Effects of isoenergetic glucose-based or lipid-based parenteral nutrition on glucose metabolism, de novo lipogenesis, and respiratory gas exchanges in critically ill patients

Details

Serval ID
serval:BIB_68DFCAC5CBF8
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Effects of isoenergetic glucose-based or lipid-based parenteral nutrition on glucose metabolism, de novo lipogenesis, and respiratory gas exchanges in critically ill patients
Journal
Critical Care Medicine
Author(s)
Tappy  L., Schwarz  J. M., Schneiter  P., Cayeux  C., Revelly  J. P., Fagerquist  C. K., Jequier  E., Chiolero  R.
ISSN
0090-3493 (Print)
Publication state
Published
Issued date
05/1998
Volume
26
Number
5
Pages
860-7
Notes
Clinical Trial
Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't --- Old month value: May
Abstract
OBJECTIVE: To compare the effects of isocaloric, isonitrogenous carbohydrate nutrition vs. lipid-based total parenteral nutrition on respiratory gas exchange and intermediary metabolism in critically ill patients. DESIGN: Prospective, clinical trial. SETTING: Surgical intensive care unit in a major university hospital in Switzerland. PATIENTS: Sixteen patients admitted to the surgical intensive care unit. INTERVENTIONS: Patients were randomized to receive isocaloric isonitrogenous total parenteral nutrition (TPN) containing 75% (TPN-glucose) or 15% (TPN-lipid) glucose over a 5-day period. MEASUREMENTS AND MAIN RESULTS: Indirect glucose metabolism was assessed from plasma carbon-13 (13C)-labeled glucose and 13C-labeled CO2 production during a tracer infusion of uniformly 13C-labeled glucose, and de novo lipogenesis was estimated from the incorporation of 13C into palmitate-very low density lipoproteins (VLDL) during a tracer infusion of 1-(13)C acetate. Compared with TPN-lipid, TPN-glucose increased plasma glucose more (by 26% vs. 7%, p < .05), increased insulin more (by 284% vs. 40%, p < .01), and increased total CO2 more (by 15% vs. 0%, p < .01). Both nutrient mixtures failed to inhibit endogenous glucose production and net protein oxidation, suggesting absence of suppression of gluconeogenesis. Fractional de novo lipogenesis was markedly increased by TPN-glucose to 17.4% vs. 3.3% with TPN lipids. CONCLUSIONS: The rate of glucose administration commonly used during TPN of critically ill patients does not suppress endogenous glucose production or net protein loss, but markedly stimulates de novo lipogenesis and CO2 production. Increasing the proportion of fat may be beneficial, provided that lipid emulsion has no adverse effects.
Keywords
Adolescent Adult Aged Calorimetry, Indirect Carbon Dioxide/metabolism Critical Illness/*therapy Female Glucose/administration & dosage/*metabolism Humans Injury Severity Score Intensive Care Units Lipids/administration & dosage/*biosynthesis Male Middle Aged Oxygen Consumption *Parenteral Nutrition/methods *Pulmonary Gas Exchange Wounds and Injuries/metabolism/therapy
Pubmed
Web of science
Create date
24/01/2008 13:36
Last modification date
20/08/2019 14:24
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