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PubMed1990

General and specialized parenteral amino acid formulations for nutrition support.

Advances in the understanding of amino acid metabolism and of the interaction of amino acids with skeletal muscle, liver, brain, and other tissues have led to refinements of parenteral amino acid solutions. Clinical situations may dictate the use of specific amino acid formulations. Branched-chain amino acid (BCAA) solutions may normalize aberrant amino acid profiles in patients with hepatic encephalopathy; however, controlled trials demonstrate little effect on clinical outcome, and the effectiveness in patients with acute liver failure or undergoing orthotopic liver transplantation is unproved. BCAA solutions have also been tried in septic and severely stressed patients with equivocal results. Renal failure has been treated with essential amino acid solutions, yet low-dose standard amino acid formulations are probably equally effective. Pediatric preparations have been tailored to "normalize" amino acid profiles to those of healthy term, breast-fed neonates. Recent studies suggest that premature infants receiving these formulations may achieve intrauterine growth rates, although the effect on long-term outcome is unknown. Glutamine may be essential for the preservation of intestinal mucosal structure and function; further study is indicated to determine the necessity of adding glutamine to parenteral amino acid solutions. Recently, amino acid infusions have been associated with enhanced ventilatory drive, possibly via stimulation of central ventilatory mechanisms. A variety of other side effects have been documented, including acidosis, hyperammonemia, hypercalciuria, and possibly bone disease and hepatotoxicity. Further understanding of the metabolism of intravenous infusion of amino acids is necessary to provide optimal nutritional protein support. Because full information regarding the complex effects of intravenous substrates is lacking, special amino acid formulations must be used with caution.

Amino Acids↗
PubMed1980

Pharmacokinetic comparison of cefroxadin (CGP 9000) and cephalexin by simultaneous administration to humans.

The pharmacokinetic parameters of cefroxadin and cephalexin were compared after simultaneous oral administration of the two cephalosporins to 21 subjects. The influence of the dose, the formulation, and food intake on these parameters was investigated. Both drugs were equally well absorbed from all of the tested formulations; identical percentages of the dose were recovered in the urine in all cases. The elimination half-life of cefroxadin and, consequently, the area under the plasma concentration-time curve were about 10% less than those of cephalexin. Plasma concentrations and cumulative excretion curves of the two drugs were almost superimposable. Food intake had the same effect on both drugs; absorption was slowed, but the amounts absorbed were almost the same as those in fasted subjects.

Adult↗
PubMed2002

Weaning foods: a review of the Indian experience.

Although breastmilk is adequate to meet the energy and nutrient requirements of an infant up to four to six months of age, thereafter it is insufficient to sustain normal growth and needs to be supplemented with other foods, such as weaning foods. However, the capacity of a weaning diet to meet the protein and energy requirements of infants depends on its nutritional quality as well as its dietary bulk. This review highlights varieties of weaning foods, blend formulations, nutrient requirements, process characteristics, physicochemical parameters, quality evaluation, and other important aspects of developing a weaning food that satisfies all the requirements of the infant during the vulnerable transitional stage. Traditional weaning foods of India are briefly summarized.

Humans↗
PubMed1994

Shelf life of weaning foods developed from locally available food stuffs.

Four weaning foods were formulated using locally available cereals and pulses such as wheat (Triticum aestivum), barley (Hordeum vulgare), green gram (Vigna radiata) and jaggery. Cereal, pulse and jaggery were used in the proportion of 70:30:25. Roasting and malting were two processing techniques used. The developed weaning foods were evaluated for their nutritional characteristics and shelf life. All the formulations had a nutrient composition within the range prescribed by the Indian Standard Institute (ISI) for processed weaning foods. Peroxide value and fat acidity of weaning foods increased with increase in storage period. Malting of weaning foods resulted in higher increase of peroxide value and fat acidity as compared to roasted ones during the period of storage. All the blends were found to be acceptable up to 60 days of storage. The results, indicated that weaning foods developed from locally available less inexpensive foods may be used as good supplements for infants.

Dietary Fats↗
PubMed2002

Foods provided through U.S. Government Emergency Food Aid Programs: policies and customs governing their formulation, selection and distribution.

This report describes the food commodities that are used in U.S. emergency food aid programs and outlines issues in their distribution, selection and formulation that may limit their ability to meet the nutrition needs of recipients. Issues are being raised at this time because the U.S. Congress plans to renew the authorizing legislation by the end of 2002. The author summarizes quantity and quality problems with food aid contributions and the difficulties experienced with the coordination of food aid with related needs of disaster victims. He identifies the foods supplied for emergency feeding by the U.S. Government and the World Food Program, and describes the limited applications of nutrition science to the formulation of the processed foods provided through U.S. food programs. The core of the report outlines the dominant nonnutritional priorities, stemming from the linkages to U.S. agricultural supply markets, U.S. commercial food interests, food aid pledging customs and difficulties in U.S. Government humanitarian response coordination. The presentation concludes with a review of issues, emphasizing the need for further studies, and some suggestions for shaping future food aid programs and policy with a strengthened capacity for protecting and promoting the nutritional status of disaster victims.

Financing, Government↗
PubMed2006

Starch thickening of human milk is ineffective in reducing the gastroesophageal reflux in preterm infants: a crossover study using intraluminal impedance.

We evaluated the efficacy of the thickening of human milk by precooked starch in reducing gastroesophageal reflux in preterm infants. Five preterm infants with frequent regurgitations (median gestational age, 28 weeks; range, 27 to 32 weeks; median birth weight, 990 g; range, 570 to 1900 g) were fed alternately during 24 hours with four meals of fortified maternal milk (milk A) and four meals of fortified maternal milk thickened by 1.5 g of precooked starch per 100 mL of milk (milk B). The acidic and buffered refluxes were detected by simultaneous pH monitoring and multiple intraluminal impedance. Eight feeding periods for each baby were recorded. The number of the acidic (34 after milk A vs 36 after milk B) and buffered (112 after milk A vs 134 after milk B) episodes of gastroesophageal reflux did not differ. Thickening human milk by precooked starch is ineffective in reducing gastroesophageal reflux in premature infants.

Cross-Over Studies↗
PubMed1997

Effects of discontinuing coffee intake on iron status of iron-deficient Guatemalan toddlers: a randomized intervention study.

Coffee is one of the first liquids given to infants in Guatemala. To evaluate whether this practice has an adverse effect on iron status, 160 children 12-24 mo of age who had received coffee for > or = 2 mo and had at least one indicator of iron deficiency were stratified by initial hemoglobin concentration (anemic, or nonanemic, ie, hemoglobin > or = 105 g/L) and randomly assigned to a control (continuation of coffee; coffee) or intervention (provided with a substitute consisting of sugar and coloring; substitute) group for 5 mo. Anemic children were provided with iron supplements for 2-3 mo. Hematologic and anthropometric measurements were made before and after the intervention and dietary and morbidity data were collected every 2 wk. A total of 139 children completed the study: 45 coffee, nonanemic; 56 substitute, nonanemic; 19 coffee, anemic; and 19 substitute, anemic. Compliance with the procedures was good: median coffee intake was 891 mL/wk in the coffee group compared with 18 mL/wk in the substitute group (P = 0.0001). There was no significant effect of discontinuing coffee consumption on changes in hemoglobin, hematocrit, ratio of zinc protoporphyrin to heme or plasma iron, zinc or copper in either nonanemic or anemic children, or plasma ferritin in children who did not take iron supplements. In children who took iron supplements, change in plasma ferritin was significantly greater in the substitute group than in the coffee group (106% compared with 1%, P < 0.05). This implies that coffee interferes with the utilization of supplemental iron. It is likely that the amount and strength of coffee consumed by Guatemalan toddlers are too low to significantly affect the other indexes of iron status.

Anemia↗
PubMed2000

Vegetable proteins: are they nutritionally equivalent to animal protein.

On the basis of the rate of animal growth, proteins have been traditionally classed as high quality, such as egg and milk protein, or low quality such as gluten. In general, vegetable proteins are of low quality but soy protein is an exception. The paper by Capristo et al. in this issue of the journal has shown that enteral formulations consisting of soy protein are as effective nutritionally as enteral formulations containing milk protein.

Dietary Proteins↗
PubMed1987

Use of refractive index measurement for quality assurance of pediatric parenteral nutrient solutions.

Use of refractive index measurements to assure accurate formulation of pediatric parenteral nutrient base solutions is described. The refractive indexes for various amino acid and dextrose concentrations were determined. An equation was derived to define the theoretical refractive index for combinations of amino acids and dextrose. Finally, a clinically acceptable range (deviation from theoretical) was determined. The actual refractive index for 300 pediatric parenteral nutrient solutions was compared with the calculated theoretical reading. The actual refractive index for all solutions was consistently predicted by the derived equation. Discussions with clinicians resulted in identification of an allowable range for these readings. All reading were within the identified range. The use of refractive index measurements is a valuable quality assurance tool for pediatric parenteral nutrient base formulations.

Amino Acids↗
PubMed2006

Sources of saturated fatty acids in Belgian adolescents' diet: implications for the development of food-based dietary guidelines.

The objectives of the present study are to describe the dietary sources of total fat and of saturated fatty acids (SFA) and to formulate food-based dietary guidelines for SFA in Belgian adolescents. A random sample of 13-18-year-old adolescents was drawn from secondary schools in the region of Ghent. A 7 d estimated food record method was used to quantify nutrient and food intake. The average daily SFA intake is 4 % above the recommended 10 % of the total energy contribution. The most important contributors of SFA on food group level were 'fats, oils and savoury sauces', 'meat and meat products', 'sugar, confectionery, sweet fillings and sauces', 'cheese', 'milk and milk products' and 'bread, rusk and breakfast rolls'. On food subgroup level 'fresh meat', 'high-fat margarine' and 'high-fat cheese' had the highest contribution to SFA intake in all adolescents. Adolescents with a low SFA intake (lowest tertile) were compared with adolescents with a high intake (highest tertile). In the lowest tertile the intake of total fat and MUFA was significantly lower than in the highest tertile, while the intake of total carbohydrates, mono- and disaccharides and complex carbohydrates was significantly higher. Overall, the high-fat cheese intake is significantly lower in the lowest tertile, while the fruit intake is higher. The present analysis shows that the nutritional profile of Belgian adolescents could be potentially improved by decreasing the portion sizes of fresh meat (in boys), high-fat margarine, high-fat cheese and reducing intake of commercially prepared baked goods and processed foods, including fast foods.

Adolescent↗
PubMed1995

Effects of food on the bioequivalence of different verapamil sustained-release formulations.

Previously, clinical studies comparing generic and reference formulations of sustained-release (SR) verapamil tablets revealed significant increases in the PR interval in subjects given the generic formulation in the presence of food. To determine the mechanisms underlying these differences in pharmacodynamics, the present analyses examined the pharmacokinetics of these formulations in the presence and absence of food. After single or multiple doses in fasting subjects, AUCs, Cmaxs, and tmaxs were similar, suggesting that these formulations were bioequivalent in the fasted state. However, the generic formulation exhibited a higher AUC(0-6) in fed subjects, suggesting that this formulation may be absorbed more rapidly than the reference formulation when given with food. Analysis of AUC(0-6) showed that 34% of the subjects receiving the generic formulation exhibited rapid absorption, compared with only 8% receiving the reference formulation. Significant increases in the PR interval were seen in nine fed subjects receiving the generic formulation compared with two receiving the reference formulation. Similarly, three fed subjects receiving the generic drug who were rapid absorbers exhibited first-degree heart block, whereas this conduction disturbance was seen in only one fed subject receiving the reference formulation. Thus, increased conduction disturbances seen in subjects given the generic formulation with a meal likely reflect more rapid absorption of this formulation in the presence of food, resulting in an increase in the ratio of more potent to less potent enantiomers of verapamil in the systemic circulation.

Adult↗
PubMed1983

Selected topics in therapeutic nutrition.

Although parenteral and enteral nutrition has advanced rapidly in the last 5 years, prevention of nutritional problems in children still depends on the practice of basic nutritional principles. Breast-feeding remains the best alimentation for the infant. Increased support of breast-feeding in children with cleft lip and/or palate is a simple application of basic therapeutic nutrition. Proper feeding can avert the need for parenteral or enteral nutrition. As our knowledge of nutritional therapeutics expands, the practitioner will be able to play a greater role in both preventive and therapeutic nutrition.

Acute Kidney Injury↗
PubMed1991

Octenylsuccinic aciduria in children fed protein-hydrolysate formulas containing modified cornstarch.

The excretion of 2-(2'-octenyl)succinic acid (OSA) and several metabolites of OSA was studied by gas chromatography/mass spectrometry in 17 infants and children fed one of three proprietary elemental or protein-hydrolysate formulas that use OSA-modified cornstarch as an emulsifying agent. Variable but often large amounts (up to 2500 mg/g creatinine) of the fatty acid-like OSA and its metabolites were found in the urine of these children, and levels of OSA in their blood ranged from 9.5 to 57.9 mumol/L. Apparently secondary abnormalities, such as increased urinary levels of glutaric acid and 2-ketoglutaric acid, were also found in more than half of the urine specimens. The molecular weight and mass fragmentation patterns of the nine compounds associated with the excretion of OSA are consistent with the proposal that OSA is metabolized in human infants and children by a combination of omega-, omega-1-, and beta-oxidation steps, similar to the metabolism of another branched-chain fatty acid, valproic acid. The urinary organic acid pattern of children fed elemental formulas containing OSA-modified starch often was dominated by OSA and its metabolites, and in several children the OSA-related changes were mistaken for a primary metabolic disease. Physicians and laboratories evaluating children for suspected metabolic diseases should be aware of the possibility of abnormal organic acid studies associated with OSA-containing formulas.

Child↗
PubMed1982

Use and design of low protein diets for children with inborn metabolic disorders.

Low protein diets are used to treat infants and children with hyperammonemia due to urea cycle and other metabolic disorders as well as a number of amino and organic acidopathies. The incidence of these disorders is small and many are life-threatening. As a result, there is little in the literature on the dietary management of these patients. This paper draws on 10 years of clinical experience at the Hospital for Sick Children in Toronto, Ontario and presents a guide to the preparation of infant formulas providing levels of protein intake from 0.5 to 2.0 g per kg. Also described is a low protein equivalency system that is a useful guide for measuring both baby foods and table foods for affected children up to about six years of age. This dietary information is accompanied by a description of the disorders amenable to low protein diets, some of the adjunctive therapies employed and the nutritional concerns associated with severe restriction of protein.

Child↗
PubMed2004

Fructooligosaccharides maximize bone-sparing effects of soy isoflavone-enriched diet in the ovariectomized rat.

Isoflavones (IF) have been increasingly implicated for use in the prevention of osteoporosis. As their bioavailability could be improved by modulating intestinal microflora, the present study was undertaken to investigate whether IF and fructooligosaccharides (FOS), which are known to modify large-bowel flora and metabolism, may exhibit a cooperative bone-sparing effect. This work was carried out on 3-month-old Wistar rats assigned to 12 groups: 2 SH (sham-operated) and 10 OVX (ovariectomized). Animals received a diet for 90 days containing total IF (Prevastei HC, Central Soya) at 0 (OVX and SH), 10 (IF10), 20 (IF20), 40 (IF40), or 80 (IF80) microg/g body weight per day. FOS (Actilight, Beghin-Meiji) were orally given to half of the groups, (OVX FOS), (IF10 FOS), (IF20 FOS), (IF40 FOS), (IF80 FOS), and (SH FOS). Isoflavones exhibited a bone-sparing effect as soon as consumption reached 20 microg/g/day, whereas only the highest dose induced a weak uterotrophic activity. Indeed, total femoral bone mineral density (BMD) was significantly enhanced (compared with that of OVX rats), as was the metaphyseal compartment. Bone strength was improved as well. As far as the FOS diet is concerned, addition of prebiotics significantly raised the efficiency of the IF protective effect on both femoral BMD and mechanical properties. The trend toward higher BMD levels with the lowest IF dose (IF10) even reached a significant level when FOS were added. This effect could be explained by a reduced bone resorption. In conclusion, daily IF consumption prevented castration-induced osteopenia by decreasing bone resorption when given at 20, 40, or 80 microg (total isoflavones)/g/day. Simultaneous FOS consumption improved IF protective effect on the skeleton, with the lowest IF dose becoming efficient. Enhancement of IF bioavailability, following FOS fermentation, is probably involved.

Animals↗
PubMed1984

Cardiac dysfunction in obese dieters: a potentially lethal complication of rapid, massive weight loss.

During 1977 and 1978, 17 obese but otherwise healthy adult Americans died suddenly of ventricular arrhythmias during or shortly after completing rapid, massive weight reduction induced by very low-calorie diets consisting largely of collagen hydrolysates for 2 to 8 months. A reexamination of the data on these victims has disclosed a significant positive correlation (r = 0.824) between their prediet body mass index and their duration of survival on the very low-calorie diets. Since body mass index reflects degree of fatness, this observation indicates that the ability to defer the lethal effects of severe caloric restriction was a function of the proportion of body fat before dieting. During caloric reduction, the ratio of nitrogen loss to weight loss is inversely related to body fat content; accordingly, we suggest that the fattest dieters survived the longest because they were better able to conserve body (and myocardial) protein. Also, obese people have an enlarged lean body mass which may afford additional protection.

Adult↗