Protein-energy Supplementation Research Articles

SUPLEMENTAÇÃO DE NOVILHOS RED ANGUS X NELORE CRIADOS EM PASTAGEM TROPICAL DURANTE A ÉPOCA CHUVOSA

This experiment was carried out to evaluate the effects of proteic-energetic supplementation for Red Angus x Nellore steers raised on Brachiaria purpurascens (Henr. Blumea) tropical pastures during the wet season. Thirty-two steers were used to form four groups containing eight animals each. The experimental treatments were: (1) control (commercial mineral mix); (2) concentrate (concentrate ration, formulated to ensure a gain of 1.10 kg/day), and (3) proteic-energetic supplement containing whether corn (SCC) or (4) wheat midllings (SCWM). Daily weight gain, supplement intake, income over feed costs and the frequency of water trough access were assessed. The supplement intake was 0.076, 2.77, 0.74 and 0.86 kg/steer/day for the control, concentrate, SCC and SCWM groups, respectively. There were no differences in the daily weight gain amongst the control, SCC and SCWM groups and the concentrate group had the highest daily weight gain. The animals that received SCC had the highest income over feed costs and the concentrate group had the lowest one. Proteic-energetic supplementation during the wet season can, numerically, improve the daily weight gain, but this nutritional strategy must be done with caution to avoid economic losses.KEYWORDS: beef cattle; protein-energy supplementation; tropical grasses.

Leucine supplementation chronically improves muscle protein synthesis in older adults consuming the RDA for protein

Protein-energy supplementation is routinely employed to combat muscle loss. However, success is often compromised by increased satiety, poor palatability, high costs and low compliance. For 2-weeks we supplemented meals of older individuals with leucine (4 g/meal; 3 meals/day; days 2-14). Metabolic studies were performed prior to (Day 1) and following (Day 15) supplementation. Leucine was not provided on metabolic study days. Venous blood and vastus lateralis muscle biopsies were obtained during a primed constant infusion of L-[ring-(13)C(6)] phenylalanine. Mixed muscle fractional synthesis rate (FSR), body composition and markers of nutrient signaling (mTOR, 4E-BP1 and p70S6K1 phosphorylation) were measured before and after a low protein/carbohydrate simulated meal. The meal modestly increased FSR on Day 1 (postabsorptive: 0.063 ± 0.004 vs. postprandial: 0.075 ± 0.006%/h; p = 0.03), however, two weeks of leucine supplementation increased postabsorptive FSR (p = 0.004) and the response to the meal (p = 0.01) (postabsorptive: 0.074 ± 0.007 vs. postprandial: 0.10 ± 0.007%/h). Changes in FSR were mirrored by increased phosphorylation of mTOR, 4E-BP1 and p70S6K1 (p ≤ 0.1). No change in fat free mass was observed (p > 0.05). In older adults, leucine supplementation may improve muscle protein synthesis in response to lower protein meals.

Nutritional supplementation during pregnancy and offspring cardiovascular disease risk in The Gambia

Maternal nutritional intake during pregnancy may have important consequences for long-term health in offspring. The objective was to follow up the offspring in 2 randomized trials of nutrient supplementation during pregnancy to investigate the effect on cardiovascular disease (CVD) risk in offspring. We recruited offspring born during 2 trials in The Gambia, West Africa. One trial provided protein-energy-dense food supplements (1015 kcal and 22 g protein/d) to pregnant (intervention, from 20 wk gestation until delivery) or lactating (control, for 20 wk from birth) women and was randomized at the village level. The second was a double-blind, individually randomized, placebo-controlled trial of calcium supplementation (1.5 g/d), which was also provided from 20 wk gestation until delivery. Sixty-two percent (n = 1267) of children (aged 11-17 y) born during the protein-energy trial were recruited and included in the analysis, and 64% (n = 350) of children (aged 5-10 y) born during the calcium trial were recruited and included in the analysis. Fasted plasma glucose was marginally lower in children born to mothers receiving protein-energy supplements during pregnancy than in those children of the lactating group (adjusted mean difference: -0.05 mmol/L; 95% CI: -0.10, -0.001 mmol/L). There were no other differences in CVD risk factors, including blood pressure, body composition, and cholesterol, between children born to intervention and control women from the protein-energy trial. Maternal calcium supplementation during pregnancy was unrelated to offspring blood pressure. These data suggest that providing supplements to pregnant women in the second half of pregnancy may have little effect on the CVD risk of their offspring, at least in this setting and at the ages studied here. This trial was registered at www.controlled-trials.com as ISRCTN96502494.

The effect of energy–protein supplementation on weight, body composition and handgrip strength among pulmonary tuberculosis HIV-co-infected patients: randomised controlled trial in Mwanza, Tanzania

Undernutrition is common among smear-positive pulmonary tuberculosis (PTB+) patients. Micronutrient supplementation may improve treatment outcomes, but it is unclear whether additional energy-protein would be beneficial. The present study aimed to assess the effect of energy-protein supplementation on weight, body composition and handgrip strength against a background of high micronutrient intake during tuberculosis (TB) treatment. A total of 377 PTB+ patients co-infected with HIV were randomly allocated one or six biscuits daily for 60d during TB treatment. Weight, arm fat area, arm muscle area and handgrip strength were assessed at baseline and 2 and 5 months. There were no effects on any outcome at 2 months, but energy-protein supplementation was associated with a 1·3 (95% CI -0·1, 2·8)kg marginally significant gain in handgrip strength at 5 months. However, after 2 months, energy-protein supplementation led to a weight gain of 1·9 (95% CI 0·1, 3·7)kg among patients with cluster of differentiation 4 (CD4) counts ≥350cells/μl, but not among patients with low CD4 counts (-0·2kg; 95% CI -1·3, 0·8, Pinteraction=0·03). Similarly, at 5 months, energy-protein supplementation led to a 2·3 (95% CI 0·6, 4·1)kg higher handgrip strength gain among patients with CD4 counts <350cells/μl, but not in those with high CD4 counts (Pinteraction=0·04). In conclusion, energy-protein supplementation to PTB+ HIV-co-infected patients had no overall effects on weight and body composition, but was associated with marginally significant gain in handgrip strength. More research is needed to develop an effective supplement, before it is recommended to TB programmes.

Evidence-based prevention of childhood malnutrition

Childhood malnutrition is prevalent in developing countries and contributes to one-third of all deaths in these countries. There have been advances in prevention of childhood malnutrition and the purpose of this article was to review the current evidence in the field. Multiple micronutrient (MMN) supplements during pregnancy reduce the incidence of maternal anemia and small for gestational-age babies. Recent evidence suggest that combined supplementation of MMNs with protein energy supplement is more effective than MMN supplementation alone. It is now recommended that HIV-infected mothers can exclusively breast-feed their infants for 6 months when the mother or infant is on effective antiretroviral therapy. Home fortification of complementary foods reduces the prevalence of anemia in infancy and combined supplementation of MMNs with lipid-based supplements improves growth in young children. Ready-to-use therapeutic foods have been successfully used to manage severe acute malnutrition in the community. Zinc supplementation is associated with a reduction in diarrhea and respiratory disease morbidity and improves linear growth. Vitamin A supplementation decreases the incidence of diarrhea and measles. Water supply, sanitation, and hygiene are important for the prevention of malnutrition because of their direct impact on infectious disease. There is clear evidence on the causes and consequences of malnutrition as well as effective interventions to prevent undernutrition. The next step is to implement these packages of interventions at large scale. A global effort is required that should entail unified and compelling advocacy among governments, lead organizations, and institutions.

The effect of folic acid, protein energy and multiple micronutrient supplements in pregnancy on stillbirths

BackgroundPregnancy is a state of increased requirement of macro- and micronutrients, and malnourishment or inadequate dietary intake before and during pregnancy, can lead to adverse perinatal outcomes including stillbirths. Many nutritional interventions have been proposed during pregnancy according to the nutritional status of the mother and baseline risk factors for different gestational disorders. In this paper, we have reviewed three nutritional interventions including peri-conceptional folic acid supplementation, balanced protein energy supplementation and multiple micronutrients supplementation during pregnancy. This paper is a part of a series to estimate the effect of interventions on stillbirths for input to Live Saved Tool (LiST) model.MethodsWe systematically reviewed all published literature to identify studies evaluating effectiveness of peri-conceptional folic acid supplementation in reducing neural tube defects (NTD), related stillbirths and balanced protein energy and multiple micronutrients supplementation during pregnancy in reducing all-cause stillbirths. The primary outcome was stillbirths. Meta-analyses were generated where data were available from more than one study. Recommendations were made for the Lives Saved Tool (LiST) model based on rules developed by the Child Health Epidemiology Reference Group (CHERG).ResultsThere were 18 studies that addressed peri-conceptional folic acid supplementation for prevention of neural tube defects (NTDs). Out of these, 7 studies addressed folic acid supplementation while 11 studies evaluated effect of folic acid fortification. Pooled results from 11 fortification studies showed that it reduces primary incidence of NTDs by 41 % [Relative risk (RR) 0.59; 95 % confidence interval (CI) 0.52-0.68]. This estimate has been recommended for inclusion in the LiST as proxy for reduction in stillbirths. Pooled results from three studies considered to be of low quality and suggest that balanced protein energy supplementation during pregnancy could lead to a reduction of 45% in stillbirths [RR 0.55, 95 % CI 0.31-0.97]. While promising, the intervention needs more effectiveness studies before inclusion in any programs. Pooled results from 13 studies evaluating role of multiple micronutrients supplementation during pregnancy showed no significant effect in reducing stillbirths [RR = 0.98; 95% CI: 0.88 – 1.10] or perinatal mortality [RR = 1.07; 95% CI: 0.92 – 1.25; random model]. No recommendations have been made for this intervention for inclusion in the LiST model.ConclusionsPeri-conceptional folic acid supplementation reduces stillbirths due to NTDs by approximately 41%, a point estimate recommended for inclusion in LiST.

Effect of balanced protein energy supplementation during pregnancy on birth outcomes

BackgroundThe nutritional status of the mother prior to and during pregnancy plays a vital role in fetal growth and development, and maternal undernourishment may lead to adverse perinatal outcomes including intrauterine growth restriction (IUGR). Several macronutrient interventions had been proposed for adequate protein and energy supplementation during pregnancy. The objective of this paper was to review the effect of balanced protein energy supplementation during pregnancy on birth outcomes. This paper is a part of a series of reviews undertaken for getting estimates of effectiveness of an intervention for input to Lives Saved Tool (LiST) model.MethodsA literature search was conducted on PubMed, Cochrane Library and WHO regional data bases to identify randomized trials (RCTs) and quasi RCTs that evaluated the impact of balanced protein energy supplementation in pregnancy. Balanced protein energy supplementation was defined as nutritional supplementation during pregnancy in which proteins provided less than 25% of the total energy content. Those studies were excluded in which the main intervention was dietary advice to pregnant women for increase in protein energy intake, high protein supplementation (i.e. supplementation in which protein provides at least 25% of total energy content), isocaloric protein supplementation (where protein replaces an equal quantity of non-protein energy content), or low energy diet to pregnant women who are either overweight or who exhibit high weight gain earlier in gestation. The primary outcomes were incidence of small for gestational age (SGA) birth, mean birth weight and neonatal mortality. Quality of evidence was evaluated according to the Child Health Epidemiology Reference group (CHERG) adaptation of Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria.ResultsThe final number of studies included in our review was eleven comprising of both RCTs and quasi-RCTs. Our meta-analysis indicates that providing pregnant females with balanced protein energy supplementation resulted in a significant reduction of 31 % in the risk of giving birth to small for gestational age infants (Relative risk (RR) =0.69, 95% Confidence interval (CI) 0.56 to 0.85). This estimate had been recommended for LiST as a proxy for reduction in IUGR. Pooled results for mean birth weight showed that balanced protein supplemented group gained more weight compared to control [Mean difference 59.89 g, 95 % CI 33.09-86.68]. This effect was more pronounced in malnourished women compared to adequately nourished women. There was no statistically significant effect of balanced protein energy supplementation on neonatal mortality (RR= 0.63, 95% CI 0.37 to 1.06).ConclusionProviding pregnant females with balanced protein energy supplementation leads to reduction in risk of small for gestational age infants, especially among undernourished pregnant women. Given these findings, we can recommend balanced protein energy supplementation as an intervention among undernourished women for inclusion in the LiST model with a point estimate of 31% [95% CI 15% to 44%] reduction in IUGR.

Perioperative oral nutritional supplements in normally or mildly undernourished geriatric patients submitted to surgery for hip fracture: A randomized clinical trial

Oral nutritional supplements have been recommended after orthopedic surgery in geriatric patients. This has been shown to be effective even in normally nourished or mildly undernourished geriatric patients. Whether perioperative administration of these products is also effective and suitable is not known. Randomized, controlled, open, paralleled two-arms clinical trial, comparing energy-protein supplements (40 g of protein and 400 kcal per day), with no intervention in normally nourished or mildly undernourished patients. Outcomes were serum proteins, body mass index, postoperative complications among others. 60 Elderly patients were included. Patients in the intervention group (n = 30) ingested 52.2 ± 12.1% of the prescribed supplements per day for 5.8 ± 1.8 days before surgery and until hospital discharge. There was a significant change in serum albumin at follow-up (F = 22.536, P < 0.001), and between the two groups (F = 5.763, P = 0.002), favouring the intervention. The same was observed for serum prealbumin (F = 6.654, P = 0.001 within subjects, F = 2.865, P = 0.045 for interaction). Logistic regression showed that only supplemented proteins per day (OR[95%CI] = 0.925[0.869-0.985]) were associated with less postoperative complications (R(2) = 0.323, χ(2) = 11.541, P = 0.003). Perioperative supplements in geriatric patients with hip fracture submitted to surgery showed better recovery of plasma proteins. Higher daily protein intakes were associated with less postoperative complications.

Global report on preterm birth and stillbirth (3 of 7): evidence for effectiveness of interventions.

IntroductionInterventions directed toward mothers before and during pregnancy and childbirth may help reduce preterm births and stillbirths. Survival of preterm newborns may also be improved with interventions given during these times or soon after birth. This comprehensive review assesses existing interventions for low- and middle-income countries (LMICs).MethodsApproximately 2,000 intervention studies were systematically evaluated through December 31, 2008. They addressed preterm birth or low birth weight; stillbirth or perinatal mortality; and management of preterm newborns. Out of 82 identified interventions, 49 were relevant to LMICs and had reasonable amounts of evidence, and therefore selected for in-depth reviews. Each was classified and assessed by the quality of available evidence and its potential to treat or prevent preterm birth and stillbirth. Impacts on other maternal, fetal, newborn or child health outcomes were also considered. Assessments were based on an adaptation of the Grades of Recommendation Assessment, Development and Evaluation criteria.ResultsMost interventions require additional research to improve the quality of evidence. Others had little evidence of benefit and should be discontinued. The following are supported by moderate- to high-quality evidence and strongly recommended for LMICs:• Two interventions prevent preterm births—smoking cessation and progesterone• Eight interventions prevent stillbirths—balanced protein energy supplementation, screening and treatment of syphilis, intermittant presumptive treatment for malaria during pregnancy, insecticide-treated mosquito nets, birth preparedness, emergency obstetric care, cesarean section for breech presentation, and elective induction for post-term delivery• Eleven interventions improve survival of preterm newborns—prophylactic steroids in preterm labor, antibiotics for PROM, vitamin K supplementation at delivery, case management of neonatal sepsis and pneumonia, delayed cord clamping, room air (vs. 100% oxygen) for resuscitation, hospital-based kangaroo mother care, early breastfeeding, thermal care, and surfactant therapy and application of continued distending pressure to the lungs for respiratory distress syndromeConclusionThe research paradigm for discovery science and intervention development must be balanced to address prevention as well as improve morbidity and mortality in all settings. This review also reveals significant gaps in current knowledge of interventions spanning the continuum of maternal and fetal outcomes, and the critical need to generate further high-quality evidence for promising interventions.

Níveis e frequência de suplementação de novilhos de corte a pasto na estação seca

Objetivou-se avaliar os níveis de suplementação proteico-energética, oferecida em diferentes frequências, a animais em recria mantidos em pastagem de Bracharia decumbens na estação seca do ano. Foram utilizados 25 novilhos não-castrados, com peso inicial médio de 191 kg, distribuídos em delineamento de blocos casualizados, com cinco repetições por tratamento, em arranjo fatorial 2 × 2 + 1, ou seja, dois níveis de suplementação energético-proteica (0,3 e 0,6% em relação ao peso vivo (PV) do animal), duas frequências de fornecimento - diariamente ou em dias alternados (dia sim, dia não) - mais um tratamento adicional (apenas suplementação mineral). O consumo de matéria seca da forragem (CMSF) foi estimado utilizando-se os indicadores óxido crômico e matéria seca indigestível (MSi). O consumo de matéria seca do suplemento foi medido diariamente, uma vez que o suplemento foi fornecido individualmente. A suplementação aumentou o consumo de matéria seca total e o ganho médio diário (1,66% do PV e 290 g/dia) em comparação ao suplemento adicional (1,49% do PV e 107 g/dia de perda média diária de PV). Os consumos de matéria seca da forragem e de fibra em detergente neutro foram maiores nos animais que receberam apenas mistura mineral (1,48 e 1,1% do PV, respectivamente) e menores naqueles sob suplementação (1,27 e 0,95% do PV, respectivamente). A redução da ingestão de forragem não diferiu entre os níveis de suplementação (média 299 g/dia). No nível de 0,6% do PV, a suplementação promoveu o maior ganho médio diário, em comparação ao nível de 0,3% do PV (343 vs 238 g/dia), porém foi 39% menos eficiente para conversão de suplemento em ganho de peso. Nenhuma variável estudada foi alterada pelas frequências de suplementação. Em comparação à suplementação diária, a suplementação em dias alternados é viável nos níveis estudados.

DESEMPENHO DE FÊMEAS NELORE DE REPOSIÇÃO COM SUPLEMENTAÇÃO ALIMENTAR NA SECA EM PASTAGENS RENOVADAS

The objective of this work was to evaluate the performance in live weight gain (LWG) and economic of Nellore heifers in two strategies of alimentary supplementation: energy-protein (EP) and urea-salt (US). Twelve heifers with approximately twenty months old and initial live weight 306+21 kg were evaluated. The heifers had been kept in renewed pastures of Brachiaria brizantha cv Marandu. The duration of the experiment was of 55 days. The LWG and LWG/ha (live weight gain for hectare) were evaluated. For the economic analysis was considered operational cost, gross revenue, gross margin and the financial return direct. The heifers of EP showed 0.71 kg/animal/day higher than 0.43 kg/animal/day for SU (P Key words: Economic performance, energy-protein supplements, rearing of heifers, weight profit.

Reducing stillbirths: behavioural and nutritional interventions before and during pregnancy.

BackgroundThe vast majority of global stillbirths occur in low- and middle-income countries, and in many settings, the majority of stillbirths occur antenatally, prior to the onset of labour. Poor nutritional status, lack of antenatal care and a number of behaviours increase women's risk of stillbirth in many resource-poor settings. Interventions to reduce these risks could reduce the resulting burden of stillbirths, but the evidence for the impact of such interventions has not yet been comprehensively evaluated.MethodsThis second paper of a systematic review of interventions that could plausibly impact stillbirth rates covers 12 different interventions relating to behavioural and socially mediated risk factors, including exposures to harmful practices and substances, antenatal care utilisation and quality, and maternal nutrition before and during pregnancy. The search strategy reviewed indexed medical journals on PubMed and the Cochrane Library. If any eligible randomised controlled trials were identified that were published after the most recent Cochrane review, they were added to generate new meta-analyses. Interventions covered in this paper have a focus on low- and middle-income countries, both because of the large burden of stillbirths and because of the high prevalence of risk factors including maternal malnutrition and harmful environmental exposures. The reviews and studies belonging to these interventions were graded and conclusions derived about the evidence of benefit of these interventions.ResultsFrom a programmatic perspective, none of the interventions achieved clear evidence of benefit. Evidence for some socially mediated risk factors were identified, such as exposure to indoor air pollution and birth spacing, but still require the development of appropriate interventions. There is a need for additional studies on culturally appropriate behavioural interventions and clinical trials to increase smoking cessation and reduce exposure to smokeless tobacco. Balanced protein-energy supplementation was associated with reduced stillbirth rates, but larger well-designed trials are required to confirm findings. Peri-conceptional folic acid supplementation significantly reduces neural tube defects, yet no significant associated reductions in stillbirth rates have been documented. Evidence for other nutritional interventions including multiple micronutrient and Vitamin A supplementation is weak, suggesting the need for further research to assess potential of nutritional interventions to reduce stillbirths.ConclusionAntenatal care is widely used in low- and middle-income countries, and provides a natural facility-based contact through which to provide or educate about many of the interventions we reviewed. The impact of broader socially mediated behaviors, such as fertility decision-making, access to antenatal care, and maternal diet and exposures like tobacco and indoor air pollution during pregnancy, are poorly understood, and further research and appropriate interventions are needed to test the association of these behaviours with stillbirth outcomes. For most nutritional interventions, larger randomised controlled trials are needed which report stillbirths disaggregated from composite perinatal mortality. Many antepartum stillbirths are potentially preventable in low- and middle-income countries, particularly through dietary and environmental improvement, and through improving the quality of antenatal care – particularly including diagnosis and management of high-risk pregnancies – that pregnant women receive.

Leucine supplemented meals improve muscle protein synthesis in older adults

Protein‐energy supplementation is routinely employed to combat the sarcopenia of aging. However, many regimens are impractical or ineffective due to issues including increased satiety, poor palatability, cost and compliance. To this end, we conducted a 14 day study in which we supplemented regular daily meals of community dwelling elders (n=8, 63‐76 yrs) with a small amount of the key regulatory amino acid leucine (4 g per meal; 3 meals per day; days 2‐13). Stable isotope studies consisting of a primed continuous L‐[ring‐13C6] phenylalanine infusion, arterialized blood samples and vastus lateralis muscle biopsies were performed on days 1 and 14. Mixed muscle fractional synthesis rate (FSR) was measured during the post‐absorptive state and following ingestion of a standardized test meal containing 10 g of carbohydrate and 7 g of mixed essential amino acids. Leucine supplementation significantly increased postabsorptive FSR (Day 1: 0.061 + 0.005 vs. Day 14: 0.074 + 0.006 %/hr; p=0.003) and the response to the standardized meal (Day 1: 0.073 + 0.006 vs. Day 14: 0.100 + 0.007 %/hr; p=0.02). These data suggest that a low volume leucine supplement may provide a minimally disruptive and efficient means of chronically stimulating muscle protein synthesis and improving the anabolic response to meals ingested by older adults.Grant Funding SourceFunded by the UTMB Claude D. Pepper Older Americans Independence Center # P30 AG024832. Studies conducted on the GCRC at UTMB funded by grant M01 RR 00073 from the National Center for Research Resources, NIH, USPHS.

Antinutritional factors, ruminal degradation and in vitro protein digestibility of gamma irradiated full-fat soybean

Whole soybean is used as a high energy-protein supplement for dairy cows, but contains various antinutritional factors and the protein is highly degradable by rumen microbes. Roasting and extrusion are very popular ways of feeding soybeans to dairy cows but these processing methods may adversely affect the protein digestibility and lysine availability of the final product in the small intestine. Gamma irradiation has been recognized as a reliable and safe method for improving the nutritional value and inactivation or removal of certain antinutritional factors in foods and feeds (Siddhuraju et al., 2002). As far as we know, information about the effects of γ-irradiation on ruminal crude protein (CP) degradation of full-fat soybean in the literature is scarce. The aim of this study was to evaluate the effects of gamma irradiation (γ-irradiation) on nutritional value and antinutritional factors of soybean (SB) for ruminants.

Dietary Supplementation of Rural Gambian Women during Pregnancy Does Not Affect Body Composition in Offspring at 11–17 Years of Age

Fetal nutrition is thought to be an important determinant of later disease risk, although evidence from randomized-controlled trials in humans is lacking. We followed children born during a protein-energy supplementation trial to investigate to what extent this maternal supplement, which improved birth weight, influenced offspring body composition in adolescence. Subjects were 1270 Gambian children (659 boys, 611 girls) aged 11–17 y whose mothers had participated in the original cluster-randomized trial and had received the supplement during pregnancy (intervention) or postpartum (control). Basic anthropometry was measured using standard techniques and fatness was assessed by bioelectrical impedance analysis and population-specific prediction equations. For boys, mean body fat was 12.6% for both intervention and control groups. Mean trunk fat was 11.9% in the intervention group and 12.0% in the control. Intervention girls had a mean body fat of 19.5% and trunk fat of 15.2%; for control girls, it was 19.3 and 14.8%, respectively. BMI, body fat, trunk fat, fat mass index, and fat-free mass index did not differ for either sex when analyzed with generalized estimating equations adjusted for age, maternal height, maternal parity, location, season of birth, and menarche in females. Neither infant-attained size nor the onset of menarche were affected by maternal supplementation. These findings suggest that protein-energy supplements to pregnant women, compared with lactating women, do not affect offspring body composition during adolescence.

Exploiting dietary supplementation trials to assess the impact of the prenatal environment on CVD risk

Animal studies have demonstrated that altering the maternal diet during pregnancy affects offspring disease risk. Data from human subjects on the early-life determinants of disease have been derived primarily from birth-weight associations; studies of the impact of the maternal diet are scarce and inconsistent. Investigating CVD risk factors in the offspring of women who have participated in maternal supplementation trials provides a useful resource in this research field, by virtue of employing an experimental design (as compared with observational studies). To date, follow-up studies have been published only for a small number of trials; these trials include the impact of maternal protein–energy, multiple-micronutrient and Ca supplementation on offspring disease risk. In Nepal maternal micronutrient supplementation has been shown to be associated with lower offspring systolic blood pressure at 2 years of age. Data from Guatemala on a pre- and postnatal protein–energy community intervention have suggested long-term improvements in fasting glucose and body composition but not in blood pressure. In The Gambia no association has been found between prenatal protein–energy supplementation and markers of CVD risk including body composition, blood pressure and fasting glucose and insulin in childhood and adolescence. Little evidence of an effect of maternal Ca supplementation on offspring blood pressure has been demonstrated in four trials, although the risk of high systolic blood pressure was found to be reduced in one trial. The present paper reviews the current evidence relating maternal nutritional supplementation during pregnancy to offspring CVD risk and explores the potential explanations for the lack of association.

Nutritional supplements

Rehabilitation of stroke patients is as much art as science. Although management of stroke patients in the rehabilitation setting predominantly derives from anecdotal experience, evidence-based approaches are increasingly employed as data from clinical trials become available. General medical and supportive management of patients in the recovery period complement specific therapies targeting stroke-related impairments but may vary in different settings and patient groups. Little is known about the effects of sleep, diet, and nontherapeutic activities. The randomized, double-blinded, placebo-controlled trial by Rabadi et al. in this issue of Neurology ® explores the effect of nutritional supplementation on stroke recovery.1 The primary hypothesis was that better nutritional status would improve Functional Independence Measure (FIM) scores, particularly those on the motor subscale. In observational studies, nutritional status has been shown a predictor of stroke outcome.2,3 Data from interventional studies have been inconclusive. The pivotal Feed or Ordinary Diet (FOOD) trial was comprised of three multicenter international trials testing the hypothesis that protein-energy supplements would improve 6-month stroke …

Maternal protein-energy supplementation does not affect adolescent blood pressure in The Gambia

Background Birthweight, and by inference maternal nutrition during pregnancy, is thought to be an important determinant of offspring blood pressure but the evidence base for this in humans is lacking data from randomized controlled trials.Methods The offspring from a maternal prenatal protein-energy supplementation trial were enrolled into a follow-up study of chronic disease risk factors including blood pressure. Subjects were 11–17 years of age and blood pressure was measured in triplicate using an automated monitor (Omron 705IT). One-thousand two-hundred sixty seven individuals (71% of potential participants) were included in the analysis.Results There was no difference in blood pressure between those whose mothers had consumed protein-energy biscuits during pregnancy and those whose mothers had consumed the same supplement post-partum. For systolic blood pressure the intention-to-treat regression coefficient was 0.46 (95% CI: –1.12, 2.04). Mean systolic blood pressure for control children was 110.2 (SD ± 9.3) mmHg and for intervention children was 110.8 (SD ± 8.8) mmHg. Mean diastolic blood pressure for control children was 64.7 (SD ± 7.7) mmHg and for intervention children was 64.6 (SD ± 7.6) mmHg.Conclusions We have found no association between maternal prenatal protein-energy supplementation and offspring blood pressure in adolescence amongst rural Gambians. We found some evidence to suggest that offspring body composition may interact with the effect of maternal supplementation on blood pressure.

Análise econômica da suplementação protéico-energética de novilhos durante o período de transição entre água-seca

Avaliou-se economicamente o efeito da suplementação protéico-energética em dois níveis de ingestão diária, 0,17% e 0,37% do peso vivo, sobre o desempenho de novilhos, em pastagens de Brachiaria brizantha cv. Marandu utilizando-se 14 animais por tratamento. Os tratamentos foram: SM - suplementação mineral (controle), SUP1 - suplementação protéico-energética com média de ingestão diária de 0,17% do peso vivo e SUP2 - suplementação protéico-energética com média de ingestão diária de 0,37% do peso vivo. Novilhos que receberam a suplementação protéico-energética SUP1 e SUP2 apresentaram maiores ganhos de peso, 0,655 e 0,746kg/animal/dia, respectivamente em relação aos que receberam apenas suplementação mineral, 0,535kg/animal/dia. Os maiores lucros operacionais, observados para os animais dos tratamentos SUP1 e SUP2. 67,12 e 72,08 R$/animal/período, respectivamente, em relação aos do tratamento controle, 66,67 R$/animal/período; os resíduos para remuneração foram de R$59,92, R$55,10 e R$54,85/animal/período, para novilhos que receberam SUP2, SUP1 e SM, respectivamente e sugerem que a suplementação protéico-energética possibilitou maior retorno econômico.

Effects of Oral Nutritional Supplements in Normally Nourished or Mildly Undernourished Geriatric Patients After Surgery for Hip Fracture: A Randomized Clinical Trial

Oral nutritional supplements have been recommended after orthopedic surgery in geriatric patients to reduce postoperative complications. However, tolerability of supplements could be a limitation, and their universal use is not supported by the heterogeneity of previous studies, especially in patients without malnutrition. This study is a randomized, controlled, open, parallel, 3-arm clinical trial comparing supplementation with protein powder dissolved in liquids to aim at 36 g of protein per day, energy and protein supplements to aim at 37.6 g of protein and 500 kcal per day, or no intervention in normally nourished or mildly undernourished patients. Outcomes were serum albumin, prealbumin, retinol-binding globulin, and body mass index, among others. Postoperative complications were also recorded. Ninety patients aged 83.8 +/- 6.6 years were included. The mean ingested amount of supplements was 41.1% +/- 20.6% in the protein powder supplement group and 51.4% +/- 13.2% in the energy protein supplement group (t = 2.278, P = .027). Postoperative supplements had no effect on the nutrition status during in-hospital follow-up, as assessed by serum albumin (P = .251), prealbumin (P = .530), retinol-binding globulin (P = .552), or body mass index (P = .582). Multivariate analysis showed that length of hospital stay with an established complication until its resolution (beta = .230, P = .031), total hospital stay (beta = .450, P < .001), baseline body mass index (beta = .204, P = .045), and total daily ingested proteins per body weight (beta = .252, P = .018) were predictive variables on the change in serum albumin (R2 = 0.409, F = 11.246, P < .001). Oral nutritional supplements in normally nourished or only mildly undernourished geriatric patients with hip fracture submitted to surgery may be of interest for patients with postoperative complications and long hospital stays.