|
Metabolic and immune effects of dietary arginine,
glutamine and omega-3 fatty acids supplementation in
immunocompromised patients.
Chuntrasakul C; Siltharm S; Sarasombath S; Sittapairochana C;
Leowattana W; Chockvivatanavanit S; Bunnak A
Research Center for Nutritional Support, Siriraj
Hospital.
J Med Assoc Thai (Thailand) May 1998, 81 (5)
p334-43
To evaluate the nutritional, metabolic and immune effects
of dietary arginine, glutamine and omega-3 fatty acids (fish
oil) supplementation in immunocompromised patients, we
performed a prospective study on the effect of immune formula
administered to 11 severe trauma patients (average ISS = 24),
10 burn patients (average % TBSA = 48) and 5 cancer patients.
Daily calorie and protein administration were based on the
patient's severity (Stress factor with the range of 35-50
kcal/kg/day and 1.5-2.5 g/kg/day, respectively) Starting with
half concentration liquid immune formula through nasogastric
tube by continuous drip at 30 ml/h and increasing to maximum
level within 4 days. The additional energy and protein
requirement will be given either by parenteral or oral
nutritional support. Various nutritional, metabolic,
immunologic and clinical parameters were observed on day 0
(baseline), day 3, 7, and 14. Analysis was performed by paired
student-t test. Initial mean serum albumin and transferrin
showed mild (trauma ) to moderate (burn and cancer) degree of
malnutrition. Significant improvement of nutritional
parameters was seen at day 7 and 14 in trauma and burn
patients. Significant increase of total lymphocyte count (day
7, P < 0.01), CD4 + count (day 7, p < 0.01), CD8 + count
(day 7, p < 0.0005 & day 14, p < 0.05), complement
C3 (day 7, p < 0.005 day 14, p < 0.01), IgG (day 7, and
14, p < 0.0005), IgA (day 7, p < 0.0005 & day 14, p
< 0.05), in all patients. C-reactive protein decreased
significantly on day 7 (p < 0.0005) and day 14 (p <
0.005). 3 cases of burn wound infection, one case of UTI and
one case of sepsis were observed. Two cases of hyperglycemia
in burn, 3 cases of hyperbilirubinemia in trauma, 10 cases of
elevated LFT (5 trauma /5 burn), and one case of hyponatremia
in cancer patients were observed. Two cases of nausea, 4 cases
of vomiting, 5 cases of diarrhea (< 3 times/day), 2 cases
of abdominal cramp, 1 case of distension were observed. The
feeding of IMMUNE FORMULA was well tolerated and significant
improvement was observed in nutritional and immunologic
parameters as in other immunoenhancing diets. Further clinical
trials of prospective double-blind randomized design are
necessary to address the so that the necessity of using
immunonutrition in critically ill patients will be
clarified.
Changes in the plasma concentrations of retinol,
alpha-tocopherole and beta-carotene in polytraumatized
patients and in patients with osteitis in dependence on the
outcome of injury
Weiss E.; Buchholz I.; Schweigert F.J.
Dr. E. Weiss, Leiter Abteilung fur Unfallchirurgie,
Parkkrankenhaus Leipzig-Dosen, Akad. Lehrkrankenhaus Univ.
Leipzig, Chemnitzer Str. 50, D-04289 Leipzig Germany
Zentralblatt fur Chirurgie (Germany), 1998, 123/11
(1277-1283)
In 17 patients with osteitis and 16 polytraumatized
patients changes in the plasma levels of vitamin A, vitamin E
and beta-carotene were investigated. Plasma samples taken
preoperatively, daily during the first three days and then
twice a week postoperatively were analysed for fat-soluble
vitamins by high performance liquid chromatography (HPLC).
Significant changes in plasma levels of all three components
depending on the outcome of injury were found in all patients.
Increased levels were observed in patients that survived the
injury, while in those who died a significant decrease was
observed. Recommendations regarding the supplementation with
these vitamins in clinical practice can not be made based on
these results, but substitute might prove beneficial for
vitamin E in certain types of injury.
Aphthous ulcers and vitamin B12 deficiency
Weusten B.L.A.M.; van de Wiel A.
B.L.A.M. Weusten, University Hospital Utrecht, Department of
Internal Medicine, PO Box 85500, 3800 ED Amersfoort
Netherlands
Netherlands Journal of Medicine (Netherlands), 1998, 53/4
(172-175)
Aphthous ulcers of the oral cavity are frequently
encountered in general practice. Although the exact
pathophysiology remains obscure, many factors can contribute
to the pathogenesis of these lesions, such as immunological
factors, local trauma, smoking, stress, hormonal state, family
history, food hypersensitivity, and infection. We describe
three patients in whom a clear relationship appeared to exist
between recurrent aphthous ulcers and a deficiency of vitamin
B12. It is concluded that in all patients with recurrent
aphthous ulceration, deficiency of vitamin B12 should be
considered.
Essential fatty acids predict metabolites of
serotonin and dopamine in cerebrospinal fluid among healthy
control subjects, and early- and late-onset alcoholics
Hibbeln J.R.; Linnoila M.; Umhau J.C.; Rawlings R.; George
D.T.; Salem N. Jr.
Dr. J.R. Hibbeln, Outpatient Clinic, Natl. Inst. Alcohol
Abuse/Alcoholism, 12420 Parklawn Drive, Rockville, MD 20852
United States
Biological Psychiatry (United States), 1998, 44/4
(235-242)
Background: Impulsive violence, suicide, and depression are
strongly associated with low concentrations of cerebrospinal
fluid 5- hydroxyindoleacetic acid (CSF 5-HIAA). Increased
suicide and trauma reported in some cholesterol-lowering
trials may be related to altered concentrations of
polyunsaturated fatty acids rather than cholesterol, a
possible surrogate marker.
Methods: CSF 5-HIAA and homovanillic acid (HVA), total
cholesterol, and plasma fatty acid concentrations were
examined in 176 subjects, including 49 healthy volunteers, and
88 early- and 39 late-onset alcoholics.
Results: Among each group, polyunsaturated fatty acids
predicted both CSF 5-HIAA and CSF HVA concentrations, but
total cholesterol was unrelated to either neurotransmitter
metabolite. The relationships between plasma 22: 6n3 and CSF
5-HIAA were significantly different when healthy volunteers (r
= .35) were compared to early-onset alcoholics (r = -.38) (p
<02).
Conclusions: Dietary studies are indicated to determine if
essential fatty acid supplementation can influence central
nervous system serotonin and dopamine metabolism and modify
impulsive behaviors related to these neurotransmitters.
Treatment of hyperpathia/allodinia in CRPS, earlier
called RSDS, a metabolic approach
Moesker A.
Dr. A. Moesker, Pain Treatment Department, Refaja Hospital,
Boerhaavestroat 1, 9501 HE Stadskanaal Netherlands
Pain Clinic (Netherlands), 1998, 10/4 (261-274)
Why some people, often after a mild trauma, are developing
a Chronic Regional Pain Syndrome is at present still not
understood. For decades, sympathetic nervous involvement was
the main goal of understanding. The most effective therapy was
blocking the sympathetic innervation by phenol ore
themolaesion, or by the farmacon guanethidine. Restoring the
circulation by a serotonine- antagonist, ketanserin, was a
development in a way that most of the complaints could be
treated, but not the symptoms of hyperpathia and allodinia. In
recent years an interesting new field of treatment was
explored. Because of the fact that oxigen free radicals are
found in cases of CRPS, an oxigen free radical scavenger,
dimethylsulfoxide was applied on the affected area. On the
basis of these experiences a new hypothesis was build. Because
of the symptoms there must be an area of ischemia. In this
area the metabolism has to use the anaerobiosis. In the
anaerobiosis there will be a production of ATP, free radicals
and lactate. Restoring the circulation will not always be
sufficient to facilitate the metabolism in the direction of
aerobiosis. Carnitine is a pivotal factor in stimulating the
aerobiosis by enhancing the fatty acid oxidation. These
processes take place in the mitochondrion. Carnitine is a
metabolic modulator by way of stimulation of the
beta-oxidation. It will modulate the ATP production, reduce
the lactate production, inhibite the formation of superoxide,
and reduce the formation of hydrogen peroxide. ATP seems to be
a co-transmitter for the sympathetic nerve endings. In this
way the circle is complete and the involvement of the
sympathetic nerves is explained. In cases of CRPS in the Pain
Clinic of the Refaja Hospital a trial investigated the
possibility of treating CRPS patients with restoring
circulation by ketanserin and to restore the metabolism by
carnitine. The results of the first 12 patients were very
promising and are presented. Not only the circulation
disorders did react better, but also the hyperpathia and
allodinia diminished in a way we never had seen.
Influence of arginine, omega-3 fatty acids and
nucleotide-supplemented enteral support on systemic
inflammatory resp. syndrome and multiple organ failure in
patients after severe trauma
Weimann A.; Bastian L.; Bischoff W.E.; Grotz M.; Hansel M.;
Lotz J.; Trautwein C.; Tusch G.; Schlitt H.J.; Regel G.
Dr. A. Weimann, Klin. Abdom.-/Transplantationschir.,
Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625
Hannover Germany
Nutrition (United States), 1998, 14/2 (165-172)
This study investigated the influence of an enteral diet
supplemented with arginine, omega-3 fatty acids, and
nucleotides (Impact, Sandoz Nutrition, Berne, Switzerland) on
the incidence of systemic inflammatory response syndrome
(SIRS) and multiple organ failure (MOF) in patients after
severe trauma . Thirty-two patients with an injury-severity
score >20 were included in this prospective, randomized,
double-blind, controlled study. Primary endpoints were the
incidence of SIRS and MOF. Secondary endpoints were parameters
of acute phase and immune response as well as infection rate,
mortality, and hospital stay. For statistical analysis 29
patients (test group n = 16, control n = 13) were eligible. In
the test group, significantly fewer SIRS days per patient were
found during 28 d. The difference was highly significant
between d 8-14 (P < 0.001). MOF score was significantly
lower in the test group on d 3 and d 8-11 (P < 0.05). Acute
phase parameters showed lower C-reactive protein serum levels
(significant on D day 4) and fibrinogen plasma levels
(significant on d 12 and 14; P < 0.05). HLA-DR expression
on monocytes showed significantly higher fluorescence activity
on d 7. No significant difference was found for T-lymphocyte
CD4/CD8 ratio, interleukin- 2 receptor expression, infection
rate, mortality (2/16 vs. 4/13), and hospital stay. The
results of the study provide further support for beneficial
effects of arginine, omega-3-fatty acids and nucleotide-
supplemented enteral diet in critically ill patients.
Impact of supplemented enteral nutrition in
patients with multiple trauma
Bastian L.; Weimann A.; Bischoff W.; Meier P.N.; Grotz M.;
Stan C.; Regel G.
Dr. L.Bastian, Unfallchirurgische Klinik, Medizinische
Hochschule Hannover, D-30623 Hannover Germany
Unfallchirurg (Germany), 1998, 101/2 (105-114)
Previous studies in critically ill patients have shown the
beneficial effects of early enteral nutrition supplemented
with arginine, omega-3 fatty acids and nucleotides (Impact) on
immunological response, infection rate and length of stay in
hospital. No specific data exist for patients with severe
multiple injury, who represent a high risk group for systemic
inflammatory response syndrome (SIRS), septic complications
and multiple organ failure (MOF). In this prospective,
randomized, double-blind controlled clinical study on patients
after severe trauma (ISS ca. 40) the primary study endpoints
were incidence of SIRS and MOF (definitions according to Am
Soc Crit Care Med (5) and Goris (23), Sauaia (43)). Thirty-two
patients enrolled in the study, and 29 were eligible for
analysis: test (Impact) (n = 16), control (n = 13). Both
groups were comparable according to age, body mass index and
severity of trauma (PTS-test: 38.8 plus or minus 12.5,
PTS-control: 40.8 plus or minus 15.5, ISS-test: 39.6 plus or
minus 11.4, ISS-control: 40.5 plus or minus 9.2). Patients
were randomized to receive either Impact (test) or an
isonitrogenous isocaloric diet (control). Feeding was started
on the 2nd day after trauma via endoscopically placed
nasoduodenal or-jejunal feeding tubes. The experimental diet
was safe and well tolerated. During the 1st week the enteral
feeding amount was about 2000 ml without significant
difference. Test-fed patients developed SIRS significantly
less frequently between day 1 and day 28 (8 vs 13.3; P <
0.05) and especially between day 8 and day 14 (3 vs 6.2; P
< 0.001). In the control group the Goris score was
significantly worse (P < 0.05) on days 3, 4, 6, 7, 10, 11,
16 and 17 and the Sauaia score on days 8, 9, 10 and 11 (P <
0.05; P < 0.01). Mortality rate did not significantly
differ (test 2/16, control 4/13), nor did length of ICU or
hospital stay. With regard to the acute-phase response,
C-reactive protein was significantly lower on day 4 in the
test group (test: 131 plus or minus 67 mg/1, control: 221 plus
or minus 110 mg/l) as was fibrinogen on day 12 (6.6 plus or
minus 1.4 vs 7.5 plus or minus 1,4 g/l) and day 14 (7.1 plus
or minus 1.3 vs 7.8 plus or minus 0,8 g/l). No significant
difference could be observed for CD4/CD8 ratio, CD45 isotope
on activated T-cells and lymphocytic interleukin (II)-2-
receptor- and 11-6 level. However, HLA-DR antigen presentation
on peripheral monocytes was significantly elevated on day 7 in
the test group (P < 0.05). According to the results,
arginine, omega-3 fatty acids and nucleotides-enriched diet
during early enteral feeding leads to reduction of SIRS after
severe multiple injury. There is evidence for improvement of
post-traumatic immunological response which helps to overcome
the immunological depression after trauma .
Diets and infection: Composition and
consequences
Alexander J.W.; Ogle C.K.; Nelson J.L.
Dr. J.W. Alexander, Department of Surgery, Transplantation
Division, Univ. of Cincinnati Medical Center, 231 Bethesda
Avenue, Cincinnati, OH 45267-0558 United States
World Journal of Surgery (United States), 1998, 22/2
(209-212)
This brief review focuses on the effects of nutrient
composition of enteral diets on the outcome of surgical
patients and experimental models of infection. Complete
enteral diets containing combinations of immunonutrients
(arginine, glutamine, RNA, omega-3 fatty acids), when given
postoperatively or after trauma to surgical patients, can
reduce hospital stay, overall costs, and the incidence of
wound complications and acquired infections. Immunonutrient
diets can also reduce the length of hospital stay when given
to patients admired to the surgical intensive care unit. A
high protein diet is usually required for optimal benefit,
although administration of high protein immunoenhancing diets
may have adverse effects in animals with severe untreated
peritonitis because of a sustained overproduction of
cytokines.
[Nutritional support for the large burn
patient]
Pelaez J; Garcia de Lorenzo A; Denia R; Martinez Ratero S;
Lopez Martinez J; Caparros T
Servicio de Medicina Intensiva de la Fundacion Jimenez Diaz,
Hospital La Paz, Madrid, Espana.
Nutr Hosp (Spain) May-Jun 1997, 12 (3) p121-33
Large burn patients make up a subgroup of critical patients
in whom the nutro-metabolic support reaches its maximum
importance, due to the fact thermal aggression induces a
hypermetabolic response which is prolonged until the wounds
heal. In fact, there are few deubt with regard to the
importance of nutritional support tin the management of these
patients for reducing the complications and facilitating the
closing of the wounds and the recovery of the patients.
Thermal trauma induces the release of counter-regulatory
hormones and of other mediators which favor proteineic
catabolism, mainly muscular, lipolysis, and gluconeogenesis;
as well, there is an alteration of thermoregulation, raising
the equilibrium point. The estimate of the energetic
requirements may be done by means of predictive equations,
although these tend to over-estimate it; indirect calorimetry
is the most exact method and this permits monitorization of
the evolution, which is very variable in time, it gives the
metabolic response to the thermal aggression, at the same time
as permitting the analysis of the use of the administrated
substrates. Its use has meant a dramatic decrease in the
supply of calories administered to burn patients, with the
present recommendation being 35-40 kcal/kg/d. The supply of
non-proteineic calories has also been modified: It is
recommended that at least 60-70% of the calories administered,
be in the form of carbohydrates, without surpassing 1600
kcal/kg/d. The optimal relation of non-proteineic
kcal:nitrogen, is 150:1. The administration route of the
artificial nutrition support should be individualized in each
patient, with the enteral route being the route of choice, as
this is the most physiologic, the cheapest, and the safest;
its use prevents the appearance of certain complications
(Curling ulcer, cholecystitis, bacterial translocation);
however, if his does not cover nutritional requirements of the
burn patient, parenteral nutrition should be associated to
this. (108 Refs.)
Effects of intravenously infused fish oil on
platelet fatty acid phospholipid composition and on platelet
function in postoperative trauma
Roulet M; Frascarolo P; Pilet M; Chapuis G
Nutrition Unit, University of Lausanne, Switzerland.
JPEN J Parenter Enteral Nutr (United States) Sep-Oct 1997, 21
(5) p296-301
BACKGROUND: The aim of this study was to assess the
short-term effect of IV infusion of fish oil emulsion on the
fatty acid profiles of platelet phosphatidylcholine and
phosphatidylethanolamine and on platelet function in
postoperative patients.
METHODS: Over a 7-day period, 10 patients received a 20%
soybean fat emulsion with an added 10% marine fish oil
emulsion, whereas 9 controls received only 20% soybean fat
emulsion.
RESULTS: By comparison with controls, in patients receiving
fish oil, (1) a large increase in eicosapentaenoic acid
(20:5n-3) was observed in both platelet phosphatidylcholine
(1.55% +/- 0.17% vs 0.38% +/- 0.06% by weight, p < .01) and
phosphatidylethanolamine 2.21% +/- 0.18% vs 0.66% +/- 0.08% by
weight, p < .01); (2) eicosapentaenoic acid
(20:5n-3)/arachidonic acid (20:4n-6) ratios doubled in both
platelet phosphatidylcholine (p < .01) and
phosphatidylethanolamine (p < .05); (3) with collagen as
aggregating factor, maximal reaction speed decreased (p <
.02) and latency increased (p < .002); and (4) no toxic
effect, in particular no increase of postoperative bleeding
and no perturbation of hepatic and renal function, was
observed during the fish oil infusion.
CONCLUSIONS: A short-term IV infusion of fish oil clearly
modifies the platelet composition and changes some parameters
of platelet function.
The effect of nutritional support on the
perioperative course in patients after extensive surgical
procedures
Kalacinski J; Kalacinska B; Kurczych K; WojdyLo A
OddziaLu Chirurgii Ogolnej, Apteki Szpitalnej Szpitala
Miejskiego w Oswiecimiu.
Wiad Lek (Poland) 1997, 50 Su 1 Pt 2 p447-51
Nutritional treatment in patient undergoing extensive
surgical procedures is a condition of shortening of catabolic
phase of postoperative period. Giving a basal quantity of
nutritional components, authors tried to do a clinical
evaluation of treated patients and possibilities of the
nutritional treatment in a provincial hospital. 51 patients
was fed parenterally or/and enterally, all-in-one admixtures
or with multi- bottles system, with using of
peristaltic/infusion pump or gravity. Patients were divided
into 4 groups: 1. treated with laparostomy because of
pancreatic necrosis or complications of acute pancreatitis, 2.
with complications after total or subtotal gastrectomy, 3.
with complications after extensive resections of jejunum or
colon Clinical status, weight loss, accessible laboratory
investigations were studied. Authors gave on the average:
energy 32 kcal/kg b.m./day, protein 0.15 gN/kg b.m./day,
potassium 1.15 mEq/kg b.m./day. In 37 patients appeared weight
loss av. 4.8 kg. In 20 patients with decreased serum protein
level or blood cell count-plasma and erythrocytes were
applied. In examined groups 9 persons died because of
myocardial infarction, pulmonary embolism, intestinal necrosis
with peritonitis, lesions of CNS following trauma, sepsis.
Conclusions: 1. Effective treatment of postoperative
complications is possible with application of nutritional
treatment. 2. Adequate (not excessive) nutritional components
administration should be applied intravenously, enterally or
by both of them.
Vitamins Q and E, extracorporal circulation and
hemolysis.
Karlsson J; Ronneberg R; Semb B
Mol Cell Biochem (Netherlands) Aug 1997, 173 (1-2)
p33-41
Whole blood vitamin Q (ubiquinone), plasma vitamins Q and E
(alpha-(alpha-)tocopherol) and free cholesterol (FC) were
studied before (control or base-line value, sample I) and
during open chest surgery and extracorporal circulation
(samples II-IV) in 10 male IHD patients. Identity existed
between control whole blood and plasma ubiquinone. During
surgery an increased discrepancy with lower plasma vitamin Q
levels were seen. Control plasma vitamins Q, E and FC averaged
0.88 +/- 0.16 (SE), 12.1 +/- 2.2 mg x l(-1) and 0.75 +/- 0.15
g x l(-1). Corresponding molar values were 1.02 +/- 0.17, 28.1
+/- 5.1 micromol x l(-1) and 1.94 +/- 0.74 mmol x l(-1).
Vitamin Q and E decreased continuously and averaged 0.64 mg x
l(-1) in sample IV (0.74 micromol x l(-1), p < 0.001) and
9.4 mg x l(-1) in sample III (21.8 micromol x l(-1), p <
0.001). Hemolysis in all sample IV vials, ruined all vitamin E
determinations. When normalized for FC (NQ and NE), decreases
were found to be 17 (IV) and 12% (III), respectively. Large
interindividual variations existed. High control NQ and NE
values allowed a larger antioxidant vitamin depletion. High NQ
seemed also to be a prerequisite for NE depletion. In
addition, signs indicated an active liver vitamin Q release
for patients rich in control antioxidant values. It was
suggested that the antioxidant vitamin depletion did not
prevent from radical trauma to membrane structural lipids
(especially omega-3 fatty acids or vitamin F1), less membrane
fluidity, erythrocyte fragility and hemolysis.
Metabolic response to injury and sepsis: changes in
protein metabolism.
Biolo G; Toigo G; Ciocchi B; Situlin R; Iscra F; Gullo A;
Guarnieri G
Institute of Clinical Medicine, University of Trieste,
Italy.
Nutrition (United States) Sep 1997, 13 (9 Suppl)
p52S-57S
The metabolic response to trauma and sepsis involves an
increased loss of body proteins. Specific sites of changes of
protein and amino acid metabolism have been identified. In
skeletal muscle, the rate of proteolysis is accelerated
greatly. The rate of protein synthesis also may be increased
but not enough to match the increase in degradation.
Intramuscular glutamine concentration is decreased because of
increased efflux and possibly decreased de novo synthesis. In
the liver, the rate of synthesis of selected proteins (i.e.,
albumin, transferrin, prealbumin, retinol-binding protein, and
fibronectin) is decreased, whereas acute phase protein
synthesis is accelerated. Tissues characterized by rapidly
replicating cells, such as enterocytes, immune cells,
granulation tissue, and keratinocytes, exhibit early
alterations in the case of decreased protein synthesis
capacity. In these tissues, glutamine use is accelerated.
Increased stress hormone (cortisol and glucagon) and cytokine
secretion, as well as intracellular glutamine depletion, are
potential mediators of altered protein metabolism in trauma
and sepsis. However, the relative importance of these factors
has not been clarified. Therapy of acute protein catabolism
may include the use of biosynthetic human growth hormone,
possibly in combination with insulin-like growth factor-1, and
the administration of metabolites at pharmacologic doses. We
recently studied the effects of carnitine and alanyl-glutamine
administration in severely traumatized patients. We found that
both carnitine and the glutamine dipeptide restrained
whole-body nitrogen loss without affecting selected indices of
protein metabolism in the skeletal muscle. (52 Refs.)
Carotenoids and antioxidant vitamins in patients
after burn injury.
Rock CL; Dechert RE; Khilnani R; Parker RS; Rodriguez
JL
Department of Surgery, the University of Michigan, Ann Arbor,
USA.
J Burn Care Rehabil (United States) May-Jun 1997, 18 (3)
p269-78; discussion 268
Oxidative stress may contribute to secondary tissue damage
and impaired immune function in patients after burn injury.
The purpose of our study was to describe plasma antioxidant
micronutrient concentrations in 26 adult patients admitted
with extensive burn injuries (> 20 % total burn surface
area) to a level-1 trauma burn center during a 21-day period
after admission. The effect of administering beta-carotene was
also examined with use of a prospective randomized subjects
design: patients received either placebo or 30 mg/day in an
enteral feeding. Plasma concentrations of alpha- and
gamma-tocopherol, carotenoids (alpha and beta-carotene,
lycopene, beta-cryptoxanthin, lutein), and retinol were
measured with high- performance liquid chromatography, and
vitamin C was quantified with spectrophotometry, at baseline
and twice per week. Vitamin C, tocopherol, and retinol
concentrations were low at baseline, but levels increased
significantly over the study period in both groups (p <
0.05). Plasma beta-carotene concentration increased when this
carotenoid was provided in the oral feeding. Otherwise, plasma
carotenoid concentrations were low at baseline and remained
low throughout the study period despite normalization of
associated lipids.
The role of IGFs in catabolism
Botfield C.; Ross R.J.M.; Hinds C.J.
C. Botfield, Dept. of Intensive Care, St Bartholomew's
Hospital, London EC1A 7BE U.K.
Bailliere's Clinical Endocrinology and Metabolism (United
Kingdom), 1997, 11/4 (679-697)
The hypercatabolic response to trauma, extensive surgery
and sepsis is characterized by an increased metabolic rate,
severe muscle wasting and a negative nitrogen balance. This
process of 'autocannibalism' may be in part a consequence of a
disordered growth hormone (GH)/insulin-like growth factor
(IGF) axis. In this chapter the normal physiology of the
GH/IGF axis is first briefly reviewed. This is followed by a
discussion of the changes that accompany fasting and catabolic
illness, the effects of IGF-1 administration in health and
disease and a comparison of the effects of IGF-1, GH and
insulin on catabolism. Although initial investigations of
IGF-1 administration in animals and human volunteers have
often been encouraging, studies in catabolic patients have so
far proved disappointing. Combined treatment with GH, IGF-1
(and insulin) or with IGF-1 and its major binding protein, may
prove more effective, especially when used in conjunction with
nutritional supplements such as glutamine.
Antioxidant defense of the brain: A role for
astrocytes
Wilson J.X.
J.X. Wilson, Dept. of Physiology, University of Western
Ontario, London, Ont. N6A 5C1 Canada
Canadian Journal of Physiology and Pharmacology (Canada),
1997, 75/10-11 (1149-1163)
Partially reduced forms of oxygen are produced in the brain
during cellular respiration and, at accelerated rates, during
brain insults. The most reactive forms, such as the hydroxyl
radical, are capable of oxidizing proteins, lipids, and
nucleic acids. Oxidative injury has been implicated in
degenerative diseases, epilepsy, trauma, and stroke. It is a
threshold phenomenon that occurs after antioxidant mechanisms
are overwhelmed. Oxidative stress is a disparity between the
rates of free radical production and elimination. This
imbalance is initiated by numerous factors: acidosis;
transition metals; amyloid beta-peptide; the neurotransmitters
dopamine, glutamate, and nitric oxide; and uncouplers of
mitochondrial electron transport. Antioxidant defenses include
the enzymes superoxide dismutase, glutathione peroxidase, and
catalase, as well as the low molecular weight reductants
alpha-tocopherol (vitamin E), glutathione, and ascorbate
(reduced vitamin C). Astrocytes maintain high intracellular
concentrations of certain antioxidants, making these cells
resistant to oxidative stress relative to oligodendrocytcs and
neurons. Following reactive gliosis, the neuroprotective role
of astrocytes may be accentuated because of increases in a
number of activities: expression of antioxidant enzymes;
transport and metabolism of glucose that yields reducing
equivalents for antioxidant regeneration and lactate for
neuronal metabolism; synthesis of glutathione; and recycling
of vitamin C. In the latter process, astrocytes take up
oxidized vitamin C (dehydroascorbic acid, DHAA) through plasma
membrane transporters, reduce it to ascorbate, and then
release ascorbate to the extracellular fluid, where it may
contribute to antioxidant defense of neurons.
Parenteral nutritional treatment
Schricker T.; Geisser W.; Georgieff M.
Prof. Dr. M. Georgieff, Universitatsklinik Anasthesiologie,
Klinikum, Universitat Ulm, Steinhovelstrasse 9, D-89075 Ulm
Germany
Anaesthesist (Germany), 1997, 46/5 (371-384)
The object of this review is to demonstrate the
non-nutritional importance of carbohydrates and fat as they
represent the classic energy carriers in parenteral nutrition.
Concerning the pathophysiological changes of organ metabolism
and intermediary metabolism as well as the pharmacological
function of this nutritive substrates it is necessary to
adjust parenteral nutrition strategy to various clinical
pictures. The major goals of parenteral applicated
carbohydrates are to avoid hyperglycemia, to return the
increased hepatic glucose production during trauma and sepsis
back to normal, and to reduce protein catabolism. Realizing
this goals the dosage of glucose infusion underlies close
metabolic borders depending on the present disease. Because of
favourable effects of hepatic glucose and protein metabolism,
xylitol, a non-glucose polyol, represents an useful
alternative energy source to glucose. The non-energetic
nutrition therapy with fat consists of application of the
essential fatty acids linoleic and alpha-linolenic acid and
considers the immunmodulatory effects of various fatty acids
as precursors in the eicosanoid metabolism. As demonstrated at
the organ systems of liver and lung this pharmacological
effect of any lipid infusion might influence specific organ
functions.
Influence of large intakes of trace elements on
recovery after major burns
Berger M.M.; Cavadini C.; Chiolero R.; Guinchard S.; Krupp
S.; Dirren H.; Shenkin A.
CHUV,CH-1011 Lausanne Switzerland
Nutrition (United States) 1994, 10/4
(327-334+352)
Because Cu, Se, and Zn are involved in immune and
antioxidative defense mechanisms and tissue repair,
deficiencies might aggravate complications classically
observed with burns. After measuring massive cutaneous trace
element losses in 10 burn patients, our aim in this study was
to determine whether large intravenous intakes of Cu, Zn, and
Sc can modify serum trace element levels and recovery after
major burns. Ten patients, aged 34 +/- 6 yr (mean +/- SD),
admitted to the burns center of a Swiss university hospital
with thermal burns on 41 +/- 9% of their body surface were
studied prospectively, with trace element balance studies from
day 1 (D1) to D7 postinjury. Urine and blood samples were also
collected on D10, D15, D20, and D25. The patients were divided
into two groups of five and received either standard (group 1,
control) or greatly increased (group 2, treatment: 4.5 mg Cu,
190 mug Se, and 40 mg Zn/day) trace element intakes. Energy
and protein intake and wound treatment were similar in both
groups. The treatment group was characterized by improved Cu,
Se, and Zn status (increase in serum levels and various
protein indicators), a much larger leukocyte increase between
D4 and D14 (mainly neutrophils), and shorter hospital stay (45
days) compared with the untreated group (57 days). Grafting
requirements were more extensive in group 1. Although severity
of injury and wound treatment were similar in the groups, the
duration of hospitalization was lower in the treated group.
Further studies are required to determine whether this is
related to trace element supplementation.
Proline metabolism in adult male burned patients
and healthy control subjects
Jaksic T.; Wagner D.A.; Burke J.F.; Young V.R.
Shriners Burns Institute, 51 Blossom Street,Boston, MA 02114
United States
American Journal of Clinical Nutrition (United States) 1991,
54/2 (408-413)
Postabsorptive proline flux, oxidation, and endogenous
biosynthesis were determined in five severely burned
intensive-care-unit patients (x- age 27 y) and in six healthy,
young-adult control subjects. Continuous primed, intravenous,
160-min, dual stable-isotope-tracer infusions of L-(1-sup 1sup
3C)proline and L-(methyl-sup 2Hinf 3)leucine were used in
conjunction with measurement of plasma proline concentration
and 24-h urinary hydroxyproline output. Burn patients,
compared with normal individuals, demonstrated a doubling in
proline and leucine flux (P < 0.01 for both findings), a
threefold enhancement of proline oxidation (P < 0.05), a
trend toward decreased proline synthesis, and a 37% reduction
in plasma proline concentrations (P < 0.05). Further, the
injured group, unlike the control group, was in a distinct
negative body proline balance, as proline oxidation greatly
exceeded endogenous proline biosynthesis (P < 0.01). These
studies indicate that significant proline deficits may evolve
during the postabsorptive period in severely burned patients
and that an exogenous supply of proline might benefit the
nitrogen economy of the traumatized patient.
Magnesium- deficiency syndrome in burns.
Broughton A; Anderson IR; Bowden CH
Lancet (England) Nov 30 1968, 2 (7579) p1156-8
No abstract.
Reversal of postburn immunosuppression by the
administration of vitamin A
Fusi S.; Kupper T.S.; Green D.R.; Ariyan S.
Department of Surgery, Yale University School of Medicine,
New Haven, CT United States
Surgery (United States) 1984, 96/2 (330-335)
The effect of high doses of vitamin A was evaluated on the
suppression of cellular immunity after a 30% body surface area
experimental scald burn in a mouse model. Male CBA/J mice were
treated postburn with daily intraperitoneal injections of
either 3000 IU of vitamin A or an equal volume of 0.9N saline.
Similar groups of unburned mice were also studies as controls.
At the seventh postburn day, one-way mixed lymphocyte
reactions were tested for each group with whole spleen cells
of CBA/J mice used as responders and mitomycin C-treated whole
spleen cells of C57 BL/6 mice used as stimulators. When
results were expressed as mean percentage of the values of
control animals, no significant difference was observed
between the saline-injected unburned control group (taken as
100%) and the vitamin A -treated unburned control groups
(89%). The burned animals treated with saline showed
suppression to 21% of the control values. However, the burned
animals treated postburn with vitamin A improved the response
rate dramatically to 52% of control values. This improvement
over the untreated burned animals was significant in all
experiments performed (p < 0.02). This study suggests that
vitamin A may be an effective agent in the reversal of
cellular immunosuppression after burns.
Serum carotene, vitamin A, retinol-binding protein
and lipoproteins before and after jejunoileal bypass
surgery.
Vahlquist A; Carlson K; Hallberg D; Rossner S
Int J Obes (England) 1982, 6 (5) p491-7
The plasma vitamin A and carotene transport in 45 obese
patients was examined before and at various times after bypass
surgery. The serum levels of lipoproteins, carotene, vitamin A
and retinol-binding protein (RBP) were monitored and compared
to those of healthy controls. LDL-cholesterol levels were
decreased by 40 per cent (P less than 0.001) within the first
year after surgery and remained low thereafter. The reduction
of serum carotene (from a mean of 64 to 17 micrograms/dl) was
rapid and constant. This change was observed already within
1-2 weeks post-surgery. The serum concentrations of carotene
and LDL-cholesterol were highly correlated (r = 0.74). The
concentrations of vitamin A and RBP were normal before the
operation and remained so until 30 months after surgery, when
slight reductions were observed compared to the control values
[46 +/- 28 vs 66 +/- 11 micrograms/dl for vitamin A (P less
than 0.01) and 32 +/- 8 vs 41 +/- 6 mg/l for RBP (P less than
0.01)]. No overt signs of vitamin A deficiency were observed.
The mechanisms by which carotene (but not vitamin A) decreases
so rapidly after bypass surgery cannot be explained by the
decreased LDL levels.
Bypass phrynoderma. Vitamin A deficiency associated
with bowel-bypass surgery.
Barr DJ; Riley RJ; Greco DJ
Arch Dermatol (United States) Jul 1984, 120 (7)
p919-21
A 41-year-old woman had multiple keratotic papules and
nodules on the trunk and extremities four years after a
bowel-bypass procedure for morbid obesity. The microscopic
features were those of a perforating folliculitis. Serum
vitamin A levels were extremely low. Oral vitamin A therapy
resulted in dramatic improvement of the cutaneous lesions.
|