Increased Protein Requirements Research Articles

Determinants of market participation for small scale broiler farmers in Leribe District of Lesotho

The poultry industry is the fasted growing sub-sector of agriculture in the developing world and this is attributed to several pulling and pushing factors. On the demand side, the issue of urbanisation, income increase and animal protein requirements particularly for chicken has a positive influence on the growth of poultry production. Poultry farming is highly practised in rural households in Lesotho, and it constitutes an important contribution to the development of the rural economy in most developing countries. The poultry industry remains an important sub-sector of agriculture like in many other developing countries and it remains the main source of livelihood for village people and other small-scale farmers in the economy. Many rural communities are keeping poultry as a source of meat and eggs to feed their families, raise income from the surplus and create employment opportunities. However, access to formals markets remains a critical challenge for the farmers. This study examined the socio-economic, market and institutional factors that influenced broiler farmers’ market participation and intensity of participation in the Leribe district in Lesotho. A two-stage sampling technique was employed to select 114 respondents from five villages and the survey data was collected through a structured questionnaire. Heckman's two-stage model was used to analyse factors influencing farmers' market participation and the intensity of market participation. Gender, farmer income, storage access, production experience, extension service, credit access and information access were significant and influenced farmers’ market participation decisions. The study recommends interventions that will increase access and formal market participation.

Changes in protein requirements of elderly people over 5 years assessed using the indicator amino acid oxidation method

To evaluate the changes in protein requirements of the elderly during the past five years. Based on the previous study of protein requirements of 14 elderly in 2017, 4 of these elderly(70-80 y) were included as study participants and protein requirements were re-evaluated using the indicator amino acid oxidation method. There were seven protein levels: 0.1, 0.3, 0.6, 0.9, 1.2, 1.5 and 1.8 g/(kg·d). Maintenance diets were given for the first two days of each protein level. A stable isotope study was conducted on the day 3, using L-~(13)C-phenylalanine as an indicator on the basis of an amino acid rationed diet, which was orally ingested into the body along with the amino acid rationed diet, and breath and urine samples were collected when the metabolism of L-~(13)C-phenylalanine reached steady state in the body. By measuring the kinetic parameters of labeled amino acids in the samples, a nonlinear mixed-effects model was constructed for the protein intake to be tested and the oxidation rate of labeled amino acids. The mean protein requirement of the study population was determined by the protein intake corresponding to the inflection point of the curve. Based on the production rate of ~(13)CO_2 in exhaled breath of four elderly people at different protein levels, the mean protein requirement was 1.05(95%CI 0.51-1.60) g/(kg·d). The protein recommended nutrient intake was 1.31(95%CI 0.64-2.00) g/(kg·d) was estimated by applying the coefficient of variation of the mean protein requirement to derive the recommended nutrient intake. Protein requirements in the elderly have increased over a five-year period and sarcopenia may be the main cause of increased protein requirements.

Rats Treated with Somatotropin Select Diets Higher in Protein

It was previously shown that somatotropin (STH) increases growth rate, improves food efficiency and stimulates protein accretion. In rats, STH also increases food intake. This study examined the effect of exogenous STH on rats' selection of diets varying in protein content. It was hypothesized that the increase in food intake in response to STH is driven by an increased protein requirement. Rats were allowed to select between two diets varying in casein (5 and 30%) or given a diet of a single casein level (20%). In each diet group, rats were treated with 0 or 4 mg of porcine STH/d. Rats treated with STH showed greater food intake (20%) and protein accretion (125%), regardless of diet. However, the greater food intake in rats allowed to select was due to greater consumption of the high protein diet. Diet selecting, STH-treated rats consumed 75% more of the 30% casein diet than did the saline-treated controls, while consuming a similar amount of 5% casein diet. Total protein intake (g/d) was 22 and 53% greater in rats injected with STH consuming the 20% casein diet and selection diets, respectively. The results indicate that rats injected with somatotropin select a diet greater in protein when compared with those not receiving somatotropin. It is suggested that the STH-induced increase in protein accretion results in a greater demand for essential amino acids. The mechanism whereby animals are able to monitor this greater need is not clear.

Protein Preparations as Ingredients for the Enrichment of Non-Fermented Milks.

Milk enriched with functional ingredients of milk proteins delivers health and nutritional benefits, and it can be particularly recommended to consumers with increased protein requirements. The aim of this study was to evaluate the applicability of casein and serum protein preparations obtained by membrane filtration in the laboratory as additives to non-fermented milks, as compared with commercial protein, preparations (whey protein isolate or concentrate and casein concentrate). The addition of protein preparations increased the pH, viscosity and heat stability of non-fermented milks. Milks enriched with whey proteins were characterized by a higher content of valine and isoleucine and a lower content of leucine, lysine and arginine. Addition of casein or whey protein concentrate decreased the phosphorus content and increased the calcium content of milk, but only in the products enriched with casein or whey protein concentrate. Color saturation was higher in products fortified with protein preparations obtained in the laboratory and commercial whey protein concentrate. Milk enriched with whey protein isolate, followed by milk serum protein concentrate, received the highest scores in the sensory evaluation. The presented results make a valuable contribution to the production of milks enriched with various protein fractions. The study proposes the possibility of production of protein preparations and milks enhanced with protein preparations, which can be implemented in industrial dairy plants.

Medical Nutrition Therapy In Enterocutaneous Fistula: A Step-By-Step Approach

Enterocutaneous fistula (ECF) management is a challenge that requires a multidisciplinary team approach in achieving optimal clinical output. Nutrition as a component of management plays a vital role in determining the prognosis, both as a predictor of morbidity and mortality. Malnutrition can also occurs as a preceeding situation or complication of ECF caused by the underlying disease, decreased food intake, increased protein requirements associated with systemic inflammation, and increased nutrient loss associated with the amount of fistula output. Thus, nutrition management can act as prevention, therapy, or both. Nutritional medical therapy in ECF cases aims to adequately estimate nutritional needs, maintain fluid and electrolyte balance, and stimulate spontaneous ECF closure whenever possible. To achieve optimal outcome, nutrition needs analysis must be done individually by considering the etiology, anatomical location of the fistula, and the amount of output. In the following article, we will discuss a comprehensive step-by-step nutrition treatment, both from the nutritional routes consideration, macronutrient and micronutrient requirements, specific nutrients, pharmacotherapy, and monitoring and evaluation that need to be done to achieve optimal clinical outcomes.

Antioxidant activity and characterization of whey protein-based beverages: Effect of shelf life and gastrointestinal transit on bioactivity

Abstract Whey proteins can exhibit antioxidant activity. The objectives of this study were to formulate model whey based beverages with well-established antioxidants (plant polyphenols, vitamins and astaxanthin) to investigate (1) the antioxidant shelf life over a 24-week period and (2) the antioxidant activity after upper gastrointestinal transit. Pilot scale processing (pasteurization, ultra-high temperature or spray drying) was used to prepare beverages which were representative of current product formats. In vitro gastrointestinal digestion of test samples was performed using the standardised INFOGEST method and antioxidant activity of samples was determined using ABTS, FRAP and ORAC. Results from the antioxidant shelf life study provided evidence that powder products functionality was preserved. Whey beverages (pasteurised or spray dried) increased or maintained antioxidant activity during gastrointestinal transit. Combination of whey with additional antioxidant ingredients increased the bioactivity of formulated products; however, this greater bioactivity was altered after gastrointestinal transit, depending on processing type and antioxidant methodology. Industrial relevance Whey protein-based antioxidant beverages could benefit the elderly consumer to meet their increased protein requirements and boost their antioxidant status. Consumer's acceptance for whey protein-based beverages often improves with clear formulations. This work generated whey protein-based UHT beverages with greater stability and clarity than pasteurised formulations. A novel combination of plant and marine antioxidants increased antioxidant activity of whey protein-based formulations. Furthermore, to suit export markets this work generated spray dried whey protein formulations that did not alter antioxidant potential.

Dietary protein intake in older adults undergoing cardiac surgery

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

Indicator amino acid oxidation protein requirement estimate in endurance-trained men 24 h postexercise exceeds both the EAR and current athlete guidelines

Despite studies indicating increased protein requirements in strength-trained or endurance-trained (ET) individuals, the Institute of Medicine has concluded that "no additional dietary protein is suggested for healthy adults undertaking resistance or endurance exercise," and the controversy regarding exercise effects on protein requirements continues. The objective of this study was to determine the dietary protein requirement of healthy young ET men (≥1 yr training experience) 24 h post exercise (to minimize any acute effects of the previous training session) by measuring the oxidation of ingested l-[1-13C]phenylalanine to 13CO2 in response to graded intakes of protein (indicator amino acid oxidation technique). Eight men [maximal oxygen consumption 64.1 ml·kg-1·min-1 (SD 3.7)] were each studied 24 h postexercise repeatedly with protein intakes ranging from 0.3 to 3.5 g·kg-1·day-1. Protein was fed as an amino acid mixture based on the protein pattern in egg, except for phenylalanine and tyrosine, which were maintained at constant amounts across all protein intakes. For 2 days before the study day, all participants consumed 1.6 g protein·kg-1·day-1. The estimated average requirement (EAR) for protein was determined by applying a nonlinear mixed-effects change-point regression analysis to F13CO2 (label tracer oxidation in 13CO2 breath), which identified a breakpoint in the F13CO2 in response to the graded amounts of protein. The EAR for protein and the upper 95% confidence interval were 2.1 and 2.6 g·kg-1·day-1, respectively. These data suggest that the protein EAR for ET men 24 h postexercise exceeds the Institute of Medicine EAR and established athlete guidelines by ~3.5- and 1.3-fold, respectively.

Nutritionally non-essential amino acids are dispensable for whole-body protein synthesis after exercise in endurance athletes with an adequate essential amino acid intake.

The increased protein requirement of endurance athletes may be related to the need to replace exercise-induced oxidative losses, especially of the branched-chain amino acids (BCAA). However, it is unknown if non-essential amino acids (NEAA) influence the requirement for essential amino acids (EAA) during post-exercise recovery. Seven endurance-trained males ran 20km prior to consuming [13C]phenylalanine, sufficient energy, and: (1) deficient protein (BASE); (2) BASE supplemented with sufficient BCAA (BCAAsup); (3) an equivalent EAA intake as BCAA (LowEAA), and; (4) sufficient EAA intake (HighEAA). [13C]Phenylalanine oxidation (the reciprocal of protein synthesis) for BCAAsup and HighEAA (0.54 ± 0.15, 0.49 ± 0.11µmolkg-1h-1; Mean ± SD) were significantly lower than BASE (0.74 ± 0.14µmolkg-1h-1; P < 0.01 for both) and LowEAA (0.70 ± 0.11µmolkg-1h-1; P < 0.05 and 0.01, respectively). Our results suggest that exogenous NEAA are dispensable for whole-body protein synthesis during recovery from endurance exercise provided sufficient EAA are consumed. Endurance athletes who may be at risk of not meeting their elevated protein requirements should prioritize the intake of EAA-enriched foods and/or supplements.

Preserved anabolic threshold and capacity as estimated by a novel stable tracer approach suggests no anabolic resistance or increased requirements in weight stable COPD patients

Assessing the ability to respond anabolic to dietary protein intake during illness provides important insight in the capacity of lean body mass maintenance. We applied a newly developed stable tracer approach to assess in one session in patients with chronic obstructive pulmonary disease (COPD) and healthy older adults both the minimal amount of protein intake to obtain protein anabolism (anabolic threshold) and the efficiency of dietary protein to promote protein anabolism (anabolic capacity). We studied 12 clinically and weight stable patients with moderate to very severe COPD (mean±SE forced expiratory volume in 1s: 36±3% of predicted) and 10 healthy age-matched older adults. At 2-h intervals and in consecutive order, all participants consumed a mixture of 0.0, 0.04, 0.10 and 0.30g hydrolyzed casein protein×kg ffm-1×2h-1 and carbohydrates (2:1). We assessed whole body protein synthesis (PS), breakdown (PB), net PS (PS-PB) and net protein balance (phenylalanine (PHE) intake - PHE to tyrosine (TYR) hydroxylation) by IV primed and continuous infusion of L-[ring-2H5]PHE and L-[13C9,15N]-TYR. Anabolic threshold (net protein balance=0) and capacity (slope) were determined on an individual basis from the assumed linear relationship between protein intake and net protein balance. We confirmed a linear relationship between protein intake and net protein balance for all participants (R2 range: 0.9988-1.0, p≤0.0006). On average, the anabolic threshold and anabolic capacity were comparable between the groups (anabolic threshold COPD vs. healthy: 3.82±0.31 vs. 4.20±0.36μmol PHE×kg ffm-1×hr-1; anabolic capacity COPD vs. healthy: 0.952±0.007 and 0.954±0.004). At protein intake around the anabolic threshold (0.04 and 0.10g protein×kg ffm-1×2h-1), the increase in net PS resulted mainly from PB reduction (p<0.0001) whereas at a higher protein intake (0.30g protein×kg ffm-1×2h-1) PS was also stimulated (p<0.0001). The preserved anabolic threshold and capacity in clinically and weight stable COPD patients suggests no disease related anabolic resistance and/or increased protein requirements. ClinicalTrials.gov; No. NCT01734473; URL: www.clinicaltrials.gov.

Хліб для споживачів з підвищеними білковими потребами

Хліб для споживачів з підвищеними білковими потребами

Determining Protein Requirements In The Acutely Ill Patient

This review discusses protein requirements in disease. It begins by explaining how protein requirements are determined in normal health and the process of nutritional adaptation. It points out the salient features of diseases that increase a patient’s protein requirement, with detailed attention to the effect of systemic inflammation both to increase protein requirements and prevent normal adaptation to starvation. The review also explains and reconciles problems of uncertainty about how much protein to provide to acutely ill patients. Finally, it provides the clinical information and physiologic reasoning necessary to choose appropriate amounts of protein to provide to individual acutely ill patients. This review contains 1 figure and 59 references Key words: adaptation, cachexia, frailty, hypoalbuminemia, inflammation, malnutrition, muscle atrophy, nutritional requirements, protein-energy malnutrition, protein requirements, systemic inflammation

The effects of dietary protein intake on appendicular lean mass and muscle function in elderly men: a 10-wk randomized controlled trial

Background: The Recommended Daily Allowance (RDA) for protein intake in the adult population is widely promoted as 0.8 g · kg-1 · d-1 Aging may increase protein requirements, particularly to maintain muscle mass.Objective: We investigated whether controlled protein consumption at the current RDA or twice the RDA (2RDA) affects skeletal muscle mass and physical function in elderly men.Design: In this parallel-group randomized trial, 29 men aged >70 y [mean ± SD body mass index (in kg/m2): 28.3 ± 4.2] were provided with a complete diet containing either 0.8 (RDA) or 1.6 (2RDA) g protein · kg-1 · d-1, aimed to balance energy needs. Before treatment and after 10 wk of intervention, whole-body and appendicular lean mass were measured by using dual-energy X-ray absorptiometry. Knee-extension peak power was measured with dynamometry.Results: Both groups were found to have been in a moderate negative energy balance (mean ± SD RDA: 209 ± 213 kcal/d; 2RDA 145 ± 214 kcal/d; P= 0.427 for difference between the groups). In comparison with RDA, whole-body lean mass increased in 2RDA (P = 0.001; 1.49 ± 1.30 kg, P < 0.001 compared with -0.55 ± 1.49 kg, P = 0.149). This difference was mostly accounted for by an increase in trunk lean mass found in 2RDA (+1.39 ± 1.09 kg, P < 0.001). Appendicular lean mass also decreased in RDA compared with 2RDA (P = 0.022), driven by a reduction in RDA (-0.64 ± 0.91 kg, P = 0.005 compared with 0.11 ± 0.57 kg, P = 0.592). Adjusting for energy imbalances did not alter these findings. Knee-extension peak power was also differently affected (P = 0.012; 26.6 ± 47.7 W, P = 0.015 in 2RDA compared with -11.7 ± 31.0 W, P = 0.180 in RDA).Conclusions: Consumption of a diet providing 2RDA for protein compared with the current guidelines was found to have beneficial effects on lean body mass and leg power in elderly men. These effects were not explained by differences in energy balance. This trial was registered at the Australia New Zealand Clinical Trial Registry (www.anzctr.org.au) as ACTRN12616000310460.

Increased Protein Requirements in Female Athletes after Variable-Intensity Exercise.

Protein requirements are primarily studied in the context of resistance or endurance exercise with little research devoted to variable-intensity intermittent exercise characteristic of many team sports. Further, female populations are underrepresented in dietary sports science studies. We aimed to determine a dietary protein requirement in active females performing variable-intensity intermittent exercise using the indicator amino acid oxidation (IAAO) method. We hypothesized that these requirements would be greater than current IAAO-derived estimates in nonactive adult males. Six females (21.2 ± 0.8 yr, 68.8 ± 4.1 kg, 47.1 ± 1.2 mL O2·kg·min; mean ± SE) completed five to seven metabolic trials during the luteal phase of the menstrual cycle. Participants performed a modified Loughborough Intermittent Shuttle Test before consuming eight hourly mixed meals providing the test protein intake (0.2-2.66 g·kg·d), 6 g·kg·d CHO and sufficient energy for resting and exercise-induced energy expenditure. Protein was provided as crystalline amino acid modeling egg protein with [C]phenylalanine as the indicator amino acid. Phenylalanine turnover (Q) was determined from urinary [C]phenylalanine enrichment. Breath CO2 excretion (FCO2) was analyzed using mixed effects biphase linear regression with the breakpoint and upper 95% confidence interval approximating the estimated average requirement and recommended dietary allowance, respectively. Protein intake had no effect on Q (68.7 ± 7.3 μmol·kg·h; mean ± SE). FCO2 displayed a robust biphase response (R = 0.66) with an estimated average requirement of 1.41 g·kg·d and recommended dietary allowance of 1.71 g·kg·d. The protein requirement estimate of 1.41 and 1.71 g·kg·d for females performing variable-intensity intermittent exercise is greater than the IAAO-derived estimates of adult males (0.93 and 1.2 g·kg·d) and at the upper range of the American College of Sports Medicine athlete recommendations (1.2-2.0 g·kg·d).

Dietary Protein Is Important in the Practical Management of Prediabetes and Type 2 Diabetes1–3

Many misconceptions surround the role of dietary protein in the management of diabetes. Although dietary recommendations for managing diabetes have changed greatly over the centuries, recommended protein intake has remained relatively constant. Currently, recommendations for protein intake are based on individual assessment and the consideration of other health issues and implications, such as the extent of glycemic control, the presence of kidney disease, overweight and obesity, and the age of the patient. Two common misconceptions about dietary protein in diabetes management are that a certain amount of the protein consumed is converted into blood glucose and that consuming too much protein can lead to diabetic kidney disease. These misconceptions have been disproven. For many people with type 2 diabetes, aiming for 20–30% of total energy intake as protein is the goal. Exceptions may be for those individuals with impaired renal function. A protein intake of this amount can be beneficial by improving glycemic control, aiding in satiety and preservation of lean body mass during weight loss in those with both diabetes and prediabetes, and providing for the increased protein requirements of the older adult. Health care providers should discuss the role of dietary protein with their patients, reinforce sources of protein in the diet, and use simple but effective teaching tools, such as the plate method, to convey important nutrition messages. In addition, health care providers should recognize that persons with diabetes are attempting to manage many other aspects of their diabetes, including blood glucose monitoring, physical activity, taking of medication, risk reduction, and problem solving.

Protein requirements and aging 1

Protein requirements and aging 1

Nutrition for Adventure Racing

Adventure racing requires competitors to perform various disciplines ranging from, but not limited to, mountain biking, running, kayaking, climbing, mountaineering, flat- and white-water boating and orienteering over a rugged, often remote and wilderness terrain. Races can vary from 6 hours to expedition-length events that can last up to 10-consecutive days or more. The purpose of this article is to provide evidence-based nutritional recommendations for adventure racing competitors. Energy expenditures of 365-750 kcal/hour have been reported with total energy expenditures of 18 000-80 000 kcal required to complete adventure races, and large negative energy balances during competitions have been reported. Nutrition, therefore, plays a major role in the successful completion of such ultra-endurance events. Conducting research in these events is challenging and the limited studies investigating dietary surveys and nutritional status of adventure racers indicate that competitors do not meet nutrition recommendations for ultra-endurance exercise. Carbohydrate intakes of 7-12 g/kg are needed during periods of prolonged training to meet requirements and replenish glycogen stores. Protein intakes of 1.4-1.7 g/kg are recommended to build and repair tissue. Adequate replacement of fluid and electrolytes are crucial, particularly during extreme temperatures; however, sweat rates can vary greatly between competitors. There is considerable evidence to support the use of sports drinks, gels and bars, as they are a convenient and portable source of carbohydrate that can be consumed during exercise, in training and in competition. Similarly, protein and amino acid supplements can be useful to help meet periods of increased protein requirements. Caffeine can be used as an ergogenic aid to help competitors stay awake during prolonged periods, enhance glycogen resynthesis and enhance endurance performance.

Protein intake in athletes: a review

The current recommendation of the American College of Sports Medicine for proteins is 1.2–1.7 g/kg/day. This recommended protein intake is actually greater than the recommended dietary allowance (RDA) for protein, which is around 0.8 g/kg/day, and is based on several studies that documented increased protein requirement in athletes. Most athletes generally consume more than the recommended protein intake of 1.7 g/kg/day apart from taking amino acid and protein supplements. The current review analyses if the increased protein intake has any beneficial effect on muscle building and performance of athletes, and if there is an optimal time and type of protein for ingestion if this is the case. Studies have shown that high protein intake accentuates renal insufficiency in patients with chronic kidney disease (CKD). We also review if the high protein intake predisposes healthy athletes with normal kidneys and kidney function to any renal problems in the future.

21 Uric acid and oxidative status in obese subjects

losses of 0.6 to 1.2 g/kg per day have been reported. There is a marked reduction in key micronutrient levels in fevers (vitamin B2), tuberculosis (vitamins A, D, C and E, zinc and iron) and cancer (vitamin C, B2, B6, B12 and D, magnesium and zinc). Almost any nutritional deficiency can further compromise the immune functionality, impacting health outcome, quality of life and recovery from illness. It is therefore, essential to replace the nutritional losses sustained during illness as well as provide additional allowances for convalescence. Increased protein requirements of up to 2 g/day and micronutrient intakes to at least the recommended allowances or higher are indicated. Studies report positive effects of optimal nutritional support with significant increases in body weight, total lean mass and grip strength in TB subjects. Cancer subjects reported improved nutritional status, body weight, un-interrupted course of radiation (in case of subjects undergoing radiotherapy), reduced postoperative complications and improved quality of life as a result of nutrition intervention. Nutritional support should therefore be an integral part of the comprehensive care to optimise treatment for illness like fevers, TB and cancer.

Difficulty in administration of liquid protein solution via an enteral feeding tube

Patients with head or other trauma, thermal injury, or obesity may require aggressive protein supplementation beyond the protein content of commercially-available enteral feeding solutions.1,–3 Use of protein supplementation as adjuvant therapy to a liquid enteral nutrition formula is particularly useful when trying to avoid caloric overfeeding of the critically ill patient while maintaining an aggressive protein intake. Our previous approach toward meeting these increased protein requirements has been to use a protein powder supplement that, unfortunately, has been discontinued by the manufacturer. As a result, we employed the use of a liquid protein supplement as adjuvant therapy to the polymeric enteral feeding formula. These liquid protein supplements are a concentrated protein solution (1 g/2 mL) and their administration is usually in bolus increments one to four times daily via an enteral feeding tube. We discovered that the liquid protein solution could not be administered via feeding tube without dilution because significant resistance occurred when attempting to administer the solution via a small-bore feeding tube. The amount of dilution necessary for an adequate reduction in resistance was not standardized, and the nursing staff were often diluting the protein solution with variable volumes of water with each administration period. As a result of this difficulty in medication administration, some nurses became frustrated and doses were sometimes omitted.