1.
The effect of low-nitrogen and low-calorie parenteral nutrition combined with enteral nutrition on inflammatory cytokines and immune functions in patients with gastric cancer: a double blind placebo trial.
Li, JH, Han, L, Du, TP, Guo, MJ
European review for medical and pharmacological sciences. 2015;(8):1345-50
Abstract
OBJECTIVE The aim of this study is to investigate the effect of low-nitrogen and low-calorie parenteral nutrition (PN) combined with enteral nutrition (EN) on the inflammatory cytokines and immune function in patients with gastric cancer. PATIENTS AND METHODS Between May 2012 and May 2014, 90 patients undergoing surgery for gastric cancer in our institution were involved in this double blind placebo study and randomly divided into experimental group and control group, 45 patients of each group. Patients in the control group would receive total parenteral nutrition (TPN) whereas patients in the experimental group would be supported with low-nitrogen and low-calorie PN combined with EN. RESULTS On the 7th postoperative day 7, levels of IgA, IgM and IgG in experimental group were significantly higher than those in the control group and preoperative values (p < 0.05). CRP level was significantly lower than that of controls and preoperatively (p < 0.05). Levels of IL-2 and TNF-α were significantly higher than those of controls and preoperatively (p < 0.05). CONCLUSIONS As low-nitrogen and low-calorie PN combined with EN can effectively improve the immune function, reduce the inflammatory reactions and improve the postoperative quality of life (QoL) and prognosis in patients with gastric cancer, it is suitable for clinical application.
2.
Protein for the critically ill patient--what and when?
Plank, LD
European journal of clinical nutrition. 2013;(5):565-8
Abstract
Critical illness is characterised by catabolism of the skeletal muscle that releases amino acids for protein synthesis to support tissue repair, immune defence and inflammatory and acute-phase responses. Protein requirements for these patients have generally been based on levels that result in the lowest catabolic rates or most favourable nitrogen balance. The definition of these levels, in particular, in relation to indexing to a measure of patient weight or lean body mass, is controversial. Furthermore, optimal nitrogen balance may not necessarily equate to best clinical outcome. There is some evidence that administration of specific amino acids may be advantageous at least during the early or most catabolic phases of illness, in order to support the specific amino acid requirements of the metabolic pathways activated by the injury or infection. Current widely used guidelines differ in the protein prescription they recommend and in the timing of administration in relation to intensive care admission. A pressing need exists for well-designed randomised trials that compare differing levels of protein or amino acid provision, and the timing of this provision, for their effects on clinical endpoints.
3.
Early enteral administration of immunonutrition in critically ill children: results of a blinded randomized controlled clinical trial.
Briassoulis, G, Filippou, O, Hatzi, E, Papassotiriou, I, Hatzis, T
Nutrition (Burbank, Los Angeles County, Calif.). 2005;(7-8):799-807
Abstract
OBJECTIVES In a blinded, prospective, randomized, controlled clinical trial, we compared nitrogen balance (NB), nutritional indices, antioxidant catalysts, and outcome in critically ill children given an immune-enhancing formula (I) or conventional early enteral nutrition (C). METHODS Fifty patients, 103 +/- 7 months old, with disorders prompting admission to the pediatric intensive care unit, including sepsis, respiratory failure, and severe head injury, were enrolled in the study. Within 12 h of admission, patients were randomized to receive I (n=25) or C (n=25). Caloric intake was aimed at meeting patient's predicted basal metabolic rate by day 2 and predicted energy expenditure by day 4, irrespective of group assignment. Outcome endpoints and complications were recorded; NB, transthyretin, retinol-binding protein, transferrin, zinc, copper, and metabolic indices were measured on days 1 and 5 and compared with clinical and nutritional characteristics within and between groups. RESULTS Both diets achieved their initial targets of covering predicted basal metabolic rate by day 2 and predicted energy expenditure by day 4. Twenty four-hour NB became positive in 40% of patients in group C and occurred in 64% of patients in group I by day 5. Only in group I did the mean NB become positive by day 5 (0.07+/-0.07 g/kg versus -0.24+/-0.03 g/kg on day 1, P<0.001) compared with group C in which the mean NB remained negative (-0.06+/-0.04 g/kg versus -0.25+/-0.06 g/kg on day 1, P<0.001). By day 5, nutritional indices and antioxidant catalysts showed a higher increasing trend in group I compared with group C and higher osmolality (P<0.02), sodium (P<0.03), and urea (P<0.04). Diarrhea for group I (P<0.02) and gastric distention for group C (P<0.04) were the most frequently recorded complications. Mortality or length of stay did not differ between groups, but there was a trend for less gastric gram plus isolates (P<0.05) or for Candida species (P<0.04) and nosocomial infections in group I compared with group C. CONCLUSIONS Although less well tolerated, immunonutrition is a feasible method of early enteral nutrition in the pediatric intensive care unit. It has a favorable effect on nutritional indices and antioxidant catalysts, but not on outcome hard endpoints. Although it poses a higher metabolic burden to the patient, it shows a trend to improve colonization and infection rates. Appropriate modifications for specific age populations might improve its tolerability and benefits among critically ill children.
4.
The effect of glutamine-supplemented total parenteral nutrition on nitrogen economy depends on severity of diseases in surgical patients.
Lin, MT, Kung, SP, Yeh, SL, Lin, C, Lin, TH, Chen, KH, Liaw, KY, Lee, PH, Chang, KJ, Chen, WJ
Clinical nutrition (Edinburgh, Scotland). 2002;(3):213-8
Abstract
BACKGROUND Gln is an important substrate for enterocyte and rapid proliferation cells. Studies have shown that parenteral supplementation of Gln maintains the intracellular Gln pool, improves nitrogen balance and shortens hospital stay. However, some studies showed Gln-supplemented TPN had no effect on restoring the Gln pool in critically ill patients. OBJECTIVE To evaluate the effect of glutamine (Gln) dipeptide supplementation of total parenteral nutrition (TPN) on postoperative nitrogen balance and immune response of patients undergoing surgery. METHODS This study is a prospective, randomized double-blind clinical trial. APACHE II score and TISS were used to evaluate the patients after admission. Forty-eight patients with major abdominal surgery were allocated to two groups to receive isonitrogenous (0.228 g nitrogen/kg/day) and isoenergetic (30 kcal/kg/day) TPN for 6 days. Two groups (Conv and Ala-Gln) were further divided to high (APACHE>or=6) and low (APACHE <6) groups. Control group (Conv) received 1.5 g amino acids/kg/day, whereas the Ala-Gln group received 0.972 g amino acids/kg/day and 0.417 g of L-alanyl-L-glutamine (Ala-Gln)/kg/day. Blood samples were collected on day 1 and day 6 after surgery for plasma amino acid and CD4, CD8 cell and T lymphocyte analysis. Cumulative nitrogen balance were also measured on day 2, 3, 4, 5 postoperatively. RESULTS Although there was a tendency to have better cumulative nitrogen balance on the postoperative days in the Ala-Gln group, no significant difference was observed between two groups. However, a better significant cumulative nitrogen balance was observed on the 2nd, 3rd and 5th postoperative day in the Ala-Gln group than in the Conv group in patients with APACHE II <6, whereas no significant difference was noted in patients with APACHE II >or= 6. No difference in urine 3-methylhistidine excretion were observed between the 2 groups. Patients in the Ala-Gln group had significant higher T lymphocyte and CD4 cells than did those in the Conv group. CONCLUSION TPN supplemented with Gln dipeptide had beneficial effect on enhancing the immune response. However, the effect of Ala-Gln administration on improving nitrogen economy was only observed in patients with low APACHE II scores. These results may indicate that Gln required for reversing the catabolic condition may depend on the characteristics and severity of the diseases.
5.
Protein and amino acid requirements in the elderly.
Kurpad, AV, Vaz, M
European journal of clinical nutrition. 2000;:S131-42
Abstract
Estimates of protein and amino acid requirements in this paper are proposed for healthy elderly people. The estimate of protein requirement was based on nitrogen (N) balance, as well as functional indicators such as immune function or muscle strength. Data suggest that the protein requirement for nitrogen equilibrium in the elderly, is greater than 0.8 gm/kg body weight/day. There do not appear to be any adverse consequences with protein intakes that are about 1 gm/kg body weight/day. The tentative recommendation in this paper is higher than the current mean recommended intake of protein (FAO/WHO/UNU, 1985). However, because of methodological difficulties, the data does not allow for a confident prediction of what the exact level of protein intake should be. Further studies are needed to come to a firm conclusion on the exact protein requirement. Indispensable amino acid requirements based on nitrogen balance data, in the elderly, are fragmentary and conflicting. These requirements can alternatively be based on obligatory nitrogen loss, for which data is available in the elderly. The overlap of the obligatory nitrogen loss between the young and the elderly, suggest that the amino acid requirement based on this technique is similar in young and elderly individuals. Tracer based techniques measuring amino acid balance at different amino acid intakes, also support the view that there are no differences in the amino acid requirements between young and elderly people. In general, these amino acid requirement studies have been performed in healthy USA subjects, and data is needed to know if these estimates can be extended to populations from other, less-developed countries.