efficiency of digestion (%)

5% lost in faeces

%EE used by gut and liver

35% of EE

% of glucose used by gut and intestines

10%

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

33%

European Food Safety Authority recommends that ?%

of calories should be contributed by linoleic acid and

?% by α-linolenic acid

4% of calories should be contributed by linoleic acid and

0.5% by α-linolenic acid

PN Phosphides

Higher in 10% than in 30%

TG is broken down by an enzyme called?

lipoprotein lipase

How to measure lipids peroxidation ?

MDA

How to reduce lipids peroxidation?

vitamin E

Lowering carbohydrates intake

Disadvantages of lipids

“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

High levels of phytosterols from parenteral nutrition may lead to

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

acute phase proteins are particularly high in

sulphur amino acids

% of leucine utilised by intestine and liver

24-50

% of lysine utilised by intestine and liver

20

% of glutamine utilised by intestine and liver

up to 50

Egg protein is high in

Relatively high in phenylalanine

How much of each amino acid should be given parenterally?

Reference profile for premature infants

umbilical cord

antioxidant enzymes

intracellular

extracellular

chemical antioxidants

• fat soluble

• water soluble

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

intra- and extracellular superoxide dismutases

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

Catalases

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

glutathione peroxidase

1. Mitochondria H2O2 -> water
2. Lipids peroxides

anti-oxidant roles of micronutrients in PN

• iron (catalase)

• copper (superoxide dismutase)

• zinc (superoxide dismutase)

• manganese (superoxide dismutase)

• selenium (glutathione peroxidase)