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A Prospective Randomized Study

Michael M. Meguid, MD, PhD; Michael P. Akahoshi, PharmD; Susan Jeffers, RN, MS; Robert J. Hayashi, PharmD; William G. Hammond, MD

Arch Surg. 1984;119(11):1294-1298.

Abstract
• The most common metabolic complications of total parenteral nutrition (TPN), glucose intolerance and abnormal liver function, can be significantly reduced when 30% of the glucose calories are replaced by fat. We gave 88 patients either conventional TPN (CON-TPN, 25% dextrose and 4.25% amino acids) or modified TPN (MOD-TPN, 15% dextrose, fat, and 5% amino acids). The treatment groups were as follows: group A, no surgery with TPN only; group B, postoperative TPN; and group C, preoperative and postoperative TPN. Serial blood samples were analyzed for glucose, albumin, triglycerides, and insulin, and for liver function values. Nine patients manifested hyperglycemia and were removed from the study; seven patients had received CON-TPN and two had received MOD-TPN. In group A, the insulin level rose 50% less with MOD-TPN. There was a 50% smaller rise in the triglyceride, SGOT, and SGPT levels in patients who received MOD-TPN. Replacing one third of the TPN glucose calories with fat leads to better glucose tolerance and fewer hepatic complications.

(Arch Surg 1984;119:1294-1298)

Author Affiliations
From the Department of Clinical Nutrition, Division of Surgery, City of Hope National Medical Center, Duarte, Calif.

Footnotes
Accepted for publication July 3, 1984.

Read before the Annual Meeting of the Southern California Chapter of the American College of Surgeons, Santa Barbara, Calif, Jan 27, 1984.

Reprint requests to Department of Surgery, University Hospital, Upstate Medical Center, 750 E Adams St, Syracuse, NY 13210 (Dr Meguid).

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