Nutrition
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Randomized Controlled Trial Clinical Trial
Branched-chain and mixed amino acid solutions and thermogenesis in postoperative patients.
The effect of amino acid composition on the thermogenic response to amino acid infusion was studied in 20 spontaneously breathing postoperative coronary bypass patients and 6 healthy volunteers. On the 1st postoperative day, patients received either a balanced amino acid solution (2510 kJ/24 h) or an amino acid solution consisting primarily (88.8%) of branched-chain amino acids (BCAAs; 2510 kJ/24 h) for 6 h. Another group of patients receiving only hypocaloric glucose served as control subjects. ⋯ In the healthy subjects, REE increased only during the balanced amino acid infusion (p < 0.05). The thermogenic response to the balanced amino acid solution was 20.7 +/- 4.2% (p < 0.05), whereas no thermogenic response to the BCAA-enriched solution was observed (-5.6 +/- 3.3%, NS). This difference was probably due to the smaller energy cost of BCAA metabolism.(ABSTRACT TRUNCATED AT 250 WORDS)
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The effect of the degree of metabolic stress on the thermogenic response to parenteral nutrition was studied in surgical and intensive-care patients. Indirect calorimetry was measured before and 3 h after the start of parenteral nutrition. The following patient groups were studied: depleted ward patients before and after surgery for gastrointestinal malignancy (n = 16), mechanically ventilated sepsis/injury patients (n = 21), and spontaneously breathing intensive-care sepsis/injury patients (n = 8). ⋯ In the sepsis/trauma patients, REE increased in both nutrition groups (p < 0.05). The thermogenic response (19.7 +/- 6.5 and 8.0 +/- 3.2% in patients receiving amino acids and nonprotein energy, respectively) was similar to that of the depleted patients postoperatively and was similar in sepsis and trauma patients. We conclude that the thermogenic response to parenteral amino acids and nonprotein energy is minor in depleted patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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The regional distribution of body fat has been identified as a significant risk factor for the development of noninsulin-dependent diabetes mellitus and cardiovascular disease (CVD). Several studies that have investigated the potential associations between topographic features of adipose tissue and indices reflecting carbohydrate and lipid metabolism have reported significant associations between abdominal fat deposition and metabolic complications. The development of computed tomography as a means to precisely measure the amount of subcutaneous and deep adipose tissue at any site of the body has shown that determination of the level of visceral adipose tissue is a critical measurement to perform in the assessment of the health hazards of obesity. ⋯ We have also reported that a high level of visceral adipose tissue is associated with a deterioration of glucose tolerance and that the relationship between visceral fat deposition and glucose tolerance remains significant after controlling for the level of total-body fat. Because significant interrelationships were observed between abdominal visceral obesity, insulin resistance, and dyslipoproteinemias in obese women, it is suggested that visceral obesity is an important component of the insulin-resistance syndrome (syndrome X) that has been previously described. This cluster of morphological, hormonal, and metabolic alterations observed in abdominal obesity may have substantial implications for the treatment of this condition.
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Hormonal responses to major trauma trigger a cascade of metabolic adjustments leading to catabolism and substrate mobilization. Energy deficit and energy surfeit have profound effects on hormone levels. To characterize the course of changes in regulatory hormone levels after multiple injury, we measured the plasma levels of eight hormones, once within 48-60 h after injury in the fasting state and then daily for 5 days during the administration of total parenteral nutrition in 10 hypermetabolic, highly catabolic, and severely injured adult patients. ⋯ The persistent low levels of IGF-1 reflect the altered nutrition status of the patients, as characterized by the continued negative nitrogen balance and elevated cortisol levels in the early posttrauma period. Anabolic IGF-1 and insulin levels showed significant negative correlation with the catabolic indicators 3-methylhistidine and catecholamine excretion. The results suggest that IGF-1 is regulated by nutritional intake independently of growth hormone and may be a better nutrition indicator.