The role of macronutrients in gastrointestinal blood flow

Current Opinion in Clinical Nutrition and Metabolic Care

Volumn 8, Issue 5, 2005, Pages 552-556

  De Aguilar Nascimento, José Eduardo ^a,b  

^a FEDERAL UNIVERSITY OF MATO GROSSO   (Brazil)

^b NONE   (Brazil)

Author keywords

Enteral nutrition; Gastrointestinal blood flow; Ischaemia; Macronutrients; Mesenteric blood flow

Indexed keywords

ADRENERGIC SYSTEM; BLOOD PRESSURE; CRITICAL ILLNESS; ENTERIC FEEDING; GASTROINTESTINAL TRACT; HEART OUTPUT; HEART RATE; HUMAN; HYPEREMIA; ISCHEMIA; MACRONUTRIENT; MESENTERY BLOOD FLOW; NUTRITIONAL SUPPORT; OXYGEN CONSUMPTION; OXYGEN SUPPLY; PERFUSION; POSTPRANDIAL STATE; REPERFUSION INJURY; REVIEW; SPLANCHNIC BLOOD FLOW; STOMACH MUCOSA;

EID: 23944461527     PISSN: 13631950     EISSN: 15353885     Source Type: Journal    
DOI: 10.1097/01.mco.0000170755.32996.1d     Document Type: Review

References (48)

1. Ceppa EP, Fuh KC, Bulkley GB. Mesenteric hemodynamic response to circulatory shock. Curr Opin Crit Care 2003; 9:127-132.
2. Jacob SM. Splanchnic blood flow in low-flow states. Anesth Analg 2003; 96:1129-1138.
3. Matheson PJ, Wilson MA, Garrison RN. Regulation of intestinal blood flow. J Surg Res 2000; 93:182-196.
4. Kazamias P, Kotzampassi K, Koufogiannis D, Eleftheriadis E. Influence of enteral nutrition-induced splanchnic hyperemia on the septic origin of splanchnic ischemia. World J Surg 1998; 22:6-11.
5. Sigalet DL, Mackenzie SL, Morad Hameed S. Enteral nutrition and mucosal immunity: implications for feeding strategies in surgery and trauma. Can J Surg 2004; 47:109-116. An outstanding review focusing on the implications of enteral nutrition on gut immunity in various critical conditions.
6. Kudsk KA, Croce MA, Fabian TC, et al. Enteral versus parenteral feeding. Effects on septic morbidity after blunt and penetrating abdominal trauma. Ann Surg 1992; 215:503-513.
7. Braunschweig CL, Levy P, Sheean PM, Wang X. Enteral compared to parenteral nutrition: a meta-analysis. Am J Clin Nutr 2001; 74:534-542.
8. Gramlich L, Kichian K, Pinilla J, et al. Does enteral nutrition compared to parenteral nutrition result in better outcomes in critically ill adult patients? A systematic review of the literature. Nutrition 2004; 20:843-848. A well-conducted systematic review comparing enteral nutrition with TPN in the critically ill. A total of 13 studies involving 856 patients in ICU were analysed.
9. Jorba R, Fabregat J, Borobia FG, et al. Small bowel necrosis in association with early postoperative enteral feeding after pancreatic resection. Surgery 2000; 128:111-112.
10. Munshi IA, Steingrub JS, Wolpert L. Small bowel necrosis associated with early postoperative jejunal tube feeding in a trauma patient. J Trauma 2000; 49:163-165.
11. Frey C, Takala J, Krahenbuhl L. Non-occlusive small bowel necrosis during gastric tube feeding: a case report. Intern Med 2001; 40:304-307.
12. Marvin RG, McKinley BA, McKeegan M, et al. Non-occlusive bowel necrosis occurring in critical ill trauma patients receiving enteral nutrition manifests no reliable signs for early detection. Am J Surg 2000; 179:7-12.
13. Rokyta R Jr, Matejovic M, Krouzecky A, Novak I. Enteral nutrition and hepatosplanchnic region in critically iil patients - friends or foes? Physiol Res 2003; 52:31-37.
14. Kudsk KA. Effect of route and type of nutrition on intestine-derived inflammatory responses. Am J Surg 2003; 185:16-21.
15. Chou CC, Coatney RW. Nutrient induced changes in intestinal blood flow in the dog. Br Vet J 1994; 150:423-437.
16. Gallavan RH Jr, Chou CC. Possible mechanisms for the initiation and maintenance of postprandial intestinal hyperemia. Am J Physiol 1985; 249:G301-G308.
17. Chou CC. Splanchnic and overall cardiovascular hemodynamics during eating and digestion. Fed Proc 1983; 42:1658-1661.
18. Shah V, Lyford G, Gores G, Farrugia G. Nitric oxide in gastrointestinal health and disease. Gastroenterology 2004; 126:903-913. An exceptional review of the effects of NO in the gastrointestinal tract.
19. Matheson PJ, Spain DA, Harris PD, et al. Glucose and glutamine gavage increase portal vein nitric oxide metabolite levels via adenosine A2b activation. J Surg Res 1999; 84:57-63.
20. Matheson PJ, Wilson MA, Spain DA, et al. Glucose-induced intestinal hyperemia is mediated by nitric oxide. J Surg Res 1997; 72:146-154.
21. Matheson PJ, Hurt RT, Mittel OF, et al. Immune-enhancing enteral diet increases blood flow and proinflammatory cytokines in the rat ileum. J Surg Res 2003; 110:360-370.
22. Matheson PJ, Lusco V, Wilson MA, Garrison RN. Omega-3 fatty acids in immune-enhancing enteral diets selectively increase blood flow to the ileum by a bile acid dependent mechanism. Surgery 2002; 132:673-681.
23. Houdijk AP, van Leewen PA, Boermeester MA, et al. Glutamine-enriched enteral diet increases splanchnic blood in the rat. Am J Physiol 1994; 267:G1035-G1040.
24. Mercier A, Eurin D, Poulet-Young V, et al. Effect of enteral supplementation with glutamine on mesenteric blood flow in premature neonates. Clin Nutr 2003; 22:133-137.
25. Carver JD, Sosa R, Saste M, Kuchan M. Dietary nucleotides and intestinal blood flow velocity in term infants. J Pediatr Gastroenterol Nutr 2004; 39:38-42. This interesting paper supports previous studies on the increased mesenteric blood flow in neonates as a result of nucleotides.
26. Carver JD, Saste M, Sosa R, et al. The effects of dietary nucleotides on intestinal blood flow in neonates. Pediatr Res 2002; 52:425-429.
27. Ozkan H, Oren H, Erdag N, et al. Breast milk versus infant formulas: effects on intestinal blood flow in neonates. Indian J Pediatr 1994; 61:703-709.
28. Spirit MJ, Guth PH, Randall G, Leung FW. Gastroduodenal perfusion in mortality in mechanical-ventilated patients with systemic inflammatory response syndrome. Dig Dis Sci 2004; 49:906-913. This study highlights the impact of GIBF on the prognosis of mechanical-ventilated patients.
29. Revelly JP, Tappy L, Berger MM, et al. Early metabolic and splanchnic responses to enteral nutrition in post-operative cardiac surgery patients with circulatory compromise. Intensive Care Med 2001; 27:540-547.
30. Andel H, Rab M, Andel D, et al. Impact of duodenal feeding on the oxygen balance of the splanchnic region during different phases of severe burn injury. Burns 2002; 28:60-64.
31. Rokyta R, Matejovic M, Krouzecky A, et al. Post-pyloric enteral nutrition in septic patients: effects on hepato-splanchnic hemodynamics and energy status. Intensive Care Med 2004; 30:714-717. This excellent clinical study showed that enteral nutrition might not be harmful in septic patients even in those receiving inotropes.
32. Bartsch S, Bruning A, Reimann FM, Ludwig D. Haemodynamic effects of dopexamine on postprandial splanchnic hyperemia. Eur J Clin Invest 2004; 34:268-274. The authors showed that dopexamine, a synthetic beta, mimetic, may not affect the course of postprandial hyperemia in healthy volunteers.
33. Kong SE, Blennerhassett LR, Heel KA, et al. Ischemia-reperfusion injury to the intestine. Aust NZ J Surg 1998; 68:554-561.
34. Fukatsu K, Zarzaur BL, Johnson CD, et al. Enteral nutrition prevents remote organ injury and death after a gut ischemic insult. Ann Surg 2001; 233:660-668.
35. Kozar RA, Sen H, Hassoun HT, et al. Specific intraluminal nutrients after mucosal blood flow during gut ischemia/reperfusion. Parenter Enter Nutr 2002; 26:226-229.
36. Kles KA, Wallig MA, Tappenden KA. Luminal nutrients exacerbate intestinal hypoxia in the hypoperfused jejunum. J Parenter Enter Nutr 2001; 25:246-253.
37. Saito H, Furukawa S, Matsuda T. Glutamine as an immunoenhancing nutrient. J Parenter Enter Nutr 1999; 23 (5 Suppl.):S59-S61.
38. Gibson DD, Brackett DJ, Squires RA, et al. Evidence that the large loss of glutathione observed in ischemia/reperfusion of the small intestine is not due to oxidation to glutathione disulfide. Free Radic Biol Med 1993; 14:427-433.
39. Martenssen J, Jain A, Meister A. Glutathione is required for intestinal function. Proc Natl Acad Sci U S A 1990; 87:1715-1719.
40. Ikeda S, Zarzaur BL, Jonson CD, et al. Total parenteral nutrition supplementation with glutamine improves survival after gut ischemia/reperfusion. J Parenter Enter Nutr 2002; 26:169-173.
41. Wu GH, Wang H, Zhang YW, et al. Glutamine supplemented parenteral nutrition prevents intestinal ischemia-reperfusion injury in rats. World J Gastroenterol 2004; 10:2592-2594.
42. Fukatsu K, Ueno C, Hashiguchi Y, et al. Glutamine infusion during ischemia is detrimental in a murine gut ischemia/reperfusion model. J Parenter Enter Nutr 2003; 27:187-192.
43. Aguilar-Nascimento JE, Gurgel Marques C, Carvalho Mariano A, et al. Benefits of intraluminal injection of glutamine for intestinal mucosa during ischemia-reperfusion. Eur Surg Res 2003; 35:352-356.
44. Kozar RA, Schultz SG, Bick RJ, et al. Enteral glutamine but not alanine maintains small bowel barrier function after ischemia/reperfusion injury in rats. Shock 2004; 21:433-437. This excellent experimental paper showed that individual components of enteral nutrition may differentially modulate gut barrier function. The metabolizable solute glutamine was more protective to the mucosa than non-metabolizable alanine after IRI.
45. Nose K, Wasa M, Okada A. Gut glutamine metabolism at different stages of sepsis in rats. Surg Today 2002; 32:695-700.
46. Stechmiller JK, Childress B, Porter T. Arginine immunonutrition in critically ill patients: a clinical dilemma. Am J Crit Care 2004; 13:17-23.
47. Fukatsu K, Ueno C, Maeshima Y, et al. Effects of L-arginine infusion during ischemia on gut blood perfusion, oxygen tension, and circulating myeloid cell activation in a murine gut ischemia/reperfusion model. J Parenter Enter Nutr 2004; 28:224-230. This experimental study showed that intravenous L-arginine improves GIBF but increases mortality probably because of excessive reactive oxygen metabolite formation and the priming of myeloid cells during IRI.
48. Kozar RA, Verner-Cole E, Schultz SG, et al. The immune-enhancing enteral agents arginine and glutamine differentially modulate gut barrier function following mesenteric ischemia/reperfusion. J Trauma 2004; 57:1150-1156. An elegant experimental study evidencing the deleterious effects of arginine on gut permeability and mucosal barrier during IRI.