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O.08In vivo effects of olive oil-based lipid emulsion on lymphocyte activation in rats
0.08 In vivo effects of olive oil-based lipid emulsion on lymphocyte activation in rats J. Garcia* J. Tkaczuk** J. Ragab* B. P~riquet*, J. LeBoucher***, G. Dutot*** E. Ohayon** J. Ghisolfi* and J. P. Thouvenot* *Groupe d'Etude en Nutrition Infantile CHU Pur.pan 31059 Toulouse, **lmmunologie CHU Rangueil 31054 France, ***Baxter SA 78311 Maurepas, France. M. Moussa*,
Numerous studies have shown that diets enriched in polyunsaturated fatty acids are immunosuppressive. However the effects on the immune system of parenteral lipid emulsions, which contain high level of linoleic acid remain controversial. The aim of this study was to evaluate, in vivo, the effects of a lipid emultion (ClinOleic ® 20%), containing a reduced amount (18%) of linoleic acid in comparison with a conventional soybean oil-based lipid emulsion (Ivelip ®, 52% linoleic acid) on lymphocyte functions. Weaning male Wistar rats (n = 24) were orally fed a lab chow which contained 12% of total energy intake as lipids from soybean oil for 4 weeks. Then they received during 6 days, a total parenteral nutrition (260 Kcal/kg/d) in which 12% of total energy was brought by one of the 2 lipid
emulsions. Both lipid emulsions altered the fatty acid profile (tool/100mol) of spleen lymphocyte phospholipids reflecting the fatty acid intake. In ClinOleic group, linoleic acid was lower (9.06 _+0.21) and oleic acid higher (13.01 _+0.53) than in Ivelip group (13.96 _+0.68, 8.24 _+0.22 respectively; P < 0.0001). Arachidonic acid was similar in both groups. After 48h of lymphocyte culture with Concanavaline A and autologous serum, interleukin 2 recepteur ~ chain (CD25) analysed by flow cytometry (% of CD25 positive cells) was significantly more expressed in ClinOleic than Ivelip group (55.43 _ 3.47 vs 45.48 _+3.26, P < 0.050). Moreover this expression was positively correlated with oleic acid content of spleen lymphocyte phospholipids (Pearson coefficient r = 0.500, P < 0.018). These results confirm the previously described inhibitory effect of linoleic acid riched diet on the immune functions with a modification of fatty acid lymphocyte phospholipids composition 1. In agreement with in vitro data2, an olive oil-based emulsion is able to prevent the inhibition of CD25 expression. Furthermore, our results suggest that oleic acid could have a role in the observed effects. 1Moussa et al. Nutr. Clin. Metabol. 9: 161, 1995. 2Granato et al. Clin. Nutr. 15: 13S, 1996
Session 2 - E N T E R A L & P A R E N T E R A L N U T R I T I O N
0.09 Impact of bolus feeding via nasogastric tube on appetite and food intake in humans
0.10 Preoperative carbohydrates instead of overnight fasting reduces hospital stay following elective surgery
R. J. Stratton*, R. J. Stubbs**, T. J. Cole* and M. Ella*
O. Ljungqvist, J. Nygren*andA. Thore//
*MRC Dunn Clinical Nutrition Centre, Cambridge, UK. **Rowett Research Institute, Aberdeen, UK.
Karolinska Institute at Department of Surgery, Huddinge University Hospital and *Karolinska Hospital, Stockholm, Sweden.
The effect of nasogastric (NG) bolus feeding on appetite and food intake is unknown. Aims: To investigate the extent to which such effects occur in healthy subjects. Methods: Six healthy men (age 33 _+8 years, body mass index 21.1 _+1.6 kg/m2), resident in a metabolic suite, were studied. A NG tube was in situ throughout the 9 day study. On days 1-2, subjects ate a 'maintenance' diet (energy 1.5 x BMR). On days 3-9, boluses (volume 415 _+23.5 ml) were administered at 9.00h, 12.30h, 16.00h and 19.30h via the NG tube. On days 3-4, boluses were water, coloured to look like feed; on days 5-7, boluses of feed (4.18 kJ/ml, provision 6.9 _+0.38 MJ/d) were given; and on days 8 and 9, cotoured water boluses were again administered. Throughout the bolus feeding period (days 3-9) subjects had ad libitum access to covertly manipulated foods (each item 550 kJ/100g, 13% energey from protein, 47% carbohydrate, 40% fat). Unknown to subjects, food intake was assessed using a weighed inventory. Appetite was subjectively assessed using 100 mm visual analogue scales completed each waking hour during the study. Results: Total energy intake was significantly increased during bolus feeding compared to the coloured water days (days 5-7, mean 18.2 -+2.1 MJ, P < 0.002 ANOVA with contrasts), since the feed suppressed oral intake by only 20% (compared to days 3-4, see table) (15% reduction in oral energy intake between days 5 and 7 (P< 0.007)).
Purpose: Overnight fasting (NPO) is the traditional way to prepare for elective surgery. The purpose of this investigation was to examine if preoperative carbodydrate (CHO) instead of NPO reduced hospital stay following uncomplicated elective surgery. Methods:The analysis consisted of a total of 52 patients from three separate protocols. Within each study the patients were randomly assigned to NPO or preoperative treatment with 1) i.v. glucose 300 g (n = 12, open cholecystectomy); 2) insulin 0.8 lJU/kg/min + variable glucose infusion to maintain normoglycemia, which begun 3 h before the operation and continued until about 3 h after the operation (n = 7, hip replacement) or; 3) a CHO beverage (12.5% CHO [Nutricia PreOp Dnnk®, Nutricia Zoetermeer, The Netherlands) 400 ml 3 h preoperatively, n = 7, lower abdominal surgery). Each treatment group had a similar number of matched controls (NPO) undergoing the same procedures under standardized conditions. The time of discharge from the hospital was determined by an independent staff, blinded to the treatments. Sequential multiple regression analysis was performed. Results: No patient had any postoperative complications. Hospital stay was best predicted using a regression (Adj R square = 0.71, P = 0.0000) containing the type of surgery (P < 0.02), treatment (P < 0.01, B value: -1.1), BMI (P< 0.05, B:-0.09) and age (P= 0.09, B: 0.03) as independent variables. Blood loss, time of surgery, or preoperative insulin sensitivity did not improve the regression. The average reduction in hospital stay was 1 day (about 20%) in patients prepared with CHO in this model. Each separate study showed the same trend towards a reduction in hospital stay in patients prepared with CHO. The only other difference between the treatment groups was a less reduced postoperative insulin sensitivity in the CHO groups vs NPO (P< 0.05). Conclusions: From this data it can be concluded that preoperative fasting is not an optimal way to prepare for elective surgery. Preparing with CHO reduced need for hospitalisation, presumably by reducing postoperative insulin resistance.
Colouredwaterd3-4 0ralenergy d314.56d4 13.45 MJ/d *Mean_+SD -+3.16 -+2.02
Bolusfeeding(6.9MJ/d)d5-7
Coloured waterd 8-9
d5 11.68 d6 12.12 d7 9.94
d8 11.91 d9 13.68
-+2.02
+2.42
-+1.99
-+2.87
_+3.52
*Repeated Measures ANOVA with contrasts, P < 0.02 feed days (5-7) vs. coloured water days (3-4, 8-9) Overall daily ratings of appetite (including hunger, fullness, desire to eat) did not change with bolus tube feeding (e.g. median hunger d3-4 34 mm, d5-7 32 mm, d8-9 33 mm). Conclusions: (i) Bolus tube feeding partially suppressed voluntary food intake (40% of the energy content of the feed and 60% by the third day of feeding). (ii) Appetite sensations were maintained at a near constant level during the period of bolus feeding despite a 30% increase in total energy intake.
0.11 Preoperative oral carbohydrate intake attenuates metabolic changes immediately after hip replacement M. Soop, P. Myrenfors*, J. Nygren, A. Thorell and O. Ljungqvist**
Karolinska Institute, Departments of Surgery and *Anesthesiology, Karolinska Hospital, and **Department of Surgery at Huddinge University Hospital, Stockholm, Sweden.
Aims: It was hypothesized that insulin sensitivity is unaffected immediately after surgery in patients treated with a carbohydrate drink shortly
Numerous studies have shown that diets enriched in polyunsaturated fatty acids are immunosuppressive. However the effects on the immune system of parenteral lipid emulsions, which contain high level of linoleic acid remain controversial. The aim of this study was to evaluate, in vivo, the effects of a lipid emultion (ClinOleic ® 20%), containing a reduced amount (18%) of linoleic acid in comparison with a conventional soybean oil-based lipid emulsion (Ivelip ®, 52% linoleic acid) on lymphocyte functions. Weaning male Wistar rats (n = 24) were orally fed a lab chow which contained 12% of total energy intake as lipids from soybean oil for 4 weeks. Then they received during 6 days, a total parenteral nutrition (260 Kcal/kg/d) in which 12% of total energy was brought by one of the 2 lipid
emulsions. Both lipid emulsions altered the fatty acid profile (tool/100mol) of spleen lymphocyte phospholipids reflecting the fatty acid intake. In ClinOleic group, linoleic acid was lower (9.06 _+0.21) and oleic acid higher (13.01 _+0.53) than in Ivelip group (13.96 _+0.68, 8.24 _+0.22 respectively; P < 0.0001). Arachidonic acid was similar in both groups. After 48h of lymphocyte culture with Concanavaline A and autologous serum, interleukin 2 recepteur ~ chain (CD25) analysed by flow cytometry (% of CD25 positive cells) was significantly more expressed in ClinOleic than Ivelip group (55.43 _ 3.47 vs 45.48 _+3.26, P < 0.050). Moreover this expression was positively correlated with oleic acid content of spleen lymphocyte phospholipids (Pearson coefficient r = 0.500, P < 0.018). These results confirm the previously described inhibitory effect of linoleic acid riched diet on the immune functions with a modification of fatty acid lymphocyte phospholipids composition 1. In agreement with in vitro data2, an olive oil-based emulsion is able to prevent the inhibition of CD25 expression. Furthermore, our results suggest that oleic acid could have a role in the observed effects. 1Moussa et al. Nutr. Clin. Metabol. 9: 161, 1995. 2Granato et al. Clin. Nutr. 15: 13S, 1996
Session 2 - E N T E R A L & P A R E N T E R A L N U T R I T I O N
0.09 Impact of bolus feeding via nasogastric tube on appetite and food intake in humans
0.10 Preoperative carbohydrates instead of overnight fasting reduces hospital stay following elective surgery
R. J. Stratton*, R. J. Stubbs**, T. J. Cole* and M. Ella*
O. Ljungqvist, J. Nygren*andA. Thore//
*MRC Dunn Clinical Nutrition Centre, Cambridge, UK. **Rowett Research Institute, Aberdeen, UK.
Karolinska Institute at Department of Surgery, Huddinge University Hospital and *Karolinska Hospital, Stockholm, Sweden.
The effect of nasogastric (NG) bolus feeding on appetite and food intake is unknown. Aims: To investigate the extent to which such effects occur in healthy subjects. Methods: Six healthy men (age 33 _+8 years, body mass index 21.1 _+1.6 kg/m2), resident in a metabolic suite, were studied. A NG tube was in situ throughout the 9 day study. On days 1-2, subjects ate a 'maintenance' diet (energy 1.5 x BMR). On days 3-9, boluses (volume 415 _+23.5 ml) were administered at 9.00h, 12.30h, 16.00h and 19.30h via the NG tube. On days 3-4, boluses were water, coloured to look like feed; on days 5-7, boluses of feed (4.18 kJ/ml, provision 6.9 _+0.38 MJ/d) were given; and on days 8 and 9, cotoured water boluses were again administered. Throughout the bolus feeding period (days 3-9) subjects had ad libitum access to covertly manipulated foods (each item 550 kJ/100g, 13% energey from protein, 47% carbohydrate, 40% fat). Unknown to subjects, food intake was assessed using a weighed inventory. Appetite was subjectively assessed using 100 mm visual analogue scales completed each waking hour during the study. Results: Total energy intake was significantly increased during bolus feeding compared to the coloured water days (days 5-7, mean 18.2 -+2.1 MJ, P < 0.002 ANOVA with contrasts), since the feed suppressed oral intake by only 20% (compared to days 3-4, see table) (15% reduction in oral energy intake between days 5 and 7 (P< 0.007)).
Purpose: Overnight fasting (NPO) is the traditional way to prepare for elective surgery. The purpose of this investigation was to examine if preoperative carbodydrate (CHO) instead of NPO reduced hospital stay following uncomplicated elective surgery. Methods:The analysis consisted of a total of 52 patients from three separate protocols. Within each study the patients were randomly assigned to NPO or preoperative treatment with 1) i.v. glucose 300 g (n = 12, open cholecystectomy); 2) insulin 0.8 lJU/kg/min + variable glucose infusion to maintain normoglycemia, which begun 3 h before the operation and continued until about 3 h after the operation (n = 7, hip replacement) or; 3) a CHO beverage (12.5% CHO [Nutricia PreOp Dnnk®, Nutricia Zoetermeer, The Netherlands) 400 ml 3 h preoperatively, n = 7, lower abdominal surgery). Each treatment group had a similar number of matched controls (NPO) undergoing the same procedures under standardized conditions. The time of discharge from the hospital was determined by an independent staff, blinded to the treatments. Sequential multiple regression analysis was performed. Results: No patient had any postoperative complications. Hospital stay was best predicted using a regression (Adj R square = 0.71, P = 0.0000) containing the type of surgery (P < 0.02), treatment (P < 0.01, B value: -1.1), BMI (P< 0.05, B:-0.09) and age (P= 0.09, B: 0.03) as independent variables. Blood loss, time of surgery, or preoperative insulin sensitivity did not improve the regression. The average reduction in hospital stay was 1 day (about 20%) in patients prepared with CHO in this model. Each separate study showed the same trend towards a reduction in hospital stay in patients prepared with CHO. The only other difference between the treatment groups was a less reduced postoperative insulin sensitivity in the CHO groups vs NPO (P< 0.05). Conclusions: From this data it can be concluded that preoperative fasting is not an optimal way to prepare for elective surgery. Preparing with CHO reduced need for hospitalisation, presumably by reducing postoperative insulin resistance.
Colouredwaterd3-4 0ralenergy d314.56d4 13.45 MJ/d *Mean_+SD -+3.16 -+2.02
Bolusfeeding(6.9MJ/d)d5-7
Coloured waterd 8-9
d5 11.68 d6 12.12 d7 9.94
d8 11.91 d9 13.68
-+2.02
+2.42
-+1.99
-+2.87
_+3.52
*Repeated Measures ANOVA with contrasts, P < 0.02 feed days (5-7) vs. coloured water days (3-4, 8-9) Overall daily ratings of appetite (including hunger, fullness, desire to eat) did not change with bolus tube feeding (e.g. median hunger d3-4 34 mm, d5-7 32 mm, d8-9 33 mm). Conclusions: (i) Bolus tube feeding partially suppressed voluntary food intake (40% of the energy content of the feed and 60% by the third day of feeding). (ii) Appetite sensations were maintained at a near constant level during the period of bolus feeding despite a 30% increase in total energy intake.
0.11 Preoperative oral carbohydrate intake attenuates metabolic changes immediately after hip replacement M. Soop, P. Myrenfors*, J. Nygren, A. Thorell and O. Ljungqvist**
Karolinska Institute, Departments of Surgery and *Anesthesiology, Karolinska Hospital, and **Department of Surgery at Huddinge University Hospital, Stockholm, Sweden.
Aims: It was hypothesized that insulin sensitivity is unaffected immediately after surgery in patients treated with a carbohydrate drink shortly