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Free amino acid concentrations in human duodenal mucosa during standard parenteral nutrition and glutamine supplemented parenteral nutrition
solution B (0.5(0.2) mmolcm-‘.h-‘) did not increase Na’ or water absorption compared with solution A. This study confirms that water uptake is faster from a moderately hypotonic CES compared to an isotonic CES or plain water. Although glutamine may be necessary for the maintenance of mucosal function especially during diarrhoeal disease, at the concentration used in this study it has no effect on water or Na’ absorption from a hypotonic CES in the healthy human jejunum.
Methods: Six well adapted patients on former parenteral nutrition, with short bowels (50-I 00 cm) caused by infarction, and with preserved normal colons, were given two isocaloric diets: a 60% (as calories)high-carbohydrate diet (with 20% fat and 20% proteins), and reversely a 60% highfat diet (with 20% carbohydrates and 20% proteins). Both diets were given for 4 days in a crossed over design, and feces were collected the last 24 hours in both periods. Results: Fecal excretions of fat increased as expected at the 60% fat diet (Table). The fecal excretions of carbohydrates, however, did not increase when the 60% carbohydrate enriched diet was given, which resulted in a 451 +68 Kcal/d (mean & SEM; range 300-769; bomb calorimetry) lower loss of excreted energy (Table). In the high carbohydrate diets 63+7% of the calories were absorbed, compared with only 47 57% from the high fat diets.
0.27 Colon as an important digestive organ in patients with short bowel syndromes on high carbohydrate diets. I. Nordgaard, P. Brobech Mortensen. B. Stenb@k Dept. of Medicine A, Rigshospitalet, University of Copenhagen, Denmark Thecolonic absorption of malabsorbed fat and carbohydrates is very different in patients with short bowel syndromes. Long-chain fatty acids pass undegraded through the large intestine and are excreted in feces, representing a loss of energy. Malabsorbed carbohydrates are converted to shortchain fatty acids (SCFAs) by the colonic bacteria, and the SCFAs are easily absorbed from the large intestine. This is a major digestive principle in many plant eating animals, because the oxidation of SCFAs is a supply of calories to the organism. Do patients with short bowels and preserved colons benefit from “colonic digestion” of carbohydrates?
FeCal
Volume :&arbohydrate 60% Fat Diff+SEM P
:&266 823+165 74+145 0 63
Carbohydrate s!g6
2;:: 0.65
Nitro9en 9/d 9kl 9*1 l&l 0.56
izfb’ 7Eso+105 1236k122 451 k68 0 001
Conclusions: These results suggest that the large intestine has an important digestive potential in short bowel patients, possibly due to the conversion of malabsorbed dietary carbohydrates to SCFAs, which are rapidly absorbed from the large intestine.
Topic 20-GLUTAMINE
AND ANALOGUES
0.28 Free amino acid concentrations in human duodenal mucosa during standard parenteral nutrition and glutamine supplemented parenteral nutrition R. R. W. J. van der Hulst. N. E. P. Deutz, M. F. von Meyenfeldt, R. J. Brummer’, P. B. Soeters Department of Surgery and Gastroenterology”, Hospital of Maastricht, The Netherlands
Fat 9/d 42klO 10717 59+12 0 005
Results: last day day0 ;;tNd;y CONT GLN Plasma Gln 572+69 726149’t 58ak43 614+33 Mucosa Gin 3560_+518 5582_+719? 3412 i 266 4031 i 344% Plasma sumAA 2163k127 3038k92t 2196k143 3246*117* Mucosa sumAA 67333 + 5042 77151+ 6450 68513k5784 81210+6489 SumAA = som individual amino acids, plasma in ~unolll, mucosa in pmollkg dry weight * = p < 0 05 verws last day CONT (Mann- Whitney), 0.02 YBISOS day 0 GLN, t = p < 0.05 versus day 0 CONT Wilcoxon).
2rr
t =p <
University
Introduction: The small intestine has been identified as an important site of the metabolism of circulating glutamine (Gln). The impairment of gut mucosa integrity during total parenteral nutrition (TPN) has been ascribed to a depletion of mucosa Gln, due to the lack of Gln in standard TPN. Recently, we observed a decrease in duodenal mucosa glutamine concentrations in nutritionally depleted patients. This study was performed to observe changes in mucosa amino acids, during infusion of standard TPN compared with TPN enriched with glycyl-L-glutamine and glycyl-L-tyrosin dipeptides. Methods: Twenty patients receiving TPN were randomly allocated to an experimental (GLN, 0.23 g Gin/kg) and a control group (CONT, no Gin). Patients received isonitrogenous and isocaloric total parenteral nutrition during 10-14 days. Compared with the GLN, the CONT solution had a lower amount of all amino acids, except for tyrosine, glycine and Gln. After an overnight fast, before starting TPN, patients underwent a duodenoscopy, and biopsies were taken from the second part of the duodenum. Blood for determination of amino acids was drawn. This procedure was repeated on the last day of TPN during infusion of the solution.
Conclusion: Plasma Gln in the GLN group rose about 25% whereas plasma Gln concentrations in the CONT group remained unchanged. The increase in mucosa [Gln] in the GLN group was about 40% higher compared to the CONT group. The rise of plasma and mucosa [Gln] was associated with an equivalent diminished increase of other amino acids, resulting in similar levels of total AA. Gln supplemented parenteral nutrition increases mucosa Gln concentrations. The significance of these data in relation to gut integrity and mucosal architecture are under investigation.
0.29 Glutamine the human gut.
uptake
at different
sites
of
R. R. W. J. van der Hulst, N. E. P. Deutz, P. B. Soeters, M. F. von Meyenfeldt Department of Surgery, University Hospital of Maastricht, The Netherlands Introduction: The intestine is an important consumer of circulating glutamine (GLN). Portal sampling in man revealed an extraction ratio for GLN of about 15%. We recently reported an extraction ratio for GLN of about 10% across 10
Methods: Six well adapted patients on former parenteral nutrition, with short bowels (50-I 00 cm) caused by infarction, and with preserved normal colons, were given two isocaloric diets: a 60% (as calories)high-carbohydrate diet (with 20% fat and 20% proteins), and reversely a 60% highfat diet (with 20% carbohydrates and 20% proteins). Both diets were given for 4 days in a crossed over design, and feces were collected the last 24 hours in both periods. Results: Fecal excretions of fat increased as expected at the 60% fat diet (Table). The fecal excretions of carbohydrates, however, did not increase when the 60% carbohydrate enriched diet was given, which resulted in a 451 +68 Kcal/d (mean & SEM; range 300-769; bomb calorimetry) lower loss of excreted energy (Table). In the high carbohydrate diets 63+7% of the calories were absorbed, compared with only 47 57% from the high fat diets.
0.27 Colon as an important digestive organ in patients with short bowel syndromes on high carbohydrate diets. I. Nordgaard, P. Brobech Mortensen. B. Stenb@k Dept. of Medicine A, Rigshospitalet, University of Copenhagen, Denmark Thecolonic absorption of malabsorbed fat and carbohydrates is very different in patients with short bowel syndromes. Long-chain fatty acids pass undegraded through the large intestine and are excreted in feces, representing a loss of energy. Malabsorbed carbohydrates are converted to shortchain fatty acids (SCFAs) by the colonic bacteria, and the SCFAs are easily absorbed from the large intestine. This is a major digestive principle in many plant eating animals, because the oxidation of SCFAs is a supply of calories to the organism. Do patients with short bowels and preserved colons benefit from “colonic digestion” of carbohydrates?
FeCal
Volume :&arbohydrate 60% Fat Diff+SEM P
:&266 823+165 74+145 0 63
Carbohydrate s!g6
2;:: 0.65
Nitro9en 9/d 9kl 9*1 l&l 0.56
izfb’ 7Eso+105 1236k122 451 k68 0 001
Conclusions: These results suggest that the large intestine has an important digestive potential in short bowel patients, possibly due to the conversion of malabsorbed dietary carbohydrates to SCFAs, which are rapidly absorbed from the large intestine.
Topic 20-GLUTAMINE
AND ANALOGUES
0.28 Free amino acid concentrations in human duodenal mucosa during standard parenteral nutrition and glutamine supplemented parenteral nutrition R. R. W. J. van der Hulst. N. E. P. Deutz, M. F. von Meyenfeldt, R. J. Brummer’, P. B. Soeters Department of Surgery and Gastroenterology”, Hospital of Maastricht, The Netherlands
Fat 9/d 42klO 10717 59+12 0 005
Results: last day day0 ;;tNd;y CONT GLN Plasma Gln 572+69 726149’t 58ak43 614+33 Mucosa Gin 3560_+518 5582_+719? 3412 i 266 4031 i 344% Plasma sumAA 2163k127 3038k92t 2196k143 3246*117* Mucosa sumAA 67333 + 5042 77151+ 6450 68513k5784 81210+6489 SumAA = som individual amino acids, plasma in ~unolll, mucosa in pmollkg dry weight * = p < 0 05 verws last day CONT (Mann- Whitney), 0.02 YBISOS day 0 GLN, t = p < 0.05 versus day 0 CONT Wilcoxon).
2rr
t =p <
University
Introduction: The small intestine has been identified as an important site of the metabolism of circulating glutamine (Gln). The impairment of gut mucosa integrity during total parenteral nutrition (TPN) has been ascribed to a depletion of mucosa Gln, due to the lack of Gln in standard TPN. Recently, we observed a decrease in duodenal mucosa glutamine concentrations in nutritionally depleted patients. This study was performed to observe changes in mucosa amino acids, during infusion of standard TPN compared with TPN enriched with glycyl-L-glutamine and glycyl-L-tyrosin dipeptides. Methods: Twenty patients receiving TPN were randomly allocated to an experimental (GLN, 0.23 g Gin/kg) and a control group (CONT, no Gin). Patients received isonitrogenous and isocaloric total parenteral nutrition during 10-14 days. Compared with the GLN, the CONT solution had a lower amount of all amino acids, except for tyrosine, glycine and Gln. After an overnight fast, before starting TPN, patients underwent a duodenoscopy, and biopsies were taken from the second part of the duodenum. Blood for determination of amino acids was drawn. This procedure was repeated on the last day of TPN during infusion of the solution.
Conclusion: Plasma Gln in the GLN group rose about 25% whereas plasma Gln concentrations in the CONT group remained unchanged. The increase in mucosa [Gln] in the GLN group was about 40% higher compared to the CONT group. The rise of plasma and mucosa [Gln] was associated with an equivalent diminished increase of other amino acids, resulting in similar levels of total AA. Gln supplemented parenteral nutrition increases mucosa Gln concentrations. The significance of these data in relation to gut integrity and mucosal architecture are under investigation.
0.29 Glutamine the human gut.
uptake
at different
sites
of
R. R. W. J. van der Hulst, N. E. P. Deutz, P. B. Soeters, M. F. von Meyenfeldt Department of Surgery, University Hospital of Maastricht, The Netherlands Introduction: The intestine is an important consumer of circulating glutamine (GLN). Portal sampling in man revealed an extraction ratio for GLN of about 15%. We recently reported an extraction ratio for GLN of about 10% across 10