title: Improved clinical status and length of care with low-fat nutrition support in burn patients.
abstract: BACKGROUND
  The optimal amount and type of fat in the nutrition support of burned patients have not been determined. The aim of this study was to test low-fat nutritional solutions, with or without fish oil, on protein metabolism, morbidity, and length of care in severely burned adults.
  
  
  METHODS
  In a prospective randomized clinical trial, 43 patients were assigned to one of the following groups: control (35% fat), low-fat solution (ie, 15% of total calories as fat), low-fat with fish oil, given for 30 days. Nitrogen balance, urinary 3-methylhistidine excretion, urinary cortisol, and clinical status were measured daily. Corticosteroid-binding globulin and total and free serum cortisol were measured every 3 days.
  
  
  RESULTS
  Compared with controls, patients on low-fat support had fewer cases of pneumonia: 3/24 vs 7/13 (p = .02), better respiratory and nutrition status, and shorter time to healing: 1.2 vs 1.8 days/% burned area (p = 0.01). There was no difference in nitrogen balance between groups, and 3-methylhistidine excretion was higher and serum free cortisol was lower in log-fat--fed patients than in controls. There was no difference between the two low-fat groups in any of the parameters measured.
  
  
  CONCLUSIONS
  This study showed that low-fat nutrition support decreases infectious morbidity and shortens length of stay in burn patients. Fish oil does not seem to add clinical benefit to low-fat solutions. In addition, this study provides the first evidence that nutrition intervention modulates cortisol-binding globulin and the concentration of free circulating cortisol after a severe stress.
authors: Hôtel-Dieu Hospital, Burn Center, University of Montréal Medical School, Québec, Canada.
authors: D R
authors: DR
authors: Garrel
authors: M
authors: M
authors: Razi
authors: F
authors: F
authors: Larivière
authors: N
authors: N
authors: Jobin
authors: N
authors: N
authors: Naman
authors: A
authors: A
authors: Emptoz-Bonneton
authors: M M
authors: MM
authors: Pugeat
mesh_terms: D000293:Adolescent; D000328:Adult; D002056:Burns / Q000628:therapy*; D004041:Dietary Fats / Q000008:administration & dosage*; D002149:Energy Intake; D004750:Enteral Nutrition; D015525:Fatty Acids, Omega-3 / Q000008:administration & dosage; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007902:Length of Stay; D008297:Male; D008762:Methylhistidines / Q000652:urine; D008875:Middle Aged; D009752:Nutritional Status; D010288:Parenteral Nutrition; D011446:Prospective Studies; D011506:Proteins / Q000378:metabolism
chemical_list: D004041:Dietary Fats; D015525:Fatty Acids, Omega-3; D008762:Methylhistidines; D011506:Proteins; C028118:3-methylhistidine; D006854:Hydrocortisone