Parenteral Nutrition Is Associated With Intestinal Morphologic and Functional Changes in Humans

作者：Alan L. Buchman, Adib A. Moukarzel, Sunita M. Bhuta, Michal Belle, Marvin E. Ament, Curtis D. Eckhert, Daniel Hollander, Jeff Gornbeln, Joel D. Kopple, Sudarsana R. Vijayaroghavan · 发表于：Journal of Parenteral and Enteral Nutrition · 年份：1995 · DOI：10.1177/0148607195019006453 · 被引用次数：413 · 研究领域：Clinical Nutrition and Gastroenterology、Nutrition and Health in Aging、Enhanced Recovery After Surgery

BACKGROUND: Numerous animal studies have demonstrated intestinal villus atrophy occurs when luminal nutrition is withheld and total parenteral nutrition (TPN) is provided. Intestinal morphologic and functional changes have not been well studied in humans during TPN. METHODS: Eight normal volunteers were hospitalized in the Clinical Research Center for 3 weeks. The subjects received TPN as an exclusive means of nutritional support for 14 days followed by 5 days of enteral refeeding with either a standard or a glutamine and arginine-supplemented formula. Endoscopic jejunal biopsies were taken before and after TPN and after enteral refeeding. Intestinal morphology was examined by light and transmission electron microscopy. Mucosa DNA, RNA, and protein concentrations were measured. Lactose breath hydrogen and intestinal permeability testing (urinary lactulose and mannitol excretion after an oral dose) were performed before and after TPN and after enteral refeeding. RESULTS: Total mucosal thickness decreased after TPN (645 +/- 19 to 512 +/_ 19 microns, p = .003) and increased significantly towards baseline after enteral refeeding (575 +/- 19 microns, p = .04). The change was related solely to villus height; crypt depth was unaffected. Villus cell count decreased from 179 +/- 15 to 163 +/- 12 after TPN (p = .03) and increased after enteral refeeding to 176 +/- 21 (p = .06). Crypt cell count was unaffected by TPN or refeeding. A nonsignificant decrease in the mitotic index after TPN...