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Aluminium intake in foods with special reference to hospital nutrition
p.71
ALUM1NI UM INTAKE IN FOODS ( WITH SPECIAL
REFERENCE TO HOSPITAL NUTRITION
F. Frier and R. Klu-Le. Set iion of NuiziLional Medicine and Dieieklcs, Medical University Hospital, Freiburg, FHG.
The toxicity of alumini urn was unknown until a syndrome defined aa haemodialyaie sncephalopathy waa related to it. At present, enhanced uptake of Al is thought to cause encephalopathy, vitamin D-resistant oateomalacia or microcytic anaemia (Alfrey et al. 1980, Davison et al. 1982). There are many studies dealing with Al intake via phosphate binders or dialyeie fluids, while only few reliable data are available concerning Al content of food. Therefore we started to examine syrtematically food flameleaa ( by Atomic Absorption) prepared in the central kitchen of the Univerei ty hospital. Moat food contained less than 5 mg Al/kg wet weight. Maxi mum value was determined in mushrooms of species “Black funguu” (up to 45 mini mum values were found in tap water (less ,than 10 ug/lf. mg.1kg) , Analysi ng complete meals prepared by the University hospital kitchen i. e. general diet, vegetarian diet and protein reduced diet. Al content ranged from 1.6 to 6.9 mg Al/day, seldom exceeding In 5 mg Al/day. balance studies with general hoepital diet in healthy persons an Al intake of 2. 6 f 0. 7 mg/day was measured. The stool excretion war 2. 5 * 1.6 mg/d, the urine excretion was 0. 02 t 0. 01 mg/d. There were no indices for a Al retention in the healthy volunteere. As a result it can be stated, that the usual Al supply by food seem6 to represent no haaard compared with Al uptake with phosphate binders. Alfrey A C et al.: N Engl J Med 294 ( 1980) q84-8 Davison A M et al.: Lancet II ( 1982) 785-7
P.72
POSTOPERATIVE ENTERAL NUTRITION BY LOW RESIDUAL DIET AFTER SUBTOTAL GASTRECTOMY. Y. Shima u, M. Totsuka, H. Hayasaka. Department of Surgery 1, Sapporo Medical College, Sapporo,'Japan
It has been reported that postoperative enternal nutrition might be of practical use after abdominal surgery. The aim of this study was to evaluate the effeicacy of administration of low residual diet (LRD) in the immediate postoperative period. Ten patients who underwent subtotal gastrectomy, received LRD (EN) and were compared with 12 patients parenteraly fed undergoing the same surgical procedure (PN) at the point of stress reaction. Enteral nutrition was performed by a nasoenteral tube which was inserted during the operation and the tip was placed in the jejunum over 20cm from the Treitz's fossa, and with a 24-hour constant infusion using a pump. LRD was administered from the first postpoerative day (POD) to POD7 by the following schedule : PODI; 400m1(400Cal), POD2; 800, POD3; 1200, POD4; 1600, POD5 to 7; 2000. EN group had a positive nitrogen balance from POD5. Urinary 3 methylhistidine excretion attained the preoperative level in POD6. Serum total protein, albumin, transferrin and prealbumin quickly elevated from POD3, but did'nt reach the preoperative value in POD7. Retinol binding protein recovered to the preoperative level in POD5. Postoperative blood glucose level was maintained 170 to 180mg/dl despite disuse of insulin, except in the case of one diabetes mellitus patient. Plasma glucagon and glucagon/insulin ratio was lower in EN than in PN (glucagon:PODl; 169+60pg/ml vs 296+137, p (0.02, POD; 134+50 vs 242t135, p 0.05, glucagon/insulin ra%o: PODI; 6.6tF.4 pg/uU vs 9.7t4.9, PnD2; 5.1+2:8 vs 8.6 t4.9). Urinary catecholamine excretion was significantly Tower in EN thaii in PN on FODI (165+54 uglday vs 285+116, p (0.01). Serum total fatty acid analysis was performed in EN group. Essential fatly acids, such as C18:2w6, C18:3w6 and C20:3w6, increased postoperatively. But, unessential fatty acids, including C16:0, C16:lw7 and C18:lw9 did'nt elevate. This result suggests that fat blended in LRD was effectively absorbed after the abdominal operation. We conclude that the postoperative enteral feeding by LRD is useful1 and effeicacious in that it suppresses the stress reaction in the postoperative period. 90
ALUM1NI UM INTAKE IN FOODS ( WITH SPECIAL
REFERENCE TO HOSPITAL NUTRITION
F. Frier and R. Klu-Le. Set iion of NuiziLional Medicine and Dieieklcs, Medical University Hospital, Freiburg, FHG.
The toxicity of alumini urn was unknown until a syndrome defined aa haemodialyaie sncephalopathy waa related to it. At present, enhanced uptake of Al is thought to cause encephalopathy, vitamin D-resistant oateomalacia or microcytic anaemia (Alfrey et al. 1980, Davison et al. 1982). There are many studies dealing with Al intake via phosphate binders or dialyeie fluids, while only few reliable data are available concerning Al content of food. Therefore we started to examine syrtematically food flameleaa ( by Atomic Absorption) prepared in the central kitchen of the Univerei ty hospital. Moat food contained less than 5 mg Al/kg wet weight. Maxi mum value was determined in mushrooms of species “Black funguu” (up to 45 mini mum values were found in tap water (less ,than 10 ug/lf. mg.1kg) , Analysi ng complete meals prepared by the University hospital kitchen i. e. general diet, vegetarian diet and protein reduced diet. Al content ranged from 1.6 to 6.9 mg Al/day, seldom exceeding In 5 mg Al/day. balance studies with general hoepital diet in healthy persons an Al intake of 2. 6 f 0. 7 mg/day was measured. The stool excretion war 2. 5 * 1.6 mg/d, the urine excretion was 0. 02 t 0. 01 mg/d. There were no indices for a Al retention in the healthy volunteere. As a result it can be stated, that the usual Al supply by food seem6 to represent no haaard compared with Al uptake with phosphate binders. Alfrey A C et al.: N Engl J Med 294 ( 1980) q84-8 Davison A M et al.: Lancet II ( 1982) 785-7
P.72
POSTOPERATIVE ENTERAL NUTRITION BY LOW RESIDUAL DIET AFTER SUBTOTAL GASTRECTOMY. Y. Shima u, M. Totsuka, H. Hayasaka. Department of Surgery 1, Sapporo Medical College, Sapporo,'Japan
It has been reported that postoperative enternal nutrition might be of practical use after abdominal surgery. The aim of this study was to evaluate the effeicacy of administration of low residual diet (LRD) in the immediate postoperative period. Ten patients who underwent subtotal gastrectomy, received LRD (EN) and were compared with 12 patients parenteraly fed undergoing the same surgical procedure (PN) at the point of stress reaction. Enteral nutrition was performed by a nasoenteral tube which was inserted during the operation and the tip was placed in the jejunum over 20cm from the Treitz's fossa, and with a 24-hour constant infusion using a pump. LRD was administered from the first postpoerative day (POD) to POD7 by the following schedule : PODI; 400m1(400Cal), POD2; 800, POD3; 1200, POD4; 1600, POD5 to 7; 2000. EN group had a positive nitrogen balance from POD5. Urinary 3 methylhistidine excretion attained the preoperative level in POD6. Serum total protein, albumin, transferrin and prealbumin quickly elevated from POD3, but did'nt reach the preoperative value in POD7. Retinol binding protein recovered to the preoperative level in POD5. Postoperative blood glucose level was maintained 170 to 180mg/dl despite disuse of insulin, except in the case of one diabetes mellitus patient. Plasma glucagon and glucagon/insulin ratio was lower in EN than in PN (glucagon:PODl; 169+60pg/ml vs 296+137, p (0.02, POD; 134+50 vs 242t135, p 0.05, glucagon/insulin ra%o: PODI; 6.6tF.4 pg/uU vs 9.7t4.9, PnD2; 5.1+2:8 vs 8.6 t4.9). Urinary catecholamine excretion was significantly Tower in EN thaii in PN on FODI (165+54 uglday vs 285+116, p (0.01). Serum total fatty acid analysis was performed in EN group. Essential fatly acids, such as C18:2w6, C18:3w6 and C20:3w6, increased postoperatively. But, unessential fatty acids, including C16:0, C16:lw7 and C18:lw9 did'nt elevate. This result suggests that fat blended in LRD was effectively absorbed after the abdominal operation. We conclude that the postoperative enteral feeding by LRD is useful1 and effeicacious in that it suppresses the stress reaction in the postoperative period. 90