24-hour Intake Research Articles

Evaluation of 24-hour nutrition intake in indoor hockey student-athletes

Evaluation of 24-hour nutrition intake in indoor hockey student-athletes

Abstract P310: Subclinical primary aldosteronism is associated with an increased risk of major adverse cardiovascular events

Background: Subclinical primary aldosteronism (PA), defined as renin-independent aldosterone production without overt PA, has recently been associated with adverse cardiac remodelling, unfavorable indices of arterial stiffness and incident hypertension. The objective of this study was to evaluate whether subclinical PA is linked to an increased risk of cardiovascular events. Methods: This study used data from CARTaGENE, a populational cohort of randomly selected individuals aged 40-69 years, with prospective outcomes data obtained from linkage with governmental administrative databases. The outcome of interest was major adverse cardiovascular events (MACE), a composite of cardiovascular death, myocardial infarction, stroke and heart failure, assessed from enrollment (2009-2010) to March 2021. All individuals with available plasma renin and aldosterone measurements, outcomes data and nutritional assessment were included in this study. Cox regression models were used to test the associated between MACE and the log-transformed aldosterone-to-renin ratio (ARR), with adjustments for sex, age, height, weight, race, diabetes, prior cardiovascular disease, smoking status, systolic BP, heart rate, estimated glomerular filtration rate, sodium and potassium levels, LDL- and total-cholesterol, antihypertensive drugs (listed as individual classes), statin and aspirin use, and 24-hour nutritional intake of sodium and potassium. Multiple imputation was used for missing data. Results: In 2,055 participants with available data (45.5% female, mean age 55.6 years, 6.6% diabetes, 2.9% prior cardiovascular disease, mean baseline systolic BP 128.5 mmHg), 58 MACEs occurred over a median follow-up of 10.8 years (IQR 10.6-11.0). In the Cox regression analysis, the log-transformed ARR was predictive of MACE with a hazard ratio (HR) of 2.86 (95% CI 1.34 to 6.10, p=0.007). Results were similar when participants taking any anti-hypertensive drug were excluded (HR 3.05, 95% CI 1.38 to 6.71, p=0.006). Conclusion: In a representative sample of the general population, a higher ARR appears to be highly predictive of adverse cardiovascular events. This indicates that subclinical PA could be an important and yet unrecognized risk factor for cardiovascular diseases, and may warrant screening in a broader population.

Use of Bioimpedance Spectroscopy for Postoperative Fluid Management in Patients Undergoing Cardiac Surgery with Cardiopulmonary Bypass

ObjectiveTo assess whether bioimpedance spectroscopy analysis (BIA) can be used as a potential tool to guide postoperative fluid management in patients who undergo cardiac surgery. DesignAn observational study. SettingA single, tertiary hospital. ParticipantsPatients who underwent cardiac surgery with cardiopulmonary bypass between June to November 2023 who were able to undergo BIA measurements. InterventionsNone. Measurements and Main ResultsCorrelations between BIA measurements of extracellular fluid (ECF) and total body water (TBW) volumes and daily changes in weight and 24-hour net intake and output (I/O) of fluids were assessed. Correlations between pre-discharge ECF volume as a percentage of TBW volume (ECF%TBW) and pre-discharge Pro-BNP (Pro-BNP) levels and readmissions were analyzed. Changes in daily ECF volume significantly correlated with daily weight changes (p<0.01) and 24-hr I/O (p<0.01). TBW volume significantly correlated with daily weight changes (p<0.01) and with 24-hr I/O (p=0.04). Daily weight changes did not correlate with 24-hr I/O (p=0.06). The patients with pre-discharge ECF%TBW(%) greater than or equal to 51 had significantly higher pre-discharge Pro-BNP than those with ECF%TBW(%) less than 51 (p<0.01). Patients who had heart failure revisits or admissions after discharge had a higher pre-discharge ECF%TBW(%) on index admission compared to patients that did not have heart failure readmissions (p=0.01). ConclusionsUtilization of BIA measurements in postoperative cardiac surgery patients may be a valuable tool to quantitatively determine fluid status to help guide fluid management in this patient population. Further studies validating the use of BIA for postoperative care in this population are warranted.

Effects of Local Wound Infiltration Post-Mastectomy Using Bupivacaine Alone, Bupivacaine With Ketamine, and Bupivacaine With Dexmedetomidine: A Randomized Double-Blind Study.

Background and aim While the infiltration of surgical incisions with local anesthetics is not a new practice, it remains a crucial component of contemporary multimodal analgesia protocols. This study aimed to evaluate the efficacy and safety of using adjuvants in combination with local anesthetic wound infiltration for pain management in patients undergoing mastectomy surgery. Methods Eighty-one patients aged 18-60 years, classified as American Society of Anesthesiologists (ASA) grade I or II, were scheduled for unilateral mastectomy and randomly assigned to three groups of 27 each. The groups were designated as Group C (bupivacaine alone), Group D (bupivacaine with dexmedetomidine), and Group K (bupivacaine with ketamine). Group C received 0.25% bupivacaine alone, Group D received 0.25% bupivacaine with 1 mcg/kg dexmedetomidine, and Group K received 0.25% bupivacaine with 1 mg/kg ketamine. The time to achieve a Visual Analogue Scale (VAS) score of 3 following local wound infiltration was recorded for each group. Additionally, total postoperative fentanyl intake during the first 24 hours, as measured by the patient-controlled analgesia (PCA) pump, was compared among the groups. Sedation levels were assessed using the Ramsay Sedation Scale (RSS). Data were analyzed using the Chi-Square test and one-way ANOVA in IBM SPSS Statistics for Windows, Version 28.0 (Released 2021; IBM Corp., Armonk, NY, USA). Results Demographic factors were similar across the three groups. Analysis of the VAS scores revealed that the ketamine group provided better postoperative pain control than the dexmedetomidine group (p < 0.001). Groups D (71.72 ± 71.73) and K (3.53 ± 13.42) had significantly lower 24-hour fentanyl intake (in mcg) compared to Group C (the control group), as measured by PCA. Additionally, Group C had a significantly lower RSS at the sixth hour (p = 0.003) compared to both Groups D and K. Conclusion Ketamine, when used as an adjuvant to bupivacaine for local infiltration, enhances the effectiveness and prolongs postoperative analgesia more effectively than dexmedetomidine in patients undergoing mastectomy.

Are People Consuming the Diets They Say They Are? Self-Reported vs Estimated Adherence to Low-Carbohydrate and Low-Fat Diets: National Health and Nutrition Examination Survey, 2007-2018

BackgroundMischaracterization of dietary intake by patients and study participants is a common problem that presents challenges to clinical and public health approaches to improve diet quality, identify healthy eating patterns, and reduce the risk of chronic disease. ObjectiveThis study examined participants’ self-reported adherence to low-carbohydrate and low-fat diets compared with their estimated adherence using up to 2 24-hour recalls. DesignThis cross-sectional study acquired data on dietary intake from respondents in the National Health and Nutrition Examination Survey, 2007-2018. Participants/settingThis study included 30 219 respondents aged 20 years and older who had complete and reliable dietary data and were not pregnant or breastfeeding. Main outcome measuresThe main outcome was prevalence of self-reported and estimated adherence to low-carbohydrate or low-fat diet patterns. Statistical analyses performedSelf-reported adherence to low-carbohydrate or low-fat diets was evaluated using responses to questionnaires. Estimated adherence to these diets was assessed using data from up to 2 24-hour recalls and usual intake methodology developed by the National Cancer Institute. ResultsOf the 1.4% of participants who reported following a low-carbohydrate diet, estimated adherence (<26% energy from carbohydrates) using 24-hour recalls was 4.1%, whereas estimated adherence among those that did not report following a low-carbohydrate diet was <1% (P value for difference = .014). Of the 2.0% of participants who reported following a low-fat diet, estimated adherence (<30% energy from fat) was 23.0%, whereas estimated adherence among those who did not report following a low-fat diet was 17.8% (P value for difference = .048). ConclusionsThis research demonstrates that most individuals mischaracterized their diet pattern when compared with up to 2 24-hour recalls. These findings emphasize the need for clinicians and public health professionals to be cautious when interpreting individuals’ self-reported diet patterns, and should aim to collect more detailed dietary data when possible.

Salt and sugar intakes of adults in the central division of Fiji: findings from a nutrition survey in 2022

BackgroundExcess salt and sugar consumption contribute to diseases, such as diabetes and hypertension. This study aimed to estimate salt and sugar intakes and main sources, in a population of adults in the Central Division of Fiji. MethodsOne adult per household was randomly selected to participate (n=700). Sociodemographic characteristics; blood pressure, weight, and height; a 24-hour diet recall; and spot-urine samples were collected, with 24-hour urine samples from a sub-sample (n=200). Sugar intake was estimated from the 24-hour diet recalls and salt intake from the spot-urines. 24-hr diet recall was used to identify main sources of salt and sugar by food groups. Findings534 adults (response rate 76%, 50% women, mean age 42 years) participated. Salt intake was 8.8 g/day (95% CI, 8·7 to 9·0), and free sugar intake was 74.1 g/day (67·5 to 80·7), 16.1% of total energy intake (15.0 to 17·1%). Main sources of salt were mixed cooked dishes (40·9% (38·2 to 43·5)), and bread and bakery products (28·7% (26·5 to 31·0)). Main sources of sugar were table sugars, honey, and related products (24.3% (21·7 to 26·8)), non-alcoholic beverages (21·4% (18·8 to 24·0)) and bread and bakery products (18·0% (16·2 to 19·9)). InterpretationSalt and sugar intakes exceeded World Health Organization recommendations in this sample of adults. Given dietary sources were foods high in salt and sugar, along with the addition to food or drinks, interventions focused on behavior along with environmental strategies to encourage healthier choices are needed. FundingNHMRC and GACD grant APP1169322.

The effects of renal dopaminergic system on the development of hypertension with high salt diet and L-NNA administration

Objective: We aimed to investigate the intrarenal dopamine synthesis efficiency, blood pressure changes and the effects of this system on hypertension developed by NOS inhibition and high salt diet. Method: Wistar Albino male rats were administered water containing 50mg/L or 100mg/L concentrations of L-NNA, standard rat feed containing 0.8%salt, or 4%high salt alone or with L-NNA for 7days. Blood pressure measurements were made with the tail-cuff method. 24-hour water intake and urine volume were also measured. Results: Administration of L-NNA or high-salt diet alone for 7days did not cause a change in blood pressure, while their combined administration resulted in a significant increase in blood pressure. Blood pressures were found to be higher in the L-NNA100+HS group compared to the other groups. While the amount of water intake in 24hours did not change, the amount of 24-hour urine was reduced. 24-hour urinary sodium excretion, sodium clearance and GFR was decreased, and 24-hour urine dopamine concentrations were increased. Conclusion: Co-administration of nitric-oxide inhibitor and high-salt diet failed to prevent renal dopaminergic system blood pressure increase. Despite the increase in dopamine synthesis, intrarenal dopamine activity could not be realized by receptor interaction and it is thought that the increase in blood pressure is caused by the development of renal oxidative stress.

Daily ingestion of protein bars (with or without added fiber) increased energy intake and body fat mass after one week in healthy adults: A crossover trial

BackgroundAlthough the global protein bar market is rapidly escalating, there is a scarcity of controlled trials examining their dietary impact. This cross-over study examined the impact of protein bar ingestion (with or without added fibre) on energy intake. MethodsAdults (n = 21; 21.9 ± 2.6 y) recorded food and beverage consumption using a smartphone application and appetite ratings using 100-mm VAS scales. Body composition was recorded at baseline and following each one-week feeding phase. ResultsAverage 24-hour energy intakes during the weeks bars were consumed were elevated significantly (7–13%) from control weeks with no difference between bars. Postprandial appetite scores were significantly below fasting scores but did not differ between bars. Body fat mass was significantly elevated (+3%) at the end of each feeding period compared to the control week. ConclusionThese results suggest that the daily ingestion of protein bars increased overall energy intakes and may impact body mass over time.

COMPARISON OF PROLONGATION OF ANALGESIA AND CONSUMPTION OF OPIOIDS IN PATIENTS GIVEN SAB WITH LOCAL ANESTHESIA ALONE VERSUS WITH TRAMADOL AS ADJUVANT THERAPY UNDERGOING LOWER LIMB SURGERY

The purpose of this study was to determine whether or not adding intrathecal tramadol to bupivacaine for lower limb procedures increased the duration of analgesia and decreased the mean post-operative opioid intake. This research was carried out between June 1 and November 30, 2022, in the Department of Anaesthesiology at Aziz Bhatti Shaheed Teaching Hospital in Gujrat, Pakistan. Non-probabilistic sequential sampling was used to pick the patients. One hundred patients from the ASA I, II, and III categories who met the inclusion criteria and were scheduled for lower limb surgery were randomly assigned to one of two groups. The tramadol-bupivacaine group (T) was given 15 milligrams of tramadol and 10 milligrams of bupivacaine (0.5 percent). In comparison, the bupivacaine-alone group (B) was given 1 milliliter of saline and 10 milligrams of bupivacaine (0.5 percent). The duration of analgesia was recorded by tracking the time until the patient first asked for pain medication. The average amount of opioid analgesia taken by both groups in the first 24 hours after surgery was also compared. SPSS version 22 was used for the data analysis. Anesthesia lasted much longer, 174.26 ± 15.21 minutes in the tramadol group, compared to 132.5 ± 14.48 minutes in the bupivacaine group. (p = 0.006). As expected, there was a significant (p 0.001) reduction in 24-hour opioid intake (308.2 ± 23.8) in group T compared to group B (470.5 ±36.2mg). This research confirmed that intrathecal tramadol (15mg) could be safely used with bupivacaine in subarachnoid blocking to increase the duration of analgesia and reduce the need for opioids in the post-operative period following lower limb procedures.

S-54-5: CHANGES IN ESTIMATED SALT AND POTASSIUM INTAKE AND SODIUM-TO-POTASSIUM RATIO USING SPOT URINE MEASUREMENTS: A 10-YEAR FOLLOW-UP OF NIPPON DATA2010

Background: Reducing dietary salt (sodium) intake and increasing potassium intake and sodium to potassium ratio (Na/K) are crucial in preventing hypertension. However, these changes by aging have not yet been evaluated in Japanese general population. Methods: NIPPON DATA2010 is a cohort study in the participants of the National Health and Nutrition Survey of Japan in 2010, we assessed changes in dietary sodium and potassium intake from 2010 to 2020 using spot urine. Of 2,732 participants in the 2010 survey, 667 participants (mean age 54.8 ± 8.2 years, women 59.1%) underwent spot urine measurements in both 2010 and 2020 survey. Using Tanaka formula, we estimated 24-hour salt intake (g/day) and potassium excretion (mg/day), and calculated sodium to potassium (Na/K) ratio (mmol/mmol) in spot urine for each participant. We assessed these changes from 2010 to 2020 by sex and age groups. Results: Change in estimated 24-hour salt intake from 2010 to 2020 was not a statistically significant in all groups (see table). Only estimated 24-hour potassium excretion showed a statistically significant increase in women and men ≧60 years, and the change showed a tendency towards statistical significance in men &lt; 60 years. Na/K ratio was significantly reduced in women and men ≧60 years, not in men &lt; 60 years. Conclusions: Potassium intake increased and dietary Na/K ratio decreased by 10-year aging in Japanese men and women, except for relatively younger men.

Does preventive single dose of intravenous dexketoprofen reduce pain and swelling after orthognathic surgery? A prospective, randomized, double blind clinical trial.

The purpose of this study was to evaluate the effect of a single-dose intravenous dexketoprofen administration for preventive analgesia on postoperative pain and reducing swelling in double jaw surgery. The authors designed a prospective, randomized, and double-blind cohort study. Patients who have Class III malocclusion were randomly divided in two groups. 50 mg intravenous dexketoprofen trometamol were administrated 30 minutes before incision in treatment group, while intravenous sterile saline was administrated 30 minutes before incision in placebo group. The primary predictor variable was treatment group. Primary outcomes were pain, swelling and 24-hour opioid intake. Patient- controlled analgesia with tramadol was given for management of postoperative pain. Other variables were demographic and operation related parameters. Visual analogue scale was used to evaluate postoperative pain. 3dMD Face System (3dMD, USA) was used to measure postoperative swelling. Data were analysed using two independent samples t test and Mann Whitney U test. The study sample was composed of 30 patients with a mean age of 20,63 years and 21 were female. Preemptive dexketoprofen administration decreased postoperative tramadol consumption by 25.9% compared to placebo group, and there was a statistically significant decrease in VAS scores (p<0,05). There was no statistically significant difference between the groups in terms of swelling (p>0,05). Preventive administration of intravenous dexketoprofen provides adequate analgesic effect in the postoperative 24-hour period and reduces opioid consumption in orthognathic surgery.

Effects of relaxation therapy on maternal psychological status and infant growth following late preterm and early-term delivery: a randomized controlled trial

BackgroundMaternal stress is one modifiable variable that could influence mother–infant signaling and negatively affect breastfeeding and infant growth. ObjectivesThis study aimed to test the hypothesis that relaxation therapy would reduce maternal stress and improve infant growth, behavior, and breastfeeding outcomes after late preterm (LP) and early-term (ET) delivery. MethodsA single-blind randomized controlled trial was conducted in healthy Chinese primiparous mother–infant pairs after LP or ET delivery (34+0–37+6 gestation weeks). Mothers were randomly assigned to the intervention group (IG, listening to relaxation meditation at least once a day) or control group (CG, normal care). Primary outcomes—changes in maternal stress (perceived stress scale), anxiety (Beck Anxiety Inventory), and infant weight and length standard deviation score—were assessed at 1 wk and 8 wks postpartum. Secondary outcomes—breast milk energy and macronutrient composition, maternal breastfeeding attitudes, infant behaviors (3-d diary), and 24-hour milk intake—were assessed at 8 wks. ResultsIn total, 96 mother–infant pairs were recruited. There was a significantly greater reduction in maternal perceived stress (Perceived Stress Scale score) (mean difference [MD] = 2.65; 95% CI: 0.8, 4.5) and significantly greater infant weight standard deviation score gain (MD = 0.51; 95% CI: 0.2, 0.9) from 1 wk to 8 wks in the IG than those in the CG. Exploratory analyses showed a significant interaction between intervention and sex, with greater effects on weight gain in female infants. Mothers of female infants used the intervention more frequently with significantly higher milk energy observed at 8 wks. ConclusionsThe relaxation meditation tape is a simple, effective practical tool that could easily be used in clinical settings to support breastfeeding mothers after LP and ET delivery. The findings need confirmation in larger groups and in other populations.

PATIENT PERCEPTIONS OF USING VOICE-BASED DIETARY ASSESSMENT TOOLS AMONG OLDER ADULTS

Abstract Poor diet among older adults is a risk factor for developing multiple chronic diseases. Dietary recall comprises an important component in intervention research and clinical care. Commonly used tools include the web-based automated self-administered 24-hour assessment (ASA-24). Yet voice assistant (VAS) systems (i.e., Amazon Alexa) have not been developed for this purpose. Hence, we evaluated patient perceptions on performing a VAS-based dietary assessment among older adults. Community-dwelling adults (age 65+ years) participated in two virtual sessions who reported their past 24-hour intake, first using ASA-24, and then using a VAS. All completed a Likert questionnaire (binary, % strongly agree/strongly disagree reported) regarding the simplicity of using both systems, completion time, and user satisfaction. Semi-structured interviews allowed us to ask about technology use. Of the 40 participants (100% enrolled), mean age was 69±1.0 years (85% female, 100% white, 5% Latinx). Only 40% owned a VAS; 60% reported having VAS experience prior to the study. After completing both sessions, 80% preferred a VAS over the ASA-24. Participants reported that web-based recalls were unnecessarily complex (60%), time-consuming (50%), and 60% did not wish to use them. Comparatively, VAS recalls were intuitive (75%), easily reportable (85%), and there was willingness to report food while preparing meals (85%). In 16 participants, we evaluated themes of VAS use including easier navigation, less time, and ability to have a natural conversation. A VAS provides a more convenient, conversational, and computerless interaction to report meals over web-based solutions suggesting they hold promise for dietary recall in older adults.

Daily consumption of monosodium glutamate pronounced hypertension and altered renal excretory function in normotensive and hypertensive rats

This study aimed to investigate the effects of monosodium glutamate (MSG) on the levels of arterial blood pressure (ABP) and renal excretory function. Male Wistar rats were divided into 2 groups (n = 24 each) namely sham operation (SO) and 2-kidneys-1-clip (2K1C) to develop the normotensive and hypertensive model, respectively. Four weeks after the operation, each group of rats were further divided into 4 subgroups (n = 6 each) which were orally administered of either distilled water or MSG at the doses of 80, 160, or 320 mg/kg BW/day once a day for 8 weeks. The body weight, the 24-hour water intake, and the 24-hour urine output were recorded weekly. Then, each rat was anesthetized and the ABP was measured via carotid artery. The renal excretory function was examined by using the clearance technique to measure the levels of the glomerular filtration rate and the renal blood flow. The levels of serum malondialdehyde (MDA) as a marker of oxidative stress were analyzed. The expression of tumor necrosis factor alpha (TNF-α) in the kidneys was also investigated using immunohistochemistry. It was found that all doses of MSG significantly increased the ABP in both SO and 2K1C groups. All doses of MSG significantly increased the serum MDA levels and the expression of TNF-α in the kidneys of the SO groups. Long-term intake of 320 mg/kg BW MSG significantly decreased the renal excretion of salt and water in both SO and 2K1C groups. As a whole, this study demonstrated that MSG consumption contributed to an increase in oxidative stress which could lead to alterations in the cardiovascular and renal function.

Association between drinking water arsenic and urinary inorganic arsenic in the US: NHANES 2003-2014

BACKGROUND AND AIM: Important inequalities exist in arsenic (As) in drinking water across US populations. A critical research gap is how water As corresponds to internal dose, measured by urinary biomarkers. We evaluated the association between assigned private well and regulated community water system (CWS) As and urinary As concentrations in the National Health and Nutrition Examination Survey (NHANES). METHODS: We assigned 13,163 NHANES 2003-2014 participants county-level population- weighted CWS concentrations (µg/L) and private well estimates (probability &amp;#x3e;10 µg/L) using published nationwide estimates from US Environmental Protection Agency and US Geological Survey datasets, respectively. The internal dose of inorganic As related to drinking water was estimated by recalibrating urine dimethylarsinate (DMA) concentrations to adjust for arsenobetaine, seafood, smoking status, and past 24-hour intake of rice and other dietary sources. We evaluated geometric mean ratios (GMRs) of DMA across tertiles of water As, the lowest tertile as reference, for all participants and stratified by census region and quartile of geologic risk of elevated water As. RESULTS: Among CWS users, participants in the highest tertile of CWS As had significantly higher DMA overall (GMR= 1.17, 95% CI 1.09, 1.26) and in the South (GMR =1.23, 95% CI 1.09, 1.38), compared to participants in the lowest tertile. Among private well users, participants in the highest tertile of private well As had significantly higher DMA overall (GMR = 1.23, 95% CI 1.01, 1.50) and in the West (GMR = 1.34, 95% CI 1.18, 1.53). CONCLUSIONS: Arsenic in private wells and CWSs contributes to As exposure, measured in urine, in general US populations. Water As and urine DMA were more strongly associated among private-well users compared to CWS users nationwide, with differences by region. Positive associations were also observed among CWS users in the highest two quartiles of geologic risk. KEYWORDS: arsenic, exposure, water quality

Performance of equations for estimation of 24-hour urinary sodium from morning fasting urine samples in a multisite study in India.

Background Dietary salt intake is an important modifiable risk factor for cardiovascular diseases. Estimation of 24-hour salt intake using morning urine samples needs to be validated in the Indian context. We examined the performance of INTERSALT, Tanaka and Kawasaki equations for the estimation of 24-hour urinary sodium from morning fasting urine (MFU) samples. Methods We enrolled 486 adults aged 18-69 years from four regions of India with equal rural/urban and sex representation to provide 24-hour urine samples. The next day, a MFU sample was obtained. Based on the volume and sodium content of the 24-hour urine sample, 24-hour sodium excretion (reference method) was calculated. Sodium levels in the MFU samples were measured along with other parameters required, and the above equations were used to estimate 24-hour urinary sodium levels. Intraclass correlation coefficient (ICC) was used to assess the degree of agreement between the estimates from the reference method and the three equations. Bland-Altman (BA) plots were used to identify systematic bias and limits of agreement. A difference of 1 g of salt (0.39 g of sodium) between the mean salt intake by 24-hour urine and as estimated by equations was considered acceptable. Results A total of 346 participants provided both the samples. The mean (SD) daily salt intake estimated by the 24-hour urine sample method was 9.9 (5.8) g. ICC was low for all the three equations: highest for Kawasaki (0.16; 95% CI 0.05-0.26) and least for Tanaka (0.12; 0.02-0.22). Only Tanaka equation provided estimates within 1 g of measured 24-hour salt intake (-0.36 g). BA plots showed that as the mean values increased, all the three equations provided lower estimates of salt intake. Conclusion Tanaka equation provided acceptable values of 24-hour salt intake at the population level. However, poor performance of all the equations highlights the need to understand the reasons and develop better methods for the measurement of sodium intake at the population level.

Abstract P3027: Intermittent Fasting Improves High Fat Diet Mediated Heart Failure With Preserved Ejection Fraction

Intermittent fasting (IF) has improved metabolic aberrations in metabolic diseases, however, the mechanism is unclear. Our lab focuses on 4-hydroxy-2-nonenal (4HNE), an oxidative stress byproduct which accumulates in metabolic diseases, in cardiac damage and activity of aldehyde dehydrogenase 2 (ALDH2), a 4HNE detoxifying enzyme, which was implicated in cardioprotection. We reported that the ALDH2*2 knock-in mutant mice (AL) with low intrinsic ALDH2 activity that were fed with high-fat diet (HFD) exhibited severe heart failure with preserved ejection fraction (HFpEF) compared to HFD fed control mice (C57). We hypothesized that IF can contribute to the improvement of HFpEF even in AL mice by reducing 4HNE. C57 and AL mice that were fed HFD and L-NAME (nitric oxide inhibitor) in drinking water were grouped as C57-free and AL-free meaning taking food freely or C57-IF and AL-IF meaning daily 16 hours fasting with 8-hr free access to food. After 2-months of HFD feeding, the body weights of C57-IF (35.5±3.8g) and AL-IF (36.7±3.4g) groups were significantly lower than C57-free (43.5±4.2g, p&lt;0.05 vs C57-IF) and AL-free (45.8±5.6g, p&lt;0.05 vs AL-IF) groups. The 24-hour food intakes of C57-IF (8.6±0.9 KCal) and AL-IF (8.8±1.1 KCal) were significantly decreased, compared to C57-free (12.3±1.7 KCal, p&lt;0.05 vs C57-IF) and AL-free (13.3±1.5 KCal, p&lt;0.05 vs AL-IF) groups. The respiratory exchange ratio (RER) of AL-free group (0.62±0.12) was significantly lower than three other groups (p&lt;0.05 vs C57-free, C57-IF and AL-IF, respectively). The E/A ratio (E/A), a diastolic parameter, was decreased in C57-free (1.14±0.21) and AL-free (0.89±0.17) groups, not in C57-IF (2.15±0.31, p&lt;0.05 vs C57-free) and AL-IF (1.97±0.25, p&lt;0.05 vs AL-free) groups. The E/A in AL-free group was also lower than C57-free group (p&lt;0.05). Another diastolic parameter, isovolumic relaxation time (IVRT) was also prolonged in C57-free (27.3±3.3 ms) and AL-free (29.4±3.7 ms) mice, not in C57-IF (13.3±1.8 ms, p&lt;0.05 vs C57-free) and AL-IF (15.2±2.1 ms, p&lt;0.5 vs AL-free) mice. In conclusion, IF decreased food intake and obesity, and improved metabolism and heart function in both C57 and ALDH2*2 mice with HFpEF, and also diminished the differences in RER and E/A between them via lowering the 4HNE adducts.

THE VALUE OF MULTIPLE 24-HOUR URINE SAMPLES FOR ESTIMATING SODIUM INTAKE

Objective: A single 24-hour urine collection is frequently used to estimate daily sodium intake. Long-term balance studies, however, observed large discrepancies between 24-hour sodium intake and sodium excretion. In a controlled setting with stable sodium intake, the use of up to 7 consecutive 24-hour urine samples has been shown to increase the accuracy of sodium intake estimates. The value of multiple 24-hour urine collections for estimation of sodium intake has not been investigated in the clinical setting with uncontrolled intake, use of natriuretic medication and comorbidities that may affect sodium excretion. Design and method: In a retrospective cohort study, we included adult subjects who collected an outpatient 24-hour urine sample between 1998 and 2000, and had collected at least 6 additional 24-hour urine collections during follow-up. Mean sodium excretion was calculated for 2, 3, 4, 5, 6, and 7 consecutive 24-hour urine collections. We calculated the absolute change in 24-hour urine sodium excretion with each added urine sample. We considered a 0.4-gram change in sodium (1 gram salt) intake clinically relevant. Results: We included 316 subjects with an average age of 44 years, and 46% were male. 50% of the subjects had a history of hypertension, 30% had diabetes and 9% had a history with a cardiovascular event. Diuretics were used by 22% of the subjects and 44% used ennin-angiotensin-aldosterone system inhibitors. The median follow-up period was 16.4 years. The median time to collection of 7 urine samples was 2.5 years (IQR 1.3–4.8). Mean sodium excretion was 159 mmol/day (SD 62). With addition of a second 24-hour urine sample, individual estimated sodium intake changed with 0.43 gram sodium (IQR 0.17–0.90) and changed &gt; 0.4 gram in 52% of the subjects. When a fifth or seventh collection was added, estimated sodium intake changed &gt; 0.4 gram in 14% and 7% of our cohort (Figure). Conclusions: Collection of multiple 24-hour urine samples substantially changes estimated individual sodium intake in the clinical setting. The added value of collecting &gt; 5 24-hour urine samples is limited and changes sodium intake estimations only in 14% of the subjects.

8 Less Is More: Reconsidering Hourly Urine Output Goals in Burn Resuscitation

IntroductionSignificant morbidity and mortality is seen with high volume burn resuscitations. Surpassing the Ivy Index, defined as 250 milliliters/kilogram (ml/kg), has been correlated with increased incidence of complications such as abdominal compartment syndrome. Cognizance of factors contributing to over-resuscitation can help optimize fluid administration strategies to minimize associated morbidity.MethodsA single-center Quality Improvement review was performed of all adult (age ≧ 18 years) burn-injured patients presenting to a major metropolitan burn center with burns ≧ 20% total body surface area (TBSA) between 12/2020-8/2021. Those not surviving the first 24 hours were excluded. Patient demographics and injury characteristics were collected, and resuscitation volumes and timing were recorded prospectively. Patients were categorized by whether their initial 24-hour intake exceeded their Ivy Index, and groups were compared to assess factors associated with over-resuscitation.ResultsDuring the study period 11 patients met inclusion criteria, and one early mortality was excluded. Patients were predominantly male (70.0%), with mean age 49.9±17.4 years. Burns were primarily due to flame injury, with mean TBSA 41.4±18.6%. Patients required resuscitation volumes of 5.9±1.7 ml/kg/TBSA%, with half surpassing their Ivy Index in the first 24 hours. These patients had larger burns (55.1±17.0% v. 27.7±5.1%) with a significantly higher third degree component (41.4±15.8% v. 15.4±15.2%, p = 0.029). None had diagnosed inhalation injury, and none required abdominal decompression for resuscitation-related compartment syndrome. Observed mortality rate was 30.0%. Patients resuscitating beyond their Ivy Index had significantly higher hourly urine output rates (0.96 v. 0.52 ml/kg, p = 0.024), and hourly urine output was significantly higher among non-survivors as compared to survivors (1.10 v. 0.60 ml/kg, p = 0.033).ConclusionsPatients with severe burn injury are at high risk for over-resuscitation and associated complications. While traditional teaching instructs a goal of hourly urine output of 0.5-1.0 ml/kg, our study shows that patients resuscitated on the higher end of this range were significantly more likely to surpass their Ivy Index and less likely to survive.

Breast Milk Production in Women Who Use Nipple Shields for Persistent Nipple Pain

ObjectiveTo examine relationships between nipple pain scores and 24-hour milk production volumes, breastfeeding and pumping frequencies, and breastfeeding duration in women using nipple shields for persistent nipple pain. DesignSecondary outcome analysis of a prospective cohort study. SettingResearch laboratory and participants’ homes. ParticipantsTwenty-five breastfeeding women (6 ± 4 weeks after birth) who used nipple shields for persistent nipple pain. MethodsWe conducted a randomized trial to investigate the primary outcome of milk transfer with and without nipple shields among participants with and without nipple pain. Here, we report secondary outcomes of associations between 24-hour milk production, breastfeeding and pumping frequencies, breastfeeding durations, and intake in participants using a nipple shield for nipple pain. Participants completed demographic, health and breastfeeding questionnaires and, at two monitored breastfeeding sessions, completed a pain visual analogue scale and Brief Pain Inventory–Short Form (BPI-SF; total and subscale scores for pain interference with General Activity, Mood, Sleep, and Breastfeeding). Milk production (milliliters per 24 hours), feed volumes, and percentage of available milk removed were calculated from data and milk samples obtained by participants over one 24-hour period and at study visits. Participants logged 24-hour data on a customized research website. We used descriptive statistics as well as simple and multiple linear regression for analyses. ResultsMilk production and feeding duration were not associated with nipple pain scores (visual analogue scale: p = .80, BPI-SF: p = .44). An increase in BPI-SF Breastfeeding subscale score of 1 unit, indicating pain interference with breastfeeding, was associated with a 0.28 decrease in 24-hour breastfeeding frequency (p = .02) and an 18.8-ml decrease in 24-hour breastfeeding intake (p = .04). ConclusionPersistent nipple pain was associated with reduced breastfeeding frequency; therefore, continuing professional support is required to ensure adequate milk removal and pain management.