High-fat enteral nutrition reduces endotoxin, tumor necrosis factor-alpha and gut permeability in bile duct-ligated rats subjected to hemorrhagic shock.
OBJECTIVE
Cholestatic patients are prone to septic complications after major surgery due to an increased susceptibility to endotoxin and hypotension. High-fat enteral nutrition reduces endotoxin after hemorrhagic shock. However, it is unknown whether this nutritional intervention is protective in biliary obstruction. We investigated the effect of high-fat enteral nutrition on endotoxin, tumor necrosis factor-alpha (TNF-alpha) and intestinal permeability in cholestatic rats subjected to hemorrhagic shock.


METHODS
Bile duct-ligated (BDL) rats were fasted or fed with low-fat or high-fat enteral nutrition before hemorrhagic shock. Blood and tissue samples were taken after 90 min.


RESULTS
Plasma endotoxin decreased after hemorrhagic shock in BDL-rats fed with high-fat nutrition compared to fasted (P<0.01) and low-fat treated rats (P<0.05). Additionally, circulating TNF-alpha was reduced in BDL-rats pretreated with high-fat nutrition compared to fasted rats (P<0.01). The increased intestinal permeability to macromolecules was reduced by high-fat enteral nutrition, whereas bacterial translocation did not significantly change. Simultaneously, tight junction distribution in ileum and colon was disrupted in non-treated BDL-rats but remained unchanged in high-fat pretreated BDL-rats.


CONCLUSIONS
High-fat enteral nutrition protects against endotoxin-mediated complications independently of intraluminal bile. These results provide a potential new strategy to prevent endotoxin-mediated complications in cholestatic patients undergoing major surgery.
Luyer
Misha D P
MD
Department of Surgery, Nutrition and Toxicology Research Institute Maastricht (NUTRIM), University of Maastricht, University Hospital, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
Buurman
Wim A
WA
Hadfoune
M'hamed
M
Jacobs
Jan A
JA
Dejong
Cornelis H C
CH
Greve
Jan Willem M
JW
D000818:Animals; D004041:Dietary Fats / Q000008:administration & dosage*; D004731:Endotoxins / Q000097:blood; D004750:Enteral Nutrition; D041981:Gastrointestinal Tract / Q000503:physiopathology; D006801:Humans; D007408:Intestinal Absorption; D041781:Jaundice, Obstructive / Q000150:complications / Q000178:diet therapy / Q000601:surgery; D008297:Male; D010539:Permeability; D011183:Postoperative Complications / Q000517:prevention & control; D051381:Rats; D017207:Rats, Sprague-Dawley; D012771:Shock, Hemorrhagic / Q000150:complications / Q000178:diet therapy* / Q000503:physiopathology; D014280:Triglycerides / Q000097:blood; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism
D004041:Dietary Fats; D004731:Endotoxins; D014280:Triglycerides; D014409:Tumor Necrosis Factor-alpha