Nutrition
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Metabolic and hemodynamic measurements performed in 72 septic (S) and 40 nonseptic (NS) surgical patients undergoing total parenteral nutrition were analyzed to assess the role of substrate supply as a determinant of O2 extraction (O2Ex). In S, O2Ex was inversely related to cardiac index (CI); at any given CI, significant increases in O2Ex with simultaneous increases in O2 consumption (VO2) were related to increasing doses of amino acids, with a less remarkable effect of fat and no effect of glucose dose. ⋯ The increase in VO2 per gram of administered amino acids, at any CI and O2 transport index, was 817 ml in S and 267 ml in NS. These results suggest that the impaired O2Ex and VO2 in S may at least partly reflect abnormalities in substrate utilization and that amino acid support may have a role in modulating these abnormal O2Ex patterns by providing preferential substrate for oxidative metabolism.
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Biography Historical Article
John M. Kinney Award. Reflections on a long term interest in energy metabolism and injury.
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Liquid Isosource was supplemented with soy fiber (Isosource-soy) or guar fiber (Isosource-guar) to study the effects of fiber supplementation of a liquid diet on the composition of mouse cecal flora and on the incidence of bacterial translocation, quantified as the number of mice with viable intestinal bacteria recovered from mesenteric lymph nodes. Mice fed chow, Isosource, Isosource-soy, or Isosource-guar had similar concentrations of cecal bacteria and similarly low incidences of bacterial translocation. ⋯ However, among the dietary groups of LPS-treated mice, the incidence of translocation was significantly less in mice fed Isosource-soy or Isosource-guar compared with mice fed unsupplemented Isosource. These results suggest that soy or guar supplementation of Isosource might be beneficial in some circumstances.
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A new gamma-linolenic acid-enriched fat emulsion (PFE 4501) was given for 13 mo as part of a home parenteral nutrition regimen to a 28-yr-old patient with cystic fibrosis. Blood biochemistry, hematological data, and fatty acid profile were followed. No side effects were reported, and pulmonary function tests remained stable. gamma-Linolenic acid appears to be safe for clinical use and may benefit patients with derangements in essential fatty acid metabolism. The potential role of a gamma-linolenic acid-enriched intravenous fat emulsion is discussed.
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Comparative Study
Intravenous intralipid 10% vs. 20%, hyperlipidemia, and increase in lipoprotein X in humans.
To clarify the mechanisms of hyperlipidemia caused by infusion of Intralipid 10%, we compared lipoprotein metabolism during intravenous Intralipid 10% and Intralipid 20%, which contains only half the amount of egg yolk lecithin for the same content of triglyceride as Intralipid 10%. Ten patients receiving 20 ml.kg-1.day-1 of Intralipid 10% and 10 receiving 10 ml.kg-1.day-1 of Intralipid 20% were fed exclusively by total parenteral nutrition (TPN) providing 1.1 g amino acid and 30 kcal.kg-1.day-1 for 4-6 wk. Intravenous Intralipid 10% caused a marked increase in low-density lipoprotein (LDL), together with increases in phospholipid and cholesterol, especially free cholesterol. ⋯ From these findings, the hyperlipidemia with Intralipid 10% was caused almost exclusively by the increase in lipoprotein X. The excess lecithin may be responsible for the formation of and increase in lipoprotein X. Furthermore, it was revealed that Intralipid 20% could be safely used without inducing hyperlipidemia.