Observations on the patterns of 24-hour energy expenditure changes in body composition and gastric emptying in head-injured patients receiving nasogastric tube feeding [see comments]

TY - JOUR

T1 - Observations on the patterns of 24-hour energy expenditure changes in body composition and gastric emptying in head-injured patients receiving nasogastric tube feeding [see comments]

AU - Weekes, Elizabeth

AU - Elia, M

PY - 1996

Y1 - 1996

N2 - BACKGROUND: Although intolerance to nasogastric feeding is commonly observed after head injury, quantitative measurements of gastric emptying are lacking. Concepts about energy requirements are limited by the lack of long-term measurements of total energy expenditure. METHODS: Six male subjects with severe head injury had their gastric emptying measured by the phenol red technique. N and energy balances were measured by classic balance techniques, which included continuous indirect calorimetry for up to 24 hours (days 3 to 5). Measurements of body composition were made on days 3 to 5 and 12 to 19 (4 subjects only). RESULTS: The subjects lost a mean of 9.8 kg of which 2.3 kg was estimated to be due to fat (equivalent to -14 g N/d and -1690 kcal/d). On days 3 to 5, basal metabolic rate (BMR) was 130% to 135% of predicted. The low dietary intake (650 kcal and 4.2g N/d) was associated with negative energy (-1710 +/- 520 kcal/d) and N balances (-19 +/- 5 g N/d). Gastric emptying was delayed twofold (days 3 to 5) compared with controls (p <.001) and was associated with significant regurgitation of feed into the mouth (16 of 31 saliva samples contained glucose at a concentration of > 0.5 mmol/L compared with control values of <0.2 mmol/L. CONCLUSIONS: The large negative energy balance in the subjects studied was largely due to the inadequate nasogastric feeding, which was associated with a twofold reduction in the rate of gastric emptying and frequent regurgitation of feed. The large negative N balance and the high contribution of protein oxidation to total energy expenditure (25% to 28%) was predominantly due to the injury sustained and immobility. An increase in BMR is not necessarily associated with increased total energy expenditure or energy requirements

AB - BACKGROUND: Although intolerance to nasogastric feeding is commonly observed after head injury, quantitative measurements of gastric emptying are lacking. Concepts about energy requirements are limited by the lack of long-term measurements of total energy expenditure. METHODS: Six male subjects with severe head injury had their gastric emptying measured by the phenol red technique. N and energy balances were measured by classic balance techniques, which included continuous indirect calorimetry for up to 24 hours (days 3 to 5). Measurements of body composition were made on days 3 to 5 and 12 to 19 (4 subjects only). RESULTS: The subjects lost a mean of 9.8 kg of which 2.3 kg was estimated to be due to fat (equivalent to -14 g N/d and -1690 kcal/d). On days 3 to 5, basal metabolic rate (BMR) was 130% to 135% of predicted. The low dietary intake (650 kcal and 4.2g N/d) was associated with negative energy (-1710 +/- 520 kcal/d) and N balances (-19 +/- 5 g N/d). Gastric emptying was delayed twofold (days 3 to 5) compared with controls (p <.001) and was associated with significant regurgitation of feed into the mouth (16 of 31 saliva samples contained glucose at a concentration of > 0.5 mmol/L compared with control values of <0.2 mmol/L. CONCLUSIONS: The large negative energy balance in the subjects studied was largely due to the inadequate nasogastric feeding, which was associated with a twofold reduction in the rate of gastric emptying and frequent regurgitation of feed. The large negative N balance and the high contribution of protein oxidation to total energy expenditure (25% to 28%) was predominantly due to the injury sustained and immobility. An increase in BMR is not necessarily associated with increased total energy expenditure or energy requirements

U2 - 10.1177/014860719602000131

DO - 10.1177/014860719602000131

M3 - Article

C2 - 8788260

SN - 0148-6071

VL - 20

SP - 31

EP - 37

JO - Journal of Parenteral and Enteral Nutrition

JF - Journal of Parenteral and Enteral Nutrition

IS - 1

ER -