Fish oil-enriched nutritional supplement attenuates progression of the acute-phase response in weight-losing patients with advanced pancreatic cancer.

The presence of an acute-phase protein response (APPR) has been suggested to shorten survival and contribute to weight loss in patients with pancreatic cancer. Fatty acids derived from fish oil have been shown to alter proinflammatory cytokine production and acute-phase protein synthesis in vitro. The present study was designed to determine the effects of a fish oil-enriched nutritional supplement on the concentrations of a range of individual acute-phase proteins (APP) in patients with advanced pancreatic cancer. In a sequential series, 18 patients with pancreatic cancer received the supplement (providing 2 g eicosapentaenoic acid and 1 g docosahexaenoic acid/d) for 3 wk while another 18 received full supportive care alone. Six healthy subjects served as additional controls. Acute-phase proteins were measured before and after the 3-wk intervention period in cancer patients. At baseline, albumin, transferrin and pre-albumin were significantly reduced and fibrinogen, haptoglobin, alpha-1-acid glycoprotein, alpha-1-antitrypsin, ceruloplasmin and C-reactive protein (CRP) were significantly elevated in the cancer patients compared with healthy controls, reflecting their roles as negative and positive acute phase proteins, respectively. In the supplemented cancer group, the only significant change in APP concentrations over the 4-wk study period was an increase in transferrin. In the control cancer group there were further significant reductions in albumin, transferrin and pre-albumin, and a significant increase in CRP concentration. These results suggest that many positive and negative APP are altered in advanced pancreatic cancer. The APPR tends to progress in untreated patients but may be stabilized by the administration of a fish oil-enriched nutritional supplement. This may have implications for reducing wasting in such patients.     

Different quantities of two commercial liquid diets consumed by weight-losing cancer patients.

Twenty ambulatory, weight-losing patients with advanced cancer of the lung, breast, or ovary were randomized to supplement their diet for 2 months with either of two commercial complete liquid diets, one containing intact milk proteins and the other partially hydrolyzed soy proteins. Both products were prescribed as sip feeds in addition to normal food. The patients consumed more of the hydrolysate-containing product than of that with intact (milk) protein. The difference was significant and was maintained during both months of the study. An increase in total energy and protein was obtained in both groups, but was significant only with the hydrolysate product. At the end of the study there was no group difference in measures of nutritional status, but weight loss was halted in both groups.     

Relationship between metabolism and peripheral blood mononuclear cell mitochondrial complex I activity before and after a short-term refeeding in weight-losing cancer patients

BACKGROUND AND AIMS: Previous investigations showed that mitochondrial complex I activity seems to be a specific marker of dietary malnutrition in human. Since cancer has a more complex etiology than simple calorie deficiency, the aim of this study was to investigate the relationship between mitochondrial complex I activity and cancer. METHODS: Nine cancer patients (CaPs) with weight loss and 14 age-matched healthy volunteers (HVs) were recruited. Body mass index (BMI), body composition as well as resting energy expenditure (REE) and RQ were measured. Mitochondrial complex I activity was measured as described previously in isolated peripheral blood mononuclear cells. Six patients were investigated again after 7 days of refeeding. RESULTS: Weight loss in CaPs was mainly due to a loss of fat mass (FM), while fat-free mass (FFM) was preserved. The RQ was significantly lower in CaPs compared to HVs (P<0.001) and peripheral blood mononuclear cell complex I activity was significantly correlated with the %FM and RQ in CaPs. Furthermore, complex I activity increased significantly after 1 week of refeeding. CONCLUSIONS: Our study showed that mitochondrial complex I activity was inversely correlated to parameters of increased fat oxidation and reduced FM, which are indices of dietary insufficiency rather than loss of lean body mass, which is an index of increased catabolism in cancer.     

膀胱灌注预防膀胱癌患者术后医院感染全身炎症反应和氧化应激水平

目的研究膀胱灌注治疗膀胱癌患者医院感染全身炎症反应和氧化应激水平。方法选取2016年12月-2018年5月遵义医学院附属医院膀胱灌注治疗膀胱癌医院感染者116例设为感染组;选取膀胱灌注治疗膀胱癌未感染者120例设为未感染组;同期健康体检者60例,为对照组。观察感染组患者感染时(T0)、感染24 h(T1)、感染48 h(T2)和感染控制后(T3)全身炎症反应指标[白细胞介素-6(IL-6)、IL-8、肿瘤坏死因子-α(TNF-α)]和氧化应激指标[谷胱甘肽过氧化物酶(Glutathione peroxidase,GSH-PX)、超氧化物歧化酶(Superoxide dismutase,SOD)、丙二醛(Malondialdehyde,MDA)、晚期氧化蛋白产物(Advanced oxidative protein production,AOPP)]水平和感染组患者中全身炎症反应综合征(SIRS)患者、非SIRS患者感染时(T0)及未感染组、对照组纳入时刻(T0)上述指标水平。结果共培养分离病原菌168株,其中革兰阴性菌119株占70.83%,革兰阳性菌49株占29.17%。感染组T0时刻患者IL-6、IL-8、TNF-α、GSH-PX、SOD、MDA、AOPP水平均高于未感染组、对照组(P<0.05);感染组T0时刻SIRS患者上述指标均高于非SIRS者(P<0.05)。T0、T1、T2、T3时上述指标均先升高、后下降,差异有统计学意义(P<0.05);IL-6、IL-8、TNF-α与GSH-PX、SOD、MDA、AOPP水平呈正相关(P<0.05)。结论全身炎症反应和氧化应激共同参与了膀胱灌注治疗膀胱癌医院感染的发生与感染进展,是其重要的作用机制之一;减轻全身炎症反应、降低氧化应激水平、提高机体抗氧化能力,有助于降低膀胱灌注治疗膀胱癌医院感染率及感染严重程度。     

Insulin response to glucose and glucose tolerance following feeding in sheep

Sheep offered a roughage diet for 4 h daily were injected intravenously with glucose before and at various times after feeding. The insulin secretory response to glucose and the rate of disappearance of injected glucose were determined. While the basal concentration of plasma insulin was unchanged, the base-line plasma glucose concentration tended to decrease during the meal. The glucose load brought about an increase in the plasma insulin concentration at each injection, but the insulin response to glucose and the rate of glucose disposal were increased during the meal. On varying the time of feeding between 08.00 and 16.00 hours, the increase in the insulin response to glucose and in the rate of glucose disposal always appeared to be related to the giving of food, independent of the time food was offered. It is concluded that feeding increases the insulin response to an intravenous glucose load even when the increase in the basal level of plasma insulin on feeding is very modest in sheep given a roughage diet. The increased insulin response and glucose disposal rate following feeding did not appear to be related to diurnal rhythms in insulin secretory activity or glucose metabolism.     

Effect of glucose supply on fasting nitrogen excretion and effect of level and type of volatile fatty acid infusion on response to protein infusion in cattle

Two experiments were carried out on cattle nourished entirely by intragastric infusion, to determine the extent to which glucose or a glucose precursor determines the response to protein infusion in energy-undernourished animals. In order to determine the requirement for glucose in 1-year-old fasting cattle, glucose was infused at increments to supply 0, 1.5, 2.5, 3.5, 4.5, 5.5 and 6.5 g/kg metabolic body weight (W0.75) and the effects on plasma beta-hydroxybutyrate and N excretion were measured. At 5.5 g glucose/kg W0.75 plasma beta-hydroxybutyrate was reduced to a basal level of 1.65 mmol/l and fasting N excretion reduced from 529 to 280 mg N/kg W0.75. No further reduction was observed with the higher level of 6.5 g glucose/kg W0.75. In the second trial, three steers were used in a 3 x 3 Latin square design and infused with a volatile fatty acid mixture of 65, 27 and 8 mol acetic, propionic and butyric acids respectively/100 mol, either at an estimated maintenance energy level of 450 kJ/kg W0.75 and supplying a calculated glucose equivalent level of 13.0 g/kg W0.75 (M1A), or at 1.5 x maintenance supplying a glucose equivalent of 20 g/kg W0.75 (M1.5A). Another mixture infused at the maintenance energy level contained 49, 43 and 8 mol acetic, propionic and butyric acids respectively/100 mol but with a glucose equivalent of 20 g/kg W0.75 (M1P). Casein was infused at each of these energy treatments to supply 0, 200, 400, 800, 1600 and 2500 mg N/kg W0.75 daily, and N balance and blood metabolites were measured. N retention increased linearly (r 0.98) with casein infusion. The coefficients for N retention were 0.55, 0.57 and 0.64 for M1A, M1.5A and M1P respectively. The mean efficiency of N utilization was 0.58. The results suggest that provided the glucose need is met there is no relationship between energy supply and efficiency and level of protein retention. However, the results also indicate that glucose requirement in cattle may be higher than that previously observed in sheep.     

Postprandial glucose response to Chinese foods in patients with type 2 diabetes

The objective of this study is to examine the glycemic response to common Chinese foods in patients with type 2 diabetes. Twenty-four Chinese adults with type 2 diabetes participated. Subjects were allocated to eat a pair of test meals in random order. Test meals included plain porridge with lean pork (meal 1A), plain porridge and Shrimp Shao Mai (Doll Brand, Winner Food Products Limited, Hong Kong) (meal 1B), boiled rice with boiled egg white (meal 2A), fried rice with whole egg (meal 2B), plain noodles in clear soup (meal 3A), and Pickled Vegetable and Pork-flavored Instant Bowl Noodles (Doll Brand, Winner Food Products Limited) (meal 3B). Nutritional content of the meals was calculated from the nutritional label on the food package and the food composition table. Plasma glucose was checked before the meal and in 30-minute intervals for up to 4 hours after the meal. Significant differences in the area under the curve of glucose up to 2 hours after the meal were detected between meal 1A and 2A (P=.044), 1A and 3A (P=.001), and 3A and 3B (P=.017). The results suggest that fat alone does not alter the glycemic response to rice or porridge. Porridge produces a higher glycemic response than rice and noodles despite similar carbohydrate contents, and different noodles lead to differences in glycemic excursion, suggesting that the glycemic index of common Chinese foods is affected by cooking methods and food processing.     

Whole body protein turnover in malnourished cystic fibrosis patients and its relationship to pulmonary disease

To investigate the effect of pulmonary disease in cystic fibrosis (CF), total body protein synthesis and catabolism were determined in eight CF children with acute exacerbations of pulmonary infection at the time of study (CF I), a group of CF children (n = 7) with chronic but stable pulmonary disease (CF II) and a group (n = 8) of healthy children. Protein synthesis was determined by the method of Waterlow et al (1978) using a single oral dose of 15N glycine and protein catabolism derived from nitrogen balance. Protein synthesis was markedly decreased (p less than 0.001) in the CF I group (1.01 +/- 0.10 g kg-1 10 h-1) compared with that of controls (2.02 +/- 0.08) and with CF children with chronic but stable pulmonary disease (CF II) (2.36 +/- 0.17). Protein catabolism was increased (p less than 0.01) in the CF II group compared with both controls and CF I. These findings contrast strongly to studies in normal children and those with mild protein-energy malnutrition (PEM) and infection, where infection increased protein synthesis, but are consistent with the observed decrease in protein turnover where severe PEM is accompanied by infection. We conclude that repeated pulmonary infection can adversely affect protein-energy balance and that adequate nutritional support should be considered in management during and after each episode.     

Glucose metabolism and thermogenesis during glucose and insulin infusion in severely underweight patients.

This study investigates the effects of gross loss of body weight on glucose disposal (GD), storage (GS), oxidation (GO), and the thermogenic response (TR) during hyperinsulinemic euglycemic glucose infusion in 9 underweight but nourished patients (UP) and in 3 of the patients after weight gain (WGP). In UP, baseline metabolic rate (MR) was 4.1 +/- 0.2 kJ/min and respiratory exchange ratio (RER) 0.97 +/- 0.02. During the final 30 minutes of hyperinsulinemia MR rose by 0.32 +/- 0.07 kJ/min (p less than .01) and RER rose to 1.09 +/- 0.03 (p less than .01). GD was 61 +/- 3 mumol/kg per minute, GO 35 +/- 1 mumol/kg per minute, and GS 26 +/- 4 mumol/kg per minute. The energy cost of glucose storage as glycogen was 0.15 kJ/min, and as lipid was 0.2 kJ/min. In WGP baseline MR was 4.5 +/- 0.4 kJ/min and RER was 0.91 +/- 0.03. During hyperinsulinemia MR rose by 0.63 +/- 0.2 kJ/min, RER rose to 0.93 +/- 0.02, GD was 53 +/- 4 mumol/kg per minute, GO was 30 +/- 3 mumol/kg per minute, and GS was 23 +/- 1 mumol/kg per minute. The energy cost for this glucose storage was 0.22 kJ/min. Therefore, during hyperinsulinemia in UP, GD, and TR are similar, but GO is greater and GS is less than previously reported in healthy subjects. However, this TR is entirely accounted for by the energy cost of glucose storage with no evidence of facultative thermogenesis. In WGP, all responses were similar to those in healthy subjects, and the TR was in excess of that required of the energy cost of glucose storage.     

Hormonal and metabolic responses to glucose infusion in sepsis studied by the hyperglycemic glucose clamp technique

Although nutritional support is vital to treatment of severe sepsis, the septic patient does not respond normally to glucose infusion. We have used the hyperglycemic glucose clamp technique to investigate the initial hormonal and metabolic responses of the septic patient to glucose under controlled conditions. The plasma glucose concentration was raised to and maintained at 12 mmol/liter for 2 hr in 12 septic patients and 11 normal controls. Glucose utilization, assessed from the amount infused, was significantly depressed in the patients, despite similar plasma insulin concentrations in the two groups. Forearm glucose uptake was similarly impaired. Despite very similar plasma free fatty acid concentrations in the two groups, which were suppressed equally by the glucose infusion, whole-body fat oxidation was elevated in the patients compared with the controls, and suppressed to a lesser extent in response to glucose. Glycerol and ketone body concentrations were elevated in the patients in keeping with a picture of accelerated release, clearance, and oxidation of fatty acids. Plasma cortisol, epinephrine, and norepinephrine concentrations were elevated in the septic patients in a severity-related manner, but not to high levels compared with experimental work. Norepinephrine showed no response to the glucose infusion in either group. Plasma glucagon concentrations were not significantly elevated in the septic patients. We conclude that the hyperglycemic glucose clamp provides a useful model for studying glucose intolerance in sepsis. Impaired glucose utilization in septic patients is associated with increased fat oxidation, although the hormonal basis for these changes is still unclear.     

Self-perceptions of the stigma of overweight in relationship to weight-losing patterns.

Preliminary, exploratory studies examine self-perceptions of the stigma of overweight in relatiopship to weight-losing patterns of female and male children of different ages. It is suggested that the concept of stigma may be a viable analytical tool in studying overweight as: an exclusive focus in interaction, related to a negative body image, overwhelming others with mixed emotions, clashing with other attributes of the person, an equivocal predictor of activities, and related to one's sense of responsibility for one's overweight. Female adolescents in the Slimnastics class in a high school and children and adolescents in an obesity clinic in a hospital were studied. Male children and female adolescents had more trouble losing weight than did female children and male adolescents. Youth who viewed overweight as both one's responsibility and as an illness that required the joint efforts of oneself and others, especially professional experts, were more successful in losing weight than those youth who believed that overweight was solely their responsibility or not at all their responsibility. Intensive focusing on one's overweight and one one's negative body image seemed to inhibit or deter weight losing for some youth.     

Amino acids enhance insulin resistance to exogenous glucose infusion in overnight-fasted humans

The role that amino acids play in regulating exogenous glucose infusion during hyperinsulinemia was examined in overnight-fasted volunteers. Each study consisted of both a 30-minute basal period and a 4-hour experimental period during which insulin was infused at either 0.6, 1.2, 2.5, 5.0, 10, or 20 mU/kg/min with euglycemia maintained. Two protocols were used. In the first (I), subjects were allowed to develop hypoaminoacidemia, and in the second (II), plasma amino acid levels were maintained near basal by frequently monitoring plasma leucine levels in conjunction with exogenous infusion of an L-amino acid solution. The amount of amino acids infused were 0.85 +/- 0.11, 1.53 +/- 0.17, 1.97 +/- 0.13, 2.18 +/- 0.50, 2.78 +/- 0.61, and 2.83 +/- 0.44 mg/kg/min at escalating insulin doses, respectively. When amino acids were infused, the amount of glucose required to maintain euglycemia was lower at each insulin dose used (4.5 +/- 0.3 vs 3.6 +/- 0.4, 7.6 +/- 0.5 vs 6.9 +/- 0.3, 10.4 +/- 1.0 vs 8.7 +/- 0.5, 13.3 +/- 0.8 vs 10.2 +/- 0.4, 14.7 +/- 0.8 vs 11.7 +/- 0.6, and 14.9 +/- 0.6 vs 11.8 +/- 0.8 mg/kg/min at escalating insulin doses, respectively; p less than 0.05). The calculated maximal infusion rates were 15.8 +/- 0.6 vs 12.6 +/- 0.4 mg/kg/min (protocol I vs II, p less than 0.001), while the concentrations required to achieve half-maximal rates were 153 +/- 22 and 134 +/- 22 microU/ml (p = ns), respectively.(ABSTRACT TRUNCATED AT 250 WORDS)     

糖尿病病人膳食生糖效应与膳食纤维摄入的关系研究

目的通过对膳食血糖指数(DGI)和膳食血糖负荷(DGL)的评估,研究膳食生糖效应与膳食纤维的关系。方法采用食物称重记账法调查105名2型糖尿病病人的2个3日膳食摄入状况,根据食物血糖指数和膳食碳水化合物摄入量计算DGI和DGL,采用酶-重量法测定食物中总膳食纤维(TDF)、不可溶性膳食纤维(IDF)和可溶性膳食纤维(SDF)含量。结果调查对象的DGI值是62.9±6.8,DGL值是142.4±39.8,TDF、IDF和SDF的摄入量分别是(22.5±6.7)g/d,(16.1±5.5)g/d,(6.4±2.0)g/d。DGI与TDF的相关系数是-0.407(P<0.01)。与DGI最低五分位组的调查对象相比,DGI最高五分位组的调查对象蔬菜类食物摄入量减少了221.9g(P<0.01),TDF、IDF和SDF摄入量分别减少了6.5g、5.0g和1.4g(P值均<0.01),其中由蔬菜提供的膳食纤维减少量最多,谷类摄入量增加了68.0g(P<0.01)。结论DGI与膳食纤维摄入量呈负相关。富含蔬菜和膳食纤维的膳食可降低膳食生糖效应。     

The effects of underfeeding for 7 d on the thermogenic and physiological response to glucose and insulin infusion (hyperinsulinaemic euglycaemic clamp)

The effect of underfeeding for 7 d (at 60 kJ/kg ideal body-weight) on the thermic and physiological responses to glucose and insulin infusions (hyperinsulinaemic euglycaemic clamp) was studied in six healthy women. Underfeeding had no significant effect on baseline metabolic rate, heart rate, forearm blood flow, diastolic blood pressure, blood intermediary metabolites, plasma insulin or catecholamines, but reduced both respiratory exchange ratio (RER; control (C) 0.86 (SE 0.02), underfed (U) 0.75 (SE 0.01); P less than 0.01) and systolic blood pressure (by approximately 10 mmHg, P less than 0.01). Baseline forearm glucose uptake and oxygen consumption were similar in both states. During the final 30 min of the glucose and insulin infusion, metabolic rate rose by 0.43 (SE 0.05) kJ/min in the C state, but no rise was seen in the U state (P less than 0.01). Glucose disposal rate (C 47.9 (SE 1.8), U 47.3 (SE 4.1) mumol/kg per min) and storage rate (C 27.5 (SE 2.4), U 31.6 (SE 3.6) mumol/kg per min) were similar in both states, but glucose oxidation rate was reduced in the U state (C 20.5 (SE 1.7), U 15.4 (SE 0.7) mumol/kg per min; P less than 0.05). RER rose to a higher value in the C state than in the U state (C 0.97 (SE 0.2), U 0.80 (SE 0.01); P less than 0.01). During hyperinsulinaemia, the forearm glucose uptake and O2 consumption rose in both states. No significant differences were seen in the cardiovascular responses to hyperinsulinaemia in either state. Thus underfeeding abolishes the rise in thermogenesis and reduces glucose oxidation during glucose and insulin infusions in healthy women, but does not affect the glucose disposal or storage rates or the other measured responses.     

Gastric pressure response to low dose dopamine infusion in normal man

The gastric pressure response to distension was measured during intravenous infusion of dopamine at a rate of 2 mug min(-1)kg(-1) over 2h 50min in 5 normal volunteers to determine whether dopamine at this dose potentiated gastric adaptive relaxation, leading to a fall in gastric pressure and thus a potential delay in gastric emptying. This would be of obvious importance in patients being given dopamine at this dose to support renal function and at the same time being fed by nasogastric tube. The pressure response decreased during the first hour in all five subjects (p < 0.01). In 2 it recovered during the third hour to pre-infusion values, but in 2 it remained diminished; in 1 subject the results were equivocal. Circulating dopamine, noradrenaline and adrenaline concentrations all increased during dopamine (p < 0.05), but compared with control there was no difference in plasma free fatty acids, glycerol, cortisol or glucose concentrations. Dopamine at 2 mug min(-1) kg(-1) produced a transient fall in gastric pressure in all subjects, and a persistent fall in some. The changes in gastric pressures were seen at infusion rates that produced no metabolic or inotropic effects.