Actual Protein Intake Research Articles

The Importance of Dietary Protein Quality in Mid- to High-Income Countries

In wealthy countries, the protein intake of adults is usually considered to be adequate, and considerations of protein quality are often deemed irrelevant. The objective was to examine dietary protein intakes of adults in developed countries in the context of dietary protein quality. An analysis of NHANES population data on actual protein intakes in the United States (a developed country) demonstrated that for a dietary Digestible Indispensable Amino Acid Score (DIAAS) of 100%, 11% of the adult (19–50 y) population had habitual protein intakes below the Estimated Average Requirement (EAR) and 22% below the Recommended Dietary Allowance. The percentage of the population with utilizable protein intakes potentially falling below the EAR increased as the assumed DIAAS declined. Analysis of the NHANES data and several other datasets also indicated that total protein intakes can be limiting or close to limiting for the elderly and some vegetarians and vegans. Here, lower dietary protein quality can potentially lead to inadequate utilizable protein intakes. For many people in specific physiological states (e.g., weight loss, endurance sports, resistance exercise) attempting to meet higher dietary protein targets often with accompanying lowered energy intakes, low dietary protein quality can lead to protein calories expressed as a proportion of total calories, falling outside what may be acceptable limits (maximum of 30% protein calories from total calories). In general, individuals within the adult population may be susceptible to macronutrient imbalance (whenever total protein intakes are high, daily energy intakes low) and for diets with lower protein quality (DIAAS <100%). Our analysis shows that dietary protein quality is relevant in mid- to high-income countries.

Natural Protein Intake in Children with Phenylketonuria: Prescription vs. Actual Intakes

In phenylketonuria (PKU), an important component of the UK dietary management system is a 50 mg phenylalanine (Phe)/1 g protein exchange system used to allocate the Phe/natural protein intakes according to individual patient tolerance. Any foods containing protein ≤ 0.5 g/100 g or fruits/vegetables containing Phe ≤ 75 mg/100 g are allowed without measurement or limit. In children with PKU, we aimed to assess the difference between the prescribed natural protein intake and their actual consumed intake, and to calculate the natural protein/Phe intake from foods given without measurement or restriction. Over a 6-month duration, three one-day diet diaries were collected every month by caregivers of children with PKU at the beginning of a follow-up study. Dietary intakes of Phe, as well as natural and total protein intakes, were calculated using Nutritics® (v5.09). Weekly blood Phe spots were collected by caregivers. The target blood Phe level was ≤360 μmol/L for ages up to 12 years and ≤600 μmol/L for ages ≥12 years. Sixteen early treated children (69% females) with PKU were recruited. The median age was 11 years (range: 9–13), and most had classical PKU (n = 14/16). A median of 18 (range 12–18) one-day diaries and 22 blood spots were analysed for each subject over 6 months. The median prescribed natural protein was 6 g/day (range: 3–27), but when calculated, the actual median intake from all foods consumed was 10 g/day (range: 4–37). The median prescribed Phe was 300 mg/day (range: 150–1350), but the actual median intake was 500 mg/day (range: 200–1850). The median difference between the prescribed and actual natural protein daily intakes was +4 g/day (range: −2.5 to +11.5), with a median percentage increase of 40% for natural protein/Phe intake (p &lt; 0.001). The median blood Phe level was 250 μmol/L (range 20–750), with 91% of blood Phe levels within the target range. Only one patient (11 years) had less than 75% of their blood Phe levels within the target range. The UK Phe exchange system provides flexibility in the dietary management of PKU. With this method, the actual natural protein intake was 167% higher than the prescribed amount. Although this led to a variable daily protein intake, the majority of children (n = 15/16) experienced no deterioration in their metabolic control.

Effect of early achievement of energy target by different nutritional support strategies on nosocomial infections in patients undergoing major abdominal surgery: a secondary analysis of two randomized clinical trials.

The effect of early achievement of energy targets (EAETs) using different nutritional support strategies in patients undergoing major abdominal surgery is unclear. This study determined the impact of EAETs on the incidence of nosocomial infections in patients undergoing major abdominal surgery. This was a secondary analysis of two open-label randomized clinical trials. Patients from the general surgery department of 11 academic hospitals in China undergoing major abdominal surgery and at nutritional risk (Nutritional risk screening 2002≥3) were divided into two groups based on whether they met the 70% energy targets, the EAET (521 EAET and non-achievement of energy target (114 NAET) groups. The primary outcome was the incidence of nosocomial infections between postoperative day 3 and discharge, and the secondary outcomes were actual energy and protein intake, postoperative noninfectious complications, intensive care unit admission, mechanical ventilation, and hospital stay. Overall, 635 patients [mean (SD) age, 59.5 (11.3) years] were included. The EAET group received more mean energy between days 3 and 7 than the NAET group (22.7±5.0 vs. 15.1±4.8kcal/kg/d; P <0.001). The EAET group had significantly fewer nosocomial infections than the NAET group [46/521(8.8%) vs. 21/114(18.4%); risk difference, 9.6%; 95% CI, 2.1-17.1%; P =0.004]. A significant difference was found in the mean (SD) number of noninfectious complications between the EAET and NAET groups [121/521(23.2%) vs. 38/114(33.3%); risk difference, 10.1%; 95% CI, 0.7-19.5%; P =0.024]. The nutritional status of the EAET group was significantly improved at discharge compared with the NAET group ( P <0.001), and other indicators were comparable between groups. EAETs was associated with fewer nosocomial infections and improved clinical outcomes, regardless of the nutritional support strategy (early enteral nutrition alone or combined with early supplemental parenteral nutrition).

Dietary lipid and protein levels influence the growth and feed utilisation of large yellowtail kingfish (Seriola lalandi) at summer water temperatures

Yellowtail Kingfish (Seriola lalandi; YTK) have a fast growth rate, and as a result, a high energy demand that could be satisfied by dietary lipids. The aim of this experiment was to determine the optimum dietary protein and lipid levels for large YTK maintained during a summer growing season. In this 84-day experiment (2 × 3 factorial design), the growth, feed utilisation and health of YTK (initial weight 2.13 ± 0.02 kg, mean ± SE) fed two nominal lipid levels 25% crude lipid (CL) (20 MJ kg−1 energy) and 30% CL (21 MJ kg−1 energy) and three nominal crude protein (CP) levels (40, 44 and 48%) were investigated. The specific growth rate of fish was significantly affected by the interaction between dietary CP and CL level. The results indicate that fish fed the 25% CL diets grew better than those fed the 30% CL diets. The interaction effect was primarily driven by the significant increase in growth for fish fed diet 1 (40% CP × 25% CL) and diet 2 (44% CP × 25% CL) compared to their respective 30% CL diets, diet 4 (40% CP × 30% CL) and diet 5 (44% CP × 30% CL). The growth of fish fed diet 3 (48% CP × 25% CL) and diet 6 (48% CP× 30% CL) was not significantly different. Feed conversion ratio (FCR) was not significantly influenced by diet however, the fish fed the 25% CL diet series and 40% protein series consumed the most feed. Fish fed the 25% CL series increased their feed intake with decreasing dietary CP level, to potentially compensate for reduced dietary protein. In contrast, fish fed the 30% CL series did not. Crude protein intake was higher when fish were fed the 48% CP diets and was reduced when fed the 40% and 44% CP diets. This response was more pronounced in the 30% CL diet series. There were no negative health effects noted during the study for various analyses including blood biochemistry and haematology, and gastrointestinal tract morphology. Numerically, the highest final weight, biomass gain, SGR, and FCR were consistently observed in the fish fed diet 2, however these were not significantly different to diet 1. Based on the combined results for 2.1–3.5 kg YTK raised during summer, the diet should contain at least 42.9% CP and 25.3% CL (equivalent to diet 2) corresponding to 19.9 MJ kg−1 GE diet with and a CP: GE ratio of 21.6 g MJ−1. In terms of actual protein and energy intake required this corresponds to 5.2 g CP−1 kg BW−1 d−1 (4.5 g DP−1 kg BW−1 d−1) and 242 KJ−1 GE kg BW−1 d−1 (207 KJ−1 DE kg BW−1 d−1) which appears to be optimal. We do not recommend diet lipid levels of approximately 30% over summer periods, as demonstrated in this experiment.

EVALUATING THE IMPACT OF EARLY NUTRITIONAL ASSESSMENT AND INTERVENTION IN HOSPITALIZED LIVER CIRRHOSIS PATIENTS.

Malnutrition is common in liver cirrhosis patients that is correlated with early complications, morbidity and mortality. The purpose of the study was to assess nutritional status, impact of nutritional screening and intervention in liver cirrhosis patients by evaluating their actual energy and protein intake during hospital stay. A cross sectional study was conducted wherein all patients' nutritional status was defined by Subjective Global Assessment tool. Adequate energy and protein supply were planned and executed by using individualized nutritional plan for patients with dietitian's collaboration. Anthropometric measurements included height, weight, body mass index, mid upper arm circumference, hand grip strength and triceps skin-fold thickness. Biochemical tests included haemoglobin, mean corpuscular haemoglobin, volume and concentration, albumin and liver function tests. To record the daily food intake, a 24-hour dietary recall was used. Overall 83 patients (mean age 55) were included, among them 46% of patients were moderately malnourished, 12% were normal, while 42% of cirrhotic patients were severely depleted according to Subjective Global Assessment. The mean intake of calories and protein was improved during stay in hospital after nutritional intervention and critical monitoring (P<0.05). Anthropometric measurements at baseline and discharge showed significant differences (P <0.05) in weight, body mass index, triceps skin fold thickness and mid upper arm circumference values, but not in hand grip strength that was associated with malnourishment among patients. Providing individualized nutritional intervention and its monitoring by qualified dietitians during hospital stay helps to improve intake in patients that prevent further risk of malnutrition and related complications.

Clinical application of protein-enhanced diet using mealworms in patients undergoing hepato-pancreato-biliary surgery

ObjectivePatients with or without cancers who undergo major gastrointestinal surgery experience malnutrition owing to their catabolic status during the postoperative period. In this study, we evaluated the effect of the clinical application of protein-enhanced diet using mealworms in patients who underwent hepato-pancreato-biliary surgeries. MethodsThis study was designed as a prospective, two-armed, and double-blinded phase III study. The target number of enrolled patients was 216, and the patients were randomized on a 1:1 basis, either to the trial group (consuming mealworms) or to the control group (consuming grain powder). The primary endpoint was to examine the changes in body composition, including phase angle. For secondary outcomes, the activities of immune cells were evaluated using the patients’ blood samples. ResultsNo difference in the demographic characteristics of patients was observed. The ratio of the actual protein intake to the recommended daily intake in the trial group was significantly higher than that in the control group (110.03% vs. 98.80%, P = 0.023). In the data on body composition measured by InBody S-10 (Biospace, Seoul, South Korea), the ratios in body cell mass, fat free mass, muscle mass, and phase angle at the study endpoint compared with those at admission showed no statistically significant difference between the two groups. Immune cell analyses suggested that cytotoxic T cells in the trial group had higher activity than in the study group (1.192 vs. 0.974, P = 0.028). ConclusionsIn this study, protein-enhanced diet using mealworms clinically improved the activity of immune cells. However, it did not significantly improve the patients’ nutritional status after they experienced hepato-pancreato-biliary surgeries.

Protein and Energy Intake Assessment and Their Association With In-Hospital Mortality in Critically Ill COVID-19 Patients: A Prospective Cohort Study.

Background and Aim: It is partially known that nutritional intake could alleviate proteolysis and course of disease severity in patients with COVID-19; however, not enough data are available in this regard. The present study aimed to assess protein and energy intake and their association with in-hospital mortality in critically ill COVID-19 patients.Methods: A total of 126 patients with COVID-19, who were critically ill, ≥5 days and a subset of 111 patients in ICU ≥10 days completed the present prospective observational cohort study.Results: Protein and energy intakes on Day 5 of ICU admission in survivors were 46 and 58% of target values, respectively. These values in non-survivors were 42 and 50% of target values, respectively (p < 0.05). In the sample ≥10 days, protein and energy intakes in survivors reached 64 and 87% of target values, respectively, without statistically significant differences with non-survivors. In the sample ≥5 days, Cox proportional hazard regression was adjusted for GLIM, APACHE II, comorbidity, and age; the results indicated that the patients with protein and energy intake lower than 0.59 g/kg/day and 14 kcal/kg/day, had ~2-fold mortality hazard (protein: HR, 2.38; 95% CI, 1.40–4.03; P = 0.001 and energy: HR, 2.23; 95% CI, 1.27–3.92; P = 0.005).Conclusion: Actual protein and energy intakes in critically ill patients with COVID-19 are in suboptimal levels compared with goal recommendations in these patients. Moreover, higher amounts of protein and energy intakes in the early acute phase were significantly associated with better survival and lower risk of in-hospital mortality.

Evaluation of the effect of high protein supply on diaphragm atrophy in critically ill patients receiving prolonged mechanical ventilation.

Our aim was to evaluate the effect of high protein to the target of 2.0 g/kg/d on diaphragm atrophy and clinical prognosis of patients receiving prolonged mechanical ventilation (MV). This prospective, randomized, controlled, single-center study included 41 patients who were treated with ≥7 days' MV. The patients were randomly divided into a standard nutrition treatment (SNT) group and intensive nutrition treatment (INT) group, followed by evaluation of computer tomography-analyzed diaphragm volume, the level of butyrylcholinesterase (BChE) as a muscle mass indicator, and respiratory mechanics indices weekly to observe and compare the differences between the groups. In the INT group, the actual protein (1.70 ± 0.21 vs 1.06 ± 0.21 g/kg/d, P < .001) and calorie intake (33.46 ± 2.78 vs 25.75 ± 4.81 kcal/kg/d, P < .001) were significantly different from those of the SNT group. Compared with the SNT group, the INT group's diaphragm atrophy improved in the fourth and fifth weeks (all P < .05). The BChE after the third week was higher (all P < .05). No significant differences in respiratory mechanical indices and clinical outcomes were found in the surviving patients between the groups. INT improved the diaphragm atrophy and muscle mass of critically ill patients receiving prolonged MV. There was no evidence that increasing protein to the target amount of 2.0 g/kg/d is related to improvement in clinical prognosis for patients receiving prolonged MV.

The Dietary Intake of Patients With Decompensated Cirrhosis Is Less Than the Prescribed Half: It Is Not Enough to Prescribe, It Is Necessary to Monitor

Abstract Objectives The objective of this study was to compare the prescribed nutrition with dietary intake in hospitalized patients with decompensated cirrhosis. Methods This is a cross-sectional study performed with hospitalized decompensated cirrhotic patients. The individual nutritional requirements were determined through the registered dietitian and the patient's nutrition prescription was checked from the electronic medical records. A one-day food record was applied to all participants, who received prior guidance on how to properly report their meals. Data are expressed as mean ± SD or median [interquartile range]. The student's t-test was used to compare variables with a parametric distribution and the Wilcoxon signed-rank test was used for those with a non-parametric distribution. P &amp;lt; 0.05 was considered statistically significant. Results This study included 94 patients with a mean age of 60.3 ± 9.3 years and 64.8% were men. The main etiology of cirrhosis was hepatitis C (27.6%). Ascites was the most common complication, with a prevalence of 73.4%. The mean energy prescribed and the actual mean dietary intake were 2191.25 ± 295.77 kcal/d (31.25 ± 7.7 kcal/kg/d) and 1289.40 ± 509.71 kcal/d (18.61 ± 7.93 kcal/kg/d), respectively. The actual mean dietary intake was 902.68 ± 475.08 kcal/d less than the energy prescribed, p &amp;lt; 0.001. The median protein prescribed and the actual median protein intake were 94 g/d [88.9–110] (1.4 g/kg/d [1.2–1.7]) and 51.44 g/d [34.79–64.84] (0.7 g/ptn/d [0.5–0.9]), respectively. The actual median protein intake was 48.69 g/d [34.07–64.70] less than the protein prescribed, P &amp;lt; 0.001. The mean carbohydrate prescribed and the actual mean carbohydrate intake were 304.77 ± 80.74 g/d and 179.65 ± 73.62 g/d, respectively. The actual mean carbohydrate intake was 124.57 ± 96.82 less than the carbohydrate prescribed, P &amp;lt; 0.001. Conclusions The results of this study demonstrate that patients with decompensated cirrhosis have inadequate food intake. Encourage eating and monitoring of the daily food intake should be part of the management of these patients and occur throughout hospitalization. Funding Sources This study was supported by a CAPES and FIPE/HCPA scholarship. The sources of funding were not involved in study design; in the collection, analysis, and interpretation of the data.

Actual postoperative protein and calorie intake in patients undergoing major open abdominal cancer surgery: A prospective, observational cohort study.

BackgroundAdequate nutritional protein and energy intake are required for optimal postoperative recovery. There are limited studies reporting the actual postoperative protein and energy intake within the first week after major abdominal cancer surgery. The main objective of this study was to quantify the protein and energy intake after major abdominal cancer surgery.MethodsWe conducted a prospective cohort study. Nutrition intake was assessed with a nutrition diary. The amount of protein and energy consumed through oral, enteral, and parenteral nutrition was recorded and calculated separately. Based on the recommendations of the European Society for Clinical Nutrition and Metabolism (ESPEN), protein and energy intake were considered insufficient when patients received <1.5 g/kg protein and 25 kcal/kg for 2 or more days during the first postoperative week.ResultsFifty patients were enrolled in this study. Mean daily protein and energy intake was 0.61 ± 0.44 g/kg/day and 9.58 ± 3.33 kcal/kg/day within the first postoperative week, respectively. Protein and energy intake were insufficient in 45 [90%] and 41 [82%] of the 50 patients, respectively. Patients with Clavien‐Dindo grade ≥III complications consumed less daily protein compared with the group of patients without complications and patients with grade I or II complications.ConclusionDuring the first week after major abdominal cancer surgery, the majority of patients do not consume an adequate amount of protein and energy. Incorporating a registered dietitian into postoperative care and adequate nutrition support after major abdominal cancer surgery should be a standard therapeutic goal to improve nutrition intake.

Medical high-protein nutrition therapy and loss of muscle mass in adult ICU patients: A randomized controlled trial

BACKGROUND & AIMS The degradation of muscle mass and loss of functional proteins due to catabolism are associated with adverse outcomes in critically ill patients. While an adequate supply of protein within a medical nutrition concept is suggested to minimize proteolysis, the specificities on appropriate dosage and timing are still under debate. The current study aimed to evaluate the effect of two different quantities of protein as part of a standardized energetically controlled nutrition therapy for the preservation of muscle mass in the later phase of critical illness. METHODS A randomized controlled trial was conducted in 42 critically ill patients (age 65 ± 15; 12 females; SAPS 45 ± 11; TISS 20 ± 7; SOFA-score 7 ± 3). The subjects were randomly assigned to either the intervention (1.8 g protein/kg body weight [BW]/d) or standard (1.2 g protein/kg BW/d) group. Nutrient supply via enteral and/or parenteral nutrition was calculated based on the individual energy expenditure measured by indirect calorimetry and target protein content. Quadriceps muscle layer thickness (QMLT) was observed through sonography at inclusion, and during the follow-up period, two and four weeks after inclusion. The measurement points were fixed on two sides at the midpoint and two-thirds between the anterior superior iliac spine and top of the patella. The data were analyzed descriptively wherein chi-squared tests or unpaired two-samle t-tests checked group differences. Daily changes in muscle mass were estimated using a linear mixed model. All data are shown as the mean ± standard deviation (SD). RESULTS Actual protein intake reached 1.5 ± 0.5 g and 1.0 ± 0.5 g/kg BW/d in the intervention and standard group, respectively. Mean values of all measurements of QMLT at inclusion (day 13 ± 2 after ICU admission) were 13.5 ± 7.4 mm and 13.4 ± 7.1 mm in the intervention and standard group, respectively (P = 0.967). In both the groups, QMLT decreased over time (P < 0.001), while the estimated mean values of daily QMLT changes were -0.15 ± 0.08 mm (intervention) and -0.28 ± 0.08 mm (standard) without significant between-group differences (intervention effect, P = 0.368; time x intervention effect, P = 0.242). Illness scores and clinical outcomes showed no group differences. CONCLUSION In this single-center trial the increased amounts of protein (1.5 g vs. 1.0 g/kg BW/d) provided through medical nutrition therapy in the late phase of critical illness did not achieve a statistically significant impact on the loss of muscle mass in long-term immobilized ICU patients. Larger multi-center trials are needed to evaluate whether observed numerical differences in muscle mass could be a true finding, and will translate into improved clinical outcomes. TRIAL REGISTRATION German Clinical Trials Register (http://www.drks.de/), DRKS-ID: DRKS00013594.

Postoperative dietary intake and nutritional support among patients undergoing pancreatic surgery

Rationale: The adequate dietary intake and the effective nutritional support postoperatively consist two important components of the recovery process of the patients undergoing pancreatic surgery. The aim of this study was to record the actual energy and protein intake of the patients during the first postoperative period, as well as to assess any parenteral support given to them.

Nutrition During Critical Care: An Audit on Actual Energy and Protein Intakes.

Oral nutrition is delivered frequently in intensive care units (ICUs) but rarely studied. The primary objective of this study was to quantify nutrition intakes in patients exclusively orally fed (OF) and in those receiving medical nutrition solutions or both. Adults who stayed in a mixed ICU for ≥3 days were studied. Nutrition deficits were calculated as the difference between estimated energy or protein targets (determined by weight-based formulas) and actual intakes (recorded on a daily basis by nurses). Total volumes of enteral or parenteral nutrition solutions, propofol, and glucose infused over 24hours were collected and energy and protein amounts were calculated. In OF patients, food intake at each meal (breakfast, lunch, and dinner) was estimated using the "one-quarter portion" method. Among the 289 included patients aged 67 (57-75.5) years, 253 were fed and received, on average, 14.3 (7.8-19) kcal/kg/d and 0.53 (0.27-0.8) g/kg/d protein. In OF patients (n = 126), intakes were 9.7 (5.8-19) kcal/kg/d and 0.35 (0.17-0.57) g/kg/d protein. In the subset of OF patients with ICU stay ≥ 7 days (n = 37), respectively, 51% and 94% never received ≥80% of their energy and protein targets. Nutrition intakes were lower by oral feeding compared with other exclusive or combined medical nutrition. Compared with the prescribed amounts, the deficit was larger for proteins than for energy.

Improvement in Protein Delivery for Critically Ill Patients Requiring High-Dose Propofol Therapy and Enteral Nutrition.

Patients with traumatic brain (TBI) injury often require a high dosage of propofol, which can provide an excessive caloric intake. We evaluated our strategy of using liquid protein supplement boluses concurrently with high protein-containing enteral nutrition (EN) formulas and formula rate reduction to avoid caloric overfeeding and inadequate protein intake. Adult patients (aged >17 years) with TBI admitted to the trauma intensive care unit (TICU) who received concurrent propofol and EN were retrospectively reviewed. Caloric intakes from propofol and EN were obtained. Actual protein intake was compared with projected protein intakes from high protein content and standard protein content enteral formulas when given at an isocaloric intake. Fifty-one patients were enrolled. Average caloric intake from propofol was 356 ± 243 kcal/d or 5 ± 3 kcal/kg/d (range, <1-15 kcal/kg/d). Daily EN caloric intake ranged from 7 ± 4 kcal/kg/d (day 2) to 16 ± 9 kcal/kg/d (day 5; P < .001). Average protein intake ranged from 0.6 ± 0.4 g/kg/d (day 2) to 1.5 ± 0.7 g/kg/d (day 5; P < .001). The modified EN strategy resulted in daily delivery of 24%-38% more protein than an isocaloric regimen with a high protein-content formula and twice as much protein than the standard protein-content formula (P < .001). The strategy of providing an EN regimen comprised liquid protein boluses, and high and very high protein-containing EN formulas at a reduced rate improved protein delivery without caloric overfeeding.

15 Nutrition Therapy in the Burn Care Setting: What Is Best Achievable Practice?

Abstract Introduction The fourth most common injury worldwide are burn injuries. The uncontrolled inflammation, hyper-catabolism, and nutrient deficiencies associated with burn injuries can translate into worse clinical outcomes. Accordingly, CPGs recommends increasing energy requirements from 25–35 kcal/kg/day and provide 1.5–2 grams of protein/kg/day. Thus, the aim of this research is to evaluate the adherence level to CPGs recommendations in adult burn patients and describe the nutritional variability intake across Burn Units (BU) in North America (NA), Latin America (LATAM), and Europe (EU). Methods In a multi-national, multi-centre (n=43), double-blinded, controlled RCT of adult burn patients randomly allocated to receive either L-glutamine (0.5g/kg/day) or placebo via enteral nutrition (EN), we explored the nutritional adequacy. Patients with a deep 2nd-3rd degree burns were enrolled. Patients with renal failure, electrical injuries, BMI &amp;lt; 18 or &amp;gt; 50, liver cirrhosis, contraindication for EN, pregnancy, or moribund were excluded. BUs with &amp;gt;5 burn patients with completed data were included in this analysis. Patient demographics, nutritional intake and clinical outcomes were collected. Nutritional adequacy was calculated from all sources (glucose and oral intake no collected). Descriptive analyses for quantitative data were performed. The data is presented as mean and standard deviation (±) or median with interquartile range [25th to 75th percentile] Results Six hundred and eight burn patients from 32 BUs were included. Overall, 75% (n=455) of the patients were male and Caucasians (78% [n=477]) with a median age of 51 [34–64] years, moderately ill (12 [8–19] APACHE II score), and the most common type of burn was fire (87% [n=530]) with a %TBSA of 27 [20–40], Table 1. Overall, 242 (40%) patients received artificial nutrition. The proportion of patients receiving EN alone at each BU averaged 84% [worst: 7% to best site:88%]. Overall, time from admission to start of EN was an average of 0.7 [0.4 – 0.9] days across all BUs [best:0.2 to worst site: 1.7 day]. PN+EN was used on 13% (n=31) of the patients [site range, 5–89%]. Average adequacy of calories at all sites was 71 % (site average range, 22–82 %) and 72 % (29%– 97%) for protein with greater adequacy observed in LATAM BUs and worst adequacy observed in NA BUs, Figure 1. At the site level, a total of 7 (21%) and 9 (28%) BU successfully achieved &amp;gt;80% of calories and protein via artificial nutrition, respectively, Figure 2. The average use of motility agents in patients receiving &amp;gt;80% at site level was 72 [60–85 %]. Conclusions The actual energy and protein intake remains suboptimal in burn patients worldwide but tremendous variability exists across BU worldwide. Efforts to standardize and enhance EN delivery are warranted. Applicability of Research to Practice Compliance with clinical guidelines recommendations might improve clinical outcomes in burn victims.

Dietary protein intake in older adults undergoing cardiac surgery

BackgroundOlder adults undergoing major surgery have increased protein requirements in the postoperative period, but there are limited data describing actual protein intake following cardiac surgery. Methods and resultsWe performed a prospective sub-study within a registry of older adults ≥60 years of age undergoing cardiac surgery at a tertiary care centre. A dietician administered a food frequency questionnaire before surgery and 1–4 months after surgery. In-hospital food intake was recorded by direct observation for 3 days in the early postoperative period. Food intake was analyzed to calculate the protein intake per kilogram of body weight per day (g/kg/d) during the three phases of care, compared to the dietary reference intake. Frailty was measured by a questionnaire and physical performance tests before surgery. There were 22 patients (8 females, 14 males; 59% frail) enrolled in the study with a mean age of 72.0 ± 7.8 years. The mean protein intake was 1.3 ± 0.5 g/kg/d, 0.7 ± 0.3 g/kg/d, and 1.3 ± 0.6 g/kg/d in the preoperative, early postoperative, and postdischarge periods, respectively (P < 0.0001 for early postoperative compared to other periods). Compared to the targeted dietary reference intake of 1.5 g/kg/d, there was a mean protein deficit of 0.8 g/kg/d in the early postoperative period. Only one patient (5%) met the protein dietary reference intake in the early postoperative period. ConclusionIn older adults undergoing cardiac surgery, dietary protein intake was substantially lower than the recommended target in the early postoperative period. Strategies to improve protein intake, particularly in frail older patients, may be considered as a therapeutic target.

Effect of supplementary parenteral nutrition on glucose and lipid metabolisms, risk of infection, and prognosis in critically ill patients with low body weight

Background: While enteral nutrition (EN) is the preferred route of nutrition support, and total EN often fails to meet the nutritional needs of patients. A combination of multiple nutritional strategies can reach nutritional goals earlier and improve clinical outcomes. Methods: Totally 108 critically ill patients with a body mass index (BMI) of Results: There were no significant differences in albumin, urea nitrogen, alanine aminotransferase, fasting blood glucose, and triglyceride between the EN group and the SPN group before the nutritional support therapy (P>0.05). After the treatment, the albumin level was significantly higher in SPN group than in EN group (P 0.05). The actual calories and protein intakes in the SPN group were significantly higher than those in the control group (both P 0.05). Conclusions: SPN can improve the caloric and protein intakes, shorten the duration of mechanical ventilation, LOS in ICU, and LOS in hospital, and reduce the incidences of infection complications without apparent impact on blood lipid and sugar profiles or liver/kidney functions.

Analysis of Nutrition Support in Very Low-Birth-Weight Infants With Extrauterine Growth Restriction.

ObjectiveTo assess the incidence of extrauterine growth restriction (EUGR) in very low‐birth‐weight infants (VLBWIs) and evaluate the nutrition factors in VLBWIs associated with inadequate nutrient intakes during hospitalization.MethodsA total of 128 VLBWIs were divided into an EUGR group (n = 87) and a non‐EUGR group (n = 41). Growth and parenteral nutrition (PN) and enteral nutrition (EN) practices were analyzed. Actual energy and protein intakes were subtracted from recommended energy (120 kcal/kg/d) and protein (3.75 g/kg/d) intakes, and nutrition deficits were calculated.ResultsGrowth restriction was 21.9% at birth and 68.0% at discharge. Compared with established guidelines, PN was started late, and the maximum amino acid intake was low in both groups. EN interruption rate was higher in the EUGR group. The average energy intake in the first day after PN termination was lower in the EUGR group. There were significant differences in actual energy and protein intakes in the 2 groups for several weeks during hospitalization. The cumulative energy and protein deficits were significantly higher in the first 8 weeks and during the third to seventh weeks in the EUGR group, respectively. Step regression analysis showed that there was a significant negative correlation between the cumulative deficit of energy and changes of weight z‐scores (r = −0.001, P < .05): as the energy deficit loss increased by 100 kcal, the weight z‐scores dropped by 0.1 SD.ConclusionInadequate nutrition intake aggravated the occurrence of EUGR in VLBWIs, especially the energy intake.

The fortification method relying on assumed human milk composition overestimates the actual energy and macronutrient intakes in very preterm infants

BackgroundTo achieve recommended nutrient intakes in preterm infants, the target fortification method of human milk (HM) was proposed as an alternative to standard fortification method. We aimed to compare assumed energy and macronutrient intakes based on standard fortified HM with actual intakes relying on measured composition of human milk (HM), in a cohort of HM-fed very preterm infants.MethodsThis study is a secondary retrospective analysis, in which assumed energy and macronutrient contents of daily pools of own mother’s milk (OMM) from 33 mothers and donated HM (DHM) delivered to infants were compared with the measured values using a mid-infrared HM analyzer. A fortification method consisting of modular protein and/or fat supplements added to standard fortified HM was used to provide the minimum recommended daily intakes of energy 110 Kcal/kg and protein up to 4.0 g/kg. Assumed nutrient intakes were compared with actual nutrient intakes from full enteral feeding to 35 weeks plus 6 days postmenstrual age, using the Wilcoxon matched-pairs signed ranks test.ResultsThe composition of 1181 samples of daily pools of HM were measured. For 90.2% of study days, infants were exclusively fed OMM and in remaining days fed OMM plus DHM. Comparing with reported preterm OMM composition, measured protein concentration was significantly lower, and energy and other macronutrient concentrations were lower only from the second to third postnatal week. Using fortified HM, the actual median daily intakes of energy, protein, and fat were significantly lower (113.3 vs. 120.7 Kcal/kg, 4.45 vs. 4.73 g/kg, and 4.96 vs. 5.35 g/kg, respectively) and the actual protein-to-energy ratio (PER) significantly higher than what was assumed (4.2 vs. 4.0), without differences in carbohydrate intake.ConclusionsWhen fortifying the HM, we used conservative target intakes trying not to exceed the osmolarity recommended for infant feeds. Actual energy, protein and fat intakes in OMM were significantly lower than assumed. This resulted in inadequate intake using our fortification method, that did not compensate the suboptimal measured energy and macronutrient contents of OMM delivered. Further studies comparing assumed with the gold standard target fortification are needed to determine safe upper limits of assumed fortification.

Enteral Protein Supplementation in Critically Ill Children: A Randomized Controlled Pilot and Feasibility Study.

Loss of muscle mass in critically ill children can negatively impact outcomes. The aims of this study were to conduct a pilot randomized control trial (RCT) to examine the difference in protein delivery and nitrogen balance in critically ill children with enteral protein supplementation vs controls. We also aimed to assess the feasibility, safety, and tolerance of the pilot trial. This is a 3-arm RCT in critically ill children eligible for enteral nutrition (EN) therapy. Patients were randomized to 1 of the 3 groups: (1) control (routine EN), (2) polymeric protein module added to EN to reach protein goal by day 4, or (3) oligomeric protein supplementation. Demographics, clinical characteristics, nutrition status, and daily nutrition intake variables were recorded. Protein delivery, nitrogen balance, feasibility variables, and rate of adverse events were the outcomes. After screening 286 consecutive patients admitted to the pediatric intensive care unit over 11 months, we enrolled and randomized 25 patients. Twenty-two patients (88% of the enrolled) completed the study procedures. Significantly higher protein prescription and actual protein intake within the first 5 days was achieved in the intervention groups, compared with the control group. Nitrogen balance was obtained in 15 patients. There was no significant difference between the groups for the rate of adverse effects and clinical outcomes. In our pilot trial, protein supplementation was safe and well tolerated. Our preliminary results suggest that a larger RCT is potentially feasible, with some modifications of the entry criteria. Trial enrollment was low, likely due to restrictive entry criteria.