PART â…  Effect Of Complete Enteral Nutrition Through Gastrostomy And Jejunostomy On Plasma Glucose Level And A Few GI Hormones PART â…¡ Nutritional Risk Screening In Hospitalized Elderly Patients Of Internal Medicine And Effect Of Nutritional Support On

Background:The gastrointestinal tract is the largest endocrine system in the human body. The regulation of glucose homeostasis consists of a series of complex mechanisms, such as insulin, glucagon, ghrelin, GLP-1, PYY and other hormones.Objective:To study the effect of enteral nutrition through different positon of Gl tract, including gastrostomy and jejunostomy, on blood glucose and a few Gl hormones including insulin, glucagon, ghrelin, GLP-1, PYY and C-peptide.Methods:Animals of rat are divided into different groups:normal control group, laparotomy group, gastrostomy group and jejunostomy group. Enteral nutrition model of rat is established through gastrostomy and jejunostomy. Rats of NC group and laparotomy group live on oral feed. Rats of gastrostomy group and jejunostomy group live on complete enteral nutrition through nutritional tube. After3days,7days and12days of enteral nutrition, plasma is obtained through abdominal aotic artery. During the period of enteral nutrition, blood glucose is measured by tail vein blood. Datas from different groups were analyzed by one-way ANOVA (analysis of variance)(P<0.05).Results:Animal model of enteral nutrition is successfully established. Value of blood glucose is obtained and detection of Gl hormones is smoothly conducted. Weight of jejunostomy is less than that of gastrostomy and NC group after12days of enteral nutrition (p=0.000as to NC, p=0.048as to gastrostomy).Changes of Blood Glucose(1)Blood glucose level of gastrostomy and jejunostomy is higher than that of NC and laparotomy group.(2) Blood glucose level of and jejunostomy is higher than that of gastrostomy group.(3)Peak level of blood glucose in gastrostomy group is at the time of60min with infusion rate of2ml/h and4ml/h.(4) Peak level of blood glucose in jejunostomy group is at the time of60min with infusion rate of2ml/h and30min with infusion rate of4ml/h.(5)Level of blood glucose is positively correlated with the infusion rate. Changes of Gl hormone:(1)Surgical stress can cause elevated levels of Ghrelin. In POD3, Ghrelin level of the jejunostomy group is significantly lower than that of the gastrostomy group (p=0.000), suggesting that enteral nutrition by the jejunostomy can inhibit appetite and promote insulin secretion, thereby reducing blood glucose.(2)GLP-1level of gastrostomy reached a peak at30min. GLP-1gradually increased in jejunostomy and reached a peak at120min, which could stimulate more insulin secretion.(3)The basic level of PYY is significantly elevated after7days of EN in gastrostomy and jejunostomy (p=0.000, p=0.000), which significantly inhibited eppetite. PYY of120min after EN in gastrostomy is higher than that of jejunostomy (p=0.006).(4)Basic level of Serum C-peptide (on behalf of insulin) is elevated in gastrostomy and jejunostomy after3,7,12days of EN (p<0.05). Level of C-peptide after EN reaches a peak at30min in jejunostomy and at60min in gastrostomy. C-peptide in gastrostomy at120min is much higher than that in jejunostomy (p=0.006).Conclusions:(1) Enteral nutrition animal model is successfully established by gastrostomy and jejunostomy.(2) Levels of blood glucose differs in different ways of EN. Level of BG in jejunostomy is higher than that in gastrostomy at the same infusion rate. And level of BG is positively correlated with infusion rate.(3) A variety of Gl hormones (grehlin, GLP-1, PYY, Glucagon, Insulin, etc) regulates the level of BG in different mechanisms. Weight can significantly reduce after EN by gastrostomy and jejunostomy. Two kinds of EN can significantly promote insulin secretion. Insulin secretion is more rapid in jejunostomy. Background:Nutrition is an important element of health in the older population and affects the aging process. Malnutrition and nutritional risk are prevalent in hospitalized patients, especially in geriatric wards. But less attention was paid on nutritional risk screening and nutritrional support of elderly patients.Objective:To investigate the prevalence of elderly patients who were under malnutrion or nutritional risk, two different methods including NRS2002and MNA were applied. The applicability and consistency of the two methods were compared. Detect the correlation of nutritional support and clinical outcome. Datas from different groups were analyzed by one-way ANOVA(analysis of variance) and kai square test(P<0.05).Methods:The investigation was conducted by using a continuous fixed-point survey method from July1,2010to April30,2011. NRS2002and MNA were applied to the eligible patients admitted in respiratory ward and gastroenterology ward PUMC Hosipital. Fill out the Case Report Form when clinical observation was completed. The survey results were analyzed using SPSS statistical software.Results:279valid cases were collected and CRF was completed.(1) Nutritional risk is prevalent in elderly hospitalized patients (NRS200268.1%, MNA59.5%). Using the same method in respiratory ward and gastroenterology ward, nutritional risk is not significantly different: NRS200269.5%,66.1%(p=0.552); MNA61.7%,56.3%(p=0.365). But there is significant difference between the two methods in the same wards (p=0.000).(2)In Respotatory ward and gastrointestinal ward of PUMC Hosipital, the rate of nutritional support is29.7%(respectively25.75%,18.75%), which is higher than record. But there is still unreasonable nutritional support cases (12.4%).(3)In the cases with nutritional risk by NRS2002and MNA, the total cost of hospitalization, the average daily total cost, total cost of medicines and the cost of nutritional support are significantly higher than those without nutritional risk.Conclusions:(1)The rate of nutritional risk in PUMCH is higher than documented.(2)Both NRS2002and MNA can be used in elderly hospitalized patients in internal medicine. But patients without risk are more likely to be assessed to those with risk by NRS2002methods. MNA method clearly pointed out patients with malnutrition and patients at the risk of nutrition. So MNA is better for medical elderly patients.(3)Nutritional risk significantly increased the cost of hospitalization.(4)Clincian should learn nutrition screening, further standardize the clinical nutrition support.(5)The choice of nutrition support methods should follow the wishes of patients. For elderly medical patients who can eat by mouth, better choiceis to import intake EN products. If oral feeding is not allowed for4-6weeks, nasogastric tube is better. If fasting for more than6weeks, PEG or PEG-J is better. And EN infusion pump should be applied to increase tolerance and reduce complications. Due to operational complexity, high cost and high incidence of complications, parenteral nutrition support should not be a long-term conventional mothod.