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Title: Continuous administration of an elemental diet induces insulin resistance in neonatal pigs

item STOLL, B - Children'S Nutrition Research Center (CNRC)
item PUIMAN, P - Erasmus Medical Center
item BENIGHT, N - Children'S Nutrition Research Center (CNRC)
item BAUCHART-THEVRET, C - Children'S Nutrition Research Center (CNRC)
item Burrin, Douglas - Doug

Submitted to: Acta Paediatrica
Publication Type: Abstract Only
Publication Acceptance Date: 10/9/2009
Publication Date: 10/9/2009
Citation: Stoll, B., Puiman, P., Benight, N., Bauchart-Thevret, C., Burrin, D.G. 2009. Continuous administration of an elemental diet induces insulin resistance in neonatal pigs [abstract]. Acta Paediatrica. 98(Suppl.460):55.

Interpretive Summary:

Technical Abstract: We previously showed that total parenteral nutrition (TPN) compared to intermittent enteral feeding of a milk-based formula induces insulin resistance and hepatic steatosis in neonatal pigs. We hypothesized that intravenous (IV) feeding rather than the nature of the diet (elemental vs polymeric) or the feeding pattern (continuous vs intermittent) had contributed to the outcome. Neonatal pigs implanted with catheters in the jugular vein, carotid artery, and stomach received one of four feeding regimen for 14 d: elemental diet continuously IV (TPN), or continuously intragastrically (CEN), or intermittently intragastrically (IEN), or a milk-based formula intermittently intragastrically (FORM). Insulin sensitivity was examined with an intravenous glucose tolerance test (IVGTT) and hyperinsulinemic-euglycemic clamp technique (CLAMP) on days 7 and 14, respectively. IVGTT demonstrated no difference between TPN and CEN which both had increased insulin resistance compared to FORM. During CLAMP, the glucose infusion rates required to maintain fasting blood glucose levels were not different between TPN and CEN. IEN was significantly higher than TPN and CEN, and IEN was lower than FORM. Liver weights were 50% higher in TPN compared to the other groups. When given continuously, enteral compared to intravenous administration of an elemental diet does not ameliorate TPN-induced insulin resistance. Insulin sensitivity was improved by intermittent enteral feeding of elemental diet. It appears that the pattern rather than the route of nutrient administration affects insulin sensitivity. It remains to be seen whether insulin sensitivity is increased by intermittent TPN, or decreased by continuous formula feeding.