Objective: To explore the objective basis of the time and characterstics of refeeding of patients with acute pancreatitis (AP). Methods: AP patients were randomly divided into routine group (n=105) and special group (...Objective: To explore the objective basis of the time and characterstics of refeeding of patients with acute pancreatitis (AP). Methods: AP patients were randomly divided into routine group (n=105) and special group (n=99). The refeeding time and characteristics of the routine group were based on their levels of blood and urine amylase, function of the gastrointestinal tract, and symptoms and signs, and those of the special group on their imaging changes of ultrasonography and CT of the pancreas. Clinical data from the groups were analyzed prospectively and statistically. Results: At the beginning of refeeding, patients of the two groups showed a high recurrence rate of ab- dominal pain (routine group, 9.1%; special group, 10.5%), but no AP relapse. Three days to 2 weeks after refeeding, the patients of the routine group had a higher recurrence rate of abdominal pain (11.1%) and a relapse rate of AP (14.1%) as compared with those of the special group (P<0. 05). Two weeks later, both rates decreased apparently. However, 3 days to 4 weeks after refeeding, the patients of the special group had no recurrence of abdominal pain and relapse of AP. Imaging changes of the pancreas and peripancreatic tissue were not consistent with the symptoms and signs of AP patients. The higher the Balthazar CT grading and APACHE-Ⅱ score, the higher the recurrence rate of abdominal pain and the relapse rate of AP after refeeding (P<0. 05). Conclusions: Symptoms and signs were usually dis- cordant to the imaging changes of the pancreas in AP patients. Imaging changes of the pancreas might serve as a basis for the best occasion of refeeding light semi-fluid or light food in AP patients.展开更多
Although the idea that pancreas rest has long been considered as a very relevant topic in acute pancreatitis (AP)therapy,the right time and type of diet to be offered to patients recovering from an acute attack are a ...Although the idea that pancreas rest has long been considered as a very relevant topic in acute pancreatitis (AP)therapy,the right time and type of diet to be offered to patients recovering from an acute attack are a great challenge to clinicians who treat this condition.Fortunately,the last decade was noted for several trials looking for the best answer to the question:"when and how to start oral refeeding in AP?"It is well known that 80%of patients present with mild disease characterized by usually uncomplicated clinical course are managed with pancreatic rest through nil per oral;while the use of specific nutritional intervention is an exception.Therefore,mild AP has been the most investigated form of AP and researchers have tried different kind of meals to offer calories and reduce costs by shortening hospitalization time.Usually in mild AP,the oral refeeding is introduced between the first 3 d and 7 d after hospitalization but,the type of diet and patients’tolerance have been scrutinized in detail with mixed results.Although 20%to 25%have pain recurrence requiring nutritional support and greater time of hospitalization,most patients seem to tolerate oral refeeding well.We propose analyzing the most recent investigations of this matter and their conclusions to develop a better understanding of the management of AP.展开更多
The present study investigated the effect of starvation-refeeding status on cholesterol metabolism in rats fed a high-cholesterol diet or a cholesterol-free diet. Twenty male and 20 female Donryu rats (age 5 weeks) we...The present study investigated the effect of starvation-refeeding status on cholesterol metabolism in rats fed a high-cholesterol diet or a cholesterol-free diet. Twenty male and 20 female Donryu rats (age 5 weeks) were fed a cho-lesterol-free diet for 14 days. Then the male and female rats were each divided into two groups: feeding and starva-tion-refeeding groups. The feeding groups were fed the experimental diet for 3 days, and the starvation-refeeding groups fasted for 2 days followed by 3 days of feeding. Half of each of groups was fed a cholesterol-free diet and the other half was fed a high-cholesterol diet. Starvation-refeeding significantly increased the plasma free cholesterol and HDL-cholesterol concentrations in both the high-cholesterol-diet-fed rats and the cholesterol-free-diet-fed rats. In the female rats, plasma total cholesterol and cholesteryl ester concentrations were significantly higher in the high-cholesterol groups than in the cholesterol-free groups, whereas TG concentration and total cholesterol/TG ratio were not significantly different among all of the groups. Liver total cholesterol and cholesteryl ester were significantly higher in the high-cholesterol groups than in the cholesterol-free groups in both male and female rats. These results suggest that starvation-refeeding affected cholesterol metabolism at least in part. The reactivity of the cholesterol me-tabolism may be different between male and female rats.展开更多
Takotsubo cardiomyopathy is characterized by the development of transient left ventricular regional wall motion abnormalities,in the absence of significant coronary artery obstruction. This syndrome usually occurs in ...Takotsubo cardiomyopathy is characterized by the development of transient left ventricular regional wall motion abnormalities,in the absence of significant coronary artery obstruction. This syndrome usually occurs in women and is frequently associated with an intense emotional or physical stress. It usually involves apical segments,but in the recent years atypical forms have been described. Inverted or reverse Takotsubo is a variant in which the basal and midventricular segments are hypokinetic,sparing contractile function of the apex. In this report we describe the case of a 54-year-old woman,with chronic malnutrition,initially admitted because of hypoglycemia and severe electrolyte disturbance due to a refeeding syndrome. Within the next hours she experienced acute cardiac symptoms and developed heart failure with low cardiac output. Electrocardiogram(ECG),elevation of troponin and echocardiographic findings were consistent with inverted Takotsubo cardiomyopathy. To the best of our knowledge,this is the first incidence reported of inverted Takotsubo triggered by refeeding syndrome.展开更多
The present study was performed to investegate the effects of high-fat diets containing different fats on cholesterol metabolism in starvation-refeeding rats. Forty female Donryu rats were divided into two groups and ...The present study was performed to investegate the effects of high-fat diets containing different fats on cholesterol metabolism in starvation-refeeding rats. Forty female Donryu rats were divided into two groups and then fed high-fat diets containing beef tallow or corn oil without cholesterol for 14 days. Then, 10 rats from each group were divided into high-cholesterol and cholesterol-free groups (Experiment 1). Another 10 rats from beef tallow and corn oil groups were divided into high-cholesterol and high-cholesterol-cholestyramine groups (Experiment 2). All rats were fasted for 2 days followed by 3 days of feeding. In Experiment 1, the high-cholesterol diet caused significant increases in plasma total cholesterol and cholesteryl ester concentrations in the beef tallow diet group. In Experiment 2, dietary cholestyramine markedly decreased plasma and liver cholesterol levels;however, these cholesterol levels were higher in the beef tallow diet group even if cholestyramine was added to the diet. These results suggested that the cholesterol- lowering effect of dietary corn oil may not be due solely to reabsorption of bile acids. This study suggested that high-fat diets containing different fats affected cholesterol metabolism under conditions of starvation-refeeding.展开更多
Early life overfeeding in the rat can be experimentally induced by reducing litter size. This investigation assessed the consequences of this manipulation on glucose metabolism in vivo and in isolated hepatocytes in 1...Early life overfeeding in the rat can be experimentally induced by reducing litter size. This investigation assessed the consequences of this manipulation on glucose metabolism in vivo and in isolated hepatocytes in 150-day old rats. Additionally, after body growth, the effects of caloric restriction and refeeding were tested. Adult rats from control （G9） and reduced litters （G3L） did not differ in body and fat weights, glucose tolerance or insulin resistance （insulin-induced hypoglycemia）, or hepatocyte glucose release under basal or gluconeogenic conditions. Caloric restriction （G3R） reduced body and fat weights, decreased glucose decay after insulin injection and decreased hepatocyte gluconeogenic glucose release. Refeeding after caloric restriction reversed these parameters to those of the freely-fed groups （G9 and G3L）. Taken together, these results suggest that the liver glucose metabolism is not programmed by lactational overfeeding, but rather is responsive to the current nutritional condition of the animal.展开更多
Background and Objectives:Refeeding syndrome(RS)is a potentially life-threatening condition characterised by significant electrolyte and fluid imbalances,posing a considerable risk in patients undergoing parenteral nu...Background and Objectives:Refeeding syndrome(RS)is a potentially life-threatening condition characterised by significant electrolyte and fluid imbalances,posing a considerable risk in patients undergoing parenteral nutri tion(PN)therapy.This study aimed to determine the occurrence,risk factors,severity,and complications of RS in a teaching hospital in Malaysia.Methods and Study Design:A retrospective observational study was con ducted using universal sampling from October to December 2023.Data were collected for adult patients receiving PN for more than 48 hours between July 2022 and July 2023 at Hospital Canselor Tuanku Muhriz.Results:Among 90 patients included,30(33.3%)developed RS.Upon consideration of interaction terms due to collinerity of variables,a statistically significant correlation was observed between pre-existing electrolyte derangements and RS occurrence(p=0.001).Phosphate levels showed the most significant decline post-PN initiation(43%),followed by potassium(19%)and magnesium(17%),primarily within the first 24 hours.No significant associa tions were found between BMI,fasting duration,unintentional weight loss,or medication history and RS.How ever,fasting for more than five days(AOR 2.8,95%CI 0.4-17.7)and≥10%unintentional weight loss(AOR 1.8,95%CI 0.4-7.7)increased the likelihood of RS.Conclusions:RS is prevalent among adult PN patients,predom inantly with mild severity.Pre-existing electrolyte abnormalities,especially in phosphate levels,were robust pre dictors.Larger studies are needed to better elucidate the associations between risk factors and RS in the local population.展开更多
Background Early enteral feeding （EF） may result in fever, elevated white blood cell count, increased serum levels of liver enzymes, and diarrhea. We name the complications ＂enteral refeeding syndrome＂, as a subty...Background Early enteral feeding （EF） may result in fever, elevated white blood cell count, increased serum levels of liver enzymes, and diarrhea. We name the complications ＂enteral refeeding syndrome＂, as a subtype of refeeding syndrome, because they are likely to result from long-term lack of lumen nutrition. The aim of this study was to investigate the characteristics of enteral refeeding syndrome after long-term total parenteral nutrition （TPN）, and the solution for the disease. Methods We collected the clinical data of 100 patients with gastrointestinal fistula, who were cured from Apirl 2001 to July 2002. Their fasting time, daily stool frequency, body temperature, heart rate, respiratory rate, levels of transaminases, alkaline phosphatase （AKP）, and γ-glutamylcyclotransferase （γ-GT）, white blood cell count, and systemic inflammatory reaction syndrome （SIRS） score were recorded before and 1, 3, 5, 10, and 15 days after EF. Student＇s t test and analysis of variance were used to analyze the data. Results Of the 100 patients, 56 were cured after selective resection of intestinal fistula, 15 were cured by emergency operation, and 29 recovered spontaneously. The levels of AKP and y-GT increased significantly on the 3rd day after EF [On the 3rd day after EF, （243.0±121.6） U/L and （177.2±109.9） U/L vs. before EF （181.5±127.5） U/L and （118.4±94.2） U/L, P〈0.05], and decreased gradually afterwards. The SIRS scores on the 1st day （1.05±1.08） and 3rd day （0.96±1.11） after EF were significantly higher than that before EF （0.72＋0.84）, then decreased to 0.83±0.91, 0.49±0.73 and 0.32±0.60 on the 5th, 10th and 15th days after EE The number of patients with diarrhea at 1, 3, 5, 10 and 15 days post-EF were 31, 26, 12, 13, and 7, respectively. Conclusions The longer the TPN lasts, the more severe the enteral refeeding syndrome becomes. Continuous EF is effective for the syndrome. Early enteral nutrition is useful in preventing it.展开更多
Gluconeogenesis responses was assessed during a short starvation period and subsequent refeeding in Siberian sturgeon(Acipenser baerii) previously fed different dietary carbohydrates levels and experienced to a glucos...Gluconeogenesis responses was assessed during a short starvation period and subsequent refeeding in Siberian sturgeon(Acipenser baerii) previously fed different dietary carbohydrates levels and experienced to a glucose stimuli during early life. The sturgeon larvae were previously fed either a high glucose diet(G) or a low glucose diet(F) from the first feeding to yolk absorption(8 to 12 d post-hatching [dph]). Each group of fish was sub-divided into 2 treatments at 13 dph and was fed either a high-carbohydrate diet(H) or a low carbohydrate diet(L) until 20 wk. In the current study, the fish in 4 groups(GL, FL, GH and FH) were experienced to starvation for 21 d following by re-feeding of their corresponding diets for 21 d.Fish were sampled at postprandial 6 and 24 h before starvation(P6 h and P24 h), starvation 7,14 and 21 d(S7, S14 and S21) and 1, 7,14 and 21 d during refeeding(R1, R7, R14 and R21). Plasma samples during refeeding were taken at P6 h at each time point. Glycaemia levels, liver and muscle glycogen contents,activities and mRNA levels of hepatic gluconeogenic enzymes were examined. We found that both dietary carbohydrate levels and early glucose stimuli significantly affected the metabolic responses to starvation and refeeding in Siberian sturgeon(P < 0.05). During prolonged starvation, Siberian sturgeon firstly mobilized the liver glycogen and then improved gluconeogenesis when the dietary carbohydrates were abundant, whereas preserved the liver glycogen stores at a stable level and more effectively promoted gluconeogenesis when the dietary carbohydrates are absent to maintain glucose homoeostasis.During refeeding, as most teleostean, Siberian sturgeon failed controlling the activities and mRNA levels of phosphoenolpyruvate carboxykinase cytosolic forms(PEPCK-C), fructose-1,6-bisphosphatase(FBPase),but particularly controlled phosphoenolpyruvate carboxykinase mitochondrial forms(PEPCK-M) activities and mRNA expression of glucose-6-phosphatase(G6 Pase, except in GL group). Siberian sturgeon has a full compensatory ability on growth, but this ability would be obstructed by early glucose stimuli when refeeding the low carbohydrate diet after S21.展开更多
Liver is the central hub regulating energy metabolism during feeding-fasting transition.Evidence suggests that fasting and refeeding induce dynamic changes in liver size,but the underlying mechanisms remain unclear.Ye...Liver is the central hub regulating energy metabolism during feeding-fasting transition.Evidence suggests that fasting and refeeding induce dynamic changes in liver size,but the underlying mechanisms remain unclear.Yes-associated protein(YAP)is a key regulator of organ size.This study aims to explore the role of YAP in fasting-and refeeding-induced changes in liver size.Here,fasting significantly reduced liver size,which was recovered to the normal level after refeeding.Moreover,hepatocyte size was decreased and hepatocyte proliferation was inhibited after fasting.Conversely,refeeding promoted hepatocyte enlargement and proliferation compared to fasted state.Mechanistically,fasting or refeeding regulated the expression of YAP and its downstream targets,as well as the proliferation-related protein cyclin D1(CCND1).Furthermore,fasting significantly reduced the liver size in AAV-control mice,which was mitigated in AAV Yap(5SA)mice.Yap overexpression also prevented the effect of fasting on hepatocyte size and proliferation.Besides,the recovery of liver size after refeeding was delayed in AAV Yap shRNA mice.Yap knockdown attenuated refeeding-induced hepatocyte enlargement and proliferation.In summary,this study demonstrated that YAP plays an important role in dynamic changes of liver size during fasting-refeeding transition,which provides new evidence for YAP in regulating liver size under energy stress.展开更多
Fasting is a popular dietary strategy because it grants numerous advantages,and redox regulation is one mecha-nism involved.However,the precise redox changes with respect to the redox species,organelles and tissues re...Fasting is a popular dietary strategy because it grants numerous advantages,and redox regulation is one mecha-nism involved.However,the precise redox changes with respect to the redox species,organelles and tissues remain unclear,which hinders the understanding of the metabolic mechanism,and exploring the precision redox map under various dietary statuses is of great significance.Twelve redox-sensitive C.elegans strains stably expressing genetically encoded redox fluorescent probes(Hyperion sensing H_(2)O_(2) and Grx1-roGFP2 sensing GSH/GSSG)in three organelles(cytoplasm,mitochondria and endoplasmic reticulum(ER))were constructed in two tissues(body wall muscle and neurons)and were confirmed to respond to redox challenge.The H_(2)O_(2) and GSSG/GSH redox changes in two tissues and three organelles were obtained by confocal microscopy during fasting,refeeding,and satiation.We found that under fasting condition,H_(2)O_(2) decreased in most compartments,except for an increase in mitochondria,while GSSG/GSH increased in the cytoplasm of body muscle and the ER of neurons.After refeeding,the redox changes in H_(2)O_(2) and GSSG/GSH caused by fasting were reversed in most organelles of the body wall muscle and neurons.In the sati-ated state,H_(2)O_(2) increased markedly in the cytoplasm,mitochondria and ER of muscle and the ER of neurons,while GSSG/GSH exhibited no change in most organelles of the two tissues except for an increase in the ER of muscle.Our study systematically and precisely presents the redox characteristics under different dietary states in living animals and provides a basis for further investigating the redox mechanism in metabolism and optimizing dietary guidance.展开更多
Anorexia nervosa(AN)is one of the most common psychiatric disorders among young adults and is associated with a substantial risk of death from suicide and medical complications.Transaminase elevations are common in pa...Anorexia nervosa(AN)is one of the most common psychiatric disorders among young adults and is associated with a substantial risk of death from suicide and medical complications.Transaminase elevations are common in patients with AN at the time of hospital admission and have been associated with longer lengths of hospital stay.Multiple types of hepatitis may occur in these patients,including two types that occur only in patients with AN:starvation hepatitis and refeeding-induced hepatitis.Starvation hepatitis is characterized by severe transaminase elevation in patients in the advanced phase of protein-energy deprivation and is associated with complications of severe starvation,such as hypoglycaemia,hypothermia,and hypotension.Refeeding-induced hepatitis is characterized by a milder increase in transaminases that occurs in the early refeeding phase and is associated with hypophosphatemia,hypokalemia,and hypomagnesaemia.Among the most common forms of hepatitis,drug-induced liver injury is particularly relevant in this patient cohort,given the frequent use and abuse of methamphetamines,laxatives,antidepressants,and antipsychotics.In this review,we provided an overview of the different forms of anorexic-associated hepatitis,a diagnostic approach that can help the clinician to correctly frame the problem,and indications on their management and treatment.展开更多
文摘Objective: To explore the objective basis of the time and characterstics of refeeding of patients with acute pancreatitis (AP). Methods: AP patients were randomly divided into routine group (n=105) and special group (n=99). The refeeding time and characteristics of the routine group were based on their levels of blood and urine amylase, function of the gastrointestinal tract, and symptoms and signs, and those of the special group on their imaging changes of ultrasonography and CT of the pancreas. Clinical data from the groups were analyzed prospectively and statistically. Results: At the beginning of refeeding, patients of the two groups showed a high recurrence rate of ab- dominal pain (routine group, 9.1%; special group, 10.5%), but no AP relapse. Three days to 2 weeks after refeeding, the patients of the routine group had a higher recurrence rate of abdominal pain (11.1%) and a relapse rate of AP (14.1%) as compared with those of the special group (P<0. 05). Two weeks later, both rates decreased apparently. However, 3 days to 4 weeks after refeeding, the patients of the special group had no recurrence of abdominal pain and relapse of AP. Imaging changes of the pancreas and peripancreatic tissue were not consistent with the symptoms and signs of AP patients. The higher the Balthazar CT grading and APACHE-Ⅱ score, the higher the recurrence rate of abdominal pain and the relapse rate of AP after refeeding (P<0. 05). Conclusions: Symptoms and signs were usually dis- cordant to the imaging changes of the pancreas in AP patients. Imaging changes of the pancreas might serve as a basis for the best occasion of refeeding light semi-fluid or light food in AP patients.
基金Supported by A grant from CNPq,Brazil(to Julio Maria Fonseca Chebli)a clinical research fund from the CNPq and FAPE- MIG,Brazil(in part)
文摘Although the idea that pancreas rest has long been considered as a very relevant topic in acute pancreatitis (AP)therapy,the right time and type of diet to be offered to patients recovering from an acute attack are a great challenge to clinicians who treat this condition.Fortunately,the last decade was noted for several trials looking for the best answer to the question:"when and how to start oral refeeding in AP?"It is well known that 80%of patients present with mild disease characterized by usually uncomplicated clinical course are managed with pancreatic rest through nil per oral;while the use of specific nutritional intervention is an exception.Therefore,mild AP has been the most investigated form of AP and researchers have tried different kind of meals to offer calories and reduce costs by shortening hospitalization time.Usually in mild AP,the oral refeeding is introduced between the first 3 d and 7 d after hospitalization but,the type of diet and patients’tolerance have been scrutinized in detail with mixed results.Although 20%to 25%have pain recurrence requiring nutritional support and greater time of hospitalization,most patients seem to tolerate oral refeeding well.We propose analyzing the most recent investigations of this matter and their conclusions to develop a better understanding of the management of AP.
文摘The present study investigated the effect of starvation-refeeding status on cholesterol metabolism in rats fed a high-cholesterol diet or a cholesterol-free diet. Twenty male and 20 female Donryu rats (age 5 weeks) were fed a cho-lesterol-free diet for 14 days. Then the male and female rats were each divided into two groups: feeding and starva-tion-refeeding groups. The feeding groups were fed the experimental diet for 3 days, and the starvation-refeeding groups fasted for 2 days followed by 3 days of feeding. Half of each of groups was fed a cholesterol-free diet and the other half was fed a high-cholesterol diet. Starvation-refeeding significantly increased the plasma free cholesterol and HDL-cholesterol concentrations in both the high-cholesterol-diet-fed rats and the cholesterol-free-diet-fed rats. In the female rats, plasma total cholesterol and cholesteryl ester concentrations were significantly higher in the high-cholesterol groups than in the cholesterol-free groups, whereas TG concentration and total cholesterol/TG ratio were not significantly different among all of the groups. Liver total cholesterol and cholesteryl ester were significantly higher in the high-cholesterol groups than in the cholesterol-free groups in both male and female rats. These results suggest that starvation-refeeding affected cholesterol metabolism at least in part. The reactivity of the cholesterol me-tabolism may be different between male and female rats.
基金Supported by Hospital Universitario Fundación Alcorcón,Madrid(Spain)
文摘Takotsubo cardiomyopathy is characterized by the development of transient left ventricular regional wall motion abnormalities,in the absence of significant coronary artery obstruction. This syndrome usually occurs in women and is frequently associated with an intense emotional or physical stress. It usually involves apical segments,but in the recent years atypical forms have been described. Inverted or reverse Takotsubo is a variant in which the basal and midventricular segments are hypokinetic,sparing contractile function of the apex. In this report we describe the case of a 54-year-old woman,with chronic malnutrition,initially admitted because of hypoglycemia and severe electrolyte disturbance due to a refeeding syndrome. Within the next hours she experienced acute cardiac symptoms and developed heart failure with low cardiac output. Electrocardiogram(ECG),elevation of troponin and echocardiographic findings were consistent with inverted Takotsubo cardiomyopathy. To the best of our knowledge,this is the first incidence reported of inverted Takotsubo triggered by refeeding syndrome.
文摘The present study was performed to investegate the effects of high-fat diets containing different fats on cholesterol metabolism in starvation-refeeding rats. Forty female Donryu rats were divided into two groups and then fed high-fat diets containing beef tallow or corn oil without cholesterol for 14 days. Then, 10 rats from each group were divided into high-cholesterol and cholesterol-free groups (Experiment 1). Another 10 rats from beef tallow and corn oil groups were divided into high-cholesterol and high-cholesterol-cholestyramine groups (Experiment 2). All rats were fasted for 2 days followed by 3 days of feeding. In Experiment 1, the high-cholesterol diet caused significant increases in plasma total cholesterol and cholesteryl ester concentrations in the beef tallow diet group. In Experiment 2, dietary cholestyramine markedly decreased plasma and liver cholesterol levels;however, these cholesterol levels were higher in the beef tallow diet group even if cholestyramine was added to the diet. These results suggested that the cholesterol- lowering effect of dietary corn oil may not be due solely to reabsorption of bile acids. This study suggested that high-fat diets containing different fats affected cholesterol metabolism under conditions of starvation-refeeding.
文摘Early life overfeeding in the rat can be experimentally induced by reducing litter size. This investigation assessed the consequences of this manipulation on glucose metabolism in vivo and in isolated hepatocytes in 150-day old rats. Additionally, after body growth, the effects of caloric restriction and refeeding were tested. Adult rats from control （G9） and reduced litters （G3L） did not differ in body and fat weights, glucose tolerance or insulin resistance （insulin-induced hypoglycemia）, or hepatocyte glucose release under basal or gluconeogenic conditions. Caloric restriction （G3R） reduced body and fat weights, decreased glucose decay after insulin injection and decreased hepatocyte gluconeogenic glucose release. Refeeding after caloric restriction reversed these parameters to those of the freely-fed groups （G9 and G3L）. Taken together, these results suggest that the liver glucose metabolism is not programmed by lactational overfeeding, but rather is responsive to the current nutritional condition of the animal.
文摘Background and Objectives:Refeeding syndrome(RS)is a potentially life-threatening condition characterised by significant electrolyte and fluid imbalances,posing a considerable risk in patients undergoing parenteral nutri tion(PN)therapy.This study aimed to determine the occurrence,risk factors,severity,and complications of RS in a teaching hospital in Malaysia.Methods and Study Design:A retrospective observational study was con ducted using universal sampling from October to December 2023.Data were collected for adult patients receiving PN for more than 48 hours between July 2022 and July 2023 at Hospital Canselor Tuanku Muhriz.Results:Among 90 patients included,30(33.3%)developed RS.Upon consideration of interaction terms due to collinerity of variables,a statistically significant correlation was observed between pre-existing electrolyte derangements and RS occurrence(p=0.001).Phosphate levels showed the most significant decline post-PN initiation(43%),followed by potassium(19%)and magnesium(17%),primarily within the first 24 hours.No significant associa tions were found between BMI,fasting duration,unintentional weight loss,or medication history and RS.How ever,fasting for more than five days(AOR 2.8,95%CI 0.4-17.7)and≥10%unintentional weight loss(AOR 1.8,95%CI 0.4-7.7)increased the likelihood of RS.Conclusions:RS is prevalent among adult PN patients,predom inantly with mild severity.Pre-existing electrolyte abnormalities,especially in phosphate levels,were robust pre dictors.Larger studies are needed to better elucidate the associations between risk factors and RS in the local population.
文摘Background Early enteral feeding （EF） may result in fever, elevated white blood cell count, increased serum levels of liver enzymes, and diarrhea. We name the complications ＂enteral refeeding syndrome＂, as a subtype of refeeding syndrome, because they are likely to result from long-term lack of lumen nutrition. The aim of this study was to investigate the characteristics of enteral refeeding syndrome after long-term total parenteral nutrition （TPN）, and the solution for the disease. Methods We collected the clinical data of 100 patients with gastrointestinal fistula, who were cured from Apirl 2001 to July 2002. Their fasting time, daily stool frequency, body temperature, heart rate, respiratory rate, levels of transaminases, alkaline phosphatase （AKP）, and γ-glutamylcyclotransferase （γ-GT）, white blood cell count, and systemic inflammatory reaction syndrome （SIRS） score were recorded before and 1, 3, 5, 10, and 15 days after EF. Student＇s t test and analysis of variance were used to analyze the data. Results Of the 100 patients, 56 were cured after selective resection of intestinal fistula, 15 were cured by emergency operation, and 29 recovered spontaneously. The levels of AKP and y-GT increased significantly on the 3rd day after EF [On the 3rd day after EF, （243.0±121.6） U/L and （177.2±109.9） U/L vs. before EF （181.5±127.5） U/L and （118.4±94.2） U/L, P〈0.05], and decreased gradually afterwards. The SIRS scores on the 1st day （1.05±1.08） and 3rd day （0.96±1.11） after EF were significantly higher than that before EF （0.72＋0.84）, then decreased to 0.83±0.91, 0.49±0.73 and 0.32±0.60 on the 5th, 10th and 15th days after EE The number of patients with diarrhea at 1, 3, 5, 10 and 15 days post-EF were 31, 26, 12, 13, and 7, respectively. Conclusions The longer the TPN lasts, the more severe the enteral refeeding syndrome becomes. Continuous EF is effective for the syndrome. Early enteral nutrition is useful in preventing it.
基金supported by the National Basic Research Program of China(2014CB138601)The National Natural Science Foundation of China(No.31572631,No.31372539)+2 种基金Beijing Technology System for Sturgeon and Salmonids(SCGWZJ 20171103-1)the National Key Research and Development Program of China(2016YFF0201900)The special Fund for Agro-Scientific Research in the Public Interest(201203015)
文摘Gluconeogenesis responses was assessed during a short starvation period and subsequent refeeding in Siberian sturgeon(Acipenser baerii) previously fed different dietary carbohydrates levels and experienced to a glucose stimuli during early life. The sturgeon larvae were previously fed either a high glucose diet(G) or a low glucose diet(F) from the first feeding to yolk absorption(8 to 12 d post-hatching [dph]). Each group of fish was sub-divided into 2 treatments at 13 dph and was fed either a high-carbohydrate diet(H) or a low carbohydrate diet(L) until 20 wk. In the current study, the fish in 4 groups(GL, FL, GH and FH) were experienced to starvation for 21 d following by re-feeding of their corresponding diets for 21 d.Fish were sampled at postprandial 6 and 24 h before starvation(P6 h and P24 h), starvation 7,14 and 21 d(S7, S14 and S21) and 1, 7,14 and 21 d during refeeding(R1, R7, R14 and R21). Plasma samples during refeeding were taken at P6 h at each time point. Glycaemia levels, liver and muscle glycogen contents,activities and mRNA levels of hepatic gluconeogenic enzymes were examined. We found that both dietary carbohydrate levels and early glucose stimuli significantly affected the metabolic responses to starvation and refeeding in Siberian sturgeon(P < 0.05). During prolonged starvation, Siberian sturgeon firstly mobilized the liver glycogen and then improved gluconeogenesis when the dietary carbohydrates were abundant, whereas preserved the liver glycogen stores at a stable level and more effectively promoted gluconeogenesis when the dietary carbohydrates are absent to maintain glucose homoeostasis.During refeeding, as most teleostean, Siberian sturgeon failed controlling the activities and mRNA levels of phosphoenolpyruvate carboxykinase cytosolic forms(PEPCK-C), fructose-1,6-bisphosphatase(FBPase),but particularly controlled phosphoenolpyruvate carboxykinase mitochondrial forms(PEPCK-M) activities and mRNA expression of glucose-6-phosphatase(G6 Pase, except in GL group). Siberian sturgeon has a full compensatory ability on growth, but this ability would be obstructed by early glucose stimuli when refeeding the low carbohydrate diet after S21.
基金supported by the National Key R&D Program of China(2022YFA1104900)the Natural Science Foundation of China(Grant number:82025034,81973392)+3 种基金the Shenzhen Science and Technology Program(KQTD20190929174023858,China)the 111 project(Grant number:B16047,China)the Local Innovative and Research Teams Project of Guangdong Pearl River Talents Program(Grant number:2017BT01Y093,China)the National Engineering and Technology Research Center for New drug Druggability Evaluation(Seed Program of Guangdong Province,Grant number:2017B090903004,China)。
文摘Liver is the central hub regulating energy metabolism during feeding-fasting transition.Evidence suggests that fasting and refeeding induce dynamic changes in liver size,but the underlying mechanisms remain unclear.Yes-associated protein(YAP)is a key regulator of organ size.This study aims to explore the role of YAP in fasting-and refeeding-induced changes in liver size.Here,fasting significantly reduced liver size,which was recovered to the normal level after refeeding.Moreover,hepatocyte size was decreased and hepatocyte proliferation was inhibited after fasting.Conversely,refeeding promoted hepatocyte enlargement and proliferation compared to fasted state.Mechanistically,fasting or refeeding regulated the expression of YAP and its downstream targets,as well as the proliferation-related protein cyclin D1(CCND1).Furthermore,fasting significantly reduced the liver size in AAV-control mice,which was mitigated in AAV Yap(5SA)mice.Yap overexpression also prevented the effect of fasting on hepatocyte size and proliferation.Besides,the recovery of liver size after refeeding was delayed in AAV Yap shRNA mice.Yap knockdown attenuated refeeding-induced hepatocyte enlargement and proliferation.In summary,this study demonstrated that YAP plays an important role in dynamic changes of liver size during fasting-refeeding transition,which provides new evidence for YAP in regulating liver size under energy stress.
基金supported by the National Key R&D Program(2022YFA1303000 and 2017YFA0504000)the National Natural Science Foundation of China(91849203,31900893)the Strategic Priority Research Program of the Chinese Academy of Sciences(XDB39000000).
文摘Fasting is a popular dietary strategy because it grants numerous advantages,and redox regulation is one mecha-nism involved.However,the precise redox changes with respect to the redox species,organelles and tissues remain unclear,which hinders the understanding of the metabolic mechanism,and exploring the precision redox map under various dietary statuses is of great significance.Twelve redox-sensitive C.elegans strains stably expressing genetically encoded redox fluorescent probes(Hyperion sensing H_(2)O_(2) and Grx1-roGFP2 sensing GSH/GSSG)in three organelles(cytoplasm,mitochondria and endoplasmic reticulum(ER))were constructed in two tissues(body wall muscle and neurons)and were confirmed to respond to redox challenge.The H_(2)O_(2) and GSSG/GSH redox changes in two tissues and three organelles were obtained by confocal microscopy during fasting,refeeding,and satiation.We found that under fasting condition,H_(2)O_(2) decreased in most compartments,except for an increase in mitochondria,while GSSG/GSH increased in the cytoplasm of body muscle and the ER of neurons.After refeeding,the redox changes in H_(2)O_(2) and GSSG/GSH caused by fasting were reversed in most organelles of the body wall muscle and neurons.In the sati-ated state,H_(2)O_(2) increased markedly in the cytoplasm,mitochondria and ER of muscle and the ER of neurons,while GSSG/GSH exhibited no change in most organelles of the two tissues except for an increase in the ER of muscle.Our study systematically and precisely presents the redox characteristics under different dietary states in living animals and provides a basis for further investigating the redox mechanism in metabolism and optimizing dietary guidance.
基金Thanks to Fondazione Roma for the invaluable support for scientific research-FR-CEMAD 21-25.
文摘Anorexia nervosa(AN)is one of the most common psychiatric disorders among young adults and is associated with a substantial risk of death from suicide and medical complications.Transaminase elevations are common in patients with AN at the time of hospital admission and have been associated with longer lengths of hospital stay.Multiple types of hepatitis may occur in these patients,including two types that occur only in patients with AN:starvation hepatitis and refeeding-induced hepatitis.Starvation hepatitis is characterized by severe transaminase elevation in patients in the advanced phase of protein-energy deprivation and is associated with complications of severe starvation,such as hypoglycaemia,hypothermia,and hypotension.Refeeding-induced hepatitis is characterized by a milder increase in transaminases that occurs in the early refeeding phase and is associated with hypophosphatemia,hypokalemia,and hypomagnesaemia.Among the most common forms of hepatitis,drug-induced liver injury is particularly relevant in this patient cohort,given the frequent use and abuse of methamphetamines,laxatives,antidepressants,and antipsychotics.In this review,we provided an overview of the different forms of anorexic-associated hepatitis,a diagnostic approach that can help the clinician to correctly frame the problem,and indications on their management and treatment.
