A study of parenteral versus enteral nutrition following caecal ligation and puncture in the rat: Influence on survival and tissue protein turnover.
OBJECTIVE
Methods of nutritional management in abdominal sepsis remain controversial.


METHODS
Sprague Dawley rats were either fed via a central line in the right internal jugular vein or duodenally via a gastrostomy tube, and were randomised to undergo either caecal ligation and puncture (CLP) or laparotomy only. Post-operatively, animals received either parenteral nutrition, enteral nutrition or saline only (parenteral and enteral nutrition protocols were isocaloric and isonitrogenous). After 72 h, fractional rate of protein synthesis (Ks, %/day) was measured in gastrocnemius muscle and liver, and protein breakdown was measured in incubated epitrochlearis muscles. Serum insulin-like growth factor-I (IGF-I), acid-labile subunit (ALS) and IGF binding protein-1 (IGFBP-1) levels were determined by specific radioimmunoassay methods.


RESULTS
After CLP, when compared with starved animals, only enteral nutrition resulted in a significant decrease in survival to 72 h (P < 0.001). Parenteral nutrition, but not enteral nutrition, increased muscle (P = 0.02) and liver (P < 0.001) Ks, IGF-I (P < 0.001) and ALS levels (P < 0.001), whereas both parenteral and enteral nutrition reduced IGFBP-1 levels (P < 0.001). Neither enteral nor parenteral nutrition reduced protein breakdown in septic animals.


CONCLUSIONS
In this model of severe abdominal sepsis where gut function cannot be assessed, enteral nutrition was associated with increased mortality and was less effective than parenteral nutrition in augmenting muscle and liver protein synthesis.
Scarlett
Christopher J
CJ
Department of Surgery, Royal North Shore Hospital, University of Sydney, St Leonards NSW 2065, Australia.
O'leary
Michael J
MJ
Kee
Anthony J
AJ
Nielsen
Aiqun
A
Sevette
Andre
A
Baxter
Robert C
RC
Smith
Ross C
RC
D000818:Animals; D001424:Bacterial Infections / Q000378:metabolism / Q000628:therapy*; D002352:Carrier Proteins / Q000378:metabolism; D002429:Cecal Diseases / Q000378:metabolism / Q000628:therapy*; D004750:Enteral Nutrition / Q000009:adverse effects; D006023:Glycoproteins / Q000378:metabolism; D018970:Insulin-Like Growth Factor Binding Protein 1 / Q000378:metabolism; D007334:Insulin-Like Growth Factor I / Q000378:metabolism; D008099:Liver / Q000378:metabolism*; D008297:Male; D009124:Muscle Proteins / Q000378:metabolism*; D010288:Parenteral Nutrition; D011897:Random Allocation; D051381:Rats; D017207:Rats, Sprague-Dawley; D016019:Survival Analysis; D016896:Treatment Outcome
D002352:Carrier Proteins; D006023:Glycoproteins; D018970:Insulin-Like Growth Factor Binding Protein 1; D009124:Muscle Proteins; C075944:insulin-like growth factor binding protein, acid labile subunit; D007334:Insulin-Like Growth Factor I