Gastric emptying in humans: influence of different regimens of parenteral nutrition.

Intravenous administration of nutrients can suppress oral food intake. Inhibition of gastric emptying (GE) is a potential explanation for this process. Inhibition of GE during parenteral nutrition (PN) and attenuation of this by parenteral nutrition enriched with branched-chain amino acids (BCAAs) was examined in nine healthy males maintained on standard liquid diets for 6 d before each of three GE studies.

Plasma lipoprotein pattern during long-term home parenteral nutrition with two lipid emulsions.

Hypertriglyceridemia induced by short-term lipid infusions causes redistribution of neutral lipid components between endogenous lipoproteins and emulsion particles. To determine whether such redistribution occurs over a long-term infusion period and affects lipoprotein pattern, we studied seven patients with inflammatory bowel disease who received cyclic home parenteral nutrition for two consecutive periods of 3 months with two different lipid emulsions. During each period, they received in random order either an emulsion composed exclusively of soy-derived long-chain triglycerides (LCTs) or another emulsion containing an equal weight:weight mixture of long- and medium-chain triglycerides (MCTs/LCTs).

[Parenterally administered medium-chain triglyceride-induced changes in carnitine metabolism].

Medium-chain triglycerides are generally assumed to be metabolized independently of carnitine. The effects of infusing medium-chain triglycerides on plasma concentrations of carnitine derivatives and beta-hydroxybutyrate was studied in four healthy male adults. Glucose and amino acids were infused alone for three hours, then continued for another 5.

Nutritional and metabolic support.

The problem of hunger accompanies any mass casualty situation that results in large numbers of patients with traumatic and burn injuries complicated by sepsis and end organ failure. This is caused by the inability of many of these patients to eat. Such patients require artificial nutrition.

Resting energy expenditure in injured, septic, and malnourished adult patients on intravenous diets.

Energy expenditures of 237 adult patients and 37 normal subjects receiving all nutrition intravenously were analysed retrospectively. Patients were classified as nutritionally depleted (67), post-operative (96), injured (43), or septic/depleted (31). Groups were further divided into those receiving either: (1) only 5% dextrose (D5W); (2) hypocaloric regimens including glucose and amino-acids; and (3) eucaloric or hypercaloric total parenteral nutrition (TPN) which also included fat.

Medium-chain triglycerides induce alterations in carnitine metabolism.

Medium-chain triglycerides are generally assumed to be metabolized independently of carnitine. The effects of infusing medium-chain triglycerides on plasma concentrations of carnitine derivatives and beta-hydroxybutyrate were studied in four healthy male adults. Glucose and amino acids were infused alone for 3 h, then continued for another 5.

Growth hormone and pulmonary disease. Metabolic effects in patients receiving parenteral nutrition.

Six severely malnourished patients with chronic obstructive pulmonary disease were maintained for 3 days with infusions of 5% dextrose in water followed by 12 days of eucaloric total parenteral nutrition. On days 8 through 11, they received 30 micrograms/d of growth hormone and twice this amount on days 11 through 15. Growth hormone had no significant effects on the plasma concentration of glucose, cortisol, or glucagon but caused a 50% increase in insulin and a 250% increase in somatomedin C concentrations.

Effects of glucose on nitrogen balance during high nitrogen intake in malnourished patients.

1. The effects of increasing glucose intake on nitrogen balance, energy expenditure and fuel utilization were measured in 12 malnourished adult patients receiving parenteral nutrition with constant, very high nitrogen intake (500 mg of N/kg), high (105 kJ/kg) or low (30 kJ/kg) glucose intake and constant fat intake (7 kJ/kg). Each patient received each diet for 8-day periods in random order.

Effects of glucose on fuel utilization and glycerol turnover in normal and injured man.

Rates of fat mobilization (glycerol turnover), and fuel utilization and energy expenditure (indirect calorimetry) were measured in normal subjects and injured or septic patients maintained on high or low iv intakes of glucose as their sole nutrient source during 3-day periods. Regimens were given consecutively to each subject in random order. Concentrations of glucose, glycerol, fatty acids, 3-hydroxybutyrate, urea, insulin, and glucagon were determined in plasma, and of epinephrine and norepinephrine in urine.

Functional and metabolic changes during feeding in gastrointestinal cancer.

The impact of feeding a hypercaloric parenteral solution on N balance, energy metabolism, and muscle strength has been investigated in cachectic patients with gastrointestinal cancer and in malnourished patients without evidence of cancer (controls). Patients were examined during 5% dextrose administration (D5W) for 2 days, followed by an infusion of a carbohydrate-based (53% carbohydrate, CB) or fat-based (55% fat, FB) diet with a constant protein intake. Diets were administered for 1 week each, in a randomized crossover design.

Submaximal exercise in emphysema and malnutrition at two levels of carbohydrate and fat intake.

Eight malnourished patients with emphysema (EMPH) and eight malnourished patients without evidence of lung disease (MLAN) received an infusion of 5% dextrose plus electrolytes (D5W) for 48 h and were then randomly assigned to a hypercaloric diet with either 53% of the calories as carbohydrate (CB) or with 55% as fat (FB) for the 1st wk, maintaining a constant protein intake. The alternate diet was given the following week. Ventilation and gas exchange were measured during supine cycle ergometry at 0, 12, and 25 W during the D5W, CB, and FB diet periods.

A mathematical analysis of indirect calorimetry measurements in acutely ill patients.

Beside indirect calorimetry is generally accepted as reliable for evaluating energy expenditure (EE) and oxidation of carbohydrate (dCH) and fat (dF) in critically ill patients. Daily measurement of nitrogen excretion is usually included in the calculation of EE, dCH, and dF but it is difficult to perform in the clinical setting and is not necessary for accurate determination of EE. In this paper new equations, which are suitable for use with critically ill patients, are given for calculating EE, dCH, and dF without N-excretion measurements.

Fatty acid kinetics in man during chronic and acute illness.

Eight nutritionally depleted and five injured patients were studied prior to and during total parenteral nutrition (TPN). Five additional injured patients were studied at intervals while receiving only 5% dextrose. Fatty acid kinetics and oxidation were determined using an infusion of [1-14C]palmitate.

The effects of injury and sepsis on fuel utilization.

The metabolic response to injury may be presumed to be adaptive, at least in terms of days to weeks. In the wild state where these patterns developed, the wounded organism has poor access to food and must live off its own stores of nutrients, mainly fat, and tissue proteins, mainly from muscle. In fasting, without injury, the organism conserves protein.

Measurement of fatty acid oxidation: validation of isotopic equilibrium extrapolation.

Measurement of whole body substrate oxidation requires prolonged isotope infusion to attain plateau specific activity (SA) of expired CO2. We have investigated in 13 hospitalized patients a technique whereby plateau 14CO2 SA is extrapolated using computer curve fitting based upon the early exponential rise. A primed-constant infusion of albumin-bound 1-14C-palmitate was continued for 260 minutes with isotope priming of the secondary bicarbonate pool at 70 minutes.

Intravenous infusion of a medium-chain triglyceride-enriched lipid emulsion.

There has been much interest in the parenteral use of medium-chain triglycerides (MCT) as a noncarbohydrate energy source. This study examines the effects of infusion iv into postabsorptive normal subjects with three doses (0.5, 1.

Nitrogen and energy relationships in malnourished patients with emphysema.

The purpose of this study was to examine the impact of nutritional support on nitrogen-energy relationships and functional parameters in malnourished patients with emphysema. Malnourished patients without lung disease served as the control group. Ten ambulatory, stable patients with emphysema and six patients without lung disease received an infusion of 5% dextrose (baseline) plus electrolytes (D5W) for two days, which was followed by an enteral or a parenteral infusion of either a carbohydrate-based (CB, 53% carbohydrate) or a fat-based diet (FB, 55% fat) for 1 wk each, in a randomized cross-over design.

Changes in respiratory control induced by amino acid infusions.

We compared the metabolic and respiratory responses to a 4-h infusion of an amino acid solution consisting primarily of branched-chain amino acids (BCAA) to those after a standard amino acid solution in healthy subjects. Both the BCAA solution and the standard amino acid solution increased minute ventilation (mean increase 22%, p less than .001, and 18%, p less than .

Muscle high energy phosphates in chronic peripheral vascular disease.

There is little information available concerning the alterations in skeletal muscle energy metabolism which occur in response to chronic arterial occlusive disease. In addition, the effect of arterial reconstruction on skeletal muscle energy metabolism in patients with peripheral vascular disease has not been defined. Needle biopsies were obtained from the quadriceps femoris muscle of 7 patients with aortoiliac disease and 15 patients with femoropopliteal disease and from the gastrocnemius muscle of 9 patients with femoropopliteal disease.