1.
Effects and Tolerance of Protein and Energy-Enriched Formula in Infants Following Congenital Heart Surgery: A Randomized Controlled Trial.
Cui, Y, Li, L, Hu, C, Shi, H, Li, J, Gupta, RK, Liang, H, Chen, X, Gong, S
JPEN. Journal of parenteral and enteral nutrition. 2018;(1):196-204
Abstract
BACKGROUND Nutrition support is important for clinical management to improve outcomes of infants following congenital heart surgery. Protein-enriched and energy-enriched formula (PE-formula) may help provide adequate nutrition and promote wound healing. However, the effects and tolerance of increased protein and energy intakes of these infants have not been well defined. OBJECTIVE To evaluate nutrition effects and tolerance of a PE-formula compared with the standard formula (S-formula) in infants in the first 5 days after congenital heart surgery. METHODS Fifty infants were randomly assigned to S-formula (S-group, n = 24) or PE-formula (PE-group, n = 26). Daily nutrient intakes and tolerance were recorded. Plasma amino acid concentrations were measured. Cumulative energy balance and nitrogen balance were calculated. RESULTS Nutrient intakes were significantly higher in the PE-group after day 1, and all met the adequate intakes as early as day 2. Nitrogen balance in the PE-group met positive balance from day 2, whereas in the S-group, this was not until day 5. The PE-group also had a significantly higher increase in many essential amino acids. With the exception of tolerable diarrhea (multivariate adjusted hazard ratio, 3.16; 95% confidence interval, 1.24-8.01), the PE-group did not have a significantly higher incidence of intolerable events. CONCLUSIONS In infants during the early postoperative period after congenital heart surgery, early administration of PE-formula was as well tolerated as S-formula and effective in achieving higher nutrition intakes and earlier nitrogen balance. Further research is warranted to support the use of PE-formula in this special group of infants.
2.
Supervised oral protein supplementation during dialysis in patients with elevated C-reactive protein levels: a two phase, longitudinal, single center, open labeled study.
Beddhu, S, Filipowicz, R, Chen, X, Neilson, JL, Wei, G, Huang, Y, Greene, T
BMC nephrology. 2015;:87
Abstract
BACKGROUND Inflammation is considered one of the major causes of protein-energy wasting in maintenance hemodialysis (MHD) patients. It is unclear whether dietary interventions can impact nutritional status and quality of life in MHD patients with elevated C-reactive protein (CRP) levels. Therefore, we examined the hypothesis that supervised intra-dialysis protein supplementation in MHD patients with elevated plasma CRP will improve protein stores and quality of life. METHODS A 24 week, two phase, longitudinal, single center, open labeled study of 50 MHD patients with plasma CRP > 3 mg/L was conducted. During the 12-week observation phase dietary advice was provided to increase protein intake to 1.2 g/kg/day. In the 12-week treatment phase 45 g of liquid protein supplement was provided at each dialysis treatment. Protein nitrogen appearance (PNA), mid-arm muscle circumference (MAMC), serum albumin, body mass index (BMI) and quality of life (assessed by Short Form-12 questionnaire) were measured at baseline, 12 and 24 weeks. RESULTS Median plasma CRP at baseline was 16.0 (IQR 7.7 to 25.1) mg/L. The mean MAMC was 26.5 ± 3.9 cm, BMI 29.2 ± 6.9 kg/m(2) and plasma albumin 3.8 ± 0.3 g/dl. During the intervention period, mean PNA increased by 0.13 g/kg/d (p = 0.01) under a mixed effects model. However, there were no clinically or statistically significant effects on MAMC (p = 0.87), plasma albumin (p = 0.70), BMI (p = 0.09), physical (p = 0.32) or mental (p = 0.96) composite scores. CONCLUSIONS In MHD patients with elevated plasma CRP but otherwise mostly normal nutritional parameters, intra-dialytic oral protein supplement was effective in increasing protein intake but did not provide a detectable impact on nutritional status or quality of life.