Growth hormone enables effective nutrition by peripheral vein in postoperative patients: a pilot study.

The purpose of this pilot study was to investigate the metabolic effects of growth hormone (GH) (Humatrope, Eli Lilly & Co., Indianapolis, IN) administration in postoperative (PO) patients receiving peripheral vein nutrition. Seven, well-nourished, nondiabetic patients undergoing elective surgical procedures were given either no drug (n = 3), GH 30 micrograms/kg/day (n = 2), or GH 60 micrograms/kg/day (n = 2) sub-Q daily until eating, up to 7 days PO. All the patients received 5% dextrose with electrolytes in the first 24 hours PO and then received calories at 80 +/? 5% of the measured resting energy expenditure (REE) and amino acid at 1 g/kg/day with electrolytes, vitamins, and minerals. There were no significant outcome differences between the 30 and 60 micrograms/kg/day groups and, therefore, these groups were analyzed together (n = 4). By day 6 of the study, the GH group had a significant reduction in the respiratory quotient (RQ) measured by indirect calorimetry; an increase in nitrogen retention; an increase in plasma transferrin concentrations; and an increase in plasma insulinlike growth factor (IGF1) concentration. There was no increase in blood glucose concentrations, or decrease in urinary 3-methylhistidine excretion; and no adverse effects occurred. We concluded that GH in PO patients on hypocaloric nutrition promoted protein synthesis, fat oxidation, and nitrogen retention. Effective parenteral nutritional support in postoperative adult patients can be achieved without the use of central vein access.     

Growth hormone as a nutritional adjunct in cystic fibrosis: results of a pilot study

Growth hormone (GH) stimulates linear growth and improves nitrogen balance in many catabolic states, including sepsis, and in malnutrition associated with chronic obstructive pulmonary disease. In children with cystic fibrosis (CF), these anabolic effects could aid survival and enhance suitability for transplantation. We assessed response to 0.49 IU/kg/week of recombinant human growth hormone (hGH) for 6–12 months in seven children with cystic fibrosis. All showed an initial increase in height velocity (0.33-4.14 cm/year) and height standard deviation score (P<0.01). Knemometry also demonstrated a significant improvement in lower leg growth [P < 0.05). Weight velocity increased in five patients but there was no change in body mass index or skinfold thickness. The number of respiratory exacerbations decreased during therapy, although there was no measurable improvement in respiratory function. Growth hormone may be a useful adjunct therapy in cystic fibrosis.     

Nightly enteral nutrition support of elderly hip fracture patients: a pilot study

OBJECTIVES: Assess whether postoperative nightly enteral nutrition support improves outcomes of elderly patients with an acute hip fracture DESIGN: Randomized controlled trial. SETTING: A University and a Department of Veteran's Affairs Hospital SUBJECTS: Adults >64 years of age who underwent surgical repair of an acute hip fracture. INTERVENTIONS: Subjects randomized to the control (Ctrl) group received standard care while the treatment (Tx) group received standard care plus up to 1,375 Kcal [5,755 kJ/d] of nasoenteral tube feedings each night. When tube feedings had to be discontinued, Tx subjects were asked to drink an equivalent amount of the nutritional supplement each night. Measures of Outcome: Rate of postoperative complications and 6-month postoperative survival. RESULTS: Fifty-seven patients were randomized to the Tx (n = 27, mean age 75.9 +/- 7.4 yrs) or Ctrl groups (age 81.7 +/- 7.7 yrs). All subjects had reduced volitional nutrient intakes after surgery. During the first week subsequent to surgery, there was no difference between the treatment and control groups in the amount of nutrients that they volitionally consumed during the day. However, the treatment subjects had a greater total daily nutrient intake (Median 5,866 (IQR 5,024 to 7,335) kJ/d vs. 3,965 (IQR 2,968 to 4,664) kJ/d, p < 0.001). However, by the second postoperative week this difference was no longer statistically significant. Intolerance to the tube feedings developed commonly. There was no difference between the groups in the rate of postoperative life-threatening complications or mortality within six months subsequent to surgery. CONCLUSIONS: This study failed to confirm findings from a prior study of improved postoperative survival with nutrition support. However, it was conducted on multiple hospital wards which may have contributed to the higher rate of tube-related problems and less nutrient delivery signifying the need for further study.     

Interactive learning for congregate nutrition site nutrition education: a pilot study

Older adults who participate in the Older Americans Act Title III-C Elderly Nutrition Program often are at moderate to high nutritional risk. Although nutrition education is a component of the Elderly Nutrition Program, there are numerous barriers to promoting behavior change in older adults. Nutrition education programs targeted to congregate nutrition site participants must address their unique nutritional needs, while engaging them in activities that promote learning and motivate them to make positive behavior changes. This paper describes a pilot study of a theory-driven, five-lesson educational module designed to promote healthful eating behaviors among congregate nutrition site participants through interactive learning.     

门静脉与外周静脉途径肠外营养代谢效应的比较

12例大肠癌手术患者随机分成二组,6例术中留置门脉导管.术后第2日行肠外营养5日,每日提供6.2gN及1340keal非蛋白热卡,糖/脂热卡比为62%:38%,营养液经门静脉(门脉组)或外周静脉(对照组)输入.血浆白蛋白、三酸甘油酯、胆固醇、胆红素、转氨酶及血糖在营养前后均行监测,未见明显改变.营养结束时累积氮平衡门脉组与对照组分别为-0.13±2.40与-5.72±2.98gN/5d(P<0.01),提示经门静脉PN能更好地维持氮平衡.     

Study of hypocaloric peripheral parenteral nutrition in postoperative patients (European project)

The objective of this study is to ascertain whether or not the supply of a low-calorie amino acids (AA) parenteral solution is useful in postoperative patients, by assessing a series of parameters that indicate nutritional status. 75 postoperative patients who met at least 2 of the 3 criteria: 1) albumin less than 3 g/dl; 2)prealbumin less than 21 mg/dl; 3) body weight less than 95% of ideal weight, were studied. Patients were divided into 4 groups: control group, 15 patients receiving conventional infusion therapy; group I, 20 patients receiving glucose + AA; group II, 20 patients receiving glycerol + AA; and group III, 20 patients receiving sorbitol-xylitol + AA. The most significant findings were a prompt recovery of short half-life proteins (prealbumin and retinol binding protein), a less negative nitrogen balance, a greater decrease in urinary 3-methylhistidine and a marked increase in most AAs when hypocaloric peripheral parenteral nutrition (HPPN) was used. As regards complications, suture dehiscence occurred in a greater percentage of control patients than in the active therapy groups (13.3% versus 5%) and, in contrast, a greater number of cases of infusion phlebitis was observed in the HPPN groups. Clinical data were not statistically significant. We conclude that HPPN is a valid means for providing nutritional support but, at present, there are few randomized, controlled studies that show that its use is clearly beneficial.     

重组人生长激素对术后患者营养状态的影响

目的探讨小剂量重组人生长激素对腹部手术患者营养状态的影响。方法48例需行腹部手术的患者随机分为3组，A、B组每日给予重组人生长激素皮下注射0.15U·kg－1·d-1和0．075U·kg-1·d-1，C组为对照组，以生理盐水为安慰剂。每例患者进行体重、握力、上臂中部周长、尿中尿素氮、肌酐、血中转铁蛋白及淋巴细胞总数定期测定和相关性分析。结果A组患者的体重、握力较C组显著增加（P＜0.05）；A组累积氮平衡亦明显高于对照组（P＜0.05）;其余指标无显著改变。而B组各项指标变化与对照组比较均无统计学差异。结论重组人生长激素能促进术后患者的蛋白质合成，尽快达到正氮平衡，增加患者的体重和握力，提高术后生活质量和对手术打击的耐受性，加速患者恢复，其作用与剂量有关。     

Parenteral nutrition via peripheral veins: a feasibility study.

Twenty patients who had undergone uncomplicated surgery of moderate severity were randomly allocated to two groups (both n = 10) who were fed using a peripheral vein for up to six days. Group I received, each day, a nutrient solution providing 10 grams of nitrogen as Perifusin (E Merck Ltd) and 1400 calories as dextrose and Intralipid (Kabivitrum Ltd) with an osmolality of 490 mosmol/kg. Group II received only 15 grams of nitrogen per day as Perifusin with an osmolality of 376 mosmol/kg. The mean (+/- s.e. mean) nitrogen balance over the study was similar in both groups, in Group I being -1.23 +/- 0.89, and in Group II being -1.05 +/- 1.08 g (P greater than 0.05 Mann-Whitney U test). The nutrient mixture given to Group I resulted in elevated levels of serum 3-hydroxybutyrate and lower levels of serum non-esterified fatty acids. These data suggest that lipolysis and ketogenesis were suppressed. There was no significant difference in serum lactate levels in either group. Venous thrombophlebitis at the infusion site was assessed daily using Maddox's criteria, with a minimal degree of inflammation occurring in either group. This preliminary study suggests that a total parenteral feeding regimen may be designed for peripheral vein infusion. Further studies are indicated.     

胃癌和结直肠癌病人术后不同途径营养支持的比较

目的:比较不同营养支持途径对胃癌和结直肠癌病人术后指标的影响。方法:将120例胃癌和结直肠癌根治术后病人,随机分为EEN组、PN组和对照组(传统营养)三组,每组40例。EEN组和PN组于术后第1和第2天给予1/3、2/3目标量。第3至第8天维持目标量,两组病人基本等氮、等热量。对照组按传统做法给予禁食、流质和半流质。于手术前1天和术后第9天检测病人血清ALB、TF、PA、CD3、CD4、CD4/CD8,记录营养支持不良反应的发生率、胃肠道功能恢复时间、感染性并发症的发生率、营养支持费用和感染性并发症的治疗费用。结果:手术前1天EEN组、PN组和对照组营养指标、免疫指标水平无显著性差异。术后第9天EEN组和PN组的营养指标、免疫指标水平均优于对照组(P<0.01)。EEN组和PN组的营养指标无显著性差异(P>0.05),但EEN组的免疫指标高于PN组(P<0.05)。EEN组和PN组营养支持不良反应的发生率无显著性差异(P>0.05)。EEN组胃肠道功能恢复时间早于PN组和对照组(P<0.01)。EEN组感染性并发症的发生率低于PN组(P<0.05),EEN组营养支持费用和感染性并发症治疗费用均少于PN组(P<...     

Pre- and postoperative immunonutrition in patients undergoing liver transplantation: a pilot study of safety and efficacy

BACKGROUND & AIMS: Malnutrition is common in patients with end-stage liver disease and is a risk factor for post-transplant morbidity. The goal of this study was to assess the safety of an immune-enhancing diet in patients undergoing liver transplantation and to investigate its effects on nutritional status. METHODS: Fifteen consecutive patients received oral Impact (0.6l/d) for a median 54 (range 10-168)d pre-transplant and enteral Impact was started early after transplant. Total body protein was measured prior to commencing supplemental Impact, immediately prior to transplant and 10, 15, 30, 90, and 180 days post-transplant. The results were compared with those from 17 patients who received standard nutritional intervention. RESULTS: All study patients tolerated Impact pre- and postoperatively and there were no safety concerns. Over the preoperative period total body protein increased significantly (P = 0.017). In 7 patients followed for 6 months post-transplant, a significant (P = 0.026) loss of body protein occurred over the first 15 postoperative days which was regained by 6 months. In the patients who did not receive Impact, body protein did not change preoperatively and the loss after surgery was not regained. Infectious complications occurred in 5/15 (33%) Impact patients and 12/17 (71%) non-Impact patients (P = 0.074). CONCLUSIONS: In patients with end-stage liver disease, our results suggest the possibility that Impact may have a role in improving preoperative nutritional status, hastening recovery after transplant, and reducing postoperative infectious complications. These potential benefits need to be confirmed in a randomised controlled trial.     

Incidence of vein thrombosis in peripheral intravenous nutrition: effect of fat emulsions.

The relative risk of thrombophlebitis induced by either Long-chain Triglycerides (LCTs) or Medium-chain Triglycerides (MCTs) during peripheral i.v. nutrition (PIN) was evaluated. A total of 76 patients were randomly assigned into group A (n=40) and group B (n=36). The nutritional requirements in both groups were covered by a standardized regime of osmolality 1130 mOsm and pH 5.2, which provided 14 kg/day(-1) nitrogen, 600 kcal/day(-1) of carbohydrates and 1000 kcal/day(-1) of lipids. Group A received the lipids as pure LCTs while group B received a mixture of LCTs/MCTs at a ratio 1:1. The infused nutritional volume was 2000 ml and was delivered via a suitable vein in a proximal forearm, using a fine bore polyurethane 22G catheter. The two standardized regimes were evaluated over a 10 day period regarding the incidence of thrombophlebitis. The cumulative risk of thrombophlebitis was documented to be significantly lower in group A compared to group B (17.5% versus 44.4%, P < 0.05). LCTs appear to prolong peripheral vein feeding by lessening the reaction of venous endothelium to the irritating nutritional infusate.     

Can a nutrition intervention improve albumin levels among hemodialysis patients? A pilot study.

OBJECTIVE: To determine the effect of a tailored intervention on albumin levels among hemodialysis patients. DESIGN: Randomized controlled trial. SETTING: Eight freestanding chronic hemodialysis units in northeast Ohio. SUBJECTS: Eighty-three randomly selected adult patients who had been on dialysis for at least 6 months and had a mean albumin <3.7 g/dL (bromcresol green method) or <3.4 g/dL (bromcresol purple method) for the last 3 months. To better elucidate the feasibility and outcomes of the intervention, we selected more intervention than control patients. INTERVENTION: Dietitians of the 52 intervention patients determined whether any of the following potential barriers to adequate protein nutrition were present for each patient: (1) poor knowledge of protein-containing foods, (2) poor appetite, (3) needing help shopping or cooking, (4) low fluid intake, and (5) inadequate dialysis. Depending on the specific barriers present, the dietitians (1) educated patients on protein-containing foods, (2) recommended snacks for which patients had preserved appetite, (3) helped set up social supports, (4) provided recommendations on fluid intake, and/or (5) arranged for improved dialysis. Dietitians of the 31 control patients continued to provide usual care. MAIN OUTCOME MEASURES: Change in albumin after 6 months, stratified as minimal change (less than.25 g/dL increase or decrease), moderate improvement (.25 to.49 g/dL increase), and large improvement (increase of .50 g/dL or more). To examine the role of inflammatory states, we also determined serum C-reactive protein levels at the beginning and end of the trial. RESULTS: Among intervention patients, 29% had a minimal change in albumin, 44% had a moderate improvement, and 27% had a large improvement. Among control patients, 74% had a minimal change in albumin, 19% had a moderate improvement, and 6% had a large improvement (P <.001 for comparison of intervention and control subjects). About 60% of subjects had high baseline C-reactive protein levels (> 10 mg/L). However, there was little relationship between change in albumin and either baseline C-reactive protein levels or changes in C-reactive protein levels (P = .83). CONCLUSION: A nutrition intervention tailored to patient-specific barriers resulted in improved albumin levels even among patients with high C-reactive protein levels. Further work is needed to refine and test this intervention on a larger sample.     

肠内免疫营养制剂应用于食管癌术后病人的临床观察

目的:通过食管癌术后病人应用肠内免疫营养制剂观察营养状况和免疫功能的影响. 方法:将60例食管癌病人随机分为试验组(n=30)和对照组(n=30).试验组于术后第2天开始给予肠内免疫营养制剂(瑞能)至术后第7天;对照组术后给予全肠外营养.两组病人分别于术前1d、术后第2和第7天分别检测血清清蛋白(ALB)、前清蛋白(PA)、免疫球蛋白(IgG、IgA、IgM)、T淋巴细胞亚群(CD3+、CD4+、CD8+)水平.同时观察两组病人胃肠功能恢复情况、肝功能和术后感染性并发症的差异.结果:试验组病人术后胃肠功能和肝功能恢复得更早,并发症的发生率明显低于对照组(P＜0.05).试验组病人PA、IgG、IgA、CD3+、CD4+等营养和免疫指标明显升高,与对照组比有显著性差异(P＜0.05).结论:食管癌病人术后应用肠内免疫营养制剂能促进胃肠道功能尽早恢复,改善病人术后的营养状况和免疫功能.     

结直肠癌病人腹腔镜术后早期肠内营养的临床研究

目的:探讨结直肠癌腹腔镜手术和剖腹手术术后早期肠内营养(EEN)支持的效果和肠功能的恢复情况,并观察其安全性.方法:将32例结直肠癌病人随机分为两组,即剖腹组行剖腹手术;腹腔镜组行腹腔镜手术,每组16例.所有病人于术后第1天起给予同样肠内营养,并逐量增加,共6 d,前4 d同时给予肠外营养.观察肝肾功能、血脂、前清蛋白(PA)、肠功能恢复时间、消化道症状和各种相关并发症的发生情况等.结果:腹腔镜组较剖腹组术后肠功能恢复时间显著提前(P＝0.002).两组高密度脂蛋白、低密度脂蛋白、胆固醇和谷丙转氨酶经营养支持后与术前比均有显著性差异(P＜0.05).剖腹组肌酐、尿素氮术前和营养支持后比有显著性差异(P＝0.002,P＝0.012).剖腹组清蛋白营养支持后显著低于术前(P＝0.001),两组营养支持后清蛋白和总蛋白剖腹组显著低于腹腔镜组(P=0.004,P=0.031).结论:结直肠癌病人术后EEN支持,有利于营养状况恢复,是安全、合理的营养支持途径.在EEN治疗下腹腔镜组在营养状况和肠功能恢复上较剖腹组有明显优势.     

癌性阻塞性黄疸病人术后早期肠内营养支持的临床观察

目的:研究癌性阻塞性黄疸病人手术后早期肠内营养支持的效果与临床意义.方法:30例手术治疗的癌性阻塞性黄疸病人,随机分为术后早期肠内营养支持(EN)组和早期肠外营养支持(PN)组,对两组治疗结果进行回顾性分析.结果:两组病人术后体质量及血清前清蛋白、清蛋白、转铁蛋白均较术前降低,EN组降低小于PN组,但两组间差异不显著.EN组氮平衡总体上优于PN组,累计氮平衡为正氮平衡,PN组累计氮平衡为负氮平衡,两组间差异显著.EN对肝酶影响明显减轻,且治疗费用明显少于PN.结论:术后早期EN可以更安全、有效、经济地改善癌性阻塞性黄疸病人术后的营养不良状态.     

Impact of nutrition messages on children's food choice: pilot study

This pilot study tested the influence of nutrition message framing on snack choice among kindergarteners. Three classrooms were randomly assigned to watch one of the following 60s videos: (a) a gain-framed nutrition message (i.e. the positive benefits of eating apples) (n=14); (b) a loss-framed message (i.e. the negative consequences of not eating apples) (n=18); or (c) a control scene (children playing a game) (n=18). Following this, the children were offered a choice between animal crackers and an apple for their snack. Among the children who saw one of the nutrition message videos, 56% chose apples rather than animal crackers; in the control condition only 33% chose apples. This difference was statistically significant (chi2=7.56, p<0.01). These results suggest that videos containing nutritional messages may have a positive influence on children's short-term food choices.