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Bone mass during long term parenteral nutrition in children
Topic 13-PAEDIATRICS Topic lo--HEART AND LUNG
0.66 Comparison of fatty acid status in TPNdependent children receiving two lipid emulsions with different essential fatty acid (EFA) content.
assess the safety and the biological status, during long-term administration of a new IVFE (PFE 4501 - Kabi Pharmacia) containing y-LA and carnitine. 10 children aged l-9 years, on home PN with a daily intake of non protein energy including 30% as lipid (2.7-3.3/kg/day), by using PFE 4501 followtng lntralipid 20% administration period. Clinical and laboratory assessments were performed on days 0, 30, 60 and 90. No signs of clinical intolerance were observed. Serum triglycerices, cholesterol and albumine remain unchanged as well as liver function test: bilirubine, ASAT, ALAT, y-GT and Alkaline phosphatase. Plasma free, esterified and total carnitine levels increased significantly (p < 0.05) at day 30 and remain stable. Main FA plasma levels are: l p < 0.05 when compared to values determined on study day 0.
A. Munck. E. Marinier. V. P&ennec’, G. B&&iat”, A. Le Brun”. G. Dutot’. F. Driss’“, C. Melin”, J. P. CBzard, J. Navarro. HBpital Robert Deb&, Paris, “‘St Antoine, Paris, “Clintec Technologies. V&lizy, France A major rdle of lipid emulsions in total parenteral nutrition (TPN) is to supply EFA. However, excess EFA intake has been suggested to inhibit their conversion to long chain derivatives which serve as prostaglandin precursors. This prospective study aimed to compare the fatty acid status in 13 infants receiving exclusive TPN including either a soybean oil emulsion (60% EFA; n = 7) or a newly developed olive oil based emulsion (20% EFA; n = 6). Patients received a lipid dose of 2.9 g/kg/d corresponding to 22% of non protein calories for at least 15 days. Plasma phospholipids, the most predictive plasma lipids for membrane changes, were analyzed for their fatty acid composition at day 0 (DO) and day 15 (D15).
Fatty
Fatty
(‘)
acids n-7 Cl6.1
Olive DO 3.7
015 2:.zi
!-I
C18:l n-9 C20.3 n-6 Cl%2
2147 4 4 8
09 126
Cl8:3 C20:3 C20:4 C79.4 22:5 iX>Cl82)183
0.3 5.0 109 1 n 1.1
0.4 4.9 11.0 04 0.9 181 D15
Olive DO
acids
n-3 Cl8:3 C22:5 C20:5 C22:6 (Z > Cl8:3) p < 0.10, p
*
0.4 0.8 0.4 2.5 3.6 < 0.05,
0.5 0.5 1 .o 4.7 6.2 “p < 0.01.
D15 0.5
?*
RS
NS ...
18.3 4.9 5.6
13.9 0.5 21.5
(‘) I”
LA “’
1:
0.3 5.6 11.7 14 i.3 204
0.1 2.9 9.8 0.6 0.5 138
!‘)
;:
NS NS NS NS
NS +a **
NS **
p
“D”
D15
p
0.4 05 1.1 7.8 9.3
N”; *** -*
0.1 0.4 1.2 3.7 5.3 < 0.001
*
Day 0 861 i 296 29219 55k24 242+85 17*10 88+25 79~06
Day 30 868k237 43+12’ 75k20 245+79 15k6 9Ok26 85kl4
Day60 852+257 44+16’ 75+35 260+95 14+6 88+28 87il2
Day90 793+253 42+16’ SO*43 250+91 13+7 84+27 88?10
These results show that ?-LA supplementation enables in case of high supply of K-LA and linoleic acid to circumvene a possible competitive and substrate inhibition of the A6 desaturase. The levels of elongation products both in the w3 and 016 families seem to indicate that the A5 and A4 desaturases are not rate limiting enzymes in these conditions. Adjunction of :-LA should be considered for design pediatric IVFE.
0 “S s
SOY DO 2.6
NS E ** ” “‘p
Variable mg/ml Is:206 18:3w6 20: 31x6 20.4~6 20:5w3 22’6~3 Ratlo ,,,6;,r,3
(‘)
0 YS s P
0.70 Bone mass during nutrition in children
long term
parenteral
1: NS * NS
M. Ben Hark. 0. Goulet, S. de Potter, V. Colomb. 8. Francois, J.-C. Ruiz, C. Ricour H6pital Necker-Enfants Malades, 149, rue de SBvres, 75015 PARIS. France Abnormal bone mineralization is one of the complications related to total parenteral nutrition (TPN). We studied bone mass status in 16 patients (2.5-l 5 y) who had been receiving TPN for 56+32 months for short bowel (n = 8). intractable diarrhea (n = 5). chronic intestinal pseudoobstruction (n = 2), Crohn disease (n = 1). The average daily intakes of calcium, phosphorus and vitamin D were respectively: 15;_+3 mg/Kg, 23_+6 mg/Kg and 220 units. Total bone mass (TBM), fat-free mass (FFM) and fat body mass (FBM) were determined by using dual-photon absorptiometry (DPA) (Hologic QDR 1000/w, Model 5.35). Vitamin D metabolites levels: serum 25-OH and 1.25 (OH)2-D3 were determined in 12 patients. Moreover, 10 patients with a mean growth velocity of 6+3 cm/year, underwent a second DPA, 12 to 21 months later. Skeletal calcium was determined according to the correlation between total body calcium (TBCa) and TBM: TBCa = 0.34 TBM+124.5 (1 ); calcium accretion was compared to data of children of the same age and sex (2). Results: There is a positive correlation between height and TBM (r =0.81, p < 0.01) and between TBM and FFM (r = 0.89, p i 0.01). All but one patient studied twice had TBM increase: 29&23%, without any correlation between TBM changes and height gain. Theorical calcium accretion (1.2) was below 60% in 5 children and negative in one. All serum vit D metabolites were normal.
In both groups, we observed a similar correction of biochemical indices of EFA deficiency (C 20:3 n-9, C 16:l n7) despite large differences in EFA intake. Linoleic acid (C 18:2 n-6) increased significantly, particularly in the soy group, thus reflecting emulsion composition. While long chain derivatives of the n-3 family similarly increased in both groups, the long chain fatty acids of n-6 series were preserved only with the olive oil based emulsion, These findings indicate an improved conversion of EFA with this new emulsion, which may favourably influence membrane integrity and prostaglandin synthesis.
Long term utilization of a y-linolenic acid 0.69 enriched intravenous fat emulsion in children. 0. Goulet, S. De Potter, 0. Corriol, V. Colomb, 1. Boya, M. Lamor, C. Ricour Hdpital Necker-Enfants Malades. 149, rue de SBvres. 75015 PARIS. France Intravenous fat emulsion (IVFE) are widely used in pediatric patients as source of energy and essential fatty acids (EFA). According to human milk, usual IVFE from soya bean oil lack (y-linolenic acid (y-LA). The aim of this study was to 25
Conclusion: Height growth in children does not predict the quality of bone mineralization. Bone loss can be observed in children on long term TPN. Mechanisms of mineral loss have to be elucidated. These results suggest that a regular bone mass assessment should be performed in children on long term TPN by using dual photon absorptiometry. (1) Am J Clin Nutr 1989, 49: 1283-g. (2) Am J Clin Nutr 1991, 54: 261 S-5.9
SOL). The LPS was estimated according to following indices: degree of mechanical peroxidation hemolysis, content of malonic aldehyde (MA), MA/peroxidation hemolysis ratio, intensity of MA degradation and erythrocyte deformation index. We discovered that in most asphyxic neonates (18) the increase of mechanical hemolysis was registered, as compared with normal premature infants (1.80+0, 14% and 1 .I 9+0, IO%, respectively); the MA content being 2.1O-tO.10 and 1.17~0.10 nmol/lO” erythrocytes, respectively); MA/peroxidation hemolysis ratio elevated (I .40&0.09and 0.48$-0.05, respectively) with thedecreased erythrocyte deformation index (0.180+0.008 and 0.229+0.011 conditional units, respectively). All these indices characterize the disbalance of lipid peroxidation processes. The fall of erythrocyte hemolysis accretion during the incubation period (6%versus 144% in normal prematures) indicates at the decrease of peroxidation processes. Enteral administration of POLYSOL (starting from 3 ml for 4-6 days) normalized the degree of mechanical and peroxidation hemolysis, MAcontent and MA/peroxidation hemolysisratio, erythrocyte deformation index. Asphyxic neonates without POLYSOL (11 patients) showed profound disturbances in LPS, as judged by the assayed indices. We conclude that malt-based product (POLYSOL) administered enterally for a period of 4-6 days may render correction of lipid peroxidation status in erythrocytes’ membranes, which fact is proved by normalization of mechanical and peroxidation hemolysis degree, MA content, erythrocyte deformation index and MA/peroxidation hemolysis ratio.
0.71 Effects of lipid emulsion and alpha-tocopheryl acetate on the release of free radicals in long term hyperoxia exposed rats. E. Tomsits’, K. Rischati, L. Torndciz, L. Szolla? Semmelweiss University of Medicine, ‘2nd Department of Pediatrics, %stitute of Pathophysiology, Budapest, Hungary It is observed that certain complications in ill premature infants explained by the increase of free radicals, are more frequent with early parenteral nutrition of lipid emulsions containing mostly unsaturated fatty acids (UFA). However, in cell cultures, lipid peroxidation generated in the case of hyperoxia, can be decreased by UFAs. In our studies, we examined the effects of a-tocopheryl acetate (vitamin E) administration along with the abundance of UFA and hyperoxia on the states which can often be found in prematures. We used rats, kept on a diet of decreased vitamin E for 35 days prior to the experiment and onwards. We infused lntralipid 20% solution to reach an abundant quantity of UFAs. Besides, weset up hyperoxic (FiO? 70%) and normoxic conditions, and we examined the effects of 20 mg/kg vitamin E on free radical formation. Substances reacting to thiobarbituric acid (TBARS) in HDL, LDL, as well as in red blood cells as the autoxidative susceptibility (AOS) of them were measured. The excess of UFAs of the lipid emulsion increased both the AOS (Control (C): 173.6k54.9, lipid (L): 205.52k72.88nmol MDA/gHb; p i 0.05) and LDL-TBARS (C: 104.1 _t 33.3, L: 1195k422.46 pmol/ml; p < 0.001) as well as HDL-TBARS (C: 83.34k26.34, L: 1404.8k573.38 pmol/ml; p < 0.05). In hyperoxia, the increase of the measured parameters in every group was more significant (p < 0.001). Vitamin E administration (E) neutralized the elevated AOS in hyperoxia (0) compared to control values in normoxia (E: 132.6+41.97. 0: 416.36+131.76 nmol MDA/gHb; p 2 0.05), aswell as the higher fiLand HDLTBARS levels of hyperoxia. Vitamin E could not fully eliminate LDL- and HDL-TBARS increase caused by unsaturated fatty acids (LE) (LE: 619+206.3, 1886.6k420.78 pmol/ml for LDL- and HDL-TBARS levels). Based on our findings, we suggest that vitamin E administration to infants with high possibility of exposure to hyperoxic periods along with lipid containing parenteral nutrition, is particularly important.
0.72 Enteral feeding with malt-based therapeutic product improves lipid peroxidation status in premature neonates R. H. Sharipov Russian Academy of Medical Sciences Institute of Pediatrics The aim of our investigation was to study lipid peroxidation status (LPS) in post-asphyxic premature infants receiving enterally specialized malt-based therapeutic product (POLY-
0.73 Recombinant growth hormone (rGH) on muscle function in chronic obstructive pulmonary disease (COPD) patients on mechanical ventilation C. Pichard’, U. Kyle’, J. C. Chevrolef, P. Jollied. D. Slosmar?, N. Mensi“ ‘Divisions of Clinical Nutrition and Dietetics, ‘Intensive Care University Unit, 3Nuclear Medicine, 4Clinical Laboratory, Hospital, Geneva, Switzerland Severe decompensation of COPD necessitates mechanical ventilation and results in muscle wasting and dysfunction. We hypothetized that rGH, a powerful anabolistic agent, may counteract this adverse effect. 14 consecutive mechanically ventilated patients have been randomly distributed to receive either rGH (0.46 IU/kg/d) or placebo (NaCI 0.9%). and fed enterally (30.9 and 31.1 kcal/kg/d, 1.2 and 1 .O g protein/kg/d; respectively) for 12 days. Their thumb muscle function (maximal force, fatigue) was measured during electrical stimulation as previously described* at intubation and on day 12. In addition, the daily duration of full assistance by mechanical ventilation was recorded during weaning. In spite of an improved cumulative nitrogen retention (+83.7+42.5 g/12 d) in rGH supplemented versus control group (+28.7f37.5 g/l2 d; p. < 0.0246), muscle function test remained similar in both groups. None of the patients have been fully weaned by day 12. We conclude that despite a sparing-effect on nitrogen utilization, rGH at the tested doses seems unable to improve muscle function of intubated patients with severe COPD decompensation. *. Pichard C. & Jeejeebhoy K. N.: Muscle Dysfunction in Malnourished Patients. Quarter J Int Med 260, 1021-I 045, 1988. 26
0.66 Comparison of fatty acid status in TPNdependent children receiving two lipid emulsions with different essential fatty acid (EFA) content.
assess the safety and the biological status, during long-term administration of a new IVFE (PFE 4501 - Kabi Pharmacia) containing y-LA and carnitine. 10 children aged l-9 years, on home PN with a daily intake of non protein energy including 30% as lipid (2.7-3.3/kg/day), by using PFE 4501 followtng lntralipid 20% administration period. Clinical and laboratory assessments were performed on days 0, 30, 60 and 90. No signs of clinical intolerance were observed. Serum triglycerices, cholesterol and albumine remain unchanged as well as liver function test: bilirubine, ASAT, ALAT, y-GT and Alkaline phosphatase. Plasma free, esterified and total carnitine levels increased significantly (p < 0.05) at day 30 and remain stable. Main FA plasma levels are: l p < 0.05 when compared to values determined on study day 0.
A. Munck. E. Marinier. V. P&ennec’, G. B&&iat”, A. Le Brun”. G. Dutot’. F. Driss’“, C. Melin”, J. P. CBzard, J. Navarro. HBpital Robert Deb&, Paris, “‘St Antoine, Paris, “Clintec Technologies. V&lizy, France A major rdle of lipid emulsions in total parenteral nutrition (TPN) is to supply EFA. However, excess EFA intake has been suggested to inhibit their conversion to long chain derivatives which serve as prostaglandin precursors. This prospective study aimed to compare the fatty acid status in 13 infants receiving exclusive TPN including either a soybean oil emulsion (60% EFA; n = 7) or a newly developed olive oil based emulsion (20% EFA; n = 6). Patients received a lipid dose of 2.9 g/kg/d corresponding to 22% of non protein calories for at least 15 days. Plasma phospholipids, the most predictive plasma lipids for membrane changes, were analyzed for their fatty acid composition at day 0 (DO) and day 15 (D15).
Fatty
Fatty
(‘)
acids n-7 Cl6.1
Olive DO 3.7
015 2:.zi
!-I
C18:l n-9 C20.3 n-6 Cl%2
2147 4 4 8
09 126
Cl8:3 C20:3 C20:4 C79.4 22:5 iX>Cl82)183
0.3 5.0 109 1 n 1.1
0.4 4.9 11.0 04 0.9 181 D15
Olive DO
acids
n-3 Cl8:3 C22:5 C20:5 C22:6 (Z > Cl8:3) p < 0.10, p
*
0.4 0.8 0.4 2.5 3.6 < 0.05,
0.5 0.5 1 .o 4.7 6.2 “p < 0.01.
D15 0.5
?*
RS
NS ...
18.3 4.9 5.6
13.9 0.5 21.5
(‘) I”
LA “’
1:
0.3 5.6 11.7 14 i.3 204
0.1 2.9 9.8 0.6 0.5 138
!‘)
;:
NS NS NS NS
NS +a **
NS **
p
“D”
D15
p
0.4 05 1.1 7.8 9.3
N”; *** -*
0.1 0.4 1.2 3.7 5.3 < 0.001
*
Day 0 861 i 296 29219 55k24 242+85 17*10 88+25 79~06
Day 30 868k237 43+12’ 75k20 245+79 15k6 9Ok26 85kl4
Day60 852+257 44+16’ 75+35 260+95 14+6 88+28 87il2
Day90 793+253 42+16’ SO*43 250+91 13+7 84+27 88?10
These results show that ?-LA supplementation enables in case of high supply of K-LA and linoleic acid to circumvene a possible competitive and substrate inhibition of the A6 desaturase. The levels of elongation products both in the w3 and 016 families seem to indicate that the A5 and A4 desaturases are not rate limiting enzymes in these conditions. Adjunction of :-LA should be considered for design pediatric IVFE.
0 “S s
SOY DO 2.6
NS E ** ” “‘p
Variable mg/ml Is:206 18:3w6 20: 31x6 20.4~6 20:5w3 22’6~3 Ratlo ,,,6;,r,3
(‘)
0 YS s P
0.70 Bone mass during nutrition in children
long term
parenteral
1: NS * NS
M. Ben Hark. 0. Goulet, S. de Potter, V. Colomb. 8. Francois, J.-C. Ruiz, C. Ricour H6pital Necker-Enfants Malades, 149, rue de SBvres, 75015 PARIS. France Abnormal bone mineralization is one of the complications related to total parenteral nutrition (TPN). We studied bone mass status in 16 patients (2.5-l 5 y) who had been receiving TPN for 56+32 months for short bowel (n = 8). intractable diarrhea (n = 5). chronic intestinal pseudoobstruction (n = 2), Crohn disease (n = 1). The average daily intakes of calcium, phosphorus and vitamin D were respectively: 15;_+3 mg/Kg, 23_+6 mg/Kg and 220 units. Total bone mass (TBM), fat-free mass (FFM) and fat body mass (FBM) were determined by using dual-photon absorptiometry (DPA) (Hologic QDR 1000/w, Model 5.35). Vitamin D metabolites levels: serum 25-OH and 1.25 (OH)2-D3 were determined in 12 patients. Moreover, 10 patients with a mean growth velocity of 6+3 cm/year, underwent a second DPA, 12 to 21 months later. Skeletal calcium was determined according to the correlation between total body calcium (TBCa) and TBM: TBCa = 0.34 TBM+124.5 (1 ); calcium accretion was compared to data of children of the same age and sex (2). Results: There is a positive correlation between height and TBM (r =0.81, p < 0.01) and between TBM and FFM (r = 0.89, p i 0.01). All but one patient studied twice had TBM increase: 29&23%, without any correlation between TBM changes and height gain. Theorical calcium accretion (1.2) was below 60% in 5 children and negative in one. All serum vit D metabolites were normal.
In both groups, we observed a similar correction of biochemical indices of EFA deficiency (C 20:3 n-9, C 16:l n7) despite large differences in EFA intake. Linoleic acid (C 18:2 n-6) increased significantly, particularly in the soy group, thus reflecting emulsion composition. While long chain derivatives of the n-3 family similarly increased in both groups, the long chain fatty acids of n-6 series were preserved only with the olive oil based emulsion, These findings indicate an improved conversion of EFA with this new emulsion, which may favourably influence membrane integrity and prostaglandin synthesis.
Long term utilization of a y-linolenic acid 0.69 enriched intravenous fat emulsion in children. 0. Goulet, S. De Potter, 0. Corriol, V. Colomb, 1. Boya, M. Lamor, C. Ricour Hdpital Necker-Enfants Malades. 149, rue de SBvres. 75015 PARIS. France Intravenous fat emulsion (IVFE) are widely used in pediatric patients as source of energy and essential fatty acids (EFA). According to human milk, usual IVFE from soya bean oil lack (y-linolenic acid (y-LA). The aim of this study was to 25
Conclusion: Height growth in children does not predict the quality of bone mineralization. Bone loss can be observed in children on long term TPN. Mechanisms of mineral loss have to be elucidated. These results suggest that a regular bone mass assessment should be performed in children on long term TPN by using dual photon absorptiometry. (1) Am J Clin Nutr 1989, 49: 1283-g. (2) Am J Clin Nutr 1991, 54: 261 S-5.9
SOL). The LPS was estimated according to following indices: degree of mechanical peroxidation hemolysis, content of malonic aldehyde (MA), MA/peroxidation hemolysis ratio, intensity of MA degradation and erythrocyte deformation index. We discovered that in most asphyxic neonates (18) the increase of mechanical hemolysis was registered, as compared with normal premature infants (1.80+0, 14% and 1 .I 9+0, IO%, respectively); the MA content being 2.1O-tO.10 and 1.17~0.10 nmol/lO” erythrocytes, respectively); MA/peroxidation hemolysis ratio elevated (I .40&0.09and 0.48$-0.05, respectively) with thedecreased erythrocyte deformation index (0.180+0.008 and 0.229+0.011 conditional units, respectively). All these indices characterize the disbalance of lipid peroxidation processes. The fall of erythrocyte hemolysis accretion during the incubation period (6%versus 144% in normal prematures) indicates at the decrease of peroxidation processes. Enteral administration of POLYSOL (starting from 3 ml for 4-6 days) normalized the degree of mechanical and peroxidation hemolysis, MAcontent and MA/peroxidation hemolysisratio, erythrocyte deformation index. Asphyxic neonates without POLYSOL (11 patients) showed profound disturbances in LPS, as judged by the assayed indices. We conclude that malt-based product (POLYSOL) administered enterally for a period of 4-6 days may render correction of lipid peroxidation status in erythrocytes’ membranes, which fact is proved by normalization of mechanical and peroxidation hemolysis degree, MA content, erythrocyte deformation index and MA/peroxidation hemolysis ratio.
0.71 Effects of lipid emulsion and alpha-tocopheryl acetate on the release of free radicals in long term hyperoxia exposed rats. E. Tomsits’, K. Rischati, L. Torndciz, L. Szolla? Semmelweiss University of Medicine, ‘2nd Department of Pediatrics, %stitute of Pathophysiology, Budapest, Hungary It is observed that certain complications in ill premature infants explained by the increase of free radicals, are more frequent with early parenteral nutrition of lipid emulsions containing mostly unsaturated fatty acids (UFA). However, in cell cultures, lipid peroxidation generated in the case of hyperoxia, can be decreased by UFAs. In our studies, we examined the effects of a-tocopheryl acetate (vitamin E) administration along with the abundance of UFA and hyperoxia on the states which can often be found in prematures. We used rats, kept on a diet of decreased vitamin E for 35 days prior to the experiment and onwards. We infused lntralipid 20% solution to reach an abundant quantity of UFAs. Besides, weset up hyperoxic (FiO? 70%) and normoxic conditions, and we examined the effects of 20 mg/kg vitamin E on free radical formation. Substances reacting to thiobarbituric acid (TBARS) in HDL, LDL, as well as in red blood cells as the autoxidative susceptibility (AOS) of them were measured. The excess of UFAs of the lipid emulsion increased both the AOS (Control (C): 173.6k54.9, lipid (L): 205.52k72.88nmol MDA/gHb; p i 0.05) and LDL-TBARS (C: 104.1 _t 33.3, L: 1195k422.46 pmol/ml; p < 0.001) as well as HDL-TBARS (C: 83.34k26.34, L: 1404.8k573.38 pmol/ml; p < 0.05). In hyperoxia, the increase of the measured parameters in every group was more significant (p < 0.001). Vitamin E administration (E) neutralized the elevated AOS in hyperoxia (0) compared to control values in normoxia (E: 132.6+41.97. 0: 416.36+131.76 nmol MDA/gHb; p 2 0.05), aswell as the higher fiLand HDLTBARS levels of hyperoxia. Vitamin E could not fully eliminate LDL- and HDL-TBARS increase caused by unsaturated fatty acids (LE) (LE: 619+206.3, 1886.6k420.78 pmol/ml for LDL- and HDL-TBARS levels). Based on our findings, we suggest that vitamin E administration to infants with high possibility of exposure to hyperoxic periods along with lipid containing parenteral nutrition, is particularly important.
0.72 Enteral feeding with malt-based therapeutic product improves lipid peroxidation status in premature neonates R. H. Sharipov Russian Academy of Medical Sciences Institute of Pediatrics The aim of our investigation was to study lipid peroxidation status (LPS) in post-asphyxic premature infants receiving enterally specialized malt-based therapeutic product (POLY-
0.73 Recombinant growth hormone (rGH) on muscle function in chronic obstructive pulmonary disease (COPD) patients on mechanical ventilation C. Pichard’, U. Kyle’, J. C. Chevrolef, P. Jollied. D. Slosmar?, N. Mensi“ ‘Divisions of Clinical Nutrition and Dietetics, ‘Intensive Care University Unit, 3Nuclear Medicine, 4Clinical Laboratory, Hospital, Geneva, Switzerland Severe decompensation of COPD necessitates mechanical ventilation and results in muscle wasting and dysfunction. We hypothetized that rGH, a powerful anabolistic agent, may counteract this adverse effect. 14 consecutive mechanically ventilated patients have been randomly distributed to receive either rGH (0.46 IU/kg/d) or placebo (NaCI 0.9%). and fed enterally (30.9 and 31.1 kcal/kg/d, 1.2 and 1 .O g protein/kg/d; respectively) for 12 days. Their thumb muscle function (maximal force, fatigue) was measured during electrical stimulation as previously described* at intubation and on day 12. In addition, the daily duration of full assistance by mechanical ventilation was recorded during weaning. In spite of an improved cumulative nitrogen retention (+83.7+42.5 g/12 d) in rGH supplemented versus control group (+28.7f37.5 g/l2 d; p. < 0.0246), muscle function test remained similar in both groups. None of the patients have been fully weaned by day 12. We conclude that despite a sparing-effect on nitrogen utilization, rGH at the tested doses seems unable to improve muscle function of intubated patients with severe COPD decompensation. *. Pichard C. & Jeejeebhoy K. N.: Muscle Dysfunction in Malnourished Patients. Quarter J Int Med 260, 1021-I 045, 1988. 26