Protein-metabolism kinetics and energy-substrate utilization in infants fed parenteral solutions with different glucose-fat ratios

Article Abstract:

Parenteral feeding (PF), in which sugars, amino acids (the building blocks of proteins), and fats are given intravenously, is widely used in the treatment of infants who cannot tolerate stomach feedings. However, the effects of PF on protein metabolism are poorly understood. Proteins are the only macronutrients containing nitrogen. Nitrogen retention, an indicator of protein use, is necessary for growth of muscle and other tissues and for body development, particularly in infants who normally experience rapid growth. The amount of protein ingested affects protein deposition in the body, and total energy (calories) ingested also influences the use of protein. However, the specific effects of glucose and lipids, which are the major energy fuels, are disputable. Previous studies have suggested that nitrogen utilization is most efficient when carbohydrate is the major fuel, while other studies suggest that addition of fat enhances nitrogen balance (retention of nitrogen in the body) and still others show no difference in the effects of diets. Some of these studies were carried out in severely ill adults, and the results may reflect the effects of disease or infection rather than normal fuel use. The effects of differing glucose and fat intake on protein usage were studied in eight infants who were receiving continuous PF. Protein and calorie intake were kept constant. Infants who were fed glucose had higher rates of protein turnover and breakdown of amino acid oxidation (use for fuel) than those given glucose-fat mixtures, but the rates of protein synthesis were similar. The study indicates that less protein is lost when glucose-fat mixtures are used in PF. These results, along with past studies which showed an increase in energy use and fat deposition in liver associated with the glucose-rich diet, indicate that the glucose-fat PF mixture is preferable. (Consumer Summary produced by Reliance Medical Information, Inc.)

Composition, Protein metabolism

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Oral nutrition in patients receiving home cyclic parenteral nutrition: pattern of substrate utilization

Article Abstract:

Parenteral nutrition (PN) is used to provide nutrients to patients with disorders that prevent the normal absorption of nutrients in the digestive system. In some cases, it is used in combination with modified oral diets to improve gastrointestinal function. This article describes the results of a study designed to compare energy intake, energy utilization, and nitrogen balance in patients receiving both PN and oral nutrition with patients receiving PN alone. The study included eight patients with small intestine disorders who had been receiving PN at home for 13 months and had been taking oral meals with PN for 11 months. During the first part of the study, each patient received 12 hours of nocturnal PN followed by 12 hours of fasting (PN only treatment). In the second part of the study, each patient received 12 hours of nocturnal PN followed by three unrestricted meals consumed over the next 12 hours (PN plus oral treatment). During the PN only period, the amount of energy taken in was equal to the amount of energy used by the body (BEE, basal energy expenditure). The oral supplements alone provided 80 percent of BEE, and when used in combination with PN created a positive energy and nitrogen balance (more energy and nitrogen taken in than used by the body); this resulted in an increase in the production of body fat. It is concluded that PN plus oral supplements provide more energy than PN alone and allow patients to face the increased energy requirements associated with performing daily activities. However, the excess energy provided leads to the production of fat. For patients receiving PN plus oral meals it may be beneficial to reduce the amount of energy given during nocturnal PN so that it equals and does not exceed the amount of energy used by the body during rest. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Energy metabolism, Nitrogen metabolism

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