Glucose-lipid ratio is a determinant of nitrogen balance during total parenteral nutrition in critically ill patients: a prospective, randomized, multicenter blind trial with an intention-to-treat analysis.
OBJECTIVE
Protein sparing, the major goal of nutritional support, may be affected by the glucose/lipid ratio. This study in critically ill patients compared the efficacy and tolerance of two isocaloric isonitrogenous total parenteral nutritions (TPN) having different glucose/lipid ratios.


METHODS
Multicentric prospective randomized study.


METHODS
47 patients with SAPS I score higher than 8 and requiring exclusive TPN.


METHODS
Patients received glucose/lipid ratios of 50/50 or 80/20. For 7 days all patients received 32 glucidolipidic kcal/kg and 0.27 g/kg nitrogen daily. All-in-one bags were prepared using industrial mixtures and a fat emulsion.


RESULTS
We determined TPN efficacy by nitrogen balance, urinary 3-methylhistidine/creatinine ratio, transthyretin and tolerance by glycemia, and liver enzymes. After controlling for five variables with significant effects, patients receiving the 50/50 ratio during TPN had significantly higher nitrogen balance than those receiving the 80/20 ratio. The daily difference in mean nitrogen sparing effect in favor of the latter group was 1.367 g (95% CI 0.0686-2.048). Glycemia on day 4 and gamma-glutamyltranspeptidase on day 8 were higher in group receiving the the 80/20 ratio.


CONCLUSIONS
In critically ill patients TPN at a glucose/lipid ratio of 80/20 ratio induces a small nitrogen sparing effect compared to the ratio of 50/50, at the expense of poorer glycemic control. The clinical significance is unclear.
Boulétreau
P
P
Department of Anesthesiology and Nutrition, CHU, Hôpital E Herriot, 69473, Lyon Cedex 03, France. paul.bouletreau@chu-lyon.fr
Chassard
D
D
Allaouchiche
B
B
Dumont
J C
JC
Auboyer
C
C
Bertin-Maghit
M
M
Bricard
H
H
Ecochard
R
R
Rangaraj
J
J
Chambrier
C
C
Schneid
C
C
Cynober
L
L
D003422:Critical Care; D004041:Dietary Fats / Q000008:administration & dosage / Q000378:metabolism*; D005260:Female; D005947:Glucose / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009584:Nitrogen / Q000378:metabolism*; D010289:Parenteral Nutrition, Total; D012720:Severity of Illness Index; D016037:Single-Blind Method
D004041:Dietary Fats; D005947:Glucose; D009584:Nitrogen