Luo Menghua, Estívariz Concepción F, Schleicher Rosemary L, Bazargan Niloofar, Leader Lorraine M, Galloway John R, Ziegler Thomas R
Nutrition and Health Science Program, Graduate School of Arts and Sciences, Emory University, Atlanta, Georgia, USA.
Nutrition. 2009 Apr;25(4):400-7. doi: 10.1016/j.nut.2008.10.003. Epub 2008 Dec 10.
Carotenoids, vitamin A, and tocopherols serve important roles in many key body functions. However, availability of these compounds may be decreased in patients with short bowel syndrome (SBS) due to decreased oral intake of fruits and vegetables and/or decreased intestinal absorption. Little information is available on serum concentrations of carotenoids, vitamin A, and tocopherols during chronic parenteral nutrition (PN) or during PN weaning. The aim of this study was to prospectively examine serum concentrations of a wide variety of carotenoids, vitamin A, and tocopherols in patients with SBS undergoing an intensive 12-wk intestinal rehabilitation program.
Twenty-one PN-dependent adult patients with SBS were enrolled in a 12-wk intestinal rehabilitation program, which included individualized dietary modification, multivitamin supplementation, and randomization to receive subcutaneous placebo (n = 9) or human growth hormone (0.1 mg . kg(-1) . d(-1); n = 12). PN weaning was initiated after week 4 and advanced as tolerated. Serum concentrations of carotenoids, vitamin A, and tocopherols were determined at baseline and at weeks 4 and 12.
A significant percentage of subjects exhibited low serum concentrations for carotenoids and alpha-tocopherol at study entry, and a few subjects had low concentrations of retinol (5%). Carotenoid and vitamin A valves did not improve over time, while alpha-tocopherol levels rose. Serum alpha-tocopherol concentration was negatively associated with PN lipid dose (r = -0.34, P < 0.008).
Patients with SBS are depleted in diet-derived carotenoids despite oral and intravenous multivitamin supplementation and dietary adjustment during intestinal rehabilitation and PN weaning. Reduction of PN lipid infusion may improve serum alpha-tocopherol concentrations.
类胡萝卜素、维生素A和生育酚在人体许多关键生理功能中发挥着重要作用。然而，由于水果和蔬菜的口服摄入量减少和/或肠道吸收减少，短肠综合征（SBS）患者体内这些化合物的可利用性可能会降低。关于长期肠外营养（PN）期间或PN撤减期间类胡萝卜素、维生素A和生育酚的血清浓度，目前所知甚少。本研究的目的是前瞻性地检测接受为期12周强化肠道康复计划的SBS患者体内多种类胡萝卜素、维生素A和生育酚的血清浓度。
21例依赖PN的成年SBS患者参加了一项为期12周的肠道康复计划，该计划包括个性化饮食调整、多种维生素补充，并随机分为皮下注射安慰剂组（n = 9）或人生长激素组（0.1 mg·kg⁻¹·d⁻¹；n = 12）。第4周后开始PN撤减，并根据耐受情况逐步推进。在基线、第4周和第12周测定类胡萝卜素、维生素A和生育酚的血清浓度。
在研究开始时，相当比例的受试者类胡萝卜素和α-生育酚血清浓度较低，少数受试者视黄醇浓度较低（5%）。类胡萝卜素和维生素A水平未随时间改善，而α-生育酚水平升高。血清α-生育酚浓度与PN脂质剂量呈负相关（r = -0.34，P < 0.008）。
尽管在肠道康复和PN撤减期间进行了口服和静脉多种维生素补充及饮食调整，但SBS患者饮食来源的类胡萝卜素仍缺乏。减少PN脂质输注可能会提高血清α-生育酚浓度。
