The impact of parenteral nutrition on the body composition of patients with acute pancreatitis.
BACKGROUND
Nutrition support by the enteral route is now the preferred modality in patients with severe acute pancreatitis. Parenteral nutrition is now required to supplement enteral nutrition when the latter is not able to provide the full nutritional requirement. We report the changes in body composition, plasma proteins, and resting energy expenditure (REE) during 14 days of parenteral nutrition (PN) in patients with acute pancreatitis.


METHODS
Total body protein (TBP), total body water (TBW), and total body fat (TBF) were measured by neutron activation analysis and tritium dilution before and after PN. Fat-free mass (FFM) was derived as the difference between body weight and TBF. REE was measured by indirect calorimetry. Protein index (PI) was the ratio of measured TBP to TBP, calculated from healthy volunteers.


RESULTS
Fifteen patients with acute pancreatitis (11 men, 4 women; median age 56, range 30-80 years) were studied. Thirteen patients had severe acute pancreatitis (Atlanta criteria), and 1 patient died. The gains in body weight (1.05 +/- 0.77 kg), TBW (0.49 +/- 0.87 kg), TBP (0.20 +/- 0.22 kg), FFM (0.73 +/- 0.92 kg), TBF (0.32 +/- 0.95 kg), and REE (146 +/- 90 kcal/d) after 14 days of PN were not significant. Plasma prealbumin increased by 46.5% (p = .020). When patients (n = 6) with intercurrent sepsis and recent surgery were excluded, there were significant increases in TBP (0.65 +/- 0.17 kg, p = .005) and PI (0.060 +/- 0.011, p = .0006).


CONCLUSIONS
Body composition is preserved in acute pancreatitis during 14 days of PN. In patients without sepsis or recent surgery, PN is able to significantly increase body protein stores.
Chandrasegaram
Manju D
MD
Department of Surgery, University of Auckland, Auckland, New Zealand.
Plank
Lindsay D
LD
Windsor
John A
JA
D000208:Acute Disease; D000273:Adipose Tissue / Q000378:metabolism; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001481:Basal Metabolism / Q000502:physiology*; D001798:Blood Proteins / Q000378:metabolism*; D001823:Body Composition / Q000502:physiology*; D001834:Body Water / Q000378:metabolism; D002153:Calorimetry, Indirect; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000378:metabolism* / Q000601:surgery / Q000628:therapy*; D010288:Parenteral Nutrition; D016896:Treatment Outcome
D001798:Blood Proteins