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- Title
Glucose-lipid ratio is a determinant of nitrogen balance during total parenteral nutrition in critically ill patients: a prospective, randomized, multicenter blind trial with an intention-to-treat analysis.
- Authors
Boulétreau, P.; Chassard, D.; Allaouchiche, B.; Dumont, J.; Auboyer, C.; Bertin-Maghit, M.; Bricard, H.; Ecochard, R.; Rangaraj, J.; Chambrier, C.; Schneid, C.; Cynober, L.; Boulétreau, P; Dumont, J C
- Abstract
<bold>Objective: </bold>Protein sparing, the major goal of nutritional support, may be affected by the glucose/lipid ratio. This study in critically ill patients compared the efficacy and tolerance of two isocaloric isonitrogenous total parenteral nutritions (TPN) having different glucose/lipid ratios.<bold>Design: </bold>Multicentric prospective randomized study.<bold>Patients: </bold>47 patients with SAPS I score higher than 8 and requiring exclusive TPN.<bold>Interventions: </bold>Patients received glucose/lipid ratios of 50/50 or 80/20. For 7 days all patients received 32 glucidolipidic kcal/kg and 0.27 g/kg nitrogen daily. All-in-one bags were prepared using industrial mixtures and a fat emulsion.<bold>Measurements and Results: </bold>We determined TPN efficacy by nitrogen balance, urinary 3-methylhistidine/creatinine ratio, transthyretin and tolerance by glycemia, and liver enzymes. After controlling for five variables with significant effects, patients receiving the 50/50 ratio during TPN had significantly higher nitrogen balance than those receiving the 80/20 ratio. The daily difference in mean nitrogen sparing effect in favor of the latter group was 1.367 g (95% CI 0.0686-2.048). Glycemia on day 4 and gamma-glutamyltranspeptidase on day 8 were higher in group receiving the the 80/20 ratio.<bold>Conclusions: </bold>In critically ill patients TPN at a glucose/lipid ratio of 80/20 ratio induces a small nitrogen sparing effect compared to the ratio of 50/50, at the expense of poorer glycemic control. The clinical significance is unclear.
- Subjects
TOTAL parenteral feeding; CRITICAL care medicine; CRITICALLY ill; ARTIFICIAL feeding; PARENTERAL therapy; NUTRITION; NITROGEN metabolism; COMPARATIVE studies; FAT content of food; GLUCOSE; RESEARCH methodology; MEDICAL cooperation; RESEARCH; STATISTICAL sampling; EVALUATION research; RANDOMIZED controlled trials; BLIND experiment; SEVERITY of illness index
- Publication
Intensive Care Medicine, 2005, Vol 31, Issue 10, p1394
- ISSN
0342-4642
- Publication type
journal article
- DOI
10.1007/s00134-005-2771-5