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36 2.4 Metabolism of Parenteral Nutrients

front 1

efficiency of digestion (%)

back 1

5% lost in faeces

front 2

%EE used by gut and liver

back 2

35% of EE

front 3

% of glucose used by gut and intestines

back 3

10%

front 4

% of glucose used by the gut and intestines in preterm infants

back 4

33%

front 5

European Food Safety Authority recommends that ?%

of calories should be contributed by linoleic acid and

?% by α-linolenic acid

back 5

4% of calories should be contributed by linoleic acid and

0.5% by α-linolenic acid

front 6

PN Phosphides

back 6

Higher in 10% than in 30%

front 7

TG is broken down by an enzyme called?

back 7

lipoprotein lipase

front 8

How to measure lipids peroxidation ?

back 8

MDA

front 9

How to reduce lipids peroxidation?

back 9

vitamin E

Lowering carbohydrates intake

front 10

Disadvantages of lipids

back 10

“fat overload syndrome” – activation of platelets

and immune system

• Cholestasis

• Fat is increased slowly in PN due to intolerance

• Excessive triglyceride and or free fatty acid levels

deleterious and need to be monitored

front 11

High levels of phytosterols from parenteral nutrition may lead to

back 11

increase hepatic lipogenesis and bile acid synthesis, leading to fatty liver and cholestasis and PNAC

front 12

acute phase proteins are particularly high in

back 12

sulphur amino acids

front 13

% of leucine utilised by intestine and liver

back 13

24-50

front 14

% of lysine utilised by intestine and liver

back 14

20

front 15

% of glutamine utilised by intestine and liver

back 15

up to 50

front 16

Egg protein is high in

back 16

Relatively high in phenylalanine

front 17

How much of each amino acid should be given parenterally?

Reference profile for premature infants

back 17

umbilical cord

front 18

antioxidant enzymes

back 18

intracellular

extracellular

front 19

chemical antioxidants

back 19

• fat soluble

• water soluble

• non-specific antioxidants e.g. amino acids, proteins

front 20

intra- and extracellular superoxide dismutases

back 20

  1. CuZn-SOD (lung extracellular fluids and plasma) (cystolic)
  2. Mn-SOD (mitochondria)
  3. superoxide O2- -> H2O2 hydroxides

front 21

Catalases

back 21

  1. Peroxisomes
  2. contains Fe+3 at active site
  3. active at high H2O2 concentration

front 22

glutathione peroxidase

back 22

  1. Mitochondria H2O2 -> water
  2. Lipids peroxides

front 23

anti-oxidant roles of micronutrients in PN

back 23

• iron (catalase)

• copper (superoxide dismutase)

• zinc (superoxide dismutase)

• manganese (superoxide dismutase)

• selenium (glutathione peroxidase)