The effect of glutamine-supplemented total parenteral nutrition on nitrogen economy depends on severity of diseases in surgical patients

BACKGROUND: Gln is an important substrate for enterocyte and rapid proliferation cells. Studies have shown that parenteral supplementation of Gln maintains the intracellular Gln pool, improves nitrogen balance and shortens hospital stay. However, some studies showed Gln-supplemented TPN had no effect on restoring the Gln pool in critically ill patients. OBJECTIVE: To evaluate the effect of glutamine (Gln) dipeptide supplementation of total parenteral nutrition (TPN) on postoperative nitrogen balance and immune response of patients undergoing surgery. METHODS: This study is a prospective, randomized double-blind clinical trial. APACHE II score and TISS were used to evaluate the patients after admission. Forty-eight patients with major abdominal surgery were allocated to two groups to receive isonitrogenous (0.228 g nitrogen/kg/day) and isoenergetic (30 kcal/kg/day) TPN for 6 days. Two groups (Conv and Ala-Gln) were further divided to high (APACHE>or=6) and low (APACHE <6) groups. Control group (Conv) received 1.5 g amino acids/kg/day, whereas the Ala-Gln group received 0.972 g amino acids/kg/day and 0.417 g of L-alanyl-L-glutamine (Ala-Gln)/kg/day. Blood samples were collected on day 1 and day 6 after surgery for plasma amino acid and CD4, CD8 cell and T lymphocyte analysis. Cumulative nitrogen balance were also measured on day 2, 3, 4, 5 postoperatively. RESULTS: Although there was a tendency to have better cumulative nitrogen balance on the postoperative days in the Ala-Gln group, no significant difference was observed between two groups. However, a better significant cumulative nitrogen balance was observed on the 2nd, 3rd and 5th postoperative day in the Ala-Gln group than in the Conv group in patients with APACHE II <6, whereas no significant difference was noted in patients with APACHE II >or= 6. No difference in urine 3-methylhistidine excretion were observed between the 2 groups. Patients in the Ala-Gln group had significant higher T lymphocyte and CD4 cells than did those in the Conv group.CONCLUSION: TPN supplemented with Gln dipeptide had beneficial effect on enhancing the immune response. However, the effect of Ala-Gln administration on improving nitrogen economy was only observed in patients with low APACHE II scores. These results may indicate that Gln required for reversing the catabolic condition may depend on the characteristics and severity of the diseases.     

Nitrogen and energy balance in depleted patients undergoing major gastrointestinal surgery: response to TPN

We studied energy and nitrogen balance during pre- and post-operative parental nutrition in 16 malnourished patients undergoing major abdominal surgery due to suspected gastrointestinal malignancy. The response to amino-acids alone (1.5g/kg; group AA) and energy alone (energy intake equal to pre-nutrition energy expenditure; group REE) was studied during the first day of pre- and post-operative nutrition. On the second day of parental nutrition both groups received amino-acids (1.5g/kg) and non-protein energy equal to pre-nutrition energy expenditure. Energy expenditure (EE) was increased both pre- and post-operatively (EE 112 +/- 15 and 121 +/- 14% of predicted, respectively). Nitrogen balance in group REE was more positive than in group AA on pre-operative day 2 (81.1 +/- 35.8 vs. 17.8 +/- 60.5 mg/kg; p < 0.05). N balance was better pre- than post-operatively on day 2 in both groups (17.8 +/- 60.5 vs. -49.6 +/- 49.2 mg/kg; group AA and 81.1 +/- 35.8 vs. 7.8 +/- 82.6 mg/kg; group REE; p < 0.05). Pre-operatively, administration of energy alone reduced EE (1489 +/- 301 vs. 1403 +/- 312 kcal/day; p < 0.05). We conclude that: 1) The patients were hypermetabolic both pre- and post-operatively. 2) Surgical trauma had a minor effect on EE. 3) Good nitrogen retention could be obtained both pre- and post-operatively at close to zero energy balance. 4) EE increased during the infusion of amino-acids more post-operatively than pre-operatively; non-protein energy at EE had no thermogenic effect. 5) Priming with energy improved nitrogen balance on the following day.     

Body composition, nitrogen metabolism, and energy utilization with feeding of mildly restricted (4.2 MJ/d) and severely restricted (2.1 MJ/d) isonitrogenous diets.

To determine the effects on weight loss of feeding isonitrogenous diets in mildly restricted (4.2 MJ/d) and severely restricted (2.1 MJ/d) amounts, we measured body composition, weight loss-energy deficit ratio, and nitrogen metabolism in 14 obese women housed in a metabolic ward consuming hypoenergetic diets for 21 d. Subjects consumed either a 4.2-MJ/d diet (50 g protein, 175 g carbohydrate) or a 2.1-MJ/d diet (50 g protein, 75 g carbohydrate). Body composition and leucine oxidation and turnover were determined before and after weight loss. Energy deficit was calculated from resting metabolic rates. Subjects fed the 2.1-MJ/d diet showed a greater weight loss (6.1 +/- 0.5 vs 4.5 +/- 0.5 kg; mean +/- SE, P less than 0.05) and fat loss (3.9 +/- 0.3 vs 3.0 +/- 0.3 kg, P less than 0.05). Weight loss-energy deficit ratio was the same with both diets. Nitrogen balance and leucine oxidation and turnover were similar in both groups. We conclude that with feeding of isonitrogenous hypoenergetic diets, severe restriction of energy content (2.1 MJ/d, 75 g carbohydrate) will enhance weight and fat loss without increasing nitrogen loss compared with mild restriction of energy (4.2 MJ/d).     

Oral glutamine and amino acid supplementation inhibit whole-body protein degradation in children with Duchenne muscular dystrophy

BACKGROUND: Glutamine has been shown to acutely decrease whole-body protein degradation in Duchenne muscular dystrophy (DMD). OBJECTIVE: To improve nutritional support in DMD, we tested whether oral supplementation with glutamine for 10 d decreased whole-body protein degradation significantly more than did an isonitrogenous amino acid control mixture. DESIGN: Twenty-six boys with DMD were included in this randomized, double-blind parallel study; they received an oral supplement of either glutamine (0.5 g . kg(-1) . d(-1)) or an isonitrogenous, nonspecific amino acid mixture (0.8 g . kg(-1) . d(-1)) for 10 d. The subjects in each group were not clinically different at entry. Leucine and glutamine metabolisms were estimated in the postabsorptive state by using a primed continuous intravenous infusion of [1-(13)C]leucine and [2-(15)N]glutamine before and 10 d after supplementation. RESULTS: A significant effect of time was observed on estimates of whole-body protein degradation. A significant (P < 0.05) decrease in the rate of leucine appearance (an index of whole-body protein degradation) was observed after both glutamine and isonitrogenous amino acid supplementation [x +/-SEM: 136 +/- 9 to 124 +/- 6 micromol . kg fat-free mass (FFM)(-1) . h(-1) for glutamine and 136 +/- 6 to 131 +/- 8 micromol . kg FFM(-1) . h(-1) for amino acids]. A significant (P < 0.05) decrease in endogenous glutamine due to protein breakdown was also observed (91 +/- 6 to 83 +/- 4 micromol . kg FFM(-1) . h(-1) for glutamine and 91 +/- 4 to 88 +/- 5 micromol . kg FFM(-1) . h(-1) for amino acids). The decrease in the estimates of whole-body protein degradation did not differ significantly between the 2 supplemental groups. CONCLUSION: Oral glutamine or amino acid supplementation over 10 d equally inhibits whole-body protein degradation in DMD.     

Glutamine-enriched total parenteral nutrition in patients with inflammatory bowel disease

BACKGROUND: Studies in animal models of inflammatory bowel disease (IBD) suggest that supplementation of total parenteral nutrition with glutamine (gln), a conditionally essential amino acid in catabolic conditions, increases gln plasma concentrations, reduces intestinal damage, improves nitrogen balance and may improve the course of the disease. However, human data supporting this assumption are missing. METHODS: A total of 24 consecutive patients with an acute exacerbation of IBD (19 Crohn's disease; five ulcerative colitis) and scheduled for total parenteral nutrition (TPN) (>7 days) were randomised. Parallel to a standardised anti-inflammatory therapy, the patients received either a TPN with 1.5 g/kg body weight of a standard amino acid or an isonitrogenic, isocaloric TPN with 1.2 g/kg body weight of a standard amino acid and 0.3 g/kg L-alanine-L-glutamine. Primary end points were gln plasma concentrations and intestinal permeability assessed by urinary lactulose and D-xylose ratio. RESULTS: Gln plasma levels did not differ significantly in either group throughout the study. Intestinal permeability did not change within 7 days either with or without gln supplementation (Delta-lactulose/xylose ratio: 0.01+/-0.05 (gln+) vs 0.02+/-0.1 (gln-)). The observed changes in inflammatory and nutritional parameters, and also disease activity, length of TPN and hospital stay, were independent of glutamine substitution. Five (41%) patients in the gln+ group and three (25%) patients in the gln- group needed surgical intervention. CONCLUSION: Although limited by the sample size, these results do not support the hypothesis that glutamine substitution has an obvious biochemical or clinical benefit in patients with active IBD scheduled for total parenteral nutrition.     

Effects of glutamine-enriched total parenteral nutrition on acute pancreatitis

AIM: This study was performed to determine the effects of glutamine enriched total parenteral nutrition (TPN) on the patients with acute pancreatitis (AP). METHOD: Forty patients with AP, who had Ranson's score between 2 and 4 received either standard TPN (control group) or TPN with glutamine (treatment group). The patients in the treatment group received TPN containing 0.3 g/kg/days glutamine. At the end of the study, patients were evaluated for nutritional and inflammatory parameters, length of TPN and length of hospital stay. RESULTS: The length of TPN applications were 10.5+/-3.6 days and 11.6+/-2.5 days, and the length of hospital stays were 14.2+/-4.4 and 16.4+/-3.9 days for the treatment and control groups (NS), and the complication rates in the treatment and control groups were 10 and 40%, respectively (P<0.05). The transferrin level increased by 11.7% in the group that received glutamine-enriched TPN (P<0.05), whereas the transferrin level decreased by 12.1% in the control group (NS). At the end of the study, slight but not significant changes were determined in both groups in fasting blood sugar, albumin, blood urea nitrogen (BUN), creatinine, total cholesterol concentrations, aspartate aminotransferase (AST), alanine transaminase (ALT) and lactate dehydrogenase (LDH) activities, leukocytes, CD(4), CD(8), serum Zn, Ca and P levels compare to the baseline levels (NS). Significant decreases were determined in serum lipase, amylase activities and C-reactive protein (CRP) levels in both groups (P<0.05). CONCLUSIONS: The results of this study have shown that glutamine supplementation to TPN have beneficial effects on the prevention of complications in patients with AP.     

Leucine supplementation has an anabolic effect on proteins in rabbit skin wound and muscle

We investigated the effect of leucine supplementation on protein metabolism in skin wounds and muscle in anesthetized rabbits. l-[ring-(13)C(6)]phenylalanine was infused on d 7 after the ear was scalded, and the scalded ear and uninjured hindlimb were used as arteriovenous units to reflect protein kinetics in skin wounds and muscle. In comparison with a commercially available amino acid solution (10% Travasol), isonitrogenous [1638 micromol/(kg . h)] infusion of the amino acid solution with supplemental leucine to account for 35% of total nitrogen increased the net phenylalanine balance (P < 0.05) in the skin wound and muscle from -6.7 +/- 6.1 to 0.9 +/- 1.4 and from -4.4 +/- 2.4 to -1.0 +/- 0.4 micromol/(100 g . h), respectively. Infusion of leucine alone did not significantly improve the net phenylalanine balance in either skin wounds [-4.0 +/- 4.6 micromol/(100 g . h)] or muscle [-2.7 +/- 0.7 micromol/(100 g . h)]. We conclude that leucine supplementation had an anabolic effect on proteins in skin wounds and muscle, provided that adequate additional amino acids were also available.     

Nitrogen requirement of amino acid mixture with maintenance energy in young men

The effect of energy on nitrogen balance was examined in young men given amino acid mixture. The minimum amino acid nitrogen requirement for nitrogen equilibrium was determined together with the egg protein requirement. In experiment 1, the nitrogen sparing effect of energy was evaluated in four male students receiving diet containing an amino acid mixture and a constant nitrogen intake of 3.5 g N/day, which was equivalent to the nitrogen requirement with excess energy intake determined by Rose and Wixom (1). When the dietary energy supply was 45 kcal/kg, which is approximately the maintenance level, the mean nitrogen balance was negative, being -23.9 +/- 9.3 mg N/kg. However, with an excess energy intake of 55 kcal/kg, the nitrogen balance improved significantly, being -6.1 +/- 7.7 mg N/kg. In experiment 2, the nitrogen requirement of egg-pattern amino acid mixture for apparently zero balance was evaluated at maintenance energy intake in 28 Japanese young men and was compared with that of egg protein. After receiving standard diet, the subjects were given a semi-purified experimental diet containing egg-pattern amino acid mixture at nitrogen intake levels of 60, 75, 100, and 130 mg N/kg for two weeks. Then all groups except the 60 mg N/kg group were given isonitrogenous egg protein diet for another week. Energy intake was kept constant at approximately the maintenance level of 44.4 +/- 1.4 kcal/kg throughout the experiment. Nitrogen balance was not significantly different in groups given egg-pattern amino acid mixture and intact egg protein in each nitrogen intake level. From regression analysis, the nitrogen requirement for nitrogen equilibrium of the amino acid mixture was calculated to be 110.1 +/- 50.2 mg N/kg, which was not significantly different from the value of 88.4 +/- 40.6 mg N/kg of egg protein. It was concluded that the total amino acid requirement estimated by Rose and Wixom (1) was too low because they gave excess energy, and that there was no difference between the nitrogen requirement of egg protein and that of the corresponding amino acid mixture.     

A double-blind, placebo-controlled, glutamine-supplementation trial in growth-faltering Gambian infants

BACKGROUND: Growth faltering during infancy is a characteristic of life in developing countries. Previous studies have shown that small-intestine mucosal enteropathy, accompanied by endotoxemia and a persistent systemic inflammatory response, accounts for up to 64% of the growth faltering in Gambian infants. OBJECTIVE: The objective was to test whether glutamine, with its putative trophic effects on enterocytes, immune cells, and intestinal integrity, can accelerate the repair of the intestine, lower immunostimulation, and reduce growth faltering. DESIGN: Ninety-three infants aged 4-10 mo from the West Kiang region of The Gambia were studied in a double-blind, double-placebo, controlled trial. Glutamine (0.25 mg/kg body wt) or a placebo that contained an isonitrogenous, isoenergetic mix of nonessential amino acids was orally administered twice daily throughout the 5-mo rainy season. Anthropometric measurements were made monthly during the supplementation period and for 6 mo after supplementation. Intestinal permeability was measured monthly (by determining the ratio of lactulose to mannitol), and finger-prick blood samples were collected for the analysis of plasma proteins on 3 occasions. RESULTS: Gambian infants showed a seasonal deterioration in growth and persistently elevated acute phase protein concentrations and intestinal permeability. Oral supplementation with glutamine did not improve growth (x +/- SE: weight gain, 60 +/- 19 and 69 +/- 20 g/mo; length gain, 1.01 +/- 0.05 and 0.95 +/- 0.03 cm/mo) or intestinal permeability [lactulose:mannitol ratio: 0.29 (95% CI: 0.23, 0.35) and 0.26 (95% CI: 0.21, 0.32)] in the glutamine and placebo groups, respectively. It also had no effect on infant morbidity or on plasma concentrations of immunoglobulins or acute phase proteins. CONCLUSION: Glutamine supplementation failed to improve growth or intestinal status in malnourished Gambian infants.     

青少年营养转型期体重指数与血压、血脂、血糖、心脏结构及功能相关关系的队列研究

目的应用队列研究方法探讨超重／肥胖学龄儿童在青少年期体重指数(BMI)与血压、血脂、血糖、心脏结构及功能的相关关系。方法采用整群抽样横断面调查与追踪调查的流行病学方法调查北京市健康学龄儿童(7-11岁)与9年后同一观察对象(16-20岁)共193名,于基线时(9年前)及随访时(9年后)对每名学生均测量身高、体重、血压,并均应用生化法于空腹12小时后抽血检查血清总胆固醇、血糖和甘油三酯水平。应用超声心动图方法检测随访时16-20岁学生的心脏结构、血流及功能。根据儿童期BMI值分为儿童期肥胖组、超重组、正常体重组,比较同一观察对象儿童期与青少年期各项指标的变化。结果同一人群青少年期较儿童期血脂、血糖水平无明显差异。儿童期肥胖组较正常体重组于9年后随访时(青少年期)的BMI(24．71 kg／m2±4．57 kg/m2和20．54 kg／m2±2．84 kg／m2)及收缩压(117．22 mm Hg±17．44 mm Hg和102．20 mm Hg±11．68 mm Hg,1 mm Hg=0．133 kPa)明显增高(P<0．001和P<0 05),室间隔增厚(0．87 cm±0.12 cm和0．77 cm±0．12 cm)及左室后壁增厚(0．91 cm±0．13 cm和0．79 cm±0．31 cm)(P<0．01和P<0．05)、左室心肌质量(167．84 g±16．29 g和128．95 g±63．00 g)及左室心肌质量指数(88．12 g／m2±17．19 g／m2和79．35 g／m2±39．01g/m2)明显增加(P值均<0．05),差异有统计学意义;左室舒张末期容积及心输出量增加,射血分数及左室短轴缩短率下降(P值均<0．05),心脏舒张功能各项指标体重正常组与肥胖组及超重组间差异均无统计学意义。结论学龄肥胖儿童较学龄体重正常儿童在成长为青少年后,BMI及血压明显增高,左室壁增厚,左室心肌质量增加,提示儿童期单纯肥胖症是成年后心血管疾病的重要危险因素。     

Long-term validation of 1 g of protein per kilogram body weight from a predominantly vegetable mixed diet to meet the requirements of young adult males

Eight healthy young men participated in a 90-d metabolic balance study designed to assess the adequacy of 1 g of protein (N X 6.25) per kilogram body weight per day provided by a predominantly vegetable diet. The mean gross energy intake of the subjects was 49 kcal/(kg X d). The individuals received the experimental diet for eleven 8-d experimental periods. Three isoenergetic, isonitrogenous meals were served at 0800, 1200 and 1900. Anthropometric measurements and biochemical determinations in blood were made at the beginning of the study and afterwards at regular 15-d intervals. Body weight was measured daily. The mean overall weight change for the group was -0.8 kg. The mean daily urinary nitrogen output decreased from an initial value of 134.6 mg/(kg X d) to a final figure of 115.1 mg/(kg X d) (P less than 0.01), while the daily fecal N decreased from 31.5 to 26.3 mg/(kg X d) (P less than 0.05). Mean cumulative nitrogen balances were slightly positive for seven out of the eight individuals with an overall mean nitrogen balance value of +6.7 mg N/(kg X d). Biochemical and hematological values showed no significant changes throughout the study, except for a decrease in serum cholesterol. It is concluded that the "Chilean" mixed diet fed at the level of 1 g of protein per kilogram body weight per day with sufficient energy meets the long-term protein-energy needs of healthy young men, thus supporting the 1984 FAO/WHO/UNU safe recommended daily protein allowance of 0.75 g of reference protein, with a correction for the lower digestibility of vegetable sources.     

Effect of enterally administered n-3 polyunsaturated fatty acids in acute pancreatitis--a prospective randomized clinical trial

BACKGROUND: In acute pancreatitis (AP) administration of n-3 polyunsaturated fatty acids (PUFAs) might change the course of the disease through modulation of eicosanoid synthesis. PATIENTS AND METHODS: In a prospective, randomized clinical trial from 28 patients with moderate-severe AP, 14 received n-3 PUFAs (fish oil) enterally (3.3g/day for 5-7 days). Measurement of erythrocyte superoxide-dysmutase (SOD) activity, serum total antioxidant status (TAS), vitamin A and E, fatty acids, C-reactive protein, transthyretin concentrations were performed at admission, day 3, 7 and 14. RESULTS: The n-3 to n-6 LCPUFA ratios increased significantly in serum lipids of the patients receiving n-3 PUFA supplementation, whereas remained unchanged in the controls. Supplementation resulted in significant decrease in length of hospitalization (13.07+/-6.70 vs. 19.28+/-7.18 days, P<0.05) and jejunal feeding (10.57+/-6.70 vs. 17.57+/-10.52, P<0.05). Complications developed in 6/14 (42%) of treated and 9/14 (64%) of control patients. The SOD activity was significantly higher at day 3 in the supplemented group (P<0.05), but there were no significant differences between the two groups in other antioxidants and acute phase reactants. CONCLUSION: The use of enteral formula enriched with n-3 PUFAs in the treatment of AP seems to have clinical benefits based upon the shortened time of jejunal feeding and hospital stay.     

Resistance training reduces fasted- and fed-state leucine turnover and increases dietary nitrogen retention in previously untrained young men

We aimed to determine the impact of intense resistance training, designed to increase lean body mass (LBM), on both fasted and fed whole body protein kinetics in untrained young men. Twelve healthy males (22 +/- 2 y of age; BMI, 24.3 +/- 2.4 kg/m(2)) participated in a 12-wk (5-d/wk) resistance training program. Before and after training, a primed constant infusion of [1-(13)C]leucine was used to measure whole body leucine turnover, protein breakdown, and nonoxidative leucine disposal in the fasted and fed states. Participants were studied during 5-d controlled diet periods that provided a moderate protein intake [1.4 g/(kg body wt . d)]. We estimated protein turnover and nitrogen balance. Training increased LBM (61.6 +/- 6.9 vs. 64.8 +/- 6.7 kg, P < 0.05). After training, whole body leucine turnover was reduced (P < 0.01) in both fasted (167 +/- 18 vs. 152 +/- 17) and fed (197 +/- 23 vs. 178 +/- 21) states [all values micromol/(kg LBM . h)]. Training-induced decreases (P < 0.01) in protein breakdown occurred in the fasted (165 +/- 18 vs. 144 +/- 17) and fed (111 +/- 23 vs. 93 +/- 20) states. Following training, nonoxidative leucine disposal was similarly reduced (P < 0.01) in the fasted (144 +/- 18 vs. 126 +/- 18) and fed (151 +/- 20 vs. 133 +/- 19) states. Nitrogen balance was more positive after training (13.7 +/- 8.1 vs. 33.4 +/- 12.5 g/(kg LBM . d), P < 0.01) indicating an increased retention of dietary nitrogen. Intense resistance training alters whole body protein kinetics in novice weightlifters regardless of feeding status. The increase in nitrogen balance after training demonstrates a more efficient utilization of dietary nitrogen, suggesting that protein requirements for novice weightlifters are not elevated.     

Nutritional and clinical efficacy of ornithine alpha-ketoglutarate in severe burn patients

Ornithine alpha-Ketoglutarate (OKG) displays anabolic and anticatabolic properties in situations of stress. However, studies including both biological and clinical end points are scarce. In this prospective, randomized and double-blind study, 60 patients who had undergone severe burns (20-60% of body surface area) received either ornithine alpha-ketoglutarate (20 g/day) or an isocaloric placebo, for 21 days, starting mean 4 days after injury. In the OKG group, nitrogen balance reached positive values at d5 and stabilized at higher levels vs controls (P< 0.05 or less from day 3 to day 21), resulting in a strongly positive cumulated nitrogen balance at day 21 (mean +/- SEM, OKG group: +127 +/- 13; Control group: -63 +/- 18g nitrogen). As measured at day 21, transthyretin and RBP levels were higher in the OKG group (respectively 259 +/- 9 vs 161 +/- 10, and 45 +/- 1 vs 33 +/- 1 mg/l, P< 0.001). Body weight loss was counteracted at d21 in the OKG group (-2.6% vs -6.3%, P< 0.001). Assessment of the quality of wound healing using objective scoring showed better performances in the OKG group (P< 0.05). The results suggest that improvement in nutritional parameters observed during the treatment of burn-injured patients with ornithine a-ketoglutarate allows better clinical recovery.     

Hyperemesis gravidarum and fetal outcome

BACKGROUND: Hyperemesis gravidarum (HG) is reported in 0.5-2% of all pregnancies. The purpose of this research was to evaluate the relationship of maternal HG, neonatal birth weight, and birth outcomes. METHODS: This is a prospective cohort study of 45 patients diagnosed, by Fairweather's criteria, with HG compared with 306 non-HG control pregnant patients with singleton pregnancies. Sociodemographic and clinical data were obtained from the pregnant patients. Neonatal data were also collected, including indicators of neonatal wellness. RESULTS: Significantly higher incidences of being nonwhite (33% vs 16%; p < .05) and of attaining post-high school education (60% vs 38%) were noted in the HG group, relative to controls. Mothers in the control group experienced greater gestational weight gain, 14.9 +/- 0.3 kg (mean +/- SEM) relative to mothers in the HG group (10.6 +/- 1.3 kg). Infants from HG pregnancies manifested significantly lower birth weight (3.23 +/- 0.09 kg vs 3.52 +/- 0.03 kg), younger gestational age (38.4 +/- 0.3 weeks vs 39.7 +/- 0.1 weeks), and a greater length of hospital stay (2.9 +/- 0.5 days vs 1.8 +/- 0.1 day), relative to infants from the control group. After undergoing multivariate analysis, HG was a significant predictor of decreased gestational age and increased hospital length of stay. CONCLUSIONS: Infants born of women who had HG are more likely to experience decreased gestational age and increased length of hospital stay. Efficacy of early and aggressive treatment of HG, including nutrition support, in minimizing these outcomes needs to be studied.     

Dose dependency of the effect of ornithine alpha-ketoglutarate on tissue glutamine concentrations and hypercatabolic response in endotoxaemic rats

The optimal dosage of ornithine alpha-ketoglutarate (OKG) for repleting tissue glutamine (Gln) concentrations and maintaining N homeostasis after injury is unknown. We set out to perform 'dose-ranging' of OKG supplementation after an endotoxaemic challenge. Sixty-one male Wistar rats were injected with 3 mg lipopolysaccharide (LPS) from Escherichia coli/kg (n 50) or saline vehicle (9 g NaCl/l; controls n 11). After a 24 h fast, survivors were fed by gavage for 48 h with a polymeric standard diet (879 kJ/kg per d and 1.18 g N/kg per d) supplemented with non-essential amino acids (control, n 11; LPS-OKG-0.0, n 9), or with 0.5 g OKG/kg per d (LPS-OKG-0.5, n 12), 1.5 OKG/kg per d (LPS-OKG-1.5, n 11) or 4.5 g OKG/kg per d (LPS-OKG-4.5, n 10). The diets for all groups were made isonitrogenous with the LPS-OKG-4.5 diet by adding an appropriate amount of non-essential amino acids. Rats were killed on day 3 for blood and tissue sampling (muscle, jejunum mucosa, liver). Urine was collected daily for 3-methylhistidine and total N assays. The OKG dose was correlated with Gln concentrations in every tissue and with cumulative N balance (Spearman test, P<0.01). 3-Methylhistidine excretion was increased in endotoxaemic groups compared with controls (ANOVA, P<0.05) except in the LPS-OKG-4.5 group. Only the LPS-OKG-4.5 group achieved a positive post-injury N balance (t test, P<0.05). In conclusion, OKG exerted a dose-dependent effect on tissue Gln concentration and N balance, but only the highest dosage counteracted myofibrillar hypercatabolism and caused a positive N balance.     

Aerobic exercise training increases skeletal muscle protein turnover in healthy adults at rest

The effect of a 4-wk aerobic exercise training program (30-45 min, 3-5 d/wk, >or=65% maximal heart rate) on mixed skeletal muscle protein fractional synthetic rate (FSR), fractional breakdown rate (FBR), and net protein balance (FSR - FBR) (NET) was examined in 8 healthy, previously unfit men and women [21.0+/- 0.4 y, 163.7+/- 4.4 cm, 75.6+/- 5.7 kg, 33.5+/- 4.1% body fat, VO(2 peak) 38.6+/- 2.3 mL/(kg.min)] fed eucaloric diets providing 0.85 g protein/(kg.d) for the 6-wk study. Measurements were made at baseline after 2 wk of diet intervention only, and after 4 wk of aerobic exercise training and diet intervention. Primed continuous infusions of ring-[(2)H(5)]-phenylalanine (2 micromol/kg; 0.05 micromol/(kg.min) and [(15)N]-phenylalanine (2 micromol/kg; 0.05 micromol/(kg.min) were used to assess skeletal muscle protein turnover at rest via the precursor-product method. Endurance training improved cardiovascular fitness, with a significant increase in VO(2 peak) (P<0.01) and a significant decrease in running time on a standard course (P<0.01). There were o significant changes in body mass or composition. There was a significant increase in FSR (0.077+/- 0.007 vs. 0.089+/- 0.006%/h, P<0.05) and decrease in NET (FSR - FBR) (-0.023 +/-0.004 vs. -0.072 +/- 0.012%/h, P < 0.05); FBR tended to increase (0.105+/- 0.014 vs. 0.143+/- 0.018%/h; P=0.06) after training. Findings show that aerobic training for 4 wk increases skeletal muscle protein turnover in previously unfit subjects.     

Implementation of dietitian recommendations for enteral nutrition results in improved outcomes

A primary role of the registered dietitian (RD) is to assess nutritional needs of patients in states of physiological stress and illness and to recommend changes to diet and tube feedings when warranted. However, implementation of changes is dependent upon the physician accepting the recommendations of the RD. This study evaluated outcomes of two groups of enterally fed patients in a long-term acute-care facility in northwest Louisiana: (a) those for whom the physician accepted RD recommendations; and (b) those for whom the physician did not accept RD recommendations. Data showed that physician-prescribed enteral formulas provided 10.0% less kilocalories and 7.8% less protein than the RD-assessed needs. t tests showed that when RD recommendations were implemented, patients had a significantly shorter length of stay (28.5+/-1.8 vs 30.5+/-4.8 days, P<0.05), as well as significantly improved albumin (0.13+/-0.17 vs -0.44+/-0.21 g/dL [1.3+/-1.7 vs -4.4+/-2.1 g/L], P<0.05) and weight gains (0.51+/-0.1 vs -0.42+/-0.2%, P<0.05) when compared to those who continued with physician's orders. These data suggest that if RDs had the authority to write nutrition orders and provide early nutrition intervention, patient care would improve.     

Effect of glutamine-enriched total parenteral nutrition in patients with acute pancreatitis

BACKGROUND: The management of acute pancreatitis (AP) frequently includes parenteral nutrition, but conditionally essential amino acids such as glutamine are not included in conventional total parenteral nutrition (TPN).AIM: This study was conducted to determine whether the inclusion of glutamine has a beneficial effect in patients with AP receiving TPN. METHODS: In a randomized, controlled study 28 patients with AP received either a standard TPN with 1.5 g/kg body weight protein or an isonitrogen, isocaloric TPN which contains 0.3 g/kg L -alanine- L -glutamine. Patients were assessed for nutritional and inflammatory parameters, infectious complications, length of TPN, length of hospital stay (LOS) and cost of TPN. RESULTS: There were no side-effects related to glutamine substitution observed. Glutamine was associated with a significant increase of cholinesterase, albumin and lymphocyte count in AP as well a decrease of C-reactive protein compared to standard TPN at day 14. There was a reduced length of TPN (10 [6-16] vs 16 [10-18] days, P<0.05) and a trend of reduced LOS (21 [14-32] vs 25 [19-40] days) in AP patients receiving glutamine. The overall cost per patient for TPN did not differ (gln+: 929+/-586 vs gln-: 981+/-507 euro/patient). CONCLUSION: Our results suggest that glutamine substitution is beneficial and does not increase the overall cost of parenteral feeding in patients with acute pancreatitis.     

Improved fatty acid and leukotriene pattern with a novel lipid emulsion in surgical patients

OBJECTIVE: We assessed the effects of a novel lipid emulsion with reduced content of n-6 fatty acids (FA), increased share of MUFA and n-3 FA and supplemental vitamin E on fatty acid and leukotriene pattern in surgical patients. METHODS: In a double-blind, randomized study 33 patients received isonitrogenous, isocaloric TPN over 5 postoperative days following major abdominal surgery. 19 patients received the new SMOFlipid 20% and 14 patients a standard soybean oil emulsion (Lipovenoes 20%, both Fresenius Kabi), each 1.5 g fat/kg body weight (BW)/d. Routine lipid biochemistry, plasma tocopherol, fatty acid pattern in plasma phospholipids, as well as leukotriene (LT) release in leukocytes were assessed. Additionally, fatty acid pattern in leukocyte and platelet phospholipids were analysed, but results are not presented. RESULTS: On day 6, plasma alpha-tocopherol (34.2 +/- 10.3 vs. 17.6 +/- 2.9 micromol/L) and, in plasma PL, total n-3 FA were higher (11.1 +/- 1.9 vs. 4.9 +/- 0.9 mol%; p < 0.05) and total n-6 FA lower (23.8 +/- 2.2 vs. 31.8 +/- 1.7 mol%; P < 0.05); the ratio n-3/n-6 FA being elevated (0.5 +/- 0.1 vs. 0.2 +/- 0.0 p < 0.05) with SMOFlipid compared to the soybean oil emulsion. The shares of EPA (3.3+/-1.0 vs. 0.4+/-0.2 mol%; p<0.05) and DHA (6.9 +/- 1.8 vs. 3.7 +/- 0.8 mol%; p < 0.05) were highly increased but that of arachidonic acid (AA) was unchanged with SMOFlipid while the ratio EPA/AA was increased (0.7 +/- 0.2 vs. 0.1 +/- 0.0 p < 0.05). LTB(5) release was enhanced on day 6 (8.1 +/- 5.3 vs. 1.8 +/- 3.8 pmol/10(7) PMN, p < 0.05) and liberation of LTB(4) was lowered, yet not significantly with SMOFlipid (124.0 +/- 51.2 vs. 152.1 +/- 68.8 pmol/10(7) PMN). Length of hospital stay was significantly shorter with SMOFlipid (13.4 +/- 2.0 vs. 20.4 +/- 10.0 days, p < 0.05). CONCLUSION: Treatment with the new emulsion SMOFlipid is well tolerated and modulates FA and leukotriene pattern suggesting favourable anti-inflammatory effects and further clinical benefits.