Journal of Parenteral and Enteral Nutrition http://pen.sagepub.com/

Effect of a Taurine-Supplemented Diet on Conjugated Bile Acids in Biliary Surgical Patients Wen-Yen Wang and Koung-Yi Liaw JPEN J Parenter Enteral Nutr 1991 15: 294 DOI: 10.1177/0148607191015003294 The online version of this article can be found at: http://pen.sagepub.com/content/15/3/294

Published by: http://www.sagepublications.com

On behalf of:

The American Society for Parenteral & Enteral Nutrition

Additional services and information for Journal of Parenteral and Enteral Nutrition can be found at: Email Alerts: http://pen.sagepub.com/cgi/alerts Subscriptions: http://pen.sagepub.com/subscriptions Reprints: http://www.sagepub.com/journalsReprints.nav Permissions: http://www.sagepub.com/journalsPermissions.nav Citations: http://pen.sagepub.com/content/15/3/294.refs.html

>> Version of Record - May 1, 1991 What is This?

Downloaded from pen.sagepub.com at Afyon Kocatepe Universitesi on May 8, 2014

Effect of

a

Taurine-Supplemented Diet on Conjugated

Bile Acids in

Biliary Surgical Patients

WEN-YEN WANG, M.D.*

AND

KOUNG-YI LIAW, M.D. of China*;

Taiwan, Republic From the Department of Surgery, Provincial Tao- Yuan General Hospital, Tao- Yuan, Republic of China Taiwan, Taipei, Surgery, National Taiwan University Hospital,

and the

Department of

ABSTRACT. The effect of a taurine-supplemented diet on the level of conjugated bile acids in postoperative patients was investigated during two consecutive 5-day periods. Eighteen hepatobiliary patients with choledochostomies and a specific T-tube insertion were collected and divided randomly into two groups. In group 1, an ordinary postoperative soft diet was prescribed for the first 5 postoperative days and then followed with a taurine-supplemented soft diet (40 μmol/kg per day) for 5 consecutive days. In group 2, the taurine-supplemented diet was prescribed in reverse. At the end of the two periods, on days 5 and 10, bile was collected via a T-tube with an inflatable balloon and low-pressure motor suction. Analysis of conjugated

bile acids was done by high-performance liquid chromatography. The results showed that a taurine-supplemented diet increased the concentration of taurocholic acid, glycocholic

Bile is a complex aqueous solution of inorganic and organic compounds. The inorganic compounds include water and electrolytes, and the main organic compounds are the conjugated bile acids, phospholipids, cholesterol, and the bile pigments. Bile acids present in human bile are conjugated with either taurine or glycine. 1, Virtually all of the conjugated bile acids in the neonate are taurine,’ with the proportion of taurine conjugate decreasing with age.4 However, the process of conjugating bile acids, including synthesis, excretion, maintenance of the bile acid pool, etc, is affected in several different kinds of hepatobiliary disease.5 Furthermore, Treaswell et al have stated that bile acid conjugation can be augmented by increasing the taurine intake in humans with normally functioning livers.’ Hardison has reported that in cases of obstructive jaundice the percent of taurine conjugates increases in both liver tissue samples and bile shortly

the

acid, taurochenodeoxycholic acid, glycochenodeoxycholic acid, and total bile acid from 0.5, 1.9, 0.3, 1.4, and 4.7 mg/mL (on day 5) to 1.1, 3.5, 1.0, 2.6, and 8.9 mg/mL, respectively, on day 10 in group 1. Similar findings were noted in group 2. These

results indicate that a taurine-supplemented diet may enhance the conjugation and secretion of bile acid in hepatobiliary :294patients. (Journal of Parenteral and Enteral Nutrition 15

297, 1991)

patients studied. Eighteen patients who received a choledochostomy with T-tube placement between June 1986 and March 1987 were collected for this investigation. These patients were randomly divided into two groups; the clinical information of each group is shown in Tables I and II. Group 1 consisted of nine patients who received a taurine-supplemented diet (40 ~mol/kg per day divided into three portions given as meal supplements) beginning on the sixth day following the resumption of an oral diet. Group 2 consisted of another nine patients who received the same taurine-supplemented diet; however, in this group it was started on the first day following the resumption of an oral diet and discontinued after 5 days

(Table III).

Postoperative diets were supplied by the Nutrition Service, Provincial Tao-Yuan Hospital. The formula after taurine supplementation.’ But these reports have consisted of protein (1.5 g/kg per day), fat (1 g/kg per not mentioned the effects of taurine on the maintenance day), and carbohydrates. Generally, the dietary intake of bile flow and concentration. Therefore, the purpose of was 30-50% less in the first 5 days than in the second 5 this study was to define the effect of a taurine-supple- days. mented diet on the synthesis and secretion of conjugated On day 5 and day 10, bile samples were collected via a bile acids in the hepatobiliary surgical patient in the T-tube with a flattened balloon at the tip (Fig. 1). The postoperative period. T-tube, with a 1.5-mL saline-inflated balloon, was connected to a low-pressure motor suction for 3-hour periods of bile-sample collection: 8:00 to 11:00 and 15:00 to 18:00 MATERIALS AND METHODS on days 5 and 10. The amount of collected bile was The study was performed with the approval of the recorded. Human Investigation Committee of Provincial TaoYuan Hospital and informed consent was obtained from

Analytical Methods

Reprint requests: Dr Wen-Yen Wang, Department of Surgery, Provincial Tao-Yuan Hospital, Tao-Yuan, Taiwan. ROC. 294

Methods used for the of bile acids were as described by Okuda et al.8 assay a half milliliter of a Briefly, bile sample was diluted with 2 mL of ethanol and heated

Downloaded from pen.sagepub.com at Afyon Kocatepe Universitesi on May 8, 2014

295 water bath at 80°C for 3 minutes. The precipitate removed by both centrifugation at 3000 rpm for 8 minutes and a 0.45-,um Millipore filter (HAWP Cat No. 02500, Millipore Corp, Bedford, MA). The extraction procedure was performed twice and all of the supernatants were evaporated until dry under nitrogen, then redissolved in 0.5 mL of methanol. Bile acid conjugates

in

a

was

analyzed by high-performance liquid chromatography (Waters Associates, Milford, MA). An ALPS column (Nucleosil 7 C18 4.6 x 250 mm) was used for all separawere

tions. A mixture of standard bile acids and testosterone acetate was used as an internal standard for this study. The concentrations of glycocholic acid (GC), glycochenodeoxycholic acid (GCDC), glycodeoxycholic acid

(GDC), taurocholic acid (TC), taurochenodeoxycholic acid (TCDC), and taurodeoxycholic acid (TDC) were calculated and the results expressed in milligrams per milliliter. All data were summarized and compared by the paired Student’s t-test. RESULTS

Clinical Course All patients were well and without any major postoperative complications. One patient (case 4) in group 1 and two patients (cases 1 and 6) in group 2 had Whipple’s procedures. All patients started oral intake 4 to 5 days after surgery. The two groups of patients were well matched for age, liver function, and calorie intake. The amounts of bile collected in two different periods were similar (Table IV). Also, there was no significant difference in bile collection on days 5 and 10 between the two groups.

Analytical Results The concentrations of TC, GC, and GCDC increased

significantly from means of 0.5, 1.9, and 1.4 on day 5 to 1.1, 3.5, and 2.6 mg/mL on day 10, respectively, in group 1 (Fig. 2). In the mean time, the amount of total conjugated bile acid increased from a mean of 4.7 to 8.5 mg/ mL after the taurine-supplemented diet was begun in group 1. In group

2, the concentrations of TC, GC,

TCDC, and total bile acid conjugates

were

higher on the

fifth day after the taurine-supplemented diet was begun than on the 10th day of therapy (mean of 0.9 vs 0.5, 2.7 vs 1.7, 1.0 vs 0.5, and 6.1 vs 4.9 mg/mL) (Fig. 3). DISCUSSION

Several observations have confirmed that the percent of taurine conjugation in the bile is low, while the demand for bile acid conjugation is high. Studies have also shown that a taurine feeding reverses this low percentage of taurine conjugation.,&dquo; Therefore, these reports suggest that the availability of taurine is a major determinant of the bile acid conjugation pattern in humans.6,1 The data in this study support the previously described effect of a taurine-supplemented diet on the taurine-conjugated bile acids of hepatobiliary illness in the immediate postoperative period. Taurine, 2-aminoethanesulfonic acid, is a /3-amino acid. At the present time, taurine is known to be a nutrient that protects cell membranes by attenuating toxic compounds.&dquo; Furthermore, taurine is used in the formation of bile acid conjugate. This study demonstrated that a consecutive, low dose of taurine does not alter the amount of bile excretion, but it does increase the percentage of taurine-conjugated bile acids and thus maintain the ratio of taurine- to glycine-conjugate in the field of bile metabolism. This clinical study confirmed the fact that the availability of low doses of taurine given to surgical patients will increase taurine conjugation. The amount of increase varied from 80% in group 1 to 25% in group 2. These results are compatible with the liver biopsy and bile studies in Hardison’s series.’ The data regarding the effect of the timing of taurine on bile acid conjugates are interesting. In the initial period of post-biliary surgery (day 5), the effect of taurine on the increasing taurine-conjugated bile acid was 28% less than its effect in the latter period (day 10). Surgical procedures and their systemic and local effects may be the causative factor. It has been proposed that taurine feeding increases hepatic taurine concentrations and alters hepatic enzymes to select conjugate bile acids with taurine.6,7,12 This combination could enhance the synthesis of taurine-conjugated bile acid. Beneficial effects have been attributed to taurine ad-

supplementation

TABLE I Bile flow in group 1 (mean

±

SD) -

*

t

Preoperative value. CBD, common bile duct; IHD, intrahepatic

duct.

Downloaded from pen.sagepub.com at Afyon Kocatepe Universitesi on May 8, 2014

296 TABLE II Bile flow in group 2 (mean ± SD)

TABLE III

Protocol of present study

FIG. 2. Concentrations of individual,

conjugated

bile acids in.

group 1.

FIG. 3. Concentrations of group 2.

-

N -

FIG. 1. A T-tube with an inflated balloon at the tip bile duct for bile collection.

was

inserted in

common

TABLE IV Amount of bile collected

during two time periods in SD, mL/3 h)

two groups

(mean

+

individual, conjugated bile acids in

ministration in the clinical course of acute and chronic hepatitis ’13 in drug-induced liver illness,&dquo; and in ophthalmic and hepatic complications of long-term total parenteral nutrition.15,16 In this series, taurine is demonstrated to definitely be beneficial in enhancing bile acid excretion and may be considered one of the therapies available to alleviate cholestasis in hepatobiliary patients. REFERENCES

*

Taurine-supplemented.

1. Ekdahl PH, Bennike T: On the conjugation of bile acids in the human liver. Acta Chir Scand 115:203-207, 1958

Downloaded from pen.sagepub.com at Afyon Kocatepe Universitesi on May 8, 2014

297 2. Ekdahl PH, Sjovall J: On the conjugation and formation of bile acids in the human liver, I: On the excretion of bile acids by patients with post-operative choledochostomy drainage. Acta Chir Scand 114:439-452, 1958 3. Poley JR, Dawes JC, Owen CA, et al: Bile acids in infants and children. J Lab Clin Med 63:838-846, 1964 4. Sjovall K, Sjovall J: Serum bile acid levels in pregnancy with pruritus. Clin Chim Acta 13:207-211, 1966 5. Javitt NB: Bile acids and hepatobiliary disease. IN Diseases of the Liver, 5th ed., Schiff L, Schiff ER (eds). JB Lippincott Co, Philadelphia, 1982, p 119 6. Treaswell S, McVeigh S, Mitchell WD, et al: Effect in man of feeding taurine on bile acid conjugation and serum cholesterol level. J Atheroscler Res 5:526-532, 1965 7. Hardison WGM: Hepatic taurine concentration and dietary taurine as regulators of bile acid conjugation with taurine. Gastroenterol-

75:71-75, 1978 H, Obata H, Nakamishi T, et al: Quantification of individual serum bile acids in patients with liver diseases using high-performance liquid chromatography. Hepatogastroenterology 31:168-171,

ogy

10.

11. 12.

13.

68:534-544, 1975 T, Takino T, Kuriyama K, et al: Therapeutic and prophylactic effects of taurine administration on experimental liver

14. Nakashima

15.

8. Okuda

1984 9.

Sjovall

J:

Dietary glycine and taurine

on

bile acid conjugation in

Proc Soc Exp Biol Med 100:676-678, 1959 Garbutt JT, Heaton KW, Lack L, et al: Increased ratio of glycine to taurine conjugated bile salts in patients with ileal disorders. Gastroenterology 56:711-720, 1969 Wright CE, Tallan HH, Lin YY: Taurine: Biological update. Annu Rev Biochem 55:427-453, 1986 Gottbries A, Scherster T, Ekdahl PH: The capacity of human liver homogenates to synthesize taurocholic and glycocholic acid in vitro. Scan J Clin Lab Invest 18:643-653, 1966 Stiehl A, Earnest PL, Admirand WH: Sulfation and renal excretion of bile salts in patients with cirrhosis of the liver. Gastroenterology man.

16.

injury. IN Sulfur Amino Acids: Biochemical and Clinical Aspects, Kuriyama K, Huxtable R, Iwate H (eds). Alan R Liss Inc, New York, 1983, pp 449-471 Geggel HS, Ament ME, Heckenlively JR, et al: Nutritional requirement for taurine in patients receiving long-term parenteral nutrition. N Engl J Med 312:142-146, 1985 Cooper A, Betts JM, Pereira GR, et al: Taurine deficiency in the severe hepatic dysfunction complicating total parenteral nutritions. J Pediatr Surg 19:462-466, 1984

Downloaded from pen.sagepub.com at Afyon Kocatepe Universitesi on May 8, 2014

Effect of a taurine-supplemented diet on conjugated bile acids in biliary surgical patients.

The effect of a taurine-supplemented diet on the level of conjugated bile acids in postoperative patients was investigated during two consecutive 5-da...
347KB Sizes 0 Downloads 0 Views