The effect of the route of nutrient delivery on gut structure and diamine oxidase levels

Abstract

Diamine oxidase (DAO) is an intestinal mucosal enzyme which serves as a marker of cellular maturity and integrity in ontogeny and after mucosal injury in the gastrointestinal tract. Since total parenteral nutrition is known to result in intestinal hypoplasia, this study was done to determine the effect of enteral and parenteral delivery of nutrients on gut structure and DAO levels. Central venous catheters were placed in 27 Sprague-Dawley rats (180-260 g), which received nutrients for 12 days via parenteral nutrition (GpI n = 10), oral intake of the parenteral solution (GpII n = 8), or standard rat chow (GpIII n = 9). Gross and microscopic measurements were made at sacrifice. Mucosal DAO levels were determined by metabolism of [3H] putrescine. Group III animals had a greater caloric intake than groups I and II, and were the only group with a significant increase in body weight. Gut weight, mucosal weight, and villous height were significantly less in group I vs groups II and III; group II values were less than group III (p less than 0.05). Both DAO specific activity and total gut DAO were significantly less in group I and group II. Mucosal DAO content correlated with total gut and mucosal weight. DAO mucosal levels decrease with parenteral nutrition, reflecting the intestinal hypoplasia that occurs. Mucosal DAO content may be dependent on both caloric intake and diet composition. Since serum DAO levels are known to correlate with mucosal DAO content, DAO activity may prove useful as a circulating marker of the effect of nutritional therapy on the intestinal mucosa.

Significance of the Intestinal Gradient of Diamine Oxidase Activity

“…Similar ly, Laganiere et al [25] found in dogs that there was not a close correlation between the morphological and functional patterns along the intestinal tract. These findings are also consistent with our previous observations in rats receiving total parenteral nutrition that the diminished intestinal DAO activity did not correlate directly with villus height [19]. Furthermore, Guedon et al [29] found that brush border enzyme activity decreases dur ing fasting in humans without gross morpho logical changes.…”

“…Such factors include age, vitamin deficiency, endocrine function, pregnancy, diet, malignancy and medications [3,[19][20][21][22], The extent of intes tinal disease and previous intestinal resec tion are obviously important. Whether loca tion of intestinal disease is an important determinant of intestinal and serum DAO activity is another consideration.…”

“…Maltase and sucrase have lower activity more proximally with a peak in the mid small intestine which is consistent with other studies [24][25][26][27], The high proximal activity of DAO is character istic of alkaline phosphatase and the intra cellular intestinal enzymes acid p-galactosidase and hetero-P-galactosidase [26,27], Whether the similar distribution of enzymes along the gastrointestinal tract has implica tions for developmental patterns, function and response to intestinal disease is unclear [28][29][30][31][32][33]. For example, sucrase and maltase activity change more significantly in re sponse to total parenteral nutrition and oral refeeding than does lactase [32], Intestinal DAO activity diminishes during total paren teral nutrition, however [19].…”

Frühe enterale Ernährung – Grenzen und Möglichkeiten

“…Die enterale Na È hrstoffzufuhr ist die physiologische Alternative zur parenteralen Erna È hrung, wobei insbesondere ihre Auswirkung auf die Integrita È t der Darmmukosa hervorzuheben ist [3±7]. Wa Èhrend die Gabe enteraler Erna Èhrung die Darmschleimhaut schu È tzt, kommt es nach 10ta Ègiger totaler parenteraler Erna È hrung zur Ru È ckbildung der Darmmukosa auf 50% ihres Ausgangsvolumens [8]. Die trophischen Effekte selbst geringer Mengen enteraler Erna Èh-rung sind gut dokumentiert [9].…”

Nutritional concepts and considerations in head and neck surgery

“…No comparable studies have been performed using the enteral feeding route, although an increasing body of data suggests that the benefits of enteral nutrition, particularly immunological, are greater than those of isocaloric amounts of parenteral nutrition. 20,21 Caution must be taken when data obtained from patients with gastrointestinal malignancies is extrapolated to the head and neck cancer patient. However, when the postoperative complication rate in high-risk patients (based on PNI) is taken into consideration, we believe it appropriate to advocate delaying surgical procedures in this group for 10 days while preoperative nutritional support is provided, preferably via nasogastric tube feeding.…”