Nutritional Formula Research Articles

Very high-protein and low-carbohydrate enteral nutrition formula and plasma glucose control in adults with type 2 diabetes mellitus: a randomized crossover trial

Background and objectivesStandard enteral nutrition (EN) formulas can worsen hyperglycemia in diabetic patients. We hypothesized that altering the proportion of macronutrients in a formula; increasing protein while decreasing carbohydrate concentrations would improve glycemic response. The objective of this study was to demonstrate that an EN formula containing a very high concentration of protein (in the form of whey peptides) and low concentration of carbohydrate provide better control of postprandial blood glucose relative to a very high-protein/higher-carbohydrate formula.Subjects and methodsThis was a randomized crossover clinical trial of 12 ambulatory adult subjects with type 2 diabetes. The primary outcome was glycemic response following a bolus of isocaloric amounts of two EN formulas; the secondary outcome was insulin response. Subjects were randomized to the experimental or the control formula, on two separate days, 5–7 days apart.ResultsMean blood glucose concentrations at 10–180 min post-infusion and mean area under the curve for glucose over 240 min post-infusion were significantly lower with the experimental formula than with the control formula (71.99 ± 595.18 and 452.62 ± 351.38, respectively; p = 0.025). There were no significant differences in the mean insulin concentrations over time, insulinogenic indices, and first-phase insulin measurements.ConclusionsAn EN formula containing high-protein and low-carbohydrate loads can significantly improve glucose control in subjects with type 2 diabetes in ambulatory settings as evidenced by observed improved glucose control without significant difference in insulin response.

Fundamental physiochemical properties of dietary fibers used in enteral nutrition formula

Fundamental physiochemical properties of dietary fibers used in enteral nutrition formula

Cost-effectiveness of different home enteral nutrition formulae categories

Cost-effectiveness of different home enteral nutrition formulae categories

Label versus measured content of macro and micronutrients of enteral nutrition formulas

Label versus measured content of macro and micronutrients of enteral nutrition formulas

Effect of macronutrients on the bioaccessibility of trace elements from enteral nutrition formulas

Rationale: Enteral nutrition formulas (ENF) are widely used as a single nutrient and energy source in patients with high risk of undernourishment. This study assesses the total content of trace elements in ENF and the influence of macronutrients on their bioaccessibility.

Nutritional Composition Assessment of 3000 Individualized Parenteral Nutrition Bags in a Tertiary Referral Hospital: Current Prescribing Patterns.

Individualized parenteral nutrition is the most specialized type of nutritional support in the hospital setting. The composition and prescribing patterns for parenteral nutrition have evolved due to new emerging scientific evidence. In the last few years, there has been a tendency to increase the nitrogen and lipid content and decrease the carbohydrate content. To assess the prescribing pattern in a tertiary referral hospital in Spain, the nutritional composition of individualized parenteral nutrition was evaluated retrospectively from January to December of 2016. A total of 3029 parenteral nutrition units were analysed, corresponding to 257 hospitalized adult patients. Medical specialists in General Surgery and Haematology were the most common petitioners. The three most frequently prescribed parenteral nutrition formulae contained 13.4 (28.8%), 15.7 (19.54%) and 17.9 (17.79%) g of nitrogen. The quantity of carbohydrates and lipids showed a mean non-protein calories-to-nitrogen ratio of approximately 78:1 and a carbohydrate-to-lipid ratio that was near 50:50 in most cases. These results suggest a trend towards the administration of parenteral nutrition with a high content of nitrogen and smaller proportion of the non-protein components.

Enteral nutrition for maintenance of remission in Crohn's disease.

Enteral nutrition for maintenance of remission in Crohn's disease.

Correction: Different enteral nutrition formulas have no effect on glucose homeostasis but on diet-induced thermogenesis in critically ill medical patients: a randomized controlled trial.

After publication, the author noticed that Table 2 was incorrectly formatted for the final PDF despite being correct in earlier proofs. The table was correct in the HTML version of the article. The EJCN apologizes for the inadvertent error in the formatting of Table 2. The corrected version is uploaded and should be read in conjunction with the original paper. Any inconvenience to the author and readership is regretted.

Preoperative administration of Omega-3 fatty acids on postoperative pain and acute-phase reactants in patients undergoing Roux-en-Y gastric bypass: A randomized clinical trial

The term "Immunonutrition" (IMN) describes the enteral administration of certain substrates with a theoretical immunomodulating function. From all the elements conforming these IMN formulas, Omega-3 fatty acids (O3FA) are hypothesized to be the most important component for immunomodulation, with increased anti-inflammatory and antioxidant effect. A prospective randomized clinical trial of all the patients undergoing laparoscopic Roux-en-Y gastric bypass was performed. Patients were randomly assigned into 2 groups: those patients receiving a preoperative balanced energy high-protein formula (Control Group) and those ones who received the same preoperative nutritional formula enriched with O3FA (Experimental Group). In both groups, there was a restriction to 900Kcal/day. Nutritional intervention started 10 days before surgery and was maintained up to 8h before the surgical act. Preoperative weight loss, postoperative pain, complications and acute phase reactants were investigated. 40 patients were included in the study, 20 in each group. Preoperative excess weight loss (EWL) with the prescribed treatment was 10.6±7.7% in Control Group and 14.1±5.8% in the Experimental Group (p=0.024). Mean postoperative pain was 25±9.2mm in Control group and 10,9±4,4mm in Experimental Group (p=0.015). CRP determined 24h after surgery was significantly lower in the Experimental Group than in the Control Group. There were not significant differences in complications, mortality or readmission rates between groups. The use of a nutritional supplement enriched with O3FA is associated with a greater preoperative weight loss, reduced postoperative pain and decreased postoperative levels of C reactive protein.

Immunomodulatory Protein Hydrolysates and Their Application.

Immunomodulatory protein hydrolysate consumption may delay or prevent western immune-related diseases. In order to purposively develop protein hydrolysates with an optimal and reproducible immunomodulatory effect, knowledge is needed on which components in protein hydrolysates are responsible for the immune effects. Important advances have been made on this aspect. Also, knowledge on mechanisms underlying the immune modulating effects is indispensable. In this review, we discuss the most promising application possibilities for immunomodulatory protein hydrolysates. In order to do so, an overview is provided on reported in vivo immune effects of protein hydrolysates in both local intestinal and systemic organs, and the current insights in the underlying mechanisms of these effects. Furthermore, we discuss current knowledge and physicochemical approaches to identify the immune active protein sequence(s). We conclude that multiple hydrolysate compositions show specific immune effects. This knowledge can improve the efficacy of existing hydrolysate-containing products such as sports nutrition, clinical nutrition, and infant formula. We also provide arguments for why immunomodulatory protein hydrolysates could be applied to manage the immune response in the increasing number of individuals with a higher risk of immune dysfunction due to, for example, increasing age or stress.

Vitamin B12 (cyanocobalamin) in Infant Formula Adult/Pediatric Nutritional Formula by Liquid Chromatography with Ultraviolet Detection: Collaborative Study, Final Action 2014.02.

To determine the repeatability and reproducibility figures of the AOAC First Action Official MethodSM 2014.02 (Vitamin B12 in Infant Formula and Adult/Pediatric Formula by Liquid Chromatography with UV Detection), a collaborative study was organized. Twenty-one laboratories located in 13 different countries agreed to participate. The study was divided into two parts. During the first part, the laboratories analyzed two samples in duplicate by using the method described in the protocol. The laboratories that provided results within the expected range were qualified for part two, during which they analyzed 10 samples in blind duplicates. Eighteen laboratories managed to provide results on time for reporting. The results were compared with the Standard Method Performance Requirement (SMPR® 2011.005) established for vitamin B12. The precision results met the requirements stated in the SMPR except for one sample. Repeatability and reproducibility relative standard deviation ranged from 1.1 to 6.5% and from 6.0 to 23.8%, respectively, with only one matrix showing reproducibility values higher than the required 11%. Horwitz ratio values were all well below 2 (0.17-0.78). The AOAC Expert Review Panel (Stakeholder Panel for Infant Formula and Adult Nutritional Expert Review Panel) determined that the data presented met the SMPR and, hence, recommended the method to be granted Final Action status in September 2016.

Standard Method Performance Requirements (SMPRs®) 2014.016: Revised: Determination of Fluoride in Infant and Adult/Pediatric Nutritional Formula.

Standard Method Performance Requirements (SMPRs®) 2014.016: Revised: Determination of Fluoride in Infant and Adult/Pediatric Nutritional Formula.

EFFICACY OF NUTRITIONAL SUPPORT PROGRAM ON ANTHROPOMETRIC MEASUREMENT AND SUBJECTIVE GLOBAL ASSESSMENT SCORE AMONG HEMODIALYSIS PATIENTS

Background: Malnutrition is mostly common worldwide among hemodialysis patients which increased risk of morbidity and mortality. Aim of the study: To evaluate efficacy of nutritional support educational program on anthropometric measurement and subjective global assessment score among hemodialysis patients. Methods: With in this study Quasi‒ experimental research design was utilized. A purposive sample of 100 adult patients of both sexes diagnosed with chronic renal failure and on maintenance hemodialysis (MHD), the tool used for data, collection included nutritional assessment sheet, and nutritional formula. Results: the study sample consists of certain hundred hemodialysis patients who met the inclusion criteria and agreed to take part into the study; Their main age was between 30 to ≥ 60 years old .The sample consisted of 49) male and 51) female. In regards renal failure causes identified by the participants, the majority had hypertension (83%), 36% of patients had diabetes and 55 % of the sample had virus C infections. Almost all the participants (92.5%) had a three times frequency of hemodialysis per week 48%on dialysis more than 5years . 39 % of study sample were considered mildly to moderately malnourished according to subjective global assessment score . Nutrition support educational program resulted in improvements in subjective global assessment score , anthropometric measurements and nutritional knowledge of the patients. Conclusion: Planned dietary education or counseling for hemodialysis patients performs a main function withinthe preservation concerning scientific outcome and the universal health regarding affected person . Recommendation: Continuous education and training are required for all hemodialysis patients about nutrition.

Standard Method Performance Requirements (SMPRs®) 2014.003: Revised: Determinional of GOS in Infant Formula and Adult/Pediatric Nutritional Formula.

Standard Method Performance Requirements (SMPRs®) 2014.003: Revised: Determinional of GOS in Infant Formula and Adult/Pediatric Nutritional Formula.

The Impact of Two Different Cold-Extruded Feeds and Feeding Regimens on Zebrafish Survival, Growth and Reproductive Performance.

Zebrafish (Danio rerio) is one of the top model organisms used in biomedical research. Therefore, it is fundamental that zebrafish facilities continuously improve husbandry methods to provide fish with the best physiological and welfare conditions that suit each experimental purpose. Nutrition is a husbandry aspect that needs further optimization, as it greatly affects growth, reproduction, health and behaviour. Here, we have compared the impact of different feeding regimens on zebrafish survival, growth and reproductive performance. Mutant and wild-type zebrafish were raised using several combinations of two cold-extruded processed feeds—Skretting®GemmaMicro and Sparos®Zebrafeed—and one live feed (rotifers). Zebrafeed® outperformed GemmaMicro® in terms of survival rate, and embryo viability was also higher when the spawners were fed with Zebrafeed® either from larval stage or upon sexual maturation. In contrast, GemmaMicro® favoured growth, both in size and weight. The use of rotifers until 60 days post-fertilization improved survival of fish co-fed with GemmaMicro®, while delaying their growth. Zebrafeed® performance was not affected by co-feeding rotifers. Overall, we showed that different nutritional formulas affect physiological parameters, allowing for the establishment of feeding protocols adapted to the objectives of each facility. At the same time, we validated Skretting®GemmaMicro and Sparos®Zebrafeed as two commercially available feeds that are well suited for zebrafish nutrition in a laboratory environment.

HPLC Determination of Total Tryptophan in Infant Formula and Adult/Pediatric Nutritional Formula Following Enzymatic Hydrolysis: Single-Laboratory Validation, First Action 2017.03.

A method for tryptophan (Trp) analysis designed to comply with AOAC Standard Method Performance Requirement 2014.013 is described. Unlike AOAC 988.15, which uses alkaline hydrolysis, this method uses enzymatic hydrolysis to release the Trp from the intact protein. The method achieves an LOQ of 0.18 mg/100 g Trp on a ready-to-feed basis with mean recoveries ranging from 93.8 to 104.9%. Repeatability ranged from 0.2 to 5.0%. Intermediate precision ranged from 1.0 to 6.9%. The analytical range was determined to be 0.18-300 mg/100 g, with linearity over eight calibration standard levels giving an average deviation from theoretical levels of 0.3%. No single calibration point had a deviation of >5.0%. Two standard reference materials (SRMs 1849a and 927e) were analyzed, and the average deviation from the certified value was 98.5% for SRM 1849a and 101.2% for SRM 927e. Sample preparation is very similar to existing methods in terms of time and complexity. The use of an internal standard reduces laboratory error and allows for reproducible results.

Manganese Preconcentration and Speciation in Bioaccessible Fraction of Enteral Nutrition Formulas by Cloud Point Extraction (CPE) and Atomic Absorption Spectroscopy

The present study develops a new method for manganese (Mn) preconcentration and speciation in bioaccessible fraction (soluble and dialyzable fraction) of enteral nutrition formulas by cloud point extraction (CPE) and atomic absorption spectroscopy (AAS). For this purpose, a non-ionic surfactant (Triton X-100) and three chelating reagents [8-hydroxyquinoline (8-HQ); 1-phenyl-3-methyl-4-benzoyl-5-pyrazolone (PMBP); and ammonium pyrrolidine dithiocarbamate (APDC)] were used with different operating conditions. The results showed that an efficient extraction of ionic Mn could be achieved with the following conditions: pH = 10; chelating reagent concentrations of [8-HQ] = 0.36 M, [PMBP] = 0.09 M, and [APDC] = 0.09 M; surfactant Triton X-100 at 25% (w/v), and equilibration temperature-time of 85 °C and 30 min. Limits of detection and quantitation are 0.015 and 0.050 mg L−1 respectively. Furthermore, when analyzing the bioaccessible fraction of the enteral nutrition formulas, the proposed approach can be used to distinguish between ionic (free) Mn and Mn that has been previously bound to existing substances obtained from enzymatic digestion. These Mn speciation findings can be used to validate results obtained from the bioaccessibility assays.

Diabetes-Specific Formulae Versus Standard Formulae as Enteral Nutrition to Treat Hyperglycemia in Critically Ill Patients: Protocol for a Randomized Controlled Feasibility Trial.

BackgroundDuring critical illness, hyperglycemia is prevalent and is associated with adverse outcomes. While treating hyperglycemia with insulin reduces morbidity and mortality, it increases glycemic variability and hypoglycemia risk, both of which have been associated with an increase in mortality. Therefore, other interventions which improve glycemic control, without these complications should be explored. Nutrition forms part of standard care, but the carbohydrate load of these formulations has the potential to exacerbate hyperglycemia. Specific diabetic-formulae with a lesser proportion of carbohydrate are available, and these formulae are postulated to limit glycemic excursions and reduce patients’ requirements for exogenous insulin.ObjectiveThe primary outcome of this prospective, blinded, single center, randomized controlled trial is to determine whether a diabetes-specific formula reduces exogenous insulin administration. Key secondary outcomes include the feasibility of study processes as well as glycemic variability.MethodsCritically ill patients will be eligible if insulin is administered whilst receiving exclusively liquid enteral nutrition. Participants will be randomized to receive a control formula, or a diabetes-specific, low glycemic index, low in carbohydrate study formula. Additionally, a third group of patients will receive a second diabetes-specific, low glycemic index study formula, as part of a sub-study to evaluate its effect on biomarkers. This intervention group (n=12) will form part of recruitment to a nested cohort study with blood and urine samples collected at randomization and 48 hours later for the first 12 participants in each group with a secondary objective of exploring the metabolic implications of a change in nutrition formula. Data on relevant medication and infusions, nutrition provision and glucose control will be collected to a maximum of 48 hours post randomization. Baseline patient characteristics and anthropometric measures will be recorded. A 28-day phone follow-up will explore weight and appetite changes as well as blood glucose control pre and post intensive care unit (ICU) discharge.ResultsRecruitment commenced in February 2015 with an estimated completion date for data collection by May 2018. Results are expected to be available late 2018.ConclusionsThis feasibility study of the effect of diabetes-specific formulae on the administration of insulin in critically ill patients and will inform the design of a larger, multi-center trial.Trial RegistrationAustralian New Zealand Clinical Trial Registry (ANZCTR):12614000166673; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12614000166673 (Archived by WebCite at http://www.webcitation.org/6xs0phrVu)

Innovation in the incorporation of macronutrients to enteral nutrition formulas

Enteral nutrition consists of the administration of chemically defined nutrients which are partially or fully metabolised in the intestinal tract, by the oral route or through a tube, to get an adequate and efficient nutritional supply. Enteral nutrition is the first option when one needs artificial nutrition, keeping parenteral nutrition only for those cases for which enteral nutrition would be insufficient or impossible. Enteral nutrition formulas are classified according to their composition with complete or uncompleted supply of nutrients, administration route, and protein content, energy density and type and content of fibre, and in second term according to general or special purposes utilization. Indeed, enteral nutrition formulas can be grouped as polymeric, oligomeric, organ-specific, therapeutic formulas, and nutrition supplements and modules. All these formulas are susceptible of improvement and innovation based mainly on the knowledge of diseases physiopathology, composition and functionality of food ingredients, which in turn contain a number of specific nutrients and bioactive compounds able to exert particular effects on the patient, and on technological treatment technology that will result in the amelioration of nutrient bioavailability. The present work reviews some of the most relevant functional ingredients used today in the innovation of enteral formulas, as well as their main physiological and biochemical effects in selected pathologies.

MP24-19 ENTERAL NUTRITION FORMULAS WITH HIGHER OXALATE CONTENT MAY CONTRIBUTE TO HIGHER OXALATE ABSORPTION AND URINARY EXCRETION IN PATIENTS REQUIRING NUTRITION SUPPORT

You have accessJournal of UrologyStone Disease: Basic Research & Pathophysiology II1 Apr 2018MP24-19 ENTERAL NUTRITION FORMULAS WITH HIGHER OXALATE CONTENT MAY CONTRIBUTE TO HIGHER OXALATE ABSORPTION AND URINARY EXCRETION IN PATIENTS REQUIRING NUTRITION SUPPORT Kristina L. Penniston, Eve A. Palmer, Riley C. Medenwald, Sarah N. Johnson, Leema M. John, David J. Beshensky, and Ibrahim A. Saeed Kristina L. PennistonKristina L. Penniston More articles by this author , Eve A. PalmerEve A. Palmer More articles by this author , Riley C. MedenwaldRiley C. Medenwald More articles by this author , Sarah N. JohnsonSarah N. Johnson More articles by this author , Leema M. JohnLeema M. John More articles by this author , David J. BeshenskyDavid J. Beshensky More articles by this author , and Ibrahim A. SaeedIbrahim A. Saeed More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.772AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Patients requiring oral and/or enteral nutrition support for nutritional needs can form calcium oxalate (CaOx) kidney stones. Dietary oxalate, if excessive, can contribute to CaOx stones when unopposed by appropriate calcium. The oxalate concentration of oral/enteral nutrition formulas is not known. We assessed various formulas for oxalate. METHODS Adult and pediatric oral/enteral nutrition formulas commonly used in hospitals as well as in home feeding regimens were selected. Formulas designed for oral and enteral consumption (or either) were included (table); completely elemental (hydrolyzed) or modular formula products were not. Multiple samples (N, table) of each formula were acidified, heated, and centrifuged. Supernatants were filtered and analyzed for oxalate by ion chromatography. Oxalate concentration (mg/L±SD), relative standard deviation (SD) between samples (coefficient of variation; CV), and calcium:oxalate ratios (mg:mg/L of formula) were calculated. RESULTS Of 35 formulas analyzed, 9 were excluded due to inconsistent results and high CVs. Results for the 26 remaining formulas are shown (table). Oxalate concentration ranged from 4-140 mg oxalate/L of formula. Due to highly variable calcium content, calcium:oxalate ratios varied widely between formulas (from 0-286) with lower ratios suggesting higher potential for oxalate absorption. There was no difference between mean oxalate concentration of enteral vs. oral formulas (45 vs. 46 mg/L; P=0.92). Formulas designated for enteral use tended to have lower relative SDs (mean CV 16% vs. 21% for oral formulas), likely due to the generally more complex matrix of oral formulas, which contributed to more analytical variability. Depending on the formula, a patient requiring 1.5 L daily could obtain anywhere from 12-150 mg oxalate. CONCLUSIONS Patients requiring oral and/or enteral nutrition support are at risk for a high exogenous oxalate load depending on the formula ingested and on the bioavailability of oxalate. Patients with a history of or at high risk for urolithiasis would benefit from strategies to reduce the bioavailability of oxalate and urinary oxalate excretion, which may include supplemental calcium with feedings or use of an appropriate lower oxalate formula. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e297-e298 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Kristina L. Penniston More articles by this author Eve A. Palmer More articles by this author Riley C. Medenwald More articles by this author Sarah N. Johnson More articles by this author Leema M. John More articles by this author David J. Beshensky More articles by this author Ibrahim A. Saeed More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...