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Fukatsu K. Role of nutrition in gastroenterological surgery. Ann Gastroenterol Surg 2019; 3:160-168. [PMID: 30923785 PMCID: PMC6422822 DOI: 10.1002/ags3.12237] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 11/25/2018] [Accepted: 12/16/2018] [Indexed: 12/14/2022] Open
Abstract
Nutrition plays important roles in recovery after gastroenterological surgery. Severe surgical stress increases muscle breakdown and lipolysis, thereby accelerating wound healing and enhancing host defense against microbes. Malnourished patients have insufficient amounts of muscle and body fat. Therefore, they may not appropriately respond to surgical stress. Perioperative nutritional therapy maintaining nutritional status reduces postoperative complications and accelerates recovery after surgery, particularly for malnourished patients. In addition, perioperative oral or enteral nutrition is now recommended for preserving host defense mechanisms against microbes. Lack of enteral nutrition impairs gut and hepatic immunity, systemic mucosal defense and peritoneal host defense, even when nutrient amounts supplied by parenteral nutrition are adequate. Thus, surgeons should avoid no oral or enteral nutrition periods. Supplemental administration of specific nutrients such as glutamine, arginine and ω-3 fatty acids is termed "immunonutrition", and is expected to reduce the morbidity of infectious complications and length of hospital stay. Nutritional therapy is important even after discharge to maintain body weight and compensate for abnormalities in the digestion and absorption of nutrients. Understanding the significance of nutrition in gastroenterological patients leads to better outcomes.
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Schörghuber M, Fruhwald S. Effects of enteral nutrition on gastrointestinal function in patients who are critically ill. Lancet Gastroenterol Hepatol 2018. [DOI: 10.1016/s2468-1253(18)30036-0] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Abstract
Diarrhoea is a common problem in the neonatal and suckling foal. In certain circumstances supplemental nutrition is necessary depending on the age of foal, severity of diarrhoea and presence of other systemic manifestations. Nutritional supplementation can be provided either enterally or parenterally. Enteral nutrition is superior to parenteral nutrition because it is the most natural and physiologically sound means to provide nutritional support. Parenteral nutrition may be warranted if the foal is unable to receive or tolerate enteral nutrition. Dextrose alone or with amino acids and lipids can provide appropriate nutrition when enteral feeding is not tolerated. As soon as the foal stabilises enteral feeding can be reintroduced.
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Affiliation(s)
- B Barr
- Rood and Riddle Equine Hospital Lexington Kentucky USA
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Sun H, Bi J, Lei Q, Wan X, Jiang T, Wu C, Wang X. Partial enteral nutrition increases intestinal sIgA levels in mice undergoing parenteral nutrition in a dose-dependent manner. Int J Surg 2017; 49:74-79. [PMID: 29248622 DOI: 10.1016/j.ijsu.2017.12.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Accepted: 12/12/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Partial enteral nutrition (PEN) protects parenteral nutrition (PN) induced gut mucosal immunity impairment. However, the gastrointestinal function of most patients with PN is too poor to tolerate full dosage of PEN and no guidelines recommend PEN dose. We aimed to identify an optimal PEN dose and to understand the protective mechanism. METHODS Mice were assigned to groups with total parenteral nutrition (TPN), total enteral nutrition (TEN), or various degrees of PEN with PN. Additionally, AS1517499 was used to inhibit STAT6. Five days after treatment, secretory immunoglobulin A (sIgA) levels of luminal washing fluid and JAK1-STAT6 signalling in ileum tissue of different groups were assessed. RESULTS We found that TPN lowered luminal sIgA and down-regulated pIgR, phosphorylated JAK1 and STAT6, IL-4 and IL-13 as well relative to TEN. Moreover, 40% EN were lowest dose that reversed these detrimental consequences of PN to an equivalent level as TEN. The rescue of pIgR and luminal sIgA expression was decreased when the JAK1-STAT6 pathway was inhibited. CONCLUSION We conclude that 40% EN is the optimal PEN dose that reverses PN-induced impairment of gut mucosal immunity. Additionally, we hypothesise that this benefit involves activation of the JAK1-STAT6 pathway.
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Affiliation(s)
- Haifeng Sun
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, China
| | - Jingcheng Bi
- Department of Thyroid and Breast Surgery, Taizhou People's Hospital, Taizhou 225300, Jiangsu Province, China
| | - Qiucheng Lei
- Department of Liver Surgery, The First People's Hospital of Foshan, Foshan 528000, Guangdong Province, China
| | - Xiao Wan
- Anhui Provincial Hospital, Hefei 230001, Anhui Province, China
| | - Tingting Jiang
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, China
| | - Chao Wu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Xinying Wang
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, China.
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Partial Enteral Nutrition Preserves Elements of Gut Barrier Function, Including Innate Immunity, Intestinal Alkaline Phosphatase (IAP) Level, and Intestinal Microbiota in Mice. Nutrients 2015; 7:6294-312. [PMID: 26247961 PMCID: PMC4555127 DOI: 10.3390/nu7085288] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 05/20/2015] [Accepted: 07/22/2015] [Indexed: 01/28/2023] Open
Abstract
Lack of enteral nutrition (EN) during parenteral nutrition (PN) leads to higher incidence of infection because of gut barrier dysfunction. However, the effects of partial EN on intestina linnate immunity, intestinal alkaline phosphatase (IAP) and microbiota remain unclear. The mice were randomized into six groups to receive either standard chow or isocaloric and isonitrogenous nutritional support with variable partial EN to PN ratios. Five days later, the mice were sacrificed and tissue samples were collected. Bacterial translocation, the levels of lysozyme, mucin 2 (MUC2), and IAP were analyzed. The composition of intestinal microbiota was analyzed by 16S rRNA pyrosequencing. Compared with chow, total parenteral nutrition (TPN) resulted in a dysfunctional mucosal barrier, as evidenced by increased bacterial translocation (p < 0.05), loss of lysozyme, MUC2, and IAP, and changes in the gut microbiota (p < 0.001). Administration of 20% EN supplemented with PN significantly increased the concentrations of lysozyme, MUC2, IAP, and the mRNA levels of lysozyme and MUC2 (p < 0.001). The percentages of Bacteroidetes and Tenericutes were significantly lower in the 20% EN group than in the TPN group (p < 0.001). These changes were accompanied by maintained barrier function in bacterial culture (p < 0.05). Supplementation of PN with 20% EN preserves gut barrier function, by way of maintaining innate immunity, IAP and intestinal microbiota.
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Skouroliakou M, Ntountaniotis D, Kastanidou O, Massara P. Evaluation of Barley's Beta-glucan Food Fortification through Investigation of Intestinal Permeability in Healthy Adults. J Am Coll Nutr 2015; 35:13-9. [DOI: 10.1080/07315724.2014.967893] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Lima IS, Silva JS, Almeida VA, Junior FGL, Souza PAN, Larangeira DF, Moura-Neto JP, Fraga DBM, de Freitas LAR, dos-Santos WL. Severe clinical presentation of visceral leishmaniasis in naturally infected dogs with disruption of the splenic white pulp. PLoS One 2014; 9:e87742. [PMID: 24498367 PMCID: PMC3911999 DOI: 10.1371/journal.pone.0087742] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 12/28/2013] [Indexed: 11/26/2022] Open
Abstract
In this work, we investigated the association between the disruption of splenic lymphoid tissue and the severity of visceral leishmaniasis in dogs. Clinical and laboratory data from 206 dogs were reviewed. Spleen sections collected during the euthanasia of these animals were analyzed, and the splenic lymphoid tissue samples were classified as well organized (spleen type 1), slightly disorganized (spleen type 2), or moderately to extensively disorganized (spleen type 3). Of 199 dogs with evidence of Leishmania infection, 54 (27%) had spleen type 1, 99 (50%) had spleen type 2, and 46 (23%) had spleen type 3. The number of clinical signs associated with visceral leishmaniasis was significantly higher in the animals with evidence of Leishmania infection and spleen type 2 or 3 than in the animals with spleen type 1. Alopecia, anemia, dehydration, dermatitis, lymphadenopathy, and onychogryphosis were all more frequent among animals with evidence of Leishmania infection and spleen type 3 than among the dogs with evidence of Leishmania infection and spleen type 1. The association between the severity of canine visceral leishmaniasis and the disorganization of the splenic lymphoid tissue was even more evident in the group of animals with positive spleen culture. Conjunctivitis and ulceration were also more common in the animals with spleen type 3 than in the animals with spleen type 1. The serum levels (median, interquartile range) of albumin (1.8, 1.4–2.3 g/dL) and creatinine (0.7, 0.4–0.8 mg/dL) were significantly lower and the serum levels of aspartate aminotransferase were significantly higher (57, 39–95 U) in animals with spleen type 3 than in animals with spleen type 1 (2.8, 2.4–3.4 g/dL; 0.9, 0.7–1.2 mg/dL and 23, 20–32 U, respectively). Our data confirm the hypothesis that disruption of the splenic lymphoid tissue is associated with a more severe clinical presentation of canine visceral leishmaniasis.
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Affiliation(s)
- Isadora S. Lima
- Fundação Oswaldo Cruz, Centro de Pesquisas Gonçalo Moniz, Salvador, Bahia, Brazil
| | - Joselli S. Silva
- Fundação Oswaldo Cruz, Centro de Pesquisas Gonçalo Moniz, Salvador, Bahia, Brazil
| | - Valter A. Almeida
- Fundação Oswaldo Cruz, Centro de Pesquisas Gonçalo Moniz, Salvador, Bahia, Brazil
| | | | - Patrício AN. Souza
- Centro de Referência em Doenças Endêmicas Pirajá da Silva (PIEJ), Jequié, Bahia, Brazil
| | - Daniela F. Larangeira
- Universidade Federal da Bahia, Escola de Medicina Veterinária, Salvador, Bahia, Brazil
| | - José P. Moura-Neto
- Universidade Federal da Amazônia, Faculdade de Ciências Farmacêuticas, Manaus, Amazonas, Brazil
| | - Deborah BM. Fraga
- Fundação Oswaldo Cruz, Centro de Pesquisas Gonçalo Moniz, Salvador, Bahia, Brazil
- Universidade Federal da Bahia, Escola de Medicina Veterinária, Salvador, Bahia, Brazil
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Fukatsu K. The Long Road to Optimizing the Parenteral Provision of Nutrients. JPEN J Parenter Enteral Nutr 2012; 36:157-8. [DOI: 10.1177/0148607111428324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Omata J, Fukatsu K, Murakoshi S, Moriya T, Ueno C, Maeshima Y, Okamoto K, Saitoh D, Yamamoto J, Hase K. Influence of Adding Pyrroloquinoline Quinone to Parenteral Nutrition on Gut-Associated Lymphoid Tissue. JPEN J Parenter Enteral Nutr 2011; 35:616-24. [DOI: 10.1177/0148607110395512] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Jiro Omata
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | | | - Satoshi Murakoshi
- Division of Traumatology, National Defense Medical College Research Institute, Tokorozawa, Japan
| | - Tomoyuki Moriya
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Chikara Ueno
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Yoshinori Maeshima
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Koichi Okamoto
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Daizoh Saitoh
- Division of Traumatology, National Defense Medical College Research Institute, Tokorozawa, Japan
| | - Junji Yamamoto
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Kazuo Hase
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
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Clore ERS, Freeman LM, Bedenice D, Buffington CAT, Anderson DE. Retrospective evaluation of parenteral nutrition in alpacas: 22 cases (2002-2008). J Vet Intern Med 2011; 25:598-604. [PMID: 21418323 DOI: 10.1111/j.1939-1676.2011.0708.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Parenteral nutrition is an important method of nutritional support in hospitalized animals, but minimal information has been published on its use in camelids. HYPOTHESIS/OBJECTIVES The purpose of this study was to characterize the use of total parenteral nutrition (TPN) in alpacas, evaluate the formulations used, and determine potential complications. ANIMALS Twenty-two alpacas hospitalized at the Tufts Cummings School for Veterinary Medicine (site 1: n = 8) and the Ohio State University Veterinary Teaching Hospital (site 2: n = 14). METHODS A retrospective analysis of all alpacas that received TPN between 2002 and 2008 was performed to assess clinical indications, clinical and clinicopathologic data, and outcome. RESULTS The most common underlying diseases in animals receiving TPN were gastrointestinal dysfunction (n = 16), hepatic disease (n = 2), and neoplasia (n = 2). Several metabolic abnormalities were identified in animals (n = 20/22) before TPN was initiated, including lipemia (n = 12/22), hyperglycemia (11/22), and hypokalemia (n = 11/22). Median age was significantly lower for site 1 cases (0.1 years; range, 0.01-11.0) compared with those from site 2 (4.9 years; range, 0.1-13.7; P = .03). Animals at site 2 also had a longer duration of hospitalization (P = .01) and TPN administration (P = .004), as well as higher survival rate (P < .02). Twenty-one of 22 alpacas developed at least 1 complication during TPN administration. Metabolic complications were most prevalent (n = 21/22) and included hyperglycemia (n = 8/21), lipemia (n = 7/21), hypokalemia (n = 3/21), and refeeding syndrome (n = 3/21). CONCLUSIONS AND CLINICAL IMPORTANCE TPN is a feasible method of nutritional support for alpacas when enteral feeding is not possible. Prospective studies are warranted to determine optimal TPN formulations for alpacas.
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Affiliation(s)
- E R S Clore
- Department of Clinical Sciences, Tufts Cummings School of Veterinary Medicine, North Grafton, MA 01536, USA
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Greenspon J, Perrone EE, Alaish SM. Shoshin beriberi mimicking central line sepsis in a child with short bowel syndrome. World J Pediatr 2010; 6:366-8. [PMID: 20127217 DOI: 10.1007/s12519-010-0022-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Accepted: 06/11/2009] [Indexed: 11/28/2022]
Abstract
BACKGROUND Shoshin beriberi, cardiac failure secondary to a severe deficiency of the vitamin thiamine, can develop in patients following extensive intestinal resection or bypass; however, parenteral supplementation has largely eliminated this complication. Hemodynamic instability resulting from central line sepsis is a far more common complication in these parenteral nutrition-dependent patients. This case report details the diagnosis and treatment of shoshin beriberi in a patient with short bowel syndrome whose presentation mimicked central line sepsis. METHODS A retrospective chart review was performed. Appropriate laboratory data were included. RESULTS The patient was treated unsuccessfully with antibiotics and supportive measures. Resolution of symptoms was achieved only after the empiric administration of thiamine and folate. CONCLUSIONS This case highlights that life-threatening thiamine deficiency mimicking septic shock can develop in patients with short bowel syndrome, despite oral multivitamin administration. We recommend diligent monitoring of vitamin levels in any total parenteral alimentation dependent patient unable to receive the intravenous multivitamin complex, regardless of oral vitamin supplementation or clinical findings.
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Affiliation(s)
- Jose Greenspon
- Division of Pediatric Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA
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