Intravenous carbohydrate over-feeding: a method for rapid nutritional repletion.
Forty-four measurements of resting energy expenditure (REE) and respiratory quotient (RQ), and sequential measurements of body composition and nitrogen excretion were made in a cachectic male patient with inactive Crohn's disease, who was repleted with intravenous nutrition alone, over a period of 62 days. The initial energy intake (EI) of 10 MJ/day was increased to 21 MJ/day by three stepwise increments ( approximately 4MJ) in the glucose content of the feed. REE increased from 4.2 to 6.8 kJ/min, and body weight from 53 to 76kg. REE rose by a progressively greater amount with each increment in energy intake (DeltaREE DeltaEl = 0.12 to 0.26 ). The RQ increased progressively to a value up to 1.19 and persisted above 1.0 even 9h after the feed was stopped. The results suggest that the increase in REE a) was due to a combination of increasing lean body mass and increasing diet-induced thermogenesis, b) dissipated only a small proportion of the total energy infused, and c) was associated with net lipid synthesis from carbohydrate whilst on and off the feed. The results are discussed in relation to the energy equivalent of ATP and the circulating concentrations of insulin and the flux of substrates across forearm tissue.
Pullicino
E
E
Dunn Clinical Nutrition Unit, 100 Tennis Court Road, Cambridge CB2 1QL, UK.
Elia
M
M