Cross-sectional and longitudinal nutritional measurements in maintenance hemodialysis patients.

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.

Proximal muscle weakness and selenium deficiency associated with long term parenteral nutrition.

A 33-yr-old white female with short bowel syndrome secondary to trauma was maintained on home parenteral nutrition for 4 yr when her plasma, red cell, white cell, and platelet glutathione peroxidase (GSHPx) activities were found to be extremely low, as were her plasma and red cell selenium levels. During her first year on parenteral nutrition she noted the onset of an inability to rise from a squatting position, rapid tiring when stair climbing, and weakness when attempting to lift large or moderately heavy objects. Treatment with 400 micrograms/d of selenious acid intravenously was associated with a disappearance of her symptoms and an increase in proximal muscle strength within 6 wk. The plasma and red cell selenium levels, and the plasma and white cell GSHPx activities rose to normal levels within 6 wk. Red cell GSHPx activity returned to normal by 3 mo.

Decreased cholestasis with enteral instead of intravenous protein in the very low-birth-weight infant.

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).