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Effects of Two Energy :Nitrogen Ratios in Patients with Gastroenterological Disease and Malnutrition
Author(s) -
Messing Bernard,
Bernier JeanJacques
Publication year - 1980
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 - 10.1177/014860718000400306
Subject(s) - calorie , nitrogen balance , parenteral nutrition , regimen , medicine , resting energy expenditure , albumin , chemistry , malnutrition , protein–energy malnutrition , kjeldahl method , nitrogen , zoology , endocrinology , gastroenterology , surgery , body weight , biology , organic chemistry
In 10 patients with active gastroenterological disease and protein‐malnutrition (weight: 77.3 $ 2.6 (mean $ SEM) percent of ideal body weight, serum‐albumin levels: 2.59 $ 0.17 mg/100 ml) a randomized crossover study was performed to assess the effects of two energy:nitrogen ratios on body cell replenishment. After at least 3 days for equilibration, the total parenteral nutrition (TPN) study carried out with 354 $ 5 mg of casein hydrolysate‐nitrogen/kg/day, divided in two 7‐day periods during which two nonprotein calorie supplies of 47 $ 1 kcal/kg/day and 81 $ 4 kcal/kg/day were given. The same 50 $ 5% dextrose and fat emulsion energy sources were used in the two periods. Nitrogen (Kjeldahl method) and potassium retention, and weight and serum albumin concentration gains were all significantly better (Student t test) during the hypercaloric regimen than during the normocaloric regimen. In the 10 patients, the protein‐sparing effect of nonprotein calories “added” during the hypercaloric regimen was demonstrated and represented 17% of the constant infused nitrogen. The more catabolic patient was prior to TPN, the more energy‐dependent was the protein‐sparing effect observed (r = +0.638). Preliminary data obtained with 3‐methylhistidine urine determination suggests that the protein‐sparing effect of “added” calories was due to an increased protein synthesis. Finally, body cell replenishment was better with the higher 230 $ 6 energy:nitrogen ratio than with the lower 132 $ 4 energy:nitrogen ratio, which suggests that the hypercaloric TPN regimen was useful in such patients.