Nutritional Cost Research Articles

Is a starving host tastier? Reproduction in fleas parasitizing food‐limited rodents

Summary We hypothesized that food availability, and therefore body condition, of a rodent host, Meriones crassus, affects egg production and survival, and development time of preimago and adults of the first generation of the flea Xenopsylla ramesis. Egg production was significantly higher in fleas parasitizing underfed than control animals. Food availability for hosts affected survival of eggs and larvae produced by fleas on these rodents, but did not affect survival of pupae. More than twice the number of eggs from fleas on food‐limited hosts survived than those from fleas on control rodents. Highest larval survival was recorded in fleas on rodents with 30% of maintenance energy intake. Survival of new generation imagos was lowest in fleas from parents on hosts with the highest food limitation. By contrast, survival of parent fleas was highest on hosts offered 30% of maintenance energy intake. Time of egg and larval development was longest on hosts consuming 30% of energy requirements for maintenance. By contrast, there was no difference in time to emergence in pupae from flea females on rodents from different treatments. Survival time under starvation of imago of the first generation was shortest in offspring of fleas that parasitized M. crassus offered the minimal amount of food. The opposite was true for parent fleas. The results suggest nutritional and/or energetic cost of host resistance, measured as host‐mediated parasite fitness loss, as well as possible adaptive stress‐induced immunosuppression.

The Open Abdomen: Enteral Access Results in Cost Savings

Purpose To evaluate the cost savings of using enteral access for drug and nutrition delivery in patients requiring open peritoneal cavity management (laparosotomy). Methods A review of 14 patients who required laparostomy and received at least 4 consecutive days of enteral nutrition treated at our tertiary care facility between January 1999 and May 2001. Data collected included age, sex, reason for laparostomy, enteral formulation, medications, and side effects (diarrhea and gastric reflux). Cost savings were calculated as the difference between the cost of intravenous (IV) and enteral nutritional formulation and drug dosage costs. Results Patients were fed via nasojejunal feeding tube. Average duration of enteral nutrition (EN) was 19.1 ± 12.3 days. Gastric reflux and diarrhea occurred in five (36%) and six (42%) patients, respectively. These were easily treated and did not require conversion to IV nutrition or medications. Drug and electrolyte levels were therapeutic at appropriate enteral doses. A total of 267 days of EN were utilized in these 14 patients. The cost difference between the parenteral nutrition that would have been used during that time and the actual enteral formula utilized was $25,373. The use of enteral rather than IV medications also resulted in a cost savings of $7,058. Thus, the combined cost savings of enteral medication and nutrition therapy for the 14 patients was $32,431. Conclusion EN and drug therapy can be utilized in patients requiring open peritoneal cavity management. The resultant cost savings can be substantial, and these methods of cost reduction can also be applied to other patients.

The effect of concurrent corticosteroid induced immuno-suppression and infection with the intestinal parasite Trichostrongylus colubriformis on food intake and utilization in both immunologically naïve and competent sheep

AbstractThe nutritional cost of both the acquisition and maintenance of immunity to gastro-intestinal nematodes was investigated using immunologically naïve 5-month-old lambs and immunologically competent 17-month-old ewes. Within each age cohort, animals were either infected with the equivalent of 80 L3Trichostrongylus colubriformislarvae per kg live weight (LW) per day (IF), similarly infected and concurrently immuno-suppressed with weekly injections of 1·3 mg/kg LW of the glucocorticoid methylprednisolone acetate (ISIF), immuno-suppressed only (IS) or remained as controls (C). Body composition of all animals was estimated using X-ray computer tomography on days -14 and 76 relative to the start of infection. Body weight and faecal nematode egg counts (FEC; eggs per gram of fresh faeces (e.p.g.)) were taken weekly and blood samples for serum proteins and antibodies were obtained every 2 weeks. FEC in IF lambs peaked at 1250 e.p.g. before a typical decline as immunity developed to less than 100 e.p.g. by day 75. FEC of less than 100 e.p.g. in IF ewes indicated immunity was maintained. Successful immuno-suppression in ISIF lambs and ewes was indicated by FEC of 4000 e.p.g. on day 75 and was confirmed by comparative worm burdens and serum antibody titres. The typical reduction in voluntary food intake (VFI) as a consequence of infection was observed in IF lambs (proportionately 0·30,P< 0·001) but not in IF ewes, ISIF lambs or ISIF ewes. Gross efficiency of use of metabolizable energy for net energy deposition was reduced by proportionately 0·20 in lambs during acquisition of immunity and by 0·16 in ewes maintaining an established immunity. Infection in immuno-suppressed animals reduced efficiency by 0·05 and 0·15 for lambs and ewes, respectively. These findings allowed the hypothesis that the reduction in VFI and loss in performance in young parasitised sheep is caused by physiological signalling associated with the acquisition phase of the host immune response to infection, rather than simply the damage caused by the parasiteper se.

Risk Factors and the Economic Impact of Ovarian Cysts on Reproductive Performance of Dairy Cows in Korea

The objectives of this study were to determine the risk factors for development of postpartum ovarian cysts by evaluating several reproductive factors in individual cows, and to determine the economic impact of ovarian cysts on subsequent reproductive performance in dairy herds in Korea. The data, including cow parity, abnormal puerperium, endometritis, body condition score (BCS), and breeding status were collected from 634 cows in 9 dairy herds. We used logistic regression to evaluate the effects of these factors on ovarian cysts. A stepwise procedure, used to obtain the appropriate model with alpha=0.05, revealed that cow parity was the most important risk factor for ovarian cyst development within 8 weeks postpartum, while development of endometritis and BCS loss>or=1 from the dry period to 8 weeks postpartum were the most important risk factors for ovarian cyst development beyond 8 weeks postpartum. The occurrence of ovarian cysts beyond 8 weeks postpartum prolonged (P<0.01) the mean intervals from calving to first service (27 days) and conception (77 days), and increased (P<0.05) the culling rate (7.8%), while ovarian cyst development within 8 weeks postpartum did not affect (P>0.05) the mean intervals from calving to first service and conception or the culling rate. The economic loss resulting from the occurrence of ovarian cysts was estimated at approximately 823,996 won ($687) due to effects on the cost of nutrition, average growth of calves, labor and medical costs, and culling. These results suggest that cow parity is correlated with the development of ovarian cysts within 8 weeks postpartum, and endometritis and BCS loss>or=1 from the dry period to 8 weeks postpartum are correlated with the development of ovarian cysts after 8 weeks postpartum, which decreases reproductive performance and results in economic loss in dairy herds in Korea.

Preoperative Immunonutrition: Cost‐Benefit Analysis

To evaluate whether preoperative immunonutrition might lead to a savings in patient care. Data on resources consumed to treat postoperative complications are scanty, but morbidity costs continue to be a major burden for any health care system. A recent randomized clinical trial carried out in well-nourished patients with gastrointestinal cancer showed that a 5-day preoperative oral immunonutrition reduced postoperative morbidity compared with conventional treatment (no supplementation). The abovementioned trial was the basis for the economic evaluation. In-hospital related costs of routine surgical care and costs of nutrition were calculated. Estimates of complication costs were based on both resources used for treatment and additional length of hospital stay. Cost comparison and cost-effectiveness analysis were then carried out. Total cost of nutrition was 3407 euro in the conventional group and 14,729 euro in the preoperative group. In patients without complication, the cost of in-hospital routine care was similar in both groups. The mean cost of complication was 6178 euro in the conventional group and 4639 euro in the preoperative group (p = .05). Total cost of patients with complications was 535,236 euro in the conventional group and 334,148 euro in the preoperative group. Total costs consumed 93% of the diagnosis-related-group (DRG) reimbursement rate in the conventional group and 78% in the preoperative group. Cost-effectiveness was 6245 euro for the conventional group and 2985 euro for the preoperative group. The costs of postoperative morbidity consumed a large amount of the DRG reimbursement rate. Preoperative immunonutrition was cost-effective in our series.

Isolation and Determination of the Most Appropriate Microbial Strain and Fermentation Condition for Single Cell Protein Production from Whey

Background : Whey as the sewage of dairy factories with a large amount of BOD (Biochemical oxygen demand 5000 PPM) is a dangerous environmental pollutant. This important Source of lactose (4-5% Lactose) is a useful substrate for producing a large kind of useful products. Method : Single cel1 protein (SCP) is one of these products with a large cost of nutrition and comparable with other proteins. Now it is a nutrient regulator for herbivorous animal and birds. Results : In this research the microbial strain was chosen from a lot of microorganisms in whey. The criterions of election were the weight of dried Biomass, rate of lactose reduction in whey, the rate of microbial growth and the reduction of chemical oxygen demand (COD). Conclusions : The elected microorganism was yeast. The optimum conditions of fermentation were, 31 oc, pH=8.3, agitated at 800 rpm and aeration of 2VVm. After 25 hours fermentation was terminated and centrifugation of broth gave 8.8 g/l Biomass.

PRIMJENA LINEARNOG PROGRAMIRANJA U PROBLEMU PREHRANE U DOMU ZA NEZBIRNUTU DJECU U SLAVONSKOM BRODU

The nutrition model belongs to a broader set o f problems known as mixture problems. In the literature, it is used as one of the typical examples of linear programming solved by the simplex method. It is of interest to investigate the possibilities of applying this model to an actual situation, such as the problem of nutrition at the Children’s Home in Slavonski Brod. Despite certain limitations to the simplex method, as well as limitations in problem formulation, in which the issue of tastes is neglected, by solving the assigned mathematical model for nutrition using the simplex method an optimum solution has been reached which meets all the conditions set forth in the formulation of the problem. The application of the model using the simplex method indicates a possible annual saving of 74,866 kunas per single meal. Results obtained could serve as guidelines in analysing the costs of the Children’s Home and in improving costs management by helping to determine the optimum financial schedule for nutrition. Benefits would include reducing the costs of nutrition and minimizing the wastage of food.

Dietary self‐selection behaviour by the adults of the aphidophagous ladybeetle Harmonia axyridis (Coleoptera: Coccinellidae)

Summary Harmonia axyridis is a generalist predator with a high range of accepted prey. Prey differ in nutritive contents, energetic values and cost associated with their capture and ingestion. As a result of selection pressures, animals will tend to hunt for their prey efficiently. In this paper we evaluated the suitability of Myzus persicae and Aphis fabae to the adults of the aulica phenotype of H. axyridis, their feeding preferences and the impact of mixed diets on their fitness. Feeding preference of predators was evaluated through their response to different relative abundance of prey. Under a single diet regime, the adults of the aulica phenotype fed on more individuals M. persicae than A. fabae but consumed less biomass from the former. None of those prey affect relative growth rate and reproductive capacity of the ladybeetles. Males and females present different types of response to three levels of different relative abundance of prey. While males show a constant feeding preference for M. persicae, females did not show a feeding preference (i.e. null switching response). Under a mixed diet regime, adults’ voracity gradually increased as the proportion of M. persicae increased, but biomass consumed and relative growth rate was not affected. On the other hand, fecundity and fertility increased. Our results suggest that H. axyridis present self‐selection behaviour because they agree with the basic criteria of Waldbauer and Friedman's self‐selection, i.e. (i) the animal's choice of food or nutrients is non‐random, and (ii) the coccinellid benefits from self‐selecting.

Are WHO/UNAIDS/UNICEF-recommended replacement milks for infants of HIV-infected mothers appropriate in the South African context?

Little is known about the nutritional adequacy and feasibility of breastmilk replacement options recommended by WHO/UNAIDS/UNICEF. The study aim was to explore suitability of the 2001 feeding recommendations for infants of HIV-infected mothers for a rural region in KwaZulu Natal, South Africa specifically with respect to adequacy of micronutrients and essential fatty acids, cost, and preparation times of replacement milks. Nutritional adequacy, cost, and preparation time of home-prepared replacement milks containing powdered full cream milk (PM) and fresh full cream milk (FM) and different micronutrient supplements (2 g UNICEF micronutrient sachet, government supplement routinely available in district public health clinics, and best available liquid paediatric supplement found in local pharmacies) were compared. Costs of locally available ingredients for replacement milk were used to calculate monthly costs for infants aged one, three, and six months. Total monthly costs of ingredients of commercial and home-prepared replacement milks were compared with each other and the average monthly income of domestic or shop workers. Time needed to prepare one feed of replacement milk was simulated. When mixed with water, sugar, and each micronutrient supplement, PM and FM provided <50% of estimated required amounts for vitamins E and C, folic acid, iodine, and selenium and <75% for zinc and pantothenic acid. PM and FM made with UNICEF micronutrient sachets provided 30% adequate intake for niacin. FM prepared with any micronutrient supplement provided no more than 32% vitamin D. All PMs provided more than adequate amounts of vitamin D. Compared with the commercial formula, PM and FM provided 8-60% of vitamins A, E, and C, folic acid, manganese, zinc, and iodine. Preparations of PM and FM provided 11% minimum recommended linoleic acid and 67% minimum recommended alpha-linolenic acid per 450 ml mixture. It took 21-25 minutes to optimally prepare 120 ml of replacement feed from PM or commercial infant formula and 30-35 minutes for the fresh milk preparation. PM or FM cost approximately 20% of monthly income averaged over the first six months of life; commercial formula cost approximately 32%. No home-prepared replacement milks in South Africa meet all estimated micronutrient and essential fatty acid requirements of infants aged <6 months. Commercial infant formula is the only replacement milk that meets all nutritional needs. Revisions of WHO/UNAIDS/UNICEF HIV and infant feeding course replacement milk options are needed. If replacement milks are to provide total nutrition, preparations should include vegetable oils, such as soybean oil, as a source of linoleic and alpha-linolenic acids, and additional vitamins and minerals.

Poor nutritional condition as a consequence of high dominance status in the Coal Tit Parus ater

The costs and benefits of dominance status have been investigated in the past and it has generally been reported that subdominant birds are at a nutritional disadvantage owing to their low dominance status. The nutritional condition of birds during winter can be important in determining their likelihood of survival. This is particularly so in small passerines that are sensitive to severe weather conditions. Ptilochronology is an accurate method used to produce a long‐term estimate of body condition spanning the number of days that it takes to grow a new feather. Ptilochronology was used during this study to estimate the nutritional condition of Coal Tits Parus ater during one winter and how condition was affected by dominance status. Dominant Coal Tits produced poorer quality feathers, which they grew at a slower rate, than did subdominant conspecifics. This study highlights a nutritional cost to high dominance status that could have long‐term consequences because the induced tail feathers will not be replaced for at least 5 months.

Should enteral feeding be the standard of care for acute pancreatitis?: Abou-Assi S, Craig K, O'Keefe SJD, Hypocaloric jejunal feeding is better than total parenteral nutrition in acute pancreatitis: results of a randomized comparative study. Am J Gastroenterol 2002;97:2255–62

This study was performed prospectively to define outcomes including length of hospital stay, duration of feeding, complications, hospital costs, and indications for nutritional support in patients admitted with acute pancreatitis (AP). Patients who failed to improve after 48 h of conservative treatment or who could not tolerate an oral diet were randomized to receive either nasojejunal (NJ) or total parenteral (TPN) feeding. The majority of cases were related to alcohol consumption or gallstones. The goal feeding rates were intended to provide 1.5 g protein/kg/day and 25–30 Kcal/kg/day. The two nutritionally supported groups were compared on an intention to treat basis. In all, 75% of patients admitted for AP improved after conventional therapy within 48 h and did not require nutritional support. Of the patients, 27 patients were randomized to TPN and 26 to NJ feeding. Three patients in the NJ group were switched to TPN (two needed surgery and one could not tolerate the NJ feeds), and two in the TPN group were converted to NJ feeding because of sepsis. The average length of hospital stay was shorter in the NJ group versus the TPN group (14 vs 18 days) but the difference was not significant. The introduction of oral feeding was tolerated better in the NJ group, with 80% advancing to an oral diet without difficulty in comparison to 63% in the TPN group. The average length of nutritional support was significantly shorter in the enteral nutrition (EN) patients who were fed by NJ tube than in patients on TPN (6.7 vs 10.8 days, p < 0.001). However, the EN group received fewer calories (49% vs 85%) and protein (42% vs 85%) in comparison to the TPN group ( p < 0.005). The disease severity as well as the serum pancreatic enzyme levels on admission and thereafter were comparable between the groups. Nutrition associated complications were significantly more common in the TPN group. These included hyperglycemia, septic complications, and catheter-related infections requiring prolonged therapy. The incidence of severe complication and death was similar in the two groups. A post hoc analysis of patients with severe pancreatitis showed similar results, with significantly more rapid resolution of the disease process in the NJ group. The average cost per hospital stay was considerably lower for patients who improved sufficiently to forgo nutritional support ($4,597) in comparison to patients who required nutritional support. Patients who received enteral feeding had a lower total average hospitalization cost of $26,464 versus $34,530 for those who required parenteral nutrition, based on intention to treat analysis. The significantly lower average nutritional costs in the enteral group of $394 per patient in comparison to $2,756 per patient in the parenteral group ( p = 0.0004) could be explained by the combination of the lower daily costs of enteral feeding ($23.3/day vs $222/day), and the shorter duration of feeding (6.7 vs 10.8 days). Consequently, the proportion of hospital costs resulting from enteral feeding was significantly lower than for parenteral feeding (1.8% vs 8.4%, p < 0.0001). The authors concluded that NJ feeding initiated 48 h postadmission for patients with AP was safer than TPN, and does not exacerbate the disease, is well tolerated and less costly than TPN.

Functional responses for zooplankton feeding on multiple resources: a review of assumptions and biological dynamics

Modelers often need to quantify the rates at which zooplankton consume a variety of species, size classes and trophic types. Implicit in the equations used to describe the multiple resource functional response (i.e. how nutritional intake varies with resource densities) are assumptions that are not often stated, let alone tested. This is problematic because models are sensitive to the details of these formulations. Here, we enable modelers to make more informed decisions by providing them with a new framework for considering zooplankton feeding on multiple resources. We define a new classification of multiple resource responses that is based on preference, selection and switching, and we develop a set of mathematical diagnostics that elucidate model assumptions. We use these tools to evaluate the assumptions and biological dynamics inherent in published multiple resource responses. These models are shown to simulate different resource preferences, implied single resource responses, changes in intake with changing resource densities, nutritional benefits of generalism, and nutritional costs of selection. Certain formulations are further shown to exhibit anomalous dynamics such as negative switching and sub-optimal feeding. Such varied responses can have vastly different ecological consequences for both zooplankton and their resources; inappropriate choices may incorrectly quantify biologically-mediated fluxes and predict spurious dynamics. We discuss how our classes and diagnostics can help constrain parameters, interpret behaviors, and identify limitations to a formulation's applicability for both regional (e.g. High-Nitrate-Low-Chlorophyll regions comprising large areas of the Pacific) and large-scale applications (e.g. global biogeochemical or climate change models). Strategies for assessing uncertainty and for using the mathematics to guide future experimental investigations are also discussed.

Moult intensity and chronology of Tundra Swans during spring and fall migration at Long Point, Lake Erie, Ontario

Moult intensity and chronology in staging Eastern-Population (EP) Tundra Swans (Cygnus columbianus columbianus) were studied during spring in 1999 and 2000 (n = 35) and during fall in 1999, 2000, and 2001 (n = 47) at Long Point, Lake Erie, Ontario. To test for age, sex, and seasonal differences in moult intensity, 20 feather regions were scored according to the proportion of growing feathers. Adult, subadult, and juvenile Tundra Swans moulted contour feathers at low intensities during spring and fall. Males and females of all three age classes had similar patterns and intensities of moult during spring and fall. Shared costs of incubation and brood rearing, perennial monogamy, and lack of a breeding plumage could be some of the pressures selecting for intersexual similarities in feather replacement during migration. Adult, subadult, and juvenile Tundra Swans moulted more intensively during fall than spring. Larger lipid reserves and seasonal dietary differences may allow fall-staging Tundra Swans to moult more intensively than spring-staging birds at Long Point. Overlap of nutritionally costly events (moult and migration) may be necessary as Tundra Swans spend half of their annual cycle on spring and fall staging areas. However, reduced daily nutritional costs associated with moulting at low intensities and migrating slowly apparently permits the overlap of these two life-cycle events.

Macrolevel approaches to improve the availability of complementary foods.

Large numbers of infants and young children suffer from the short- and long-term health effects of poor breastfeeding and complementary feeding practices. Strategies to improve the availability of and access to low-cost fortified complementary foods can play an important corresponding role to that of behavior change in improving nutritional status of young children. However, the nutritional quality of complementary foods used in publicly funded programs is not always optimal, and such programs are costly and reach only a tiny fraction of those who could benefit. To broadly reach the target population, such foods need to be commercially available at affordable prices and promoted in a way that generates demand for their purchase. A sensible long-term policy for the promotion of low-cost fortified complementary foods calls for attention to their nutritional formulations and cost, the economics of production, and the legislative, regulatory, and competitive framework in which marketing occurs. This paper provides information on how to improve the nutritional formulations of fortified complementary foods and outlines the necessary conditions for a market approach to their production and promotion.

Effectiveness of a multidisciplinary total parenteral nutrition team in the hospital setting.

Total parenteral nutrition (TPN) is a form of nutritional support that has become an essential adjunct to the management of patients who are unable to obtain adequate nutrition either via the oral or enteral route. Previous studies indicate that TPN can be administered safely and effectively to patients; however, there are associated risks with this form of nutritional support. Researchers have indicated that due to the complexity of TPN therapy a high level of knowledge and expertise is required in the management of these patients. The multidisciplinary team approach has been supported for its ability to assess the patients' nutritional status, prescribe the nutritional requirements, and reduce the incidence of metabolic complications through regular monitoring. However, contradictory views on the effectiveness of multidisciplinary TPN teams in health-care facilities have also been reported. The aim of this review was to critically analyse the literature and present the best available evidence that investigated the effectiveness of multidisciplinary TPN teams in the provision of TPN to adult hospitalised patients. The primary outcomes included: incidence of catheter-related complications, types of catheter-related complications, incidence of metabolic and electrolyte abnormalities, provision of nutritional requirements, estimated nutritional requirements, number of patients whose nutritional goals were met and the amount of energy and protein provided. Secondary outcomes included cost effectiveness of nutritional support teams and physician compliance with team recommendations. The literature search sought to identify both published and unpublished studies utilising various search strategies and the Internet. The Cochrane Library (2001, Issue 4) was initially searched to identify randomised controlled trials. The other electronic databases searched included CINAHL, Complete Medline, Complete Biomedical Collection, Complete Nursing Collection, and EMBASE. Experts and company representatives were contacted to identify published reports as well as research in progress relevant to this review. Professional bodies were contacted and included the British Association for Parenteral and Enteral Nutrition (BAPEN) and the Australasian Society for Parenteral and Enteral Nutrition (AuSPEN). All randomised and non-randomised controlled trials comparing the effectiveness of multidisciplinary TPN teams, in the provision of TPN to adult hospitalised patients, were considered for inclusion in this review. Trials were included if they reported objective or subjective measures of nutritional, metabolic and catheter-related complications and cost effectiveness. To minimise publication bias studies reported in other languages were also considered for inclusion in the review. The eligibility of studies for inclusion, the methodological quality and data extraction were undertaken independently by two reviewers and cross-checked by a third reviewer. The studies included in the review have been synthesised as a narrative overview. Eleven studies comparing the effectiveness of a multidisciplinary TPN team in the hospital setting were analysed in this review. Six studies that investigated the incidence of total mechanical complications reported a higher incidence of these complications in patients who were managed by their physician. Catheter-related sepsis was investigated in seven studies of which five reported a reduction and two reported an increase in catheter-related sepsis in patients managed by the team. One study reported no statistically significant difference in the total metabolic and electrolyte abnormalities and four studies reported fewer of these abnormalities in patients cared for by the nutrition team. Overfeeding and underfeeding in patients not managed by the TPN team were reported in five studies. The most appropriate route of feeding was investigated in four studies. Two of the four studies reported that patients managed by the team were more likely to be fed by the most appropriate route and the findings from the remaining two studies were unclear. Cost effectiveness of the TPN team was reported in two studies and a reduction in costs was demonstrated in both studies when the patients were managed by the TPN team. Compliance by physicians to recommendations made by the TPN team was investigated in two studies, and both reported that physicians complied with at least 50% of the recommendations. The general effectiveness of the TPN team has not been conclusively demonstrated. There is evidence that patients managed by TPN teams have a reduced incidence of total mechanical complications; however, it is unclear if there is a reduction in catheter-related sepsis. The conflicting results relating to the benefit of the TPN teams in the reduction of electrolyte and metabolic abnormalities indicate that further research is needed to clarify the impact of TPN teams on this outcome. The provision of the patients estimated energy requirements are positively influenced when managed by the TPN team; however, the evidence relating to the effectiveness of the TPN team in the provision of protein requirements remains unclear. From this review it is unclear if management of the patients by the TPN team prevented the inappropriate use of TPN. The limited data obtained from the studies provide evidence of a clinically important difference between groups in terms of cost effectiveness.

Influence of nutrition and lactation on ovulation and conception in red deer

Reproduction incurs a high energetic cost and failure to meet nutritional needs results in reproductive failure. In red deer hinds, the interaction between nutrition, summer lactation and subsequent ovulation/conception is of particular interest for farmed deer production in NZ due to climatic constraints to summer pasture production in many areas. However, few studies have focussed on the potential perturbing effects of poor nutrition on lactational outputs and potential flow-on effects on ovulation/conception. As lacta tion in red deer naturally persists well beyond the autumn mating period, lactational anoestrus (through hormonal feedback mechanisms) is not a normal feature of the species reproduction. However, lactation is of high nutritional cost to the hind and can potentially exert considerable influence on the incidence and timing of conception via changes in hind liveweight, lipid depots and general body condition. Supporting evidence for this hypothesis is derived from studies of wild red deer within habitats marginal to species survival (e.g. Isle of Rhum, Scotland), where climatic variables greatly influence annual reproductive success of hinds. Under such conditions, even the differences in maternal investment (via lactation) required to raise male and female calves have been demonstrated to influence the subsequent success and timing of conceptions. Studies of farmed red deer in Scotland also demonstrated that hinds on different levels of pasture nutrition during lactation exhibited significant differences in conception date, with earlier conceptions favouring hinds on higher levels of nutrition. There is a growing body of evidence from monitoring of farmed red deer in New Zealand that the interaction between lactation and hind body condition score (BCS)/ liveweight influences subsequent conception rate and date. Recent studies on pre-rut versus post-rut calf weaning practices demonstrated effects of lactation on hind BCS and liveweight, calf growth rates and hind conception dates. These studies highlight the need to better understand the "costs" of lactation on reproductive performance, particularly under conditions of nutritional constraints. Keywords: lactation, nutrition, red deer, reproduction

Effectiveness of a clinical practice guideline for parenteral nutrition: a 5-year follow-up study in a pediatric teaching hospital.

To determine the effectiveness of a clinical practice guideline (CPG) on the use of parenteral nutrition (PN) at a tertiary care pediatric hospital. Review of prospectively collected data on hospital-wide PN use 2 years before and 5 years after the establishment of the CPG. Effectiveness of the CPG was measured as the percentage of PN courses lasting fewer than 5 days and the number of PN starts per 1000 patient days. During the study period, 5745 PN courses were administered. The mean (SD) number of PN starts per 1000 inpatient days was 8.86 (0.78) before the CPG and 9.54 (2.49) afterwards (p = .28). The percentage courses of PN lasting for fewer than 5 days declined from 26.3% before the CPG to 18.4% afterwards (p < .0001). A multivariate model confirmed that the rate of short-term PN starts declined after the CPG was issued. The mean (SD) number of PN courses shorter than 5 days in the 2 years before the CPG was 2.33 (0.42) per 1000 patient days versus 1.75 (0.45) in the 5 years after the CPG was instituted (p = .005), which is a 25% decline. The services with the highest volume of PN use showed the most significant decreases in short-term PN use. A cost savings to the hospital of more than $50,000 may have been realized. In a large pediatric tertiary care hospital, a CPG was successfully deployed. CPGs can favorably affect the use rates and costs of parenteral nutrition.

Nutrición enteral precoz en pacientes con gastrectomía total por cáncer

Total parenteral nutrition has a high cost and frequency of complications. Enteral feeding is a feasible alternative that can be started early in the postoperative period. To assess digestive tolerance to early enteral feeding in cancer patients undergoing total gastrectomy and to compare early enteral feeding (EEF) with total parenteral nutrition plus enteral feeding (TPN + EF), initiated after overcoming postoperative ileus. Subjects with a resectable gastric cancer were considered eligible for the study. During surgery a nasoenteral tube was placed and patients were prospectively randomized to EEF or TPN + EF. Digestive tolerance, effectiveness, complications and costs between both modalities of nutritional support were compared. Twenty eight patients (15 male, aged 63 +/- 14 years old) were studied. Fourteen patients were randomized to EEF and 14 to TPN + EF. Diarrhea occurred in 14 and 29% of EEF and TPN + EF patients respectively, (p: NS). Patients with TPN + EF received an average of 28 Cal/kg/day and 1.1 g/kg/day proteins. Patients with EEF received an average of 29 Cal/kg/day and 0.8 g/kg/day proteins. At the eighth postoperative day, serum albumin was 3.9 +/- 0.7 and 3.2 +/- 0.5 g/dl in EEF and TPN + EF patients respectively (p < 0.05), serum prealbumin was 16.9 +/- 5 and 12.3 +/- 4.3 mg/dl in EEF and TPN + EF patients respectively (p < 0.05) and nitrogen balance was +2.4 +/- 1.5 and -1.6 +/- 0.6 g/24 h in EEF and TPN + EF patients respectively (p < 0.05). Postoperative hyperglycemia was observed with a lower frequency and nutritional support costs and length of hospital stay were significantly lower in the EEF group. After total gastrectomy EEF is well tolerated, safe and effective, even during the early postoperative ileus. This therapeutic modality could be the first choice for nutritional support in these patients.

Hypocaloric jejunal feeding is better than total parenteral nutrition in acute pancreatitis: results of a randomized comparative study

OBJECTIVES: The aims of this study were to define the indications for, and to evaluate the cost-effectiveness of, nutritional support in patients with acute pancreatitis. METHODS: All admissions during the 12-month period from January through December 2000, were entered into a common management protocol consisting of an initial 48-h fast with i.v. fluids and analgesics. After 48 h, those patients who were improving were restarted on oral feeding (group O). The remaining patients were randomized to receive naso-jejunal (group EN) or parenteral feeding (group TPN). The randomization study was continued until 50 patients had been accrued. Outcomes in the three groups were compared with respect to length of hospital stay, duration of feeding, complications, and hospital costs. RESULTS: A total of 156 admissions were evaluated in the first 12 months. Of these, 87% patients had mild disease, 10% moderate, and 3% severe; 62% were related to alcohol abuse, 18% gallstones, and 8% idiosyncratic drug reactions. Of the patients, 75% improved on 48 h bowel rest and i.v. fluids, and were discharged within 4 days. The remainder were randomized to jejunal elemental (n = 26) or parenteral (n = 27) feeding. Duration of feeding was shorter with EN (6.7 vs 10.8 days, p < 0.05) and nutrition costs were lower, representing an average cost saving of $2362.00 per patient fed. EN was less effective in meeting estimated nutritional requirements (54 vs 88%, p < 0.0001), but metabolic ( p < 0.003) and septic complications ( p = 0.01) were lower. Subgroup analysis of patients with severe disease showed similar findings. CONCLUSION: Despite concerns that metabolic expenditure is increased and that food-stimulated pancreatic secretion might exacerbate the disease process, hypocaloric enteral feeding seems to be safer and less expensive than parenteral feeding and bowel rest in patients with acute pancreatitis.

Factors in the School Cafeteria Influencing Food Choices by High School Students

This study set three objectives: 1) to examine the perceived influence of health concerns, labeling and nutrition information, taste, cost, availability, and peers on adolescents' food choices, particularly in the school cafeteria; 2) to determine whether these factors vary by gender, grade level, or adolescents' health and weight concerns; and 3) to provide recommendations regarding promotion of low-fat foods in the school cafeteria based on factors associated with food choices. Data were collected from a school survey that assessed key influences on adolescents' food choices, including low-fat foods. Some 289 students in grades 10-12 from a senior high school in a metropolitan area served as subjects. Descriptive statistics, chi-square, and general linear models were used for analysis. Results indicated that, when choosing foods from the school cafeteria, taste and getting a lot for their money were important to most students (93.7% and 71.7%, respectively). Females, and students who thought about their health and weight more frequently when deciding what to eat, were more likely to report greater interest in labeling and nutrition information and availability of low-fat foods in the school cafeteria. Findings suggest that efforts to promote low-fat foods to adolescents need to address the taste of low-fat foods, availability of low-fat options, and point-of-purchase labeling of low-fat foods. Focusing on the value and cost of low-fat foods may offer a key strategy for promoting low-fat foods to males.