High-protein Drink Research Articles

Soy protein particles as stabilizers of heat-stable O/W emulsions with 20% protein content

In response to the increasing demand for nutritionally rich foods, consumer preference for protein-enriched beverages has grown. However, heat-induced protein aggregation and gelation significantly hinders the production of high-protein drinks. In this study, oil-in-water (O/W) emulsions with exceptional thermal stability were formulated using modified soy protein particles (MSPs). These MSPs effectively resisted gel formation, even at a protein concentration of up to 20% (w/v). In contrast, emulsions prepared with untreated soy proteins (SPs) experienced pronounced gelation under identical conditions. The compact structure of MSPs, in comparison to SPs, imparted resistance to heat-induced denaturation and aggregation. Additionally, the emulsion displayed heightened heat processing insensitivity, due to the enhanced hydrophobicity of MSPs and their rapid adsorption at the oil-water interface, resulting in a denser, more elastic, and resilient interfacial film. These findings provide practical insights for the formulation of protein-rich milk alternatives, meeting the evolving market demands.

High-protein diet with immediate post-exercise protein drink: Impact on appetite in middle-aged obesity

Successful management of obesity can be challenging if individuals constantly experience cravings. The present study investigated the effects of a high-protein diet, including a high-protein drink consumed immediately after high-intensity interval training (HIIT), on appetite and weight loss in obese middle-aged individuals. A total of 52 obese middle-aged individuals (58.2 ± 4.11 years old) were randomly assigned to one of three groups: the exercise group (E, n=19), exercise and high-protein diet group (ED, n=21), and a control group (n=12). The E and ED groups engaged in cycling HIIT (comprising 90 % of peak heart rate (HRpeak) for 3 min, followed by 70 % of HRpeak for 3 min, for a total of 5 cycles) three times a week for 3 months. The ED group consumed a high-protein drink immediately after HIIT and had a daily protein intake of 1.6g/kg. Body composition and eating behavior were assessed before and after the intervention. Additionally, appetite levels were measured before and after each exercise session, before dinner, and before bedtime during three phases of the intervention: the first phase (weeks 3-4), the second phase (weeks 5-8), and the third phase (weeks 9-12). Results showed that only the ED group experienced a decrease in body mass index (from 27.4 ± 4.28 to 26.8 ± 4.09 kg/m2, p=0.04). Appetite significantly increased after exercise in both E and ED groups (p values for the three phases ranged from 0.04 to 0.001 for the E group and from 0.042 to 0.003 for the ED group). The desire to eat significantly increased after exercise in the E group (phase 1: p = 0.026; phase 2: p = 0.011; phase 3: p = 0.003), but not in the ED group. Furthermore, the frequency of late-night snacking decreased in the ED group (the score changed from 2.4 ± 0.86 to 2.7 ± 0.80, p = 0.034). Notably, the E group tended to have a higher pre-dinner appetite score than the ED group in the third phase (p = 0.063). In summary, a high daily protein intake, combined with the consumption of high-protein drinks after exercise, resulted in reduced post-exercise appetite and a decrease in the frequency of late-night snacking.

Prebiotic properties of isomaltooligosaccharides from cassava as a potential ingredient in high-protein drinks for athletes

Background: Studies show that prebiotics can improve the health of athletes. Isomaltooligosaccharide (IMO) is a food ingredient containing prebiotic properties.Objectives: The purpose of the study is to examine the prebiotic properties of isomaltooligosaccharides based on digestibility of in vitro under-simulated upper-gut conditions and a prebiotic activity score. Additionally, the study explores the potential to use IMO as an ingredient for high protein drinks.Methods: IMO powder from cassava starch was prepared through enzymatic methods. The prebiotic properties of IMO were evaluated based on in vitro digestibility and a prebiotic activity score. Researchers assessed the digestibility of in vitro in simulated upper-gastrointestinal-tract conditions, consisting of mouth digestion, gastric digestion, and small-intestine digestion. The study calculated the probiotic activity score according to the number of growing beneficial and harmful bacteria. Finally, researchers determined the potential to use IMO as an ingredient for developing high-protein drink products.Results:The digestion of IMO by simulated salivary fluid using human salivary α-amylase for 2 min, artificial human gastric juice at pH 2.0 for two hours, intestinal fluid with pancreatic α-amylase (0.75 unit/mL), and pancreatic lipase (1.6 unit/mL) for two hours with a pH of 6.9 and a temperature of 37 oC were 1.54±0.33%, 9.19±0.64%, and 33.27±4.09%, respectively. Comparing the results with commercial isomaltooligosaccharide (cIMO), researchers found that the percentage of digestion differed significantly. Prebiotic activity scores of IMO for L. rhamnosus LGG®, L. paracasei CASEI 431®, L. acidophilus LA 5, B. longum DSM 219, B. animalis subsp. BB12® and B. bifidum BB536 were 0.477±0.07, 2.197±0.58, -0.058±0.16, 1.660±0.63, 0.801±0.59 and 1.179±0.05, respectively. Notably, the results were not significant when compared to cIMO. Researchers measured the nutritional formula in a high-protein drink containing IMO at 40 g (30 g protein) and the total serving at 148 kcal. For macronutrient distribution, the ratio of protein, carbohydrate, and fat in the product is 81:19:0. Micronutrients were added, comprising of 0-50% Thai RDI. Finally, the product also met relevant standards for the microbial quality of food products in powdered form. Conclusion:IMO from cassava was partially resistant to in vitro digestion under simulated upper-gastrointestinal conditions and promoted the growth of probiotic bacteria. Moreover, powdered IMO can be used as an ingredient for high-protein drink products.Keywords: prebiotic, probiotic, high protein drinking, athletes, IMO

Impact of High Protein and Low Carbohydrate Smoothie Drinks Versus a Diabetes-Specific Nutritional Formula on Postprandial Glucose Homeostasis in Type-2 Diabetes Mellitus

Abstract Objectives We aimed to determine the effect of high protein and low carbohydrate smoothie drinks on glucose homeostasis, insulin and lipid metabolism in obese type 2 diabetic individuals as compared with a diabetes-specific nutritional formula. Methods We compared between a regular high protein smoothie drink (SM) containing 39% carbohydrate, 24% protein and 37% fat or a high protein and low sugar smoothie drink (LS) containing 28% carbohydrate, 28% protein and 44% fat with a conventional diabetic enteral drink (Glucerna) containing 38% carbohydrate, 18% protein and 33% fat. A crossover design study was performed in 41 diabetic participants. Participants consumed 300 kilocalories of each drink at a time with one-week wash out period between drinks and glucose response curves at baseline, 30, 60, 90, 120, 180 and 240 minutes were monitored and compared. Results In all three diets blood glucose levels gradually decreased postprandially. Average postprandial plasma glucose levels and the area under the curve (AUC) were higher after Glucerna and SM intake as compared with LS (p-value < 0.05) which demonstrated that LS be the better insulin sensitive formula among of the three formulas. The peak blood glucose level was highest at 60 minutes after Glucerna intake when compared with SM and LS, respectively (p-value < 0.0001). Conclusions These results suggested the potential of smoothie formulas containing high protein and low carbohydrate for the nutritional support of type 2 diabetes mellitus and its related improved glycemic control. These smoothies may be a good candidate as promising functional foods for the management and supplementation for diabetes and obese people in the future. Funding Sources National Research Council of Thailand (NRCT).

The Acute Effects of Breakfast Drinks with Varying Protein and Energy Contents on Appetite and Free-Living Energy Intake in UK Older Adults.

Proposed strategies for preventing protein deficiencies in older patients include increasing protein intake at breakfast. However, protein is highly satiating and the effects of very high protein intakes at breakfast on subsequent appetite and free-living energy intake (EI) in older adults are unclear. This study compared the acute effects of two breakfast drinks varying in protein and energy contents on appetite and free-living EI in healthy older adults using a randomized 2 × 2 crossover design. Participants (n = 48 (20 men, 28 women); mean ± SD age: 69 ± 3 years; BMI: 22.2 ± 2.0 kg·m−2; fat-free mass: 45.5 ± 8.0 kg) consumed two drinks for breakfast (high-protein (30.4 ± 5.3 g), low-energy (211.2 ± 37.1 kcal) content (HPLE) and very high-protein (61.8 ± 9.9 g), fed to energy requirements (428.0 ± 68.9 kcal) (VHPER)) one week apart. Appetite perceptions were assessed for 3 h post-drink and free-living EI was measured for the remainder of the day. Appetite was lower in VHPER than HPLE from 30 min onwards (p < 0.01). Free-living energy and protein intake did not differ between conditions (p = 0.814). However, 24 h EI (breakfast drink intake + free-living intake) was greater in VHPER than HPLE (1937 ± 568 kcal vs. 1705 ± 490 kcal; p = 0.001), as was 24 h protein intake (123.0 ± 26.0 g vs. 88.6 ± 20.9 g; p < 0.001). Consuming a very high-protein breakfast drink acutely suppressed appetite more than a low-energy, high-protein drink in older adults, though free-living EI was unaffected. The long-term effects of adopting such a breakfast strategy in older adults at high risk of energy and protein malnutrition warrants exploration.

Кефирный напиток функционального назначения с высоким содержанием белка и железа

Кефирный напиток функционального назначения с высоким содержанием белка и железа

Gastric emptying for liquids of different compositions in children

BackgroundPre-operative fasting balances safety against patient discomfort. We compared the gastric emptying profiles of a novel clear, high protein drink against a “traditional” clear and a non-clear fluid. MethodsWe conducted a prospective cross-sectional study with 48 healthy volunteers, eight to 14 yr of age, fasted overnight and without risk factors for abnormal gastrointestinal motility. Subjects were randomized in equal ratio to ingest 296 ml of apple juice, 2% milk or Ensure Clear. The gastric antrum was seen by ultrasound in the right lateral decubitus position at baseline, after ingestion, then every 30 min thereafter until return to baseline or six h. Gastric antral cross-sectional area was measured independently by two anaesthetists, and compared between drinks. ResultsGastric emptying differed between apple juice, 2% milk and Ensure Clear by analysis of co-variance (P<0.0001), and was faster in males than females (P<0.01). The terminal phase however was similar using interval-censored time to gastric emptying in a survival model (P=0.17) or by comparing proportions with empty stomach vs not empty at 90 min (P=1.0), 120 min (P=0.32), 150 min (P=0.11), 180 min (P=0.76) or 210 min (P=1.0). ConclusionsDespite early differences, clearance from the stomach of apple juice, 2% milk or Ensure Clear is similar at the terminal phase, which is the period of greatest relevance to preoperative fasting recommendations. The stomach is essentially clear by 3-3.5 h for all three drinks studied. The differentiation between liquids in current guidelines is not supported by this study. Clinical trial registrationclinicaltrials.gov NCT02938065 clinicaltrials.gov/ct2/show/NCT02938065.

Providing Oral Nutrition to Women in Labor: American College of Nurse-Midwives.

Historically, oral intake for women during labor has been limited to nothing by mouth or clear liquids only. These restrictions are based on the risk of aspiration during or after the administration of general anesthesia. While aspiration can be life threatening, older methods of anesthesia are rarely used in current intrapartum care, and evidence is inconclusive that withholding oral nutrition reduces the risk of gastric aspiration. Additionally, withholding oral nutrition may result in the development of ketosis and may potentially contribute to a woman's stress and dissatisfaction with the birth experience. The purpose of this Clinical Bulletin is to review the evidence related to this practice and provide recommendations to promote informed, shared decision making regarding oral intake during labor with women at low risk for gastric aspiration.

Two-Year Whey Protein Supplementation Did Not Enhance Muscle Mass and Physical Function in Well-Nourished Healthy Older Postmenopausal Women1–3

Background: Protein may play a role in preventing muscle loss with aging. To our knowledge, there have been no long-term randomized controlled trials to examine the effects of increased dietary protein intake on muscle health in community-dwelling older women.Objective: In this study, we evaluated the effects of whey protein supplementation on muscle mass and physical function in community-dwelling older Australian women.Methods: In this 2 y randomized, double-blind, placebo-controlled trial, women aged 70–80 y (mean 74.3 ± 2.7 y) were randomly assigned to either a high protein drink containing 30 g of whey protein (n = 109) or a placebo drink containing 2.1 g protein (n = 110) daily. Dual-energy X-ray absorptiometry appendicular skeletal muscle mass, upper arm and calf (38% tibia) muscle cross-sectional area, physical function including hand grip strength, lower limb muscle strength and Timed Up and Go test, and 24 h urinary nitrogen were measured at baseline, 1 y, and 2 y.Results: A total of 196 women with at least one follow-up measurement were included in this analysis. Baseline mean BMI was 26.7 ± 3.9 kg/m2 and protein intake was 76 ± 17 g/d (1.1 ± 0.3 g · kg body weight−1 · d−1). A mean increase in protein intake of ∼20 g/d in the protein group was confirmed by the estimates from 24 h urinary nitrogen. Over the 2 y in both groups there was a significant decrease in the upper arm (mean ± SE: −5.59 ± 0.75 cm2) and calf (−0.77 ± 0.11 cm2) muscle area, as well as hand grip strength (−1.30 ± 0.3 kg) (all P < 0.05), but appendicular skeletal muscle mass did not change significantly. There were no significant effects of the protein intervention on any of the muscle mass or physical function measures (all P > 0.05) at 1 and 2 y.Conclusion: This study showed that in protein-replete, healthy, ambulant, postmenopausal older women, 30 g/d of extra protein did not improve the maintenance of muscle mass or physical function despite evidence of deterioration in muscle measurements in the upper limb. This trial was registered at the Australian New Zealand Clinical Trials Registry as ACTRN012607000163404.

Maternal Outcomes in Women Supplemented With a High-Protein Drink in Labor

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Maternal outcomes in women supplemented with a high-protein drink in labour

Because of the potential aspiration risk, oral intake is restricted during labour. To determine whether high-protein drink supplementation in labour decreases nausea and emesis and promotes patient satisfaction. The study was registered with www.clinicaltrials.gov (NCT01414478). Labouring women were randomised into two groups: Group P received a high-protein drink (325 mL) with ice chips/water PRN; and Group C served as control and received only ice chips/water PRN (Study 1). Incidences of nausea and emesis were measured hourly until delivery and at 1 h postdelivery. Patient satisfaction was measured the following day. A secondary aim was to evaluate the rate of gastric emptying (t½ ) in women who ingested either 325 mL of a high-protein drink or ice chips/water (Study 2) using ultrasound. In Study 1, 150 women were recruited (Group P = 75; Group C = 75). There were no differences in the overall incidences of nausea (P = 0.14), emesis (P = 0.15) or in the incidences at the measured time periods (MANOVA, P > 0.05). Median patient satisfaction scores were higher in Group P than in Group C (P = 0.007). In Study 2, 18 additional patients (Group PG = 9; Group CG = 9) were analysed to determine US gastric emptying t½ rates (PG : 25.56 ± 15.90 min [95% CI: 15.17 - 35.94] compared with CG : 20.00 ± 8.70 min [95% CI: 14.34 - 25.66], P = 0.19). In labour, patient satisfaction is improved with high-protein drink supplementation compared with ice chips/water with comparable gastric emptying rates.

Perceived thickness and creaminess modulates the short-term satiating effects of high-protein drinks

Previous research suggests that increasing beverage protein content enhances subsequent satiety, but whether this effect is entirely attributable to post-ingestive effects of protein or is partly caused by the distinct sensory characteristics imparted by the presence of protein remains unclear. To try and discriminate nutritive from sensory effects of added protein, we contrasted effects of three higher-energy (about 1·2 MJ) and one lower-energy (LE: 0·35 MJ) drink preloads on subsequent appetite and lunch intake. Two higher-energy drinks had 44% of energy from protein, one with the sensory characteristics of a juice drink (HP2, low-sensory protein) and the second a thicker and creamier (HPþ, high-sensory protein) drink. The high-carbohydrate preload (HCþ, high-sensory carbohydrate) was matched for thickness and creaminess to the HPþ drink. Participants (healthy male volunteers, n 26) consumed significantly less at lunch after the HPþ(566 g) and HCþ(572 g) than after HP2 (623 g) and LE (668 g) drinks, although the compensation for drink energy accounted for only 50% of extra energy at best. Appetite ratings indicated that participants felt significantly less hungry and more full immediately before lunch in HPþ and HCþ groups compared with LE, with HP2 being intermediate. The finding that protein generated stronger satiety in the context of a thicker creamier drink (HPþ but not HP2) and that an isoenergetic carbohydrate drink (HCþ), matched in thickness and creaminess to the HPþ drink, generated the same pattern of satiety as HPþ, both suggest an important role for these sensory cues in the development of protein-based satiety.

Diet behavior and low hemoglobin level after laparoscopic mini-gastric bypass surgery.

Nutrition problems caused by laparoscopic mini-gastric bypass surgery (LMGB) include lack of iron, calcium and poor nutrition. Iron deficiency anemia is the common. The purpose of this study was to investigate why our patients' hemoglobin level was at a low value after surgery and the relationship between diet frequency, diet behavior, and low hemoglobin level. From January 2009 to April 2010, 120 patients who received laparoscopic mini-gastric bypass surgery were included in this study. Among all patients, there were 34 men and 86 women. Hemoglobin level of male patients less than 13mg/dL and that of female patients less than 11.5mg/dL was defined as anemia. The clinical characteristics and diet behavior were analyzed. The mean age was 30.9±10.5 years and the mean body mass index was 41.4±7.2kg/m2. Before and after surgery, the proportion of anemia was 4.1% and 26.6%, respectively. The proportion of anemia in females increased more than in males. Hemoglobin level after surgery showed positive correlation (p<0.05) with the diet frequency of high protein, sugar drinks with balanced formula, alcoholic drinks and exercise, but negative correlation (p<0.01) with iron supplements. The study concluded that patients after laparoscopic mini-gastric bypass surgery should increase the ingestion of high-protein drinks or food, alcoholic drinks and exercise, to prevent a low hemoglobin level.

The effects of a two-year randomized, controlled trial of whey protein supplementation on bone structure, IGF-1, and urinary calcium excretion in older postmenopausal women

The effects of dietary protein on bone structure and metabolism have been controversial, with evidence for and against beneficial effects. Because no long-term randomized, controlled studies have been performed, a two-year study of protein supplementation in 219 healthy ambulant women aged 70 to 80 years was undertaken. Participants were randomized to either a high-protein drink containing 30 g of whey protein (n = 109) or a placebo drink identical in energy content, appearance, and taste containing 2.1 g of protein (n = 110). Both drinks provided 600 mg of calcium. Dual-energy X-ray absorptiometric (DXA) hip areal bone mineral density (aBMD), 24-hour urinary calcium excretion, and serum insulin-like growth factor 1 (IGF-1) were measured at baseline and at 1 and 2 years. Quantitative computed tomographic (QCT) hip volumetric bone mineral density (vBMD) and a femoral neck engineering strength analysis were undertaken at baseline and at 2 years. Baseline average protein intake was 1.1 g/kg of body weight per day. There was a significant decrease in hip DXA aBMD and QCT vBMD over 2 years with no between-group differences. Femoral neck strength was unchanged in either group over time. The 24-hour urinary calcium excretion increased significantly from baseline in both groups at 1 year but returned to baseline in the placebo group at 2 years, at which time the protein group had a marginally higher value. Compared with the placebo group, the protein group had significantly higher serum IGF-1 level at 1 and 2 years (7.3% to 8.0%, p < .05). Our study showed that in protein-replete healthy ambulant women, 30 g of extra protein increased IGF-1 but did not have beneficial or deleterious effects on bone mass or strength. The effect of protein supplementation in populations with low dietary protein intake requires urgent attention.

Losing weight without dieting. Use of commercial foods as meal replacements for lunch produces an extended energy deficit

High-protein liquid meal replacements have proven to be effective in reducing caloric intake and body weight. Recently, substituting high fiber breakfast cereals for the more expensive high-protein drinks has been found to be equally effective to reduce weight. The following study tested the hypothesis that the mechanism responsible for the reduced intake was not the dietary composition of the meal replacement, but the controlled portion sized meals. Seventeen volunteers ate all of their meals and snacks from foods provided by the research unit from Monday to Friday for five consecutive weeks. For the first week, all participants selected their food from a buffet where each food was weighed before and after eating. For the next two weeks, half of the group selected their lunch by choosing one food from a selection of six commercially available portion controlled foods. They could eat as much as they wished at other meals or snacks. For final weeks four and five, the conditions were reversed for the two groups. Consuming the portion controlled lunches resulted in about a 250 kcal reduction in energy intake. More importantly, no sign of caloric compensation was evident across the 10 days of testing, an observation substantiated by a significant loss of body weight. The results suggest that the mere substitution of one smaller portioned meal each day is sufficient to cause reduction in daily energy intake and a significant amount of weight.

Dose-dependent effects of beverage protein content upon short-term intake

Protein is considered to be more satiating than carbohydrate, quantified by energy adjustment and subjective appetite. However, the effect of increasing protein content upon short-term energy adjustment in beverage contexts is unclear. This study used a repeated-measures, cross-over design. 28 male volunteers (18–35 years) ate a standard breakfast in the laboratory and 210min later consumed one of four preloads 30min prior to an ad libitum pasta meal. Three of the preloads were isocaloric (∼1155kJ) mixed composition dairy fruit drinks (300g) of low (13% protein energy/87% carbohydrate energy), medium (25% protein energy/75% carbohydrate energy) and high (50% protein energy/50% carbohydrate energy) protein content. The control drink was a low energy (328kJ) alternative. Results indicated a dose response effect of preload protein level on intake (g) at the ad libitum meal. Ad libitum intake was: control (637.6g±39.7), low (596.9g±40.5), medium (546.9g±34.7), and high protein (533.6g±42.3). 100% compensation was not achieved; however total energy intake after the medium and high protein drinks did not differ significantly from control. There were no significant differences in hunger and fullness ratings. Our findings support the view that increasing the protein composition of beverages relative to carbohydrate proportionally affects short-term subsequent intake in controlled conditions.

The impact of the covert manipulation of macronutrient intake on energy intake and the variability in daily food intake in nonobese men

To investigate the effect of macronutrient composition on ad libitum food intake in nonobese men. Balanced, incomplete-block, crossover study where subjects received two of three treatments. Macronutrient composition was manipulated by providing 2.1 MJ/day high-carbohydrate (CHO), high-fat (FAT), and/or high-protein (PRO) drinks every day over the course of two, 8-week periods. In all, 12 healthy normal weight men (age: 39+/-9 years, BMI: 24.1+/-1.4 kg/m2). Ad libitum food intake was measured continuously for 16 weeks at the Beltsville Human Nutrition Research Center (BHNRC). Body composition (DEXA) and body weight were also measured. Average energy intake (EI) during weeks 1 and 2 was lower for CHO than FAT (P<0.05), but this effect disappeared by week 3. EI during CHO increased by 11% from week 1 to 8 through the increased selection of carbohydrate and protein-containing foods, but not fat foods. Food intake was variable, both between and within subjects, but was not related to macronutrient composition. EI appears to be influenced by macronutrient composition in the short-term when diets are modified, but the effect dissipates in a few weeks if the diet is maintained. These data suggest the presence of macronutrient-specific regulatory mechanisms in the body, but do not support the notion that a high intake of any of the three macronutrients suppresses EI over a prolonged period of time. The high variability in food intake does not appear to be related to macronutrient composition.

Functionality of Succinylated Brazil Nut (Bertholletia excelsa HBK) Kernel Globulin

One of the possible ways to improve the utilisation of defatted Brazil nut kernel flour, a by-product of oil extraction industries, is to improve its functional properties by chemical modification as it possesses very modest functional characteristics. Succinylated Brazil nut kernel globulin at 55.8%, 62.4% and 72.0% level showed a positive effect on functionality. The solubility of acylated globulin was improved above pH 4.0 but was reduced in the pH range of 3.0-4.0. Water absorption (1.96-4.00, 4.12, and 4.21 ml/g protein), oil absorption capacity (1.44-2.72, 2.80 and 2.94 ml/g protein) and apparent viscosity of the succinylated globulin increased with increase in the level of succinylation. The extent of modification also influenced emulsifying capacity, which showed a decrease at pH 3.0, but was increased at pH 5.0,7.0 and 9.0. Highest emulsion activity (approximately 63.0%) was observed at pH 3.0, followed by pH 9.0 and pH 7.0 and, least (about 11.8%) at pH 5.0. Emulsion stability also followed similar behaviour as that of emulsion activity. The improved functional properties of succinylated Brazil nut kernel globulin could be explored in a variety of food formulations such as high protein drinks, soups, bakery and meat products as well as in salad dressings and mayonnaise as an emulsifier.

Infected Chylous Ascites Post Aortic Aneurysm Repair

A fit 71-year-old man underwent routine resection of a 5.8 cm infrarenal aneurysm with a tube graft. During the operation, the only abnormal finding was complex renal vein anatomy on the left side. Two or three branches required ligation before the neck of the aneurysm could be dissected and controlled. Postoperatively, he initially made good progress. On the 7th postoperative day, he was noted to have a white cell count of 23.6, which had doubled from two days previously. However, he had no pyrexia and was well. He was started empirically on intravenous cefuroxime and metronidazole. He was discharged home on the 12th post-operative day to be reviewed in outpatients in a month. Eight days later, he was readmitted as an emergency with a three-day history of epigastric pain. On examination the vital signs were normal. He had a soft, mildly distended abdomen with vague tenderness in the epigastrium. Investigations revealed a dilated loop of small bowel in the epigastrium, a raised white cell count of 19.4 (neutrophilia) and an ESR of 94. CT revealed a fluid collection with features suggesting infection around the aorta and the graft (Fig. 1). The collection was drained percutaneously and specimens sent for culture. Antibiotics were continued. Following this, the patient’s condition improved. The fluid was initially cloudy and blood stained and drained approximately 750 ml per day. Subsequently the drainage became clear and biochemistry revealed that the fluid was high in amylase, and was likely to be lymph. Culture of the fluid revealed coliforms and Klebsiella, and further antibiotics were given. The decision was made to allow the patient home, but to continue antibiotics for 6 weeks via a Hickman line. One month later (two months after the original operation) he was readmitted because of problems with the drain. This was reinserted, and culture now revealed Candida infection. He was not symptomatic, but was placed on a course of Fluconazole. He was discharged home after 2 days. Prior to this, he was seen by the dietician, who prescribed high protein drinks and he was advised to eat little and often. The drain continued to drain about 500 ml per day. Four months after the operation, he remained well, and his antibiotics were stopped. Six months after his original operation, the drainage was still approximately 300 ml per day, but the last three cultures showed no evidence of infection (for a total of 2 months). Throughout this period, the patient had remained well, and had maintained his serum albumin level. The drain was removed at this point, leaving a percutaneous fistula. Two weeks later, all drainage through the fistula had ceased. A CT scan showed complete resolution of the collection. EJVES Extra 7, 24–25 (2003) doi: 10.1016/S1533-3167(03)00099-2, available online at http://www.sciencedirect.com on

Determination of Ephedrine Alkaloids in Botanicals and Dietary Supplements by HPLC-UV: Collaborative Study

An international collaborative study was conducted of a high-performance liquid chromatography (HPLC)-UV method for the determination of the major (ephedrine [EP] and pseudoephedrine [PS]) and minor (norephedrine [NE], norpseudoephedrine [NP], methylephedrine [ME], and methylpseudoephedrine [MP]) alkaloids in selected dietary supplements representative of the commercially available products. Ten collaborating laboratories determined the ephedrine-type alkaloid content in 8 blind replicate samples. Five products contained ephedra ground herb or ephedra extract. These 5 products included ground botanical raw material of Ephedra sinica, a common powdered extract of Ephedra sinica, a finished product containing only Ephedra sinica ground botanical raw material, a complex multicomponent dietary supplement containing Ma Huang, and a high-protein chocolate flavored drink mix containing Ma Huang extract. In addition, collaborating laboratories received a negative control and negative control spiked with ephedrine alkaloids at high and low levels for recovery studies. Test extracts were treated to solid-phase extraction using a strong-cation exchange column to help remove interferences. The HPLC analyses were performed on a polar-embedded phenyl column using UV detection at 210 nm. Repeatability relative standard deviations (RSDr) ranged from 0.64-3.0% for EP and 2.0-6.6% for PS, excluding the high protein drink mix. Reproducibility relative standard deviations (RSDR) ranged from 2.1-6.6% for EP and 9.0-11.4% for PS, excluding the high protein drink mix. Recoveries ranged from 84.7-87.2% for EP and 84.6-98.2% for PS. The data developed for the minor alkaloids are more variable with generally unsatisfactory HORRATS (i.e., >2). However, since these alkaloids generally add little to the total alkaloid content of the products, the method gives satisfactory results in measuring total alkaloid content (RSDr 0.85-3.13%; RSDR 2.03-10.97%, HORRAT 0.69-3.23, exclusive of the results from the high protein drink). On the basis of these results, the method is recommended for Official First Action for determination of EP and PS in dietary supplements exclusive of the high protein drinks.