J.Jpn. Surg. Soc.. 59(4): 657-676, 1958
A STUDY ON TUBE FEEDING USING FAT EMULSION
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2nd Department of Surgery, School of Medicine, Tokyo Medical and Dental University (Director: Prof. Eisuke HAMAGUCHI) Nobuhiko KOMI |
With our present-day facilities it is next to impossible to satisfy basic nutritional requirements by parenteral means alone. In addition to difficulty of eating the right type of food, catabolism is increased by operation and postoperative patients are affected with fever, so the patients demand excessive calories. · It is generally agreed that food taken directly into the upper gastrointestinal tract will be utilized with maximum efficiency. The tube feeding for gastrectmized patients have the advantage of direct absorption from the intestinal tract. Although the nutrient of tube feeding is limited in fat because it was believed that fat causes side effects, for instance, disturbances of metabolism of liver functions, diarrhea, abdominal cramps etc. But the application of fat is the most effective to supply enough calories. After the clinical trial of many different types of fat, the conclusion has been reached that soy bean oil emulsion is the gratifying basic constituent of tube feeding.
There are two theories about absorption of fat from the intestine.
The generally accepted lipolytic theory of fat absorption assumes that all fat ingested in the diet is completely hydrolyzed by pancreatic lipase to glycerol and fatty acids. However, Frazer believed that in addition to this method of fat absorption by complete hydrolysis, there is a second possible mechanism. According to Frazer's theory, the finely emulsified neutral fat particles less than 0.5 micron in diameter are absorbed directly through the intestinal mucosal cells in unchanged form and pass either directly into the lacteals or into the blood stream leading to the liver.
If the absorption of fat according to the partition theory does occur in the body, it was postulated that the absorption of fat from the intestine could be done easily by decreasing the particle size of the fat globules.
A fat emulsion of soy bean oil with a non-ionic surface active agent such as "Tween 80" was prepared by means of a homogenizer. The sizes of almost all of fat particles are less than 0.5 micron in diameter.
Restorgen (a high caloric, high protein nutriment) was added to the soy bean oil emulsion in order to get the nutrient of high fat, high protein, and high calory. It was administered to 41 cases of gastrectmized patients 6 hours after operation by means of a double lumen tube into the duodenum or jejunum. The amount of fat given was 50- 100 g/day.
During the tube feeding examinations were made of absorption rates of fat and protein, serum chylomicron, clinical symptoms, liver functions, urine etc.
The results are as follows :
1. The absorption rates of fat and protein were excellent, 88% in average.
2. The chylomicrons in serum were increased by administration of fat emulsion. This indicates that the administered fat emulsion is absorbed from the intestine even a short time after the operation.
3. Indisposed clinical symptoms were not observed.
4. Severe disturbances of liver functions by using of fat emulsion were not observed.
5. Examination of urine were almost normal, especially oxaluria was not observed.
6. No other indisposed signs wer found.
I have come to the following conclusion, that the application of fat emulsion appears to be well tolerated by the duodenum or jejunum of postoperative patient and fat emulsion is very useful for postoperative nutrition.
(author's abstract)
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