Gut Permeability, Intestinal Morphology, and Nutritional Depletion
Introduction
The association between nutritional depletion, septic complications,1, 2and increased mortality rates[3]in postoperative patients is well established. The exact underlying mechanism is not known.
It has been hypothesized that the gut plays an important role in the development of complications in the postoperative patient.[4]An important function of the healthy gut is to prevent bacteria and endotoxins from reaching the portal circulation. This physiologic barrier is maintained by the mucous layer, the epithelial cells with their tight junctions, and the gut-associated lymphoid tissue (GALT). Impairment of one or several components of this intestinal barrier may result in bacterial translocation or endotoxemia.5, 6
Glutamine, a conditional essential amino acid, is used as fuel for rapidly dividing cells, for example, enterocytes and lymphocytes.7, 8A diminished glutamine supply during parenteral nutrition and enteral starvation results in morphologic changes and increased intestinal permeability.[9]Recently, we showed that nutritional depletion is associated with decreased concentrations of glutamine in the intestinal mucosa.[10]Nutritional depletion, via decreased glutamine supply, may impair intestinal barrier function.
In animal experiments, protein malnutrition results in an increased risk of endotoxin-related bacterial translocation and increased susceptibility to the lethal effects of endotoxins.11, 12The purpose of this study was to investigate the potential relationship between nutritional depletion, intestinal morphology, and permeability in humans.
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Patients
Metabolically stable patients (temperature between 36.5 and 38°C, no intraabdominal abscesses, no signs of respiratory or cardiac failure) between 18 and 80 years of age admitted to the nutritional support team were eligible to enter the study. All patients were admitted because they were not allowed or were unable to receive enteral nutrition. The study was performed before parenteral nutrition was initiated. Patients with renal or liver failure, diabetes mellitus, ileus, or congenital
Patients
Intestinal biopsies were taken in 26 patients submitted to the care of the nutritional support team. Intestinal permeability was studied in 23 of these patients. Patients were treated for inflammatory bowel disease (IBD; n = 15), cancer (Ca; n = 6), and other diagnoses (NoCa/NoIBD) with subileus (n = 1), pancreatitis (n = 1), pyloric stenosis (n = 1), or fistula (n = 2). Patient data are summarized in Table I. Fourteen patients were considered nutritionally depleted because they had a PIFFM of
Discussion
This study was performed to assess the relationship between nutritional depletion, intestinal permeability, and morphology. The association between nutritional depletion and intestinal permeability in humans was first described by Maxton et al.[25]Starvation in obese patients and nutritional depletion in patients without gastrointestinal disease receiving enteral nutrition were associated with increased permeability. In our study, intestinal permeability and intestinal morphology were assessed
Acknowledgements
The authors thank Margriet Pijls, Anniek Moors, Janine Hoefnagels, and Margriet Rouflart for their help with this study.
References (46)
- et al.
Perioperative nutritional supporta randomised clinical trial
Clin Nutr
(1992) - et al.
Respiratory fuels and nitrogen metabolism in vivo in small intestine of fed rats
J Biol Chem
(1980) - et al.
Glutamine and the preservation of gut integrity
Lancet
(1993) - et al.
Decrease of mucosal glutamine concentration in the nutritionally depleted patient
Clin Nutr
(1994) - et al.
Lean body mass estimation by bioelectrical impedance analysisa four site cross-validation study
Am J Clin Nutr
(1988) - et al.
The effect of glutamine-enriched TPN on gut immune cellularity
J Surg Res
(1992) - et al.
Intestinal permeability and the prediction of relapse in Crohn’s disease
Lancet
(1993) - et al.
Neutrophil-derived oxidants mediate formyl-methionyl-leucyl-phenylalanine–induced increases in mucosal permeability in rats
Gastroenterology
(1989) - et al.
Septic shockpathogenesis
Lancet
(1991) Percentage of weight lossa basic indicator of surgical risk in patients with chronic peptic ulcer
JAMA
(1936)