[in Japanese]

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We evaluated the effect of the new diabetic enteral diet containing L-Isoleucine, “DM-1” for the inhibition of hyperglycemia and the decrease of malnutrition using diabetic animal models. DM-1 is characterized by the composition of the nutrients L-Isoleucine and medium-chain triglyceride (MCT). One of the branched-chain amino acids, L-Isoleucine inhibits hyperglycemia by promoting the uptake of glucose by muscles. MCT is absorbed more rapidly for energy than long-chain triglyceride. The gastric administration of DM-1 to type 2 diabetic model GK rats suppressed hyperglycemia more effectively than the standard formula. Moreover, a six week feeding period of DM-1 inhibited the increase of hemoglobin A1c (HbA1c) levels in the type 1 diabetic STZ rats. It was shown that DM-1 also improved the body weight of the malnourished GK rats in a comparative study with the commercial formula. We demonstrated that DM-1 was very effective for the inhibition of hyperglycemia and the decrease of malnutrition in long term nutritional support. These results indicate that DM-1 may have the same effects for diabetes patients.

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[Objective] “iEat,” a new food that is soft enough to melt in the mouth and shaped to be highly chewable/swallowable with natural appearance and flavor of usual foods, was developed using enzymolysis. Its physical properties and ingredients were analyzed, and its degradability and digestibility in the gastrointestinal tract were assessed in artificial digestion tests to evaluate the usefulness in patients with impaired chewing/swallowing.
[Materials and methods] The physical properties, composition, degradability, and digestibility in artificial digestive juices were analyzed as compared to usually cooked “regular diet” as control. The physical properties, proteins, and dietary fiber were determined. In digestion experiments, food was made to react with artificial saliva, gastric juice, or intestinal to determine the residual rates and protein elution.
[Results] All of the “iEat” food samples had a hardness of 2×10⁴ N/m² or less, markedly less than that of “regular diet.” This difference was attributed to enzymatic treatment that facilitates digestion of proteins and dietary fiber, which provide the shape and structure of food, into smaller molecules. In the artificial digestion experiments using artificial digestive juice, “iEat” was collapsed more rapidly than regular diet and almost completely digested with minimal residue. Proteins in “iEat” were eluted into the digestive juices at markedly higher levels than those in regular diet.
[Conclusion] It is shown that “iEat,” an enzymolysis-based shape-retaining softened food. Therefore, “iEat” is expected to be a novel oral nutrition product for elderly people and early gastrointestinal postoperative patients with impaired chewing/swallowing or digestive function.

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Objective: We investigated deficiencies or excesses of vitamins B₁, B₆, and C, and folic acid in elderly patients who were nutritionally managed with total parenteral nutrition containing vitamins.
Methods: Subjects were elderly inpatients who required about 1000 mL of fluid managed by total parenteral nutrition (TPN). TPN solution (1000-1500 mL) was administered continuously for 24 hours. Blood samples were collected on the start day of follow-up and days 28, 56, and 84 to determine blood levels of vitamins B₁, B₆, and C, and folic acid.
Results: The results were obtained from 17 patients whose consents could be obtained from their families. The patients consisted of 6 men and 11 women, with an average age of 84.6 ± 6.4 (between 70 and 98 years). On the start day of follow-up, mean blood vitamin C levels were 3.7 ± 1.9 μg/mL, which were lower than the standard range (5.5-16.8 μg/mL). Mean blood vitamin C levels in the 6 patients who received additional 500 mg/day of vitamin C returned to the standard range (final values: 12.5 ± 3.1 μg/mL). Mean vitamin C levels in the 11 patients who did not receive vitamin C additionally remained low (final values: 3.5 ± 2.4 μg/mL). Mean blood vitamin B₁ levels were slightly higher than the standard range. Mean blood vitamin B₆ and mean blood folic acid levels remained within the standard range.
Discussion: Blood vitamin C levels were likely to decrease in elderly patients who needed TPN. Low levels of vitamin C were consistently observed in the patients who received 1000 to 1500 mL/day of TPN containing vitamins. These findings suggest the need for adequate supply of vitamin C by measuring blood vitamin C levels regularly in elderly patients who required TPN.

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Nowadays, we sometimes have opportunities to treat the hydrocephalic patients with severe disabilities and/or poor outcomes. Percutaneous endoscopic gastrostomy (PEG) has been widely used for the patients with dysphagia and/or prolonged consciousness disturbances. There are many reports which revealed that infectious complications often occurred in the patients with VP shunt for hydrocephalus with PEG. We make an incision at unilataral lower quadrant area of the abdomen for peritoneal catheter insertion. The aim of this study is to prevent from shunt complications for the patients with enteral nutrition and planning PEG. From May 2008 to August 2010, 12 adult patients, four men and 8 women, 9 aneurysmal subarachnoid hemorrhage, 2 intracerebral hemorrhage and one idiopathic normal pressure hydrocephalus, were studied. All of them showed good recovery from hydrocephalic conditions. Only one patient had an abdominal shunt revision due to subcutaneous cyst formation. Two patients were died by pneumonia and accidental cerebral hemorrhage of Moyamoya disease. All patients showed no infectious complications, included 3 patients had PEG.

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[in Japanese]

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