Effect of home total parenteral nutrition on body composition in patients with acquired immunodeficiency syndrome

Malnutrition occurs commonly in patients with acquired immunodeficiency syndrome (AIDS). The efficacy of nutritional support is unknown. A prospective, longitudinal study was conducted to determine the effect of prolonged total parenteral nutrition on body composition in 12 AIDS patients. Five patients were malnourished because of problems with food intake or absorption, while seven had systemic infections, with or without a malabsorption syndrome. The AIDS patients gained body weight and body fat content in response to total parenteral nutrition, while mean body cell mass, estimated as total body potassium content, was unchanged. However, all five patients with altered intake or absorption had significant repletion of body cell mass which was significantly different from the patients with systemic infections. Calorie and nitrogen intake did not differ between the two groups. It is concluded that body mass repletion is possible in AIDS patients in whom malabsorption is the major pathogenetic factor in producing malnutrition and is less successful in patients with serious ongoing systemic diseases. Thus, the response to nutritional support is dependent on the particular clinical circumstances.     

Short-term parenteral nutrition with glucose and Intralipid: effects on serum lipids and lipoproteins

We prospectively investigated the effect of a 3-wk course of parenteral nutrition with 20% glucose, 4.25% amino acids, and 10% Intralipid on plasma lipids and lipoproteins in a cohort of 12 nutritionally replete patients with inflammatory bowel disease. Mean total serum cholesterol and mean total serum phospholipids increased in parallel throughout the study; density gradient ultracentrifugation demonstrated these increases were due to the appearance of lipoprotein-X. The mean low-density lipoprotein (LDL) mass on the density gradients decreased during the study and high-density lipoprotein (HDL) cholesterol levels decreased by 28% by the end of the third week. Plasma free fatty acids decreased by 42%. These results demonstrate that the glucose and 10% Intralipid regimen caused modest decreases in serum HDL cholesterol and LDL mass and the prompt appearance of lipoprotein-X with attendant hypercholesterolemia and hyperphospholipidemia. Patients undergoing long-term treatment with glucose and Intralipid should be closely monitored for the occurrence of significant dyslipoproteinemia.     

Effect of total parenteral nutrition in the restitution of body nitrogen,potassium and weight

The effects of nutritional support on body weight, nitrogen and potassium were investigated and were compared with changes in serum albumin and delayed cutaneous hypersensitivity (DCH). Fifteen malnourished patients (maintained by total parenteral nutrition (TPN) were studied for periods of 5 to 33 months. The TPN consisted of infusions of amino acids with a dual substrate of glucose and lipids. Body nitrogen was measured by prompt gamma ray analysis and potassium was determined by measurement of the naturally occurring radio-active ⁴⁰K in a whole body counter.Results of sequential measurements show on average a significant increase in body nitrogen of 30% (P<0.001) and a smaller but significant increase of 10% in body weight but a mean increase of 4.5% for potassium was not significant. While the nutritional support was very effective in improving body nitrogen, it was less effective in improving serum albumin or DCH.Thus, changes in body protein are not necessarily reflected by measurements of the body parameters of nutritional status. For a reliable estimate of body protein, the direct measurement of body nitrogen is required.     

Effect of continuous and discontinuous intravenous or intragastric total parenteral nutrition in rats on serum lipids, liver lipids and liver lipogenic rates

Lipogenesis and evidence of fat accumulation in the liver were investigated in adult male rats fed a hypertonic dextrose diet by continuous (C) and discontinuous (D) intravenous (IV) or intragastric (IG) infusion for 14 d. Rats fed by the IV and IG route were infused continuously and discontinuously (2100-0900) with 55 ml/d of a solution containing 30% dextrose and 2.72% amino acids plus vitamins and minerals. An orally (Or) fed group was fed 21.2 g of a solid diet, which provided an equivalent amount of calories and nitrogen as the infusion diet. Serum lipids, glucose, and insulin levels, de novo fatty acid synthesis in adipose tissue and liver, and the content of liver lipids were not altered by feeding the diet IV or IG. De novo lipogenesis was elevated in the livers of the continuously and discontinuously infused IV-or IG-fed rats compared with Or-fed rats. Fat accumulated in the livers of the rats infused continuously but not in the livers of the rats fed DIV, DIG or Or. Discontinuous feeding was associated with the mobilization of fatty acids that are necessary for lipoprotein formation and transport from the liver, which may explain, in part, why discontinuously infused rats do not develop fatty livers. These data indicate that cycling the total parenteral infusion may have clinical importance.     

Perdialytic parenteral nutrition with lipids and amino acids in malnourished hemodialysis patients

A 3-mo perdialytic parenteral nutrition (PDPN) regimen was tested in 26 malnourished adults receiving hemodialysis (HD). Subjects were randomly assigned to receive PDPN (n = 12) or not to receive it (n = 14). PDPN was intravenously infused three times a week during HD; each infusion was made up of 1.6 g fat/kg body wt, 0.08 g N/kg body wt, essential and nonessential amino acids, and glycyl-tyrosine. PDPN, together with a PDPN-induced increase in spontaneous eating, increased intakes from 30 +/- 8.4 kcal.kg body wt-1.d-1 (mean +/- SD) and 1 +/- 0.27 g protein.kg body wt-1.d-1 to 39 +/- 8.5 kcal.kg body wt-1.d-1 and 1.25 +/- 0.30 g protein.kg body wt-1.d-1. Compared with control subjects, PDPN patients were characterized by increases in body weight (P less than 0.01), arm-muscle circumference (P less than 0.02), serum transthyretin and albumin concentrations (P less than 0.05), interdialytic creatinine appearance (P less than 0.01), skin-test reactivity (P less than 0.02), plasma leucine (P less than 0.05) without modifications of other amino acids, and plasma apolipoprotein A-I (P less than 0.01) without significant changes in apolipoprotein B, cholesterol, triglyceride, and phospholipid concentrations. Thus, PDPN appeared to be effective and safe with respect to plasma lipids.     

Taurine status and response to intravenous taurine supplementation in adults with short-bowel syndrome undergoing long-term parenteral nutrition: a pilot study

Taurine deficiency in patients on long-term parenteral nutrition may be involved in cholestasis. We aimed to assess plasma taurine and tauro-conjugated bile acids in adults with short-bowel syndrome and their response to intravenous taurine. Thirty-two adult patients, who had been on taurine-free parenteral nutrition for a mean of 59 (SE 14) months for short-bowel syndrome, were studied retrospectively. In a second study, a subgroup of ten patients with chronic cholestasis received taurine-enriched (6.0 (SE 0.6) mg/kg per d) parenteral nutrition for 55 (SE 13) months. Post-absorptive plasma taurine and bile acid concentrations were measured and liver function tests routinely sampled. At baseline, plasma taurine was lower in patients with a jejunal length of less than 35 cm (group A, n 16) than in those with a jejunal length of 35 cm or more (group B, n 16): 43 (SE 3) v. 58 (SE 4) micromol/l (P=0.01). The groups were no different in terms of chronic cholestasis (12/16 v.13/16 patients), total bile acids (26 (SE 13) v.14 (SE 5) micromol/l) or the ratio of tauro-conjugated:glyco-conjugated bile acids (5 (SE 2) v.8(SE 4)%, usual range 30-60%). After supplementation, there was an increase in plasma taurine level (63 (SE 8) v. 43 (SE 4), P=0.007) but was no change in either total bile acids or the ratio of tauro-conjugated: glyco-conjugated bile acids. There was a significant decrease in aspartate aminotransferase level. Long-term parenteral nutrition for short-bowel syndrome is associated with an impaired tauro-conjugation of bile acids (enterohepatic pool), irrespective of plasma taurine level (systemic pool) and despite long-term taurine intravenous supplementation.     

Water-soluble vitamins in cancer patients on parenteral nutrition: a prospective study

Forty-three patients with mild weight loss were studied prospectively to determine whether the parenteral water-soluble vitamin doses in a commercially available preparation (MVI concentrate; USV Laboratories, Tarrytown, NY) maintained serum, red blood cell (RBC), and urinary concentrations of water-soluble vitamins in stressed cancer patients receiving total parenteral nutrition (TPN). Patients were divided into three groups: (1) oral diet, no intravenous vitamins given; (2) TPN plus 5 ml MVI; and (3) TPN plus 10 ml MVI. Vitamins C, B1, B2, B3, B6, and niacin were measured initially and weekly during a 6-week study period. Caloric and nitrogen balances were quantified. Most of the patients in all three groups had normal blood or urine levels of all water-soluble vitamins. No clinical evidence of vitamin deficiency or MVI toxicity was detected. The recommended parenteral dosages of vitamin C (100 mg/day) and B3 (15 mg/day) provided measurably adequate levels in all patients. Levels of vitamins B1, B2, B6, and niacin that were less than the normal range were noted in 4-40% of patients receiving the recommended daily dosages of 3 mg, 3.6 mg, 4 mg, and 40 mg, respectively. These deficiencies appeared to improve in group III patients who received twice the recommended parenteral vitamin dosages, although they did not completely disappear. Niacin deficiency appeared to be the most prevalent, occurring in 40% of patients studied. Since intravenous doses of B1, B2, B6, and niacin are safe and well tolerated, it appears that increased daily amounts of these vitamins should be given to cancer patients on parenteral nutrition.     

Catheter-related infection in patients on home parenteral nutrition: results of a prospective survey

BACKGROUND & AIMS: Central venous catheter (CVC) infection is the most frequent complication during home parenteral nutrition (HPN). We prospectively assessed incidence and catheter-related sepsis (CRS)-associated factors in the 42 adult patients enrolled in our HPN centre since its opening. METHODS: Age, frequency of infusions, CVC type, autonomy or nurse/family aid, underlying disease, involved infectious organism(s), hospital stay, efficacy of antibiotic-lock and other infectious complications, were studied. RESULTS: CRS occurred 39 times (3/1000 days of HPN). In 37/39 cases, it was proven by both peripheral and central blood cultures. In 56% of patients, clinical signs were discrete, delaying diagnosis. Individual factors like learning potency, underlying disease (especially chronic intestinal obstruction with bacterial overgrowth), and length of remaining colon and small intestine, were slightly associated with higher CRS incidence. Usually, one organism (S. epidermidis; 51%) was detected. A total of 14 CVC were immediately removed. In the others, antibiotic-lock was more effective in patients having tunnelled catheters (TC, 50%) than implanted devices (25%; P<0.05). Mean hospital stay was 22+/-15 days, which was influenced by 3 patients presenting associated osteomyelitis. CONCLUSIONS: CRS incidence was 3/1000 days of HPN. Clinical symptoms were often discrete, suggesting importance of rigorous survey. Individual apprenticeship and risk for higher bacterial translocation seem associated to higher CRS incidence. CVC sterilization was more frequent in patients with TC.     

普伐他汀对糖耐量受损合并代谢综合征患者脂肪细胞因子的影响

目的 观察普伐他汀对糖耐量受损（IGT）合并代谢综合征（MS）患者临床血生化指标及抵抗素、肿瘤坏死因子α（TNF-α）和白细胞介素6（IL-6）的影响.方法 将60例新诊断IGT合并MS患者分为普伐他汀组（30例）和生活干预组（30例）,比较两组治疗前和治疗16周后血脂、胰岛素抵抗指数（HOMA-IR）、抵抗素、TNF-α及IL-6的变化.结果 普伐他汀组较生活干预组胆固醇[（4.45±0.60）mmol/L vs（5.58±0.96）mmol/L,t=-5.42,P＜0.01]及HOMA-IR[3.22±0.64 vs3.58±0.71,t=-2.05,P＜0.05）]明显下降,抵抗素[（1.97±0.72）μg/L vs（2.76 ±0.73）μg/L,t=-4.26,P＜0.01]、TNF-α[（9.36±2.03）μg/L vs（13.87±2.30）μg/L,t=-8.06,P＜0.01]、IL-6[（3.50±0.99）μg/L vs（6.32±1.17）μg/L,t=-10.06,P＜0.01]水平明显降低.结论 普伐他汀可明显改善IGT合并MS患者的胰岛素抵抗,显著降低抵抗素、TNF-α、IL-6的浓度,改善血管炎症反应.     

Maintenance of parenteral nutrition volume reduction, without weight loss, after stopping teduglutide in a subset of patients with short bowel syndrome

Background: Teduglutide was discontinued after being tested for ≥ 24 weeks in patients with parenteral nutrition (PN) ‐dependent short bowel syndrome in a clinical trial for efficacy to reduce PN volume. This study was describes change in body mass index (BMI) and PN volume over 12 months in patients who stopped drug after the clinical trial. Methods: Prescribed PN volume, weight, and complications were reported. Patients with stable (NEUT, n = 15) or decreased (DEC, n = 7) PN volume by 12 months after stopping drug (NEUT/DEC, n = 22) were compared to those who had increased PN volume (INC, n = 15). With drug response defined by ≥20% reduction from pre‐drug PN volume to end of drug therapy, 12 INC and 13 NEUT/DEC patients were drug responders. Results: Eleven of 20 eligible sites reported data for 39 of 53 eligible study participants, with follow‐up data for 37. INC patients had shorter colon and less frequently had colon in continuity than NEUT/DEC. BMI was decreased at 3, 6, and 12 months relative to the first off‐drug visit in INC patients (P = .001), but not in NEUT/DEC patients. Change in BMI off‐drug was predicted by colon and small bowel length, baseline BMI, and on‐drug change in PN volume (adjusted R2 = 0.708). Conclusions: Gastrointestinal anatomy, baseline BMI, and PN volume reduction on‐drug predicted change in BMI off‐drug. Whether this response would be maintained for a longer time or in the context of a challenging clinical situation has not been evaluated.     

Long-term effects of ad libitum low-fat, high-carbohydrate diets on body weight and serum lipids in overweight subjects with metabolic syndrome.

BACKGROUND: Overweight individuals with metabolic syndrome are at increased risk of type 2 diabetes and coronary vascular disease. Weight gain and features of the syndrome may be ameliorated by dietary intervention. OBJECTIVE: We investigated the effects of replacing one-quarter of daily fat intake by complex or simple carbohydrate on body weight and intermediary metabolism. DESIGN: Forty-six subjects with > or =3 metabolic syndrome risk factors were randomly assigned to receive a control diet; a low-fat, complex carbohydrate diet (LF-CC); or a low-fat, simple carbohydrate diet (LF-SC) for 6 mo. Thirty-nine subjects completed the trial. About 60% of daily dietary intake was provided free of charge through a grocery store. Energy intake was ad libitum. Body weight, body mass index (BMI), blood pressure, and blood lipids were measured at months 0, 2, 4, and 6. RESULTS: There was a significant diet x time interaction on body weight and BMI (P < 0.001). Weight loss was greatest with the LF-CC diet [change in body weight: control diet, 1.03 kg (NS); LF-CC diet, -4.25 kg (P < 0.01); LF-SC diet, -0.28 kg (NS)]. Total cholesterol decreased by 0.33 mmol/L, 0.63 mmol/L, and 0.06 mmol/L in subjects consuming the control, LF-CC, and LF-SC diets, respectively (difference between the LF-CC and LF-SC groups: P < 0.05). There were no significant changes in LDL cholesterol, whereas HDL cholesterol decreased over time in all 3 groups (P < 0.0001). Triacylglycerol concentrations were higher in the LF-SC group than in the other 2 groups (P < 0.05). CONCLUSIONS: A low-fat, high-polysaccharide diet in overweight individuals with abnormal intermediary metabolism led to moderate weight loss and some improvement in serum cholesterol. Increasing simple carbohydrates did not promote weight gain, but nor was there improvement in body weight or lipid profile.     

复合营养素减肥及调节血脂作用

目的 探讨复合营养素(复合维生素、多种矿物质、几丁聚糖)对肥胖大鼠体重及高脂血症大鼠血脂的影响。方法 利用高营养饲料、高脂饲料分别诱导大鼠肥胖模型和高脂血症模型后,每种模型分为模型对照组和复合营养素低、中、高剂量组,剂量分别为0.54,1.07,3.21g/(kg.bw),观察复合营养素对大鼠体重及血脂的影响。结果 给予复合营养素45d后,复合营养素低、中、高剂量组大鼠体重分别为(469.10±29.75),(475.10±39.69),(467.85±28.79)g,均明显低于肥胖模型组的(505.65±14.34)g(P<0.05);但各组大鼠之间总摄食量比较差异无统计学意义;高脂模型大鼠中复合营养素低、中、高剂量组大鼠血清总胆固醇(TC)分别为(2.67±0.38),(2.51±0.21),(2.79±0.33)mmol/L,均明显低于高脂模型组的(3.10±0.46)mmol/L;甘油三酯(TG)分别为(1.46±0.23),(1.39±0.26),(1.48±0.15)mmol/L,均明显低于高脂模型组的(1.69±0.21)mmol/L;低密度脂蛋白胆固醇(LDL-C)分别为(0.85±0.16),(0.79±0.14),(0.93±0.13)mmol/L,均明显低于高脂模型组的(1.97±0.30)mmol/L;而血清高密度脂蛋白胆固醇(HDL-C)分别为(1.28±0.26),(1.41±0.31),(1.36±0.24)mmol/L,均明显高于高脂模型组的(0.89±0.22)mmol/L(P<0.05)。结论 复合营养素对高营养饲料及高脂饲料分别诱导的肥胖大鼠和高脂血症大鼠有减轻体重和调节血脂的作用。     

Bone mineral density in patients on home parenteral nutrition: a follow-up study

BACKGROUND AND AIMS: The variations of bone mineral density (BMD) during home parenteral nutrition (HPN) and their relationship with general, life style, primary disease and HPN risk factors were investigated by a follow-up study. DESIGN: Patients who had BMD assessment in a previous cross-sectional survey underwent a 2nd BMD at femoral neck (FN) and lumbar spine (LS). Data about risk factors were collected by a structured questionnaire. BMD Z-score (number of standard deviations from normal values corrected for sex and age) and the annualized percent BMD change were analysed. RESULTS: Sixty-five adult patients were enrolled (follow-up: 18.1+/-5.5 months). The mean BMD Z-score significantly increased at the LS (P = 0.040) and remained unchanged at FN. In multiple regression analysis, the variations of the LS Z-score during HPN negatively correlated with the female sex (P = 0.021) and the age at starting HPN (P = 0.022). The analysis of the annualized percent BMD change confirmed the results obtained by the analysis of the Z-score. No factor was associated with BMD variation at FN. CONCLUSIONS: HPN was not associated with a decrease of BMD in most of the patients; LS BMD Z-score variations were related to general risk factors rather than to HPN factors, showing a negative association with age and female sex.     

Intradialytic parenteral nutrition in malnourished hemodialysis patients: a prospective long-term study

BACKGROUND: Malnutrition is a frequent problem of patients on intermittent hemodialysis and substantially contributes to their morbidity and mortality. METHODS: In 26 hemodialysis patients who, despite dietary advice and oral nutritional supplements, still had malnutrition, the feasibility and effects of a specific intradialytic parenteral nutritional (IPN) regimen were evaluated during a 9-month study period. An IPN solution consisting of 250 mL glucose 50%, 250 mL lipids 20%, and 250 mL amino acids 7% was infused i.v. three times a week during the dialysis session. At the end of each dialysis session an additional volume of 250 mL amino acids was infused as a rinsing fluid. Insulin was administered i.v. before dialysis. RESULTS: Of the 26 enrolled patients, 16 completed the study. The remaining 10 patients withdrew mainly because of muscle cramps and nausea during the initiation phase of the treatment, when sodium was not present in the IPN fluid but was supplemented intermittently. In the 16 treated patients, body weight, which had decreased in the pretreatment period from 58.2+/-1.3 kg (-6 months) to 54.8+/-10.1 kg at the start of the study, increased again up to 57.1+/-10.7 kg after 9 months IPN (p < .05). Serum transferrin and prealbumin rose from 1.7+/-0.4 to 2.0+/-0.4 g/L and from 0.23+/-0.05 to 0.27+/-0.10 g/L, respectively. Bone densitometry showed an increase of tissue mass, mostly related to a rise in fat tissue. Triceps skinfold (p < .05) and arm muscle compartment of the midarm (p = .07) increased as well. No such changes were observed in the patients who withdrew from treatment. CONCLUSIONS: An i.v. hyperalimentation regimen applied to malnourished hemodialysis patients results in a rise of body weight and in a limited, but significant, change of some parameters of nutritional status. The rise in body weight is at least in part attributable to an increase of body fat, without changes in plasma lipid levels.     

Effect of total parenteral nutrition on whole body protein kinetics in cachectic patients with benign or malignant disease

The metabolic effects of total parenteral nutrition on malnourished cancer and noncancer patients were investigated by determining whole-body protein metabolism before and during intravenous nutritional support. The results were compared to similar studies reported in normal subjects. Primed-continuous infusion of 15N glycine was used and the isotopic enrichments in urinary urea and ammonia were measured. The end product average values were used in the calculation of whole body protein turnover. After 10 days of nutritional support in cancer and noncancer patients whole body protein breakdown decreased by 50% (p = 0.01), and 59% (p = 0.001), whereas protein synthesis decreased by 21% (p = 0.005) and 33% (p = 0.025), respectively. Protein turnover did not change in noncancer patients but increased by 15% (p = 0.005) in cancer patients. The efficiency of utilization of the endogenous supply of amino acids from the breakdown of body proteins for synthetic purposes was 77% in this group of subjects. The utilization efficiency of the intravenously infused amino acids for synthesis of body protein was 39% in cancer and noncancer patients but 51% (p less than 0.05) in normals. The data suggest that depleted patients synthesize proteins from intravenous amino acids less well than normals.     

Gallstone disease in patients with severe short bowel syndrome dependent on parenteral nutrition

An increased incidence of gallbladder disease is seen in patients receiving long-term parenteral nutrition (PN). Stasis is thought to play a key role in the development of gallbladder sludge and gallstone formation. The highest incidence of gallbladder disease, by previous reports, is seen in patients with terminal ileal disease or resection. Since PN-dependent patients with severe short bowel syndrome secondary to mesenteric vascular accident have both gallbladder stasis and massive small bowel resection, a retrospective study was undertaken to evaluate the incidence of symptomatic gallbladder disease in this group. Of 11 patients followed over 9 years, five met the inclusion criteria of less than 60 cm of bowel remaining, receiving PN for longer than 6 months and the initial presence of a gallbladder. All five patients developed symptomatic gallbladder disease manifested by cholecystitis or pancreatitis. Factors contributing to gallbladder stasis included poor oral intake and use of anticholinergic and analgesic drugs. Gastric hypersecretion indirectly contributed to decreased oral intake as a means to minimize stool output. As these patients often require several laparotomies during the initial hospitalization, consideration should be given to performing prophylactic cholecystectomy, especially when the potential mortality and morbidity of emergent cholecystectomy done for symptomatic gallbladder disease is taken into account.     

应用合理热能肠外营养治疗高龄病人全身炎症反应综合征

目的：探讨以基础能量消耗（ＢＥＥ）的不同倍数提供热能进行肠外营养（ＰＮ）治疗高龄全身炎症反应综合征（ＳＩＲＳ）病人的效果。方法：采用随机对照方法,将２４例高ＳＩＲＳＵ两组分为组,一组ＰＮ时按ＢＥＥ的１．２倍提供热能,另一组按ＢＥＥ的１．５倍提供热能,均治疗６天。结果：两组在改善血清蛋白和氮平衡方面的效果相同;１．２ＢＥＥ组ＰＮ支持的代谢性并发症发生率为８．３３％,１．５ＢＥＥ组为５８．３％;两组Ｐ