Clinical nutrition : official journal of the European Society of Parenteral and Enteral Nutrition
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This study was designed to investigate the effects of high energy infusion and insulin treatment on plasma and liver lipids in diabetic rats receiving total parenteral nutrition (TPN). Diabetes was induced in rats by streptozotocin. The diabetic rats were assigned to two TPN groups to receive either long chain triglyceride (LCT) or medium chain triglyceride (MCT)/LCT (1:1) as a fat source. ⋯ Insulin treated groups had significantly higher liver fat content than did those without insulin treatment. Furthermore, liver fat content was significantly higher in the LCT group than in the MCT/LCT group among insulin treated TPN rats. These results suggest that compared with the LCT emulsion, infusion of the MCT/LCT emulsion ameliorated liver fat deposition in insulin-treated diabetic rats receiving TPN.
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Clinical Trial
Preoperative oral carbohydrate administration reduces postoperative insulin resistance.
Infusions of carbohydrates before surgery reduce postoperative insulin resistance. We in-vestigated the effects of a carbohydrate drink, given shortly before surgery, on postoperative metabolism. ⋯ Patients given a carbohydrate drink shortly before elective colorectal surgery displayed less reduced insulin sensitivity after surgery as compared to patients who were operated after an overnight fast.
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Energy expenditure increases after cardiac surgery, but changes in peripheral tissue metabolism do not explain this increase. We hypothesized that the splanchnic region is a major contributor to the postoperative hypermetabolism, and this should be reflected in the exchange of amino acids across the splanchnic bed. We measured systemic and regional (splanchnic and leg) amino acid exchange, oxygen uptake and hemodynamics in 22 elective coronary bypass grafting patients postoperatively after arrival to the intensive care unit, 2 h later, and after stabilization of hemodynamics. ⋯ Femoral exchange of glutamine and alanine did not change, although femoral blood flow and oxygen consumption increased during rewarming. High metabolic activity was observed in the splanchnic region during the early postoperative phase after hypothermic cardiac surgery. The increased plasma amino acid concentration indicates a release of amino acids from other sources than the peripheral muscle.
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Randomized Controlled Trial Comparative Study Clinical Trial
Use of a mixture of medium-chain triglycerides and longchain triglycerides versus long-chain triglycerides in critically ill surgical patients: a randomized prospective double-blind study.
Twenty critically-ill surgical patients who needed total parenteral nutrition were randomly enrolled in a double-blind study comparing two intravenous fat emulsions: one containing a mixture of 50% medium-chain triglycerides and 50% long-chain triglycerides and another containing 100% longchain triglycerides. The purpose of this study was to investigate metabolic and biochemical differences between both emulsions with special reference to liver enzymes. After a baseline period of 24 h with only glucose and NaCl infusion, the lipid emulsion was added continuously during 24 h over 5 days. ⋯ There was no significant difference in energy expenditure, nitrogen balance, liver function tests, carnitine, transferrin, pre-albumin, albumin, cholesterol, triglycerides and free fatty acids. The only parameter that showed a different pattern of reaction between the two emulsions was serum bilirubin concentration. In this study no evidence of any advantageous effect of a mixture of medium-chain triglycerides and long-chain triglycerides was seen.