title: Effects of a diabetes-specific enteral nutrition on nutritional and immune status of diabetic, obese, and endotoxemic rats: interest of a graded arginine supply.
abstract: OBJECTIVE
  Obese and type 2 diabetic patients present metabolic disturbance-related alterations in nonspecific immunity, to which the decrease in their plasma arginine contributes. Although diabetes-specific formulas have been developed, they have never been tested in the context of an acute infectious situation as can be seen in intensive care unit patients. Our aim was to investigate the effects of a diabetes-specific diet enriched or not with arginine in a model of infectious stress in a diabetes and obesity situation. As a large intake of arginine may be deleterious, this amino acid was given in graded fashion.
  
  
  METHODS
  Randomized, controlled experimental study.
  
  
  METHODS
  University research laboratory.
  
  
  METHODS
  Zucker diabetic fatty rats.
  
  
  METHODS
  Gastrostomized Zucker diabetic fatty rats were submitted to intraperitoneal lipopolysaccharide administration and fed for 7 days with either a diabetes-specific enteral nutrition without (G group, n=7) or with graded arginine supply (1-5 g/kg/day) (GA group, n=7) or a standard enteral nutrition (HP group, n=10).
  
  
  RESULTS
  Survival rate was better in G and GA groups than in the HP group. On day 7, plasma insulin to glucose ratio tended to be lower in the same G and GA groups. Macrophage tumor necrosis factor-α (G: 5.0±1.1 ng/2×10⁶ cells·hr⁻¹; GA: 3.7±0.8 ng/2×10⁶ cells·hr⁻¹; and HP: 1.7±0.6 ng/2×10⁶ cells·hr⁻¹; p<.05 G vs. HP) and nitric oxide (G: 4.5±1.1 ng/2×10⁶ cells·hr⁻¹; GA: 5.1±1.0 ng/2×10⁶ cells·hr⁻¹; and HP: 1.0±0.5 nmol/2×10⁶ cells·hr⁻¹; p<.05 G and GA vs. HP) productions were higher in the G and GA groups compared to the HP group. Macrophages from the G and GA groups exhibited increased arginine consumption.
  
  
  CONCLUSIONS
  In diabetic obese and endotoxemic rats, a diabetes-specific formula leads to a lower mortality, a decreased insulin resistance, and an improvement in peritoneal macrophage function. Arginine supplementation has no additional effect. These data support the use of such disease-specific diets in critically ill diabetic and obese patients.
authors.affiliation: Laboratoire de Biologie de la Nutrition, Faculté de Pharmacie, Université Paris Descartes, Service de Biochimie, Hôpitaux Universitaires Paris Centre, Paris, France. charlotte.breuillard@parisdescartes.fr
authors.forename: Charlotte
authors.initials: C
authors.lastname: Breuillard
authors.forename: Sylviane
authors.initials: S
authors.lastname: Darquy
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Curis
authors.forename: Nathalie
authors.initials: N
authors.lastname: Neveux
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Garnier
authors.forename: Luc
authors.initials: L
authors.lastname: Cynober
authors.forename: Jean-Pascal
authors.initials: JP
authors.lastname: De Bandt
mesh_terms: D000818:Animals; D001120:Arginine / Q000627:therapeutic use*; D001786:Blood Glucose / Q000032:analysis; D003921:Diabetes Mellitus, Experimental / Q000150:complications / Q000276:immunology / Q000628:therapy*; D019446:Endotoxemia / Q000150:complications / Q000276:immunology / Q000628:therapy*; D004750:Enteral Nutrition / Q000379:methods*; D005526:Food, Formulated; D007328:Insulin / Q000097:blood; D008264:Macrophages / Q000737:chemistry; D008297:Male; D009569:Nitric Oxide / Q000032:analysis; D009752:Nutritional Status; D009765:Obesity / Q000150:complications / Q000276:immunology / Q000628:therapy*; D051381:Rats; D011924:Rats, Zucker / Q000276:immunology / Q000378:metabolism*; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis
chemical_list: D001786:Blood Glucose; D007328:Insulin; D014409:Tumor Necrosis Factor-alpha; D009569:Nitric Oxide; D001120:Arginine