Skip to main content
PMC home page
The Journal of Clinical Investigation logoLink to The Journal of Clinical Investigation
. 1976 Jan;57(1):125–136. doi: 10.1172/JCI108252

Metabolic studies in total parenteral nutrition with lipid in man. Comparison with glucose.

K N Jeejee hoy, G H Anderson, A F Nakhooda, G R Greenberg, I Sanderson, E B Marliss
PMCID: PMC436632  PMID: 812887

Abstract

A study was undertaken of patients on a regimen of total parenteral nutrition comparing the nitrogen balance, energy substrates, blood amino acids, immunoreactive insulin, and immunoreactive glucagon levels during the sequential infusion of nonprotein calories as either glucose alone (glucose system) or 83% as Intralipid (Pharmacia Fine Chemicals, Montreal, Canada) and 17% glucose (lipid system). These nonprotein calories were administered with a constant background of amino acids (1 g/kg per day), vitamins, and minerals. Each system was infused for a week at a time and the order of infusion randomized. In some patients whole blood arteriovenous (A-V) levels of amino acids were measured across forearm muscle. During the glucose system there was a significantly higher level of pyruvate, lactate, alanine, and immunoreactive insulin, consistent with glucose being the principal source of energy. In contrast, during the lipid system there was a rise in free fatty acids and ketone bodies with a fall in insulin, suggesting that lipid was now the principal source of energy. Despite these two very diverse metabolic situations the nitrogen balance with both systems was positive to a comparable degree after the establishment of equilibrium. Correspondingly, A-V differences of whole blood amino acid nitrogen showed uptake by muscle to an equivalent degree with both systems. Clinical studies indicated that the lipid system as defined herein could be infused by peripheral vein for up to 43 days with resultant weight gain, elevation of serum proteins, and healing of fistulae. Our studies suggest that for both metabolic and clinical reasons exogenously infused lipid is a suitable source of nonprotein calories.

Full text

PDF
127

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Allison S. P., Prowse K., Chamberlain M. J. Failure of insulin response to glucose load during operation and after myocardial infarction. Lancet. 1967 Mar 4;1(7488):478–481. doi: 10.1016/s0140-6736(67)91097-5. [DOI] [PubMed] [Google Scholar]
  2. Anderson G. H., Patel D. G., Jeejeebhoy K. N. Design and evaluation by nitrogen balance and blood aminograms of an amino acid mixture for total parenteral nutrition of adults with gastrointestinal disease. J Clin Invest. 1974 Mar;53(3):904–912. doi: 10.1172/JCI107631. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Blackburn G. L., Flatt J. P., Clowes G. H., Jr, O'Donnell T. F., Hensle T. E. Protein sparing therapy during periods of starvation with sepsis of trauma. Ann Surg. 1973 May;177(5):588–594. doi: 10.1097/00000658-197305000-00012. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Blackburn G. L., Flatt J. P., Clowes G. H., O'Donnell T. E. Peripheral intravenous feeding with isotonic amino acid solutions. Am J Surg. 1973 Apr;125(4):447–454. doi: 10.1016/0002-9610(73)90080-9. [DOI] [PubMed] [Google Scholar]
  5. Cahill G. F., Jr Starvation in man. N Engl J Med. 1970 Mar 19;282(12):668–675. doi: 10.1056/NEJM197003192821209. [DOI] [PubMed] [Google Scholar]
  6. Collins F. D., Sinclair A. J., Royle J. P., Coats D. A., Maynard A. T., Leonard R. F. Plasma lipids in human linoleic acid deficiency. Nutr Metab. 1971;13(3):150–167. doi: 10.1159/000175332. [DOI] [PubMed] [Google Scholar]
  7. Dudrick S. J., Ruberg R. L. Principles and practice of parenteral nutrition. Gastroenterology. 1971 Dec;61(6):901–910. [PubMed] [Google Scholar]
  8. Dudrick S. J., Wilmore D. W., Vars H. M., Rhoads J. E. Long-term total parenteral nutrition with growth, development, and positive nitrogen balance. Surgery. 1968 Jul;64(1):134–142. [PubMed] [Google Scholar]
  9. Fekl W. Some principles of modern parenteral nutrition. Scand J Gastroenterol Suppl. 1969;3:17–34. [PubMed] [Google Scholar]
  10. Girard J. R., Cuendet G. S., Marliss E. B., Kervran A., Rieutort M., Assan R. Fuels, hormones, and liver metabolism at term and during the early postnatal period in the rat. J Clin Invest. 1973 Dec;52(12):3190–3200. doi: 10.1172/JCI107519. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Hallberg D., Holm I., Obel A. L., Schuberth O., Wretlind A. Fat emulsions for complete intravenous nutrition. Postgrad Med J. 1967 Apr;43(498):307–316. [PMC free article] [PubMed] [Google Scholar]
  12. Herbert V., Lau K. S., Gottlieb C. W., Bleicher S. J. Coated charcoal immunoassay of insulin. J Clin Endocrinol Metab. 1965 Oct;25(10):1375–1384. doi: 10.1210/jcem-25-10-1375. [DOI] [PubMed] [Google Scholar]
  13. Hinton P., Allison S. P., Littlejohn S., Lloyd J. Insulin and glucose to reduce catabolic response to injury in burned patients. Lancet. 1971 Apr 17;1(7703):767–769. doi: 10.1016/s0140-6736(71)91213-x. [DOI] [PubMed] [Google Scholar]
  14. Ho R. J. Radiochemical assay of long-chain fatty acids using 63Ni as tracer. Anal Biochem. 1970 Jul;36(1):105–113. doi: 10.1016/0003-2697(70)90337-4. [DOI] [PubMed] [Google Scholar]
  15. Jeejeebhoy K. N., Zohrab W. J., Langer B., Phillips M. J., Kuksis A., Anderson G. H. Total parenteral nutrition at home for 23 months, without complication, and with good rehabilitation. A study of technical and metabolic features. Gastroenterology. 1973 Nov;65(5):811–820. [PubMed] [Google Scholar]
  16. Lawson L. J. Parenteral nutrition in surgery. Br J Surg. 1965 Oct;52(10):795–800. doi: 10.1002/bjs.1800521023. [DOI] [PubMed] [Google Scholar]
  17. Marliss E. B., Aoki T. T., Pozefsky T., Most A. S., Cahill G. F., Jr Muscle and splanchnic glutmine and glutamate metabolism in postabsorptive andstarved man. J Clin Invest. 1971 Apr;50(4):814–817. doi: 10.1172/JCI106552. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. McGill D. B. Letter: Long-term parenteral nutrition. Gastroenterology. 1974 Jul;67(1):195–197. [PubMed] [Google Scholar]
  19. Patel D., Anderson G. H., Jeejeebhoy K. N. Amino acid adequacy of parenteral casein hydrolysate and oral cottage cheese in patients with gastrointestinal disease as measured by nitrogen balance and blood aminogram. Gastroenterology. 1973 Sep;65(3):427–437. [PubMed] [Google Scholar]
  20. Ruderman N. B., Herrera M. G. Glucose regulation of hepatic gluconeogenesis. Am J Physiol. 1968 Jun;214(6):1346–1351. doi: 10.1152/ajplegacy.1968.214.6.1346. [DOI] [PubMed] [Google Scholar]
  21. Rudman D., Millikan W. J., Richardson T. J., Bixler T. J., 2nd, Stackhouse J., McGarrity W. C. Elemental balances during intravenous hyperalimentation of underweight adult subjects. J Clin Invest. 1975 Jan;55(1):94–104. doi: 10.1172/JCI107922. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Ryan N. T., Blackburn G. L., Clowes H. A., Jr Differential tissue sensitivity to elevated endogenous insulin levels during experimental peritonitis in rats. Metabolism. 1974 Nov;23(11):1081–1089. doi: 10.1016/0026-0495(74)90075-4. [DOI] [PubMed] [Google Scholar]
  23. Valverde I., Villanueva M. L., Lozano I., Marco J. Presence of glucagon immunoreactivity in the globulin fraction of human plasma ("big plasma glucagon"). J Clin Endocrinol Metab. 1974 Dec;39(6):1090–1098. doi: 10.1210/jcem-39-6-1090. [DOI] [PubMed] [Google Scholar]
  24. Weir G. C., Knowlton S. D., Martin D. B. High molecular weight glucagon-like immunoreactivity in plasma. J Clin Endocrinol Metab. 1975 Feb;40(2):296–302. doi: 10.1210/jcem-40-2-296. [DOI] [PubMed] [Google Scholar]
  25. Wilmore D. W., Moylan J. A., Helmkamp G. M., Pruitt B. A., Jr Clinical evaluation of a 10 percent intravenous fat emulsion for parenteral nutrition in thermally injured patients. Ann Surg. 1973 Oct;178(4):503–513. doi: 10.1097/00000658-197310000-00013. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Yeo M. T., Gazzaniga A. B., Bartlett R. H., Shobe J. B. Total intravenous nutrition. Experience with fat emulsions and hypertonic glucose. Arch Surg. 1973 Jun;106(6):792–796. doi: 10.1001/archsurg.1973.01350180032011. [DOI] [PubMed] [Google Scholar]
  27. Zierler K. L. THEORY OF THE USE OF ARTERIOVENOUS CONCENTRATION DIFFERENCES FOR MEASURING METABOLISM IN STEADY AND NON-STEADY STATES. J Clin Invest. 1961 Dec;40(12):2111–2125. doi: 10.1172/JCI104437. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Zohrab W. J., McHattie J. D., Jeejeebhoy K. N. Total parenteral alimentation, with lipid. Gastroenterology. 1973 Apr;64(4):583–592. [PubMed] [Google Scholar]

Articles from Journal of Clinical Investigation are provided here courtesy of American Society for Clinical Investigation

RESOURCES