Percent body fat in obese white females predicted by anthropometric measurements.

The percent body fat (PBF) and 15 anthropometric measurements were measured in 221 obese white females randomly assigned to validation and cross-validation groups. Two new anthropometric equations for the prediction of the percent of body fat were generated by multiple regression. Equation 1 includes the residual lung volume (RV) as a factor and had a correlation coefficient (r) of 0.85 and a standard error of the estimate (SEE) of 3.9%. Equation 2 does not include the RV and has an r of 0.82 and an SEE of 4.3%. Both equations were more precise than two previous widely used equations. In a subgroup of 37 subjects who underwent weight loss, equation 1 gave a more precise estimate of the change in PBF. We conclude that the new equations permit a better prediction of the PBF in obese white females.

Microbial growth in clinically used enteral delivery systems.

Potential contamination of enteral formulas has led to the development of policies limiting formula hangtimes. However, enteral administration bags can easily become contaminated during formula refilling. We prospectively studied enteral formula contamination when the hangtime of a prefilled 1000 ml pouch was compared with the standard 4-hour hangtime of a refilled enteral administration bag. Samples of formula collected from different locations along the enteral delivery system were cultured during 57 days of enteral hyperalimentation in 19 patients. The overall enteral formula contamination rate was 61%, where the greatest microbial growth occurred in reconstituted enteral formulas. The presence of microbial growth did not differ between canned formulas administered according to a 4-hour hangtime and the prefilled pouch. Greatest growth in all cases was at the distal tubing hub, where contamination during system manipulation or from the patient probably occurred. Use of prefilled enteral administration bags may delay formula contamination in the administration reservoir. A change in equipment design that would decrease the need to manipulate feeding sets or feeding tube connections should be further investigated.

Enhancing enteral nutrition delivery: development of an enteral preparation facility.

As a result of prospective reimbursement, departments of clinical dietetics must define and maintain the nutrition services offered in the most cost-effective manner. The processing, preparation, and provision of quality enteral hyperalimentation to patients provide an example of a nutrition service in which cost-saving measures can be employed. Saint Vincent Charity Hospital and Health Center, Cleveland, decided to evaluate and increase the efficiency of tube-feeding preparation, delivery, inventory, and purchasing because of an increased demand for those services. The evaluation process resulted in the development of an enteral preparation facility, a specialty kitchen located within the foodservice department, specifically designed for cost-effective preparation and dispensation of all enteral formulas. The effort required physical space reallocation and personnel retraining. Implementation of the enteral preparation facility has resulted in improved quality of enteral nutrition services and has significantly aided nutrition support and cost-containment efforts at the hospital.

Microbial growth comparisons of five commercial parenteral lipid emulsions.

The ability of parenteral lipid emulsions to support microbial growth was compared using commercially available brands of lipid emulsion. Both 10 and 20% concentrations of soybean and safflower oil emulsions were used. Washed cultures of six gram-negative, three gram-positive, and one yeast, in concentrations of 1 x 10(4) to 2 x 10(4) colony-forming units/ml, were inoculated into lipid emulsion aliquots and stored at room temperature. There were than subcultured at 0, 6, 12, 24 and 48 hr. After 48 hr at 37 degrees C, growth was recorded as colony-forming units/ml. Normalized growth curves were expressed as mean +/- SEM. ANOVA demonstrated no difference in growth patterns due to the nature of the oil or its concentration. Gram-negative organisms multiplied faster when compared to gram-positive (p less than 0.05 at 12 hr, p less than 0.01 at 24 hr, and p less than 0.005 at 48 hr). Yeast grew as well as bacteria. The Center for Disease Control's recommendation of a 12-hr hang time for parenteral lipid emulsions should be observed until correlation of laboratory microbial growth patterns and clinical use are studied further.

Selenium deficiency with total parenteral nutrition: reversal of biochemical and functional abnormalities by selenium supplementation: a case report.

A patient with multiple intestinal fistulae maintained on total parenteral nutrition for 18 months developed low serum selenium. Erythrocyte glutathione peroxidase activity was 6% of normal. Erythrocytes were not able to metabolize H2O2 as well as those from controls, although the hexose monophosphate shunt itself was intact. Granulocytes from this patient had 15% of the erythrocyte glutathione peroxidase activity found in normals. Patient granulocytes were not able to metabolize H2O2 as well as controls, although the hexose monophosphate shunt was intact. Erythrocyte glutathione peroxidase-deficient granulocytes incubated with a respiratory burst stimulant, phorbol myristate acetate, had only 60% of the hexose monophosphate shunt activity present in control granulocytes. These abnormalities were reversed with selenium supplementation. Bacterial killing of Staphylococcus aureus 502A and cardiac function were not affected by selenium deficiency. Thus, selenium deficiency resulted in biochemical and functional abnormalities of erythrocytes and granulocytes. These abnormalities were reversed with selenium supplementation.

Alternate dietary lifestyles.

Various forms of vegetarian diets are discussed and evaluated for their nutritional adequacy. Health, philosophical, religious, ecological, and economic concerns are suggested as possible reasons for these alternate dietary lifestyles. Nutrients of specific concern ot the vegetarian are highlighted and suggestions given to help incorporate these in the diet, thereby avoiding marginal intakes. With judicious menu planning and careful thought to food selections, most vegetarian diets can supply excellent nutrition. Very restricted vegetarian diets or higher level macrobiotic diets may not be nutritionally complete, and individuals following these diets may benefit from special dietary counseling and dietary supplementation. Otherwise, these diets may place the adult as well as pregnant and lactating women, infants, and children at a nutritional risk. As vegetarian food habits are becoming more widespread, physicians and nutritionists must be knowledgeable about these alternate dietary lifestyles in order to counsel their patients appropriately, to understand the reasons for these eating habits, and to be supportive of the choice of diet.

Performance evaluation of a new nasogastric feeding tube.

A performance evaluation of a new polyurethane nasogastric feeding tube and stainless steel stylette (Nutriflex, No 8 French) was conducted at University Hospital. Thirty-eight tubes were successfully placed in 18 patients. Tubes remained in place less than 1-29 days and feedings were administered for a total of 196 patient days. Enteral formulas commonly available were administered via continuous drip. The tube use was surveyed for ease of insertion primarily; however, patency and comfort to the patient were felt to be positive with the use of this tube. With slight modifications the new feeding tube is a welcome addition to the expanding technology associated with enteral feedings.