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Pironi L, Cuerda C, Jeppesen PB, Joly F, Jonkers C, Krznarić Ž, Lal S, Lamprecht G, Lichota M, Mundi MS, Schneider SM, Szczepanek K, Van Gossum A, Wanten G, Wheatley C, Weimann A. ESPEN guideline on chronic intestinal failure in adults - Update 2023. Clin Nutr 2023; 42:1940-2021. [PMID: 37639741 DOI: 10.1016/j.clnu.2023.07.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 07/21/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND & AIMS In 2016, ESPEN published the guideline for Chronic Intestinal Failure (CIF) in adults. An updated version of ESPEN guidelines on CIF due to benign disease in adults was devised in order to incorporate new evidence since the publication of the previous ESPEN guidelines. METHODS The grading system of the Scottish Intercollegiate Guidelines Network (SIGN) was used to grade the literature. Recommendations were graded according to the levels of evidence available as A (strong), B (conditional), 0 (weak) and Good practice points (GPP). The recommendations of the 2016 guideline (graded using the GRADE system) which were still valid, because no studies supporting an update were retrieved, were reworded and re-graded accordingly. RESULTS The recommendations of the 2016 guideline were reviewed, particularly focusing on definitions, and new chapters were included to devise recommendations on IF centers, chronic enterocutaneous fistulas, costs of IF, caring for CIF patients during pregnancy, transition of patients from pediatric to adult centers. The new guideline consist of 149 recommendations and 16 statements which were voted for consensus by ESPEN members, online in July 2022 and at conference during the annual Congress in September 2022. The Grade of recommendation is GPP for 96 (64.4%) of the recommendations, 0 for 29 (19.5%), B for 19 (12.7%), and A for only five (3.4%). The grade of consensus is "strong consensus" for 148 (99.3%) and "consensus" for one (0.7%) recommendation. The grade of consensus for the statements is "strong consensus" for 14 (87.5%) and "consensus" for two (12.5%). CONCLUSIONS It is confirmed that CIF management requires complex technologies, multidisciplinary and multiprofessional activity, and expertise to care for the underlying gastrointestinal disease and to provide HPN support. Most of the recommendations were graded as GPP, but almost all received a strong consensus.
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Affiliation(s)
- Loris Pironi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; Center for Chronic Intestinal Failure, IRCCS AOUBO, Bologna, Italy.
| | - Cristina Cuerda
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Francisca Joly
- Center for Intestinal Failure, Department of Gastroenterology and Nutritional Support, Hôpital Beaujon, Clichy, France
| | - Cora Jonkers
- Nutrition Support Team, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands
| | - Željko Krznarić
- Center of Clinical Nutrition, Department of Medicine, University Hospital Center, Zagreb, Croatia
| | - Simon Lal
- Intestinal Failure Unit, Salford Royal Foundation Trust, Salford, United Kingdom
| | | | - Marek Lichota
- Intestinal Failure Patients Association "Appetite for Life", Cracow, Poland
| | - Manpreet S Mundi
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic College of Medicine, Rochester, MN, USA
| | | | - Kinga Szczepanek
- General and Oncology Surgery Unit, Stanley Dudrick's Memorial Hospital, Skawina, Poland
| | | | - Geert Wanten
- Intestinal Failure Unit, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Carolyn Wheatley
- Support and Advocacy Group for People on Home Artificial Nutrition (PINNT), United Kingdom
| | - Arved Weimann
- Department of General, Visceral and Oncological Surgery, St. George Hospital, Leipzig, Germany
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Berger MM, Shenkin A, Schweinlin A, Amrein K, Augsburger M, Biesalski HK, Bischoff SC, Casaer MP, Gundogan K, Lepp HL, de Man AME, Muscogiuri G, Pietka M, Pironi L, Rezzi S, Cuerda C. ESPEN micronutrient guideline. Clin Nutr 2022; 41:1357-1424. [PMID: 35365361 DOI: 10.1016/j.clnu.2022.02.015] [Citation(s) in RCA: 186] [Impact Index Per Article: 93.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 02/16/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Trace elements and vitamins, named together micronutrients (MNs), are essential for human metabolism. Recent research has shown the importance of MNs in common pathologies, with significant deficiencies impacting the outcome. OBJECTIVE This guideline aims to provide information for daily clinical nutrition practice regarding assessment of MN status, monitoring, and prescription. It proposes a consensus terminology, since many words are used imprecisely, resulting in confusion. This is particularly true for the words "deficiency", "repletion", "complement", and "supplement". METHODS The expert group attempted to apply the 2015 standard operating procedures (SOP) for ESPEN which focuses on disease. However, this approach could not be applied due to the multiple diseases requiring clinical nutrition resulting in one text for each MN, rather than for diseases. An extensive search of the literature was conducted in the databases Medline, PubMed, Cochrane, Google Scholar, and CINAHL. The search focused on physiological data, historical evidence (published before PubMed release in 1996), and observational and/or randomized trials. For each MN, the main functions, optimal analytical methods, impact of inflammation, potential toxicity, and provision during enteral or parenteral nutrition were addressed. The SOP wording was applied for strength of recommendations. RESULTS There was a limited number of interventional trials, preventing meta-analysis and leading to a low level of evidence. The recommendations underwent a consensus process, which resulted in a percentage of agreement (%): strong consensus required of >90% of votes. Altogether the guideline proposes sets of recommendations for 26 MNs, resulting in 170 single recommendations. Critical MNs were identified with deficiencies being present in numerous acute and chronic diseases. Monitoring and management strategies are proposed. CONCLUSION This guideline should enable addressing suboptimal and deficient status of a bundle of MNs in at-risk diseases. In particular, it offers practical advice on MN provision and monitoring during nutritional support.
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Affiliation(s)
- Mette M Berger
- Department of Adult Intensive Care, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
| | - Alan Shenkin
- Institute of Aging and Chronic Disease, University of Liverpool, Liverpool, UK.
| | - Anna Schweinlin
- Institute of Nutritional Medicine, University of Hohenheim, Stuttgart, Germany.
| | - Karin Amrein
- Medical University of Graz, Department of Internal Medicine, Division of Endocrinology and Diabetology, Austria.
| | - Marc Augsburger
- University Centre of Legal Medicine Lausanne-Geneva, Lausanne University Hospital and University of Lausanne, Geneva University Hospital and University of Geneva, Lausanne-Geneva, Switzerland.
| | | | - Stephan C Bischoff
- Institute of Nutritional Medicine, University of Hohenheim, Stuttgart, Germany.
| | - Michael P Casaer
- KU Leuven, Department of Cellular and Molecular Medicine, Laboratory of Intensive Care Medicine, Leuven, Belgium.
| | - Kursat Gundogan
- Division of Intensive Care Medicine, Department of Internal Medicine, Erciyes University School of Medicine, Kayseri, Turkey.
| | | | - Angélique M E de Man
- Department of Intensive Care Medicine, Research VUmc Intensive Care (REVIVE), Amsterdam Cardiovascular Science (ACS), Amsterdam Infection and Immunity Institute (AI&II), Amsterdam Medical Data Science (AMDS), Amsterdam UMC, Location VUmc, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands.
| | - Giovanna Muscogiuri
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università di Napoli (Federico II), Naples, Italy; United Nations Educational, Scientific and Cultural Organization (UNESCO) Chair for Health Education and Sustainable Development, Federico II, University, Naples, Italy.
| | - Magdalena Pietka
- Pharmacy Department, Stanley Dudrick's Memorial Hospital, Skawina, Poland.
| | - Loris Pironi
- Alma Mater Studiorum - University of Bologna, Department of Medical and Surgical Sciences, Italy; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Centre for Chronic Intestinal Failure - Clinical Nutrition and Metabolism Unit, Italy.
| | - Serge Rezzi
- Swiss Nutrition and Health Foundation (SNHf), Epalinges, Switzerland.
| | - Cristina Cuerda
- Departamento de Medicina, Universidad Complutense de Madrid, Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
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Arakeri G, Boraks G, Aljabab AS, Patil SG, Merkx MAW, Brennan PA. Breath Alkane as an index of severity for oral submucous fibrosis: A new perspective? Med Hypotheses 2016; 98:18-20. [PMID: 28012596 DOI: 10.1016/j.mehy.2016.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 11/16/2016] [Indexed: 10/20/2022]
Abstract
Oral submucous fibrosis (OSMF) is a devastating disease commonly seen in the Asian subcontinent that results in significant functional morbidity for patients and has a high potential for malignant transformation. Over the last three decades, different diagnostic methods have been described to quantify and grade OSMF severity. Some methods have been used with perceived favorable outcomes although recurrence and malignant transformation remains a problem in many cases, and OSMF presents a major therapeutic challenge. We present a simple, noninvasive and less time-consuming diagnostic method which measures the severity of OSMF, helping to predict its malignant transformation and monitoring the effect of medical therapy on this disease.
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Affiliation(s)
- Gururaj Arakeri
- Department of Oral and Maxillofacial Surgery, Navodaya Dental College and Hospital, Raichur, Karnataka, India.
| | - George Boraks
- Department of Oral and Maxillofacial Surgery and Oral Disease of Arnaldo Viera de Carvalho Cancer Institute, SP, Brazil
| | | | - Shekar Gowda Patil
- King Fahad Medical City, Department of Dentistry, Faculty of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - M A W Merkx
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Peter A Brennan
- Department of Oral & Maxillofacial Surgery, Queen Alexandra Hospital, Cosham, Portsmouth PO6 3LY, United Kingdom
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Choi SJ, Jang BH, Lee SJ, Min BK, Rothschild A, Kim ID. Selective detection of acetone and hydrogen sulfide for the diagnosis of diabetes and halitosis using SnO(2) nanofibers functionalized with reduced graphene oxide nanosheets. ACS APPLIED MATERIALS & INTERFACES 2014; 6:2588-97. [PMID: 24456186 DOI: 10.1021/am405088q] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Sensitive detection of acetone and hydrogen sulfide levels in exhaled human breath, serving as breath markers for some diseases such as diabetes and halitosis, may offer useful information for early diagnosis of these diseases. Exhaled breath analyzers using semiconductor metal oxide (SMO) gas sensors have attracted much attention because they offer low cost fabrication, miniaturization, and integration into portable devices for noninvasive medical diagnosis. However, SMO gas sensors often display cross sensitivity to interfering species. Therefore, selective real-time detection of specific disease markers is a major challenge that must be overcome to ensure reliable breath analysis. In this work, we report on highly sensitive and selective acetone and hydrogen sulfide detection achieved by sensitizing electrospun SnO2 nanofibers with reduced graphene oxide (RGO) nanosheets. SnO2 nanofibers mixed with a small amount (0.01 wt %) of RGO nanosheets exhibited sensitive response to hydrogen sulfide (Rair/Rgas = 34 at 5 ppm) at 200 °C, whereas sensitive acetone detection (Rair/Rgas = 10 at 5 ppm) was achieved by increasing the RGO loading to 5 wt % and raising the operation temperature to 350 °C. The detection limit of these sensors is predicted to be as low as 1 ppm for hydrogen sulfide and 100 ppb for acetone, respectively. These concentrations are much lower than in the exhaled breath of healthy people. This demonstrates that optimization of the RGO loading and the operation temperature of RGO-SnO2 nanocomposite gas sensors enables highly sensitive and selective detection of breath markers for the diagnosis of diabetes and halitosis.
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Affiliation(s)
- Seon-Jin Choi
- Department of Materials Science and Engineering, Korea Advanced Institute of Science and Technology , 291 Daehak-ro, Yuseong-gu, Daejeon 305-701, Republic of Korea
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Choi SJ, Lee I, Jang BH, Youn DY, Ryu WH, Park CO, Kim ID. Selective Diagnosis of Diabetes Using Pt-Functionalized WO3 Hemitube Networks As a Sensing Layer of Acetone in Exhaled Breath. Anal Chem 2013; 85:1792-6. [DOI: 10.1021/ac303148a] [Citation(s) in RCA: 243] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Seon-Jin Choi
- Department of Materials
Science and Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon 305-701, Republic
of Korea
| | - Inkun Lee
- Department of Materials
Science and Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon 305-701, Republic
of Korea
| | - Bong-Hoon Jang
- Department of Materials
Science and Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon 305-701, Republic
of Korea
| | - Doo-Young Youn
- Department of Materials
Science and Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon 305-701, Republic
of Korea
| | - Won-Hee Ryu
- Department of Materials
Science and Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon 305-701, Republic
of Korea
| | - Chong Ook Park
- Department of Materials
Science and Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon 305-701, Republic
of Korea
| | - Il-Doo Kim
- Department of Materials
Science and Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon 305-701, Republic
of Korea
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7
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Vanderlelie J, Perkins AVA. Selenium and preeclampsia: A global perspective. Pregnancy Hypertens 2011; 1:213-24. [PMID: 26009029 DOI: 10.1016/j.preghy.2011.07.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Revised: 05/26/2011] [Accepted: 07/04/2011] [Indexed: 11/30/2022]
Abstract
Preeclampsia is a complex multisystem disorder of pregnancy where oxidative stress plays an important aetiological role. The role of selenium in the synthesis of endogenous antioxidants is well documented, and a significant reduction in selenium has been reported in preeclamptic women. The objective of this study was to map global selenium status and preeclampsia incidence. This study identified peer reviewed journal articles reporting national preeclampsia incidence (%) and matched these with reported values of selenium intake and plasma/serum selenium concentrations (μg/L). Matched data were obtained for 45 regions, reporting 6456,570 births, spanning Europe, Asia, Australasia, Africa, North and South America. Increasing plasma selenium concentration was found to be correlated with a reduction in preeclampsia incidence (Pearson's r=-0.604, P<0.0001). Countries with a reported serum/plasma selenium level of ⩾95μg/L were considered selenium sufficient and a significant reduction in preeclampsia incidence for countries above this value (P=0.0007) was noted. Significant reductions in preeclampsia incidence were found to coincide with increases in plasma/serum selenium concentration in the New Zealand (P=0.0003) and Finland (0.0028) populations following Government intervention. This study supports the hypothesis that selenium supplementation may be beneficial in reducing oxidative stress in women at risk of preeclampsia.
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Affiliation(s)
- J Vanderlelie
- School of Medical Science, Griffith Health Institute, Griffith University, Southport, Queensland, Australia.
| | - A V A Perkins
- School of Medical Science, Griffith Health Institute, Griffith University, Southport, Queensland, Australia.
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8
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Schrijver J. Indices of vitamin status in man: An urgent need of functional markers. FOOD REVIEWS INTERNATIONAL 2009. [DOI: 10.1080/87559129109540901] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Richards GA, White H, Grimmer H, Ramoroka C, Channa K, Hopley M, Fickl H, Gulumian M. Increased Oxidants and Reduced Antioxidants in Irradiated Parenteral Nutrition Solutions May Contribute to the Inflammatory Response. J Intensive Care Med 2009; 24:252-60. [DOI: 10.1177/0885066609332744] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background/Objectives: To measure reactive oxidant production and the decline in antioxidant potential in commercially available, irradiated parenteral nutrition (PN) solutions and the effect that these have on oxidant production in patients in the intensive care unit. Subjects and Methods: Vitamin E and malondialdehyde in irradiated and nonirradiated commercially available, PN solutions were measured. The PBN (α-phenyl-n-test-butylnitrone (PBN) spin trap was used to measure free radicals and TEMPOL (2,2,6,6-tetramethyl-4-hydroxy-piperidine-oxyl) was used to assess antioxidant capacity. The irradiated PN was administered (as per unit protocol) to 10 patients with gut failure and plasma and urinary isoprostanes and interleukin-6 (IL-6) were measured 1 hour preadministration, at the time of, and 1 and 2 hours postadministration of PN. Results: Irradiation reduced vitamin E significantly (P < .0025). Malondialdehyde products were present in both samples, but more so in irradiated samples (P < .0001), as were free radicals measured by PBN spin trapping. Irradiated samples had a higher scavenging capacity of TEMPOL free radical due to depletion of antioxidants in irradiated samples. Urinary isoprostanes increased at time 2 by 6.3 units relative to time 0 and by 5.23 units relative to time 1(Friedman ANOVA: P < .01413). Conclusions: Lipid hydroperoxides are formed in PN solutions and increase further following irradiation. This is associated with a significant reduction in vitamin E and antioxidant potential. The increase in urinary isoprostanes indicates a potentially proinflammatory effect of irradiated PN.
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Affiliation(s)
- Guy A. Richards
- Intensive Care Unit, Johannesburg Hospital and University of the Witwatersrand, Johannesburg, South Africa,
| | | | - Heidi Grimmer
- National Institute for Occupational Health, Johannesburg, South Africa
| | - Caiphus Ramoroka
- National Institute for Occupational Health, Johannesburg, South Africa
| | - Kalavati Channa
- National Institute for Occupational Health, Johannesburg, South Africa
| | - Mark Hopley
- Departments of Medicine and Pulmonology, Baragwanath Hospital and University of the Witwatersrand Johannesburg, South Africa
| | - Heidi Fickl
- Medical Research Council Unit for Inflammation and Immunity, Department of Immunology, Tshwane Academic Division of the National Health Laboratory Service and Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Mary Gulumian
- Haematology and Molecular Medicine Department, School of Health Sciences, Parktown, Johannesburg, South Africa
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Hawkes WC, Richter BD, Alkan Z, Souza EC, Derricote M, Mackey BE, Bonnel EL. Response of selenium status indicators to supplementation of healthy North American men with high-selenium yeast. Biol Trace Elem Res 2008; 122:107-21. [PMID: 18193397 DOI: 10.1007/s12011-007-8066-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2007] [Revised: 10/29/2007] [Accepted: 11/27/2007] [Indexed: 10/22/2022]
Abstract
The essential nutrient selenium is required in microgram amounts [recommended dietary allowance (RDA) = 55 microg/day, 699 nmol/day] and has a narrow margin of safety (upper tolerable intake limit = 400 microg/day, 5 micromol/day). We conducted a randomized placebo-controlled study of high-selenium yeast, the form used in most supplements (300 microg/day, 3.8 micromol/day), administered to 42 free-living healthy men for 48 weeks. Dietary intakes of selenium, macronutrients, and micronutrients were not different between groups and did not change during the study. Supplementation more than doubled urinary selenium excretion from 69 to 160 microg/day (876 to 2,032 nmol/day). Urinary excretion was correlated with recent selenium intake estimated from 3-day diet records: urinary selenium excretion = 42 microg/day (533 nmol/day) + 0.132 x dietary selenium intake, p < 0.001. Dietary selenium intake was not significantly correlated with the other indicators of selenium status, presumably because urinary selenium excretion reflected recent intake, and tissue selenium was homeostatically controlled. After 48 weeks of supplementation, plasma selenium was increased 60% from 142 to 228 microg/l (1.8 to 2.9 micromol/l), and erythrocyte selenium was approximately doubled from 261 to 524 microg/l (3.3 to 6.6 micromol/l). Selenium concentrations increased more modestly in hair (56%) and platelets (42%). Platelets were the only blood component in which glutathione peroxidase activity was significantly related to selenium content. Selenium levels decreased rapidly after the end of supplementation, and there were no significant differences in selenium status indicators between groups by week 96. The absorption, distribution, and excretion of selenium from high-Se yeast were similar to selenium in foods.
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Affiliation(s)
- Wayne Chris Hawkes
- Agricultural Research Service, United States Department of Agriculture, University of California at Davis, Davis, CA 95616, USA.
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Abstract
Food systems need to produce enough of the essential trace element Se to provide regular adult intakes of at least 40 μg/d to support the maximal expression of the Se enzymes, and perhaps as much as 300 μg/d to reduce risks of cancer. Deprivation of Se is associated with impairments in antioxidant protection, redox regulation and energy production as consequences of suboptimal expression of one or more of the Se-containing enzymes. These impairments may not cause deficiency signs in the classical sense, but instead contribute to health problems caused by physiological and environmental oxidative stresses and infections. At the same time, supranutritional intakes of Se, i.e. intakes greater than those required for selenocysteine enzyme expression, appear to reduce cancer risk. The lower, nutritional, level is greater than the typical intakes of many people in several parts of the world, and few populations have intakes approaching the latter, supranutritional, level. Accordingly, low Se status is likely to contribute to morbidity and mortality due to infectious as well as chronic diseases, and increasing Se intakes in all parts of the world can be expected to reduce cancer rates.
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Affiliation(s)
- G F Combs
- Department of Nutritional Sciences, Cornell University, Ithaca, NY 14853, USA.
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Schepens MAA, Roelofs HMJ, Peters WHM, Wanten GJA. No evidence for oxidative stress in patients on home parenteral nutrition. Clin Nutr 2006; 25:939-48. [PMID: 16777272 DOI: 10.1016/j.clnu.2006.05.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2006] [Revised: 04/12/2006] [Accepted: 05/02/2006] [Indexed: 02/03/2023]
Abstract
BACKGROUND & AIMS Patients on total parenteral nutrition depend on the composition of the nutritional formulation for maintenance of their oxidant-antioxidant balance. The present observational study was conducted to evaluate a substantial part of our patient population for evidence of oxidative stress. METHODS Venous blood samples were obtained from 41 patients on home parenteral nutrition (HPN) and 41 healthy controls. Glutathione in plasma and whole blood, glutathione peroxidase and superoxide dismutase in erythrocytes and total plasma antioxidant capacity were measured to assess the antioxidant status. Oxidant status was evaluated by measuring the production of reactive oxygen species by leukocytes. Oxidative damage was assessed by measuring lipid peroxidation and protein oxidation products. RESULTS Patients on HPN showed some signs of increased oxidative stress, however, there were no signs for oxidative damage, compared with healthy controls. In addition, activity of any underlying disease was not associated with increased oxidative stress. CONCLUSIONS The current treatment regime for patients on HPN at our center apparently prevents the development of significant oxidative damage, despite signs of some oxidative stress. Based on these data, adaptations in the composition of parenteral nutritional formulations do not seem mandatory.
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Affiliation(s)
- Marloes A A Schepens
- Department of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
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Miekisch W, Schubert JK, Noeldge-Schomburg GFE. Diagnostic potential of breath analysis--focus on volatile organic compounds. Clin Chim Acta 2004; 347:25-39. [PMID: 15313139 DOI: 10.1016/j.cccn.2004.04.023] [Citation(s) in RCA: 595] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2003] [Revised: 01/30/2004] [Accepted: 04/16/2004] [Indexed: 01/03/2023]
Abstract
Breath analysis has attracted a considerable amount of scientific and clinical interest during the last decade. In contrast to NO, which is predominantly generated in the bronchial system, volatile organic compounds (VOCs) are mainly blood borne and therefore enable monitoring of different processes in the body. Exhaled ethane and pentane concentrations were elevated in inflammatory diseases. Acetone was linked to dextrose metabolism and lipolysis. Exhaled isoprene concentrations showed correlations with cholesterol biosynthesis. Exhaled levels of sulphur-containing compounds were elevated in liver failure and allograft rejection. Looking at a set of volatile markers may enable recognition and diagnosis of complex diseases such as lung or breast cancer. Due to technical problems of sampling and analysis and a lack of normalization and standardization, huge variations exist between results of different studies. This is among the main reasons why breath analysis could not yet been introduced into clinical practice. This review addresses the basic principles of breath analysis and the diagnostic potential of different volatile breath markers. Analytical procedures, issues concerning biochemistry and exhalation mechanisms of volatile substances, and future developments will be discussed.
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Affiliation(s)
- Wolfram Miekisch
- Department of Anaesthesia and Intensive Care Medicine, University Hospital of Rostock, Rostock, Germany.
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Pironi L, Guidetti M, Zolezzi C, Fasano MC, Paganelli F, Merli C, Bersani G, Pizzoferrato A, Miglioli M. Peroxidation potential of lipid emulsions after compounding in all-in-one solutions. Nutrition 2003; 19:784-8. [PMID: 12921890 DOI: 10.1016/s0899-9007(03)00099-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES We investigated the peroxidation potential of fat emulsions in all-in-one solutions (AIOs). METHODS Three 20% emulsions were compared: soybean oil (SO; 60% polyunsaturated fatty acids [PUFAs], alpha-tocopherol:PUFAs = 0.44), soybean plus medium-chain triacylglycerol (SO-MCT; 31% PUFAs, alpha-tocopherol:PUFAs = 0.35), and olive oil (OO; 21% PUFAs, alpha-tocopherol:PUFAs = 1.42). For each emulsion, six AIO solutions were prepared by adding 250 mL of emulsion to a lipid-free solution. Lipid peroxide (LPX) and malondialdehyde (MDA) concentrations were evaluated in fat emulsions, lipid-free solutions, and AIOs immediately (T0) and 24 h (T24) after lipid addition. Statistical analysis was done with analysis of variance. RESULTS Fat emulsion LPX in SO-MCT was lower than that in SO (P = 0.015) and OO (P = 0.024); LPX in SO was greater than that in OO (P = 0.013); MDA in SO was greater than that in SO-MCT (P = 0.001) and OO (P = 0.013); and MDA in SO-MCT was greater than that in OO (P = 0.001). In comparison with MDA at AIO-T0, MDA at AIO-T24 increased in SO (P = 0.005) and SO-MCT (P < 0.001) and decreased in OO (P = 0.003); at AIO-T24, LPX was greater in SO, but not significantly. CONCLUSIONS In AIO bags, LPX occurred within 24 h after the addition of the lipid emulsion and seemed to be directly related to the PUFA content and inversely related to the alpha-tocopherol:PUFA ratio of the emulsion.
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Affiliation(s)
- Loris Pironi
- Departement of Internal Medicine and Gastroenterology, Bologna, Italy
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16
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Wanten G, Beunk J, Naber A, Swinkels D. Tocopherol isoforms in parenteral lipid emulsions and neutrophil activation. Clin Nutr 2002; 21:417-22. [PMID: 12381340 DOI: 10.1054/clnu.2002.0570] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND AIMS Tocopherol is a lipid-soluble anti-oxidant that exists in several isoforms. Patients on total parenteral nutrition depend on lipid emulsions for their tocopherol intake. In the present study, we analysed the content of tocopherol isoforms in various lipid emulsions. We also tested the hypothesis that immune-modulating effects of lipid emulsions could be attributed to different concentrations of alpha-tocopherol (alpha-toc) or peroxidation products. METHOD alpha-, beta-, gamma- and delta-toc were measured in emulsions containing long-chain triglycerides (LCT), mixed long- and medium-chain triglycerides (LCT/MCT), structured lipids (SL), olive oil (OO) or fish oil (FO). As a measure for cellular activation, neutrophil membrane adhesion markers were assessed after exposure to two LCT/MCT emulsions that differ only in alpha-toc content. RESULTS Various emulsions differed widely in tocopherol contents, especially with respect to the alpha- isoform. The latter isomer also was subject to considerable degradation despite adequate storage conditions. The previously observed activation of neutrophils by LCT/MCT was not influenced by the increased concentration of alpha-toc or the decreased concentration of lipid peroxidation products in a new LCT/MCT emulsion. CONCLUSIONS Tocopherol supplementation by parenteral lipid emulsions strongly depends on the lipid source and the storage lifetime of the emulsion. The effects of LCT/MCT on the immune system are not modulated by alpha-toc or by lipid peroxidation products.
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Affiliation(s)
- G Wanten
- Department of Gastroenterology, University Medical Centre Nijmegen, Nijmegen, The Netherlands
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Manuel-y-Keenoy B, Nonneman L, De Bosscher H, Vertommen J, Schrans S, Klütsch K, De Leeuw I. Effects of intravenous supplementation with alpha-tocopherol in patients receiving total parenteral nutrition containing medium- and long-chain triglycerides. Eur J Clin Nutr 2002; 56:121-8. [PMID: 11857045 DOI: 10.1038/sj.ejcn.1601294] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2001] [Revised: 06/20/2001] [Accepted: 06/22/2001] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To compare the effects of a lipid emulsion containing medium-chain triglycerides (MCT) and supplemented with alpha-tocopherol to a conventional long-chain triglyceride (LCT) emulsion. DESIGN Randomised double blind study. SETTING Department of Internal Medicine, Antwerp University Hospital. SUBJECTS AND INTERVENTIONS Twenty-four patients with an indication for total parenteral nutrition for a minimum of 10 days were randomly assigned to two groups: group E received as lipid source MCT/LCT (50/50) suplemented with 100 mg DL-alpha-tocopherol/day and group C received LCT. Blood samples were analysed at inclusion, after 4-6 and after 9-11 days. RESULTS In group E, serum alpha-tocopherol doubled from 11.4+/-6.9 at inclusion to 20.9+/-7.9 and to 23.8+/-8.8 microg/ml after 4 and 9 days, respectively, but did not change in group C (P=0.008). Production of thiobarbituric acid-reacting substances (TBARS) after 120 min incubation with copper decreased from 66+/-34 at inclusion to 29+/-25 nmol MDA/mg LDL and VLDL-cholesterol after 4 and to 42+/-17 after 9 days (P=0.022 when compared to group C, which underwent no significant changes). Velocity of production of fluorescent products decreased in group E but not in group C (P=0.026). CONCLUSIONS Supplementation of TPN containing MCT/LCT with 100 mg DL-alpha-tocopherol/day leads to a doubling in serum alpha-tocopherol and to a decrease in the susceptibility of LDL and VLDL to peroxidation in vitro. SPONSORSHIP This study was partly financed by B Braun Medical NVSA, Diegem, Belgium.
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Affiliation(s)
- B Manuel-y-Keenoy
- Laboratory of Endocrinology, University Hospital, University of Antwerp, Antwerp, Belgium.
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18
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Linseisen J, Hoffmann J, Lienhard S, Jauch KW, Wolfram G. Antioxidant status of surgical patients receiving TPN with an omega-3-fatty acid-containing lipid emulsion supplemented with alpha-tocopherol. Clin Nutr 2000; 19:177-84. [PMID: 10895108 DOI: 10.1054/clnu.1999.0096] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND LCT lipid emulsions and even more fish oil-containing lipid emulsions are under debate regarding their tocopherol and PUFA content as well as their effect on the antioxidative status especially in patients with oxidative stress. METHODS Thirty-three patients undergoing major abdominal surgery were randomly assigned to receive either an alpha-tocopherol-supplemented (562 micromol/l) MCT/LCT/omega-3-acid triglycerides (MLF, 5/4/1 w/w/w, 20%) emulsion or a soybean oil-based LCT emulsion (20%). The TPN regimen continuously provided 1.4 g fat kg bw(-1)d(-1)over 5 days. RESULTS Plasma antioxidant concentrations were strongly reduced by surgical treatment. Following 5 days of TPN with the MLF emulsion, mean plasma alpha-tocopherol increased by 20.0 micromol/l (1.98 micromol/mmol lipid), while nearly no change was observed in the LCT emulsion group. In both groups, plasma concentrations of all non-supplemented antioxidants (vitamin C, carotenoids, selenium) as well as serum total antioxidant capacity further decreased during TPN. The concentrations of plasma cholesterol oxidation products as a measure of in vivo lipid peroxidation revealed no changes over the TPN period in either group. CONCLUSION In contrast to the LCT emulsion, administration of the a-tocopherol supplemented MLF lipid emulsion normalized a-tocopherol plasma concentrations. Despite its high long-chain PUFA content, no hint for increased lipid peroxidation was found.
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Affiliation(s)
- J Linseisen
- Institute of Nutrition Science, Technical University of Munich, Freising-Weihenstephan, Germany
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19
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Abstract
Isolation and quantification of volatile breath biomarkers indicative of relevant alterations in clinical status has required development of new techniques and applications of existing analytical chemical methods. The most significant obstacles to successful application of this type of sample have been reduction in required sample volume permitting replicate analysis (an absolute requirement for all clinical studies), separation of the analyte(s) of interest from background molecules, water vapor and other molecules with similar physical properties, introduction of automation in analysis and the use of selective detection systems (electron impact mass spectrometry, flame photometric, thermionic detectors), and automated sample collection from the human subject. Advances in adsorption technology and trace gas analysis have permitted rapid progress in this area of clinical chemistry.
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Affiliation(s)
- T H Risby
- Department of Environmental Health Sciences, The Johns Hopkins University School of Hygiene and Public Health, Baltimore, MD 21205, USA
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20
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de Zwart LL, Meerman JH, Commandeur JN, Vermeulen NP. Biomarkers of free radical damage applications in experimental animals and in humans. Free Radic Biol Med 1999; 26:202-26. [PMID: 9890655 DOI: 10.1016/s0891-5849(98)00196-8] [Citation(s) in RCA: 516] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Free radical damage is an important factor in many pathological and toxicological processes. Despite extensive research efforts in biomarkers in recent years, yielding promising results in experimental animals, there is still a great need for additional research on the applicability of, especially non-invasive, biomarkers of free radical damage in humans. This review gives an overview of the applications in experimental and human situations of four main groups of products resulting from free radical damage, these include: lipid peroxidation products, isoprostanes, DNA-hydroxylation products and protein hydroxylation products.
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Affiliation(s)
- L L de Zwart
- Leiden-Amsterdam Center for Drug Research, Department of Pharmacochemistry, Vrije Universiteit, The Netherlands.
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21
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Abstract
Breath testing for volatile organic compounds (VOCs) provides an intrinsically safe method for investigating human metabolism. An improved breath-collecting apparatus (BCA) is described which was acceptable to patients, simple to use, highly sensitive, and free from chemical contamination. VOCs in 10.0 L alveolar breath and 10.0 L room air were collected onto adsorptive traps. Using automated instrumentation, VOCs were thermally desorbed and assayed by gas chromatography/mass spectroscopy. Twenty normal volunteers were studied, and the alveolar gradient (concentration in breath minus concentration in air) was determined for the most abundant VOCs. A total of 1259 VOCs were observed and tentatively identified in the breath of normal subjects. The mean alveolar gradients were positive in 461 VOCs and negative in 798 VOCs. The method provided a sensitive and convenient assay for breath VOCs and permitted tentative determination of their origin from either inside or outside the body.
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Affiliation(s)
- M Phillips
- Menssana Research, Inc., Fort Lee, New Jersey 07024, USA
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22
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23
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Goode HF, Cowley HC, Walker BE, Howdle PD, Webster NR. Decreased antioxidant status and increased lipid peroxidation in patients with septic shock and secondary organ dysfunction. Crit Care Med 1995; 23:646-51. [PMID: 7712754 DOI: 10.1097/00003246-199504000-00011] [Citation(s) in RCA: 314] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To determine antioxidant vitamin concentrations, lipid peroxidation, and an index of nitric oxide production in patients in the intensive care unit (ICU) with septic shock and relate the findings to the presence of secondary organ failure. DESIGN A prospective, observational study. SETTING A nine-bed ICU in a University teaching hospital. PATIENTS Sixteen consecutive patients with septic shock, defined as: a) clinical evidence of acute infection; b) hypo- or hyperthermia (< 35.6 degrees C or > 38.3 degrees C); c) tachypnea (> 20 breaths/min or being mechanically ventilated); d) tachycardia (> 90 beats/min); e) shock (systolic pressure < 90 mm Hg) or receiving inotropes. Fourteen patients also had secondary organ dysfunction. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Antioxidant vitamin concentrations were significantly lower in the patients than the reference range obtained from a comparable group of healthy controls. The mean plasma retinol (vitamin A) concentration was 26.5 +/- 19.3 micrograms/dL compared with 73.5 +/- 18.3 micrograms/dL in healthy subjects (p < .01). Additionally, 13 (81%) patients had retinol values below the lower limit of our reference range (< 37.0 micrograms/dL). Tocopherol (vitamin E) plasma concentrations were below the reference range in all patients (< 9.0 mg/L), with a mean value of 3.6 +/- 2.0 mg/L compared with 11.5 +/- 1.3 mg/L in healthy subjects (p < .001). Plasma beta carotene and lycopene concentrations were undetectable (< 15 micrograms/L) in eight (50%) patients, and below our reference range (< 101 micrograms/L and < 154 micrograms/L, respectively) in the remaining patients. In the five patients with three or more dysfunctional secondary organs, plasma thiobarbituric acid-reactive substances were significantly increased (p < .05), suggesting increased lipid peroxidation. Concentrations of thiobarbituric acid-reactive substances correlated negatively with both plasma retinol and plasma tocopherol (r2 = .42, p < .01 and r2 = .48, p < .005, respectively). In the five patients from whom we were able to collect urine, nitrite excretion was increased approximately 400-fold (p < .001). CONCLUSIONS These data indicate decreased antioxidant status in the face of enhanced free radical activity, and suggest potential therapeutic strategies involving antioxidant repletion.
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Affiliation(s)
- H F Goode
- Clinical Oxidant Research Group, St. James's University Hospital, UK
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24
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Kneepkens CM, Lepage G, Roy CC. The potential of the hydrocarbon breath test as a measure of lipid peroxidation. Free Radic Biol Med 1994; 17:127-60. [PMID: 7959173 DOI: 10.1016/0891-5849(94)90110-4] [Citation(s) in RCA: 255] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The straight chain aliphatic hydrocarbons ethane and pentane have been advocated as noninvasive markers of free-radical induced lipid peroxidation in humans. In in vitro studies, the evolution of ethane and pentane as end products of n-3 and n-6 polyunsaturated fatty acids, respectively, correlates very well with other markers of lipid peroxidation and even seems to be the most sensitive test available. In laboratory animals the use of both hydrocarbons as in vivo markers of lipid peroxidation has been validated extensively. Although there are other possible sources of hydrocarbons in the body, such as protein oxidation and colonic bacterial metabolism, these apparently are of limited importance and do not interfere with the interpretation of the hydrocarbon breath test. The production of hydrocarbons relative to that of other end products of lipid peroxidation depends on variables that are difficult to control, such as the local availability of iron(II) ions and dioxygen. In addition, hydrocarbons are metabolized in the body, which especially influences the excretion of pentane. Because of the extremely low concentrations of ethane and pentane in human breath, which often are not significantly higher than those in ambient air, the hydrocarbon breath test requires a flawless technique regarding such factors as: (1) the preparation of the subject with hydrocarbon-free air to wash out ambient air hydrocarbons from the lungs, (2) the avoidance of ambient air contamination of the breath sample by using appropriate materials for sampling and storing, and (3) the procedures used to concentrate and filter the samples prior to gas chromatographic determination. For the gas chromatographic separation of hydrocarbons, open tubular capillary columns are preferred because of their high resolution capacity. Only in those settings where expired hydrocarbon levels are substantially higher than ambient air levels might washout prove to be unnecessary, at least in adults. Although many investigators have concentrated on one marker, it seems preferable to measure both ethane and pentane concurrently. The results of the hydrocarbon breath test are not influenced by prior food consumption, but both vitamin E and beta-carotene supplementation decrease hydrocarbon excretion. Nevertheless, the long-term use of a diet high in polyunsaturated fatty acids, such as in parenteral nutrition regimens, may result in increased hydrocarbon exhalation. Hydrocarbon excretion slightly increases with increasing age. Short-term increases follow physical and intellectual stress and exposure to hyperbaric dioxygen.(ABSTRACT TRUNCATED AT 400 WORDS)
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Affiliation(s)
- C M Kneepkens
- Gastroenterology-Nutrition Unit, Hôpital Ste-Justine, Université de Montréal, Quebec, Canada
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25
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Abstract
Previous studies have raised the question of whether pentane is a normal constituent of human breath, since its concentrations in inspired room air and expired breath are often similar. Using a highly sensitive assay for volatile organic compounds, we studied 37 normal subjects in order to determine the alveolar gradient of pentane in their breath (i.e. concentration in alveolar breath minus concentration in the inspired air). The chemical identity of pentane was confirmed by mass spectroscopy. The alveolar gradient of pentane was zero +/- 0.175 nmol/l in 54.1% of subjects, and distributed in an approximately bell-shaped curve. Determination of the alveolar gradient divided the normal subjects into three groups: the "passive equilibrators" who did not appear to excrete pentane in the breath (the majority), "metabolizers" who actively catabolized inhaled pentane, and "manufacturers" who excreted more pentane than they inhaled.
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Affiliation(s)
- M Phillips
- Department of Medicine, St. Vincent's Medical Center of Richmond, Staten Island, New York 10310-1699
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26
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Moodie IM, Labadarios D. Determination of pentane in human breath by gas chromatography. ACTA ACUST UNITED AC 1993. [DOI: 10.1002/jhrc.1240160712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Traber MG, Carpentier YA, Kayden HJ, Richelle M, Galeano NF, Deckelbaum RJ. Alterations in plasma alpha- and gamma-tocopherol concentrations in response to intravenous infusion of lipid emulsions in humans. Metabolism 1993; 42:701-9. [PMID: 8510513 DOI: 10.1016/0026-0495(93)90236-h] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
To study the fate of intravenously infused vitamin E, we infused lipid emulsions rich in gamma-tocopherol (Intralipid, Kabi, Stockholm, Sweden), or in both alpha- and gamma-tocopherols (Lipidem, Hausmann Laboratories, St Gallen, Switzerland); in normal human volunteers. Plasma gamma-tocopherol levels increased in four subjects infused with Intralipid 10% (0.3 g triglyceride [TG]/kg/h for 6 hours) from 3 +/- 1 to 25 +/- 2 nmol/mL, but by 24 hours they decreased to 5 +/- 1 nmol/mL. Although eight times more gamma-tocopherol was infused, plasma alpha-tocopherol levels also increased from 26 +/- 7 to 39 +/- 9 nmol/mL at 8 hours and decreased to 24 +/- 5 nmol/mL at 24 hours. Increases of alpha-tocopherol in the very-low-density lipoprotein (VLDL) density range occurred at 6 and 8 hours, while decreases occurred in low-density lipoprotein (LDL) and high-density lipoprotein (HDL) density ranges at 3, 6, 8, and 24 hours. Infusion of both emulsions in random order to six subjects at therapeutic rates (0.1 g/kg/h for 6 hours) resulted in (1) a threefold increase in plasma gamma-tocopherol concentrations at 6 hours, (2) increases in plasma alpha-tocopherol concentrations only with Lipidem (from 14.3 +/- 1.0 nmol/mL at 0 hours to 18.4 +/- 2.7 at 6 hours and 18.9 +/- 1.1 at 24 hours), and (3) no decreases in lipoprotein alpha-tocopherol levels.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- M G Traber
- Department of Medicine, New York University School of Medicine, New York 10016
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28
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Lockitch G. Perinatal and Pediatric Nutrition. Clin Lab Med 1993. [DOI: 10.1016/s0272-2712(18)30445-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Kljuchnikov S, Pitkänen O, Raivio KO, Andersson S. Haemolysis in adult and neonatal erythrocytes caused by autoxidation of lipid emulsion (Intralipid). Acta Paediatr 1993; 82:348-51. [PMID: 8318800 DOI: 10.1111/j.1651-2227.1993.tb12694.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Lipid emulsion (Intralipid) causes free radical-mediated damage to human cells in vitro. Incubation with 0.44% Intralipid for 17 h caused 40.3 +/- 3.8% haemolysis in adult human erythrocytes and 26.5 +/- 8.1% in erythrocytes from term newborns (p = 0.0001). In adult erythrocytes mean corpuscular volume increased 68.7 +/- 8.2% and in newborn erythrocytes 54.8 +/- 10.4% (p = 0.0012). Initial concentrations of reduced glutathione in adult and newborn erythrocytes were 65.1 +/- 2.5 and 62.1 +/- 4.0 mg/dl, respectively (ns); after incubation, glutathione concentrations were 21.0 +/- 4.0 and in 25.7 +/- 5.2 mg/dl in adult and newborn erythrocytes, respectively (p = 0.0004). After incubation the concentrations of thiobarbituric acid reactive material and conjugated dienes in newborn erythrocytes (2.8 +/- 0.2 microM and 0.223 +/- 0.019 OD 233, respectively) were higher than those of adult erythrocytes (2.1 +/- 0.4 microM and 0.138 +/- 0.012 OD 233) (p = 0.0001). In both adult and newborn erythrocytes, the effects of Intralipid were significantly inhibited by 0.6 mM deferroxamine or 8 mM sodium etidronate. Despite higher susceptibility to lipid peroxidation of the cell membrane, newborn erythrocytes are more resistant than adult erythrocytes to free radical-mediated effects such as depletion of intracellular glutathione, cell swelling and haemolysis.
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Affiliation(s)
- S Kljuchnikov
- Department of Paediatrics, Russian Medical University, Moscow
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30
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Van Gossum A, De Cuyper J, Ooms H, Cremer M, Jeejeebhoy KN. Assessment of lipid peroxidation in humans by breath pentane output measurement. Clin Nutr 1993; 12:121-2. [PMID: 16843301 DOI: 10.1016/0261-5614(93)90065-c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- A Van Gossum
- Laboratory of Clinical Chemistry, Hôpital Erasme, ULB, Brussels, Belgium
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31
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Absorption, lipoprotein transport, and regulation of plasma concentrations of vitamin E in humans. J Lipid Res 1993. [DOI: 10.1016/s0022-2275(20)40727-8] [Citation(s) in RCA: 422] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Zarling EJ, Mobarhan S, Bowen P, Sugerman S. Oral diet does not alter pulmonary pentane or ethane excretion in healthy subjects. J Am Coll Nutr 1992; 11:349-52. [PMID: 1619188 DOI: 10.1080/07315724.1992.10718237] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Ethane and pentane are alkanes that are excreted through the lungs to a small degree in healthy subjects. These gasses are produced from the peroxidation of unsaturated fats which are found both in body tissues and in foods. These gasses are excreted in larger amounts by patients with increased production of reactive oxygen metabolites, including those with inflammation or ischemia. Thus, detection of these gasses in excessive quantities is considered evidence for lipid peroxidation. However, the effects of dietary factors on these measurements have not been defined. To define the effects of eating on the pulmonary excretion of these alkanes, 29 healthy subjects were fed a standardized liquid diet (1060 kcal, 12.9 g linoleic acid and 385 mg linolenic acid) after an overnight fast. Breath alkanes were measured at 0, 1, 3, and 6 hours. All subjects had normal vitamin E (1.11 + 0.26 mg/dl), retinol (64 +/- 14 micrograms/dl), beta carotene (27 +/- 21 micrograms/dl), lycopene (23 +/- 12 micrograms/dl) and zinc (81.9 +/- 13.5 micrograms/dl) levels. No statistically significant changes in either alkane were noted relative to the fasting level. We conclude that oral diet does not alter pulmonary ethane or pentane excretion in healthy subjects.
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Affiliation(s)
- E J Zarling
- Department of Medicine, Loyola University of Chicago, Maywood, IL 60153
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34
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Hageman JJ, Bast A, Vermeulen NP. Monitoring of oxidative free radical damage in vivo: analytical aspects. Chem Biol Interact 1992; 82:243-93. [PMID: 1318789 DOI: 10.1016/0009-2797(92)90001-2] [Citation(s) in RCA: 83] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Free radical damage is an important factor in many pathological and toxicological processes. During the last decade a wide range of methods has been developed to determine free radical damage in various biological fluids and at various stages of development. This review offers an overview of the state of the art of monitoring free radical damage in vivo, with special emphasis on the analytical aspects of non-invasive methods.
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Affiliation(s)
- J J Hageman
- Department of Pharmacochemistry, Vrije Universiteit Amsterdam, The Netherlands
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Steephen AC, Traber MG, Ito Y, Lewis LH, Kayden HJ, Shike M. Vitamin E status of patients receiving long-term parenteral nutrition: is vitamin E supplementation adequate? JPEN J Parenter Enteral Nutr 1991; 15:647-52. [PMID: 1766055 DOI: 10.1177/0148607191015006647] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Vitamin E status of eight patients receiving total parenteral nutrition (TPN), including 10 IU of all-racemic alpha-tocopheryl acetate daily and Intralipid 20% (500 mL; 12 mg of RRR-alpha- and 92 mg of RRR-gamma-tocopherols) two to three times per week for 69 +/- 45 (mean +/- SD) months was assessed by measuring plasma and adipose tissue tocopherol concentrations. Plasma alpha-tocopherols of TPN patients were similar to controls (17.5 +/- 6.6 mumol/L vs 22.4 +/- 5.1), whereas gamma-tocopherols were significantly reduced (6.0 +/- 3.1 vs 11.2 +/- 3.6, p less than 0.03). The adipose tissue alpha- and gamma-tocopherol/triglycerides (TG) were similar (369 +/- 215 nmol/mmol vs 452 +/- 228, and 125 +/- 102 vs 140 +/- 130, respectively), but cholesterol/TG were increased in the TPN patients (7.8 +/- 2.5 mumol/mmol vs 5.1 +/- 3.5, p less than 0.05), suggesting that adipose tissue was relatively TG-depleted and tocopherol/cholesterol measurements better reflect vitamin E status. The mean alpha-tocopherol/cholesterol ratios were significantly lower in the TPN patients than the controls (55 +/- 36 vs 106 +/- 63, p less than 0.04). Thus, current vitamin E supplementation of TPN patients seems insufficient for maintenance of adequate tissue stores.
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Affiliation(s)
- A C Steephen
- GI-Nutrition Service Department of Medicine, Memorial Sloan-Kettering Cancer Center, Cornell University Medical College, NY 10021
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37
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Abstract
Interaction of active oxygen species with polyunsaturated fatty acids (PUFA) results in a series of reactions called lipid peroxidation. During the process of peroxidation of polyunsaturated fatty acids there is a scission of an alkane fragment extending from the methyl end of the fatty acid to the double bond. Thus, with a w-6 polyunsaturated fatty acid pentane is released, and with a w-3 polyunsaturated fatty acid ethane is released. These hydrocarbons are distributed in the body, partly metabolized, and excreted in the breath, making it possible to estimate the magnitude of in vivo lipid peroxidation by measuring pentane and ethane exhaled in breath. Advantages of this method are discussed as well as limitations and possible sources of error.
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Affiliation(s)
- K N Jeejeebhoy
- Department of Medicine, University of Toronto, ON, Canada
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38
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Robberecht H, Deelstra H, Van Grieken R. Determination of selenium in blood components by X-ray emission spectrometry. Procedures, concentration levels, and health implications. Biol Trace Elem Res 1990; 25:149-85. [PMID: 1698415 DOI: 10.1007/bf02990412] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Sampling, storing, sample pretreatment, and experimental conditions for selenium (Se) determination in human serum, plasma, and whole blood by X-ray emission spectrometric (XRS) methods are described. Concentration levels in these biological fluids, found by this technique, are discussed and compared to values found by other techniques for the same healthy population group in the same area. XRS analysis of blood from patients with various pathological conditions is reviewed, with special attention to the relation of Se with the concentration level of other essential or nonessential trace elements.
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Affiliation(s)
- H Robberecht
- Provinciaal Hoger Technisch Instituut voor Scheikunde, Antwerp, Belgium
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39
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Abstract
Selenium is an essential trace element in humans and animals. Its only established function in humans is the antioxidant activity of glutathione peroxidase, a selenoenzyme. Severe prolonged deficiency may cause a fatal cardiomyopathy. Iatrogenic causes of selenium deficiency include parenteral and enteral nutrition. Low plasma selenium is also found in malabsorption, cystic fibrosis, rheumatoid arthritis, neoplasia, and other varied clinical disorders. Death has resulted from a single massive ingestion of selenium, while chronic excessive intake causes skin, nail, and hair pathology. Extreme geographical variation in population blood and urine selenium levels and a marked age-specific variation in population reference intervals are important factors in understanding selenium nutrition. Nutritional requirements, biological availability, and metabolism are discussed in relation to geographical, age, and method variability. Sampling, processing procedures, and methods for selenium quantitation are reviewed. Selenium content in different biological matrices and reference values for pediatric, adult, and obstetric populations are provided.
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Affiliation(s)
- G Lockitch
- Department of Pathology, British Columbia's Children's Hospital, Vancouver, Canada
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