Abstract
In 6 infants and children, ages 2 months to 9 years, with congenital gastrointestinal anomalies (4 patients) or with prior history of malignant disease admitted in remission for bone marrow transplantation (2 patients), the effects of three isocaloric intravenous nutritional regimens on energy metabolism and substrate utilization were studied to determine the effect of different levels of carbohydrate and fat on nitrogen retention. All three regimens were designed to deliver adequate calories for growth and fluid volumes normal for age. Solution A provided 8% of energy as amino acids, 87% as carbohydrate and 5% as fat. Solution B provided 8% of energy as amino acids, 60% as carbohydrate and 32% as fat. Solution C provided 8% of energy as amino acids, 34% as carbohydrate and 58% as fat. Each regimen was given through a random crossover design for 3-5 consecutive days to each subject. Oxygen consumption and respiratory quotient (RQ) were measured by indirect calorimetry for 20-30 minutes in the morning on the final day of each study period. Energy metabolism and carbohydrate, fat and protein utilization were calculated from the urinary nitrogen excretion end the nonprotein RQ. Administration of solution A (high carbohydrate, low fat) was associated with moderately increased BMR and RQ and withlownilrogenretention(19.1±12.7%. 1.06±0.14, and 98±28mg N/kg/D). Both the BMR and the RQ decreased when less carbohydrate and more lipid were given (BMR 4.3±11.6% [p<0.051, RQ 0.92±0.09 (p<0.01) for solution B; BMR 3.94±10.6% [p<0.01], RQ0.86±0.09 [p<0.01] for solution C). Among the solutions tested, optimal nitrogen retention (163±60mg N/kg/D [p<0.05]) was noted with solution B. Our data supports the conclusion that a physiologic balance of fat and carbohydrate administration results in optimal nitrogen retention.
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Nose, O., Tipton, J. & Ament, M. 706 ADMINISTRATION OF LIPID IMPROVES NITROGEN RETENTION IN CH,LDREN RECEIVING ISOCALORIC TPN. Pediatr Res 19, 228 (1985). https://doi.org/10.1203/00006450-198504000-00736
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DOI: https://doi.org/10.1203/00006450-198504000-00736