Die parenterale ErnährungstherapieEnergetische und nicht-energetische Wirkungen von Kohlenhydraten und Fetten

Abstract

The object of this review is to demonstrate the non-nutritional importance of carbohydrates and fat as they represent the classic energy carriers in parenteral nutrition. Concerning the pathophysiological changes of organ metabolism and intermediary metabolism as well as the pharmacological function of this nutritive substrates it is necessary to adjust parenteral nutrition strategy to various clinical pictures. The major goals of parenteral applicated carbohydrates are to avoid hyperglycemia, to return the increased hepatic glucose production during trauma and sepsis back to normal, and to reduce protein catabolism. Realizing this goals the dosage of glucose infusion underlies close metabolic borders depending on the present disease. Because of favourable effects of hepatic glucose and protein metabolism, xylitol, a non-glucose polyol, represents an useful alternative energy source to glucose. The non-energetic nutrition therapy with fat consists of application of the essential fatty acids linoleic and alpha-linolenic acid and considers the immunmodulatory effects of various fatty acids as precursors in the eicosanoid metabolism. As demonstrated at the organ systems of liver and lung this pharmacological effects of any lipid infusion might influence specific organ functions.

Immunomodulation by perioperative administration of n-3 fatty acids

“…Initial studies have shown favourable effects of administration of granulocyte colony-stimulating factor (G-CSF) or interferon gamma (IFN-g), and plasma separation on the immune system and the outcome of patients with sepsis or SIRS (Lundblad et al 1996;Murray, 1996;Reeves et al 1999). In addition, the advantageous effect of immunonutrition in critically ill patients has been reported using substances such as glutamine, arginine, purine nucleotides or n-3 fatty acids (Grimminger et al 1997;Schricker et al 1997;Weimann et al 1998).…”

“…Arachidonic acid metabolites lead to vasoconstriction, bronchoconstriction, platelet activation, increased vascular permeability, activation of the inflammatory processes and supression of cell-mediated immune function. n-3 Fatty acids compete with n-6 fatty acids for metabolism, resulting in products such as eicosapentaenoic acid derivatives, which are believed to be less inflammatory than those produced from arachidonic acid (Grimminger et al 1993(Grimminger et al , 1997Hayashi et al 1998;Kinsella & Lokesh 1990;Schricker et al 1997;Weimann et al 1998). Advantageous effects on the course of severe inflammatory diseases such as sepsis, ulcerative colitis, psoriasis, acute respiratory distress syndrome, and after organ transplantion as well as after surgical interventions have been observed following increased n-3 fatty acid supply (Grimminger et al 1993;Kinsella & Lokesh 1990).…”