- Email: [email protected]
‘In vivo’ determination of respiratory quotient (RQ) in single organs and body districts
P.28 Effect of lactate infusion diture in normal man
enteral nutrition (Sobotka et al., Proc. Nutr. Sec. in press). In the present study we analyzed this relationship using enteral diet enriched in MCT. Methods: Ten subjects were studied. Their resting energy expenditure (REE) and basal respiratory quotient (B-RQ) were measured by indirect calorimetry (MMC-Horizon) after an overnight fast. Then intrajejunal administration of liquid diet (Salvimulsin MCT 800) was initiated. The rate of delivery was 1.6 times higher than basal REE. REE and TEN were evaluated 2,5 and 24 h after the onset of diet infusion. These values were compared with B-RQ and basal serum triglyceride (TG) levels. Results: Significant correlations were found between B-RQ and TEN measured 5 h (r = 0.71, p < 0.01) and 24 h (r = 0.72, p < 0.01) after the onset of continual nutrition administration. TEN evaluated 2 h after the start of continual feeding correlated with basal serum TG levels (r = 0.68, p < 0.05). Conclusion: Thermic effect of continual enteral nutrition is dependent on metabolic status measured by fasting RQ and serum TG levels.
on energyexpen-
F. Carpentier, H. Roth, D. Barnoud, E. Fontaine, M. Guignier andX. Leverve Service de R&animation Me’dicale & Laboratoire de Th&apeutique, BP 27 7,38043 Grenoble Cedex 9, France Increase in glucose-lactate cycle in acutely ill patients is widely accepted. Hence, the increase in peripheric lactate production must be accompanied by an increased energy exenditure since Cori’s cycle represents a waste of energy. The purpose of our work was to investigate the metabolic effects (energy expenditure-EE and respiratory quotient-RQ) of exogenous lactate infusion in healthy man. Materials and methods: 14 healthy subjects (mean f SD, 31.8 k 7.5 yr, 66.6 k 6.6 kg, 173.8 & 9.2 cm, EE: 1655 + 139 kcal/d) were studied after an overnight fast. They received 2.5 mmol/kg during 15 min of L-sodium lactate (pH = 7.4). Venous plasma lactate, pH and glucose were measured as indicated in the results. Lactate was infused between -15 and 0 min. Energy expenditure and the RQ were monitored by using indirect calorimetry (DATEX) over 30 min periods before, during and after infusion. Results: (mean + SEM; comparisons are made using paired Student’s t-test: ** p < 0.01; *I* p < 0.0001) Time (min) -15 1: g :: 120 150 Time (min) -15 0 18-l
._
Lactate (mM) 1.1kO.1 6.7kO.2"' 4.8+0.2"' 3.6*0.2"' 2.7+01"' 2.0+0.1*** 1.5*0.1** 1.2kO.l l.Oi_O.O4 1.0*0.05
Alactate
AVO, (ml/min) 0 17.5k2.2"'
A EE (kc;l/d)
30.2~1.5" 90 120 150
12.1f1.4"' 3.Okl.4 -0.6+1.5 1.5+1.5
(mgM)
GlUCOSe (mM) 5.0*0.1 5.1k0.1
5.6kO.2"' 3.7+0.2*** 2.5iO.l" 1.6*0.1"' 5.4+0.1*** 0.9*01" 0.4*0.04" 5.4+0.1"' 0.1kO.1 -0.1 kO.1 5.4*0.1"' -0.1*0.04
115+15"
%39+0.003 0.765kO.005"'
161~11"'
0.697+0.004"'
58*9"' 7*9 -11+10 10+10
‘In vivo’ determination of respiratory P.30 quotient (RQ) in single organs and body districts
PH 7.38f0.01 7.44-1_0.01"'
I. Giovannini*t, C. Chiarla?, G. Boldrini’t and G. Nuzzot * C.N. R. Shock Center, Institutes of t Patologia Chirurgica (Chir. Geriatrica) and Clinica Chirurgica, Catholic University, Rome, Italy
7.45*0.01*** 7.45~0.01"'
RQ may be obtained as the ratio between the differences in venous-arterial CO2 concentration and in arterio-venous O2 concentr. (RQ = v-aDCO,/a-vD0,). While a-vD0, is very easily obtainable, methods for obtaining v-aDCO* are still unsatisfactory, and a new procedure has been developed by us. Arterial and venous CO1 tensions (PaCO,, PvCO,, mmHg), pH (pHa, pHv), and O2 saturation fractions (SaO,, Sv02), with hematocrit fraction (Hct) are used. Arterial CO2 concentration (CaCO,, ml/100 ml) is first calculated by combining the Henderson-Hasselbach and Gibbs-Donnan relationships:
7.44f0.01"'
0.715f0.005"' 0.741*0.005"* 0.764kO.005"' 0.776f0.004"
CaCQ,=0,06868’ Lactate infusion causes an increase in energy expenditure. Cumulative oxygen consumption was 12+4 ml O2 per mmol exogenous lactate. Theoretical calculations yield to a value of 11.2 ml O2 per mmol lactate used in the gluconeogenic pathway. Hence, the increase in oxygen consumption fits with an exclusive use of infused lactate in gluconeogenesis. Moreover, although lactate oxidation, as carbohydrate, has an RQ equal to 1, we found after infusion an immediate and significant decrease to 0.70 showing that the energy was mainly coming from lipid oxidation. Conclusion: Our data suggest that increased glucose-lactate cycle in healthy subjects and probably in acutely ill patients as well needs an increase in lipid oxidation.
-Hct[l-2.3611+0.2264(pHa)-0.2203(SaO,) +0,0376(pHa)(SaO,)]} +PaCO,[O.O6868~).00947(Hct)] The increase in CO2 concentration due to the increase in CO? tension from PaCO, to PvCO, (dCO,/dP) is calculated by application of the Newton-Raphson method based on the first derivative (y’) of the buffer equation for plasma in oxygenated blood: y’ = -18.2532-3.103044 (Hb) (units = ml COJlOO ml blood/pH unit; Hb = blood hemoglobin concentr., g/dl). The increase in CO2 concentration due to the increase in O2 saturation from SaO, to SvO, (dCO,/dS) is calculated according to data by Klocke on O,-linked CO1 exchange:
P.29 Thermic effect of continual enteral nutrition is dependent on fasting respiratory quotient and serum lipid levels L. Sobotka, Z. Zadak and J. Chaloupka Department of Metabolic Care and Gerontology, University, Hradec Kralove. Czechoslovakia
pa~0*",0[1.042'4(PHa)-8.410361
*{l
{-(pHv2)[0.2735+0.0268(log.PvCO~)] + (pHv) [4.8684+0.2009(log,PvCO2)1-20.8408) (RQ is finally obtained by dividing (dC0JdP + dCO,/dS) by a-vD0,). Linear correlation with control data from 46 experimental measurements of v-aDC0, yielded: (v-aDCOZ)meas. = 1 .OO (v-aDCOZ)ca,c. - 0.01; r2 = 0.98, p << 0.01. The new method represents a useful and reliable tool for the ‘in vivo’ determination of v-aDCO,, RQ and other related parameters
Charles
It is known that thermic effect of nutrition is reduced in severely malnourished patients. In a recent study we described relationship between fasting respiratory quotient or serum lipid levels and TEN observed 2 and 5 h after the onset of 54
from blood gases in whole body, and in single body districts or organs.
P.31 Comparison nutritional assessment ation
of subjective with objective
gastric cancer (15%). AIDS (54%), hepato pancreatobiliar diseases (9%) ulcerative colitis (8%) and other diseases (14%). The Detsky questionnaire was applied beside anthropometric measurements (body weight, triceps skinfold thickness-TSF, midarm circumference-MAC) and laboratorial examinations (seric albumin, haemoglobin, peripheric blood lymphocytes) all of them in the first 3 days of admission. SGA always preceded NOA, and always was done by the same observer. The patients were classified in normal, moderate and severely malnourished. There were X2 significant associations (p c: 0.05) between hypoalbuminemia (~3.5 g/dl) loss of TSF (< 10 mm) and MAC ( < 23.3 cm) in those patients classified as malnourished by SGA (14%). There were no significant associations between weight lost and lymphocytopenia with SGA diagnosed malnutrition. On the other hand hypoalbuminemia, low TSF and SGA severe malnutrition were all significantly associated to mortality (p < 0.05). At conclusion SGA in our hospital is a reliable diagnostic method for hospitalized adult malnutrition and keeps prognostic association with mortality.
global evolu-
L.Z. Coppini, D.L. Waitzberg, M. 7. Ferrini, M.L. Teixeira da Silva. S.L. Ciosak and J. Gama-Rodrigues Grupo de Apoio Nutritional Enteral e Parenteral (GANEP). Hospital Beneficdncia Portuguesa, S5o Paula, Brazil Nutritional objective assessment methods (NOA) are traditionally employed in hospitalized patients (anthropometry, laboratorial exams, and immunological tests). The Subjective Global Assessment (SGA) estimates weight loss, changes in dietetic intake and fat loss (Detskyet al, 1987) being allegedly efficient for protein-caloric malnutrition diagnosis of the hospitalized adult. With the aim to compare the efficacy of SGA against the traditional NOA a prospective study was done with 100 hospitalized patients. The patients were studied from 03/90 to 05/91, age of 48.5 + 16 years, being 76 men. They had
55
enteral nutrition (Sobotka et al., Proc. Nutr. Sec. in press). In the present study we analyzed this relationship using enteral diet enriched in MCT. Methods: Ten subjects were studied. Their resting energy expenditure (REE) and basal respiratory quotient (B-RQ) were measured by indirect calorimetry (MMC-Horizon) after an overnight fast. Then intrajejunal administration of liquid diet (Salvimulsin MCT 800) was initiated. The rate of delivery was 1.6 times higher than basal REE. REE and TEN were evaluated 2,5 and 24 h after the onset of diet infusion. These values were compared with B-RQ and basal serum triglyceride (TG) levels. Results: Significant correlations were found between B-RQ and TEN measured 5 h (r = 0.71, p < 0.01) and 24 h (r = 0.72, p < 0.01) after the onset of continual nutrition administration. TEN evaluated 2 h after the start of continual feeding correlated with basal serum TG levels (r = 0.68, p < 0.05). Conclusion: Thermic effect of continual enteral nutrition is dependent on metabolic status measured by fasting RQ and serum TG levels.
on energyexpen-
F. Carpentier, H. Roth, D. Barnoud, E. Fontaine, M. Guignier andX. Leverve Service de R&animation Me’dicale & Laboratoire de Th&apeutique, BP 27 7,38043 Grenoble Cedex 9, France Increase in glucose-lactate cycle in acutely ill patients is widely accepted. Hence, the increase in peripheric lactate production must be accompanied by an increased energy exenditure since Cori’s cycle represents a waste of energy. The purpose of our work was to investigate the metabolic effects (energy expenditure-EE and respiratory quotient-RQ) of exogenous lactate infusion in healthy man. Materials and methods: 14 healthy subjects (mean f SD, 31.8 k 7.5 yr, 66.6 k 6.6 kg, 173.8 & 9.2 cm, EE: 1655 + 139 kcal/d) were studied after an overnight fast. They received 2.5 mmol/kg during 15 min of L-sodium lactate (pH = 7.4). Venous plasma lactate, pH and glucose were measured as indicated in the results. Lactate was infused between -15 and 0 min. Energy expenditure and the RQ were monitored by using indirect calorimetry (DATEX) over 30 min periods before, during and after infusion. Results: (mean + SEM; comparisons are made using paired Student’s t-test: ** p < 0.01; *I* p < 0.0001) Time (min) -15 1: g :: 120 150 Time (min) -15 0 18-l
._
Lactate (mM) 1.1kO.1 6.7kO.2"' 4.8+0.2"' 3.6*0.2"' 2.7+01"' 2.0+0.1*** 1.5*0.1** 1.2kO.l l.Oi_O.O4 1.0*0.05
Alactate
AVO, (ml/min) 0 17.5k2.2"'
A EE (kc;l/d)
30.2~1.5" 90 120 150
12.1f1.4"' 3.Okl.4 -0.6+1.5 1.5+1.5
(mgM)
GlUCOSe (mM) 5.0*0.1 5.1k0.1
5.6kO.2"' 3.7+0.2*** 2.5iO.l" 1.6*0.1"' 5.4+0.1*** 0.9*01" 0.4*0.04" 5.4+0.1"' 0.1kO.1 -0.1 kO.1 5.4*0.1"' -0.1*0.04
115+15"
%39+0.003 0.765kO.005"'
161~11"'
0.697+0.004"'
58*9"' 7*9 -11+10 10+10
‘In vivo’ determination of respiratory P.30 quotient (RQ) in single organs and body districts
PH 7.38f0.01 7.44-1_0.01"'
I. Giovannini*t, C. Chiarla?, G. Boldrini’t and G. Nuzzot * C.N. R. Shock Center, Institutes of t Patologia Chirurgica (Chir. Geriatrica) and Clinica Chirurgica, Catholic University, Rome, Italy
7.45*0.01*** 7.45~0.01"'
RQ may be obtained as the ratio between the differences in venous-arterial CO2 concentration and in arterio-venous O2 concentr. (RQ = v-aDCO,/a-vD0,). While a-vD0, is very easily obtainable, methods for obtaining v-aDCO* are still unsatisfactory, and a new procedure has been developed by us. Arterial and venous CO1 tensions (PaCO,, PvCO,, mmHg), pH (pHa, pHv), and O2 saturation fractions (SaO,, Sv02), with hematocrit fraction (Hct) are used. Arterial CO2 concentration (CaCO,, ml/100 ml) is first calculated by combining the Henderson-Hasselbach and Gibbs-Donnan relationships:
7.44f0.01"'
0.715f0.005"' 0.741*0.005"* 0.764kO.005"' 0.776f0.004"
CaCQ,=0,06868’ Lactate infusion causes an increase in energy expenditure. Cumulative oxygen consumption was 12+4 ml O2 per mmol exogenous lactate. Theoretical calculations yield to a value of 11.2 ml O2 per mmol lactate used in the gluconeogenic pathway. Hence, the increase in oxygen consumption fits with an exclusive use of infused lactate in gluconeogenesis. Moreover, although lactate oxidation, as carbohydrate, has an RQ equal to 1, we found after infusion an immediate and significant decrease to 0.70 showing that the energy was mainly coming from lipid oxidation. Conclusion: Our data suggest that increased glucose-lactate cycle in healthy subjects and probably in acutely ill patients as well needs an increase in lipid oxidation.
-Hct[l-2.3611+0.2264(pHa)-0.2203(SaO,) +0,0376(pHa)(SaO,)]} +PaCO,[O.O6868~).00947(Hct)] The increase in CO2 concentration due to the increase in CO? tension from PaCO, to PvCO, (dCO,/dP) is calculated by application of the Newton-Raphson method based on the first derivative (y’) of the buffer equation for plasma in oxygenated blood: y’ = -18.2532-3.103044 (Hb) (units = ml COJlOO ml blood/pH unit; Hb = blood hemoglobin concentr., g/dl). The increase in CO2 concentration due to the increase in O2 saturation from SaO, to SvO, (dCO,/dS) is calculated according to data by Klocke on O,-linked CO1 exchange:
P.29 Thermic effect of continual enteral nutrition is dependent on fasting respiratory quotient and serum lipid levels L. Sobotka, Z. Zadak and J. Chaloupka Department of Metabolic Care and Gerontology, University, Hradec Kralove. Czechoslovakia
pa~0*",0[1.042'4(PHa)-8.410361
*{l
{-(pHv2)[0.2735+0.0268(log.PvCO~)] + (pHv) [4.8684+0.2009(log,PvCO2)1-20.8408) (RQ is finally obtained by dividing (dC0JdP + dCO,/dS) by a-vD0,). Linear correlation with control data from 46 experimental measurements of v-aDC0, yielded: (v-aDCOZ)meas. = 1 .OO (v-aDCOZ)ca,c. - 0.01; r2 = 0.98, p << 0.01. The new method represents a useful and reliable tool for the ‘in vivo’ determination of v-aDCO,, RQ and other related parameters
Charles
It is known that thermic effect of nutrition is reduced in severely malnourished patients. In a recent study we described relationship between fasting respiratory quotient or serum lipid levels and TEN observed 2 and 5 h after the onset of 54
from blood gases in whole body, and in single body districts or organs.
P.31 Comparison nutritional assessment ation
of subjective with objective
gastric cancer (15%). AIDS (54%), hepato pancreatobiliar diseases (9%) ulcerative colitis (8%) and other diseases (14%). The Detsky questionnaire was applied beside anthropometric measurements (body weight, triceps skinfold thickness-TSF, midarm circumference-MAC) and laboratorial examinations (seric albumin, haemoglobin, peripheric blood lymphocytes) all of them in the first 3 days of admission. SGA always preceded NOA, and always was done by the same observer. The patients were classified in normal, moderate and severely malnourished. There were X2 significant associations (p c: 0.05) between hypoalbuminemia (~3.5 g/dl) loss of TSF (< 10 mm) and MAC ( < 23.3 cm) in those patients classified as malnourished by SGA (14%). There were no significant associations between weight lost and lymphocytopenia with SGA diagnosed malnutrition. On the other hand hypoalbuminemia, low TSF and SGA severe malnutrition were all significantly associated to mortality (p < 0.05). At conclusion SGA in our hospital is a reliable diagnostic method for hospitalized adult malnutrition and keeps prognostic association with mortality.
global evolu-
L.Z. Coppini, D.L. Waitzberg, M. 7. Ferrini, M.L. Teixeira da Silva. S.L. Ciosak and J. Gama-Rodrigues Grupo de Apoio Nutritional Enteral e Parenteral (GANEP). Hospital Beneficdncia Portuguesa, S5o Paula, Brazil Nutritional objective assessment methods (NOA) are traditionally employed in hospitalized patients (anthropometry, laboratorial exams, and immunological tests). The Subjective Global Assessment (SGA) estimates weight loss, changes in dietetic intake and fat loss (Detskyet al, 1987) being allegedly efficient for protein-caloric malnutrition diagnosis of the hospitalized adult. With the aim to compare the efficacy of SGA against the traditional NOA a prospective study was done with 100 hospitalized patients. The patients were studied from 03/90 to 05/91, age of 48.5 + 16 years, being 76 men. They had
55