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The gastrin-releasing peptide analog bombesin preserves exocrine and endocrine pancreas morphology and function during parenteral nutrition.
Pierre JF, Neuman JC, Brill AL, Brar HK, Thompson MF, Cadena MT, Connors KM, Busch RA, Heneghan AF, Cham CM, Jones EK, Kibbe CR, Davis DB, Groblewski GE, Kudsk KA, Kimple ME
(2015) Am J Physiol Gastrointest Liver Physiol 309: G431-42
MeSH Terms: Amylases, Animals, Bombesin, DNA, Food, Formulated, Gastrin-Releasing Peptide, Gene Expression Regulation, Hyperglycemia, Islets of Langerhans, Lipase, Male, Mice, Mice, Inbred ICR, Pancreas, Exocrine, Pancreatic Hormones, Parenteral Nutrition
Show Abstract · Added August 2, 2016
Stimulation of digestive organs by enteric peptides is lost during total parental nutrition (PN). Here we examine the role of the enteric peptide bombesin (BBS) in stimulation of the exocrine and endocrine pancreas during PN. BBS protects against exocrine pancreas atrophy and dysfunction caused by PN. BBS also augments circulating insulin levels, suggesting an endocrine pancreas phenotype. While no significant changes in gross endocrine pancreas morphology were observed, pancreatic islets isolated from BBS-treated PN mice showed a significantly enhanced insulin secretion response to the glucagon-like peptide-1 (GLP-1) agonist exendin-4, correlating with enhanced GLP-1 receptor expression. BBS itself had no effect on islet function, as reflected in low expression of BBS receptors in islet samples. Intestinal BBS receptor expression was enhanced in PN with BBS, and circulating active GLP-1 levels were significantly enhanced in BBS-treated PN mice. We hypothesized that BBS preserved islet function indirectly, through the enteroendocrine cell-pancreas axis. We confirmed the ability of BBS to directly stimulate intestinal enteroid cells to express the GLP-1 precursor preproglucagon. In conclusion, BBS preserves the exocrine and endocrine pancreas functions during PN; however, the endocrine stimulation is likely indirect, through the enteroendocrine cell-pancreas axis.
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16 MeSH Terms
Bombesin Preserves Goblet Cell Resistin-Like Molecule β During Parenteral Nutrition but Not Other Goblet Cell Products.
Busch RA, Heneghan AF, Pierre JF, Neuman JC, Reimer CA, Wang X, Kimple ME, Kudsk KA
(2016) JPEN J Parenter Enteral Nutr 40: 1042-9
MeSH Terms: Animals, Bombesin, Goblet Cells, Hormones, Ectopic, Ileum, Immunity, Innate, Interleukin-13, Interleukin-4, Male, Mice, Mice, Inbred ICR, Mucin-2, Paneth Cells, Parenteral Nutrition, Trefoil Factor-3
Show Abstract · Added August 2, 2016
INTRODUCTION - Parenteral nutrition (PN) increases the risk of infection in critically ill patients and is associated with defects in gastrointestinal innate immunity. Goblet cells produce mucosal defense compounds, including mucin (principally MUC2), trefoil factor 3 (TFF3), and resistin-like molecule β (RELMβ). Bombesin (BBS), a gastrin-releasing peptide analogue, experimentally reverses PN-induced defects in Paneth cell innate immunity. We hypothesized that PN reduces goblet cell product expression and PN+BBS would reverse these PN-induced defects.
METHODS - Two days after intravenous cannulation, male Institute of Cancer Research mice were randomized to chow (n = 15), PN (n = 13), or PN+BBS (15 µg tid) (n = 12) diets for 5 days. Defined segments of ileum and luminal fluid were analyzed for MUC2, TFF3, and RELMβ by quantitative reverse transcriptase polymerase chain reaction and Western blot. Th2 cytokines interleukin (IL)-4 and IL-13 were measured by enzyme-linked immunosorbent assay.
RESULTS - Compared with chow, PN significantly reduced MUC2 in ileum (P < .01) and luminal fluid (P = .01). BBS supplementation did not improve ileal or luminal MUC2 compared with PN (P > .3). Compared with chow, PN significantly reduced TFF3 in ileum (P < .02) and luminal fluid (P < .01). BBS addition did not improve ileal or luminal TFF3 compared with PN (P > .3). Compared with chow, PN significantly reduced ileal RELMβ (P < .01). BBS supplementation significantly increased ileal RELMβ to levels similar to chow (P < .03 vs PN; P > .6 vs chow). Th2 cytokines were decreased with PN and returned to chow levels with BBS.
CONCLUSION - PN significantly impairs the goblet cell component of innate mucosal immunity. BBS only preserves goblet cell RELMβ during PN but not other goblet cell products measured.
© 2015 American Society for Parenteral and Enteral Nutrition.
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15 MeSH Terms
Comparison of new modeling methods for postnatal weight in ELBW infants using prenatal and postnatal data.
Porcelli PJ, Rosenbloom ST
(2014) J Pediatr Gastroenterol Nutr 59: e2-8
MeSH Terms: Algorithms, Birth Weight, Body Weight, Electronic Health Records, Enteral Nutrition, Female, Fluid Therapy, Forecasting, Gestational Age, Growth Charts, Humans, Infant, Extremely Low Birth Weight, Infant, Extremely Premature, Infant, Newborn, Linear Models, Male, Neural Networks (Computer), Nutritional Status, Parenteral Nutrition
Show Abstract · Added January 26, 2016
OBJECTIVES - Postnatal infant weight curves are used to assess fluid management and evaluate postnatal nutrition and growth. Traditionally, postnatal weight curves are based on birth weight and do not incorporate postnatal clinical information. The aim of the present study was to compare the accuracy of birth weight-based weight curves with weight curves created from individual patient records, including electronic records, using 2 predictive modeling methods, linear regression (LR) and an artificial neural network (NN), which apply mathematical relations between predictor and outcome variables.
METHODS - Perinatal demographic and postnatal nutrition data were collected for extremely-low-birth-weight (ELBW; birth weight <1000 g) infants. Static weight curves were generated using published algorithms. The postnatal predictive models were created using the demographic and nutrition dataset.
RESULTS - Birth weight (861 ± 83 g, mean ± 1 standard deviation [SD]), gestational age (26.2 ± 1.4 weeks), and the first month of nutrition data were collected from individual health records for 92 ELBW infants. The absolute residual (
measured-predicted
) for weight was 84.8 ± 74.4 g for the static weight curves, 60.9 ± 49.1 g for the LR model, and 12.9 ± 9.2 g for the NN model, analysis of variance: both LR and NN P<0.01 versus static curve. NPO (nothing by mouth) infants had greater weight curve discrepancies.
CONCLUSIONS - Compared with birth weight-based and logistic regression-generated weight curves, NN-generated weight curves more closely approximated ELBW infant weight curves, and, using the present electronic health record systems, may produce weight curves better reflective of the patient's status.
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19 MeSH Terms
Superior mesenteric artery blood flow velocities following medical treatment of a patent ductus arteriosus.
Yanowitz TD, Reese J, Gillam-Krakauer M, Cochran CM, Jegatheesan P, Lau J, Tran VT, Walsh M, Carey WA, Fujii A, Fabio A, Clyman R
(2014) J Pediatr 164: 661-3
MeSH Terms: Blood Flow Velocity, Cyclooxygenase Inhibitors, Ductus Arteriosus, Patent, Enteral Nutrition, Female, Humans, Ibuprofen, Indomethacin, Infant, Newborn, Infant, Premature, Infant, Very Low Birth Weight, Male, Mesenteric Artery, Superior, Ultrasonography, Doppler
Show Abstract · Added April 9, 2015
We examined superior mesenteric artery blood flow velocity in response to feeding in infants randomized to trophic feeds (n = 16) or nil per os (n = 18) during previous treatment for patent ductus arteriosus. Blood flow velocity increased earlier in the fed infants, but was similar in the 2 groups at 30 minutes after feeding.
Copyright © 2014 Mosby, Inc. All rights reserved.
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14 MeSH Terms
Amino acid losses during sustained low efficiency dialysis in critically ill patients with acute kidney injury.
Umber A, Wolley MJ, Golper TA, Shaver MJ, Marshall MR
(2014) Clin Nephrol 81: 93-9
MeSH Terms: Acute Kidney Injury, Aged, Aged, 80 and over, Amino Acids, Chromatography, High Pressure Liquid, Chromatography, Reverse-Phase, Critical Illness, Dialysis Solutions, Humans, Intensive Care Units, Male, Middle Aged, Nutritional Status, Parenteral Nutrition, Prospective Studies, Renal Dialysis, Serum Albumin, Serum Albumin, Human, Treatment Outcome
Show Abstract · Added March 19, 2014
OBJECTIVE - Sustained low efficiency dialysis (SLED) involves the use of standard dialysis machines for prolonged intermittent renal replacement therapy in critically ill patients. In this study we aimed to quantify dialysate amino acid (AA) and albumin losses in 5 patients who underwent successful SLED treatment.
DESIGN - This was a prospective observational study.
SETTING - The study was performed in a general intensive care unit.
SUBJECTS - The study was performed in critically ill patients with acute kidney injury undergoing SLED using low-flux hemodialyzers.
INTERVENTION - We performed total dialysate collection and measured dialysate AA profiles by reverse phase high-pressure liquid chromatography using an automated AA analyser.
MAIN OUTCOME MEASURE - Individual and total amino acid losses.
RESULTS - Albumin was undetectable in dialysate. The median (mean ± SD) total amino acid loss was 15.7 (23.4 ± 19.2) g/treatment, or 122.1 (180.6 ± 148.5) mmol/treatment. Two patients were receiving intravenous nutrition. One patient had severe hepatic failure with encephalopathy, and had high dialysate AA levels with a total loss of 57 g/treatment.
CONCLUSIONS - During SLED with low-flux hemodialyzers, albumin losses are negligible but AA losses to dialysate are comparable to those during continuous renal replacement therapy. Patients' nutritional protein prescriptions should be augmented to account for this.
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19 MeSH Terms
A patient with CKD and poor nutritional status.
Ikizler TA
(2013) Clin J Am Soc Nephrol 8: 2174-82
MeSH Terms: Aged, Anabolic Agents, Combined Modality Therapy, Dietary Supplements, Disease Progression, Enteral Nutrition, Exercise Therapy, Female, Humans, Kidney Failure, Chronic, Nutrition Assessment, Nutritional Status, Nutritional Support, Parenteral Nutrition, Patient Readmission, Predictive Value of Tests, Protein-Energy Malnutrition, Renal Dialysis, Renal Insufficiency, Chronic, Risk Factors, Time Factors, Treatment Outcome
Show Abstract · Added September 29, 2014
Protein energy wasting is common in patients with CKD and ESRD and is associated with adverse clinical outcomes, such as increased rates of hospitalization and death, in these patients. A multitude of factors can affect the nutritional and metabolic status of patients with CKD, including decreased dietary nutrient intake, catabolic effects of renal replacement therapy, systemic inflammation, metabolic and hormonal derangements, and comorbid conditions (such as diabetes and depression). Unique aspects of CKD also confound reliable assessment of nutritional status, further complicating management of this comorbid condition. In patients in whom preventive measures and oral dietary intake from regular meals cannot help them maintain adequate nutritional status, nutritional supplementation, administered orally, enterally, or parenterally, is effective in replenishing protein and energy stores. The advantages of oral nutritional supplements include proven efficacy, safety, and compliance. Anabolic steroids and exercise, with nutritional supplementation or alone, improve protein stores and represent potential additional approaches for the treatment of PEW. There are several emerging novel therapies, such as appetite stimulants, anti-inflammatory interventions, and anabolic agents.
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22 MeSH Terms
Head and neck cancers, version 2.2013. Featured updates to the NCCN guidelines.
Pfister DG, Ang KK, Brizel DM, Burtness BA, Busse PM, Caudell JJ, Cmelak AJ, Colevas AD, Dunphy F, Eisele DW, Gilbert J, Gillison ML, Haddad RI, Haughey BH, Hicks WL, Hitchcock YJ, Kies MS, Lydiatt WM, Maghami E, Martins R, McCaffrey T, Mittal BB, Pinto HA, Ridge JA, Samant S, Schuller DE, Shah JP, Spencer S, Weber RS, Wolf GT, Worden F, Yom SS, McMillian NR, Hughes M, National Comprehensive Cancer Network
(2013) J Natl Compr Canc Netw 11: 917-23
MeSH Terms: Eating, Enteral Nutrition, Head and Neck Neoplasms, Humans, Nutrition Policy, Practice Patterns, Physicians'
Show Abstract · Added March 7, 2014
These NCCN Guidelines Insights focus on nutrition and supportive care for patients with head and neck cancers. This topic was a recent addition to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Head and Neck Cancers. The NCCN Guidelines Insights focus on major updates to the NCCN Guidelines and discuss the new updates in greater detail. The complete version of the NCCN Guidelines for Head and Neck Cancers is available on the NCCN Web site (NCCN.org).
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6 MeSH Terms
Parenteral nutrition intravenous fat emulsions product shortage considerations.
A.S.P.E.N. Intravenous Fat Emulsion National Shortage Task Force, Vanek VW, Allen P, Harvey Banchik LP, Bistrian B, Collier S, Driscoll DF, Gura K, Houston DR, Miles J, Mirtallo J, Mogensen KM, Seidner D
(2013) Nutr Clin Pract 28: 528-9
MeSH Terms: Adult, Child, Deficiency Diseases, Dietary Fats, Fat Emulsions, Intravenous, Fatty Acids, Essential, Humans, Infant, Newborn, Parenteral Nutrition, Parenteral Nutrition Solutions, Parenteral Nutrition, Total, Practice Guidelines as Topic
Added September 30, 2015
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12 MeSH Terms
Enteral feeding during indomethacin and ibuprofen treatment of a patent ductus arteriosus.
Clyman R, Wickremasinghe A, Jhaveri N, Hassinger DC, Attridge JT, Sanocka U, Polin R, Gillam-Krakauer M, Reese J, Mammel M, Couser R, Mulrooney N, Yanowitz TD, Derrick M, Jegatheesan P, Walsh M, Fujii A, Porta N, Carey WA, Swanson JR, Ductus Arteriosus Feed or Fast with Indomethacin or Ibuprofen (DAFFII) Investigators
(2013) J Pediatr 163: 406-11
MeSH Terms: Combined Modality Therapy, Ductus Arteriosus, Patent, Enteral Nutrition, Female, Humans, Ibuprofen, Indomethacin, Infant, Newborn, Male, Prospective Studies, Time Factors
Show Abstract · Added April 9, 2015
OBJECTIVE - To test the hypothesis that infants who are just being introduced to enteral feedings will advance to full enteral nutrition at a faster rate if they receive "trophic" (15 mL/kg/d) enteral feedings while receiving indomethacin or ibuprofen treatment for patent ductus arteriosus.
STUDY DESIGN - Infants were eligible for the study if they were 23(1/7)-30(6/7) weeks' gestation, weighed 401-1250 g at birth, received maximum enteral volumes ≤60 mL/kg/d, and were about to be treated with indomethacin or ibuprofen. A standardized "feeding advance regimen" and guidelines for managing feeding intolerance were followed at each site (N = 13).
RESULTS - Infants (N = 177, 26.3 ± 1.9 weeks' mean ± SD gestation) were randomized at 6.5 ± 3.9 days to receive "trophic" feeds ("feeding" group, n = 81: indomethacin 80%, ibuprofen 20%) or no feeds ("fasting [nil per os]" group, n = 96: indomethacin 75%, ibuprofen 25%) during the drug administration period. Maximum daily enteral volumes before study entry were 14 ± 15 mL/kg/d. After drug treatment, infants randomized to the "feeding" arm required fewer days to reach the study's feeding volume end point (120 mL/kg/d). Although the enteral feeding end point was reached at an earlier postnatal age, the age at which central venous lines were removed did not differ between the 2 groups. There were no differences between the 2 groups in the incidence of infection, necrotizing enterocolitis, spontaneous intestinal perforation, or other neonatal morbidities.
CONCLUSION - Infants required less time to reach the feeding volume end point if they were given "trophic" enteral feedings when they received indomethacin or ibuprofen treatments.
Copyright © 2013 Mosby, Inc. All rights reserved.
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11 MeSH Terms
Optimal nutrition in hemodialysis patients.
Ikizler TA
(2013) Adv Chronic Kidney Dis 20: 181-9
MeSH Terms: Appetite Stimulants, Dietary Supplements, Exercise Therapy, Growth Hormone, Humans, Inflammation, Insulin Resistance, Nutritional Status, Parenteral Nutrition, Protein-Energy Malnutrition, Renal Dialysis, Renal Insufficiency, Chronic, Wasting Syndrome
Show Abstract · Added August 15, 2013
Protein-energy wasting (PEW) is highly prevalent in patients undergoing maintenance hemodialysis (MHD). It is important to note that there is a robust association between the extent of PEW and the risk of hospitalization and death in these patients, regardless of the nutritional marker used. The multiple etiologies of PEW in advanced kidney disease are still being elucidated. Apart from the multiple mechanisms that might lead to PEW, it appears that the common pathway for all of the derangements is related to exaggerated protein degradation along with decreased protein synthesis. The hemodialysis procedure per se is an important contributor to this process. Metabolic and hormonal derangements such as acidosis, inflammation, and resistance to anabolic properties of insulin resistance and growth hormone are all implicated for the development of PEW in MHD patients. Appropriate management of MHD patients at risk for PEW requires a comprehensive combination of strategies to diminish protein and energy depletion and to institute therapies that will avoid further losses. The mainstay of nutritional treatment in MHD patients is provision of an adequate amount of protein and energy, using oral supplementation as needed. Intradialytic parenteral nutrition should be attempted in patients who cannot efficiently use the gastrointestinal tract. Other anabolic strategies such as exercise, anabolic hormones, anti-inflammatory therapies, and appetite stimulants can be considered as complementary therapies in suitable patients.
Published by Elsevier Inc.
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13 MeSH Terms