 0.001; mean +/- SEM) and significantly improved glucose disappearance (P < 0.001) compared with obese controls. Glucose and insulin areas under the curve for IPGTT were significantly less for obese CrPic-treated rats than in obese controls (P < 0.001). Obese CrPic-treated rats had lower plasma total cholesterol (3.57 +/- 0.28 vs. 4.11 +/- 0.47 mmol/L, P < 0.05) and higher HDL cholesterol levels (1.92 +/- 0.09 vs. 1.37 +/- 0.36 mmol/L, P < 0.01) than obese controls. CrPic did not alter plasma glucose or cholesterol levels in lean rats. Total skeletal muscle glucose transporter (Glut)-4 did not differ among groups; however, CrPic significantly enhanced membrane-associated Glut-4 in obese rats after insulin stimulation. Thus, CrPic supplementation enhances insulin sensitivity and glucose disappearance, and improves lipids in male obese hyperinsulinemic JCR:LA-corpulent rats.     

Three-in-one parenteral nutrition: a safe and economical method of nutritional support for infants

The medical records of 20 infants under 1 year of age who received parenteral nutrition (PN) for a minimum of 1 week were reviewed. Patients were divided into two groups based on the method of PN administration. One group received PN by the traditional two-plus-one method where lipid emulsion is given separately from the dextrose-amino acid mixture. The second group received PN by the three-in-one method where lipid emulsion is admixed with the dextrose and amino acids. There were no statistically significant differences between the two groups in the amount of calories, lipid, dextrose, protein, calcium, and phosphorus received per kg of body weight. Average daily weight gain was not statistically different, and no obvious trends were noted in serum biochemical parameters between the two groups. Average total PN days for the groups (13 +/- 7 days for the two-plus-one group vs 39 +/- 35 days for the three-in-one group) were significantly different (p less than 0.05). A cost comparison of the two methods of PN administration indicated that the two-plus-one method costs our hospital $11.78 more per day than the three-in-one solution. We conclude that the three-in-one method of PN administration is safe, efficacious, and cost effective for infants under 1 year of age.     

Effect of a multistage ultraendurance triathlon on aldosterone, vasopressin, extracellular water and urine electrolytes

Prolonged endurance exercise over several days induces increase in extracellular water (ECW). We aimed to investigate an association between the increase in ECW and the change in aldosterone and vasopressin in a multistage ultraendurance triathlon, the 'World Challenge Deca Iron Triathlon' with 10 Ironman triathlons within 10 days. Before and after each Ironman, body mass, ECW, urinary [Na(+)], urinary [K(+)], urinary specific gravity, urinary osmolality and aldosterone and vasopressin in plasma were measured. The 11 finishers completed the total distance of 38 km swimming, 1800 km cycling and 422 km running within 145.5 (18.8) hours and 25 (22) minutes. ECW increased by 0.9 (1.1) L from 14.6 (1.5) L prerace to 15.5 (1.9) L postrace (P < 0.0001). Aldosterone increased from 70.8 (104.5) pg/mL to 102.6 (104.6) pg/mL (P = 0.033); vasopressin remained unchanged. The increase in ECW was related neither to postrace aldosterone nor to postrace vasopressin. In conclusion, ECW and aldosterone increased after this multistage ultraendurance triathlon, but vasopressin did not. The increase in ECW and the increase in aldosterone were not associated.     

Effect of recombinant human growth hormone on the intestinal structure of rats receiving bowel resection and parenteral nutrition

Recombinant human growth hormone (rHGH) can improve nitrogen balance and promotecell proliferation. Little is known about the relationship between rHGH and gastrointestinal mucosal structure and function after bowel resection and parenteral nutrition (PN). The aim of this study was to determine the effect of rHGH on bowel mucosal structure and barrier function in rats receiving 50% small intestinal resection and PN. Thirty Wistar rats with central vein catheterization plus 50% small bowel resection were divided into three groups: chow (chow), standard (STD) and rHGH (rHGH). The chow group received chow food; the STD group was given standard PN; the rHGH group received standard PN plus rHGH (4.8 mg/kg/day, subcutaneously). The groups were maintained on their respective diets for 8 days and then killed. Body weight, small intestinal mucosal thickness, villus height and Goblet cells in the villus were measured. Body weight loss in the STD group was significantly greater than that in the chow and rHGH groups (P< 0.01). The mucosal thickness and villus height of rHGH group were significantly greater than the STD and chow groups (mucosal thickness: 806 +/- 5.5 vs. 533 +/- 6.0 and 593 +/- 6.0 microm; Villus height: 506 +/- 6.0 vs. 295 +/- 5.5 gm and 400 +/- 6.7 lam, respectively) (P< 0.05). The number of Goblet cells in the STD group was significantly greater than the rHGH and chow groups (9.06 +/- 1.07 vs. 5.35 +/- 1.48 and 6.10 +/- 1.51/per villus) (P < 0.01). rHGH can maintain body weight and promote bowel mucosal cell growth and might improve the barrier function of the bowel in rats after 50% small intestinal resection and PN.     

Differences in glycaemic status do not predict weight loss in response to hypocaloric diets in obese patients

OBJECTIVE: The aim of our study was to detect differences in weigth loss with a hypocaloric diet in obese patients depending on their glycaemic status. SUBJECTS AND METHODS: A population of 76 obesity outpatients was analysed in a prospective way. The following variables were specifically recorded at basal time and after 3 months of hypocaloric diet (1200 kcal/day): weight, blood pressure, body mass index (BMI), waist circumference, and waist-hip ratio. Basal glucose, insulin, fibrinogen, cortisol, c-reactive protein, total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides blood levels were measured. HOMA was calculated. An indirect calorimetry, tetrapolar electrical bioimpedance and a serial assessment of nutritional intake with 3 days written food records were performed. RESULTS: The mean age was 46.9 +/- 17.1 years and the mean BMI 34.6 +/- 5.3. All subjects were weight stable during the 2 weeks period preceding the study (body weight change, 0.3 +/- 0.1 kg). Anthropometric measurements showed an average waist circumference (108.7 +/- 15.7 cm), waist-to-hip ratio (0.93 +/- 0.11), and average weight (88.7 +/- 16.9 kg). Bipolar body electrical bioimpedance showed a fat mass of 37 +/- 12.3 kg. Indirect calorimetry showed a resting metabolic rate (RMR) (1674.3 +/- 392 kcal/day). Patients were divided in to two groups by glycaemic status (group I: normal glycaemic metabolism, fasting glucose levels <109 mg/dl; n = 50) and (group II: impaired glycaemic metabolism, fasting glucose levels >110 mg/dl, n = 26). Waist circumference (I: 108 +/- 17.1cm vs. 104.6 +/- 16.7 cm; P < 0.05) and (II: 113.6 +/- 9.8 cm vs. 110.9 +/- 8.9 cm; P < 0.05), weight (I: 90.6 +/- 19.2 kg vs. 86.3 +/- 18.6 kg:P < 0.05) and (II: 89.2 +/- 11.3 kg vs. 86.4 +/- 11.6 kg: P < 0.05) and BMI (I: 34.2 +/- 5.6 vs. 33.7 +/- 5.5; P < 0.05) and (II: 34.8 +/- 4.2 vs. 34.2 +/- 4.6; P < 0.05) improved in both groups with hypocaloric diet. Blood systolic pressure, total cholesterol and LDL cholesterol improved in both groups, without statistical differences. In group II improved glucose levels and HOMA index, too. Patients of group II had higher systolic blood pressure, glucose, total cholesterol, LDL cholesterol, triglycerides, lipoprotein (a), RCP levels and HOMA index than patients in group I. ANOVA analysis did not show differences among weight loss in tertiles of HOMA and glucose. CONCLUSION: Ability to lose weight on a hypocaloric diet over a 3-month time period does not vary in obese patients as a function of glycaemic status. Improvement in cardiovascular risk factors is not related with glycaemic status, too.     

Severity of human immunodeficiency virus infection is associated with decreased phase angle, fat mass and body cell mass in adults with pulmonary tuberculosis infection in Uganda.

Although coinfection with tuberculosis and human immunodeficiency virus (HIV) is emerging as a major problem in many developing countries, nutritional status has not been well characterized in adults with tuberculosis and HIV infection. We compared nutritional status between 261 HIV-positive and 278 HIV-negative adults with pulmonary tuberculosis in Kampala, Uganda, using anthropometry and bioelectrical impedance analysis. Among 163 HIV-positive and 199 HIV-negative men, intracellular water-to-extracellular water (ICW:ECW) ratio was 1.48 +/- 0.26 and 1.59 +/- 0.48 (P = 0.006) and phase angle was 5.42 +/- 1.05 and 5.76 +/- 1.30 (P = 0.009), respectively. Among 98 HIV-positive and 79 HIV-negative women, ICW:ECW was 1.19 +/- 0.16 and 1.23 +/- 0.15 (P = 0.11) and phase angle was 5.35 +/- 1.27 and 5.43 +/- 0.93 (P = 0.61), respectively. There were no significant differences in BMI, body cell mass, fat mass or fat-free mass between HIV-positive and HIV-negative adults. Among HIV-positive subjects, BMI, ICW:ECW, body cell mass, fat mass and phase angle were significantly lower among those with CD4(+) lymphocytes < or = 200 cells/microL compared with those who had > 200 cells/microL. In sub-Saharan Africa, coinfection with pulmonary tuberculosis and HIV is associated with smaller body cell mass and intracellular water, but not fat-free mass, and by large differences in ICW:ECW and phase angle alpha.     

ω-3多不饱和脂肪酸对梗阻性黄疸患者术后全身炎症反应综合征的影响

目的 观察含有ω-3多不饱和脂肪酸(ω-3PUFAs)的肠外营养对梗阻性黄疸术后患者全身炎症反应综合征(SIRS)的影响。方法 选择2008年6月至2009年10月在滨州医学院附属医院肝胆外科住院的40例梗阻性黄疸患者,采用随机数字表法分为PUFAs组和常规组,每组20例。常规组用中长链脂肪乳剂,PUFAs组用添加ω-3PUFAs的中长链脂肪乳剂。使用等氮、等热量肠外营养,共9d,其中非蛋白质热量为117.15 kJ/(kg·d)、氮量为0.2 g/(kg·d)。测定两组患者术前1d和术后第1、3、5、7、9天血清白细胞介素-6、C反应蛋白和肿瘤坏死因子α水平,同时观察SIRS和多器官功能不全综合征(MODS)的发生率。结果 PUFAs组术后第3、5、7、9天的血清白细胞介素-6、C反应蛋白和肿瘤坏死因子-α水平较常规组显著下降（P均＜0.05）。PUFAs组的SIRS持续时间为(3.85±2.36)d,明显短于常规组的(5.31±1.47)d(P=0.0230)。PUFAs组的MODS发生率为10％,明显低于常规组的25％ (P =0.0076)。结论 添加ω-3PUFAs的肠外营养能阻断梗阻性黄疸患者术后过度炎症反应、保护重要器官功能,有利于细胞及器官功能的恢复。     

Oral nutrition in patients receiving home cyclic parenteral nutrition: pattern of substrate utilization

Patients receiving cyclic home parenteral nutrition (PN) often have a significant oral caloric intake. This study describes the metabolic use of fuels, as assessed by indirect calorimetry, in eight stable, ambulatory, noncancerous, adult patients receiving glucose-based PN with (PN + oral) or without (PN only) a self-selected oral intake. Patients' weight was 91 +/- 2% (mean +/- SE) of ideal body weight, and fat mass was 22 +/- 5 and 31 +/- 2% of actual body weight in males and females, respectively. Under the PN-only regimen, providing 104 +/- 5% of predicted basal energy expenditure (BEE), patients were in equilibrium for energy and nitrogen balances. Oral supplementation (absorbed oral intake 80 +/- 5% of BEE) was associated with positive energy and nitrogen balances but also with nearly continuous net fat synthesis. We conclude that the glucose-based PN + mixed oral regimen enables the patients to face the increased energy requirements of everyday ambulatory life but is not associated with an optimal body composition in long-term PN patients.     

Effect of glucose to fat ratio on energy substrate disposal in children with cystic fibrosis fed enterally

High fat containing diets lower VCO(2)in patients with impaired pulmonary function fed at a high level of energy intake. We tested the effect of a high fat enteral nutrition on VCO(2)and substrate oxidation in cystic fibrosis patients fed enterally 130% RDA. VCO(2)and substrate oxidation were studied in a group of eight 6-19 year old patients while receiving for 1 month and in a random order isocaloric (1000 kcal/m(2)), isonitrogenous enteral diet with a normal fat and a high fat content (40% and 67% of non-protein energy intake).Substrate oxidation and net balance were estimated using indirect calorimetry at the end of each study period. Overnight high fat enteral infusion resulted in no significant change in VCO(2)and VO(2)but lowered RQ (0.84 +/- 0.01 vs 0.88 +/- 0.01, P= 0.02) and non-protein RQ (0.83 +/- 0.01 vs 0.88 +/- 0.01). In spite of a higher glucose oxidation rate (8.1 +/- 0.5 vs 6.3 +/- 0.5 g. h(-1), P= 0.04), glucose net balance was significantly higher during normal fat formula administration (+2.5 +/- 0.8 v -0.3 7plusmn; 0.7 g/h, P< 0.05).The present study failed to show any benefit of a high fat diet on VCO(2)in non oxygenodependant cystic fibrosis children and adolescents fed slightly above RAD. Normal fat enteral formula led to higher glycogen repletion.     

Do flavonoid intakes of postmenopausal women with breast cancer vary on very low fat diets?

In the Women's Intervention Nutrition Study (WINS), a very low-fat eating pattern decreased breast cancer recurrence. We assessed whether the women's flavonoid intakes varied on the very low fat diet. A total of 550 randomly selected WINS participants who had been treated with conventional therapy (surgery, chemotherapy, and/or radiation) for primary breast cancer were randomized to either a very low fat diet (15% of calories from fat, N = 218) or their usual diets (30% calories from fat, N = 332). We compared their intakes of total flavonoids and 6 flavonoid classes (isoflavones, flavones, flavanones, flavonols, flavan-3-ols, and anthocyanins) for these 2 groups using the U.S. Department of Agriculture food flavonoid database and a flavonoid dietary supplement database on three 24-h dietary recalls at baseline and 12 mo after randomization. At baseline, neither mean fat intakes (31.7% +/- 6.8 SD of calories, n = 332 in the usual diet group and 31.6% +/- 6.8 SD of calories, n = 218 in the very low fat diet group; P = NS) nor flavonoid intakes (218 +/- 283 SD mg/day, n = 332 in the usual diet group and 236 +/- 393 SD mg/day, n = 218 in the very low fat diet group; P = NS) differed. Over half of the women's flavonoid intakes were from the flavan-3-ols. After 12 months of intervention, with 39 participants lost to follow-up, dietary fat intakes were 30.7 +/- 8.4 SD calories (n = 316) among those on their usual diets but were significantly lower among those on the very low fat diet intervention: 21.4 +/- 8.3 SD calories (n = 195), P = <0.05. However, flavonoid intakes remained similar in both groups (201 +/- 252 SD mg/day, n = 316 in the usual diet group vs. 235 +/- 425 SD mg/day, n = 195 in the very low fat group; P = NS). In this random sample of WINS participants, neither total flavonoid intakes nor intakes of subclasses of flavonoids differed between those who had dramatically decreased their fat intakes and those who had not. Flavonoid intakes are therefore unlikely to account for WINS results on differences between the groups in cancer recurrence.     

Effect of weight reduction on the renin-aldosterone axis.

Eight normotensive obese subjects participated in an inpatient study designed to determine the effect of a constant sodium intake (150 mEq) on the renin-aldosterone axis during 12 weeks of weight reduction. Two 800-calorie (3,200 kj) ketogenic diets, differing in carbohydrate content (10 g vs 70 g) were used for the study. Supine and upright plasma renin activity (PRA) and serum aldosterone (SA) were determined at the baseline and every 4 weeks. Total body water (TBW) was determined by the tritiated water technique at the baseline and 12 weeks after dieting. Extracellular water (ECW) was determined by 77Br space. Routine serum chemistries were obtained at 2-week intervals. Analysis of variance indicated no significant differences in the PRA and SA between the two diets. At the baseline, while on a self-selected 150 mEq sodium diet, there was a 3- to 4-fold increase in PRA after 2 h of ambulation (supine PRA 0.83 +/? 0.22 increased to 3.41 +/? 0.96 ng/ml/h). After the hypocaloric diets were instituted, the absolute values for PRA in the supine and upright positions declined. However, the magnitude of the postural response (3- to 4-fold increase) remained unchanged during the 12 weeks of weight reduction. There was no decline in the absolute values for supine or upright SA, during the entire study. Weight loss was significant (from 102.56 +/? 6.0 to 81.7 +/? 3.7 kg; P less than .001) and was accompanied by a mean +/? SE reduction in the TBW of 3.01 +/? 0.88 liters (P less than .011).(ABSTRACT TRUNCATED AT 250 WORDS)     

Substrate fuel kinetics in enterally fed trauma patients supplemented with ornithine alpha ketoglutarate

BACKGROUND: Ornithine-alpha-ketoglutarate (OKG) is a promising anticatabolic agent and the mechanisms of its potential use in trauma patients are not clearly understood. AIM: To determine the altered whole-body protein, lipid and glucose substrate kinetics in trauma victims in the early flow-phase of injury when they were fed enterally with or without OKG. METHODS: Fourteen adult, multiple trauma patients who were highly catabolic and hypermetabolic were studied. Whole-body protein ((15)N glycine), fat (2 stage glycerol infusion) and glucose ((3H)glucose) kinetics (t/o) and plasma parameters were measured (A) within 48-60 h after injury before starting nutritional support and then (B) after 4 days of enteral feeding. Group A (n=7, control) received a defined enteral formula (Two Cal HN, 1.4 times BEE calories) and Group B (n=7, OKG) received same isonitrogenous diet replacing 2.62gN/d from the enteral diet by OKG-N (20g OKG/d). RESULTS (Mean+/-SEM): Protein turnover is significantly (P<==0.05) increased in OKG treated patients (4.68+/-0. 15 vs 3.90+/-0.23, gP/kg/day) and glycerol turnover is decreased (0. 87+/-0.16 vs 1.46+/-0.16, micro mole/kg/min). Glucose turnover is not changed. Significant (P<== 0.05) increases in circulating plasma levels of hormones (insulin, 44.2+/-8.4 vs 15.7+/-5.0 ulU/ml, growth hormone 1.68+/-0.33 vs 0.92+/-0.16, ng/ml and IGF-1, 106+/-13 vs 75+/-18, ng/ml) and free amino acids (glutamine, 383+/-20 vs 306+/-25, Proline, 203+/-18 vs 146+/-13 and ornithine, 164+/-27 vs 49+/-5 micro mole/l) are found in OKG treated patients, compared to non OKG patients. CONCLUSION: Increased hormone secretion due to OKG and the rapid interaction between the metabolites of OKG at the intermediary metabolism level may be responsible for altered substrate fuel kinetics.