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Clinical nutrition : official journal of the Europ... 49건

  1. [해외논문]   Editorial board  


    Clinical nutrition : official journal of the European Society of Parenteral and Enteral Nutrition v.37 no.4 ,pp. i - ii , 2018 , 0261-5614 ,

    초록

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    회원님의 원문열람 권한에 따라 열람이 불가능 할 수 있으며 권한이 없는 경우 해당 사이트의 정책에 따라 회원가입 및 유료구매가 필요할 수 있습니다.이동하는 사이트에서의 모든 정보이용은 NDSL과 무관합니다.

    NDSL에서는 해당 원문을 복사서비스하고 있습니다. 아래의 원문복사신청 또는 장바구니담기를 통하여 원문복사서비스 이용이 가능합니다.

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  2. [해외논문]   The 2017 Sir David P Cuthbertson lecture. Amino acids and muscle protein metabolism in critical care  

    Wolfe, Robert R.
    Clinical nutrition : official journal of the European Society of Parenteral and Enteral Nutrition v.37 no.4 ,pp. 1093 - 1100 , 2018 , 0261-5614 ,

    초록

    Summary In this short review, our current understanding of key aspects of the catabolic response are presented in the context of the seminal contributions of Sir David Cuthbertson. Studies have confirmed that an increase in resting energy expenditure occurs in almost all forms of critical illness and injury. However, meeting the resulting increase in caloric requirement is not an insurmountable problem. The primary focus of nutritional support should be the net loss of body protein. Increased intake of dietary protein may ameliorate, but usually will not entirely reverse, the accelerated loss of body protein because of anabolic resistance. Anabolic resistance is due, at least in part, to impaired inward transport efficiency of amino acids from blood into muscle. Simultaneous consumption of excess non-protein calories in an anabolic resistant state provides minimal additional benefit, and may cause potentially adverse effects, including accumulation of liver fat and excess production of carbon dioxide. Because of the limited effectiveness of dietary protein and non-protein caloric intake, it is likely that traditional nutritional support alone will not reverse the net loss of body protein in the catabolic state. The reversal of the catabolic response can only be accomplished in many patients by combining reasonable nutritional support with appropriate metabolic control. Metabolic control may be achieved with the use of a number of pharmacological approaches, including propranolol, insulin or testosterone. Regardless of the approach, ensuring an adequate availability of dietary essential amino acids is necessary for pharmacologic therapy to result in an increased rate of protein synthesis.

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    NDSL에서는 해당 원문을 복사서비스하고 있습니다. 아래의 원문복사신청 또는 장바구니담기를 통하여 원문복사서비스 이용이 가능합니다.

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  3. [해외논문]   Prevalence and predictive value of pre-therapeutic sarcopenia in cancer patients: A systematic review  

    Pamoukdjian, Fré (APHP, Avicenne Hospital, Geriatric Department, Coordination Unit in Geriatric Oncology, F-93000, Bobigny, France ) , dé (APHP, Avicenne Hospital, Department of Medical Oncology, F-93000, Bobigny, France ) , ric (APHP, Avicenne Hospital, Clinical Research Unit/Clinical Research Center, F-93000, Bobigny, France ) , Bouillet, Thierry (APHP, Avicenne Hospital, Department of Radiology, F-93000, Bobigny, France ) , Lé (APHP, Avicenne Hospital, Department of Medical Oncology, F-93000, Bobigny, France ) , vy, Vincent (APHP, Henri-Mondor Hospital, Geriatric Department, Geriatric Oncology Unit, F-94000, Créteil, France) , Soussan, Michael , Zelek, Laurent , Paillaud, Elena
    Clinical nutrition : official journal of the European Society of Parenteral and Enteral Nutrition v.37 no.4 ,pp. 1101 - 1113 , 2018 , 0261-5614 ,

    초록

    Summary Background & aims To assess the prevalence of sarcopenia before cancer treatment and its predictive value during the treatment. Methods We searched MEDLINE via PubMed for articles published from 2008 to 2016 that reported prospective observational or interventional studies of the prevalence of pre-therapeutic sarcopenia and its consequences in adults with cancer who were 18 years or older. Two independent reviewers selected articles based on titles and/or abstracts before a complete review. Sarcopenia had to be measured before cancer treatment. Methods recommended by consensuses (CT scan, MRI, dual X-ray absorptiometry or bio-impedancemetry) to assess sarcopenia were considered. Characteristics of the studies included the prevalence of pre-therapeutic sarcopenia and the prognostic value for outcomes during the cancer treatment. Results We selected 35 articles involving 6894 participants (in/out patients, clinical trials). The mean age ranged from 53 to 69.6 years. Pre-therapeutic sarcopenia was found in 38.6% of patients [95% CI 37.4–39.8]. Oesophageal and small-cell lung cancers showed the highest prevalence of pre-therapeutic sarcopenia. Pre-therapeutic sarcopenia was significantly and independently associated with post-operative complications, chemotherapy-induced toxicity and poor survival in cancer patients. Conclusions Pre-therapeutic sarcopenia is highly prevalent in cancer patients and has severe consequences for outcomes of cancer patients.

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    회원님의 원문열람 권한에 따라 열람이 불가능 할 수 있으며 권한이 없는 경우 해당 사이트의 정책에 따라 회원가입 및 유료구매가 필요할 수 있습니다.이동하는 사이트에서의 모든 정보이용은 NDSL과 무관합니다.

    NDSL에서는 해당 원문을 복사서비스하고 있습니다. 아래의 원문복사신청 또는 장바구니담기를 통하여 원문복사서비스 이용이 가능합니다.

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  4. [해외논문]   Adult classical homocystinuria requiring parenteral nutrition: Pitfalls and management  

    Tran, Christel (Center for Molecular Diseases, Division of Genetic Medicine, Lausanne University Hospital, Lausanne, Switzerland ) , Bonafé (Center for Molecular Diseases, Division of Genetic Medicine, Lausanne University Hospital, Lausanne, Switzerland ) , , Luisa (University Institute of Clinical Chemistry, University Children's Hospital, Inselspital AG Bern, University of Bern, Bern, Switzerland ) , Nuoffer, Jean-Marc (Pharmacy, Lausanne University Hospital, Lausanne, Switzerland ) , Rieger, Julie (Service of Adult Intensive Care and Burns Centre, Lausanne University Hospital, Lausanne, Switzerland) , Berger, Mette M.
    Clinical nutrition : official journal of the European Society of Parenteral and Enteral Nutrition v.37 no.4 ,pp. 1114 - 1120 , 2018 , 0261-5614 ,

    초록

    Summary Background Homocystinuria due to cystathionine beta synthase (CBS) deficiency presents with a wide clinical spectrum. Treatment by the enteral route aims at reducing homocysteine levels by using vitamin B6, possibly methionine-restricted diet, betaine and/or folate and vitamin B 12 supplementation. Currently no nutritional guidelines exist regarding parenteral nutrition (PN) under acute conditions. Methods Exhaustive literature search was performed, in order to identify the relevant studies describing the pathogenesis and nutritional intervention of adult classical homocystinuria requiring PN. Description of an illustrative case of an adult female with CBS deficiency and intestinal perforation, who required total PN due to contraindication to enteral nutrition. Results Nutritional management of decompensated classical homocystinuria is complex and currently no recommendation exists regarding PN composition. Amino acid profile and monitoring of total homocysteine concentration are the main tools enabling a precise assessment of the severity of metabolic alterations. In case of contraindication to enteral nutrition, compounded PN will be required, as described in this paper, to ensure adequate low amounts of methionine and others essential amino acids and avoid potentially fatal toxic hypermethioninemia. Conclusions By reviewing the literature and reporting successful nutritional management of a decompensated CBS deficiency using tailored PN with limited methionine intake and n-3 PUFA addition, we would like to underscore the fact that standard PN solutions are not adapted for CBS deficient critical ill patients: new solutions are required. High methionine levels (>800 μmol/L) being potentially neurotoxic, there is an urgent need to improve our knowledge of acute nutritional therapy.

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    회원님의 원문열람 권한에 따라 열람이 불가능 할 수 있으며 권한이 없는 경우 해당 사이트의 정책에 따라 회원가입 및 유료구매가 필요할 수 있습니다.이동하는 사이트에서의 모든 정보이용은 NDSL과 무관합니다.

    NDSL에서는 해당 원문을 복사서비스하고 있습니다. 아래의 원문복사신청 또는 장바구니담기를 통하여 원문복사서비스 이용이 가능합니다.

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  5. [해외논문]   Does nutrition play a role in the prevention and management of sarcopenia?  

    Robinson, S.M. , Reginster, J.Y. , Rizzoli, R. , Shaw, S.C. , Kanis, J.A. , Bautmans, I. , Bischoff-Ferrari, H. , Bruyè , re, O. , Cesari, M. , Dawson-Hughes, B. , Fielding, R.A. , Kaufman, J.M. , Landi, F. , Malafarina, V. , Rolland, Y. , van Loon, L.J. , Vellas, B. , Visser, M. , Cooper, C. , Al-Daghri, N. , Allepaerts, S. , Bauer, J. , Brandi, M.L. , Cederholm, T. , Cherubini, A. , Cruz Jentoft, A. , Laviano, A. , Maggi, S. , McCloskey, E.V. , Petermans, J. , Roubenoff, R. , Rueda, R.
    Clinical nutrition : official journal of the European Society of Parenteral and Enteral Nutrition v.37 no.4 ,pp. 1121 - 1132 , 2018 , 0261-5614 ,

    초록

    Summary There is a growing body of evidence that links nutrition to muscle mass, strength and function in older adults, suggesting that it has an important role to play both in the prevention and management of sarcopenia. This review summarises the discussions of a working group [ESCEO working group meeting 8th September 2016] that met to review current evidence and to consider its implications for preventive and treatment strategies. The review points to the importance of ‘healthier’ dietary patterns that are adequate in quality in older age, to ensure sufficient intakes of protein, vitamin D, antioxidant nutrients and long-chain polyunsaturated fatty acids. In particular, there is substantial evidence to support the roles of dietary protein and physical activity as key anabolic stimuli for muscle protein synthesis. However, much of the evidence is observational and from high-income countries. Further high-quality trials, particularly from more diverse populations, are needed to enable an understanding of dose and duration effects of individual nutrients on function, to elucidate mechanistic links, and to define optimal profiles and patterns of nutrient intake for older adults.

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    회원님의 원문열람 권한에 따라 열람이 불가능 할 수 있으며 권한이 없는 경우 해당 사이트의 정책에 따라 회원가입 및 유료구매가 필요할 수 있습니다.이동하는 사이트에서의 모든 정보이용은 NDSL과 무관합니다.

    NDSL에서는 해당 원문을 복사서비스하고 있습니다. 아래의 원문복사신청 또는 장바구니담기를 통하여 원문복사서비스 이용이 가능합니다.

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  6. [해외논문]   Late dinner impairs glucose tolerance in MTNR1B risk allele carriers: A randomized, cross-over study  

    Lopez-Minguez, Jesus (Department of Physiology, University of Murcia, Murcia Spain ) , Saxena, Richa (Department of Anesthesia, Critical Care and Pain Medicine, Center for Human Genetic Research, Massachusetts General Hospital and Harvard Medical School, Boston, USA ) , Bandí (Department of Physiology, University of Murcia, Murcia Spain ) , n, Cristina (Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, and Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA ) , Scheer, Frank A. (Department of Physiology, University of Murcia, Murcia Spain) , Garaulet, Marta
    Clinical nutrition : official journal of the European Society of Parenteral and Enteral Nutrition v.37 no.4 ,pp. 1133 - 1140 , 2018 , 0261-5614 ,

    초록

    Summary Background & aims Late-night dinner eating is associated with increased risk for type-2 diabetes. The underlying mechanism is unclear. One explanatory hypothesis is that the concurrence of elevated circulating melatonin and high glucose concentrations (characterizing late eating) leads to impaired glucose tolerance. However, to date no study has tested the influence of physiological melatonin concentrations on glucose-tolerance. The discovery of melatonin receptor MTNR1B as a diabetes risk gene provides evidence for a role of physiological levels of melatonin in glucose control. The aim of our study was to test the hypothesis that elevated endogenous melatonin concentrations worsen glucose control when eating late. Registered under ClinicalTrials.gov Identifier no. NCT03003936. Methods We performed a randomized, cross-over trial to compare glucose tolerance in the presence (late dinner) or absence (early dinner) of elevated physiological melatonin concentrations and we compared the results between homozygous carriers and non-carriers of the MTNR1B risk allele. Results The concurrence of meal timing with elevated endogenous melatonin concentrations resulted in impaired glucose tolerance. This effect was stronger in MTNR1B risk-carriers than in non-carriers. Furthermore, eating late significantly impaired glucose tolerance only in risk-carriers and not in the non-risk carriers. Conclusions The interaction of dinner timing with MTNR1B supports a causal role of endogenous melatonin in the impairment of glucose tolerance. These results suggest that moving the dinner to an earlier time may result in better glucose tolerance specially in MTNR1B carriers. Clinical trial registration https://clinicaltrials.gov/ct2/show/NCT03003936.

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    NDSL에서는 해당 원문을 복사서비스하고 있습니다. 아래의 원문복사신청 또는 장바구니담기를 통하여 원문복사서비스 이용이 가능합니다.

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  7. [해외논문]   Red blood cell membrane omega-3 fatty acid levels and physical performance: Cross-sectional data from the MAPT study  

    Fougè , re, Bertrand , de Souto Barreto, Philipe , Goisser, Sabine , Soriano, Gaë , lle , Guyonnet, Sophie , Andrieu, Sandrine , Vellas, Bruno , Vellas, Bruno , Guyonnet, Sophie , Carrié , , Isabelle , Brigitte, Lauré , ane , Faisant, Catherine , Lala, Franç , oise , Delrieu, Julien , Villars, Hé , lè , ne , Combrouze, Emeline , Badufle, Carole , Zueras, Audrey , Andrieu, Sandrine , Cantet, Christelle , Morin, Christophe , Van Kan, Gabor Abellan , Dupuy, Charlotte , Rolland, Yves , Caillaud, Cé , line , Ousset, Pierre-Jean , Fougè , re, Bertrand , Willis, Sherry , Belleville, Sylvie , Gilbert, Brigitte , Fontaine, Francine , Dartigues, Jean-Franç , ois , Marcet, Isabelle , Delva, Fleur , Foubert, Alexandra , Marie-Noë , lle-Cuffi, Sandrine Cerda , Costes, Corinne , Rouaud, Olivier , Manckoundia, Patrick , Quipourt, Valé , rie , Marilier, Sophie , Franon, Evelyne , Bories, Lawrence , Pader, Marie-Laure , Basset, Marie-France , Lapoujade, Bruno
    Clinical nutrition : official journal of the European Society of Parenteral and Enteral Nutrition v.37 no.4 ,pp. 1141 - 1144 , 2018 , 0261-5614 ,

    초록

    Summary Background & aims Studies have shown that omega-3 polyunsaturated fatty acids (PUFAs) are associated with brain, cardiovascular and immune function, as well as physical performance and bone health in older adults. So far, few studies have highlighted the associations between PUFA status and performance-based tests of physical function. To study the associations between the omega-3 index (red blood cell (RBC) membrane content of omega-3 PUFAs, such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)) and physical performance measured with the Short Physical Performance Battery (SPPB) in a sample of community-dwelling older adults. Design Cross-sectional study using the baseline data of the Multidomain Alzheimer's Disease Trial (MAPT), a randomized, placebo-controlled trial. Participants and measurements 1449 participants with available data on PUFAs were included. Omega-3 index and Short Physical Performance Battery (SPPB) scores were measured at enrollment and the omega-3 index expressed as the percentage of total fatty acid content was calculated. We also dichotomized the omega-3 index as low (lowest quartile) vs. high (three upper quartiles). Results Participants were 75.2 (±4.4) years old, 64.5% were female. Bivariate analyses found that participants who were in the lowest omega-3 index quartile (Q1) had a SPPB score significantly lower than participants in the three other quartiles (Q2–Q4). However, adjusted (for age, gender, cognitive function, depressive status, Body Mass Index and grip strength) multiple linear regression showed that the omega-3 index-SPPB score association did not reach statistical significance [β = −0.166; (−0.346; 0.013); p = 0.07] in our sample. Conclusion This cross-sectional study found that participants with a low omega-3 index had worse performance-based test results of physical function than people with a high omega-3 index, but this association did not reach statistical significance once confounders were controlled for. Studies looking at the over-time associations between PUFA status and physical performance changes may shed more light on this topic.

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    회원님의 원문열람 권한에 따라 열람이 불가능 할 수 있으며 권한이 없는 경우 해당 사이트의 정책에 따라 회원가입 및 유료구매가 필요할 수 있습니다.이동하는 사이트에서의 모든 정보이용은 NDSL과 무관합니다.

    NDSL에서는 해당 원문을 복사서비스하고 있습니다. 아래의 원문복사신청 또는 장바구니담기를 통하여 원문복사서비스 이용이 가능합니다.

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  8. [해외논문]   Changes of renal sinus fat and renal parenchymal fat during an 18-month randomized weight loss trial  

    Zelicha, Hila (Health Sciences, Ben-Gurion University of the Negev, P.O.B. 653, Beer-Sheva 8410501, Israel ) , Schwarzfuchs, Dan (Soroka University Medical Center, P.O.B. 151, Beer-Sheva 84101, Israel ) , Shelef, Ilan (Soroka University Medical Center, P.O.B. 151, Beer-Sheva 84101, Israel ) , Gepner, Yftach (Health Sciences, Ben-Gurion University of the Negev, P.O.B. 653, Beer-Sheva 8410501, Israel ) , Tsaban, Gal (Health Sciences, Ben-Gurion University of the Negev, P.O.B. 653, Beer-Sheva 8410501, Israel ) , Tene, Lilac (Health Sciences, Ben-Gurion University of the Negev, P.O.B. 653, Beer-Sheva 8410501, Israel ) , Yaskolka Meir, Anat (Health Sciences, Ben-Gurion University of the Negev, P.O.B. 653, Beer-Sheva 8410501, Israel ) , Bilitzky, Avital (Health Sciences, Ben-Gurion University of the Negev, P.O.B. 653, Beer-Sheva 8410501, Israel ) , Komy, Oded (Health Sciences, Ben-Gurion University of the Negev, P.O.B. 653, Beer-Sheva 8410501, Israel ) , Cohen, Noa (Health Sciences, Ben-Gurion University of the Negev, P.O.B. 653, Beer-Sheva 8410501, Israel ) , Bril, Nitzan (Health Sciences, Ben-Gurion University of the Negev, P.O.B. 653, Beer-Sheva 8410501, Israel ) , Rein, Michal (Health S) , Serfaty, Dana , Kenigsbuch, Shira , Chassidim, Yoash , Sarusi, Benjamin , Thiery, Joachim , Ceglarek, Uta , Stumvoll, Michael , Blü , her, Matthias , Haviv, Yosef S. , Stampfer, Meir J. , Rudich, Assaf , Shai, Iris
    Clinical nutrition : official journal of the European Society of Parenteral and Enteral Nutrition v.37 no.4 ,pp. 1145 - 1153 , 2018 , 0261-5614 ,

    초록

    Summary Background & aims Data regarding the role of kidney adiposity, its clinical implications, and its dynamics during weight-loss are sparse. We investigated the effect of long-term weight-loss induced intervention diets on dynamics of renal-sinus-fat, an ectopic fat depot, and %renal-parenchymal-fat, lipid accumulation within the renal parenchyma. Methods We randomized 278 participants with abdominal obesity/dyslipidemia to low-fat or Mediterranean/low-carbohydrate diets, with or without exercise. We quantified renal-sinus-fat and %renal-parenchymal-fat by whole body magnetic-resonance-imaging. Results Participants (age = 48 years; 89% men; body-mass-index = 31 kg/m 2 ) had 86% retention to the trial after 18 months. Both increased renal-sinus-fat and %renal-parenchymal-fat were directly associated with hypertension, and with higher abdominal deep-subcutaneous-adipose-tissue and visceral-adipose-tissue (p of trend Conclusions Renal-sinus-fat and renal-parenchymal-fat are fairly related to weight-loss. Decreased renal-sinus-fat is associated with improved hepatic parameters, independent of changes in weight or hepatic fat, rather than with improved renal function or blood pressure parameters. ClinicalTrials.govIdentifier NCT01530724.

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    NDSL에서는 해당 원문을 복사서비스하고 있습니다. 아래의 원문복사신청 또는 장바구니담기를 통하여 원문복사서비스 이용이 가능합니다.

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  9. [해외논문]   The impact of rate of weight loss on body composition and compensatory mechanisms during weight reduction: A randomized control trial  

    Coutinho, Sí (Obesity Research Group, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway ) , lvia Ribeiro (Obesity Research Group, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway ) , With, Emilie (Department of Clinical Biochemistry, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark ) , Rehfeld, Jens F. (Obesity Research Group, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway ) , Kulseng, Bå (Department of Food, Nutrition and Dietetics, Monash University, Melbourne, Australia ) , rd (Obesity Research Group, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway) , Truby, Helen , Martins, Cá , tia
    Clinical nutrition : official journal of the European Society of Parenteral and Enteral Nutrition v.37 no.4 ,pp. 1154 - 1162 , 2018 , 0261-5614 ,

    초록

    Summary Background & aims Rapid weight loss (WL) has been associated with a larger loss of fat free mass and a disproportional reduction in resting metabolic rate (RMR), but the evidence is inconclusive. We aimed to evaluate the impact of WL rate on body composition and compensatory mechanisms activated with WL (reduced RMR, increased exercise efficiency (ExEff) and appetite), both during negative and neutral energy balance (EB). Methods Thirty-five participants with obesity were randomized to lose a similar weight rapidly (4 weeks) or gradually (8 weeks), and afterwards to maintain it (4 weeks). Body weight and composition, RMR, ExEff (10, 25 and 50 W), appetite feelings and appetite-regulating hormones (active ghrelin, cholecystokinin, total peptide YY (PYY), active glucagon-like peptide-1 and insulin), in fasting and every 30 min up to 2.5 h, were measured at baseline and after each phase. Results Changes in body weight (≈9%) and composition were similar in both groups. With WL, RMR decreased and ExEff at 10 W increased significantly in the rapid WL group only. However, fasting hunger increased significantly with gradual WL only, while fasting and postprandial prospective food consumption, and postprandial hunger decreased (and postprandial fullness increased) significantly with rapid WL only. Basal total PYY, and basal and postprandial insulin decreased significantly, and similarly in both groups. After weight stabilization and no ketosis no differences between groups were found. Conclusions Despite differences while under negative EB, WL rate does not seem to have a significant impact on body composition or on compensatory mechanisms, once EB is reestablished. Clinical trial registration number NCT01912742 (the study was registered in clinicaltrial.gov).

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  10. [해외논문]   High dose amino acid administration achieves an anabolic response in type 2 diabetic patients that is independent of glycaemic control: A randomized clinical trial  

    Gillis, Chelsia (School of Dietetics and Human Nutrition, McGill University, Montreal, Canada ) , Roque, Patricia S. (School of Dietetics and Human Nutrition, McGill University, Montreal, Canada ) , Blä (Department of Anaesthesia, St. Clara Hospital, Basel, Switzerland ) , ss, Jü (Department for Anaesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Switzerland ) , rgen (Department of Anaesthesia, St. Clara Hospital, Basel, Switzerland ) , Urwyler, Albert (Department of Anaesthesia, St. Clara Hospital, Basel, Switzerland ) , Schepperle, Harald (Interdisciplinary Centre of Nutritional and Metabolic Diseases, St. Clara Hospital, Basel, Switzerland ) , Kunz, Guido (School of Dietetics and Human Nutrition, McGill University, Montreal, Canada ) , Peters, Thomas (School of Dietetics and Human Nutrition, McGill University, Montreal, Canada ) , Schricker, Thomas (Department for Anaesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Switzerland) , Wykes, Linda , Kopp Lugli, Andrea
    Clinical nutrition : official journal of the European Society of Parenteral and Enteral Nutrition v.37 no.4 ,pp. 1163 - 1171 , 2018 , 0261-5614 ,

    초록

    Summary Background & aims Surgical stress provokes protein catabolism and hyperglycaemia that is enhanced in patients with type 2 diabetes (T2DM), and increases perioperative morbidity. This study hypothesized that perioperative administration of high dose intravenous (IV) amino acids (AA) will augment protein balance in T2DM patients receiving tight plasma glucose control via continuous IV insulin compared to standard plasma glucose control via subcutaneous (SC) insulin sliding scale. Methods Eighteen patients with well-controlled T2DM (HbA1C% n = 9) or tight glucose control (4–6 mmol/l, IV insulin, n = 9). Both groups received general anaesthesia and epidural analgesia. AA (1 ml/kg h Aminoven™ 10%, ∼2.4 g/kg d) were infused via a peripheral vein for two 3-h periods: at the beginning of surgery and in the post-operative care unit. Whole-body protein and glucose kinetics were assessed by stable isotope tracers, L-[1- 13 C]leucine and [6,6- 2 H 2 ]glucose. Results Whole-body protein balance was positive after surgery in all patients. Since protein synthesis, breakdown and leucine oxidation were comparable in both groups, whole body protein balance was not different ( p = 0.605). Tight glucose control suppressed endogenous glucose production (EGP, p p Conclusion High-dose perioperative AA administration under optimal anti-catabolic care with epidural analgesia was effective in achieving a positive protein balance in T2DM patients undergoing surgery that was independent of glycaemic control strategy. Continuous IV insulin maintained normoglycaemia by inhibiting EGP and increasing glucose clearance. Improved glucose control, without a pronounced increase in protein balance with the intravenous insulin regimen, suggests perioperative protein metabolism may be less sensitive to insulin than is glucose.

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