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Impact of Enteral and Parenteral Nutrition on Hepatic and Muscle Glucose Metabolism
Author(s) -
Song Chen Sheng,
Donmoyer Christine,
Zhang Yiqun,
Hande Scott A.,
Lacy D. Brooks,
McGuinness Owen P.
Publication year - 2000
Publication title -
journal of parenteral and enteral nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.935
H-Index - 98
eISSN - 1941-2444
pISSN - 0148-6071
DOI - 10.1177/0148607100024005255
Subject(s) - parenteral nutrition , enteral administration , medicine , metabolism , carbohydrate metabolism , intensive care medicine
Liver and muscle metabolism were assessed in dogs adapted to long‐term total parenteral (TPN) and enteral (TEN) nutrition. Studies were done in 13 conscious long‐term catheterized dogs in which sampling (artery, portal and hepatic vein, and iliac vein), infusion catheters (inferior vena cava, duodenum), and transonic flow probes (hepatic artery, portal vein, and iliac artery) were implanted. Fourteen days after surgery dogs were grouped to receive TPN or TEN. After 5 days of TPN/TEN, substrate balances across the liver and limb were assessed. The liver was a marked net consumer of glucose in both groups (23.6 ± 3.3 vs 22.6 ± 2.8 μmol · kg −1 · min −1 , TPN vs TEN) despite near normoglycemia (6.5 ± 0.3 vs 6.7 ± 0.2 mmol/L). Arterial insulin levels were higher during TEN (96 ± 6 vs 144 ± 30 pmol/L; p <.05). The majority (79 ± 13 vs 76%±7%) of the glucose taken up by the liver was released as lactate. Despite higher insulin levels during TEN the nonsplanchnic tissues consumed a lessor quantity of glucose (25.9 ± 3.3 vs 16.1 ± 3.9 μmol · kg −1 · min −1 ). In summary, the liver undergoes a profound adaptation to TPN and TEN making it a major site of glucose uptake and conversion to lactate irrespective of the route of nutrient delivery. However, the insulin requirements are higher with TEN possibly secondary to impaired peripheral glucose removal. (Journal of Parenteral and Enteral Nutrition 24: 255–260, 2000)