CLLNEAL NUTRITION (1990) 9: 281-288 0 Lanlpllpn Group UK Ltd 0990) zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA Selenium Status Prior to and During One Month Total Parenteral Nutrition in Gastroenterological Patients: A Randomised Study of Two Dosages of Se Supplementation zyxwvutsrqpo B. Messing, F. Man, P. Therond *, T. Hanh, F. Thuillier and J. C. Rambaud Centre Agree de Nutrition Parent&ale P Domicile, Hopital Saint-Lazare, INSERM U.290 et l Laboratoire de Biochimie, Hbpital Robert-Debre, Paris, France (Reprint requests to B.M. INSERM U.290-Hopital Saint-Lazare 107bis, rue du Faubourg Saint-Denis 75010 Paris, France) zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA ABSTRACT 13 consecutive adult gastroenterological patients with non-malignant disease who were candidates for total parenteral nutrition (TPN), and who had mild protein-energy malnutrition (82 f 3% of ideal body weight, serum albumin 32 & 2 g/l, mean f SEM) were found to have, prior to TPN, a Selenium level 50% less than controls (p<O.OOl) as assayed by Se and glutathione peroxidase (GSHPx) in plasma and erythrocytes. Compared with other trace metals and minerals, eg, Mn, Zn and Cu, depletion of Selenium was the most marked in this population. Patients were randomised to be supplemented with either 100 or 200pg/d of sodium-selenite, equal to 32 pg (0.4,umol) or 64pg (0.8/~mol) of selenium, in two cross-over periods of TPN, each of two weeks. In this short term study, significant increases in the four measurements of Se status (p < 0.05) were seen in all patients, but there was no difference between those receiving the high or low dose of the element. GSHPx in plasma was normalised within 1 month whereas the increase seen in the erythrocyte pool was consistent with a 4-month half-life. Pooled Se values for patients and controls showed logarithmic correlations between Se and GSHl?x in erythrocytes (p <O.OOl) and plasma (p ~0.01). Changes in GSHPx provided further evidence of Se depletion in our patients. This study suggests that malnourished gastroenterological patients receiving TPN require Se supplements and that 1OOpg (0.4hmol)/d of sodium-selenite is adequate for most patients since there was no additional benefit from the higher dose of 2OOpg (0.8 pmol). zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONML INTRODUCTION Selenium (Se) is an essential trace element in human nutrition. Glutatbione peroxidase (GSHPx) is a Se- dependent enzyme which catalyses the degradation of organic hydroperoxides and hydrogen peroxides. Cell membranes may therefore be damaged by free radi- cals in states of Se deficiency [l]. The incidence of Keshan disease, an endemic congestive cardiomyo- pathy described in Se-deficient people in China, is reduced after Se-supplementation [2]. Similarly, Kashin-Beck disease, an endemic deforming osteo- artbropatby in China has been related to a diet low in Se [3]. There have been anecdotal case reports of Se deficiency in patients undergoing total parenteral nutrition (TPN), including two cases of fatal conges- tive cardiomyopathy arising 2 and 6 years after starting TPN [4, 51 and at least five cases of skeletal muscle pain and weakness occurring as soon as 16 days and as long as 4 years after starting TPN [6- lo]. Without Se supplements some short and long- term TPN patients present variable biochemical evi- dence of Se depletion [ll-151. These results may be explained by low Se intake during TPN, and pre- existing Se status, varying with geographical location, [6]. In view of the uncertainty concerning Se requirements during TPN, the present study was carried out to compare the effect of a high and a low dose Se regimen on the Se status of controls and of gastroenterological patients prior to and after one month of TPN. MATERIALS AND METHODS Patients The patients were all candidates for TPN because of