- Email: [email protected]
Increased energy expenditure and protein catabolic rate in early starvation
NUTRITIONAL
ASSESSMENT
0.24 Effect of respiratoryalcalosison 02consumption(VO2) and CO, production (yCO2) in mechanically ventilate~J patients
022 Itwxeawd energy expenditure and protein catabolic rateinearlyst8wawl B. S&mew&& lst &wtnmnt
M. S&n&, W. Graninger, E. Roth, M. FischerandK Lenz of Medicine, University of Vienna, Austnb
D. Bamoud, X. Leverve, H. Roth, F. Catpentier and M. Guignier RBanimation M&kale et Nutrition Parent&a&, Centre Hospitalk Regional et Universitaire. BP 2 17,38048 GRENOBLE Cedex 9, France
The purpose of the study was to test the hypothesis that in healthy lean su&cts under usual living co&ions early starvation leads to an increased rather than to a decreased metabolic rate. Metabolic rates (REE) and respiratory quotients (RQ) were determined by means of indirect calorimetry in 9 healthy lean subjects (age (mean + SE) 29.9 -+ 0.9 years, weight 61.8 f 3.9kg, height 166.7 -+ 2.2cm) after a 12 (=posMso@ie), 36.60, and 84 hourfasting period. The subjects were not hospitalized. Measurements were done for a 30 minute period after a 45 minute resting period. Gas exchange data and urinary total nitrogen excretion were used to calculate substrate oxidatim rates for fat (FAT) and glucose (CHO) and the protein catabolic rate (PC@: su 12 26 61.2f3.6' 52.7f2.7 66.6f3.4' 0.74f0.01' 0.73~0.01" 0.63to.02 2.5f0.4 4.9f0.3 5.2f0.3 FATbId -0.2t0.7",a 4.6fO.l l.Of0.6 2.9to.3" 2.0f0.3 2.0f0.2 ERwl ~~~~~~'pc~Olconperedtol2h."p
Rnlan)
CHO-WI
The effect of pH changes on energy expenditure is rarely considered in clinical practice. Such pH changes occur frequently in acute condition (as in CU) as well as in chronic respiratory or renal failure. The aim of our study is to measure the changes in VOp and VCO* when pH is rapidly elevated by an increase in alveolar ventilation. Methods: 9 patients (age 29 to 83) under controlled mechanical ventilation (Fi02 8 0.40) for central or peripheral neuroiogic disorders were studied by indirect calorimetry with Deltatrac Metabolic Monitor (Datex - Finland) with the following protocol: stable condition (with enteral feeding) was confirmed on clinical data and a first 40 min period of calorimetric measurement (basal). Respiratory alcalosis was induced by increase of tidal volume; calorimetry was repeated for a 40 min period after 1 hour of stabilization. Return to initial acid-bass status was studied in the same procedure. Arterial pH was measured at the end of each period.
24 59.9t3.s 0.7oto.01"' 5.9+0.6-1.3+0.6-.a 2.3eO.3"
Results: FW
We conclude that there is an increased metabolic and protein catabolic rate on short term fasting. This can bs explained by an increasad gluconeogenesis from protein which is an energy-requiring process.
bQ (ml.mm-'jt VCQ(ml.mh-')t
Bul prlod Iml
7.424~0.009 236.if17.2 186.1+12.0 tMsm~Srm;'=pcO.O5
AW=ufnrp
7.546fO.W8 281.4k16.1 214.2t12.1
AM-M
0.111+0.011" 25.3+10.0' 16.lCZ.l"
*=p
Wcueafon: The rise in arterial pH from 7.45 to 7.54 is followed by a significant increase in V02 and VC&, reflecting an increase in energy expenditure of approximately 10%. This effect is observed without any change in respiratory work. The mechanism of this increasecould bs related, at least partly, to a change in transmembrane H+ gradient on activity of membrane energy-driven pumps,, since an increase in oxygen uptake is also observed in isolated cells (hepatccytes) incubated in an alkaline (pH = 7.6) medium.
0.23 Total energy expenditure4in free-living cystic fibrosis patients M.Raubt,K&QcherandK8chutz Nut&on Unit, Dqwtment of Pediatrics and institute of Physiology, Unive&y of Lalwme, switzerk3nd Resting energy expenditure (EE) has been shown to bs increased in cystic fibrosis (CQ patients. This does not necessarily imply an increase in total EE since the latter alsc includes energy cost of physical activity and themtogenesis. This study was designed to assess 24-hour EE of free-living CF patients using the heart rate (HR) method, and to examine the possibility of an energy dissipating basic cellular defect. Thirteen CF patients (6 females, 7 males) of age 14 k 6 years (mean + SD), weight 38.4 + 153kg, heiiht 149 f 20cm, weight for height 91 -C 4% and fat free mass 32.4 ? 13.2kg were studied. Their Shwachman score was 70 -+ 10. They were compared to 13 healthy controls matched for sex, age and the anthropometrtc parametars mentioned above. EE was measured by indirect calorimetry (hood system) at rest and at 3 standardized levels of physical exercise, i.e. walking on a treadmill with stepwise increasa in workload (1.5 km/h with 0% and 10% slope, and 3krn7h with 10% slope). Minute-by-minute HR was racordad simuttaneousty. A linear regression equation relating HR to EE was estabtiihed for each sub@ct. It was used to calculate 24-hour EE from HR recorded continuously in free-living conditllns. Resting EE was significantly higher (p < 0.01) in CF (1512 -+ 318 kcal/d) than in controls (1339 + 273 kcatAl), and remained so whsn related to bcdy weight or to fat free mass. ExpresMasapercentageofpredicteditwas122-+11%and108~8%, respectffly. In contrast, total 24-hour EE was similar in CF (2345 + 458 k&Al) and in controls (2358 f 922 kcat@, even when related to body weight or to fat frea mass. Net mechank~l work effic!ency calculated for walk at 3krWh with 10% slope was comparable in CF (20.4 + 2.6%) and in controls (19.8 & 2.1%). In conclusion, despite increased resting EE, CF patients do not have elevated total daily EE. This could be due to reduction of their spontanews physical actiii or to another compensating mechanism. Furthemtore, their work efficiency does not support the speculation on a primary defect in energy metabolism.
0.25 Favourable nutritional response to enteral nutrition therapy in acute Crohn’sdisease D. Royell, I. hbhan, K.N. [email protected]. Toronto General Hosptial and St. Michae& wada
Greenberg Hospitel, Toronto, Ontario,
The purposes of this study were: a) to quantify nutritional responses during enteral nutritional support in patients with Crohn’s disease and b) to determine if traditional measurements of body compositional analysis correlate with the simpler technique of bioelectric impedance analysis @A). In 20 patients (11 F, 9M; aged 32 f 3 years) with active Crohn’s disease, an elemental diet (Peptamen” or Vivonex@) providing 35 non-protein kcal/kg, was given for 3 wks. Total body nitrogen (TBN) by neutron activation, total body potassium (TBK) by gamma-ray counting, BIA by tetrapolar conductance and anthropometric measurements were made at the commencement of therapy and at day 21. Twelve patients had depleted body protein stores, with a mean nitrogen index (Nl) of 0.70 f 0.02 (nonal range: 0.8-l .2) and showed an increase of 0.52 + 0.23 kg total body protein (TBQ (p < 0.025) as calculatedfromTBN,after3 v&therapy. Theother8patients hadamean NI of 0.92 k 0.02 and showed no significant changs in TBP. Over 3 wks, all patients experienced weight gain with a mean of 1.9 + 0.4 kg (p < 0.0005), an increase in TBK of 2.7 * 1.5g (p < 0.05) and an increase in total bcdv water of 1.3 + 0.6kg @ < 0.025) byBtA. No change in body fat occurred. Tf3Kand BIA correlated significantly both before and after therapy (r = 0.91, p < 0.0005).
8
ASSESSMENT
0.24 Effect of respiratoryalcalosison 02consumption(VO2) and CO, production (yCO2) in mechanically ventilate~J patients
022 Itwxeawd energy expenditure and protein catabolic rateinearlyst8wawl B. S&mew&& lst &wtnmnt
M. S&n&, W. Graninger, E. Roth, M. FischerandK Lenz of Medicine, University of Vienna, Austnb
D. Bamoud, X. Leverve, H. Roth, F. Catpentier and M. Guignier RBanimation M&kale et Nutrition Parent&a&, Centre Hospitalk Regional et Universitaire. BP 2 17,38048 GRENOBLE Cedex 9, France
The purpose of the study was to test the hypothesis that in healthy lean su&cts under usual living co&ions early starvation leads to an increased rather than to a decreased metabolic rate. Metabolic rates (REE) and respiratory quotients (RQ) were determined by means of indirect calorimetry in 9 healthy lean subjects (age (mean + SE) 29.9 -+ 0.9 years, weight 61.8 f 3.9kg, height 166.7 -+ 2.2cm) after a 12 (=posMso@ie), 36.60, and 84 hourfasting period. The subjects were not hospitalized. Measurements were done for a 30 minute period after a 45 minute resting period. Gas exchange data and urinary total nitrogen excretion were used to calculate substrate oxidatim rates for fat (FAT) and glucose (CHO) and the protein catabolic rate (PC@: su 12 26 61.2f3.6' 52.7f2.7 66.6f3.4' 0.74f0.01' 0.73~0.01" 0.63to.02 2.5f0.4 4.9f0.3 5.2f0.3 FATbId -0.2t0.7",a 4.6fO.l l.Of0.6 2.9to.3" 2.0f0.3 2.0f0.2 ERwl ~~~~~~'pc~Olconperedtol2h."p
Rnlan)
CHO-WI
The effect of pH changes on energy expenditure is rarely considered in clinical practice. Such pH changes occur frequently in acute condition (as in CU) as well as in chronic respiratory or renal failure. The aim of our study is to measure the changes in VOp and VCO* when pH is rapidly elevated by an increase in alveolar ventilation. Methods: 9 patients (age 29 to 83) under controlled mechanical ventilation (Fi02 8 0.40) for central or peripheral neuroiogic disorders were studied by indirect calorimetry with Deltatrac Metabolic Monitor (Datex - Finland) with the following protocol: stable condition (with enteral feeding) was confirmed on clinical data and a first 40 min period of calorimetric measurement (basal). Respiratory alcalosis was induced by increase of tidal volume; calorimetry was repeated for a 40 min period after 1 hour of stabilization. Return to initial acid-bass status was studied in the same procedure. Arterial pH was measured at the end of each period.
24 59.9t3.s 0.7oto.01"' 5.9+0.6-1.3+0.6-.a 2.3eO.3"
Results: FW
We conclude that there is an increased metabolic and protein catabolic rate on short term fasting. This can bs explained by an increasad gluconeogenesis from protein which is an energy-requiring process.
bQ (ml.mm-'jt VCQ(ml.mh-')t
Bul prlod Iml
7.424~0.009 236.if17.2 186.1+12.0 tMsm~Srm;'=pcO.O5
AW=ufnrp
7.546fO.W8 281.4k16.1 214.2t12.1
AM-M
0.111+0.011" 25.3+10.0' 16.lCZ.l"
*=p
Wcueafon: The rise in arterial pH from 7.45 to 7.54 is followed by a significant increase in V02 and VC&, reflecting an increase in energy expenditure of approximately 10%. This effect is observed without any change in respiratory work. The mechanism of this increasecould bs related, at least partly, to a change in transmembrane H+ gradient on activity of membrane energy-driven pumps,, since an increase in oxygen uptake is also observed in isolated cells (hepatccytes) incubated in an alkaline (pH = 7.6) medium.
0.23 Total energy expenditure4in free-living cystic fibrosis patients M.Raubt,K&QcherandK8chutz Nut&on Unit, Dqwtment of Pediatrics and institute of Physiology, Unive&y of Lalwme, switzerk3nd Resting energy expenditure (EE) has been shown to bs increased in cystic fibrosis (CQ patients. This does not necessarily imply an increase in total EE since the latter alsc includes energy cost of physical activity and themtogenesis. This study was designed to assess 24-hour EE of free-living CF patients using the heart rate (HR) method, and to examine the possibility of an energy dissipating basic cellular defect. Thirteen CF patients (6 females, 7 males) of age 14 k 6 years (mean + SD), weight 38.4 + 153kg, heiiht 149 f 20cm, weight for height 91 -C 4% and fat free mass 32.4 ? 13.2kg were studied. Their Shwachman score was 70 -+ 10. They were compared to 13 healthy controls matched for sex, age and the anthropometrtc parametars mentioned above. EE was measured by indirect calorimetry (hood system) at rest and at 3 standardized levels of physical exercise, i.e. walking on a treadmill with stepwise increasa in workload (1.5 km/h with 0% and 10% slope, and 3krn7h with 10% slope). Minute-by-minute HR was racordad simuttaneousty. A linear regression equation relating HR to EE was estabtiihed for each sub@ct. It was used to calculate 24-hour EE from HR recorded continuously in free-living conditllns. Resting EE was significantly higher (p < 0.01) in CF (1512 -+ 318 kcal/d) than in controls (1339 + 273 kcatAl), and remained so whsn related to bcdy weight or to fat free mass. ExpresMasapercentageofpredicteditwas122-+11%and108~8%, respectffly. In contrast, total 24-hour EE was similar in CF (2345 + 458 k&Al) and in controls (2358 f 922 kcat@, even when related to body weight or to fat frea mass. Net mechank~l work effic!ency calculated for walk at 3krWh with 10% slope was comparable in CF (20.4 + 2.6%) and in controls (19.8 & 2.1%). In conclusion, despite increased resting EE, CF patients do not have elevated total daily EE. This could be due to reduction of their spontanews physical actiii or to another compensating mechanism. Furthemtore, their work efficiency does not support the speculation on a primary defect in energy metabolism.
0.25 Favourable nutritional response to enteral nutrition therapy in acute Crohn’sdisease D. Royell, I. hbhan, K.N. [email protected]. Toronto General Hosptial and St. Michae& wada
Greenberg Hospitel, Toronto, Ontario,
The purposes of this study were: a) to quantify nutritional responses during enteral nutritional support in patients with Crohn’s disease and b) to determine if traditional measurements of body compositional analysis correlate with the simpler technique of bioelectric impedance analysis @A). In 20 patients (11 F, 9M; aged 32 f 3 years) with active Crohn’s disease, an elemental diet (Peptamen” or Vivonex@) providing 35 non-protein kcal/kg, was given for 3 wks. Total body nitrogen (TBN) by neutron activation, total body potassium (TBK) by gamma-ray counting, BIA by tetrapolar conductance and anthropometric measurements were made at the commencement of therapy and at day 21. Twelve patients had depleted body protein stores, with a mean nitrogen index (Nl) of 0.70 f 0.02 (nonal range: 0.8-l .2) and showed an increase of 0.52 + 0.23 kg total body protein (TBQ (p < 0.025) as calculatedfromTBN,after3 v&therapy. Theother8patients hadamean NI of 0.92 k 0.02 and showed no significant changs in TBP. Over 3 wks, all patients experienced weight gain with a mean of 1.9 + 0.4 kg (p < 0.0005), an increase in TBK of 2.7 * 1.5g (p < 0.05) and an increase in total bcdv water of 1.3 + 0.6kg @ < 0.025) byBtA. No change in body fat occurred. Tf3Kand BIA correlated significantly both before and after therapy (r = 0.91, p < 0.0005).
8