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PubMed2003

Controversy of immunonutrition for surgical critical-illness patients.

Specific nutrients such as arginine, glutamine, dietary nucleotides, and omega-3 fatty acids have been shown to influence infectious morbidity, antibiotic use, and hospital length of stay. The combination of these nutrients into one enteral formulation has become known as immune-enhancing diets. Consensus guidelines developed by a number of clinical investigators and published in 2001 concluded that immune-enhancing diets were beneficial in moderate to severely malnourished patients undergoing elective gastrointestinal surgery and patients sustaining severe blunt and penetrating torso trauma. The purpose of this article is to review data published between February 1, 2001, and January 31, 2003, to determine whether new studies substantiated or refuted the current recommendations for the use of immune-enhancing diets in surgical, critically injured, and critically ill patients. Results confirmed the benefits of preoperative administration of immune-enhancing diets in surgical patients but also demonstrated that postoperative administration offered no advantages. Decreased infectious complications were also observed in critically ill patients receiving immune-enhancing diets. Accumulating evidence supports the use of immune-enhancing diets in these specific patient populations.

Arginine↗
PubMed2006

Are there any real differences between enteral feed formulations used in the critically ill?

PURPOSE OF REVIEW: We know that adequate nutritional support is essential in the treatment of critically ill patients, because it can, if applied appropriately, improve the clinical outcome. Increasing evidence seems to suggest that malnutrition itself is a predictor of poor outcome in intensive care, and significant underfeeding during intensive care stay increases the risk of bloodstream infections. The purpose of this review is to highlight recent advances in enteral nutrition in the critically ill adult patient. RECENT FINDINGS: Recent studies suggest that tight glycaemic control is associated with improved outcome. Enteral feeding should be encouraged, using simple feeding protocols, and started early if safe to do so. Gastric residual volumes do not correlate with the risk of aspiration, and therefore should be used with caution in feeding protocols. Conflicting evidence exists for supplementation with antioxidant and immunonutrition in the critically ill. Glutamine and fish oil/borage oil should be considered for burns patients and patients with adult respiratory distress syndrome, respectively. SUMMARY: This review offers information regarding the latest developments in nutritional support via the enteral route. Further research is needed to clarify the role of enteral supplements such as antioxidants and 'immune modulating substances'.

Adult↗
PubMed1981

[Formulation of a rice-based beverage of high nutritive value].

The purpose of this work was the production of a beverage with a nutritive value similar to that of milk, but available at a lower cost. A traditional beverage in Venezuela, "Chicha de Arroz" (Rice Chicha), was chosen. The various formulas studied were based on rice, non-fat milk and different kinds of soy flour, in addition to sugar, vegetable oil, vitamins, ferrous sulfate and different flavors. A product with protein and caloric values similar to those of milk was obtained. Twenty formulas were prepared and submitted to physico-chemical, microbiological and sensorial evaluations with respect to flavor, color, viscosity and stability during period of refrigeration. The most adequate formula was prepared on a pilot-plant scale. Rat assays gave the same PER results as those of casein. Consumer acceptability was tested on 1,080 school children, and showed to be greater than 95%. The stability was superior to that of milk and the cost, approximately three-fourths that of the latter. In the school-snack program of the National Institute of Nutrition, milk is now being replaced by this Chicha.

Amino Acids↗
PubMedDate not supplied

Home parenteral nutrition programs.

The technique of home parenteral nutrition (HPN) is becoming a more widely used method to treat patients who cannot eat for prolonged periods; to date, more than 500 patients have been trained nationwide. Training has been limited for the most part to larger centers which have more experience in providing this complex patient education. As this technique becomes more widely accepted, however, other less experienced health care professionals will be called upon to develop HPN training programs. For this reason, it is important to simplify these training programs, with initial attention directed toward the procedures used to prepare the total parenteral nutrition solution. The chance of potential errors can be reduced by using amino acid solutions with electrolytes included in the formulation. When possible, complexity can be reduced by administering vitamins and extra electrolytes orally. The teaching program can be simplified by developing or using existing training manuals, which standardize procedures so that consistent methods are taught and performed. The manual can serve as a reference for patient and teacher alike. Distribution of supplies can be simplified by employing commercially available shipment programs; but, while these are very convenient for the patient and pharmacy, the costs of such programs could be a limitation. Finally, the extensive work required to arrange reimbursement for services and supplies also can be simplified. Often a social worker can facilitate this process because of experience and training in dealing with payment problems. In addition, training fees should be negotiated with third party payors early in the development of HPN programs. By simplifying these basic elements in an HPN, the task of training patients is less imposing and can be made more widely available to those who need this treatment modality.

Adult↗
PubMedDate not supplied

Safety and efficacy of a new pediatric enteral product in the young child.

Children who are unable to maintain an intake of energy and nutrients adequate to meet their needs for growth and maintenance of nutritional status require modifications in feeding. A new pediatric enteral product (PediaSure) was formulated to meet the nutrient needs of children 1 to 6 years of age in a volume that can be tolerated. We designed a noncontrolled, nonrandomized study to evaluate the suitability of this product in young children with respect to growth, protein status, metabolic responses, and gastrointestinal tolerance. Fourteen chronically disabled children were fed the study formula for 12 weeks, receiving daily at least 90% of their estimated energy requirements. Anthropometric measurements and biochemical parameters were obtained throughout the study period. Weight, weight for age, length, weight index, triceps skin fold thickness, mid-arm circumference, mid-arm muscle circumference, and mid-arm muscle area all increased over the study period. Gastrointestinal tolerance and acceptance of the study formula were excellent; there were no clinically significant changes in the biochemical measurements. This study demonstrates that PediaSure is both safe and efficacious in the maintenance of the nutritional status and the promotion of growth in chronically disabled children who require specialized nutritional support.

Anthropometry↗
PubMed1997

Components of the AIN-93 diets as improvements in the AIN-76A diet.

The AIN-93 rodent diets were formulated to substitute for the previous version (AIN-76A) and to improve the performance of animals that consume them. They are called AIN-93G, formulated for growth, and AIN-93M, for maintenance. Major changes included substituting cornstarch for sucrose and soybean oil for corn oil and increasing the amount in order to supply both essential fatty acids (linoleic and linolenic). L-Cystine was substituted for DL-methionine to supplement the casein component. The mineral mix was reformulated to lower the amounts of phosphorus, manganese and chromium, to increase the amount of selenium, and to add molybdenum, silicon, fluoride, nickel, boron, lithium and vanadium. The amounts of vitamins E, K-1 and B-12 were increased over those in the AIN-76A vitamin mix. The AIN-93G diet contains 200 g of casein and 70 g of soybean oil/kg diet. The maintenance diet (AIN-93M) contains 140 g of casein and 40 g of soybean oil/kg diet. The 1993 diets have a better balance of essential nutrients than the 1976 diet and are better choices for studies with laboratory rodents.

Animal Feed↗
PubMed1990

Clinical and biochemical alterations in calves with nutritionally induced polioencephalomalacia.

Polioencephalomalacia (PEM) was induced in calves by feeding a semipurified, low-roughage diet of variable copper and molybdenum composition. Two formulations resulting in Cu-insufficient and Cu-sufficient forms of the diet were fed (n = 10 and 4 calves, respectively); both diets induced PEM. Clinical signs of disease developed as early as 15 days after transition to the experimental diets and included impaired vision, decreased response to external stimuli, and abnormal gait. Grossly evident cerebrocortical lesions consisted of laminar areas of cavitation and/or autofluorescence seen under UV illumination. Hepatic Cu concentration was decreased in calves fed the Cu-insufficient diet, but not below normal range. During the course of feeding either diet, rumen pH decreased, rumen volatile fatty acid concentrations increased, rumen and blood lactic acid concentrations increased, and rumen and plasma thiamine concentrations increased. The thiamine pyrophosphate effect on erythrocyte transketolase activity was unaltered in calves of either diet group. This nutritionally induced form of PEM does not appear to be related to Cu deficiency or reduction in plasma or rumen thiamine concentration.

Animals↗
PubMed1994

[Effect of arginine on lymphocyte responses to ConA in burned mice].

It is well accepted that nutritional support improves the immunologic functions in burned patients. Arginine has been demonstrated to have tissue-specific properties which induce beneficial effects upon the immune system. A series of experiments are carried out, in order to evaluate the immune effect of arginine on burned mice. 1. Lymphocytes from both burned and unburned mice are harvested and incubated in various concentrations of arginine solution for 72 hours, and ConA-stimulating lymphocyte transformation is determined after incubation. 2. Burned animals are divided into four groups. Standard diets for nutritional support are formulated. These formulas contain an identical carbohydrate and lipid (61% and 15% of total energy respectively) intake with varied proportions of protein for each group (24%, 23%, 22%, and 20% of total energy, respectively), in addition. 0%, 1%, 2% and 4% of protein energy is supplied by arginine for different groups. Lymphocyte proliferations in responses to ConA stimulation are determined on the 7th postburn day. The data shows that, in vitro study, increasing arginine concentrations enhanced lymphocyte responses to ConA. The arginine needed level for optimal lymphocyte responses is 1.8 mmol/L in burned mice and 0.9 mmol/L in unburned controls. This difference indicates that in burned mice, a higher arginine concentration is required for better lymphocyte responses. On the contrary, further increase of arginine concentration do not give better response. When varied amounts of arginine are given in the diet to the burned mice, the degree of lymphocyte response to ConA is different. The amount of arginine which supplies 2% of total energy is found to be optimal.

Animals↗
PubMed2005

Increasing dietary pectin level reduces utilization of digestible threonine intake, but not lysine intake, for body protein deposition in growing pigs.

Two N balance studies were conducted to investigate the effects of feeding graded levels of pectin (a soluble nonstarch polysaccharide, NSP) on the utilization of ileal digestible threonine (Thr; Thr study) and lysine (Lys; Lys study) intake for body protein deposition (PD) in growing pigs. In each study, eight Yorkshire barrows with an average initial BW of 17.2 +/- 1.3 (Thr study) and 14.3 +/- 1.4 kg (Lys study) were fed each of five experimental diets during five subsequent experimental periods, according to a crossover design. Pigs were fed twice daily at 2.6 times maintenance energy requirements. The soybean- and cornstarch-based diets, in which either Thr or Lys was the first-limiting nutrient, were formulated to contain (as-fed basis) 0, 4, 8, or 12% pectin or 8% cellulose (water-insoluble NSP), respectively, and with NSP substituting cornstarch. Across treatments, the mean daily Thr and Lys intake were 5.42 +/- 0.04 g/d (Thr study) and 7.98 +/- 0.12 g/d (Lys study), respectively. Apparent and standardized ileal digestibilities of Thr and Lys were determined in a separate study. Mean PD was 93.4, 90.2, 82.1, 76.7, and 87.9 g/d (SEM = 1.3; Thr study) and 90.7, 88.6, 87.8, 85.3, and 88.1 g/d (SEM = 1.1; Lys study) for the five respective treatments. Utilization of ileal digestible Thr intake, but not of ileal digestible Lys intake, for PD decreased linearly with dietary pectin level, and was not influenced by diet cellulose level. The current study indicates that apparent and standardized ileal digestibility values do not provide an accurate predictor of dietary effects on the utilization of ileal digestible Thr intake for protein deposition in growing pigs fed diets containing soluble NSP.

Animal Feed↗
PubMed1980

[Metabolic studies on intensive care patients during gastric tube feeding with a formulated diet, rich in bulk].

Results of metabolic investigations in 5 intensive care patients fed via gastric tube with a prefabricated formula diet (based on milk protein, rich in bulk material) are reported. Clinical handling proved to be rather simple, due to the homogeneity of the mixture tube, obstruction never occurred. Tolerance of the tested tube feeding was good in 4 of 5 patients (in 1 tetanus patient the study to be interrupted because of acute abdominal symptoms), mean body weight increased. During the 10-day treatment period, a slightly positive nitrogen balance (mean 1.4 +/- 5.9 g/day) resulted in a cumulative nitrogen retention of 15.5 g. Fat losses in faeces, probably due to high intake (more than 50% of calories administered), were moderately elevated compared to normal values; in some patients decreased fat resorption with steatorrhoea was observed on various days. The formula diet under investigation may be qualified as a suitable nutritional regime for intensive care patients with intact gastrointestinal function. In cases with impaired fat utilization, however, relative calorie deficiency interfering with protein synthesis (gluconeogenesis) might occur. Lowering of the fat quota (having been taken into account in the meantime) to the benefit of elevated carbohydrates may be desirable in this context.

Adolescent↗
PubMed1991

Zinc absorption in women: comparison of intrinsic and extrinsic stable-isotope labels.

Fractional absorption of extrinsic and intrinsic zinc from milk-based formulated diets was measured in 10 young women by using a simultaneous triple-isotope method based on fecal monitoring of unabsorbed enriched stable-isotope labels. Zinc intake was held nearly constant (mean zinc intake = 1.48 mumol.kg body wt-1.d-1) throughout the 18-d controlled feeding phase of the study by addition of extrinsic 64Zn to all formula feedings, with substitution of the extrinsic 67Zn label for some of the 64Zn when formula intrinsically labeled with 70Zn was given. Fractional absorption values of intrinsic and extrinsic zinc labels, 0.267 +/- 0.092 (mean +/- SD) and 0.282 +/- 0.086, respectively, were highly correlated (r = 0.83, P less than 0.05) and did not differ significantly. The ratio of fractional absorption of the extrinsic to that of the intrinsic label, 1.08 +/- 0.20 (mean +/- SD), was not significantly different from unity. The results show that extrinsic labeling by use of enriched stable isotopes is a valid means of determining zinc absorption from milk-based diets in adult humans.

Absorption↗
PubMed1988

A kinetic study of leucine metabolism in severely burned patients. Comparison between a conventional and branched-chain amino acid-enriched nutritional therapy.

A cross-over design study was used to examine the metabolic consequences of enteral feeding for 48 to 96 hours with either a branched-chain amino acid (BCAA)-enriched (44% BCAA) or a conventional egg protein formulation in 12 severely burned adult patients. A stable isotope labeled leucine (L-1-13C-leucine) tracer approach was used to measure leucine flux and oxidation and to estimate rates of whole body protein synthesis and breakdown. Additionally, 15N2-urea and 6,6-2H-glucose were administered to assess the status of urea and glucose kinetics with these two nutritional treatments. Average patient age was 54 years, and average burn surface area was 36%. Studies were conducted at an average of 25 days postburn. Leucine flux and oxidation were significantly (p less than 0.01, by paired t-test) elevated with BCAA feeding as compared to the egg protein formulation. However, there were no significant differences in the rates of leucine incorporation into, or release from, proteins (p greater than 0.05) between the two dietary periods. Mean rates of body protein synthesis and breakdown for each diet were about twice the rates reported for healthy young adults. Apparent nitrogen balance measurements were not statistically different (p greater than 0.1) between the two diet periods. Furthermore, urea and glucose kinetics failed to show significant differences between the two diet periods. It appears from these results that the major consequences of increased intake of leucine from the BCAA formula is an enhanced rate of leucine oxidation. In conclusion, (1) the availability of BCAAs is not rate-limiting for enhanced protein synthesis in burn patients, and (2) the use of enriched BCAA formulas in burn therapy does not appear to offer advantages over a routinely used enteral egg protein formula, at least based on the present determinations.

Amino Acids, Branched-Chain↗
PubMedDate not supplied

Effects of various enteral feeding products on postprandial blood glucose response in patients with type I diabetes.

These studies were performed to evaluate the postprandial blood glucose responses to a variety of differently formulated enteral feeding products in patients with type I diabetes. Eleven subjects with type I diabetes were evaluated in three studies, all using a Biostator (artificial endocrine pancreas) that delivered a small, basal amount of insulin and measured blood glucose levels. Subjects consumed 20 mL of the assigned formula every 15 minutes for the 240 minutes of the study. Study 1 evaluated the response to each of five products: Glucerna, Enrich, Ensure HN, Pulmocare, and Compleat Modified. When the postprandial blood glucose response to Glucerna was greater than when its research formulation (EN-8715) had been tested in 1988, studies 2 and 3 were undertaken to assess why this discrepancy occurred. Study 2 compared stored EN-8715 to Glucerna and study 3 compared frozen and thawed vs nonfrozen EN-8715, because of a concern that the original product had been frozen during shipping. In study 1 the glucose response (assessed as area under the glucose curve) correlated with the grams of carbohydrate present in the enteral feeding formula (r = .58, p = .002). The presence or absence of fiber, in the form of soy polysaccharide, did not affect the glucose response. Glucerna produced a significantly lower blood glucose response than did Enrich, Ensure HN, or Compleat Modified, although this response was greater than the response to EN-8715 in 1988. However, in study 2 no differences were found between stored EN-8715 and Glucerna and in study 3, freezing and thawing was not found to significantly alter the glucose response.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Total parenteral nutrition in the mouse: development of a technique.

A method for total parenteral nutrition in the mouse was developed using commercially available supplies and equipment. The mouse's inferior vena cava was catheterized and the catheter was exteriorized from the tail. Mice (average body weight 22.5 g) were not tethered but instead were partially restrained by immobilizing the tail to protect the infusion tubing. A solution was formulated to contain 40% dextrose and 4.3% amino acids plus vitamins, electrolytes, and trace elements. It was administered via pump in graded fashion for the first 3 days to allow the mice to adapt, and then at a rate of 8 ml/day thereafter. This volume provided approximately 12 kcal and 54 mg nitrogen per day and was calculated to meet the needs of the mouse fed per os according to guidelines of the National Research Council. During the adaptation period mice lost weight but they were in positive N balance thereafter. At the end of 12 days body weight was not different than at the start, indicating the adequacy of nutrient input. Further, there were no differences in nitrogen balance or body weight in total parenteral nutrition fed mice in comparison with tail-restrained mice given the same solution per os. All mice appeared to tolerate the partial restraint without incidence and showed no untoward side effects. The rationale and validity of this technique is discussed in detail.

Animals↗
PubMedDate not supplied

Enteral and parenteral branched chain amino acid-supplemented nutritional support in patients with encephalopathy due to alcoholic liver disease.

The effects of branched chain amino acid (BCAA)-enriched diets (fed for 7 days) on encephalopathy, plasma amino acid concentrations, aromatic amino acid turnover, and protein synthesis rates were determined in eight patients with alcoholic liver failure. Four patients were given the diet intravenously (iv group) (total amino acids, 60-80 g/day, BCAA content 51%, energy 2000 kcal/day) and four patients (NG group) were given a semi-elemental formulation via constant nasogastric (NG) infusion (amino acids 58 g, BCAA 43%, oligopeptides 19.5 g, energy 2000 kcal/day). The enteral diet was given at one-half strength for the first 3 days. A 10-hr constant infusion of [U-14C]phenylalanine tracer was used in four patients to measure aromatic amino acid (AA) turnover and rates of incorporation into various body proteins. Seven of the eight patients made a good clinical recovery, with reversal of encephalopathy within 3 days of dietary intervention. One became septicemic and deteriorated. While plasma bilirubin concentrations dropped, liver enzymes remained elevated. Mean nitrogen balance was negative at the beginning and positive at the end of the study, in both groups. Initial amino acid profiles demonstrated low plasma BCAA content and BCAA:AA ratios. Significant improvements occurred in the iv group by day 2 and in both groups by day 7. Isotope studies showed that, whereas aromatic amino acid oxidation remained unchanged, greater quantities were incorporated in whole body protein, albumin, transferrin, fibrinogen, and immunoglobulins.

Adult↗
PubMedDate not supplied

Microbiological determination of neomycin in feeds and formulated products.

An AOAC modified method is described for the microbiological assay of neomycin, which has been adapted to include complete feeds, supplements, premixes, liquids, oil suspensions, boluses, and antibiotic-impregnated paper. The method features a more sensitive standard response line with a monolayer plating system. The use of a buffered plating medium in place of the water-prepared medium results in a curve with less degree of slope, which allows for more accurate interpretation of the standard response. The feed extract diluent used for standard response line dilution, which is prepared from exposure of the feed extract fluid to pH changes, heat, and sodium hypochlorite, has been eliminated. The constant salt concentration diluent used for the preparation of standards is the same as the salt concentration of the sample extract solution to be tested. Results for 50 commercial complete feeds and 50 commercial premixes received over the last 5 years produced an overall mean recovery of 101% with a mean percent recovery range of 80-112%. A statistical analysis of these 100 commercial, complete feeds and premixes, ranging in concentration from 47 g/ton to 70 g/lb, indicates the assay has little, if any, concentration-related bias. Precision and accuracy of the method was supported by laboratory studies of 20 assays that produced a mean recovery of 101% and standard deviation of 3.

Animal Feed↗
PubMedDate not supplied

Bile acid conjugation pattern in the isolated perfused rat liver during infusion of an amino acid formulation.

The influence of the taurine-containing amino acid mixture Trophamine on the pattern of bile acid conjugation was examined in the isolated perfused rat liver using cholic acid as the bile acid substrate. In all experiments, greater than 97% of the cholic acid appearing in bile was conjugated with taurine or glycine. The pattern of taurine and glycine bile acid conjugation, however, was dependent on the availability of taurine in the perfusate medium. Thus, in the absence of Trophamine infusion, the percentage of cholic acid conjugated with taurine (ie, taurocholate) declined throughout the course of the cholic acid infusion. Trophamine infusion increased the ratio of biliary taurocholate/glycocholate by 4.5-fold over that observed in the absence of the amino acid infusion. Increasing the amount of taurine in Trophamine by 2- or 5-fold resulted in a 1.8- and 4.3-fold increase, respectively, in the taurocholate/glycocholate ratio over that observed during the Trophamine infusion. Infusion of taurine alone, at an equimolar concentration of taurine as that in Trophamine, resulted in a similar taurocholate/glycocholate ratio as that observed during the Trophamine infusion. These data indicate that taurine availability, even in the presence of high concentrations of glycine and other amino acids in Trophamine, appears to be the most important factor in determining the pattern of bile acid conjugation in the isolated perfused rat liver.

Amino Acids↗
PubMed2006

[Development of an optimized formulation of flaxseed (Linum usitatissimum) mousse].

Taguchi method was applied to determine the maximum sensory quality of a functional flaxseed mousse desert ready to mix by minimizing the deviation from the target value. An orthogonal array (OA) experimental design that allows to analize simultaneously the influence of four independent variables (thermic process; carrageen/gelatine ratio; grated cocconut/cocconut flavour ratio; whipping time) with three tolerance level each was applied to evaluate the effects of these control factors. Performance measure analysis were carried out using standard analysis to calculate average effects of factor levels and variance analysis, in order to determine the optimum levels and significant contribution of the control factors. To determine the optimum conditions, Taguchi's "the large the better" formula was used. These turn out to be thermic process, 95 degrees C/90s; carrageen/gelatine, 0.54g/ 1.07g; grated cocconut/ cocconut flavour, 10.7g/4.23g; whipping time, 8 min. Sensory quality was determined using the composite scoring test and a trained sensory panel of 12 judges. Chemical composition of optimized flaxseed mousse turn out to be protein, 20%; total dietary fibre, 18%; carbohydrates, 26.7%. Omega 6/omega 3 ratio of 0.4 was considered good. Amount of flaxseed in optimized flaxseed mousse was enough to satisfy the 30% of recommended dietary allowance of linolénic acid. Shelf life data showed a good stability for this product as well a good consumer acceptability.

Adolescent↗