ABSTRACT
Thirty to 50% of very low-birth-weight infants have parenteral nutrition-associated cholestasis. To test the hypothesis that the incidence of cholestasis would be decreased if parenteral amino acids were avoided and protein given enterally, infants with a gestational age of less than 30 weeks were randomized to two groups. One group received amino acid-free parenteral nutrition and whey protein enterally with added premature infant formula. The control group received standard parenteral nutrition with amino acids and enteral premature formula. At the end of 3 weeks of parenteral nutrition, infants who had a direct serum bilirubin level of greater than 3 mg/dl were considered to have significant cholestasis. Twenty-nine infants required parenteral nutrition for 3 weeks, 17 in the whey group and 12 in the control group. No instances of significant cholestasis were observed in the whey group (0/17), whereas seven of 12 infants (58%) in the amino acid control group had cholestasis (p less than 0.001).
Subject(s)
Cholestasis/prevention & control , Enteral Nutrition , Infant, Low Birth Weight/metabolism , Parenteral Nutrition, Total/adverse effects , Proteins/administration & dosage , Amino Acids/administration & dosage , Cholestasis/etiology , Evaluation Studies as Topic , Humans , Infant , Infant, NewbornABSTRACT
Fifty-eight nondiabetic maintenance hemodialysis patients entered a continuing nutrition survey. Eighteen were followed at 6 and 18 months. Protein-calorie malnutrition was measured by diet survey, laboratory data, and anthropometric measurements. Of patients 50% ate less proteins/calories than prescribed. Triceps skinfold thickness, transferrin, and total lymphocyte count were subnormal in 72, 81, and 69% of patients, respectively. Weight/height ratio, body mass index, arm muscle circumference, and serum albumin were normal in most. Of the patients 62% had greater than three subnormal nutrition measurements. Only two had all measures normal. Longitudinally there was little change in the patients followed up to 18 months. The study shows that protein-calorie malnutrition is widespread in stable maintenance hemodialysis patients.
