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PubMed1975

Body weight and food intake at early estrus of rats on a high-fat diet.

Body weight, food intake, and age at vaginal opening and estrus were studied for two groups of weanling rats (age 21 days), fed on high-fat (24.6% by weight) and low-fat (5.0%) diets. Fat was substituted isocalorically for carbohydrate in the high-fat diet. The high-fat rats had estrus at 33.3 +/- 0.8 days, significantly earlier (P less than 0.001) than the age at estrus, 37.4 +/- 0.7 days, of the low-fat rats. Estrus was simultaneous with vaginal opening in 81% of the high-fat rats, in comparison to 48% of the low-fat rats. The caloric intake per 100 g of body weight of the high-fat and low-fat rats did not differ at vaginal opening or at estrus, whereas the two groups differed significantly at both events in age, body weight, absolute food intake (g/day), and relative food intake (g/100 g of body weight per day) and absolute caloric intake (calories/day). Caloric intake/100 g of body weight as a function of chronological age first increased and then decreased steadily before estrus for both high-fat and low-fat rats. The findings support Kennedy's hypothesis that a food intake signal, now further defined as caloric intake/100 g of body weight, is a signal for puberty, and are in accord with the hypothesis that a critical body composition of fatness is essential for estrus in the rat, as in the human female.

Age Factors↗
PubMed1994

Children with congenital heart disease: a nutrition challenge.

Growth in children with congenital heart disease (CHD) is often compromised. For several decades, investigators have tried to identify the factors affecting growth in children with CHD. Cardiac malformations are undoubtedly responsible for malnutrition, which may range from mild undernutrition to severe failure to thrive (FTT). Malnutrition may then significantly undermine the outcome of corrective surgical operations and postoperative recovery. Mechanisms linking CHD to malnutrition may be related either to decreased energy intake and/or to increased energy requirements. Decreased energy intake can involve deficiencies of specific nutrients, or insufficient total caloric intake. Increased respiratory rate accompanying congestive heart failure may be responsible for increased energy requirements. Different types of cardiac malformations and consequent interventions may have different effects on growth and require diverse strategies. Most treatment strategies aim to facilitate "catch-up" growth, providing extra calories and protein that exceed the Recommended Dietary Allowance for age. However, there is no generally accepted set of guidelines that define appropriate caloric intake for catch-up growth. We attempt to identify the most important causes of malnutrition and highlight the most effective nutrition strategies for children with CHD.

Energy Intake↗
PubMed1977

Plasma triglyceride lowering by exercise despite increased food intake in patients with type IV hyperlipoproteinemia.

Exercise can lower fasting triglyceride levels (TG). This study was undertaken to determine whether the exercise-induced decrease in TG is the result of a negative caloric balance. Five subjects with primary type IV hyperlipoproteinemia were given diets comparable in composition to their usual diets. During one experimental period the subjects exercised while maintaining their usual caloric intakes. During another experimental period their caloric intake was increased to compensate for the exercise-induced increase in energy expenditure. The exercise, which consisted of 30 min of treadmill walking per day for 4 days, resulted in a progressive decrease in TG. The reduction in TG, which averaged 120 mg/100 ml, occurred regardless of whether or not the increase in caloric expenditure was compensated for by an increase in food intake. The decrease in TG was limited to the very low density lipoprotein fraction. No significant changes occurred in total plasma cholesterol concentration or in the distribution of cholesterol between the lipoprotein fractions. Fasting plasma glucagon concentration was constant for each individual and was unaffected by the exercise. The finding that exercise induces a decrease in TG despite increased food intake indicates that the TG lowering effect of exercise is not mediated by a negative caloric balance.

Adult↗
PubMed1996

Carnitine supplementation accelerates normalization of food intake depressed during TPN.

When total parenteral nutrition (TPN; containing glucose, fat, and amino acids; caloric ratio 50:30:20) providing 100% of the rat's daily caloric intake is given for 3-4 days, food intake rapidly decreases by approximately 85%. After stopping TPN, there is a lag period of 3-4 days before food intake returns to previous level, which appears to be related to fatty acid oxidation and fat deposition. Carnitine plays a key role in the oxidation of fatty acids, and was demonstrated to reduce fat deposition in rats receiving TPN, by increasing beta oxidation. We therefore investigated whether rats receiving TPN supplemented with carnitine may prevent either the decrease or speed up the resumption or normalization of food intake, after TPN is stopped. Fourteen adult Fischer-344 rats had a central venous catheter inserted. After 10 recovery days, controls (n = 7) were infused with TPN providing 100% of rat's daily caloric intake for 3 consecutive days, followed by 4 more days of normal saline. The carnitine group (n = 7) received the same solution, but which provided 100 mg/kg/day carnitine. Daily food intake was measured and data were analyzed using ANOVA and Student's t-test. Both parenteral solutions depressed food intake maximally by almost 90% by day 3. Carnitine accelerated the normalization of food intake by decreasing the lag period by 1 day. We conclude that the addition of carnitine enhanced the normalization of post-TPN food intake and argue that this may be on the basis of enhanced fatty acid oxidation, a substrate known to play a significant role in the anorexia induced by TPN.

Animals↗
PubMedDate not supplied

Necrotizing enterocolitis: feeding in endemic and epidemic periods.

Aggressive feeding practices are thought to increase the incidence of necrotizing enterocolitis (NEC). Detailed feeding histories of the 39 cases occurring between January 1, 1984 and May 31, 1985 were compared with matched controls. The study period included a cluster (epidemic) of 11 cases diagnosed within 1 month. Data were analyzed collectively and separately for endemic and epidemic cases. Collectively, cases had greater average daily intake volume, maximum daily intake volume, intake volume on the day prior to diagnosis, and maximum daily caloric intake (all p less than 0.05) than controls. The only recorded parameter that differed in endemic cases vs controls was intake the day prior to diagnosis. In contrast, epidemic cases were fed significantly more volume, more calories, and faster than controls: average intake volume (62.5 +/- 27.2 vs 37.4 +/- 18.0 ml/kg/day); maximum intake volume (118.5 +/- 33.5 vs 76.4 +/- 38.8 ml/kg/day); intake day prior to diagnosis (109.8 +/- 30.9 vs 63.8 +/- 43.1 ml/kg/day); maximum daily increment (42.6 +/- 16.7 vs 26.7 +/- 16.4 ml/kg); maximum caloric intake (126.1 +/- 44.6 vs 77.3 +/- 50.0) (all p less than 0.01). Five of the feeding parameters were significantly less for the epidemic controls than the endemic controls, suggesting a general slowing of feeding during the NEC epidemic. In summary, the data suggest feeding patterns may have an impact on NEC especially during epidemic periods.

Breast Feeding↗
PubMedDate not supplied

[Characteristics of the dietary intake of French children from 3 to 24 months of age. Diet of French infants].

The food consumption of 543 French infants, aged 3 to 24 months, was recorded during a 3 day period. The nutrient intake data were calculated by a computerized food table. The 1981 recommended dietary amounts proposed by the Committee of the Centre National de Coordination des Etudes et Recherches sur la Nutrition et l'Alimentation were used to assess adequacy of intake. Our results showed a great variability between individuals considering the caloric intake. The mean energy intakes were greater than the recommended amounts for the age range of 6 to 12 months: therefore a revision of the recommended amounts appears necessary. A marked decrease of the consumption of infant formulas was noted between 4-5 months (57% of the total energy intake) and 6-7 months (18% of the total energy intake). The consumption of the other baby foods was the highest at 6-7 months (23% of the total energy intake). The probability that a French infant has a protein intake less than the recommended amounts was less than 0.02. This probability was 0.04 for calcium intake and 0.50 to 0.78 for iron intake according to age. An increase of the iron intake from 4-5 months is a justified dietary goal. The mean intake of linoleic acid was the smallest at a mean age of 8 to 12 months and represented less than 2% of the caloric intake.

Calcium, Dietary↗
PubMed1987

Inhibition of chemically induced mammary and colon tumor promotion by caloric restriction in rats fed increased dietary fat.

Tumor promotion associated with increased dietary fat may be inhibited by reduction in total caloric intake. This hypothesis was tested in rats given either 7,12-dimethylbenz(a)anthracene to induce mammary tumors or 1,2-dimethylhydrazine to induce colon tumors. One week after dosage with either carcinogen, the rats were fed semipurified diets that provided 4% fat with ad libitum calories or 13.1% fat with a reduction of calories by 40% from ad libitum intake. Rats treated with 7,12-dimethylbenz(a)anthracene and subjected to caloric restriction weighed 40% less than those fed ad libitum; rats treated with 1,2-dimethylhydrazine were heavier at the onset of caloric restriction and lost weight and weighed approximately 40% less than animals fed ad libitum. At 20 weeks after 7,12-dimethylbenz(a)anthracene administration, rats fed ad libitum had 80% tumor incidence while in those fed restricted calories, 20% had tumors (P less than 0.001). All other measures of mammary tumor growth were significantly reduced in rats given restricted calories. Six months after 1,2-dimethylhydrazine administration, colon tumor incidence was 100% in rats fed ad libitum and 53% in those fed the calorie-restricted diet (P less than 0.001). This reduction of colonic carcinogenesis was seen despite a significant increase in mucosal labeling index following [3H]thymidine autoradiography. This paradoxical finding may be due to the increased fat content of the calorie-restricted diet. These data demonstrate that the tumor-promoting effects of dietary fat can be more than offset by a reduction in total caloric intake and that the promoting effect of fat may be due, at least in part, to its greater caloric density.

Animals↗
PubMed2001

The thiamine status of adult humans depends on carbohydrate intake.

Thiamine requirements for humans are generally expressed as absolute values per day (mg/d) or in relation to total caloric intake. Limited data are available on the relation between thiamine requirements and the intake of carbohydrates. This study was performed to investigate the influence of stepwise increases of carbohydrate intake on the status of thiamine in healthy volunteers under isocaloric conditions. During an adaptation phase of four days, the carbohydrate intake of twelve healthy volunteers (6 male, 6 female) was 55% of total energy intake. During the subsequent intervention periods, carbohydrate intake was increased to 65% of total energy for four days and to 75% for another four days. Thiamine intake, total energy intake, and physical activity were kept constant throughout the study. HPLC analysis was used to measure thiamine in plasma, urine and feces. Erythrocyte transketolase activity (ETK) was determined enzymatically. During the intervention periods thiamine decreased significantly (p < 0.05) in plasma (from 19.3 +/- 3.3 to 16.4 +/- 4.0 nmol/l) as well as in urine (from 72 +/- 56 to 58 +/- 21 mumol/mol creatinine). ETK and feces content of thiamine remained unchanged. An increase of dietary carbohydrate intake from 55% to 65% and 75%, respectively, of total caloric intake for four days per period at isocaloric conditions causes a decrease of plasma and urine levels of thiamine without affecting enzyme activities.

Adult↗
PubMed1983

Effect of sucrose overfeeding on brown adipose tissue lipogenesis and lipoprotein lipase activity in rats.

During cold-induced nonshivering thermogenesis, interscapular brown adipose tissue (BAT) lipoprotein lipase (LPL) activity and lipogenesis are elevated. Because of the many similarities between cold- and diet-induced thermogenesis, we examined the effect of ad libitum access to a 32% sucrose solution on caloric intake, adiposity, and BAT enzyme activities in male rats. Daily caloric intakes of sucrose-fed animals were elevated by 20%-25%, and 8 wk of sucrose feeding doubled carcass fat content. This sucrose-feeding induced obesity was associated with increases in circulating triglyceride and insulin levels as well as increased retroperitoneal white adipose tissue LPL activity. However, the increased carcass lipid content accounted for less than half of the excess calories ingested by the sucrose-fed rats. Sucrose feeding stimulated in vivo lipogenesis in BAT and elevated BAT fatty acid synthetase and acetyl-CoA carboxylase activities but not LPL activity. These findings suggest that overeating enhances endogenous lipogenesis but not uptake of circulating triglyceride in BAT. Thus, both cold- and diet-induced thermogenesis increase BAT lipogenesis, while only cold-induced thermogenesis is associated with elevated LPL activity in BAT.

Adipose Tissue↗
PubMed2003

The effect of short-term dimethylglycine treatment on oxygen consumption in cytochrome oxidase deficiency: a double-blind randomized crossover clinical trial.

OBJECTIVE: To study the effectiveness of dimethylglycine (DMG) on oxygen consumption (VO(2)) in children with Saguenay-Lac-Saint-Jean cytochrome-c oxidase (SLSJ-COX) deficiency (OMIM 220111). STUDY DESIGN: In a crossover randomized double-blind clinical trial, 5 children with SLSJ-COX deficiency, who were stable and old enough to comply with VO(2) measurement, were treated with placebo or DMG for 3 days, and with the alternate treatment after a 2-week washout period. VO(2) was measured by indirect calorimetry before and after treatment. Dietary caloric intake was calculated for 3 days before each measurement. Mean caloric intakes per day were 1562 and 1342 kcal x m(-2) before and during placebo, 1,336 and 1,380 before and during DMG, respectively. RESULTS: DMG was well tolerated and, in all cases, resulted in markedly increased blood DMG levels (617 + 203 mmol x L(-1)), versus 0 to 2 mmol x L(-1) without treatment. Mean VO(2) was lower after administration of either DMG (-1 +/- 3 mL x min(-1) x m(-2)) or placebo (-6 +/- 4), but neither difference was statistically significant. There was no detectable effect of DMG treatment on blood levels of lactate, pyruvate, bicarbonate, or pH. VO(2) values of patients (range, 101-135 mL x min(-1) x m(-2)) were lower than published norms (150-160 mL x min(-1) x m(-2)). CONCLUSION: This study suggests that treatment with DMG does not substantially change VO(2) in children with SLSJ-COX deficiency.

Child↗
PubMed2003

Nutrition treatment for HIV wasting: a prescription for food as Medicine.

BACKGROUND: The optimal nutrition approach for the promotion of weight gain in HIV-infected adults with wasting remains unclear. Previous dietary interventions report minimal success and provide inadequate information regarding the counseling approach, contact time, session format, and issues addressed with the subject. The methods we report were incorporated in a 12-week intervention trial for the reversal of HIV-wasting. METHODS: All subjects involved in the intervention trial for the reversal of HIV-wasting received weekly, customized, one-on-one counseling and an oral nutrition supplement (480 kcal/d with 30 g protein). The nutrition aims were to (1) increase caloric intake to surpass daily energy requirements by 500 kcal/d (suggested caloric intake: 40 to 50 kcal/kg current weight); (2) increase protein intake (1.6 to 1.8 g/kg current weight per day); and (3) identify foods that may exacerbate or curtail side effects associated with HIV. Also assessed were preconceptions, nutrition knowledge level and primary information source, and obstacles to healthy eating. Sessions, conducted by a nutritionist in an interactive, action-oriented learning approach, ranged from 30 to 60 minutes. RESULTS: At baseline, subjects harbored many misconceptions, reported numerous HIV-related side effects, and lacked practical nutrition strategies, all of which interfered with weight maintenance and health. The protocol strategies were acceptable to the patients (87% subjects completed all visits), with marked improvements in dietary intake, weight, and body composition, both during and after intervention. CONCLUSIONS: We describe a customized nutrition intervention that produces changes in energy intake, maintenance of appropriate protein intake, and the reversal of unintentional weight loss over 5 to 15 months. Sustained improvements occurred across a socioeconomically diverse population, despite persistent disease- and medication-associated side effects.

Journal Article↗
PubMed1985

Diet diversity and nutrient intake.

Variety is espoused as a key to dietary adequacy, yet data from new shortcut dietary measures suggest that intakes of relatively few foods can accurately classify individuals according to nutrient intake. This study examines diet diversity, caloric intake, and nutrient density values as contributors to the level of selected nutrients in the diets of 1,747 white men and 1,898 white women, 18 to 34 years old, completing the 24-hour recall in NHANES II. Nutrient intake was directly related to both number of foods eaten and total calories consumed, as well as to nutrient density values. For fat, saturated fat, and potassium, higher caloric consumption alone may account for substantial differences in nutrient intakes between the lowest and highest quartiles. For cholesterol, calcium, and vitamin A, differences in dietary density were more important in explaining nutrient intake differences. Both caloric intake and nutrient density influence sodium intake from food sources. For some nutrients, an overall measure of diversity may be useful for estimating intakes. For others, nutrient-specific diversity indexes would likely be needed. Knowledge of specific foods in diets with high levels of nutrients could aid the construction of food frequency instruments.

Adolescent↗
PubMed1981

Dietary control of pathogenesis in C57BL/KsJ db/db diabetes mice.

Weanling C57BL/KsJ homozygous diabetic (db/db) and normal littermate (+/+ or +/db) mice were maintained for 5 mon on isocaloric diets containing either 60% sucrose, 23% casein, 8% corn oil (diet C) or 0% sucrose, 83% casein, 8% corn oil (diet B). Diabetic homozygotes consumed more diet C than normals, but ate control amounts of diet B. Diabetic mice fed diet C exhibited 57% mortality between 4 or 5 mo of age. All diabetic mutants fed the carbohydrate-free diet B appeared healthy at 6 mo of age; mutant females were normoglycemic and mutant males were only moderately hyperglycemic. Histological examination of pancreatic islets confirmed the absence of islet degeneration. In diet B maintained mutants, increased carcass fat composition, plasma and pancreatic content of insulin and glucagon, and thymidine incorporation into islets, all established that the db gene was being fully expressed. These results indicate that dietary protein stimulates islet growth and function in db/db mice, while high levels of refined carbohydrate in the diet predispose islet beta cells to undefined changes that culminate in necrosis. Restricting mutants' intake of a carbohydrate-containing diet to one-half the caloric intake of normal mice failed to block onset of beta cell necrosis. Thus, dietary composition rather than total caloric intake appears to be critical in the induction of islet necrosis and atrophy in this animal model of genetically transmitted diabetes.

Animals↗
PubMedDate not supplied

The Florence city sample: dietary and life-style habits of a representative sample of adult residents. a comparison with the EPIC-Florence volunteers.

A representative sample of the general population residing in the city of Florence was invited to participate in the local section of the EPIC study with two major aims: i) to carry out a population-based survey on dietary and life-style habits in this urban area of Tuscany, Central Italy; ii) to compare these results with a large series of EPIC volunteers residing in the same municipality in order to evaluate the differences between the two groups. A random sample of 500 residents (250 women) aged 40-64 years, was invited to participate in the study; 362/500 (72.4%) accepted and followed the EPIC protocol. The distribution of selected individual characteristics (including measured weight and height) showed a high prevalence of being overweight in men (52.2%) and obesity in both sexes (17.4% in men and 12.5% in women). A dietary pattern characterized by a high consumption of red meat, processed meats, olive oil and wine emerged in both sexes; the consumption of vegetables and fresh fruit was approximately 200 and 300 g/day, respectively. The estimated mean intakes of macronutrients reflected this pattern, with a high mean intake of total fat and protein. The mean contribution to total caloric intake provided by fat was 30.9% and 33.6% in these randomly sampled men and women, respectively. The results were compared with those of 9,123 Florence residents aged 40-64 years and enrolled as EPIC volunteers. Current smokers and less educated subjects were less represented among male volunteers, who, in general, showed a healthier dietary pattern (more fresh fruit and less spirits). Female volunteers were taller and heavier and consumed more fresh fruit but also more beef and less carbohydrates. Other statistically significant differences emerged, but the absolute values of these differences were usually modest and the two groups appeared remarkably similar. Overall, our results suggest that the large EPIC-Florence cohort was not strictly selected and showed a total caloric intake and a range of dietary variability similar to that of the general population of the same area.

Adult↗
PubMed2005

Short-term caloric restriction improves ischemic tolerance independent of opening of ATP-sensitive K+ channels in both young and aged hearts.

Ischemic tolerance decreases with aging and the cardioprotective effect of ischemic preconditioning (IPC) is impaired in aged animals. Although lifelong caloric restriction (CR) profoundly affects the physiological and pathophysiological modifications induced by aging and markedly increases life span in several species, it is unclear whether short-term CR affects ischemic tolerance and IPC in aged hearts. Six-month-old (Y) and 24-month-old (O) Fischer 344 male rats were randomly divided into two groups; AL rats were fed ad libitum, whereas CR rats were fed 90% of the caloric intake of AL for 2 weeks followed by 65% of the caloric intake for 2 weeks. Isolated perfused hearts were subjected to 25 min of ischemia followed by 30 min of reperfusion with or without IPC. The recovery of LV function after reperfusion improved with IPC in ALY but not in ALO. CR improved the recovery of LV function in both CRY and CRO but the cardioprotective effect of IPC was not additive to that of CR. Neither 5-hydroxydecanoate nor glibenclamide abrogated the protective effect of CR in either CRY or CRO. The recovery of myocardial high-energy phosphates after reperfusion was better with CR in both generations. There was no difference in myocardial expression levels of AMP-activated kinase (AMPK) but AMPK-alpha phosphorylated at Thr172 increased with CR in both Y and O. In conclusion, short-term CR improves myocardial ischemic tolerance independent of the opening of KATP channels in both Y and O. CR-induced cardioprotection is associated with an increase in activated AMPK.

AMP-Activated Protein Kinases↗
PubMed1999

Synergistic anorectic effect of dehydroepiandrosterone and d-Fenfluramine on the obese Zucker rat.

Fasted obese, female Zucker rats accustomed to eating a single high fat meal within 1 h a day were treated with intraperitoneal injections of dehydroepiandrosterone (DHEA) and dextrofenfluramine (d-fen), either individually or in combination. Caloric intake was measured over a 1-h period 2 h after drug administration, and results compared to that of vehicle-treated controls. At 50 mg/kg body weight, DHEA did not affect food intake. At doses of < or = 2 mg/kg d-fen did not affect food intake. Together, however, DHEA 50 mg/kg and d-fen < or = 2 mg/kg significantly decreased food intake. At doses of > or = 3 mg/kg d-fen diminished caloric intake by itself, and the addition of DHEA significantly augmented this effect. Neurotransmitter levels in select regions of the hypothalamus of animals treated using a similar drug protocol showed several changes in the levels of serotonin and its metabolite 5 hydroxyindole acetic acid (5-HIAA). It is hypothesized that DHEA augments the production of serotonin while d-fenfluramine enhances its release, and together these two actions may account for the synergistic action of DHEA and d-fenfluramine.

Analysis of Variance↗
PubMed1991

Body fat and obesity in Japanese Americans.

In 1965 a prospective study of greater than 12,000 Japanese men 45-69 y old and living in Japan, Hawaii, and California was initiated. Among the factors measured were height, weight, skinfold thicknesses, and 24-h dietary recall. The mean body mass index (BMI) was substantially lower for Japanese men in Japan than for Japanese men in California or Hawaii for each 5-y age group. Mean BMIs in Hawaii and California were similar. Values for subscapular skinfold thickness were also lower in Japan than in Hawaii or California in all age groups. Although total caloric intake was not greatly different between Japan and Hawaii, the percent caloric intake as fat was two times greater in Hawaii. Thus, these largely first- and second-generation immigrants exhibit increases in body weight that could be expected to significantly affect cardiovascular risk factor levels and endpoints.

Adipose Tissue↗
PubMed2001

A prospective survey of nutritional support practices in intensive care unit patients: what is prescribed? What is delivered?

OBJECTIVES: To assess the amount of nutrients delivered, prescribed, and required for critically ill patients and to identify the reasons for discrepancies between prescriptions and requirements and between prescriptions and actual delivery of nutrition. DESIGN: Prospective cohort study. SETTING: Twelve-bed medical intensive care unit in a university-affiliated general hospital. PATIENTS: Fifty-one consecutive patients, receiving nutritional support either enterally or intravenously for > or = 2 days. We followed patients for the first 14 days of nutritional delivery. MEASUREMENTS AND MAIN RESULTS: The amount of calories prescribed and the amount actually delivered were recorded daily and compared with the theoretical energy requirements. A combined regimen of enteral and parenteral nutrition was administered on 58% of the 484 nutrition days analyzed, and 63.5% of total caloric intake was delivered enterally. Seventy-eight percent of the mean caloric amount required was prescribed, and 71% was effectively delivered. The amount of calories actually delivered compared with the amount prescribed was significantly lower in enteral than in parenteral administration (86.8% vs. 112.4%, p < .001). Discrepancies between prescription and delivery of enterally administered nutrients were attributable to interruptions caused by digestive intolerance (27.7%, mean daily wasted volume 641 mL), airway management (30.8%, wasted volume 745 mL), and diagnostic procedures (26.6%, wasted volume 567 mL). Factors significantly associated with a low prescription rate of nutritional support were the administration of vasoactive drugs, central venous catheterization, and the need for extrarenal replacement. CONCLUSIONS: An inadequate delivery of enteral nutrition and a low rate of nutrition prescription resulted in low caloric intake in our intensive care unit patients. A large volume of enterally administered nutrients was wasted because of inadequate timing in stopping and restarting enteral feeding. The inverse correlation between the prescription rate of nutrition and the intensity of care required suggests that physicians need to pay more attention to providing appropriate nutritional support for the most severely ill patients.

Adult↗