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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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Body weight and nutritional changes after reduction pneumoplasty for severe emphysema: a randomized study.
Mineo, TC, Ambrogi, V, Pompeo, E, Bollero, P, Mineo, D, Nofroni, I, ,
The Journal of thoracic and cardiovascular surgery. 2002;(4):660-7
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Abstract
BACKGROUND The impact of reduction pneumoplasty on body weight and nutritional status has not previously been tested in a controlled study. METHODS We investigated 60 patients with severe emphysema who were randomly assigned to receive either reduction pneumoplasty (n = 30) or a 6-week respiratory rehabilitation program (n = 30). Nutritional status was evaluated by means of body mass index, triceps skin fold measurement, midarm muscle circumference, and biochemical blood values. Fat mass and fat-free mass were calculated by bioelectric impedance. Two treatment-related deaths occurred after reduction pneumoplasty and 1 death occurred after respiratory rehabilitation. RESULTS Functional and subjective improvements were significantly showed in reduction pneumoplasty group. Despite insignificant differences in energy intake, the reduction pneumoplasty group showed significant gain (P <.0001) relative to the respiratory rehabilitation group in mean weight changes at 3 months (1.82 +/- 2.63 kg vs -0.57 +/- 2.25 kg), 6 months (2.87 +/- 3.79 kg vs -1.11 +/- 2.64 kg), and 12 months (3.29 +/- 4.01 kg vs -0.95 +/- 1.90 kg). Both fat mass and fat-free mass increased after surgery, but only fat-free mass had a significant improvement (P =.001). Six-month weight gain in the reduction pneumoplasty group was significantly correlated with low baseline weight (rho = -0.437, P =.02) and residual volume reduction (rho = -0.446, P =.01). Total proteins (P =.003), albumin (P =.03), transferrin (P =.04), cholesterol (P =.003), hemoglobin (P =.01), triceps skin fold measurement (P <.0001), and midarm muscle circumference (P <.0001) were significantly increased only in the reduction pneumoplasty group. Conversely, in the respiratory rehabilitation group no nutritional index was significantly increased at 6 months after rehabilitation. CONCLUSIONS Body weight and nutritional status improved only after reduction pneumoplasty and not after respiratory rehabilitation, and this was significantly related to fat-free mass increment. In the reduction pneumoplasty group, the residual volume result was significantly correlated with postoperative weight gain.
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A randomised controlled trial evaluating the use of enteral nutritional supplements postoperatively in malnourished surgical patients.
Beattie, AH, Prach, AT, Baxter, JP, Pennington, CR
Gut. 2000;(6):813-8
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Abstract
BACKGROUND Patients who undergo surgery are at risk of malnutrition due to periods of starvation, the stress of surgery, and subsequent increase in metabolic rate. There are limited data on nutritional outcome of surgical patients. AIMS To investigate changes in nutritional status and the influence of oral supplements on nutritional status, morbidity, and quality of life in postoperative surgical patients. METHODS Entry was determined by the presence of malnutrition, as defined by a body mass index (BMI) < or =20 kg/m(2), anthropometric measurements < or =15th percentile on admission, or initiation of oral diet postoperatively and/or a weight loss of 5% or more during the operative period. We studied 101 patients: 52 were randomised to the treatment group (TG) and prescribed a 1.5 kcal/ml nutritional supplement; 49 patients were randomised to the control group (CG) and continued with routine nutritional management. Nutritional status was assessed by weight, anthropometry, and grip strength, with measurements taken at two weekly intervals for 10 weeks. Complications, namely wound infection, chest infection, and antibiotic use were documented. Quality of life (QOL) was assessed using the UK SF-36 questionnaire. RESULTS Patients in the control group lost a maximum mean (SD) of 5.96 (4.21) kg in weight over a period of eight weeks while patients in group TG lost less weight overall (maximum mean (SD) 3.40 (0.89) kg (p<0.001) occurring at four weeks and progressively regained weight from week 4). Anthropometry, grip strength, and QOL were similarly significantly different between groups (p<0.001). Fewer patients in the treatment group (7/52) required antibiotic prescriptions compared with the control group (15/49). CONCLUSIONS Nutritional status declined for two months after discharge. Postoperative nutritional supplementation improved nutritional status, QOL, and morbidity in these patients.