Effects of cyclic (nocturnal) total parenteral nutrition and continuous enteral nutrition on circadian rhythms of blood lipids, lipoproteins and apolipoproteins in humans

Abstract

The aim of the present study was to investigate the occurrence and characteristics (acrophase, amplitude) of circadian rhythms of serum total cholesterol, free-fatty acids (FFA), triglycerides, lipoproteins (HDL-, LDL-, and VLDL-cholesterol), apolipoproteins A and B, glucose and total proteins in hospitalized patients fed with 12 h nocturnal total parenteral nutrition (TPN) (from 8 PM to 8 AM) including lipids, patients fed with continuous enteral nutrition over 24 h daily spans, and patients eating 3 meals a day serving as controls. All the subjects were synchronized with diurnal activity and nocturnal rest in the hospital routine. The results showed the following: 1) circadian rhythms of total cholesterol, triglycerides, FFA, HDL-, LDL-cholesterol, apolipoprotein A and total proteins were detected in both TPN patients and controls, rhythms of apolipoprotein B and glucose in TPN patients only; in enteral nutrition patients, rhythms were detected for total proteins, glucose and triglycerides only; 2) a significant shift in triglyceride and FFA acrophases was observed in TPN patients, as compared with controls; 3) 24 h mean of both triglyceride and cholesterol concentrations remained unchanged after one month, in both TPN and enteral nutrition patients. The present approach, by extending results of previous investigations, leads one to conclude that, on both a metabolic and a chronobiological basis, cyclic nocturnal TPN is well-tolerated.

The association of cyclic parenteral nutrition and decreased incidence of cholestatic liver disease in patients with gastroschisis

“…Diurnal variability in resting energy expenditure has been shown to be absent in continuous PN but present in cyclic PN, although reversed because of nocturnal administration [31]. Furthermore, circadian patterns of apolipoproteins with cyclic PN have been shown to more closely mimic patterns associated with natural intermittent oral feeding than those of continuous enteral feeding [33]. Finally, a cyclic pattern of human growth hormone and insulin has been demonstrated in children receiving cyclic PN [34].…”

Circadian disruption: New clinical perspective of disease pathology and basis for chronotherapeutic intervention

“…Indiscriminate ingestion of melatonin at the wrong biological time to manage dyssomnias and certain other medical conditions of youngsters (delayed sleep phase syndrome, attention-deficit hyperactivity disorder, autism spectrum disorder, mood and anxiety syndromes and some neurologic conditions) and adults, including jet-lag symptoms of travelers transported rapidly across time zones and employees of rotating day/night work schedules, in an attempt to alleviate CD and associated symptoms may actually enhance CD with the possibility of elevated risk of ill effects over the long term (see review by Smolensky et al, 2015a;Stevens, 2006). Chronic cyclic nocturnal enteral and parenteral nutrition to manage short bowel syndrome, intestinal failure and other alimentary tract conditions so as not to restrict diurnal activities is also associated with CD, with alteration of the Φ of the 24 h rhythms in core body temperature (Nishimura et al, 1992); gastric acid secretion (Bouglé et al, 1985); cortisol, parathyroid and insulin hormones (Goodman et al, 2000;Matuchansky et al, 1985;Saito et al, 1989); blood glucose, cholesterol, free fatty acid and/or triglyceride concentrations (Matuchansky et al, 1985;Saito et al, 1989); and renal function and urinary analytes (BoncompainGérard et al, 2000). Hemodialysis when done during the subjective morning or afternoon, rather than subjective nighttime, is more disruptive of the CTS and results in poorer patient outcomes (Abbott et al, 2003;Bliwise et al, 2001;Bugeja & Chan, 2004;Culleton et al, 2007;Koch et al, 2010;Suneja et al, 2011;Teles et al, 2014).…”

Recommending Small, Frequent Meals in the Clinical Care of Adults: A Review of the Evidence and Important Considerations

“…However, preliminary research supports the need for nutrition support therapy to be given during the daytime, as it may promote the integrity of the liver and better mimic “real” intermittent and noncontinuous eating patterns 72 . Limited research comparing 12‐hour overnight PN with 3 meals consumed orally found significant shifts in the rhythmicity of triglycerides and free fatty acids in patients receiving PN 76 . Animal studies suggest that PN may alter the circadian rhythms of both the central and peripheral clocks 72 .…”