High-protein Supplement Research Articles

Metabolic Responses to Early and High Protein Supplementation in a Randomized Trial Evaluating the Prevention of Hyperkalemia in Extremely Low Birth Weight Infants

Metabolic Responses to Early and High Protein Supplementation in a Randomized Trial Evaluating the Prevention of Hyperkalemia in Extremely Low Birth Weight Infants

Testing the effect of specific orders to provide oral liquid nutritional supplements to nursing home residents: a quality improvement project.

To improve nursing home (NH) staff delivery of oral liquid nutritional supplements between meals to residents with a history of weight loss. Pre-Post intervention study. Two skilled nursing homes. Eighteen long term care residents. At baseline all participants had a non-specific physician's order to receive a nutritional supplement. The intervention consisted of specifying the physician's order as follows: "Give 4 oz high protein supplement at 10 am, 2 pm, and 7 pm". Research staff conducted direct observations for two days during and between meals for a total of 4 days, or 12 possible observation periods per participant before and one week following the intervention. Research staff documented NH staff delivery of snacks (including high protein supplements) and amount consumed (fluid ounces) for the high protein supplements using a standardized protocol during each observation period. Before the specific order was written participants were offered any type of snack an average of 1.82 times per day and a high protein supplement 0.59 times per day. After the specific order was written participants were offered any type of snack an average of 1.59 times per day and a high protein supplement 0.91 times per day. There were no statistically significant differences in the average number of times snacks or supplements were offered before and after the specific order was written. The proportion of snacks offered that were high protein supplements did increase after the specific order was written (p<0.001). When a high protein supplement was provided, most residents consumed 100% of it. Oral liquid nutritional supplements were not provided consistent with orders in NH practice. The specificity of the order related to type of supplement and time of delivery did not influence when and how often supplements are provided to residents but it did influence the type of nutritional supplement offered.

Evaluation of high-protein supplementation in weight-stable HIV-positive subjects with a history of weight loss: a randomized, double-blind, multicenter trial

Background:HIV patients with wasting are at increased risk of opportunistic complications and fatality. Objective:We hypothesized that augmenting dietary intake with high-biologic-value protein would enhance weight and lean tissue in weight-stable subjects with a prior unintentional weight loss of >3%. Design:Fifty-nine subjects with HIV RNA concentrations <5000 copies/mL were randomly assigned to receive a 280-kcal supplement containing 40 g whey protein or a matched isocaloric control supplement without added protein twice daily for 12 wk. Results:Before the study, intake of total energy and protein exceeded estimated requirements (44.3 ± 12.6 kcal · kg−1 · d−1 and 1.69 ± 0.55 g · kg−1 · d−1, respectively). Both supplements failed to increase total energy intake because of decreases in self-selected food intake. Changes in weight (0.8 ± 2.4 and 0.7 ± 2.4 kg) and lean body mass (0.3 ± 1.4 and 0.3 ± 1.5 kg) did not differ significantly between the whey protein and control groups, respectively. Waist-to-hip ratio improved more with whey protein (−0.02 ± 0.05) than with the control (0.01 ± 0.03; P = 0.025) at week 6 but not at week 12. Fasting triacylglycerol increased by 39 ± 98 mg/dL with the control supplement and decreased by 16 ± 62 mg/dL with whey protein at week 12 (P = 0.03). CD4 lymphocytes increased by 31 ± 84 cells/mm3 with whey protein and decreased by 5 ± 124 cells/mm3 with the control supplement at 12 wk (P = 0.03). Gastrointestinal symptoms occurred more often with whey protein. Conclusions:A whey protein supplement did not increase weight or lean body mass in HIV-positive subjects who were eating adequately, but it did increase CD4 cell counts. The control supplement with rapidly assimilable carbohydrate substituted for protein increased cardiovascular disease risk factors. Careful dietary and weight history should be obtained before starting nutritional supplements in subjects with stable weight loss and good viral control.

Effects of branched-chain amino acids supplementation on physiological and psychological performance during an offshore sailing race

The aim of the present study was to investigate the effect of protein diets, rich in branched chain amino acids (BCAA) on perceived exertion, mental and physical performance during an offshore sailing race that lasted 32 h. Twelve sailors were randomly allocated into one of two groups [Control (CON) and BCAA: n = 6/group]. The BCAA group consumed a standard diet of 11.2 MJ day(-1) (58% carbohydrate, 30% fat, 12% Protein) along with a high-protein supplement of 1.7 MJ day(-1) (40% carbohydrate, 35% protein, 25% fat) and 1.7 MJ day(-1) composed of 50% valine, 35% leucine, and 15% isoleucine. CON was given a standard diet of 14.5 MJ day(-1) (58% carbohydrate, 30% fat and 12% protein). During the race, heart rate was monitored. Subjects self-evaluated their feeling of fatigue every 3 h, and 12 samples of saliva from each subject were collected to perform cortisol assays. Before and after the race a vertical jump and a handgrip test were performed, and mental performance was evaluated with a standardized battery of tests. A significant increase in the feeling of fatigue was noted on the second day (D2) of race in both groups; the increase was higher in CON (P < 0.05). For both groups, salivary cortisol concentration followed a nycthemeral rhythm, with an alteration during the race as evidenced by high midnight cortisol levels between D1 and D2, and significantly decreased cortisol levels observed on D2 (P < 0.05). There was no change in physical performance at the end of the race in both groups. As a significant decrease (P < 0.05) in short-term memory performance was observed only in the CON group. These data indicate that an offshore sailing race enhances the feeling of fatigue, and decreases short-term memory performance. These detrimental consequences are reduced by a high-protein diet with BCAA.

Avaliação morfológica dos testículos de ovinos jovens santa inês submetidos a diferentes regimes de suplementação alimentar e vermifugação

The present study investigated the effect of protein supplementation and parasite load in relation to testicular morphology, in young Santa Ines male sheep. Twenty-four male lambs, non-castrated, were distributed in four treatments: HPd (dewormed animals + diet with high protein), HPn (animals non dewormed + diet with high protein), LPd (dewormed animals + diet with low protein), LPn (animals not dewormed + diet with low protein) during eight months. At the end of the experiment histological cuts of testicles were taken and cell count analyzed by computer and the program IMAGE PRO-PLUS was used for evaluation of measurements of the seminiferous tubules. The following results were found: LPn presented larger number of spermatogonias, but a reduced number of the other cells parameters (Sertoli cells, spermatocytes, spermatids and spermatozoa) and smaller diameter and circumference of the seminiferous tubules and shorter seminiferous epithelium when compared to other treatments. There was a significant correlation among tubules diameter of the epithelium height and tubules circumference. Correlations between lumen diameter and lumen circumference, as well as epithelium height and tubules circumference also presented high and positive correlations (r>0.70). When the external testis parameters were compared with internal parameters no significant correlation was observed (r<0.50). In conclusion, high protein supplementation positively influences spermatogenesis, and non-deworming associated with a poor protein diet worsens almost all reproductive parameters of young Santa Ines rams. KEY WORDS: Morphology, nutrition, ovine, parasites, testicular morphometrics.

Metabolic Responses to Early and High Protein Supplementation in a Randomized Trial Evaluating the Prevention of Hyperkalemia in Extremely Low Birth Weight Infants

To determine whether early and higher intravenous amino acid (EHAA) supplementation decreases hyperkalemia in extremely low birth weight (ELBW) infants (<1000 g). Infants were enrolled at birth in a randomized, double-masked, prospective fashion and treated for 7 days. The standard group (SAA) infants received intravenous amino acid (AA) starting at 0.5 g x kg(-1) x d(-1) and increased by 0.5 g x kg(-1) every day to a maximum of 3 g x kg(-1) x d(-1). EHAA group infants received 2 g x kg(-1) x d(-1) of AA soon after birth and advanced by 1 g x kg(-1) every day to 4 g x kg(-1) x d(-1). Data analysis was by SPSS 11.5, with statistical significance at alpha = 0.05 and 90% power to determine a difference in mean K(+) level of 2. Sixty-two patients, mean gestational age of 26.0 +/- 2.0 weeks and birth weight of 775 +/- 136 g, were enrolled. Hyperkalemia (K(+) > or =6.5 mEq/L) occurred in 13% of the studied population; no difference in incidence of hyperkalemia was found between the SAA and EHAA groups (16% vs 10%, respectively, P = .70). Serum blood urea nitrogen was higher in the EHAA group. AA infusion was stopped early in 6 patients for high blood urea nitrogen or elevated ammonia level. During the study period, hyperkalemia decreased significantly and was not affected by EHAA supplementation in the first week of life.

Potential Value of Acridids as High Protein Supplement for Poultry Feed

It is well known that acridids are an attractive and important natural source of food for many kinds of vertebrate animals, including birds, lizards, snakes, amphibians, fish and other mammals. Despite that they drew very few research attentions as feed for domesticated animals, particularly poultry, swine and freshwater fish. In the present study energy estimation and proximate analysis were conducted for four acridid species in order to determine the nutritional quality of those species and their potential value as an alternative animal protein source. The experiment revealed acridids to have a higher amount of protein content in compared to the conventional soybean and fish meals. A high amount of caloric contents were also evident in the chosen acridids. The most important conclusion of this study was that the acridids can provide a reliable and sustainable source of high quality animal protein for domesticated animals.

Three month intervention with protein and energy rich supplements improve muscle function and quality of life in malnourished patients with non-neoplastic gastrointestinal disease—A randomized controlled trial

Malnutrition is a common problem in patients with digestive disease and is associated with impaired outcome. We investigated the effect of a three-month post-hospital nutritional intervention with high protein and energy supplements on body composition, muscle function and quality of life (QoL) in malnourished GI patients. Eighty malnourished patients with benign digestive disease were randomized to receive either oral nutritional supplements (ONS) for three months in addition to dietary counselling (DC) (ONS patients) or only dietary counselling (DC patients). Nutritional status was determined with the subjective global assessment, body composition by bioelectrical impedance and anthropometry, muscle function with hand-grip strength and peak flow. QoL was assessed by the 36-item short-form questionnaire. Age, body cell mass (BCM), muscle function, gender distribution and QoL did not differ between ONS patients (n=38) and DC patients (n=42) at baseline. Body weight and BCM improved significantly in both groups after three months. However, hand-grip strength (26.1+/-11.3-31.5+/-10.1 kg, p<0.0001) and peak flow (329.2+/-124.0-388.9+/-108.4 l /min, p=0.004) improved only in the ONS patients and remained unchanged in the DC patients. Similarly, all eight scales of the QoL improved in the ONS patients compared with merely three in the DC patients. DC patients experienced significantly more readmissions (n=20) than ONS patients (n=10) during the study period (p=0.041). A three month intervention with high protein oral supplements improves outcome in malnourished patients with digestive disease in terms of functional status, QoL and rehospitalization.

The effect of high and low dietary crude protein and inulin supplementation on nutrient digestibility, nitrogen excretion, intestinal microflora and manure ammonia emissions from finisher pigs

A 2 × 2 factorial experiment was performed to investigate the interaction between a high- and low-crude-protein (CP) diet (200 v. 140 g/kg) and inulin supplementation (0 v. 12.5 g/kg) on nutrient digestibility, nitrogen (N) excretion, intestinal microflora, volatile fatty acid (VFA) concentration and manure ammonia emissions from 24 boars (n = 6, 74.0 kg live weight). The diets were formulated to contain similar concentrations of digestible energy and lysine. Pigs offered the high-CP diets had a higher excretion of urinary N (P < 0.001), faecal N (P < 0.01) and total N (P < 0.001) than the pigs offered the low-CP diets. Inulin supplementation increased faecal N excretion (P < 0.05) and decreased the urine N : faeces N ratio (P < 0.05) compared with the inulin-free diets. There was no effect (P > 0.05) of dietary treatment on N retention. There was an interaction (P < 0.05) between dietary CP concentration and inulin supplementation on caecal Enterobacteria spp. Pigs offered the diet containing 200 g/kg of CP plus inulin decreased the population of Enterobacteria spp. compared to those with the inulin-supplemented 140 g/kg CP diet. However, CP level had no significant effect on the population of Enterobacteria spp. in the unsupplemented diets. Inulin supplementation increased caecal Bifidobacteria (P < 0.01) compared with the inulin-free diets. There was no effect of inulin supplementation on VFA concentration or intestinal pH (P > 0.05). Pigs offered the 200 g/kg CP diets had higher (P < 0.05) manure ammonia emissions from 0 to 240 h of storage than pigs offered the 140 g/kg CP. In conclusion, inulin supplementation resulted in an increase in Bifidobacteria concentration and a reduction in Enterobacteria spp. at the high CP level indicating that inulin has the ability to beneficially manipulate gut microflora in a proteolytic environment.

Staff Measures Limit Risk of Underhydration

Staff Measures Limit Risk of Underhydration

Supplemental energy and protein increase use of sagebrush by sheep

The ability of sheep to consume big sagebrush ( Artemisia tridentata Nutt.), a shrub that contains terpenes, may be improved with supplemental energy and protein needed for detoxification processes. We compared feeding behavior of supplemented and unsupplemented ewes grazing separately in three 0.5 ha plots of 40 m × 120 m during October 2001. Supplemented ewes were offered a choice of a high-energy (50% corn and 50% beet pulp—3.62 Mcal/kg DE and 9.5% CP) and a high-protein (85% alfalfa and 15% soybean meal—2.89 Mcal/kg DE and 15% CP) supplement for 15 min/day. Supplemented ewes consumed 492 g (S.E. = 24.3) of the high-energy supplement and 140 g (S.E. = 9.8) of the high-protein supplement. The incidence of feeding on sagebrush was recorded using scan sampling at 10-min intervals from 09:00 to 17:00 h every other day for 10 days. Incidence of feeding on sagebrush increased gradually for both treatments from 0.4% on day 1 to 28% on day 10 ( P < 0.01), but supplemented ewes increased feeding frequency on sagebrush to nearly twice that of unsupplemented ewes by the end of the trial. Averaged throughout the trial, incidence of eating sagebrush was twice as high for supplemented compared to unsupplemented ewes (22% versus 11% of the total time feeding, P < 0.01). The results of this study show that supplemental macronutrients increase use of sagebrush by ewes. Thus, strategic supplementation during fall and winter may be a way to increase intake of sagebrush by sheep and enhance and maintain biodiversity in areas of the sagebrush steppe where sagebrush is deemed too abundant.

Feed intake, growth, plasma glucose and urea nitrogen concentration, and carcass traits of lambs fed isoenergetic amounts of canola meal, soybean meal, and fish meal with forage based diet

This experiment was conducted to examine the effect of feeding small, isoenergetic amounts of supplements containing high protein and functional lipid components, rather than the greater amounts of cereal and/or legume grains usually fed during the dry season in Australia, on dry matter intake (DMI), growth performance, plasma metabolites, and fat deposition in lambs consuming low quality roughage. Thirty two crossbred wether lambs ([Merino × Border Leicester] × Poll Dorset) were divided into four groups by stratified randomization according to liveweight (26–33 kg). After a 7-day adaptation to a hay diet (lucerne hay:oaten hay; 30:70), lambs were allocated to four treatments consisting of (1) basal diet of lucerne hay:oat hay (20:80; metabolizable energy (ME) = 7.0 MJ/kg DM), Basal; (2) basal + canola meal (84 g per day), CM; (3) basal + soymeal (75 g per day), SM; or (4) basal + fishmeal (80 g per day), FM. Daily hay and supplement DMI, and weekly liveweight were recorded during a 53-day experimental study. Blood samples were taken on day 1 and pre- and post-feeding on days 30 and 53 to measure changes in plasma glucose and plasma urea nitrogen (PUN) concentration. At the end of the experiment, lambs were slaughtered and hot carcass weight (HCW) recorded; cold carcass fatness (total muscle and adipose tissue depth at 12th rib, 110 mm from midline; GR) was determined at 24 h postmortem. Total DMI was increased ( P < 0.001) in CM, SM and FM treatments, but basal hay DMI intake was only increased ( P < 0.01) in CM and FM treatments compared with Basal treatment. This resulted in significant ( P < 0.01) increases in metabolizable energy (ME) and crude protein (CP) intakes in all supplemented treatments, with the highest intakes recorded in the FM treatment. Liveweight gain (LWG) was significantly increased in CM and SM ( P < 0.05) and FM ( P < 0.01) treatments but HCW was significantly ( P < 0.01) heavier slaughter only in the FM treatment. Feed conversion efficiency ( P < 0.001) and GR fat at depth ( P < 0.05) was reduced in all supplement treatments compared with Basal. Plasma glucose concentration was significantly ( P < 0.05) increased after feeding in all treatments but there was no treatment effect. PUN was significantly increased over time in the supplemented treatments compared with the Basal treatment; there was no significant difference between supplement treatments by day 53. Results show that feeding small amounts of high protein and lipid-containing supplements improves production responses and are beneficial in producing carcasses with more lean compared with carcasses from lambs fed a low quality hay diet.

Binge eating and satiety in bulimia nervosa and binge eating disorder: Effects of macronutrient intake

The current study tested the hypothesis that supplemental dietary protein would reduce binge eating frequency and test meal intake in women with bulimia nervosa (BN) or binge eating disorder (BED). Eighteen women with BN or BED ingested high-carbohydrate or high-protein supplements (280 kcal) three times daily over two 2-week periods. On the morning after each period, participants were given a high-protein or high-carbohydrate supplement (420 kcal) 3 hr before an ad libitum meal. Binge eating episodes occurred less frequently during protein supplementation (1.12 episodes per week) than during carbohydrate supplementation (2.94 episodes per week) or baseline (3.01 episodes per week). Participants reported less hunger and greater fullness, and consumed less food at test meals, after protein than after carbohydrate (673 vs. 856 kcal). Adding protein to the diets of women with BN and BED reduced food intake and binge eating over a 2-week period. These findings may have implications for the longer-term treatment of these disorders.

Provision of high-protein supplement for patients recovering from hip fracture

Objective We compared clinical outcomes with a standard (Ensure) or a high-protein (Boost HP) liquid nutritional supplement for older adults recovering from hip fracture surgery in a rehabilitation hospital. Methods This randomized, double-blind, parallel-group study compared the clinical effectiveness of a standard (Ensure) with a high-protein (Boost HP) liquid nutritional supplement among patients ( n = 46) 60 y or older who recently underwent surgical repair of a hip fracture. Patients were encouraged to drink at least two 8-oz cans (17.8 g/d protein for Ensure versus 30 g/d protein for Boost HP) per day for 28 d. Study measurements included change in Functional Independence Measure between rehabilitation admission and discharge, length of rehabilitation stay, laboratory measures (i.e., serum albumin, prealbumin, and C-reactive protein), physical activity energy expenditure by 7-d triaxial accelerometry, and dietary intake by three random, telephonic, 24-h dietary recalls. Results There were no significant group differences with respect to age, sex, acute hospital days, hip fracture assessment parameters, or surgical treatment. Consumption of supplement (260 oz/28 d of Ensure versus 239 oz/28 d of Boost HP) was comparable. There were no differences in complication or adverse event rates during the study. The Boost HP group consumed more protein than the Ensure group (63 versus 50 g, P < 0.048) and had a greater improvement in serum albumin over the 28-d supplementation period (+0.7 versus +0.2 g/dL, P < 0.019). The Boost HP group also consumed more fiber (12 versus 8 g), calcium (821 versus 639 mg), vitamin K (66 versus 45 μg), and phosphorus (1035 versus 833 mg) than did the Ensure group. Rehabilitation length of stay was shorter in the Boost HP than in the Ensure group, although this trend did not reach statistical significance (23 versus 28 d, P = 0.27). Outcome differences were not detected in the Functional Independence Measure. Conclusions Supplementation was well tolerated in this population and contributed significantly to total dietary intake. Consumption of a high-protein liquid nutritional supplement may offer some benefits by improving visceral protein status.

Influence of fall protein supplementation with a self-fed liquid supplement on performance of beef cows grazing tallgrass prairie range (2004)

We evaluated the effect of providing a liquid, high-protein supplement during the fall grazing period on beef cow and calf performance. Mature, pregnant, spring-calving cows (n=122) grazing native range were assigned to supplementation treatments. All calves were weaned on October 15. Control cows received no fall supplementation and then were handfed a dry supplement (40% crude protein; asfed basis) from December 17 until calving. Supplemented cows were either allowed access to a liquid protein supplement (40% crude protein; as-fed basis) approximately 2 months before weaning until calving (fall supplementation from August 14 to December 17) or from weaning until calving (fall supplementation from October 15 to December 17). Supplement intake of the control cows from December 17 until calving was adjusted to match the estimated supplement intake of the liquid-fed groups and was prorated and fed 3 days/week. Supplementation was terminated upon calving, at which time all cows were treated similarly. Provision of liquid supplement during the fall increased cow body weight and body condition in the postweaning period. However, cows not supplemented during the fall phase were able to overcome their lesser previous nutrition when they were suitably supplemented during the winter phase. The pre-weaning rate of gain of calves was not affected by fall supplementation. Calves produced by cows receiving no fall supplementation gained more weight from birth to the start of the summer grazing season. Subsequent pregnancy rate was not affected by fall supplementation.

Chicken extract affects colostrum protein compositions in lactating women

This study investigated the effect of supplementation with chicken extract on plasma and colostrum protein compositions in lactating women. Thirty healthy pregnant women were evenly divided into the control ( n = 15) or chicken extract (CE) group ( n = 15). The CE group was given one bottle (70 mL/bottle) of chicken extract three times a day to provide 18 g protein from the 37th week pregnancy to 3 days postpartum. All women in the CE group consumed chicken extract at least for 2 weeks (18 ± 5 days). High protein supplement was restricted in the control group. Blood samples were collected during the 37th week pregnancy and 3-day postpartum, and milk was collected during 3-day postpartum. The results showed that plasma total protein was significantly lower by 14% in the CE group compared with that in the control group during 3-day postpartum. Plasma epidermal growth factor (EGF) significantly elevated by 236% during 3-day postpartum compared with those during the 37th week pregnancy in the CE group. The levels of lactoferrin, EGF, and transforming growth factor-β2 (TGF-β2) in colostrum significantly increased by 34%, 62%, and 196%, respectively, in the CE group compared with those in the control group. However, the levels of total protein, casein, lactalbumin, and secretory immunoglobulin A in colostrum did not significantly differ between two groups. Therefore, supplementation with chicken extract increased colostrum levels of lactoferrin, EGF, and TGF-β2, which are important for the growth and immune functions of the infants, in lactating women. Keywords: chicken extract, human colostrum, lactoferrin, epidermal growth factor, transforming growth factor-β2

High protein and iron-folate crackers supplementation on the iron status of pregnant women

Previous studies have revealed that several factors influenced the relatively low success of iron supplementation for pregnant women. The factors included poor distribution, low coverage and compliance, as well as low absorption. The aim of this study is to measure the iron status of pregnant women after consuming crackers containing fish powder and iron-folate. This study was carried out in the Purworejo district (Central Java) from February through October 2002. Using a randomized controlled trial (RCT) design, 70 pregnant women in their second-third month of pregnancy were recruited, and divided into two groups. Ten women dropped out during the study. The first group consisted of 28 women were given protein – iron enriched crackers (PIEC group), while the second group of 32 women were given iron–enriched crackers (IEC group) for a total of 12 weeks. The results showed that the hemoglobin (Hb) levels and serum transferrin receptors (sTfR) of both groups were increased. Serum ferritins (SF) of both groups were decreased. At the end of the study, the increase in Hb and sTfR levels between the two groups were significantly different, while the decrease in SF was not significantly different. Animal protein from fish powder tended to improve absorption of non-heme iron among pregnant women, resulting in improved Hb and sTfR levels. (Med J Indones 2003; 12: 243-6)

EFFECT OF FOOD SUPPLEMENTATION ON JUVENILE GROWTH AND SURVIVAL IN MARMOTA FLAVIVENTRIS

Abstract We provided 2 social groups of yellow-bellied marmots (Marmota flaviventris) with 2 types of supplemental feed (high and low protein) to test hypotheses about effects of food abundance and quality on juvenile growth rates and survival. Both supplemented litters and reference litters ceased to gain body mass by 2 weeks before hibernation even though supplemented litters had access to supplemental food. Body mass at weaning did not differ significantly between the 2 groups, but supplemented young had significantly higher growth rates (21.4–48.7 g/day) than reference young (24.1–33.3 g/day) and therefore had higher body mass late in the season. Juveniles that received high-protein supplements grew faster than the low-protein group. The addition of high-protein feed did not increase survival; however, juveniles that received low-protein feed were more likely to survive. Juveniles with higher body mass were not more likely to survive. Marmots must reach a critical body mass to survive hibernation and ...

Nutritional Interventions during Pregnancy for the Prevention or Treatment of Impaired Fetal Growth: An Overview of Randomized Controlled Trials

This paper reviews the efficacy of nutrition interventions to prevent or treat impaired fetal growth. Searches were made for Cochrane systematic reviews and randomized controlled trials published before October 2002. Balanced protein energy supplementation reduced the risk of small for gestational age (SGA) by 30% (95%CI: 20% to 43%) while one trial conducted in New York, U.S., reported a negative effect of high protein supplementation on SGA (RR 1.58; 95%CI: 1.03-2.41). Calcium supplementation protected against low birth weight (RR 0.83; 95%CI: 0.71-0.98). Micronutrient supplements did not affect birth weight, except for magnesium supplementation, which reduced the risk of SGA by 30%. This finding, however, needs or be interpreted with caution because of methodological issues in the data analysis. Programmatic recommendations can be made only for intervening with balanced protein energy supplements, especially in population with a high prevalence of undernutrition. Research is needed to determine the efficacy of multiple micronutrient supplementation and the effect of single micronutrients supplementation on specific growth outcomes such as fetal organ and bone growth. In addition, the public health relevance of these outcomes and their relation to morbidity need to be evaluated.

Effects of voluntary resistance exercise and high-protein snack on bone mass, composition, and strength in rats given glucocorticoid injections.

We examined the effects of a voluntary resistance exercise (climbing) together with high-protein snacks (60% protein) on bone mass and strength in rats given glucocorticoid-injections (2 mg/kg/day) as a model of age-related osteopenia. Fifty-two male Sprague-Dawley rats, 8 weeks age, were assigned to exercise or sedentary groups. These groups were further divided into groups that received no snack, snack during activity or a snack during rest. All groups were meal-fed 7:30-8:30 h and 19:30-20:30 h and the snack was fed 23:30-0:30 h (active) or 11:30-12:30 h (resting). Energy and protein intake were approximately equal in all groups. The exercise groups were allowed to climb a wire-mesh tower cage (phi 20 cm x 200 cm) to drink water from a bottle set at the top. Weight gain during the 8-week experimental period was inhibited by a glucocorticoid-injection. Bone mass and strength were increased by climbing exercise with a high-protein snack, while no effect of snack nor any effect of snack timing was observed. Bone weight, calcium content and protein content were positively correlated to maximum load or structural stiffness. These results suggest that resistance exercise and high-protein supplementation may be a preventive therapy for osteoporosis associated with aging.