Does Portal Nutrition Benefit Liver Protein Synthesis?

Abstract

There are only a few experimental investigations on the feasibility and potential advantages of intraportal nutrition in animals and only two uncontrolled studies in humans. The purpose of this study was to compare some metabolic variables in patients who received portal or systemic nutrition after elective surgery for colorectal cancer. Twenty patients were randomized to receive postoperatively for a week a hypocaloric, "protein sparing" standard infusion via the portal (catheter in the gastroepiploic vein) (10 patients) or systemic (10 patients) route. We evaluated the basal concentrations of some visceral and acute-phase proteins and their variations in the first postoperative week and the nitrogen balance. Statistical analysis was performed by the two-tailed Student t test. There was no difference in the daily changes of the visceral and acute-phase proteins after surgery in the two groups of patients, but in the portal group there was a significantly better recovery of the level of total protein, albumin, and cholinesterase at the end of the portal infusion vs the systemic group (p < or = .005, .03, and .02, respectively). In regard to the nitrogen balance, although there was no difference in the overall balance between portal and systemic nutrition, if we separate the acute phase of the injury from the later one we do not see any significant difference in the first period but we do see a highly significant advantage for the portal group during the last 2 days (p < or = .0001).(ABSTRACT TRUNCATED AT 250 WORDS)

New Technology for Continuous Intravenous Infusion via the Central and Portal Veins in the Rat.

“…Subsequently, from a nutritional standpoint, portal nutrition was reported to offer advantages over TPN in terms of improving amino acid utilization, promoting albumin synthesis, stabilizing blood sugar and serum osmotic pressure, and maintaining a favorable nitrogen balance (Joyeux 1974;Piccone et al 1980;Fairman et al 1983;Bozzetti et al 1993). However, the infusion of high calorie solutions into the PV has also been reported to be detrimental with regard to nitrogen balance and fatty degeneration of the liver (King et al 1983).…”

Maximizing efficacy from parenteral nutrition in critical care: Appropriate patient populations, supplemental parenteral nutrition, glucose control, parenteral glutamine, and alternative fat sources

“…In a set of elegant experiments performed over 30 years ago, Thomas Starzl, the pioneer of liver transplantation, demonstrated profound hepatic dysfunction when the liver was deprived of splanchnic blood [17]. Bozetti et al [18,19] investigated the effects of intraportal venous nutrition versus systemic PN on nitrogen balance in postoperative patients receiving identical regimens in terms of energy and nitrogen content. In these studies serum albumin and prealbumin increased in the portally fed patients, whereas it remained depressed in those receiving systemic PN.…”