title: 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.
abstract: 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.
authors.affiliation: Department of Anesthesiology and Nutrition, CHU, Hôpital E Herriot, 69473, Lyon Cedex 03, France. paul.bouletreau@chu-lyon.fr
authors.forename: P
authors.initials: P
authors.lastname: Boulétreau
authors.forename: D
authors.initials: D
authors.lastname: Chassard
authors.forename: B
authors.initials: B
authors.lastname: Allaouchiche
authors.forename: J C
authors.initials: JC
authors.lastname: Dumont
authors.forename: C
authors.initials: C
authors.lastname: Auboyer
authors.forename: M
authors.initials: M
authors.lastname: Bertin-Maghit
authors.forename: H
authors.initials: H
authors.lastname: Bricard
authors.forename: R
authors.initials: R
authors.lastname: Ecochard
authors.forename: J
authors.initials: J
authors.lastname: Rangaraj
authors.forename: C
authors.initials: C
authors.lastname: Chambrier
authors.forename: C
authors.initials: C
authors.lastname: Schneid
authors.forename: L
authors.initials: L
authors.lastname: Cynober
mesh_terms: 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
chemical_list: D004041:Dietary Fats; D005947:Glucose; D009584:Nitrogen