p.5 LACK OF INFLUENCE OF INCREASED CARBOHYDRATE SUPPLY ON PROTEIN STATUS AFTER MAJOR

AEWbfItdAL lXAUM3. D. Lijhlein, M. Tijrijk ( &partmnt_s of Surgery and Bicxnetric, University ofHannover,F'EG) The positive influence of adaequate amino acid substitution on postoperative protein catabolisn is well d ocumnted. Hcmaver, regarding the amuntof carbohydrate supply, especially after major surgery, even now the discussion is controversial. Remmenda- tions extent frcxn hype-to high-caloric dosages. That's why the following prospective studywasperfoxTned. ~thods: 29 pats. after total gastrectony received a constant AA-substitution of I,5 g/kg b.st/day and three different mounts of CH/kg b. wt/day: A = 2 g (low-caloric, n = 9), B = 5,5 g (caloric, n = IO) and C = 9 g (high-caloric, n = 10). Various plasm proteins free amino acids, FFA and ketones were measured pre- and postoperatively until the 10 th. day. Totalnitrogen (N) - and C-peptide excretion /24 h were determined at p. o. day 1,3,5and7inurine. Results: Postoperative N-balances shmed no significant differences among the groups. Cumulative N-losses /6 days: A = -IO,0 g, B = -13,3 g, C = -15,4 g; Calculated N-retan- tion: A = 86,7 %, B = 87,5 %, C = &I,4 %. Total protein, albmin, transferin, prealbumin and. ret. bind. protein were found decreased in all groups postoperatively without signi- ficant differences. FFA-levels wexe depressed only in group C (day 3 - 7) and ketons (OH-Eutyrat) in group B and C (day 1 - 7). C-peptide-excretion was elevated in all groups hcwever, significantly higher in group B and C at day 3 - 5. Inversely the total level of free amino acids was absolutely elevated in group B and C (day 1 - 3 )and in, or just below normal range in group A. Conresponding alaninelevels were found significantly lower in group Athan in group B andC (day1 - 3). Except phenylalanine and tyrosine, which were elevated in group B and C, other amino acids were not significantly altered. Conclusion: Our results demnstrate, that after major surgical trauma, protein status cannot be effectively influenced by increased, even high-dosed carbohydrate intake. It seems, that hormn-induced mbilisation of endogmous energy sources cannot be over- ame by the exogenous supply.

P.6 EFFECTS OF PAIR-FEEDING AND A MENHADEN OIL DIET ON SURVIVAL TO ENDOTOXIN IN GUINEA PIGS

E.A. Mascioli, Y. Iwasa, S. Trimbo, B.R. Bistrian, G.L. Blackburn. (Department of Medi- cine and Surgery, Harvard Medical School, and Travenol Laboratories, Boston, MA; USA).

During endotoxemia, thromboxane A2 (TxA2) and prostacyclin 12 (PG12) are thoughtto be im- portant mediators. Enhanced survival to endotoxic shock in rats has been the result of dietary pretreatment to cause essential fatty acid deficiency or pharmacologic pretreat- ment with cycle-oxygenase inhibitors (ibuprofen or indomethacin) or a thromboxane synth- ase inhibitor (imidazole). The enhanced survival has been correlated with lower levels of TxB2, a stable metabolite of TxA2. Menhaden oil contains very small amounts of w6 fatty acids and is relatively rich in w3 fatty acids, such as eicosapentaenoic and docosahexaenoic acids (EPA and DHA). Since TxA3 and PG13, the cycle-oxygenase products of EPA, have different vascular and platelet effects than TxA2 and PG12, fish oil feed- ing could be expected to decrease endotoxic mortality. Prior work done by us showed this effect, but was confounded by less weight gain in the menhaden oil fed group. Since overfeeding in dogs has led to increased mortality when challenged with distemper virus, this study investigated the effects of both menhaden oil and ad libitum feeding on survival to endotoxic shock. Since current intravenous lipid emulsions consist pre- dominantly of linoleic acid, a precursor of TxA2 and PG12, the potential exists for excessive morbidity in septic patients. Three groups (30 animals each) of male, Hartley strain guinea pigs were fed for 6 weeks modified Reid-Briggs semi-purified diets where 36% of the calories were derived from either safflower or menhaden oil. Two groups (one safflower and one menhaden) were pair-fed and the third group (safflower) was allowed to eat ad libitum. Weight gain was 342+9 gm in the ad lib-fed safflower group, 20225 gm in the pair-fed safflower group anh179+6 gm in the pair-fed menhaden group. Endotoxin, .4 mg/lOO gmBW was administered i.p. an;T survival measured. Menhaden oil delayed mortality as compared to the safflower oil pair-fed animals. The ad lib safflower oil group had consistently the worst survival of all 3 groups. We conclude that menhaden oil feeding delays mortality and ad libitum feeding increases mortality, due to endotoxic shock.

99