Effect of selenium supplementation on muscle biopsies in selenium depleted patients on home parenteral nutrition

Methods: 15 patients commenced on home enteral nutrition (HEN) were identified from a supply register. 7 had gastrointestinal pathology, 6 had neurological disease, 1 anorexia nervosa and 1 carcinoma. 8 were receiving supplemental EN and 7 total EN. 6 were receiving 2 litres of feed and all but 1 were prescribed sufficient feed to meet estimated requirements. Nutritional status was assessed using anthropometry (body mass index (BMI), triceps skinfold thickness (TSF) and mid upper arm circumference (MUAC)). Blood was taken for measurement of serum albumin, magnesium, zinc, copper, selenium and vitamins A and E. Results: Mean duration of feeding was 7.5 months (range 2.30 months). 7 patients had anthropometric evidence of protein and energy depletion (BMI < 20 and TSF or MUAC < 15th percentile) of whom 6 were severely depleted (BMI < 18 and TSF or MUAC < 5th percentile). Serum albumin was below the normal reference range (36-50 g/l) in only 3 patients. 12 patients had biochemical evidence of trace element or vitamin depletion of whom 6 had multiple (>3) depletion. 7 patients had zinc depletion (12 /imol/l), 6 had selenium depletion (selenium < 0.8 pmol and red cell glutathione peroxidase i 13 units/gHb) and 4 had vitamin A depletion (~1 .O pmol). Magnesium and copper levels were low in 2 patients (co.7 mmol/l and ~10 pmol/l respectively) and 1 patient had a low vitamin E level ( < 14 pmol/l). Depletion occurred in all diagnostic categories, even in patients with normal anthropometric measurements, and was independent of duration or volume of feeding. Conclusion: Patients receiving HEN are at risk of developing vitamin or trace element deficiency states regardless of diagnosis, anthropometric measurements or duration of feeding. Therefore close nutritional monitoring of such patients is essential, and it is recommended that patients on HEN are supervised by clinicians with appropriate interest. Acknowledgement to The Trace Element Unit, Institute of Biochemistry, The Royal Infirmary, Glasgow.

Topic 15-HORMONES P.69 Reduced muscle protein breakdown in septic rats following treatment with interleukin-I receptor antagonist 0. Zsmir’, P. 0. Hasselgren, J. E. Fischer Departments of Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio, and ‘Hadassah University Hospital Mount Scopus, Jerusalem Sepsis and trauma are characterized by increased breakdown in skeletal muscle. Cytokines, Interleukin-1 (IL-l) in particular, have been suggested as mediators responsible for this response. Using a specific IL-l receptor antagonist (IL-l ra) we examined the role of IL-1 in muscle proteolysis during sepsis. Methods: Male S-D rats (40-60 g) underwent cecal ligation and puncture (CLP) to induce sepsis or sham operation. Animals in each group were treated with IL-l ra (25 mg/kg) injected i.p. in 5 doses at 4 h intervals starting 1 h before CLP or control injection. Sixteen hours after CLP or sham operation intact extensor digitorum longus muscles were dissected and incubated. Protein breakdown rate was determined as release of tyrosine during 2 h incubation. Results: Protein breakdown rate was increased by more than two-fold following CLP. This response was significantly reduced by IL-lra treatment (Table).

P.68 Effect of selenium supplementation on muscle biopsies in selenium depleted patients on home parenteral nutrition. T. Rannem, K. Ladefoged, J. Halkjeer Kristensen and H. Laursen Division of Gastroenterology, Rheumatology and Neuropatology, Rigshospitalet, Copenhagen, Denmark Several case reports of muscular weakness or muscular pain which respond to selenium (Se) substitution have been published in patients on total parenteral nutrition. Extremely low blood Se values have been found in patients with no obvious clinical symptoms, and the clinical significance of Se deficiency is therefore not well established. Material: A biopsy of the quadriceps muscle was taken before and after intravenous substitution for 4 months with 200 pg Se per day as natriumselenite (Selenase”) in 9 patients on home parenteral nutrition. The patients had been on Se-free parenteral nutrition for 21-l 68, median 58 months. Prior to Se substitution all patients had low plasma Se: O0.51 pmol/l. median 0.21 pmol/l (control group 0.75-l .86, median 1 .ll pmol/l). After Se supplementation all patients had Se levels within normal range. Results:

Mean dnmeter Atrophy factor Hypetrophy factor Mean diameter Athrophy factor Hypertrophy factor

Flbre type 1

Fibre type 2

Before Se median (range) 57 (47-70) 20 (o-39) 12 (140) g3 {“A;;’

After Se median (range) 59 (50-83) 9 (3-21) 12 (W12) y; y;)

9 (O-90)

29 (O-51

)

p = 0.01 p = 0.11 p=O.O6 ; 1 yJJ p = 0.29

Conclusion: The study demonstrated a significant increase of the diameter of type 1 muscle fibre following Se supplementation in Se depleted patients. This supports the suggestions of a skeletal myopathy related to Se deficiency.

AND

MEDIATORS SHAM

Tyrosme release

IL-1 ra 229+8

E&y;

CLP Solvent 571143

IL-lra 469+22‘

Results are in nmol/gx2 h (mean + SEM). n = 6-8 in each group. p < 0.05 vs. all other groups (ANOVA followed by Tukey’s test). Conclusion: Results indicate that muscle proteolysis induced by sepsis can be attenuated by treatment with ILlra, suggesting that IL-l is involved in increased muscle proteolysis during sepsis.

P.70 Mediators resistance

of

postoperative

A. Thorell & 0. Ljungqvist Dept. of Surgery, Karolinska Hospital, Stockholm,

insulin

Sweden

Elective surgery has been shown to induce a state of insulin resistance. The degree of reduction of insulin sensitivity seems to be increased with greater magnitude of surgery performed. Less is known with regard to the mechanisms related to the development of insulin resistance. Presently, the possibility of a covariation between the degree of postoperative changes in relative insulin sensitivity and con-