一种改良碳水化合物配方及其成分对血糖控制和炎症标志物的影响：一项嵌套的机制子研究。

The impact of a modified carbohydrate formula, and its constituents, on glycaemic control and inflammatory markers: A nested mechanistic sub-study.

机构信息

Princess Alexandra Hospital, Mater Research Institute, The University of Queensland, Brisbane, QLD, Australia.

The Royal Melbourne Hospital, The University of Melbourne and Mater Research Institute - The University of Queensland, Brisbane, QLD, Australia.

出版信息

J Hum Nutr Diet. 2022 Jun;35(3):455-465. doi: 10.1111/jhn.12959. Epub 2021 Nov 6.

DOI:10.1111/jhn.12959

PMID:34743379

Abstract

BACKGROUND

Hyperglycaemia occurs frequently in the critically ill. Dietary intake of advanced glycation end-products (AGEs), specifically Nε-(carboxymethyl)lysine (CML), may exacerbate hyperglycaemia through perturbation of insulin sensitivity. The present study aimed to determine whether the use of nutritional formulae, with varying AGE loads, affects the amount of insulin administered and inflammation.

METHODS

Exclusively tube fed patients (n = 35) were randomised to receive Nutrison Protein Plus Multifibre®, Diason® or Glucerna Select®. Insulin administration was standardised according to protocol based on blood glucose (<10 mmol L ). Samples were obtained at randomisation and 48 h later. AGEs in nutritional formula, plasma and urine were measured using mass spectrometry. Plasma inflammatory markers were measured using an enzyme-linked immunosorbent assay and multiplex bead-based assays.

RESULTS

AGE concentrations of CML in nutritional formulae were greatest with delivery of Nutrison Protein Plus® (mean [SD]; 6335 pmol mol [2436]) compared to Diason® (4836 pmol mol [1849]) and Glucerna Select® (4493 pmol mol [1829 pmol mol ]) despite patients receiving similar amounts of energy (median [interquartile range]; 12 MJ [8.2-13.7 MJ], 11.5 MJ [8.3-14.5 MJ], 11.5 MJ [8.3-14.5 MJ]). More insulin was administered with Nutrison Protein Plus® (2.47 units h [95% confidence interval (CI) = 1.57-3.37 units h ]) compared to Diason® (1.06 units h [95% CI = 0.24-1.89 units h ]) or Glucerna Select® (1.11 units h [95% CI = 0.25-1.97 units h ]; p = 0.04). Blood glucose concentrations were similar. There were associations between greater insulin administration and reductions in circulating interleukin-6 (r = -0.46, p < 0.01), tumour necrosis factor-α (r = -0.44, p < 0.05), high sensitivity C-reactive protein (r = -0.42, p < 0.05) and soluble receptor for advanced glycation end-products (r = -0.45, p < 0.01) concentrations.

CONCLUSIONS

The administration of greater AGE load in nutritional formula potentially increases the amount of insulin required to maintain blood glucose within a normal range during critical illness. There was an inverse relationship between exogenous insulin and plasma inflammatory markers.

摘要

背景

危重病患者经常会出现高血糖。饮食中摄入的晚期糖基化终产物（AGEs），特别是 Nε-（羧甲基）赖氨酸（CML），可能通过干扰胰岛素敏感性使高血糖恶化。本研究旨在确定使用不同 AGE 负荷的营养配方是否会影响胰岛素的用量和炎症。

方法

将 35 名仅接受管饲的患者随机分为 Nutrison Protein Plus Multifibre®、Diason®或 Glucerna Select®组。根据血糖（<10mmol/L）的协议对胰岛素给药进行标准化。在随机分组和 48 小时后采集样本。使用质谱法测量营养配方、血浆和尿液中的 AGEs。使用酶联免疫吸附测定法和多重珠基检测法测量血浆炎症标志物。

结果

尽管患者接受的能量相似（中位数[四分位距]；12MJ[8.2-13.7MJ]、11.5MJ[8.3-14.5MJ]、11.5MJ[8.3-14.5MJ]），但 Nutrison Protein Plus®中 CML 的 AGE 浓度最高（平均值[标准差]；6335pmol/mol[2436]），而 Diason®（4836pmol/mol[1849]）和 Glucerna Select®（4493pmol/mol[1829pmol/mol]）。Nutrison Protein Plus®组需要更多的胰岛素（2.47 单位/h[95%置信区间（CI）=1.57-3.37 单位/h]），而 Diason®组（1.06 单位/h[95%CI=0.24-1.89 单位/h]）或 Glucerna Select®组（1.11 单位/h[95%CI=0.25-1.97 单位/h]；p=0.04）。血糖浓度相似。胰岛素用量增加与循环白细胞介素-6（r=-0.46，p<0.01）、肿瘤坏死因子-α（r=-0.44，p<0.05）、高敏 C 反应蛋白（r=-0.42，p<0.05）和可溶性晚期糖基化终产物受体（r=-0.45，p<0.01）浓度降低呈负相关。