Nutrition
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Randomized Controlled Trial Clinical Trial
Six-month outcome of critically ill patients given glutamine-supplemented parenteral nutrition.
An abundant amino acid in the human body, glutamine (Gln) has many important metabolic roles that may protect or promote tissue integrity and enhance the immune system. Low plasma and tissue levels of Gln in the critically ill suggest that demand may exceed endogenous supply. A relative deficiency of Gln in such patients could compromise recovery and result in prolonged illness and an increase in late mortality. ⋯ The excess control deaths occurred later and those patients had had a significantly longer postintervention stay (P = 0.012) and use of ICU. In the Gln recipients, the total ICU and hospital cost per survivor was reduced by 50%. In critically ill ICU patients unable to receive enteral nutrition, a Gln-containing PN solution improves survival at 6 mo and reduces the hospital costs per survivor.
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Randomized Controlled Trial Comparative Study Clinical Trial
Response of severely malnourished patients to preoperative parenteral nutrition: a randomized clinical trial of water and sodium restriction.
Preoperative parenteral nutrition (PPN) may be beneficial for severely malnourished patients who are candidates for a major elective surgical procedure. The response to PPN, however, has not been thoroughly investigated. Expansion of the extracellular water compartment may occur in some patients, producing a further decrease in the serum albumin concentration and increasing the postoperative complications. ⋯ Weight changes correlated with water (r2 = 0.46, P = 0.001) and sodium (r2 = 0.62, P = 0.0001) balances. Inappropriate responses to PPN in both groups (expansion or depletion of the extracellular water compartment) were associated with a significant increase in pulmonary postoperative complications. During PPN, extracellular water expansion--as determined by increasing weight and lowering of the serum albumin concentration--and aggressive fluid therapy to treat water and sodium depletion seem crucial to the development of postoperative respiratory complications.
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Randomized Controlled Trial Clinical Trial
Integrated nutritional, hormonal, and metabolic effects of recombinant human growth hormone (rhGH) supplementation in trauma patients.
An anabolic stimulus is needed in addition to conventional nutritional support in the catabolic "flow" phase of severe trauma. One promising therapy appears to be rhGH infusion which has direct as well as hormonal mediated substrate effects. We investigated on a whole-body level, the basic metabolic effects of trauma within 48-60 h after injury in 20 severely injured (injury severity score [ISS] = 31 +/- 2), highly catabolic (N loss = 19 +/- 2 g/d), hypermetabolic (resting energy expenditure [REE] = 141 +/- 5% basal energy expenditure [BEE]), adult (age 46 +/- 5 y) multiple-trauma victims, before starting nutrition therapy and its modification after 1 wk of rhGH supplementation with TPN (1.1 x REE calories, 250 mg N.kg-1.d-1). ⋯ The hyperglycemic, hyperinsulinemia observed during rhGH supplementation may be due to defective nonoxidative glucose disposal, as well as inhibition of glucose transport activity into tissue cells. The simultaneous operation of increased lipolytic and reesterification processes may allow the adipocyte to respond rapidly to changes in peripheral metabolic fuel requirements during injury. This integral approach helps us to better understand the mechanism of the metabolic effects of rhGH.
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Randomized Controlled Trial Comparative Study Clinical Trial
Hypermetabolism and increased peripheral release of amino acids after subarachnoidal hemorrhage and its operative treatment.
The metabolic response to surgery for acute subarachnoidal hemorrhage and its modification by amino acid infusions was studied. Thirty patients with acute subarachnoidal hemorrhage were randomly assigned to receive for 12 h either an infusion of glucose and a balanced amino acid solution (1.68 MJ = 400 kcal/d and 0.15 gN.kg-1.d-1; group AA) or a glucose and a solution containing 20% of total nitrogen as alanyl-glutamine (1.68 MJ = 400 kcal/d and 0.15 gN.kg-1.d-1; group ALAGLN). A separate control group received glucose alone (1.68 MJ = 400 kcal/d). ⋯ Also the release of alanine (ALAGLN: 35 +/- 24 mumol/min, AA: 34 +/- 24 mumol/min, and control: 30 +/- 18 mumol/min) and total amino acids (ALAGLN: 133 +/- 131 mumol/min, AA: 125 +/- 98 mumol/min, and control: 112 +/- 72 mumol/min) were similar in all groups. All groups were characterized by a pattern of preoperative hypermetabolism that persisted after the operation. The hypermetabolism was not related to increased peripheral oxygen consumption, since femoral oxygen consumption (VO2) represented only 3% of the whole body VO2-.
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Randomized Controlled Trial Clinical Trial
The use of an intravenous fish oil emulsion enriched with omega-3 fatty acids in patients with cystic fibrosis.
The effects of parenteral nutrition supplemented with a lipid emulsion enriched with the omega-3 fatty acids (FA), eicosapentaenoate (20:5n-3) and docosahexaenoate (22:6n-3), derived from fish oil were compared to a standard lipid emulsion containing omega-6 FA in patients with cystic fibrosis (CF). Patients were randomized to receive either Omegavenous 10%, which contains fish oil (IFO), or Liposyn III 10% (control) daily for 1 mo at a dose of 150 mg/kg. There were no observed allergic or toxic reactions, no abnormalities in liver function tests or coagulation parameters. ⋯ The effect of treatment on pulmonary function was also investigated. There were no significant changes in FVC, FEV1, PEFR, FEV1/ FVC, or FEF25-75 (absolute value or percentage) over the 4 weeks of study in the group receiving IFO or control. This preliminary investigation suggests that intravenous administration of fish oils enriched with long chain omega-3 FA to patients with CF is safe and bioavailable.