High Protein Supply Research Articles

Early supplemental parenteral nutrition for the achievement of nutritional goals in subarachnoid hemorrhage patients: An observational cohort study.

PurposeEnteral nutrition (EN) often fails to achieve nutritional goals in neurocritical care patients. We sought to investigate the safety and utility of supplemental parenteral nutrition (PN) in subarachnoid hemorrhage (SAH) patients.Materials and methodsData of 70 consecutive patients with non-traumatic SAH admitted to the neurological intensive care unit of a tertiary referral center were prospectively collected and retrospectively analyzed. We targeted the provision of 20–25 kilocalories per kilogram bodyweight per day (kcal/kg/d) by enteral nutrition. Supplemental PN was given when this target could not be reached. Nutritional data were analyzed for up to 14 days of ICU stay. Hospital complications were tested for associations with impaired enteral feeding. The amounts of EN and PN were tested for associations with the level of protein delivery and functional outcome. Repeated measurements within subjects were handled utilizing generalized estimating equations.ResultsForty (27 women and 13 men) of 70 screened patients were eligible for the analysis. Median age was 61 (IQR 49–71) years, 8 patients (20%) died in the hospital. Thirty-six patients (90%) received PN for a median duration of 8 (IQR 4–12) days. The provision of 20 kcal/kg by EN on at least 1 day of ICU stay was only achieved in 24 patients (60%). Hydrocephalus (p = 0.020), pneumonia (p = 0.037) and sepsis (p = 0.013) were associated with impaired enteral feeding. Neither the amount nor the duration of PN administration was associated with an increased risk of severe complications or poor outcome. Supplemental PN was associated with significantly increased protein delivery (p<0.001). In patients with sepsis or pneumonia, there was an association between higher protein delivery and good functional outcome (p<0.001 and p = 0.031), but not in the overall cohort (p = 0.08).ConclusionsEnteral feeding was insufficient to achieve nutritional goals in subarachnoid hemorrhage patients. Supplemental PN was safe and associated with increased protein delivery. A higher protein supply was associated with good functional outcome in patients who developed sepsis or pneumonia.

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

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

Nutritional support therapy during treatment of chronic critical illness

Chronic critical illness (CCI) refers to a group of critically ill patients who survive the acute phase of intensive care, but with persistent organ dysfunction, thus entering a chronic period of continuous dependence on life support system, and still need to stay in intensive care unit (ICU) for a long time. Persistent inflammatory response-immunosuppression-catabolic syndrome (PICS) is the main pathophysiological feature of CCI. Three factors interact to form a vicious circle, leading to poor prognosis. Nutritional support therapy is a key link in the comprehensive treatment of CCI. Enteral nutrition (EN) should be started as soon as possible if conditions permit. If EN can not be implemented, temporary or transitional parenteral nutrition (PN) should be used, and EN should be added gradually in time. At the same time, the amount of PN should be gradually reduced. When EN meets more than 60% of patients' energy and protein requirements, PN can be considered to be discontinued. The main strategies and functions of CCI nutritional support therapy are as follows: strengthening high protein supply to correct negative nitrogen balance and inhibit catabolism, selecting branched chain amino acids (BCAA) to promote anabolism, using immunomodulators (arginine, ω3 polyunsaturated fatty acids) to improve immune suppression and inflammatory response, supplementing micronutrients (vitamins and trace elements) to counteract the decrease in intake and the increase in consumption, and adding probiotics to maintain the intestinal microecological balance, and so on. Reasonable nutritional support therapy not only improve malnutrition of CCI patients, but also help to reduce complications, thus speeding up rehabilitation, improving prognosis, shortening ICU hospitalization time, and even reducing mortality.

Effect of gestational protein deficiency and excess on hepatic expression of genes related to cell cycle and proliferation in offspring from late gestation to finishing phase in pig

Maternal diet during gestation is known to affect offspring phenotype induction. In the present study the influence of maternal protein restriction and excess during gestation on offspring candidate gene expression was analysed. German Landrace gilts were fed control, low protein (LP) or high protein (HP) diet throughout gestation (n = 18 per diet group). After birth piglets were cross-fostered and lactated by control diet fed nursing sows. Samples of offspring liver tissue were taken at foetal, newborn, weaning and finishing phase (n = 16, respectively). Transcript amount of selected candidate genes related to cell cycle and cell proliferation was estimated by quantitative real-time PCR. Maternal protein restriction influenced gene expression of candidate genes CCND2, GADD45B, GALK1, GSTP1, MARCKS, MGMT, NEAT1, PSEN1, SNX1 and TRPM7 in liver from foetuses, newborn piglets, weaned and/or finisher pigs. In the offspring of mothers fed a HP diet expression of target genes was affected exclusively in finisher pigs showing increased transcript amount of CCND2, GALK1, MARCKS, SNX1 and TRPM7. The results of the present study clearly show a long-lasting impact of the maternal protein supply during gestation on offspring candidate genes. Remarkably, effects of gestational HP diet became evident in finisher pigs while LP supply already alters genes expression in foetal tissue. Thus it is suggested that LP and HP supply affect the offspring in utero by different physiological mechanisms with the consequence of late effects in case of prenatal protein excess in contrast to early effects in case of protein restriction.

The protein level of isoenergetic formulae does not modulate postprandial insulin secretion in piglets and has no consequences on later glucose tolerance

Early postnatal nutrition is involved in metabolic programming, an excess of protein being suspected to enhance early growth and the propensity to later develop insulin resistance and type 2 diabetes mellitus. The aim of the present study was to test the hypothesis that excessive protein intake during the suckling period would overstimulate the endocrine pancreas in the short term and alter durably its maturation, contributing to the later disruption of glucose homeostasis. Normal-birth-weight and low-birth-weight piglets were fed isoenergetic formulae providing an adequate-protein (AP, equivalent to sow milk) or a high-protein (HP, +48 %) supply between 7 and 28 d of age and were fed a standard diet until 70 d of age. During the formula-feeding period, the HP formula did not modify postprandial insulin secretion but transiently increased fasting insulin and the homeostasis model assessment-insulin resistance index (HOMA-IR, P < 0·05). Fasting insulin and HOMA-IR were restored to AP piglets' values 1 month after weaning. The structure of the endocrine pancreas was not affected by the protein content of the formula. The weight at birth had no major effect on the studied parameters. We concluded that a high-protein supply during the suckling period does not interfere with insulin secretion and endocrine pancreas maturation in the short term. It has no consequences either on glucose tolerance 1 month after weaning. The present study demonstrated that up-regulation of postprandial insulin secretion is not involved in higher growth observed in piglets fed a HP formula.

Apports nutritionnels précoces, hypotrophie acquise et devenir du prématuré

Early nutrition is an important determinant of growth, morbidity and psychomotor development in very low birth weight infants. Recent data suggest that “aggressive nutrition” providing early and high protein supply from the first hours of life improves nitrogen balance, reduces postnatal growth retardation, decreases morbidity and is positively related to psychomotor development. This paper will summarize the metabolic bases of this optimal nutrition for preterm infants.

Evaluation of undehydrated barley feed fractions and dried oat feed fractions from integrated starch-ethanol process in diets of growing pigs

The nutrient digestibility and protein utilization of undehydrated barley fractions: protein (BP), protein fibre mixture (BPF) and distillers solids (DS) at two levels of inclusion in diets fortified to equal lysine content were assayed with growing pigs in a 6 x 6 Latin square. Dried barley fibre (BF), oat protein (OP) and oat fibre (OF) from integrated starch-ethanol production were evaluated as feed ingredients for pigs in three other trials. DS and OP had a higher essential amino acids content than BP, especially with respect to lysine. All fractions had a rather high ether extract content 46-196 g/kg and their fatty acid composition is presented. BP showed higher protein digestibility than DS (0.931 vs. 0.857) and pigs on BP-diet retained more N than on DS-diet. BF showed a low digestibility of OM and CP and 0.1 inclusion of BF mixed with BP depressed CP digestibility and N-retention. A higher protein supply from cereal protein in the diet promoted N-retention but decreased protein utilization. OP had high digestibility and OF was more digestible than BF. The study confirmed the high digestibility and energy values of the proteinous grain fractions and a high protein utilization when adequately fortified with lysine. The fibrous fractions have a rather low nutrient digestibility and their use in pig diets is therefore limited.

Energy maintenance requirement and energy requirement for protein retention in growing rats and broilers. 4. Energy requirement for protein retention in broilers

The results of measurings of the total metabolism from experiments with 6 male broilers (origin: Tetra B) each, which mainly served the ascertainment of energy maintenance requirement (cf. 2) in the growth range between 100 and 2,000 g with alternating experiment phases on the maintenance and growth level, have also undergone interpretation for the further characterisation of the energy requirement for protein retention. Caused by the sequence of periods chosen, there were compensatory growth effects. Energy retention in % of gross energy varied between the experiments in the limits of 24 and 39%, and concerning energy retention per animal and day there were differences up to 100% between the experiments. The share of protein energy retention in energy retention on average amounted to 38% after a medium-high protein supply and 54% after a high protein supply. The utilisation of metabolisable energy for energy retention was significantly lower from rations of a high protein level (40% crude protein) than from those of a medium-high protein level (20% crude protein). Assuming an energy requirement for fat retention of 1.2 J metabolisable energy per J retention, a requirement of metabolisable energy for 1 J protein retention of 1.68; 1.66 and 1.86 was ascertained in the 3 experiments by means of regression analysis. An energy requirement for maintenance of 423 (30 degrees C), 511 (25 degrees C) and 432 kJ metabolisable energy/kg live weight 0 75 X d (30 degrees C) correlated with these requirement values. Energy requirement for protein retention increased significantly with N-intake and decreased significantly with the daily protein retention rate. There was no dependence on the live weight of the broilers.

Protein supply of rats and transaminase and succinate dehydrogenase activity

The influence of an isocaloric diet containing 13 and 20% of crude protein on the activities of GOT, GPT and succinic dehydrogenase in rat livers was determined and compared to the growth as well as to the body composition of the animals. The weights of the animals were significantly increased, feed efficiency and consumption of metabolizable energy per gram of body increase were much better with higher protein supply. It may be concluded that protein retention was better while fat retention was nearly unaffected. The activities of the liver enzymes increased with the protein content of the diet, especially GOT 1,8 times and succinic dehydrogenase 3 times as compared to the respective values of the lower protein group. It is discussed that the activity of succinic dehydrogenase represents a suitable criterion for the evaluation of a changed metabolism, especially when protein supply is marginal.

The protein-sparing effect of carbohydrate. 1. Nitrogen retention of growing pigs in relation to diet.

1. Measurements were made of the losses of nitrogen in the faeces and urine of sixty pigs of approximately 33 kg, given dietary regimens comprising twenty-nine combinations of fish flour (0-800 g/d) and maize starch (0-1200 g/d). 2. The results were used to develop a generalized equation describing N retention as a joint function of N intake and starch intake. 3. The protein-sparing effect of starch was exerted in all circumstances. It was greatest when protein intake exceeded 220 g/d but some effect persisted with protein-free diets. With a high protein supply, the increase in N retention per unit increase in dietary starch decreased from 36 mg/g with the first increment to 3 mg/g with the highest attainable starch intake. 4. From the generalized equation the relationships between net protein utilization and protein concentration and food intake could be described as continuous functions. The equations may be of use in comparing the protein values of diets measured under non-standardized conditions.