Effect of enteral diets on whole body and gut growth in unstressed rats

Enteral Nutrition Therapy: Historical Perspective, Utilization, and Complications

PURPOSE OF REVIEW

Enteral nutrition (EN) therapy can provide vital nutrition support for patients with various medical conditions as long as it is indicated and supported by ethical reasoning. This review seeks to offer a detailed account of the history of EN development, highlighting key milestones and recent advances in the field. Additionally, it covers common complications associated with EN and their management.

RECENT FINDINGS

After years of research and development, we have reached newer generations of enteral feeding formulations, more options for enteral tubes and connectors, and a better understanding of EN therapy challenges. Given the availability of many different formulas, selecting a feeding formula with the best evidence for specific indications for enteral feeding is recommended. Initiation of enteral feeding with standard polymeric formula remains the standard of care. Transition to small-bore connectors remains suboptimal. Evidence-based practices should be followed to recognize and reduce possible enteral feeding complications early.

A Casein Hydrolysate Does Not Enhance Ileal Endogenous Protein Flows Compared With the Parent Intact Casein When Fed to Growing Pigs

BACKGROUND

The form of dietary nitrogen (free peptides or intact proteins) may influence the amount of endogenous amino acids found at the terminal ileum of the pig, and it has been speculated that hydrolyzed dietary protein may lead to increased endogenous amino acids.

OBJECTIVE

To compare the effect of dietary free peptides on ileal endogenous nitrogen and amino acid flows [ileal endogenous nitrogen flow (ENFL), ileal endogenous amino acid flow (EAAFL)] with that of peptides released naturally from dietary protein during digestion, from the same intact parent protein source.

METHODS

Six pigs (mean body weight: 34 kg) were equipped with a postvalve T-caecum cannula. Semisynthetic test diets contained the same 15N-labeled intact casein (C) or hydrolyzed casein (HC). Pigs received the test diets every sixth day and the corresponding unlabeled diets in the intervening 5-d periods. Digesta were pooled from 4 to 10 h postprandially. EAAFL and ENFL, calculated with reference to the dietary marker titanium dioxide, were determined by isotope dilution for C and HC.

RESULTS

Ileal EAAFL and ENFL (mean flows n = 5 of 1828 and 1912 μg/g of dry matter intake for diets HC and C, respectively) did not differ (P > 0.05) between pigs fed HC and C. Centrifugation and ultrafiltration of the HC digesta allowed an estimation of label recycling into gut endogenous proteins. Some 20% of ileal endogenous protein (diet HC, ultrafiltered digesta) was 15N-labeled due to tracer recycling.

CONCLUSIONS

The administration of a casein hydrolysate had no effect on ileal endogenous protein flows compared with C. There was no evidence of enhanced ileal endogenous protein losses with the HC diet.

Personalizing protein nourishment

Proteins are not equally digestible-their proteolytic susceptibility varies by their source and processing method. Incomplete digestion increases colonic microbial protein fermentation (putrefaction), which produces toxic metabolites that can induce inflammation in vitro and have been associated with inflammation in vivo. Individual humans differ in protein digestive capacity based on phenotypes, particularly disease states. To avoid putrefaction-induced intestinal inflammation, protein sources, and processing methods must be tailored to the consumer's digestive capacity. This review explores how food processing techniques alter protein digestibility and examines how physiological conditions alter digestive capacity. Possible solutions to improving digestive function or matching low digestive capacity with more digestible protein sources are explored. Beyond the ileal digestibility measurements of protein digestibility, less invasive, quicker and cheaper techniques for monitoring the extent of protein digestion and fermentation are needed to personalize protein nourishment. Biomarkers of protein digestive capacity and efficiency can be identified with the toolsets of peptidomics, metabolomics, microbial sequencing and multiplexed protein analysis of fecal and urine samples. By monitoring individual protein digestive function, the protein component of diets can be tailored via protein source and processing selection to match individual needs to minimize colonic putrefaction and, thus, optimize gut health.

Meat proteins had different effects on oligopeptide transporter PEPT1 in the small intestine of young rats

The peptide transporter 1 (PEPT1) in the apical membrane of enterocytes is the central mechanism for regulating the absorption of di- and tripeptides. Dietary proteins may affect PEPT1 abundance and peptide absorption. The present study aimed to characterize changes in PEPT1 mRNA and PEPT1 protein levels in the duodenum and jejunum of young rats after 7-day diet intervention with casein (reference), soy, beef, pork, chicken and fish proteins and further evaluate the impact on the epithelial absorption capacity. RT-PCR and western blot analyses showed that: (1) PEPT1 protein level in duodenum was higher (p < 0.05) for soy protein group than that for casein group. However, no difference was observed in jejunal PEPT1 protein level between any two diet groups (p > 0.05). The soy protein group had lower crypt depth and higher V/C ratio in the jejunum (p < 0.05). (2) PEPT1 mRNA levels were lower (p < 0.05) in rat duodenum and jejunum in pork, chicken and fish protein groups, whose trend was contrary to the results of jejunual histological observation with lower crypt depth, greater villus height and higher V/C ratio. In conclusion, different meat proteins alter distinct PEPT1 expression level and absorption capacity as reflected by gut morphology in small intestine.

Appropriate protein and specific amino acid delivery can improve patient outcome: fact or fantasy?

Protein utilization and requirements in critical illness are much researched and debated topics. The enhanced turnover and catabolism of protein in the setting of critical illness is well described and multifactorial in nature. The need to preserve lean body mass and enhance nitrogen retention in this state to improve immunologic function and reduce morbidity is well described. Debates as to the optimum amount of protein to provide in such states still exist, and a significant amount of research has contributed to our understanding of not only how much protein to supply to these patients, but how best to do so. Small peptide formulations, intact protein formulations, branched chain amino acids, and specialty formulas all exist, and their benefits, drawbacks, and potential uses have been investigated. Specific amino acid therapy has become part of the concept of immunonutrition, or the modification and enhancement of the immune response with specific nutrients. In this article, we describe the changes in outcomes demonstrated through the provision of protein, both as a macronutrient and as specific amino acids.

What is the best way to feed patients with pancreatitis?

PURPOSE OF REVIEW

Patients with acute pancreatitis have traditionally been treated with 'bowel rest'. Recent data, however, suggest that this approach may be associated with increased morbidity and mortality. This paper reviews evolving concepts in the nutritional management of patients with acute pancreatitis.

RECENT FINDINGS

Both experimental and clinical data strongly support the concept that enteral nutrition started within 24 h of admission to hospital reduces complications, length of hospital stay and mortality in patients with acute pancreatitis. Clinical trials suggest that both gastric and jejunal tube feeding is well tolerated in patients with severe pancreatitis. Although there is limited data for the optimal type of enteral feed, a semielemental formula with omega-3 fatty acids is recommended. On the basis of current evidence, immune modulating formulas with added arginine and probiotics are not recommended.

SUMMARY

Nutritional support should be viewed as an active therapeutic intervention that improves the outcome of patients with acute pancreatitis. Enteral nutrition should begin within 24 h after admission and following the initial period of volume resuscitation and control of nausea and pain. Patients with mild acute pancreatitis should be started on a low-fat oral diet. In patients with severe acute pancreatitis, enteral nutrition may be provided by the gastric or jejunal route.

Rapid restoration of colonic goblet cells induced by a hydrolyzed diet containing probiotics in experimental malnutrition

PURPOSE

To investigate the effects of the addition of probiotic bacteria to a hydrolyzed diet on the recovery of goblet cells during renutrition in an animal model of malnutrition.

METHODS

Twenty-six male Wistar rats (200-250g) were included in the study. Six were kept under normal conditions (sham group) while twenty received an aproteic diet for 15 days, and were randomized thereafter to receive a hydrolyzed diet containing (n=6; probiotic group) or not (n=6; hydrolyzed group) probiotics (10(6) cfu/g of Streptococcus thermophilus e Lactobacillus helveticus); or immediately killed (n=8; aproteic group). Histological slides containing cecal and sigmoid biopsies were used to counting the number of goblet cells and the goblet cells/colonocytes ratio.

RESULTS

Malnutrition diminished the population of goblet cells in all sites. Goblet cells/colonocytes ratio of the probiotic group was significantly greater than hydrolyzed group at the ceccum (0.39 +/- 0.03 vs. 0.34 +/-0.02; p=0.02). Only rats fed with probiotics showed complete restoration of the normal goblet cells/colonocytes ratio at the sigmoid (0.37 +/- 0,02 vs. 0.22 +/- 0,03; p<0,001).

CONCLUSION

Streptococcus thermophilus and Lactobacillus helveticus added to a renutrition diet enhance the recovery of mucosal atrophy induced by malnutrition and especially induce a rapid restoration of goblet cells population in the malnourished colonic mucosa.

Feeding dietary peptides to growing rats enhances gut endogenous protein flows compared with feeding protein-free or free amino acid-based diets

The effect of dietary peptides on gut endogenous nitrogen (N) flow (ENFL) and amino acid (AA) flow (EAAFL) was studied. Semisynthetic diets containing enzyme-hydrolyzed casein (HC; 11%) or a free AA mixture devoid of Asp and Ser (A1) or Gly and Ala (A2) were formulated to have similar AA compositions except for the excluded AA and similar dietary electrolyte balances (Na(+)+K(+)-Cl(-)). A protein-free diet (PF) served as a control. Sprague-Dawley rats were given the diets 8 times/d for 10 min each hour for 7 d. Rats were killed and digesta were sampled (6 observations within each group) along the intestinal tract 6 h after the first meal on d 7. EAAFL and ENFL, estimated with reference to the dietary marker TiO(2), were determined directly (PF, A1, and A2) or after centrifugation and ultrafiltration of the digesta (HC). Endogenous flows of Asp and Ser or Gly and Ala did not differ (P > 0.05) in any of the intestinal sections between rats fed PF and A1 or PF and A2, respectively, except in the stomach where Ser flow was greater for rats fed A1. Ileal endogenous flows for most of the AA and for N were higher (P < 0.05) for rats fed the HC diet compared with those for rats fed the PF, A1, or A2 diets, except for Phe, Tyr, Lys, which did not differ among the groups. Ileal EAAFL and ENFL were not influenced by body N balance per se but were affected by the presence in the gut of dietary peptides derived from casein.

How dietary restriction catalyzed the evolution of the human brain: An exposition of the nutritional neurotrophic neoteny theory

The purpose of this theoretical treatise is to explain the evolution of human encephalization. The evolutionary expansion of the human brain is herein regarded as a single component of an interrelated complex encompassing depressed somatic and sexual development and increased longevity. These cardinal phenotypic features, termed the Quadripartite Complex, were selected for their adaptiveness amidst the environmental deterioration extant during the formative phase of human evolution--the Plio-Pleistocene period. This interval of environmental transformation inevitably eventuated in ecological alteration and dietary diminution. Suggestively, experimentally imposed dietary restriction routinely results in lengthened lifespan, delayed sexual maturation, depressed growth and increased encephalization as a concomitant consequence of body mass reduction and brain mass maintenance. Thus, dietary restriction ostensibly induces discernible metabolic adaptations whether incurred ontologically or evolutionarily. Several experiments indicate that dietary restriction promotes the preservation and generation of neurons via induction of neurotrophic factors. To the extent that neurogenesis is a molecular mediator of mental acuity, it is evident that nutrition and cognition are intimately linked. Extrapolating to an evolutionary context, increased intelligence ought to confer advantages to organisms enduring dietary deprivation insofar as increased intelligence ensures more facile food acquisition. This reasoning underlies the nutritional neurotrophic neoteny (N(3)) theory, which holds that humans exhibit an altered pattern of neurotrophin expression resulting from positive selection for heightened intelligence amidst environmental deterioration and consequent dietary deficiency. The altered pattern of neurotrophin expression exhibited by humans, it is deduced, results in a protracted phase of developmental neurogenesis and a resultant retention of neurons that would otherwise be extirpated due to programmed cell death. Importantly, during neonatal neurogenesis mammals produce an excess number of neurons whose eventual destruction is dictated by neurotrophic factors. An altered pattern of neurotrophin expression during neurogenesis, as N(3) proposes, could therefore furnish a larger adult brain. As to how humans could afford to accrete exuberant neural tissue under conditions of chronic food scarcity the homo hypothalamic hypometabolism (H(3)) theory offers a plausible answer: reduced growth and delayed sexual maturation, mediated by the hypothalamus and its endocrine effectors, offset the energetic costs of increased encephalization in humans. H(3) is herein presented as a general theory of human evolution while N(3) may be regarded as a special theory of human encephalization.

Semi-elemental formula or polymeric formula: is there a better choice for enteral nutrition in acute pancreatitis? Randomized comparative study

BACKGROUND

Jejunal nutrition is recommended during acute pancreatitis. The use of semi-elemental formulas presents several theoretical advantages over polymeric formulas, but their clinical value has been poorly documented. Our aim was to evaluate in patients with acute pancreatitis the effect of enteral nutrition by a semi-elemental formula compared with a polymeric formula.

METHODS

A randomized prospective pilot study, stratified according to severity, was performed in 30 consecutive patients with acute pancreatitis requiring jejunal nutrition. The semi-elemental group received 35 kcal/kg/d of Peptamen (n = 15), and the polymeric group received the same quantity of Sondalis-Iso (n = 15). Tolerance was evaluated after 7 days of enteral nutrition (D7) on visual analog scale (VAS), stool frequency, and 24-hour steatorrhea/creatorrhea. Outcome was evaluated by weight loss, length of hospital stay, and infection rate.

RESULTS

Results were calculated as mean +/- SEM, t-test, or chi2. Patients of the 2 groups were comparable in terms of age, gender, and severity. Tolerance was good in both groups (semi-elemental vs polymeric: VAS, 7.4 +/- 0.6 vs 7.1 +/- 0.6, not significant (NS); number of stools per 24 hours, 1.7 +/- 0.4 vs 1.8 +/- 0.4, NS). Steatorrhea and creatorrhea were lower than normal in both groups. In semi-elemental group, the length of hospital stay was shorter (23 +/- 2 vs 27 +/- 1, p = .006) and weight loss was less marked (1 +/- 1 vs 2 +/- 0, p = .01). One patient in semi-elemental group and 3 patients in polymeric group developed an infection (NS).

CONCLUSIONS

Semi-elemental and polymeric nutrition are very well tolerated in patients with acute pancreatitis. Nutrition with a semi-elemental formula supports the hypothesis of a more favorable clinical course than nutrition with a polymeric formula, but this conclusion needs to be established in larger adequately powered clinical trials.

Small amount of low-residue diet with parenteral nutrition can prevent decreases in intestinal mucosal integrity

OBJECTIVE

To investigate the suitable combination ratio of low-residue diet (LRD) and parenteral nutrition (PN) for nutritional support of surgical patients.

SUMMARY BACKGROUND DATA

Bacterial translocation (BT) is a severe complication of total parenteral nutrition (TPN). However, it is sometimes impossible to supply sufficient amounts of nutrients to surgical patients by the enteral route. The authors reported previously that concomitant use of LRD with PN provided preferable nutritional support for patients undergoing surgery for colorectal cancer.

METHODS

Ninety male Donryu rats were used for three experiments. In experiment 1, rats were divided into two groups to receive TPN or total enteral nutrition with LRD. In experiment 2, rats were divided into six groups, receiving variable amounts of LRD. In experiment 3, rats were divided into five groups to receive isocaloric nutritional support with variable proportions of PN and LRD. Intestinal permeability was assessed by monitoring urinary excretion of phenolsulfonphthalein. BT was assessed in tissue cultures of mesenteric lymph nodes and spleen.

RESULTS

In experiment 1, increases in intestinal permeability and BT were observed in rats maintained on 7-day TPN, but not in those maintained on total enteral nutrition for up to 14 days. In experiment 2, the changes in body weight of rats were correlated with the dose of LRD. However, the intestinal permeability was increased only in rats receiving LRD at 15 kcal/kg per day. In experiment 3, additive LRD corresponding to 15% of total caloric intake prevented increases in intestinal permeability and BT.

CONCLUSION

Combined nutritional therapy consisting of PN and small amounts of LRD can provide better nutritional support than TPN for surgical patients.

Effects of alimentary intact proteins and their oligopeptide hydrolysate on growth, nitrogen retention, and small bowel adaptation in inflammatory turpentine rat

The effects of dietary proteins given as whole proteins (WP) or as a peptide hydrolysate (PH) on growth, nitrogen retention, and small bowel adaptation were assessed using two groups of male Wistar rats. Measurements were made 18, 42, and 66 h after acute inflammation induced by subcutaneous injections of 0.125 mL turpentine and in two control groups (n = 12). The two diets had the same caloric, nitrogen, vitamin, and mineral content. The WP diet resulted in better weight gain, nitrogen retention, and small intestinal adaptation by control rats than did the PH diet. Loss of body weight after 18 h of acute inflammation was significantly lower and nitrogen retention significantly higher in animals on the WP diet than in those on the PH diet. Small intestine morphology was maintained with the WP diet, whereas villus height was significantly lower after 66 h, and there were fewer mitoses per crypt in the rats on the PH diet. Glucoamylase activity at all times, and N-aminopeptidase activity at 18 h, were significantly higher in rats on the WP diet. The putrescine (at 42 h) and spermidine (at 18 h) concentrations in the mucosa were higher in the rats on the WP diet. These data suggest that synthetic diets should be tested for their nutritional value during acute inflammation before they are used in human nutrition.

Dietary peptides improve wound healing following surgery

To determine if peptide-based enteral diets improve wound healing when compared to amino acid-based diets, a prospective randomized study was conducted using 38 male Sprague-Dawley rats. Following placement of a standardized abdominal wound, 20 animals were randomized to an isonitrogenous peptide-based (PEP) versus amino acid-based diet (AA) for 10 d. In addition, 18 animals were randomized to an amino acid-based diet supplemented with the peptide carnosine (CARN) or its constituent amino acids (Control). Diets were administered through small bowel feeding tubes. Wound bursting pressure was significantly higher in the PEP animals compared to the AA animals (179+/-9 versus 138+/-12 mmHg; P=0.02). In addition, wound bursting pressure was significantly greater in the CARN animals compared to the Control animals (143+/-10 versus 116+/-8 mmHg; P=0.005). Peptide-based enteral diets improve wound healing when compared to nonpeptide generating amino acid-based diets. We also conclude that the dietary peptide carnosine represents a dietary peptide that improves wound healing when administered as part of a complete enteral formula. This effect on wound healing may be clinically relevant because carnosine is not found in most enteral formulas.

Basal nutrition promotes human intestinal epithelial (Caco-2) proliferation, brush border enzyme activity, and motility

OBJECTIVES

Provision of nutrients to the apical membrane of intestinal epithelial cells by the enteral route is critical for normal gut mucosal function and for the sheet migration required for mucosal healing. The present work attempts to determine whether supplemental nutrient delivery to the basal epithelial surface is important for intestinal epithelial biology. Since attempts to regulate intestinal epithelial cell biology by manipulation of parenteral nutrition solutions have met with some success, we hypothesized that basally delivered nutrients might also be important for intestinal epithelial biology.

DESIGN

To test this hypothesis, we compared the brush border enzyme activity, proliferation, and motility of human intestinal epithelial (Caco-2) cells cultured on a type I collagen substrate either on cell culture dishes with culture medium above the apical side of the cell monolayer or in culture inserts on 0.45-mu semipermeable membranes with culture medium beneath the monolayers as well as above them. Proliferation was assessed by serial hematocytometric counts over 13-day period. Doubling times were calculated by logarithmic transformation of cell counts 48 hrs apart. The specific activity of the brush border enzymes, dipeptidyl dipeptidase and alkaline phosphatase, was assayed by the digestion of synthetic chromogenic substrates in protein-matched aliquots of cell lysates. Sheet migration was quantitated by the expansion of Caco-2 monolayers across collagen. Motility was dissociated from the proliferative component of monolayer expansion by blocking proliferation with mitomycin C.

SETTING

Laboratory for gastrointestinal mucosal biology.

SUBJECTS

A well-differentiated subclone of cells derived from the established human Caco-2 colonic epithelial cell line.

MEASUREMENTS AND MAIN RESULTS

Basal nutrient delivery promoted Caco-2 proliferation, brush border enzyme activity, monolayer expansion, and cell motility. Proliferation was actually increased by 694 +/- 9.89% (n = 90, p < .0001) in cells nourished apically and basally compared with a 314 +/- 3.31% increase (n = 90, p < .0001) in those cells receiving only apical nutrition. The addition of basal nutrient delivery to the cell culture system augmented both alkaline phosphatase and dipeptidyl dipeptidase specific activity by 116 +/- 5.4% and 256 +/- 14.0%, respectively (p < .0001, n = 6 for each group). The effects of basal nutrient delivery were maintained after mitomycin blockade of proliferation for both alkaline phosphatase (392 +/- 89.8% of control, n = 3, p < .0005) and dipeptidyl dipeptidase (374 +/- 79.1% of control, n = 3, p < .005), suggesting that the increased digestive enzyme-specific activity reflected differentiation rather than indirect effects of slowing of proliferation. Epithelial sheet migration increased by 389 +/- 8.8% and proliferation-blocked cell motility also increased by 76.5 +/- 1.56% (p < .0005, n = 12 for each) compared with apical nutrient delivery only.

CONCLUSIONS

These results suggest that although apical nutrition may be critical for intestinal epithelial cell biology, nutrient delivery to the basal surface of intestinal epithelial cell membranes may also promote intestinal epithelial differentiation, proliferation, and mucosal healing.

Antigenicity and nutritional value of selected milk proteins and their hydrolysate in growing rats

Two liquid diets containing selected milk proteins (SMP) or its small peptide hydrolysate (SPH) were fed to growing rats for 2 wk and the effects on growth, nitrogen balance, and small intestine adaptation were determined. Residual antigenicity of the SPH diet as measured by immunodot was reduced by 98.8%. Nitrogen intakes were not different. Weight gain was significantly higher in rats fed the SMP diet. In contrast, the absolute nitrogen balance was similar, suggesting that protein storage was identical with the two diets. A better nitrogen digestion-absorption rate with the SPH diet was observed as evidenced by the significantly increased fecal excretion with the SMP diet. Small intestine adaptation showed no difference between the two diets for mucosal weight, protein content/10 cm as well as for sucrase, glucoamylase, and N-aminopeptidase total activity/10 cm or specific activity (mU/mg protein). The DNA content of the mucosa/10 cm was significantly higher suggesting a mucosal hyperplasia in the SPH diet. The data suggest that in rats the SPH diet leads to nitrogen retention and small intestine adaptation similar to that of the SMP diet, despite better body weight gain by the latter.

Influence of casein and casein hydrolysate diets on nutritional recovery of starved rats

BACKGROUND

The aim of this study was to compare the effects of two diets, which differed in their protein source (casein and casein hydrolysate), on the nutritional recovery and intestinal repair of undernourished rats at weaning after a 3-day fasting period. Profound alterations in gut structure and signs of malnutrition appeared after the starvation period.

METHODS

The casein hydrolysate was prepared by enzymatic hydrolysis and ultrafiltration. Rats were refed the casein-based or the casein hydrolysate-based diet for 96 hours. Normal-fed male Wistar rats at weaning were given the casein diet for 7 days and were used as controls. Liver acetylcholinesterase, glutamate dehydrogenase activities, serum amino acid profiles, jejunal oligosaccharidases, alkaline phosphatase, and leucine aminopeptidase activities were studied. Intestinal permeability to intact proteins was also tested by using ovalbumin and measuring its concentration in serum.

RESULTS

Intestinal and liver enzyme activities and serum amino acid profiles reached normal values after 96 hours of refeeding, regardless of the diet used. Glutamate dehydrogenase activity remained higher in both diet groups. Intestinal permeability to ovalbumin remained significantly increased only in the group refed the casein diet.

CONCLUSIONS

Our results show that 4 days of refeeding are sufficient for complete intestinal recovery after fasting, provided the dietary protein source is a casein hydrolysate. We suggest that patients with malnutrition or malabsorption syndrome should be fed formula composed of enzymatic protein hydrolysates (because of their low antigenicity) rather than enteral formulas composed of intact proteins.

Casein and soya-bean protein have different effects on whole body protein turnover at the same nitrogen balance

The present study examined whether different proteins have different effects on whole-body protein turnover in adult rats. The rats were either starved, given a protein-free but energy-sufficient diet (1 MJ/kg body weight (BW) per d) or a diet containing intact casein, hydrolysed casein, or hydrolysed soya-bean protein at a level of 9.1 g/kg BW per d. The diets, which were isoenergetic with the same carbohydrate: fat ratio, were given as a continuous intragastric infusion for at least 4 d. During the last 19 h 15N-glycine (a primed continuous infusion) was given intragastrically and 15N was recovered from urinary ammonia and urea during isotope steady state for measurement of protein synthesis and protein degradation. Compared with starvation the protein-free diet decreased N excretion by 75%, probably by increasing the rate of reutilization of amino acids from endogenous proteins for protein synthesis. The protein diets produced a positive N balance which was independent of the protein source. Intact and hydrolysed casein increased protein synthesis 2.6- and 2.0-fold respectively, compared with the protein-free diet. Protein degradation increased 1.4- and 1.2-fold respectively. Hydrolysed soya-bean protein did not increase protein synthesis but decreased protein degradation by 35% compared with the protein-free diet. Compared with the hydrolysed soya-bean protein, intact casein resulted in 2.2- and 2.8-fold higher rates of protein synthesis and degradation respectively. These results are not easily explained by known sources of misinterpretation associated with the 15N-glycine method. Hydrolysed casein and hydrolysed soya-bean protein produced similar concentrations of insulin-like growth factor-1, insulin, glucagon, and corticosterone. The difference in amino acid composition between the dietary proteins was reflected in plasma amino acid composition and this is suggested to be responsible for the different effect on protein turnover. Preliminary results from this study have previously been published in abstract form (Nielsen et al. 1991).

Trophic effects of different enteral diets in the rat intestine

The trophic effect of 4 commercial diets compared to chow was studied in 50 rats. The 4 commercial diets were: a free amino acid diet, a diet based on soy protein hydrolysate and two diets based on intact protein with and without extra fibre added. Bowel weight, mucosa weight and DNA content were measured after 7 days of treatment. The enteral formula based on a soy protein hydrolysate had a significant growth stimulating effect on the proximal small bowel compared to rat chow. In the ileum and in the colon all diets without fibre supplementation caused significantly lower bowel weights than rat chow.

Metabolism and nutritional frontiers in pediatric surgical patients

The successful treatment of pediatric surgical disease requires an understanding of the acute metabolic stress response. Poor clinical outcome can result when the metabolic demands of acute injury exceed the ability of endogenous host mechanisms to compensate. Appropriate exogenous supplementation may provide the metabolic and nutritional support crucial to recovery. As knowledge in this area grows, more effective treatment strategies are evolving. The potential for further advances, especially in the infant critical care population, offers the hope for substantial progress in the near future.

Effect of rate of enteral nutrient supply on gut mass

Early enteral feeding after injury is important for maintenance of gut integrity. However, enteral nutrients are frequently administered at low rates because of decreased gastrointestinal motility. These low rates are said to "maintain the gut." This study was performed to evaluate the effect of rate of enteral nutrient delivery on gut mass. Six male Sprague-Dawley rats had no surgery and served as controls (ad libitum rat chow diet). Twenty-four male Sprague-Dawley rats underwent abdominal surgery for placement of gastroduodenal feeding tubes (tip located 2 cm into intestine from pylorus) and were randomized (n = 6 per group) to ad libitum rat chow, 1/2 strength peptide diet (Reabilan HN, RHN) at 1 mL/h (1/2RHN-1 mL), full-strength peptide diet at 2 mL/h (RHN-2 mL), or full-strength peptide diet at 4 mL/h (RHN-4 mL). These diets supplied approximately 30%, 13%, 50%, and 100% of rat recommended daily allowances. The control animals gained weight (38 +/- 3 g over 5 days) whereas all postsurgery animals lost weight. Weight loss was greatest in the 1/2 RHN-1 mL (-55 +/- 3 g over 5 days) and RHN-2 mL (-52 +/- 6 g over 5 days) groups compared with the RHN-4 mL animals (-41 +/- 5 g over 5 days). All animals fed liquid enteral diets had reduced gut weights compared with chow-fed animals. Gut weights did not differ between control and postsurgery ad libitum chow animals.(ABSTRACT TRUNCATED AT 250 WORDS)