Yoshiya Mashima

The effect of fat emulsion (Intralipid) on essential fatty acid deficiency in infants receiving intravenous alimentation.

Thirteen infants who received IVA in four different ways were studied. The serum fatty acid composition of the infants who received fat-free IVA showed EFA deficiency within 1 wk. This deficiency was cured by administering fat emulsion which accounted for 4% of the total caloric content of the infusate. Fat emulsion which accounted for 2% of the total calories neither improved nor prevented EFA deficiency. This means that intravenous fat emulsion, Intralipid, which accounted for 2% of the total calories as linoleic acid, still satisfies the essential fatty acid requirement.

Alteration of lipoprotein profile during total parenteral nutrition with intralipid 10

Eight patients were studied for lipoprotein profiles over a period of 3-7 weeks. Four patients received total parenteral nutrition (TPN), including 1000 ml/day of Intralipid 10%. Three patients received fat-free TPN, and one patient was tube fed 1000 ml/day of Intralipid 10% enterally. Fat-free TPN lowered plasma lipid, especially low density lipoprotein (LDL) and high density lipoproteins (HDL). On the other hand, intravenous administration of Intralipid 10% caused a marked increase of LDL, together with increases of phospholipid and cholesterol, especially free cholesterol. Triglyceride, VLDL, and HDL remained within the normal range in this group. Enteral administration of the same amount of Intralipid 10% did not cause a rise of LDL. Lipid composition of the increased LDL approximated that of lipoprotein X with the intravenous Intralipid 10%. From these findings, we suggest that phospholipids in Intralipid 10% formed abnormal LDL as the result of mobilization of cholesterol from extravascular tissues, when administered intravenously.

Effect of Calorie Overload on Puppy Livers during Parenteral Nutrition

UNLABELLED To investigate the possible cause of hepatomegaly during TPN, chemical analyses were performed on the livers of puppies weighing around 2 kg, supported by TPN for 1 wk, under 3 different calorie levels: Group I (5) under 135 cal/kg as standard calorie, Group 2 (6) fed ad libitum with dog food, Group 3 (5) received TPN for 7 days at 135 cal/kg/day, Group 4 (5) TPN at 200 cal/kg/day, and Group 5 (5) at 270 cal/kg/day. The livers of puppies starved for 24 hrs and orally fed were studied as controls. RESULTS 1) remarkable hepatomegaly with anemic discoloration and rise in sGOT, sGPT, and Alpase were the constant findings in G-2 and G-3.2). Liver weight in starved, fed G-1, G-2, and G-3 were 66.0 +/- 7.5g, 82.8 +/- 18.5g, 108.32 +/- 21.36g and 247.06 +/- 17.83g, respectively. 3) Glycogen and water contents in the livers were: in starved 0.17 +/- 0.07g and 48.75 +/- 5.75 ml, in fed 5.37 +/- 3.24g and 60.72 +/- 13.71 ml, in G-1 10.35 +/- 4.87g and 79.4 +/- 16.84 ml, in G-2 45.05 +/- 7.41G and 173.31 +/- 21.26 ml, and in G-3 45.19 +/- 20.47g and 178.45 +/- 56.63 ml, indicating that the weight increment can be explained by the increase in glycogen and water deposit in the liver. 4) Triglyceride in livers in G-2 and G-3 increased by 2 times the controls. These results suggest the possibility of the occurrence of hepatomegaly with glycogen and water accumulation accompanying the rise in serum enzyme by calorie overload in clinical TPN.

Increased Lipoprotein X Causes Hyperlipidemia During Intravenous Administration of 10% Fat Emulsion in Man

To clarify the mechanisms of hyperlipidemia during intravenous Intralipid 10%, lipoprotein profiles including lipoprotein X were studied in 13 patients receiving 2.0 g of fat per kilogram per day by Intralipid 10% over a period of 8 weeks. All patients were fed exclusively by total parenteral nutrition providing 1.1 g of amino acid and 30 kcal/kg per day. Intravenous administration of Intralipid 10% caused a marked increase of low-density lipoprotein (LDL), phospholipid, and cholesterol, especially free cholesterol, whereas triglyceride, very-low-density lipoprotein, and high-density lipoprotein remained within the normal range. Lipid composition of LDL approximated that of lipoprotein X progressively with the intravenous Intralipid 10%. Quantification of lipoprotein X revealed that its increase was proportionate with that of LDL and total lipid. From these findings, hyperlipidemia during intravenous Intralipid 10% is induced almost exclusively by the increased lipoprotein X.

Effects of severity of surgical trauma on whole body protein turnover in patients receiving total parenteral nutrition

This study was conducted to resolve discrepancies in the literature with regard to changes in protein metabolism following surgical stress. Twelve patients who had undergone abdominal surgery and six who were controls were studied. Whole body protein turnover was measured on the third and 10th postoperative day, during isonitrogenous and isocaloric total parenteral nutrition (TPN), by the method of constant infusion of [15N]glycine. Six patients who underwent abdominal surgery without any complications showed positive nitrogen balance on the 10th postoperative day (group I). However, nitrogen balance was still negative on the 10th postoperative day in another six patients who showed some critical complications after abdominal surgery (group II). A significant increase in whole body protein breakdown was seen in groups I and II on the third postoperative day (p less than 0.02, p less than 0.01, respectively), compared with control. Breakdown was greater in group II (p less than 0.05) than in group I. Protein synthesis tended to increase in group II, whereas in group I, it was at the same level as control. It was concluded that protein synthesis was unchanged in moderate stress, concomitant with increment of breakdown, but it tended to increase with a greater increase of breakdown in severe stress.

Whole body protein turnover, synthesis, and breakdown in patients receiving total parenteral nutrition before and after recovery from surgical stress.

This study was conducted to understand further the mechanisms underlying the loss of body nitrogen after trauma. Six patients who underwent abdominal surgery and six for control were studied. The measurement of whole body protein turnover was made on the 3rd and 10th postoperative day during total parenteral nutrition with constant infusion of [15N]glycine according to Picou and Taylor-Roberts. The measurement was also made on six control patients during total parenteral nutrition in the nonstressed state. The rates of whole body protein turnover, synthesis, and breakdown were calculated from the plateau 15N enrichment of urinary total N, which was analyzed with a mass spectrometer. The values were compared with control by Students t-test, and the changes in the individual patients were examined by a paired t-test. Immediately after the operation, whole body protein turnover and breakdown were significantly elevated (p less than 0.05 and less than 0.02, respectively), and decreased with the improvement of N balance after recovery from stress by 0.95 +/- 0.21 and 0.61 +/- 0.13 g . protein/kg . day, respectively. The changes in whole body protein turnover and breakdown were statistically significant (p less than 0.005 and less than 0.005, respectively). However, no tendency of alteration in whole body protein synthesis was found throughout the study. It is concluded that protein turnover rate increases in surgical stress, and that the increased protein catabolism rather than the alteration in synthesis could account for the postoperative nitrogen losses.

Alteration of Whole-Body Protein Kinetics According to Severity of Surgical Trauma in Patients Receiving Total Parenteral Nutrition

This study was conducted to clarify the mechanisms of body nitrogen losses according to the severity of surgical trauma. Thirteen male patients who underwent operation for esophageal cancer (group E), and 11 men (who underwent gastric or colorectal surgeries (group GC) were studied. The measurement of whole-body protein turnover, synthesis, and breakdown were made preoperatively on the 3rd and 10th postoperative day with constant infusion of [15N]glycine during isocaloric and isonitrogenous total parenteral nutrition. Significant increases in the rates of whole-body protein turnover (flux) and breakdown were seen in group E on the 3rd postoperative day (p less than 0.01, p less than 0.01, respectively), whereas the increases were not significant in group GC. The rates of whole-body protein flux and breakdown were significantly greater in group E than group GC (p less than 0.01, p less than 0.01, respectively). The rate of protein synthesis significantly increased in group E (p less than 0.05), but did not alter or slightly decreased in group GC. The rates of whole-body protein flux and breakdown in group E were still significantly greater on the 10th postoperative day than preoperatively. It was concluded that unchanged or slightly decreased rates of whole-body protein synthesis with slightly increased breakdown were seen in the group of patients who underwent gastric or colorectal surgery, whereas synthesis increased significantly with a greater increase of breakdown in patients receiving severe surgical procedures, esophagectomy for esophageal cancer.

Evaluation of the endotoxin retention capabilities of inline intravenous filters

The capabilities of inline filters to retain bacteria and endotoxin were examined during simulated extended infusions for up to 168 hr. The tested inline filters were the ELD96 (Pall Biomedical Corp) and the IVEX 2 (Millipore Corp). Approximately 1 x 10(8) total cells of Escherichia coli B. were challenged to the upstream site of the filter. The test solution of 5% dextrose in water, 0.9% saline, Paremental A (A basic solution for total parenteral nutrition (TPN), a TPN solution in use in our clinic were infused continuously up to 168 hr and flow rate was maintained at 83 ml/hr. The effluents were analyzed using the Limulus Amebocyte Lysate (LAL) test to detect endotoxin and also passage of the challenged bacteria was tested at 24-hr intervals over 168 hr. The results were as follows: (1) The viability control culture showed the presence of viable bacteria throughout the 168-hr period of the experiment. (2) During the experiments, all filters produced sterile effluents. (3) LAL assay indicated that only the effluents from the ELD96 contained no detectable endotoxin for 168 hr.

The Effect of Fat Emulsion on Essential Fatty Acid Deficiency During Intravenous Hyperalimentation in Pediatric Patients

A series of experiments on puppies and two newborn infants indicates that Intralipid which covered only 4% of the total caloreis, prevented or improved essential fatty acid deficiency in puppies and infants on hyperalimentation. This means that the intravenous fat emulsion, which covers about 2% of the total caloric intake with linoleic acid, still satisfies the essential fatty acid requirement, since half of the fatty acid composition of Intralipid is linoleate.

Studies on the absorption of ‘Small peptides’ and free amino acids in elemental diets

Abstract Previous studies have indicated that small peptides (di- or tri-peptides) are more rapidly absorbed from the small intestines than free amino acid mixtures. We made a practical elemental diet (ED) in which small peptides were used as the nitrogen source, and studied the absorption of nitrogen using canine Thiry-Vella loop in comparison with ED prepared with a mixture of amino acids with the same composition, as the nitrogen source. The absorption of nitrogen was significantly high in ED with small peptides (36.8±2.2%) compared to ED with free amino acids (27.3±2.5%). The result suggested that small peptides are suitable for use as the nitrogen source for ED.