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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

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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.

Design

Multicentric prospective randomized study.

Patients

47 patients with SAPS I score higher than 8 and requiring exclusive TPN.

Interventions

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.

Measurements and 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 γ-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.

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Author information

Authors and Affiliations

  1. Department of Anesthesiology and Nutrition, CHU, Hôpital E Herriot, 69473, Lyon Cedex 03, France

    P. Boulétreau, D. Chassard, B. Allaouchiche, M. Bertin-Maghit & C. Chambrier

  2. Department of Anesthesiology, CHU, Marseille, France

    J. C. Dumont

  3. Department of Anesthesiology, CHU, St. Etienne, France

    C. Auboyer

  4. Department of Anesthesiology, CHU, Caen, France

    H. Bricard

  5. Department of Biostatistics, CHU, Lyon, France

    R. Ecochard

  6. Lab Fresenius, 5 place du Marivel, Sèvres, France

    J. Rangaraj

  7. Laboratory of Biological Nutrition, Paris 5 University and Hotel-Dieu, AP-HP, Paris, France

    C. Schneid & L. Cynober

Authors
  1. P. Boulétreau
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  2. D. Chassard
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  3. B. Allaouchiche
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  4. J. C. Dumont
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  7. H. Bricard
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  10. C. Chambrier
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  12. L. Cynober
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Corresponding author

Correspondence to P. Boulétreau.

Additional information

This research was supported by a grant from Fresenius Laboratories

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Boulétreau, P., Chassard, D., Allaouchiche, B. et al. 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. Intensive Care Med 31, 1394–1400 (2005). https://doi.org/10.1007/s00134-005-2771-5

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  • DOI: https://doi.org/10.1007/s00134-005-2771-5

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