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Daily requirement for total sulfur amino acids of chronically undernourished Indian men.
Kurpad, AV, Regan, MM, Varalakshmi, S, Gnanou, J, Young, VR
The American journal of clinical nutrition. 2004;(1):95-100
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Abstract
BACKGROUND Earlier studies of the requirement for total sulfur amino acids (SAAs; methionine in the absence of cystine) in healthy, well-nourished Indians indicated a value of 15 mg.kg(-1).d(-1), but it is unknown whether this estimate is applicable to chronically undernourished subjects. OBJECTIVE We assessed the total SAA requirement in otherwise clinically healthy, young, chronically undernourished adult Indians by using 7 test methionine intakes (3, 6, 9, 13, 18, 21, and 24 mg.kg(-1).d(-1)), without cystine, and by using both the 24-h indicator amino acid oxidation (24-h IAAO) and the 24-h indicator amino acid balance (24-h IAAB) methods. DESIGN Twenty-one men were studied during each of 3 randomly assigned 7-d diet periods supplying methionine intakes (diet devoid of cystine) above and below the putative total 1985 FAO/WHO/UNU SAA requirement of 13 mg.kg(-1).d(-1). Twenty-four-hour IAAO and IAAB were measured on day 7 by use of a 24-h [(13)C]leucine tracer infusion. The breakpoint in the relation between these values and methionine intake was determined. RESULTS Two-phase linear regression of daily leucine oxidation or the daily leucine balance against methionine intake estimated a breakpoint in the response curve at a methionine intake of 16 mg.kg(-1).d(-1) (95% Fiellers CI: 13, 22 mg.kg(-1).d(-1)). CONCLUSIONS On the basis of the 24-h IAAO-IAAB approach, a mean total SAA requirement of 16 mg.kg(-1).d(-1) is proposed for undernourished Indian adults. This is not significantly different from that determined in Western and Indian well-nourished adults.
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[Application of sorbilact in complex correction of enteral insufficiency syndrome in surgical patients].
Konovalov, EP, Terletskiĭ, VN, Pliatsok, AA, Kovalenko, OA, Gumeniuk, NI, Iakovlev, VF
Klinichna khirurhiia. 2004;(10):32-4
Abstract
The most important teoretical aspects of the enteral insufficiency syndrome formation in an acute abdominal surgical diseases were suggested. Basing on the treatment results analysis of 19 patients with different abdominal surgical diseases, using hypertonic sorbitol solution, the authors confirm high therapeutic efficacy of the preparation, administration of which have had promoted the intestinal motor function restoration and optimization, as well as adapting action of the preparation in enteral probe nutrition conduction in patients during ealy postoperative period.
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Master Amino acid Pattern as sole and total substitute for dietary proteins during a weight-loss diet to achieve the body's nitrogen balance equilibrium.
Lucà-Moretti, M, Grandi, A, Lucà, E, Muratori, G, Nofroni, MG, Mucci, MP, Gambetta, P, Stimolo, R, Drago, P, Giudice, G, et al
Advances in therapy. 2003;(5):270-81
Abstract
Results of this multicentric study have shown that by giving Master Amino acid Pattern (MAP) as a sole and total substitute of dietary proteins to 500 overweight participants undergoing the American Nutrition Clinics/Overweight Management Program (ANC/OMP), the participants' body nitrogen balance could be maintained in equilibrium with essentially no calories (MAP 1 g=0.04 kcal), thereby preserving the body's structural and functional proteins, eliminating excessive water retention from the interstitial compartment, and preventing the sudden weight increase after study conclusion commonly known as the yo-yo effect. Study results have shown that the use of MAP, in conjunction with the ANC/OMP regimen, has proven to be safe and effective by preventing those adverse effects associated with a negative nitrogen balance, such as oversized or flabby tissue, stretch marks, the sagging of breast tissue, increased hair loss, faded hair color, and fragile or brittle nails. Also prevented were those anomalies commonly associated with weight-loss diets, such as hunger, weakness, headache caused by ketosis, constipation, and decreased libido. The use of MAP in conjunction with the ANC/OMP also allowed for mean weight loss of 2.5 kg (5.5 lb) per week, achieved through reduction of excessive fat tissue and elimination of excessive water retention from the interstitial compartment.
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Effect of supplementing a high-fat, low-carbohydrate enteral formula in COPD patients.
Cai, B, Zhu, Y, Ma, Yi, Xu, Z, Zao, Yi, Wang, J, Lin, Y, Comer, GM
Nutrition (Burbank, Los Angeles County, Calif.). 2003;(3):229-32
Abstract
OBJECTIVE One of the goals in treating patients with chronic obstructive pulmonary disease (COPD) who suffer from hypoxemia, hypercapnia, and malnutrition is to correct the malnutrition without increasing the respiratory quotient and minimize the production of carbon dioxide. This 3-wk study evaluated the efficacy of feeding a high-fat, low-carbohydrate (CHO) nutritional supplement as opposed to a high-carbohydrate diet in COPD patients on parameters of pulmonary function.S METHODS Sixty COPD patients with low body weight (<90% ideal body weight) were randomized to the control group, which received dietary counseling for a high-CHO diet (15% protein, 20% to 30% fat, and 60% to 70% CHO), or the experimental group, which received two to three cans (237 mL/can) of a high-fat, low-CHO oral supplement (16.7% protein, 55.1% fat, and 28.2% CHO) in the evening as part of the diet. Measurements of lung function (forced expiratory volume in 1 s or volume of air exhaled in 1 s of maximal expiration, minute ventilation, oxygen consumption per unit time, carbon dioxide production in unit time, and respiratory quotient) and blood gases (pH, arterial carbon dioxide tension, and arterial oxygen tension) were taken at baseline and after 3 wk. RESULTS Lung function measurements decreased significantly and forced expiratory volume increased significantly in the experimental group. CONCLUSION This study demonstrates that pulmonary function in COPD patients can be significantly improved with a high-fat, low-CHO oral supplement as compared with the traditional high-CHO diet.
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Appetite, food intake, and plasma concentrations of cholecystokinin, ghrelin, and other gastrointestinal hormones in undernourished older women and well-nourished young and older women.
Sturm, K, MacIntosh, CG, Parker, BA, Wishart, J, Horowitz, M, Chapman, IM
The Journal of clinical endocrinology and metabolism. 2003;(8):3747-55
Abstract
Aging is associated with a reduction in appetite and food intake, predisposing to protein-energy malnutrition. The causes of this "anorexia of aging" are largely unknown. To investigate possible contributions of enhanced satiating effects of cholecystokinin (CCK) and reduced stimulation of food intake by ghrelin, eight undernourished older women [age, 80.4 +/- 2.6 yr; body mass index (BMI), 16.9 +/- 0.57 kg/m(2)], eight well-nourished older women (age, 77 +/- 0.9 yr; BMI, 23.7 +/- 0.8 kg/m(2)), and eight well-nourished young women (age, 22 +/- 1.3 yr; BMI, 20.5 +/- 0.4 kg/m(2)), in randomized order, ate on 1 d a 280-kCal preload and on the other no preload, 90 min before an ad libitum meal. At baseline the undernourished, but not the well-nourished, older subjects were less hungry (P < 0.05) than young subjects. Before and after the preload, plasma CCK levels were higher (P < 0.05) in the older than young subjects, with no difference between the older groups. Plasma ghrelin concentrations were higher in the undernourished than both well-nourished groups and decreased similarly after the preload in all groups. The preload suppressed food intake in the well-nourished older and young subjects (P < 0.05), but was without effect in the undernourished old. These observations suggest that reduced basal hunger, rather than increased meal-induced satiety, contributes to the anorexia of aging and that changes in CCK and ghrelin are unlikely to be responsible.
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[Randomized study of two different fat emulsions in total parenteral nutrition of malnourished surgical patients;effect of infectious morbidity and mortality].
Grau, T, Ruiz de Adana, JC, Zubillaga, S, Fuerte, S, Girón, C
Nutricion hospitalaria. 2003;(3):159-66
Abstract
GOAL: Lipid infusions of a physical mixture of medium-chain triglycerides and long-chain triglycerides (MCT/LCT) used in peri-operative total parenteral nutrition (TPN) have a lower immunosuppressive effect in laboratory studies than emulsions containing only long-chain triglycerides (LCT). The purpose of the present study was to compare the incidence of nosocomial infections and the in-hospital mortality of severely undernourished surgical patients treated with TPN using an MCT/LCT lipid emulsion or with an LCT mixture, administered under a randomized, double blind protocol. PATIENTS AND METHODS A total of 72 severely undernourished patients subjected to planned or emergency laparotomy were prospectively recruited and stratified by the presence or absence of cancer, on admission to the departments of General Surgery and Intensive Care Medicine at a teaching hospital. The main outcome was the incidence of intra-hospital nosocomial infection and the secondary outcome was mortality. RESULTS The patients in the study group (MCT/LCT) and the control group (LCT) shared similar characteristics. The patients in the MCT/LCT group had a significantly lower incidence of intra- abdominal abscesses (2/26) than those in the LCT group (10/31) (p < 0.05; RR 0.18; CI 95%; 0.03-0.89). There were no significant differences in the incidence of other infections. Nor was there a difference between the two groups in terms of the intra-hospital mortality (4/26 versus 11/31). In the stratified analysis, patients without cancer treated with MCT/LCT presented significantly fewer intra-abdominal abscesses (2/14) than those with LCT (5/8) (p < 0.05; RR 0.1; CI 95%; 0.01-0.79) and a significantly lower mortality (2/14 versus 5/8; p < 0.05; RR 0.1; CI 95%; 0.01-0.79). CONCLUSIONS Lipid infusions of MCT/LCT used in peri-operative TPN protect severely undernourished surgical patients against the onset of intra-abdominal abscesses when compared with LCT infusions. Patients without cancer may obtain more benefit from the use of these mixtures.
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Master Amino acid Pattern as substitute for dietary proteins during a weight-loss diet to achieve the body's nitrogen balance equilibrium with essentially no calories.
Lucà-Moretti, M, Grandi, A, Lucà, E, Muratori, G, Nofroni, MG, Mucci, MP, Gambetta, P, Stimolo, R, Drago, P, Giudice, G, et al
Advances in therapy. 2003;(5):282-91
Abstract
Results of this multicentric study have shown that by giving 10 g (10 tablets) of Master Amino acid Pattern (MAP) as a substitute for dietary proteins, once a day, to 114 overweight participants undergoing the American Nutrition Clinics/Overweight Management Program (ANC/OMP), the participants' nitrogen balance could be maintained in equilibrium with essentially no calories (MAP 1 g=0.04 kcal), thereby preserving the body's structural and functional proteins, eliminating excessive water retention from the interstitial compartment, and preventing the sudden weight increase after study conclusion commonly known as the yo-yo effect. Study results have shown that the use of MAP, in conjunction with the ANC/OMP, has proven to be safe and effective by preventing those adverse effects associated with a negative nitrogen balance, such as oversized or flabby tissue, stretch marks, sagging of breast tissue, increased hair loss, faded hair color, and fragile or brittle nails. Also preventing those anomalies commonly associated with weight-loss diets, such as hunger, weakness, headache caused by ketosis, constipation, or decreased libido, the use of MAP, in conjunction with the ANC/OMP, allowed for mean weight loss of 1.4 kg (3 lb) per week.
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Effect of malnutrition during the first year of life on adult plasma insulin and glucose tolerance.
González-Barranco, J, Ríos-Torres, JM, Castillo-Martínez, L, López-Alvarenga, JC, Aguilar-Salinas, CA, Bouchard, C, Deprès, JP, Tremblay, A
Metabolism: clinical and experimental. 2003;(8):1005-11
Abstract
There is evidence linking intrauterine growth retardation with increased cardiovascular risk and diabetes mellitus (DM) later in life. However, little is known about the association between malnutrition during the first year of life and metabolic abnormalities in adulthood. The objective of this study was to assess the effect of documented malnutrition during the first year of life on glucose tolerance, plasma insulin, lipid profile, and blood pressure in early adulthood, as well as to assess the interaction between body mass index (BMI) and malnutrition on these variables. A study group of young men with a documented history of malnutrition during their first year of life was recruited from 4 pediatric hospitals in Mexico City and compared with a control group. Subjects included were 52 men, aged 20.2 +/- 3.6 years, with a mean birth weight of 3.0 +/- 0.7 kg and documented malnutrition in their first year of life; controls were 50 men, aged 23.3 +/- 1.8 years, with a mean birth weight of 3.2 +/- 0.5 kg. Insulin and glucose concentrations, fasting and in response to an oral glucose load, plasma lipids, blood pressure, and an insulin sensitivity index (ISI) were measured. The areas under the curves of glucose (AUCG) and insulin (AUCI) were significantly higher in cases (P =.012 and <.002, respectively), independent of birth weight, BMI, or age. BMI was significantly associated with fasting plasma insulin (FPI), AUCI, ISI, triglyceride, and high-density lipoprotein (HDL)-cholesterol concentrations in cases, but not in controls. These data suggest that early malnutrition in extrauterine life, independently of birth weight, has an adverse effect on insulin metabolism and glucose tolerance in young men, and it worsens as body mass increases even within the normal range of BMI. Therefore, it is advisable to prevent obesity in individuals exposed to early malnutrition.
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A controlled trial of intermittent enteral nutrient supplementation in maintenance hemodialysis patients.
Sharma, M, Rao, M, Jacob, S, Jacob, CK
Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation. 2002;(4):229-37
Abstract
OBJECTIVE This controlled trial was undertaken to evaluate the benefits of short-term enteral nutrient supplementation in maintenance hemodialysis (MHD) patients using a high-calorie and high-protein blend formula (low-cost home-prepared [HP] blend or a commercially available supplement) and to study its effect on selected parameters of nutritional status. The acceptability and palatability of the HP blend formula, ease of use, and cost were also assessed in comparison with the commercial nutritional supplement (CNS). DESIGN Randomized controlled trial. SETTING Hemodialysis (HD) unit of a tertiary referral care hospital in Southern India. PATIENTS Nondiabetic adult MHD patients with no intercurrent illness, on regular thrice weekly MHD for at least 1 month before recruitment, with a body mass index (BMI) <20 and a serum albumin level of <4.0 g/dL. Patients were randomized into control group and experimental group, the latter in turn to recieve either CNS or HP blend. INTERVENTION The control group received appropriate monitoring, including dietary recall and counselling for the prescribed diet (protein intake of 1.2 g/kgIBW/d and energy of 35 to 45 kcal/kgIBW/d) but no specific post-HD supplement. Patients in the supplement group received the respective supplement post-HD (providing 500 kcal and 15 g protein) for 1 month in addition to the monitored diet prescription. MAIN OUTCOME MEASURES (1) Nutritional status parameters, BMI and serum albumin; (2) functional status on a 10-point Karnofsky scale; (3) adverse metabolic effects, hyperphosphatemia at start and end of study; and (4) subjective scoring for appetite, and acceptability of and tolerance to supplement. RESULTS Both groups showed an improvement in dry weight and BMI. In addition, the supplement group showed a significant increase in serum albumin level and functional scoring. Mild hyperphosphatemia occurred in the supplement group. An increase in baseline food intake was seen in the control group, but not in the supplemented group. No intolerance was reported to either supplement. CONCLUSION Enteral nutrient supplementation was shown to bring about a significant improvement in serum albumin level even in a short-term study. Use of an HP supplement was beneficial, acceptable, and inexpensive.
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Enteral nutrition in surgical patients.
Saluja, SS, Kaur, N, Shrivastava, UK
Surgery today. 2002;(8):672-8
Abstract
PURPOSE Malnutrition is well-recognized as a potential cause of increased morbidity and mortality in surgical patients; however, enteral and parenteral nutritional support given pre- and postoperatively have been shown to decrease these rates. We conducted a prospective study to assess the short-term efficacy of oral dietary supplementation in malnourished patients undergoing major abdominal surgery. METHODS Sixty patients undergoing major abdominal surgery were divided according to nutritional risk index into borderline (BM), moderately (MM), and severely (SM) malnourished categories. The patients in each category were randomly divided into a treatment group (TG) and a control group (CG). TG patients were given an oral sip feed containing 500 kcal of energy and 16.66 g of protein in addition to their daily oral intake. The differences in nutritional intake, in terms of energy and protein, and the changes in nutritional status, as assessed by anthropometric, biochemical, and hematological values, complication rates, and duration of stay were compared. RESULTS The supplemented feeds were well tolerated and the total caloric and protein intake in the TG was significantly higher than in the CG, at 1798 vs 1182 kcal ( P < 0.01), protein 55.71 vs 39.48 g ( P < 0.01), respectively. Weight loss in the SM patients was significantly less in the TG than in the CG, at 2.15 vs 4.6 kg ( P < 0.001), respectively. Complications developed in 7 of the 30 TG patients and in 10 of the 30 CG patients, with maximum reduction seen in the SM category (7 in the CG vs 4 in the TG). CONCLUSIONS Patients with severe malnutrition are likely to develop large energy deficits postoperatively, resulting in loss of body mass and a higher incidence of infective complications. Oral nutritional supplements are well tolerated by these patients, and help to improve their energy and routine intake and reduce the risk of complications.