Supplémentation en vitamine K lors de la nutrition parentérale chez l’enfant

The supplementation of vitamin K is necessary for total parenteral nutrition (TPN) patient to avoid hemorrhagic risk. In home TPN and to simplify the children administration, the vitamin K could be added once or twice monthly in admixtures. The aim of this work was to evaluate the vitamin K stability (20 mg/L) in usual conditions of administration (binary or ternary mixtures, at room temperature and at artificial light for 24 hours) and at storage (binary mixtures protected from light, at 4 °C for 12 hours). Each step of the study was performed with quantification using HPLC method coupled with UV detection at 244 nm on five TPN bags. The results of this study show that the vitamin K was stable for 24 hours at light exposure and at room temperature in binary mixture (96.6%) also ternary (99.8%). The vitamin K was stable at 4 °C for 12 days (98.4%). This work shows that vitamin K can be added directly in TPN and could avoid painful intramuscular injection. Such nutritional admixtures could be prepared beforehand and allow administration at home. This practice is actually consensual in gastro-enterology department at Necker University Hospital. A clinical and biologic monitoring is essential.     

Vitamin E and selenium status of patients receiving short-term total parenteral nutrition

In a prospective protocol, plasma tocopherols, selenium (Se), Se-dependent glutathione peroxidase, platelet aggregation and erythrocyte hemolysis were measured in 23 control subjects, and 15 patients receiving total parenteral nutrition (TPN), before and after 2 wk of TPN unsupplemented with vitamin E and Se. The results indicate that short-term TPN did not alter status of these nutrients. However, TPN patients had significantly lower plasma levels of Se (p less than 0.01) and alpha-tocopherol (p less than 0.01) relative to control subjects. Low plasma levels, with no attendant decrease in function, suggest a marginal depletion. In view of this, and considering the low amount of vitamin E and Se supplied by the TPN solutions, supplementation with these nutrients is recommended.     

硒和维生素E对大鼠糖尿病易感性的影响

目的 :　观察硒 ( Se)和维生素 E( VE)对糖尿病 ( DM)易感性的影响。方法 :　应用膳食低 Se复加注射链脲佐菌素 ( STZ)法制成大鼠 DM模型 ,补充一定剂量的 Se和 (或 ) VE,观察对大鼠 DM易感性的影响。结果 :　膳食低 Se、低 VE可明显增加大鼠 DM易感性 ,表现为血清 C肽水平和胰岛 C肽分泌贮备显著降低 ,血糖明显升高 ,并可显著增加 DM大鼠死亡率。在膳食中联合补充 0 .2 mg Se、50 0 mg VE/ kg,明显增加了 DM大鼠血清和胰岛 C肽含量、降低 DM大鼠血糖水平 ,亦使 DM大鼠死亡率显著降低。结论 :　在 DM亚临床状态下 ,联合补充适量 Se和 VE可改善胰岛内分泌细胞代谢偏移及功能紊乱 ,拮抗致病因素的胰岛损伤效应 ,降低 DM易感性。     

Effets d'une supplémentation en antioxydants sur les taux circulants des immunoglobulines IgA,IgG et IgM chez des femmes récemment mastectomisées,en traitement chimiothérapeutique

Treatment of cancer uses different therapies with side or toxic effects; thus chemotherapy has deleterious effects on the immune system, partly mediated by oxidative stress. The objective of this work is to evaluate the benefits of a supplementation with antioxidant nutrients, in variable duration, among 20 women from 30 to 60 years, who had a breast cancer, recently mastectomized and under chemotherapeutic treatment. Women were distributed in two groups: a group called “G7”, composed by 10 women who received a supplementation containing β-carotene (15 mg), E vitamin with selenium (400 mg of alphatocopherol and 50 μg of selenium) et C vitamin (2g), during 7 days, and a second group called “G30” composed by 10 women who received the same supplementation during 30 days. The immunoglobulins IgG, IgM and IgA levels in blood were estimated before supplementation, after supplementation and after chemotherapeutic treatment. The statistical analysis of the results, by using the Wilcoxon test, show that, within each group, the IgG, IgM and IgA levels remain in the normal range and don't differ between the various stages of the study.     

Nutrition parentérale prolongée chez l'enfant : utilisation de triglycérides à chaîne moyenne

Data concerning the long-term parenteral administration of medium chain triglycerides (MCT) to children are lacking. The goal of this study was to evaluate the effect and tolerance of a 50% LCT/MCT mixture. We studied 12 children (1,5–17 yrs old) who were on TPN for 6 months to 12 years. Cyclic TPN included 4 to 7 nocturnal infusions a week with mean daily intakes of 214 ± 92 mg/kg nitrogen and 47 ± 17 kcal/kg of non-protein energy, including 10 to 32% as lipid (Intralipid® 20%). At the start of the study all the patients were switched to receive a 50% MCT/LCT mixture (Bruneau®) at the same rhythm, amount and rate as before. The following parameters were studied at day 0 and after 1, 3 and 6 months : plasma lipid status including apolipoprotein A-I, A-II, B and essential fatty acids (EFA) (plasma and red blood cells) ; liver function tests, hemoglobin (Hb), platelets (Pt) fibrin (FI), proaccelerin (FV), plasma protein (PP) and bicarbonates (BIC). Twenty-four-hour urine samples were assessed for ketone bodies and dicarboxylic acids. No clinical signs of intolerance were observed ; there was no difference in triglycerides, cholesterol, phospholipid, apo B, EFA, liver function tests results excepts for gammaglutamyl transpeptidase (GGT) or Hb, Pt, FI, FV, PP and BIC. The main differences were a significant increase in apolipoprotein A at 1, 3 and 6 months and a decrease in GGT at the 6th month. Mild urinary excretion of adipic, suberic and sebacic acids appeared at the concentrations of 13.3 ± 5.2, 17.6 ± 11 and 44 ± 39 μmol/mmol creatinin respectively. These results show no clinical or biological side-effects together with a mild benefit concerning Apo A and GGT. Omega oxidation was moderately involved, as demonstrated by urinary dicarboxylic acid excretion ; a 50% reduction in EFA intake did not affect the EFA status of these pediatric patients.     

Plasma levels of fat-soluble vitamins A and E in neonates, after administration of two different vitamin solutions

The aim of this study was to compare the effects of 2 different vitamin solutions on plasma levels of vitamin A and E during and after short term total parenteral nutrition (TPN), after neonatal surgery. 2 compounds were compared, one with a higher vitamin A content (100 mu g/ml) and no vitamin E and one with vitamin E (0.64 mg/ml) and a lower vitamin A content (69 mu g/ml). 2 randomly chosen groups of 10 neonates were studied each with gastrointestinal malformations. The groups were comparable regarding gestational age (GA), weight and length. Diagnoses within the groups were similar. TPN was given after corrective surgery for a median time of 6.5 days to both groups. Vitamin A and retinol binding protein (RBP) levels increased significantly (p < 0.05) above the pre-treatment level in patients receiving supplementation with a higher dosage of vitamin A (100 mu g/ml). In patients receiving the lower dose of vitamin A (69 mu g/ml) plasma levels of this vitamin were unchanged but RBP levels fell significantly (p < 0.05). There was no significant difference in plasma vitamin E levels in the group of patients receiving vitamin E supplementation as compared with the unsupplemented group. In both groups vitamin E levels increased significantly (p < 0.005) after introduction of oral feeding. The results indicate that even during short term TPN endogenous stores of vitamin A might become depleted. In spite of the fact that no vitamin A deficiency was noted it seems obvious that a higher vitamin A intake is advisable which is in accordance with the recommendations from the Subcommittee on Paediatric Parenteral Nutrient Requirements from the Committee on Clinical Practice Issues of The American Society for Clinical Nutrition.     

Selenium supplementation in low-birthweight premature infants: relationship to trace metals and antioxidant enzymes

We attempted to study the effect of selenium supplementation upon trace metal metabolism in low-birthweight infants less than 1000 g birthweight. Serum levels of the trace metals copper, zinc, and selenium; and white blood cell glutathione peroxidase (GSH-Px) and superoxide dismutase (SOD) activities were measured in conjunction with the trace metals when parenteral nutrition (TPN) was begun (sample A), at the initiation of enteral nutrition (sample B), and when TPN was discontinued (sample C). Two randomly selected groups of infants were evaluated: group S received selenium supplementation (1.34 micrograms/kg per d) in their parenteral nutrition solutions; group C was a control which did not receive selenium supplementation. Selenium levels declined to equally low levels in both groups by sample C, but were significantly higher in group S at sample B. GSH-Px activities demonstrated a significant increase at sample B in group S and then tended to decrease. In group C, GSH-Px tended to increase, then decreased significantly by sample C. Both groups received 20 micrograms/kg per d of copper in TPN, however, serum copper declined significantly at sample B in group S whereas there were no significant changes in group C. There were no significant changes in zinc and SOD levels. There were no significant differences between groups in clinical characteristics or outcome. This study suggests that a dose of supplemental selenium of 1.34 micrograms/kg per d in TPN is inadequate for low-birthweight premature infants. Selenium supplementation may also affect copper metabolism.     

Home parenteral nutrition in children: bioavailability of vitamins in binary mixtures stored for 8 days

Vitamin supply in children on long-term parenteral nutrition depends on the specific age-related needs and on the bioavailability of vitamins when introduced into nutritional bags. The present study aimed to investigate the vitamin status in children on home TPN receiving nutritional bags which had been stored during a prolonged period of 8 instead of 4 days and where the new vitamin preparation Cernevit has been introduced. 19 children aged from 5 months to 11 years receiving home parenteral nutrition, for 42 months on average, were studied. Daily vitamin supply for children above 2 years of age was: A 1050 ug, D 5.5 ug, E 10.2 mg plus 0.6 mg/g lipid (Intralipid), C 125 mg, B1 3.5 mg, B2 4.1 mg, B6 4.5 mg, biotine 69 mug; children who were younger than 2 years received half of these intakes. Water soluble vitamin status was only measured in children over 3 years old. Plasma levels remained stable and adequate for age, for most of the studied vitamins. Vitamin A concentration was inferior to 200 mug/l in 1 patient with hepatopathy. Plasma concentrations of vitamin E, which were initially below 6 mg/l in 4 patients, returned to normal during the study. Plasma levels of vitamin C were below 6.2 mg/l in several infants either temporarily (5 patients) or during the whole study period (2 patients). These results support a prolongation of the intervals between preparing batches of nutritional bags and also between deliveries. This results in a considerable reduction of costs, provided that plasma vitamin levels, specially vitamin C, are regularly monitored.     

GLP-2 Prevents Intestinal Mucosal Atrophy and Improves Tissue Antioxidant Capacity in a Mouse Model of Total Parenteral Nutrition

We investigated the effects of exogenous glucagon-like peptide-2 (GLP-2) on mucosal atrophy and intestinal antioxidant capacity in a mouse model of total parenteral nutrition (TPN). Male mice (6–8 weeks old) were divided into three groups (n = 8 for each group): a control group fed a standard laboratory chow diet, and experimental TPN (received standard TPN solution) and TPN + GLP-2 groups (received TPN supplemented with 60 µg/day of GLP-2 for 5 days). Mice in the TPN group had lower body weight and reduced intestinal length, villus height, and crypt depth compared to the control group (all p < 0.05). GLP-2 supplementation increased all parameters compared to TPN only (all p < 0.05). Intestinal total superoxide dismutase activity and reduced-glutathione level in the TPN + GLP-2 group were also higher relative to the TPN group (all p < 0.05). GLP-2 administration significantly upregulated proliferating cell nuclear antigen expression and increased glucose-regulated protein (GRP78) abundance. Compared with the control and TPN + GLP-2 groups, intestinal cleaved caspase-3 was increased in the TPN group (all p < 0.05). This study shows GLP-2 reduces TPN-associated intestinal atrophy and improves tissue antioxidant capacity. This effect may be dependent on enhanced epithelial cell proliferation, reduced apoptosis, and upregulated GRP78 expression.     

Serum levels of vitamin D metabolites in children receiving total parenteral nutrition

Serum levels of 25-hydroxyvitamin D (25-OHD) and 1,25-dihydroxyvitamin D (1,25-(OH)2D) were measured on 19 occasions in seven children receiving total parenteral nutrition (TPN). The daily intakes of vitamin D3 ranged from 44 to 540 IU/day, and all serum samples were obtained after the same daily intake of vitamin D3 for more than 1 month. There was a significant positive correlation between serum 25-OHD levels and parenteral vitamin D3 intakes (r = 0.90, p less than 0.01). In this study, serum 25-OHD levels in all cases taking 200 to 360 IU/day of vitamin D3 were within the normal range. On the other hand, no significant correlation was found between serum 1,25-(OH)2D levels and vitamin D3 intakes, and serum 1,25-(OH)2D levels were normal or elevated in all cases.     

Antioxidant supplementation does not affect fasting plasma glucose in the Supplementation with Antioxidant Vitamins and Minerals (SU.VI.MAX) study in France: association with dietary intake and plasma concentrations

BACKGROUND: Observational data suggest a protective effect of several antioxidants on fasting plasma glucose (FPG) and type 2 diabetes. However, randomized trials have yielded inconsistent results. OBJECTIVES: The first objective was to assess the effect of 7.5 y of antioxidant supplementation on FPG at 7.5 y. The second objective was to examine the epidemiologic association of baseline dietary intakes or plasma antioxidants and FPG (at baseline and at 7.5 y). DESIGN: Subjects (n = 3146) from the Supplementation en Vitamines et Minéraux Antioxydants (SU.VI.MAX) primary prevention trial in France were randomly assigned to receive a daily capsule containing 120 mg vitamin C, 30 mg vitamin E, 6 mg beta-carotene, 100 mug Se, and 20 mg Zn or a placebo. RESULTS: After 7.5 y, no significant difference was observed between age-adjusted mean FPG in men (P = 0.78) and women (P = 0.89) in either group. Baseline beta-carotene dietary intakes and plasma concentrations were inversely associated with FPG in multivariate mixed models (P = 0.0045 and P < 0.0001, respectively). Baseline plasma vitamin C and selenium were negatively (P = 0.0455) and positively (P < 0.0001) associated, respectively, with FPG. CONCLUSIONS: Supplementation with antioxidants at nutritional doses for 7.5 y had no effect on FPG in men or women who followed a balanced diet. An inverse association of baseline beta-carotene dietary intake and plasma concentrations with FPG was found, probably because beta-carotene is an indirect marker of fruit and vegetable intakes.     

Plasma vitamin levels in patients on prolonged total parenteral nutrition

Vitamins are essential in total parenteral nutrition (TPN), their importance being highlighted by repeated past documentation of various vitamin deficiencies particularly in patients on long-term parenteral nutrition therapy. This study evaluated the efficacy of water- (Soluvit) and fat-soluble (Vitalipid) vitamin supplementation in patients receiving total parenteral nutrition using the three in one 3-liter bag system. All patients received water-soluble vitamin supplements daily. Fat-soluble vitamin supplements were administered on a daily or twice weekly basis. Twenty-two patients were studied. In seven of the 22 patients vitamin status was assessed on more than one occasion during TPN support, thus bringing the total number of observations to 30. The mean duration of TPN support was 35 days. Eight of the observations were made during less than 10 days, three between 11-19 days, 15 between 20-60 days, and four during more than 60 days of TPN support. Biochemical deficiency as judged by subnormal enzyme activity or vitamin levels were present in 10% of the patients for thiamin, 3% for riboflavin, and 6% for nicotinic acid. By contrast 83% of the patients had low plasma vitamin C and B6 levels. Low plasma vitamin A and E levels were also present in 43 and 40% of the patients, respectively. According to the plasma concentrations of the vitamins studied it would appear that the commercial vitamin preparations used in this study are inadequate in maintaining optimal vitamin status.(ABSTRACT TRUNCATED AT 250 WORDS)     

硒、维生素E对心肌胶原蛋白代谢的影响

目的：阐明硒（Ｓｅ）、维生素Ｅ（ＶＥ）与心肌胶原蛋白代谢的关系。方法：以病区粮（低Ｓｅ、低ＶＥ）喂养大鼠,并注射异丙基肾上腺素（ＩＳＯ）诱发心肌缺血缺氧性坏死,检测心肌中谷胱甘肽氧化酶（ＧＳＨ－ＰＸ）、过氧化氢酶（ＣＡＴ）、丙二醛（ＭＤＡ）和胶原蛋白含量变化。结果：低Ｓｅ低ＶＥ组血浆和心肌ＧＳＨ－ＰＸ、ＣＡＴ活性下降,ＭＤＡ含量上升,与心肌胶原蛋白含量变化有相关性。补Ｓｅ补ＶＥ后,ＧＳＨ－ＰＸ、ＣＡＴ活性上升,ＭＤＡ水平下降,心肌胶原蛋白含量下降。结论：低Ｓｅ低ＶＥ加重ＩＳＯ诱发的心肌损伤,脂质过氧化和自由基与心肌胶原蛋白代谢关系密切。补Ｓｅ补ＶＥ后,能缓解心肌细胞对诱发因素所造成的损伤,对保护心肌细胞和防止心肌纤维化的形成具有一定作用。     

Nutrition and the Immune System: A Review of Nutrient–Nutrient Interactions

Although research on the role of single nutrients in immune function is extensive, this is not the case for multiple nutrients and subsequent nutrient–nutrient interactions. After presenting a brief overview of immune function, the authors consider reports that examine imbalance of more than one nutrient and interactive effects on immunocompetence. Availability of one nutrient may impair or enhance the action of another in the immune system, as reported for nutrients such as vitamin E and selenium, vitamin E and vitamin A, zinc and copper, and dietary fatty acids and vitamin A. Nutrient–nutrient interactions may negatively affect immune function. For example, excess calcium interferes with leukocyte function by displacing magnesium ions, thereby reducing cell adhesion. Because of consumer interest in supplementation to improve immune function, the potential for harm exists. Research is needed to improve knowledge in this area so that recommendations can be made with more confidence. JAm Diet Assoc. 1996; 96:1156–1164.     

硒和维生素E对糖尿病大鼠红细胞[Ca~(2+)]i水平的影响

目的：　观察链脲佐菌素（ＳＴＺ）糖尿病大鼠补充硒（Ｓｅ）和／或维生素Ｅ（ＶＥ）后红细胞内游离钙浓度［Ｃａ２＋ ］ｉ的变化。方法：　用ＳＴＺ制成糖尿病（ＤＭ）大鼠,分为四组：（１）ＤＭ 对照组;（２）Ｓｅ 治疗组;（３）ＶＥ治疗组;（４）Ｓｅ 和ＶＥ治疗组;另有正常对照组,每天以同体积的生理盐水灌胃。实验期为３０ 天,分析血Ｓｅ、ＶＥ及红细胞［Ｃａ２＋ ］ｉ。　结果：　补充Ｓｅ 和／或ＶＥ后,红细胞［Ｃａ２＋ ］ｉ显著下降,与ＤＭ 对照组比较,差异有显著意义（Ｐ＜ ０．０５,Ｐ＜ ０．０１）,以联合用药组降幅较大。血硒水平联合用药组高于其他各组（Ｐ＜ ０．０１）,补Ｓｅ组高于补ＶＥ组和ＤＭ 对照组（Ｐ＜ ０．０１）;血清ＶＥ浓度联合用药组高于ＤＭ 对照组和补Ｓｅ 组（Ｐ＜ ０．０１,Ｐ＜ ０．０５）,而补ＶＥ组血清ＶＥ浓度已恢复至正常水平。　结论：　Ｓｅ和ＶＥ对ＤＭ 大鼠红细胞［Ｃａ２＋ ］ｉ异常升高有明显的抑制作用。     

补充抗氧化维生素对老年机体红细胞功能改善效果的研究

目的研究抗氧化维生素E(VE)、维生素C(VC)联合不同剂量β-胡萝卜素(β-C)补充,对老年机体红细胞溶血度、红细胞膜ATP酶和红细胞膜流动性的影响。方法经知情同意后选择300名60~75岁的老年人,随机分为5组,1~4组补充VC 300mg/d+VE 200mg/d的同时,再分别补充β-C 16.7、8.4、5.6和0.0mg/d,对照5组补充VE 5mg/d,连续补充16周。补充前、后分别抽取清晨空腹静脉血,用H2O2氧化诱导溶血法测红细胞溶血度,酶学比色法测红细胞膜ATP酶活性,荧光偏振法测红细胞膜流动性。结果干预后1~4组老年人红细胞溶血度(分别为38.8%、39.9%、37.6%和40.9%)显著低于其干预前(分别为54.5%、57.1%、56.4%和55.4%)(P<0.01)和干预后第5组(55.7%)(P<0.01);干预后第1组红细胞膜Na+-K+-ATP酶0.72μmol/(mg·h)、Ca2+-Mg2+-ATP酶0.85μmol/(mg·h)显著高于干预后第5组[分别为0.49μmol/(mg·h)和0.61μmol/(mg·h)](P<0.05);干预后第1~4组红细胞膜荧光偏振度ρ值、1至3组微粘度η值均明显高于其干预前(P<0.01),也高于干预后第5组(P<0.01或P<0.05)。结论抗氧化VE、VC联合不同剂量β-C补充可降低老年机体H2O2诱导的红细胞溶血度,提高红细胞膜ATP酶的活性,改善老年机体红细胞膜的流动性。     

Changes in serum retinol,alpha-tocopherol,vitamin C,carotenoids, xinc and selenium after micronutrient supplementation during alcohol rehabilitation

OBJECTIVE: To test the effect of a 21-day supplementation with moderate doses of antioxidant nutrients on biochemical indicators of vitamin, carotenoid and trace element levels in alcohol-dependent patients during a program of alcohol rehabilitation. DESIGN: A randomized double-blind trial was performed comparing two groups receiving daily either a combination of micronutrients (beta-carotene: 6 mg, vitamin C: 120 mg, vitamin E: 30 mg, zinc: 20 mg, selenium: 100 micro g) or a placebo. SUBJECTS: 106 alcohol-dependent patients 20 to 60 years of age without severe liver disease, hospitalized for a 21-day rehabilitation program. Measure of Outcome: Vitamin C, retinol, alpha-tocopherol, zeaxanthin/lutein, beta-cryptoxanthin, lycopene, alpha- and beta-carotene, zinc and selenium were measured in serum, initially and after supplementation. RESULTS: (1) In the placebo group, after 21 days of rehabilitation, serum concentrations of vitamin C and all five carotenoids significantly increased, whereas retinol and alpha-tocopherol concentrations decreased; zinc and selenium levels were unaffected. (2) At the end of the hospital stay, serum indicators were significantly improved in the supplement group as compared to the placebo group for vitamin C, alpha-tocopherol, beta-carotene, zinc and selenium; conversely, lycopene changes were higher in the placebo group than in supplement group. (3) Of the serum antioxidants measured at entrance, only vitamin C was significantly depleted in heavy smokers, and, after the supplementation period, vitamin C was efficiently repleted in this later group. CONCLUSION: Our results indicate that a short-term supplementation with physiological doses of antioxidant vitamins, carotenoids and trace elements during alcohol rehabilitation clearly improves micronutrient status indicators. Heavy smokers in particular seem to respond to vitamin C supplementation.     

膳食硒、维生素E对克山病大鼠心肌胶原代谢及金属基质蛋白酶Ⅱ活力的影响

目的探讨低Se、低VE是否在心肌损伤后的修复过程中持续发挥作用,观察适时适量补充Se和VE,是否可减轻和逆转过度的心肌胶原蓄积。方法 Wistar大鼠30只,随机取6只大鼠做正常对照组,采用混合饲料喂养。其他大鼠均采用低Se、低VE半合成饲料喂养。81 d后,除正常对照组外,其余大鼠注射异丙基肾上腺素制备偏食大鼠心肌纤维化模型。制模成功大鼠分为4组,半合成饲料组(EG)继续采用半合成饲料喂养。其余各组膳食中施加干预如下:半合成饲料加Se组、半合成饲料加VE组、半合成饲料加硒加VE组。喂养21d后,乙醚麻醉,眼球采血,取大鼠心脏,观察大鼠氧化应激指标和心肌胶原代谢情况。结果偏食心肌纤维化模型组大鼠血清中谷胱甘肽过氧化物酶活力下降,脂质过氧化物含量升高。心肌胶原蓄积,并伴有金属基质蛋白酶-2、金属基质蛋白酶抑制剂-2表达上调、两者比值降低。膳食中补充Se、联合补充Se和VE均可一定程度的缓解这些改变。结论低Se、低VE在心肌损伤后的修复过程中持续发挥作用,适时适量的补充Se和VE有利于减轻和逆转过度的心肌胶原蓄积。     

Intravenous vitamins for very-low-birth-weight infants.

Term infants and children appear to adapt to large variations in vitamin intakes. This is supported by the finding of similar blood levels of vitamins despite several-fold differences in intake on a body weight basis. By contrast, the finding of marked elevation of some vitamins and low levels of others seen in very-low-birth-weight (VLBW) infants (less than 1500 g) suggest that this group has less adaptive capacity to high- or low-dose intakes. This indicates that their vitamin intakes need to be more closely aligned with actual needs. This paper reviews previously published data on vitamins A, E, B2, and B6 from VLBW infants receiving total parenteral nutrition (TPN). Vitamin A. VLBW infants are relatively deficient in retinol (R) at birth. During TPN large losses of R onto the delivery sets result in a further decline in stores of R as reflected in a progressive decline in plasma R during TPN. Because of the reported lower incidence of bronchopulmonary dysplasia associated with intramuscular vitamin A treatment, alternative methods of vitamin A delivery during TPN have been suggested. First, the vitamins were mixed with Intralipid (IL) and, second, retinyl palmitate (RP) rather than R was used. There was little in vitro loss of R when mixed with IL, and in vivo treatment resulted in higher blood levels after 1 month of retinol administration in IL than seen previously (21.4 +/? 4.2 vs 14.1 +/? 3.7 micrograms/dl).(ABSTRACT TRUNCATED AT 250 WORDS)     

Plasma vitamin and mineral status in home parenteral nutrition patients

Home parenteral nutrition (HPN) provides long-term nutritional support for persons whose absorptive capacity is compromised by a variety of intestinal malabsorption problems. However, the presence of vitamin and mineral deficiency syndromes that normally would not have time to develop in the hospitalized patient receiving total parenteral nutrition has been reported in patients receiving HPN. This study entails a longitudinal survey of plasma concentrations of vitamins A, E, and 1,25-dihydroxyvitamin D, as well as the minerals zinc, copper, and selenium, in patients receiving HPN. Plasma samples from eight patients who had been on HPN for 1-92 months before the study began were obtained once a month over a 12-month period. The blood was drawn immediately before their evening infusion of TPN in order to approximate fasting plasma nutrient concentrations. Patient values were compared to fasting control values and to published norms. Values for vitamin A, 1,25-dihydroxyvitamin D, and zinc all were within the normal range, and there was no evidence of metabolic bone disease. Plasma vitamin E and copper concentrations exceeded the normal range for most of the 12-month period. Of all of the nutrients studied, only plasma selenium concentrations were consistently in the low-normal to below-normal range. Selenium levels in patients on HPN should be monitored regularly, and supplementation may be necessary if clinical conditions warrant.