Nutrition
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The effect of the degree of metabolic stress on the thermogenic response to parenteral nutrition was studied in surgical and intensive-care patients. Indirect calorimetry was measured before and 3 h after the start of parenteral nutrition. The following patient groups were studied: depleted ward patients before and after surgery for gastrointestinal malignancy (n = 16), mechanically ventilated sepsis/injury patients (n = 21), and spontaneously breathing intensive-care sepsis/injury patients (n = 8). ⋯ In the sepsis/trauma patients, REE increased in both nutrition groups (p < 0.05). The thermogenic response (19.7 +/- 6.5 and 8.0 +/- 3.2% in patients receiving amino acids and nonprotein energy, respectively) was similar to that of the depleted patients postoperatively and was similar in sepsis and trauma patients. We conclude that the thermogenic response to parenteral amino acids and nonprotein energy is minor in depleted patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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The regional distribution of body fat has been identified as a significant risk factor for the development of noninsulin-dependent diabetes mellitus and cardiovascular disease (CVD). Several studies that have investigated the potential associations between topographic features of adipose tissue and indices reflecting carbohydrate and lipid metabolism have reported significant associations between abdominal fat deposition and metabolic complications. The development of computed tomography as a means to precisely measure the amount of subcutaneous and deep adipose tissue at any site of the body has shown that determination of the level of visceral adipose tissue is a critical measurement to perform in the assessment of the health hazards of obesity. ⋯ We have also reported that a high level of visceral adipose tissue is associated with a deterioration of glucose tolerance and that the relationship between visceral fat deposition and glucose tolerance remains significant after controlling for the level of total-body fat. Because significant interrelationships were observed between abdominal visceral obesity, insulin resistance, and dyslipoproteinemias in obese women, it is suggested that visceral obesity is an important component of the insulin-resistance syndrome (syndrome X) that has been previously described. This cluster of morphological, hormonal, and metabolic alterations observed in abdominal obesity may have substantial implications for the treatment of this condition.
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Hormonal responses to major trauma trigger a cascade of metabolic adjustments leading to catabolism and substrate mobilization. Energy deficit and energy surfeit have profound effects on hormone levels. To characterize the course of changes in regulatory hormone levels after multiple injury, we measured the plasma levels of eight hormones, once within 48-60 h after injury in the fasting state and then daily for 5 days during the administration of total parenteral nutrition in 10 hypermetabolic, highly catabolic, and severely injured adult patients. ⋯ The persistent low levels of IGF-1 reflect the altered nutrition status of the patients, as characterized by the continued negative nitrogen balance and elevated cortisol levels in the early posttrauma period. Anabolic IGF-1 and insulin levels showed significant negative correlation with the catabolic indicators 3-methylhistidine and catecholamine excretion. The results suggest that IGF-1 is regulated by nutritional intake independently of growth hormone and may be a better nutrition indicator.
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Blood biochemical and nutritional metabolism indices were examined in eight patients who received infusion containing glucose, fructose, and xylitol in a 4:2:1 ratio (group GFX) after liver resection compared with those in six patients who received only glucose (group G). Preoperative patient-selection criteria consisted of a parabolic oral glucose tolerance test level over time, a total activity of coagulation factors II, VII, and X of > or = 60%, and an indocyanine green disappearance rate (ICG K) of > or = 0.13. Total parenteral nutrition (TPN) was started on the 3rd postoperative day. ⋯ There was no difference between the two groups in levels of rapid-turnover proteins or in Fischer ratio of amino acids. Urinary 3-methylhistidine level decreased soon after TPN in group GFX. Nitrogen balance became positive on the 7th postoperative day in group GFX, whereas it remained negative until the 7th postoperative day in group G.(ABSTRACT TRUNCATED AT 250 WORDS)