ABSTRACT
Up to the present time medium chain triglycerides (MCT) have been applied solely for the enteral nutrition of newborn infants. Results of the oxidative utilization of parenterally applicated MCT have not yet been published. We therefore investigated the MCT oxidation with the 13C trioctanoin breath test in neonates. The patients received parenterally 10 mg/kg MCT (1-13C3 trioctanoin) enriched with the stable isotope 13C and emulsified with MCT/LCT 10%. The expired 13CO2 resulting from fat oxidation was determined by a ratio-mass-spectrometer. The 13C content of exhaled air represents the rate of fatty acid oxidation. Within the test period the fatty acid oxidation showed a clear dependency on the simultaneous carbohydrate supply. The oxidation rates of MCT were about twice als high as those of long chain triglycerides (LCT). On account of their high energetic level, MCT-containing emulsions are, in principle, also suitable for the parenteral nutrition of newborn infants.
Subject(s)
Breath Tests/methods , Caprylates , Respiratory Distress Syndrome, Newborn/metabolism , Triglycerides/metabolism , Energy Metabolism , Female , Humans , Infant, Newborn , Male , Oxidation-Reduction , Parenteral NutritionSubject(s)
Fat Emulsions, Intravenous/metabolism , Infant, Newborn/metabolism , Infant, Premature/metabolism , Triglycerides/metabolism , Breath Tests , Caprylates , Fat Emulsions, Intravenous/administration & dosage , Fatty Acids/metabolism , Humans , Infusions, Intravenous , Oxidation-Reduction , Parenteral Nutrition , Triglycerides/administration & dosageABSTRACT
The branched-chain amino acid leucine plays an important role in the protein metabolism of human beings. It not only inhibits protein degradation but also stimulates protein synthesis. The oxidation rate of leucine and the influence which nutritional conditions have on this amino acid can be measured with the intravenous 13C-leucine breath test. In order the apply the breath test on newborn infants, the required dosage of L-(1-13C)-leucine and the reproducibility of the test had, firstly, to be determined. Following this, the extent to which the leucine oxidation rate was influenced by a simultaneous carbohydrate intake was investigated. An evident discrimination between the 13CO2-exhalation and the 13CO2-baseline exhalation is demonstrated after a bolus injection of 1 mg L-(1-13C)-leucine/kg B.W. We were able to measure reproducible values of the leucine oxidation rate in newborn infants with a tracer dosage of 4 mg L-(1-13C)-leucine/kg B.W. We found that a higher intake of carbohydrate given at the same time produced a lower rate of leucine oxidation, which indicates increased utilization of leucine for the benefit of protein synthesis.
Subject(s)
Breath Tests/methods , Dietary Carbohydrates/administration & dosage , Infant, Newborn/metabolism , Leucine/metabolism , Carbon Radioisotopes , Humans , Infant , Oligosaccharides/administration & dosage , Oxidation-Reduction , Proteins/metabolismABSTRACT
Lipid infusion in low-birth-weight infants suffering from sepsis is still controversial. Consequently, we investigated the fat tolerance in six low-birth-weight infants with sepsis and 15 low-birth-weight infants without sepsis. For measurement of fat clearance, we assayed the serum concentrations of triglycerides enzymatically, and of the free fatty acids by colorimetric micromethod. The fatty acid oxidation was analyzed with the [13C]triolein breath test by means of ratio-mass spectrometry. The infants were maintained on continuous parenteral nutrition with various amounts of soybean oil emulsion (1 g, 2 g, and 3 g fat/kg body weight per day). Comparing the lipid infusion of 1 and 2 g fat/kg body weight per day between the two groups, we found triglyceride and free fatty acid values in both groups to be in the normal range. At a dose of 3 g of fat/kg body weight per day, septic low-birth-weight infants showed a significantly higher concentration of triglycerides (2.02 +/- 0.46 mmol/liter) and of free fatty acids (2.06 +/- 0.45 mmol/liter) than the nonseptic low-birth-weight infants (triglycerides: 1.09 +/- 0.43 mmol/liter; free fatty acids: 1.05 +/- 0.41 mmol/liter). The low-birth-weight infants with sepsis showed a reduced fat oxidation rate of 16.0 +/- 1.5% in contrast to that of the low-birth-weight infants without sepsis, whose rate was 38.4 +/- 1.8%. Accordingly, we apply dosages not exceeding 2 g of fat/kg body weight per day to septic low-birth-weight infants.
Subject(s)
Fat Emulsions, Intravenous/metabolism , Infant, Low Birth Weight , Infant, Premature, Diseases/metabolism , Parenteral Nutrition, Total , Sepsis/metabolism , Fat Emulsions, Intravenous/administration & dosage , Fatty Acids, Nonesterified/blood , Fatty Acids, Nonesterified/metabolism , Humans , Infant, Newborn , Infant, Premature, Diseases/therapy , Sepsis/therapy , Triglycerides/bloodABSTRACT
The elimination of parenterally administered lipids from the bloodstream of premature infants can be accelerated by activation of the lipoprotein-lipase using heparin. We have no evidence that the free fatty acids increasing under enhanced lipolytical activity are utilized for energy production. For this reason, the oxidation rates of intravenously administered lipids in premature infants are examined both with and without heparin. Triolein marked with 13C and processed in soybean oil is administered intravenously at a dosage of 10 mg/kg. 13CO2 results from fatty acid oxidation and is exhaled through the lungs, whereafter it is collected in separate breath samples over a period of 6 hours and determined by mass spectrometry. The examination was performed in 5 premature infants, first without heparin, then after heparin injection (10 U/kg). The extent of 13CO2 exhalation was not significantly influenced by heparin. Without heparin supply we measured a fatty acid oxidation of 32.0 +/- 2.57% which was the same (31.6 +/- 2.34%) after heparin injection. Single intravenous administration of 10 U heparin/kg does not cause increased fatty acid oxidation in premature infants.
