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[Cyclic parenteral nutrition in children and glucose metabolism]
Insights
Cyclic perfusion in children receiving parenteral nutrition showed good glucose regulation. However, it led to increased insulin secretion, suggesting potential long-term risks that may be mitigated by adjusting nutrient delivery.
Area of Science:
- Pediatrics
- Endocrinology
- Metabolic Research
Background:
- Prolonged parenteral nutrition (PN) is critical for children unable to achieve adequate oral intake.
- Understanding the impact of PN delivery methods on glucose metabolism and insulin response is essential for optimizing patient care.
Purpose of the Study:
- To investigate the effects of cyclic perfusion during prolonged parenteral nutrition on glucose metabolism and insulin secretion in pediatric patients.
- To assess glycemic control using glycosylated hemoglobin (HbA1c) and evaluate insulin production via urinary C-peptide excretion.
Main Methods:
- Studied 10 children receiving prolonged parenteral nutrition.
- Monitored glycosylated hemoglobin (HbA1c) levels to assess long-term glycemia.
- Measured urinary C-peptide excretion to evaluate insulin secretion in response to cyclic perfusion.
- Compared results with control groups.
Main Results:
- Good glycemic regulation was indicated by the absence of glycosuria and acceptable HbA1c levels (mean: 4.4 +/- 0.7%).
- A tenfold increase in urinary C-peptide excretion (mean: 47.2 +/- 33.3 nmol/m2-1) compared to controls demonstrated significant insulin hypersecretion.
- This hypersecretion was attributed to the high rate of glucose infusion during cyclic perfusion.
Conclusions:
- Cyclic perfusion in pediatric parenteral nutrition effectively maintains glycemic control but induces significant insulin hypersecretion.
- This insulin hypersecretion may pose long-term health risks.
- Optimizing PN by limiting glucose to energy requirements for growth and incorporating approximately 30% lipid emulsion may reduce insulin hypersecretion.
Abstract:
The effect of cyclic perfusion on glucose metabolism and insulin secretion was determined in 10 children under prolonged parenteral nutrition according to glycosylated hemoglobin (HbA1c) levels and C-peptide urinary excretion. Lack of glycosuria and increase in HbA1c levels (m: 4.4 +/- 0.7%) indicates a good regulation of glycemia. A ten times increase in urinary C-peptide (m: 47.2 +/- 33.3 nmol/m2-1) as compared with controls shows an hypersecretion of insulin induced by the high infusion delivery of glucose. This hypersecretion of insulin, which probably involves long-term risks, may be reduced if parenteral nutrition does not contain more than the energetic requirements for growth and if about 30% of the energetic intake is given as a lipid perfusion.