[A prospective randomized study of parenteral and enteral nutrition in postoperative patients]

To evaluate the metabolic effects of balanced enteral nutrition (EN) and standard parenteral nutrition (PN, without glutamine) in post-operative patients, we performed a prospective randomized trial in 24 patients after gastrectomy or semi-colectomy. All patients had normal liver, kidney, heart and lung functions. patients of the enteral nutrition group received liquid Ensure (Abbott-Ross) while patients of the parenteral nutrition group received standard parenteral nutrition. Parenteral nutrition solutions consist of amino acids, fat emulsions, glucose, electrolytes, vitamins and trace elements. Subjects of the two groups received iso-nitrogenous and isocaloric nutritional regime for seven days (from POD+5 to POD+11). Weight loss in the parenteral nutrition group and the enteral nutrition group was 1.7 +/- 0.2 kg and 0.8 +/- 0.31 kg respectively. Cumulative nitrogen balance was -82 +/- 51 mg.kg-1/d in the parenteral nutrition group vs +70 +/- 7 mg.kg-1/d in the enteral nutrition group (P < 0.05). The results showed that balanced enteral nutrition had less weight loss and better cumulative nitrogen balance than standard parenteral nutrition in this protocol. More patients study will be needed.

Effect of enteral feeding with ensure on oral bioavailabilities of ofloxacin and ciprofloxacin

The relative oral bioavailabilities of ciprofloxacin and ofloxacin when they were coadministered with water or an enteral feeding product (Ensure) were assessed in 13 healthy volunteers. The area under the concentration time curve from time zero to infinity and the maximum concentration of drug in serum for both drugs were reduced by Ensure in comparison with those by water (P < 0.01). However, Ensure reduced the percent relative bioavailability of ciprofloxacin (72% +/- 14%; range, 52 to 96%) significantly more than ofloxacin (90% +/- 8.3%; range, 74 to 105%) (P < 0.005). Coadministration of Ensure significantly diminished ciprofloxacin and ofloxacin absorption, but ciprofloxacin absorption was reduced significantly more than ofloxacin absorption.

Rat pancreatic secretory response to intraduodenal infusion of elemental vs polymeric defined-formula diet

Pancreatic protein and fluid secretion in response to intraduodenal infusion of polymeric and elemental liquid defined-formula diets were studied in conscious rats. Rats were prepared with chronic pancreatic, biliary, and duodenal cannulas and had their pancreatic secretions collected and continuously returned to the intestine during intraduodenal infusion with commercial liquid defined-formula diets. Ensure HN, a polymeric defined-formula diet containing intact protein, and two elemental diets, in which the protein component consisted of enzymatically hydrolyzed protein and free amino acids, were tested. Ensure HN strongly stimulated pancreatic protein and fluid secretion, causing a maximal 10-fold increase in protein secretion. In contrast, the elemental diets stimulated only 30% to 47% of the protein secretion caused by Ensure HN. Separate infusion of the fat, protein, and carbohydrate components of one elemental diet, RTF Elemental, showed that fat was the major stimulant, but the responses to the separate components were not significantly different from each other and none caused more than 50% of the response to the complete diet. The results demonstrate that defined-formula elemental diets are much less stimulatory for pancreatic enzyme secretion than defined-formula polymeric diets in rats. The probable explanation for this difference is the replacement of intact protein by hydrolyzed protein and amino acids in the elemental diets.

[Preoperative preparation and nutrition in colorectal cancer]

Pre-operative nutrition in patients with colon/rectum cancer is important in ensuring that they are suitably prepared for the operation. Two pre-operative methods for preparation on the colon were compared: the first is that we normally use, of five days of residue-free hospital meals, cleansing enemas, laxatives and three litres of polyethylene glucol solution. The new method we describe is easy enough to be implemented by the patient at home, and combines enhanced nutrition with an excellent level of intra-colon cleaning: it involves the exclusive administration for four days of Ensure HN (a complete, defined, pre-prepared low-fibre diet, in a variety of flavours) and the application of two cleansing enemas the evening prior to the operation. Eighteen parameters were assessed, on the entry of each patient to the study, on the day of the operation, and six days following the operations; the parameters obtained after the trial show statistically significant differences (p < 0.05-p < 0.001) in favour of the second method for 17 of the parameters, following preparation; when each group was compared within itself prior to and following preparation. The values for all but two parameters were seen to drop, notably proteins, by 28.37% (p < 0.01), weight by 8.17%, albumin by 3.43% and hemoglobin by 17.72%, in the first group while, in the second, there were rises in proteins (3.72%), albumin (7.26%), hemoglobin (5.48%), leukocytes, calcium and triglycerides. The level of cleansing of the intestine continued to be excellent, without significant differences between the two methods.(ABSTRACT TRUNCATED AT 250 WORDS)

Nutritional status of elderly patients during recovery from chest infection and the role of nutritional supplementation assessed by a prospective randomized single-blind trial

We examined changes in the nutritional status of elderly patients with chest infection for a period of 3 months after discharge from hospital, including the effects of nutritional supplementation on well-being and functional status as well as on nutritional indices. Eighty-one subjects admitted to an acute medical ward aged 65 years and over with chest infection were recruited consecutively, and randomized to receive supplement (500 ml of Ensure liquid daily) for 1 month, or no supplement, on discharge. Assessment at baseline, 1, 2 and 3 months included a questionnaire to determine health, mental and functional status, and anthropometric measurements. Biochemical nutritional status was assessed at baseline, 1 and 3 months, and dietary intake (24 h recall method) at 1 and 3 months. During recovery, both supplement and non-supplement groups showed improvement in various measures of well-being and biochemical status. In addition, the former group showed improvement in more anthropometric measurements, in thiamine and pyridoxine status, while the non-supplement group showed a lower level of functional ability after 3 months. Various measures of well-being and biochemical status of the water-soluble vitamins were better in the supplement groups. We conclude that nutritional supplementation may have a role in helping elderly patients to recover from chest infections.

Relationship between nutritional status and immune function of elderly people

Thirty-four malnourished subjects between the ages of 61 and 97 years were given appropriate food supplement(s) for a period of 6 consecutive months. They were followed for a subsequent 6 months during which time there was no nutritional intervention. Nutritional assessment and immunological evaluation were performed at 0, 6, and 12 months. Nutritional assessment included anthropometry, biochemistry, and clinical examination. Immunological evaluation included serum complement C3 concentration, delayed cutaneous hypersensitivity skin test, and the enumeration of total lymphocytes, rosetting T-cells, CD4+ cells, and CD8+ cells. Immune function improved by the end of the supplementation period. Six months of nutritional supplementation significantly increased the percentage of lymphocytes represented by mature T-cells.

[Ensure treatment for IUGR]

A prospective study on Ensure and amino acid infusion treatment for IUGR was carried out in 1989 and 1990 in PUMC Hospital. The patients were divided into two groups. Subjects in group 1 received Ensure, and those in group 2 received amino acid treatment. Each group included 40 subjects. The incidence of SGA was found to decrease from 2.18% in 1989 to 1.59% in 1990. The cure rate of IUGR reached 41.7% and 21.9% in groups 1 and 2, respectively. The average birth weights were 2,820g and 2,656g in groups 1 and 2 (t = 19.15, P < 0.001), respectively. Our conclusion is that Ensure is an effective nutritional drug for treatment of IUGR.

EFFECT OF DIETARY SUCROSE AND STARCH ON ORAL GLUCOSE TOLERANCE AND INSULIN-LIKE ACTIVITY

Substituting sucrose for starch, while keeping the fat, protein, salts, and vitamins of the diet constant, resulted in impaired oral glucose tolerance in rats. The time needed to develop impaired tolerance varied with the percentage of sucrose in the diet. In animals fed a diet containing 67% sucrose this took 21–40 days, whereas in rats fed diets with 40 or 33% sucrose, it took 40 and 100 days, respectively. This impairment was reversible if the animals were put back on starch diets, but only a few days were then required to redevelop the impaired tolerance when they were refed the sucrose diet. No difference was found between animals fed carbohydrates as starch and those fed the animal stock diet. Sucrose-fed animals showing an impaired tolerance had more fat in the liver and reduced insulin-like activity in the serum.

Distribution in renal cell fractions of sulfhydryl groups in rats on normal and sucrose diets and its relation to renal mercury distribution after mercuric chloride injection

Most rats fed a diet of sucrose and vitamins for 3 or more weeks survive intravenous injection of mercuric chloride, 3 mg/kg, a dose uniformly lethal to rats on a normal diet. It is found that the sulfhydryl content of the ‘soluble’ fraction obtained from kidney by means of the centrifuge is greater in sucrose-fed than in chow-fed rats. Three hours after injection of mercuric chloride the sucrose-fed as compared with the chow-fed rat shows the same total mercury content in kidney, but a much higher content in the ‘soluble’ fraction and much lower contents in the ‘nuclear’ and ‘granular’ fractions. The increase in resistance to the toxicity of mercuric chloride seen in sucrose-fed rats may be related to a decrease in the binding of mercury by sulfhydryl groups of the renal nuclei and mitochondria. Severe protein depletion may be causally involved in producing the state of increased resistance.

Protective effect of a sucrose diet in mercuric chloride poisoning

Rats fed only sucrose and vitamins for 3 weeks or more usually survive intravenous injection of 3 mg/ kg of mercuric chloride, a dose lethal for rats on a normal diet. Survivors returned to a normal diet grow rapidly and appear grossly normal. Survival occurs in the presence of a diminished rate of excretion of radiomercury and a renal concentration and content of radiomercury higher in sucrose-fed protected rats than in unprotected rats on a normal diet. Sucrose feeding itself causes slower excretion of mercury; evidence indicates that the renal binding of mercury in protected rats is greater than in the unprotected. Some sucrose-fed rats surviving an initial dose of mercuric chloride, survive additional doses after return to a normal diet. The excretion and renal content of mercury is not altered by ammonium chloride acidosis in chow-fed rats given mercuric chloride.