Insufficient Caloric Intake Research Articles

Total Parenteral Nutrition in Infants and Children: Central and Peripheral Approaches

Insufficient caloric intake for a prolonged period contributes appreciably to mortality in infants and children with lesions of the gastrointestinal tract. An alternative approach to hyperalimentation involves the infusion of fat solutions along with glucose and amino acids into peripheral veins.

Factors affecting the nitrogen balance in chronic uremic patients receiving essential amino acids intravenously or by mouth.

A dietary regimen employing a protein-poor diet (2.7–3 g N/day) supplemented by essential amino acids, given intravenously or orally, changed the nitrogen balance in severe uremic patients from a negative to a positive one. The addition of histidine to the essential amino acids further improved the nitrogen balance. No difference in the nitrogen balance was observed when intravenous (i.v.) and oral administration were compared. <sup>15</sup>N studies indicate that protein synthesis takes place preferably in the muscle cells when the amino acids are infused intravenously, whereas oral treatment resulted in preferential synthesis of plasma protein. Insufficient caloric intake, lack of non-essential nitrogen, potassium depletion, corticosteroid administration, infection or cardiac insufficiency have been found to cause a deterioration of the nitrogen balance and an increase of plasma urea or concentration. In preliminary studies, administration of human growth hormone (HGH) to uremic patients maintained on the protein-poor diet was found to further improve the nitrogen balance. In other preliminary experiments, administration of extra tryptophan with the diet amino acids to uremic patients was also found to improve the nitrogen balance.

THE RESPIRATORY METABOLISM IN INFANCY AND IN CHILDHOOD

Infantile marasmus is commonly attributed either to chronic inanition or to a derangement of tissue metabolism. According to the former and generally accepted view, the undernutrition is merely the end-result of prolonged starvation (insufficient caloric intake) or of repeated gastrointestinal upsets (defective absorption of foodstuffs) induced by or independent of parenteral infections. A few authors, 1 however, maintain that the basic fault is a derangement of the energy metabolism resulting from defective utilization or from excessive combustion of foodstuffs in the tissues. They believe that some marantic infants fail to thrive in spite of an adequate diet and in the absence of parenteral or alimentary infection. The experimental evidence at hand is inadequate to enable one to decide finally on the merits of this view. The only systematic study of the subject was made by Fleming and Hutchinson, 2 who concluded that evidence of defective absorption or of abnormal utilization