Efficacy of a high-carbohydrate diet in catabolic illness

D. W. Hart, S. E. Wolf, X. J. Zhang, D. L. Chinkes, M. C. Buffalo, S. I. Matin, M. A. DebRoy, R. R. Wolfe, D. N. Herndon

Research output: Contribution to journalArticle

78 Citations (Scopus)

Abstract

Objective: To determine within the setting of isocaloric, isonitrogenous enteral diets whether a diet that supplies most of its calories from fat or carbohydrate would be most beneficial at limiting muscle protein wasting in catabolic illness. Design: Prospective, randomized, crossover trial. Setting: Academic pediatric burn unit in tertiary medical center. Patients: Fourteen severely burned (>40% total body surface area) children underwent systemic metabolic and cross-leg muscle protein kinetic studies. Interventions: All were treated clinically in a similar manner, including early excision and grafting, antimicrobial therapy, and isocaloric, isonitrogenous enteral nutritional support. Subjects randomly received either a high-carbohydrate enteral diet (3% fat, 82% carbohydrate, 15% protein), or a high-fat enteral diet (44% fat, 42% carbohydrates, 14% protein) for 1 week and then crossed over to the other diet for a second week. Measurements and Main Results: On day 5 of each diet, muscle protein kinetics were determined from femoral arterial and venous blood samples during a primed-constant d5-phenylalanine infusion. Indirect calorimetry was used to determine systemic resting energy expenditure and respiratory quotient. The seven boys and seven girls were 7.1 ± 1.1 (mean ± SEM) years old and suffered burns over 65 ± 4% of their bodies, with 52 ± 6% being third-degree burns. Muscle protein degradation markedly decreased (p < .01) with administration of the high-carbohydrate diet. Protein synthesis was unaltered. Endogenous insulin concentrations increased during the high-carbohydrate feeding period. No differences in energy expenditure were seen between study diets. Conclusions: In severely burned pediatric patients, enteral nutrition supplied predominantly as carbohydrate rather than fat improves the net balance of skeletal muscle protein across the leg. This is attributable to decreased protein breakdown, suggesting a protein-sparing effect of high-carbohydrate feedings.

Original languageEnglish (US)
Pages (from-to)1318-1324
Number of pages7
JournalCritical Care Medicine
Volume29
Issue number7
StatePublished - 2001

Fingerprint

Carbohydrates
Muscle Proteins
Diet
Small Intestine
Fats
Proteins
Burns
Energy Metabolism
Leg
Pediatrics
Burn Units
Indirect Calorimetry
Nutritional Support
Body Surface Area
Enteral Nutrition
High Fat Diet
Thigh
Phenylalanine
Cross-Over Studies
Proteolysis

Keywords

  • Burns
  • Catabolism
  • Dietary composition
  • High-carbohydrate diet
  • Protein metabolism

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Hart, D. W., Wolf, S. E., Zhang, X. J., Chinkes, D. L., Buffalo, M. C., Matin, S. I., ... Herndon, D. N. (2001). Efficacy of a high-carbohydrate diet in catabolic illness. Critical Care Medicine, 29(7), 1318-1324.

Efficacy of a high-carbohydrate diet in catabolic illness. / Hart, D. W.; Wolf, S. E.; Zhang, X. J.; Chinkes, D. L.; Buffalo, M. C.; Matin, S. I.; DebRoy, M. A.; Wolfe, R. R.; Herndon, D. N.

In: Critical Care Medicine, Vol. 29, No. 7, 2001, p. 1318-1324.

Research output: Contribution to journalArticle

Hart, DW, Wolf, SE, Zhang, XJ, Chinkes, DL, Buffalo, MC, Matin, SI, DebRoy, MA, Wolfe, RR & Herndon, DN 2001, 'Efficacy of a high-carbohydrate diet in catabolic illness', Critical Care Medicine, vol. 29, no. 7, pp. 1318-1324.
Hart DW, Wolf SE, Zhang XJ, Chinkes DL, Buffalo MC, Matin SI et al. Efficacy of a high-carbohydrate diet in catabolic illness. Critical Care Medicine. 2001;29(7):1318-1324.
Hart, D. W. ; Wolf, S. E. ; Zhang, X. J. ; Chinkes, D. L. ; Buffalo, M. C. ; Matin, S. I. ; DebRoy, M. A. ; Wolfe, R. R. ; Herndon, D. N. / Efficacy of a high-carbohydrate diet in catabolic illness. In: Critical Care Medicine. 2001 ; Vol. 29, No. 7. pp. 1318-1324.
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abstract = "Objective: To determine within the setting of isocaloric, isonitrogenous enteral diets whether a diet that supplies most of its calories from fat or carbohydrate would be most beneficial at limiting muscle protein wasting in catabolic illness. Design: Prospective, randomized, crossover trial. Setting: Academic pediatric burn unit in tertiary medical center. Patients: Fourteen severely burned (>40{\%} total body surface area) children underwent systemic metabolic and cross-leg muscle protein kinetic studies. Interventions: All were treated clinically in a similar manner, including early excision and grafting, antimicrobial therapy, and isocaloric, isonitrogenous enteral nutritional support. Subjects randomly received either a high-carbohydrate enteral diet (3{\%} fat, 82{\%} carbohydrate, 15{\%} protein), or a high-fat enteral diet (44{\%} fat, 42{\%} carbohydrates, 14{\%} protein) for 1 week and then crossed over to the other diet for a second week. Measurements and Main Results: On day 5 of each diet, muscle protein kinetics were determined from femoral arterial and venous blood samples during a primed-constant d5-phenylalanine infusion. Indirect calorimetry was used to determine systemic resting energy expenditure and respiratory quotient. The seven boys and seven girls were 7.1 ± 1.1 (mean ± SEM) years old and suffered burns over 65 ± 4{\%} of their bodies, with 52 ± 6{\%} being third-degree burns. Muscle protein degradation markedly decreased (p < .01) with administration of the high-carbohydrate diet. Protein synthesis was unaltered. Endogenous insulin concentrations increased during the high-carbohydrate feeding period. No differences in energy expenditure were seen between study diets. Conclusions: In severely burned pediatric patients, enteral nutrition supplied predominantly as carbohydrate rather than fat improves the net balance of skeletal muscle protein across the leg. This is attributable to decreased protein breakdown, suggesting a protein-sparing effect of high-carbohydrate feedings.",
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AU - Hart, D. W.

AU - Wolf, S. E.

AU - Zhang, X. J.

AU - Chinkes, D. L.

AU - Buffalo, M. C.

AU - Matin, S. I.

AU - DebRoy, M. A.

AU - Wolfe, R. R.

AU - Herndon, D. N.

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N2 - Objective: To determine within the setting of isocaloric, isonitrogenous enteral diets whether a diet that supplies most of its calories from fat or carbohydrate would be most beneficial at limiting muscle protein wasting in catabolic illness. Design: Prospective, randomized, crossover trial. Setting: Academic pediatric burn unit in tertiary medical center. Patients: Fourteen severely burned (>40% total body surface area) children underwent systemic metabolic and cross-leg muscle protein kinetic studies. Interventions: All were treated clinically in a similar manner, including early excision and grafting, antimicrobial therapy, and isocaloric, isonitrogenous enteral nutritional support. Subjects randomly received either a high-carbohydrate enteral diet (3% fat, 82% carbohydrate, 15% protein), or a high-fat enteral diet (44% fat, 42% carbohydrates, 14% protein) for 1 week and then crossed over to the other diet for a second week. Measurements and Main Results: On day 5 of each diet, muscle protein kinetics were determined from femoral arterial and venous blood samples during a primed-constant d5-phenylalanine infusion. Indirect calorimetry was used to determine systemic resting energy expenditure and respiratory quotient. The seven boys and seven girls were 7.1 ± 1.1 (mean ± SEM) years old and suffered burns over 65 ± 4% of their bodies, with 52 ± 6% being third-degree burns. Muscle protein degradation markedly decreased (p < .01) with administration of the high-carbohydrate diet. Protein synthesis was unaltered. Endogenous insulin concentrations increased during the high-carbohydrate feeding period. No differences in energy expenditure were seen between study diets. Conclusions: In severely burned pediatric patients, enteral nutrition supplied predominantly as carbohydrate rather than fat improves the net balance of skeletal muscle protein across the leg. This is attributable to decreased protein breakdown, suggesting a protein-sparing effect of high-carbohydrate feedings.

AB - Objective: To determine within the setting of isocaloric, isonitrogenous enteral diets whether a diet that supplies most of its calories from fat or carbohydrate would be most beneficial at limiting muscle protein wasting in catabolic illness. Design: Prospective, randomized, crossover trial. Setting: Academic pediatric burn unit in tertiary medical center. Patients: Fourteen severely burned (>40% total body surface area) children underwent systemic metabolic and cross-leg muscle protein kinetic studies. Interventions: All were treated clinically in a similar manner, including early excision and grafting, antimicrobial therapy, and isocaloric, isonitrogenous enteral nutritional support. Subjects randomly received either a high-carbohydrate enteral diet (3% fat, 82% carbohydrate, 15% protein), or a high-fat enteral diet (44% fat, 42% carbohydrates, 14% protein) for 1 week and then crossed over to the other diet for a second week. Measurements and Main Results: On day 5 of each diet, muscle protein kinetics were determined from femoral arterial and venous blood samples during a primed-constant d5-phenylalanine infusion. Indirect calorimetry was used to determine systemic resting energy expenditure and respiratory quotient. The seven boys and seven girls were 7.1 ± 1.1 (mean ± SEM) years old and suffered burns over 65 ± 4% of their bodies, with 52 ± 6% being third-degree burns. Muscle protein degradation markedly decreased (p < .01) with administration of the high-carbohydrate diet. Protein synthesis was unaltered. Endogenous insulin concentrations increased during the high-carbohydrate feeding period. No differences in energy expenditure were seen between study diets. Conclusions: In severely burned pediatric patients, enteral nutrition supplied predominantly as carbohydrate rather than fat improves the net balance of skeletal muscle protein across the leg. This is attributable to decreased protein breakdown, suggesting a protein-sparing effect of high-carbohydrate feedings.

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KW - Protein metabolism

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