Early postoperative enteral nutrition improves peripheral protein kinetics in upper gastrointestinal cancer patients undergoing complete resection: A randomized trial

Lawrence Harrison, Steven N. Hochwald, Martin J. Heslin, Russell Berman, Michael Burt, Murray F. Brennan

Research output: Contribution to journalArticle

41 Citations (Scopus)

Abstract

Background: Patients with upper gastrointestinal (GI) tract malignancies are at risk for malnutrition and postoperative morbidity and mortality. We examined the protein kinetic effects of early enteral feeding in this population and compared it with results in patients receiving IV fluid. Methods: Twenty-nine patients undergoing resection of an upper GI tract malignancy were prospectively randomized to either enteral feeding starting on postoperative day (POD) 1 via a jejunostomy tube (FEED, n = 12) or IV fluid (IVF, n = 17). On POD5, all patients underwent a protein metabolic study using [3Hlphenylalanine to determine forearm skeletal muscle (nmol phenylalanine/100 g/min) protein net balance. Free fatty acids (FFA, mEq/dL) and insulin levels (mU/mL) were measured. Results: Protein net balance was significantly less negative in the FEED group compared with the IVF group (- 1.4 ± 0.8 vs -5.0 ± 1.4, p < .05). Respiratory quotient was significantly increased in patients receiving enteral feeding (0.85 ± 0.02 vs 0.78 ± 0.02 FEED vs IVF, p < .05). FFA levels were significantly decreased in the FEED group (0.36 ± 0.04 vs 0.85± 0.07, p < .05). Insulin levels were significantly elevated in the FEED group (19.8 ± 4.5 vs 9.3 ± 0.8, p < .05). Insulin levels correlated with amino acid fluxes. Conclusions: Postoperative enteral nutrition in upper GI cancer patients results in an improvement in protein kinetic net balance and amino acid flux across peripheral tissue. In addition, insulin levels are elevated, and this elevation correlates with amino fluxes across the forearm. By improving peripheral protein kinetics, early postoperative enteral nutrition may potentially contribute to a decrease in postoperative morbidity and mortality in upper gastrointestinal cancer patients.

Original languageEnglish (US)
Pages (from-to)202-207
Number of pages6
JournalJournal of Parenteral and Enteral Nutrition
Volume21
Issue number4
DOIs
StatePublished - Jan 1 1997
Externally publishedYes

Fingerprint

Gastrointestinal Neoplasms
Enteral Nutrition
Proteins
Insulin
Upper Gastrointestinal Tract
Forearm
Jejunostomy
Morbidity
Amino Acids
Mortality
Phenylalanine
Nonesterified Fatty Acids
Malnutrition
Neoplasms
Skeletal Muscle
Population

All Science Journal Classification (ASJC) codes

  • Medicine (miscellaneous)
  • Nutrition and Dietetics

Cite this

@article{aa639c93cc5244bfbc8af7cdb577aff1,
title = "Early postoperative enteral nutrition improves peripheral protein kinetics in upper gastrointestinal cancer patients undergoing complete resection: A randomized trial",
abstract = "Background: Patients with upper gastrointestinal (GI) tract malignancies are at risk for malnutrition and postoperative morbidity and mortality. We examined the protein kinetic effects of early enteral feeding in this population and compared it with results in patients receiving IV fluid. Methods: Twenty-nine patients undergoing resection of an upper GI tract malignancy were prospectively randomized to either enteral feeding starting on postoperative day (POD) 1 via a jejunostomy tube (FEED, n = 12) or IV fluid (IVF, n = 17). On POD5, all patients underwent a protein metabolic study using [3Hlphenylalanine to determine forearm skeletal muscle (nmol phenylalanine/100 g/min) protein net balance. Free fatty acids (FFA, mEq/dL) and insulin levels (mU/mL) were measured. Results: Protein net balance was significantly less negative in the FEED group compared with the IVF group (- 1.4 ± 0.8 vs -5.0 ± 1.4, p < .05). Respiratory quotient was significantly increased in patients receiving enteral feeding (0.85 ± 0.02 vs 0.78 ± 0.02 FEED vs IVF, p < .05). FFA levels were significantly decreased in the FEED group (0.36 ± 0.04 vs 0.85± 0.07, p < .05). Insulin levels were significantly elevated in the FEED group (19.8 ± 4.5 vs 9.3 ± 0.8, p < .05). Insulin levels correlated with amino acid fluxes. Conclusions: Postoperative enteral nutrition in upper GI cancer patients results in an improvement in protein kinetic net balance and amino acid flux across peripheral tissue. In addition, insulin levels are elevated, and this elevation correlates with amino fluxes across the forearm. By improving peripheral protein kinetics, early postoperative enteral nutrition may potentially contribute to a decrease in postoperative morbidity and mortality in upper gastrointestinal cancer patients.",
author = "Lawrence Harrison and Hochwald, {Steven N.} and Heslin, {Martin J.} and Russell Berman and Michael Burt and Brennan, {Murray F.}",
year = "1997",
month = "1",
day = "1",
doi = "10.1177/0148607197021004202",
language = "English (US)",
volume = "21",
pages = "202--207",
journal = "Journal of Parenteral and Enteral Nutrition",
issn = "0148-6071",
publisher = "SAGE Publications Inc.",
number = "4",

}

Early postoperative enteral nutrition improves peripheral protein kinetics in upper gastrointestinal cancer patients undergoing complete resection : A randomized trial. / Harrison, Lawrence; Hochwald, Steven N.; Heslin, Martin J.; Berman, Russell; Burt, Michael; Brennan, Murray F.

In: Journal of Parenteral and Enteral Nutrition, Vol. 21, No. 4, 01.01.1997, p. 202-207.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Early postoperative enteral nutrition improves peripheral protein kinetics in upper gastrointestinal cancer patients undergoing complete resection

T2 - A randomized trial

AU - Harrison, Lawrence

AU - Hochwald, Steven N.

AU - Heslin, Martin J.

AU - Berman, Russell

AU - Burt, Michael

AU - Brennan, Murray F.

PY - 1997/1/1

Y1 - 1997/1/1

N2 - Background: Patients with upper gastrointestinal (GI) tract malignancies are at risk for malnutrition and postoperative morbidity and mortality. We examined the protein kinetic effects of early enteral feeding in this population and compared it with results in patients receiving IV fluid. Methods: Twenty-nine patients undergoing resection of an upper GI tract malignancy were prospectively randomized to either enteral feeding starting on postoperative day (POD) 1 via a jejunostomy tube (FEED, n = 12) or IV fluid (IVF, n = 17). On POD5, all patients underwent a protein metabolic study using [3Hlphenylalanine to determine forearm skeletal muscle (nmol phenylalanine/100 g/min) protein net balance. Free fatty acids (FFA, mEq/dL) and insulin levels (mU/mL) were measured. Results: Protein net balance was significantly less negative in the FEED group compared with the IVF group (- 1.4 ± 0.8 vs -5.0 ± 1.4, p < .05). Respiratory quotient was significantly increased in patients receiving enteral feeding (0.85 ± 0.02 vs 0.78 ± 0.02 FEED vs IVF, p < .05). FFA levels were significantly decreased in the FEED group (0.36 ± 0.04 vs 0.85± 0.07, p < .05). Insulin levels were significantly elevated in the FEED group (19.8 ± 4.5 vs 9.3 ± 0.8, p < .05). Insulin levels correlated with amino acid fluxes. Conclusions: Postoperative enteral nutrition in upper GI cancer patients results in an improvement in protein kinetic net balance and amino acid flux across peripheral tissue. In addition, insulin levels are elevated, and this elevation correlates with amino fluxes across the forearm. By improving peripheral protein kinetics, early postoperative enteral nutrition may potentially contribute to a decrease in postoperative morbidity and mortality in upper gastrointestinal cancer patients.

AB - Background: Patients with upper gastrointestinal (GI) tract malignancies are at risk for malnutrition and postoperative morbidity and mortality. We examined the protein kinetic effects of early enteral feeding in this population and compared it with results in patients receiving IV fluid. Methods: Twenty-nine patients undergoing resection of an upper GI tract malignancy were prospectively randomized to either enteral feeding starting on postoperative day (POD) 1 via a jejunostomy tube (FEED, n = 12) or IV fluid (IVF, n = 17). On POD5, all patients underwent a protein metabolic study using [3Hlphenylalanine to determine forearm skeletal muscle (nmol phenylalanine/100 g/min) protein net balance. Free fatty acids (FFA, mEq/dL) and insulin levels (mU/mL) were measured. Results: Protein net balance was significantly less negative in the FEED group compared with the IVF group (- 1.4 ± 0.8 vs -5.0 ± 1.4, p < .05). Respiratory quotient was significantly increased in patients receiving enteral feeding (0.85 ± 0.02 vs 0.78 ± 0.02 FEED vs IVF, p < .05). FFA levels were significantly decreased in the FEED group (0.36 ± 0.04 vs 0.85± 0.07, p < .05). Insulin levels were significantly elevated in the FEED group (19.8 ± 4.5 vs 9.3 ± 0.8, p < .05). Insulin levels correlated with amino acid fluxes. Conclusions: Postoperative enteral nutrition in upper GI cancer patients results in an improvement in protein kinetic net balance and amino acid flux across peripheral tissue. In addition, insulin levels are elevated, and this elevation correlates with amino fluxes across the forearm. By improving peripheral protein kinetics, early postoperative enteral nutrition may potentially contribute to a decrease in postoperative morbidity and mortality in upper gastrointestinal cancer patients.

UR - http://www.scopus.com/inward/record.url?scp=0030839820&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0030839820&partnerID=8YFLogxK

U2 - 10.1177/0148607197021004202

DO - 10.1177/0148607197021004202

M3 - Article

C2 - 9252945

AN - SCOPUS:0030839820

VL - 21

SP - 202

EP - 207

JO - Journal of Parenteral and Enteral Nutrition

JF - Journal of Parenteral and Enteral Nutrition

SN - 0148-6071

IS - 4

ER -