Protein Deficit Research Articles

Aggressive Nutrition of the Preterm Infant

Nutrition of preterm infants should result in growth similar to that of normally growing fetuses of the same gestational age. Unfortunately, most preterm infants are not fed enough to achieve this objective; as a result they are growth restricted by term gestation. Recent studies have demonstrated that early and enhanced "aggressive" nutrition of preterm infants can reduce postnatal growth failure and improve longer-term outcomes, particularly for the brain and its cognitive functions. When preterm infants are fed more aggressively (earlier onset of intravenous and enteral feeding, earlier achievement of full enteral feeding) cumulative energy and protein deficits are reduced and they consistently regain birth weight sooner, the incidence of necrotizing enterocolitis and late-onset sepsis is unchanged or reduced, and they achieve discharge criteria and go home sooner, with overall shorter hospital stays, and have improved anthropometrics by term gestation. More research is needed, however, to determine optimum feeding of preterm infants, particularly during periods of illness and physiological instability.

Delivery of enteral nutrition for critically ill children

AbstractAimOptimal nutrition support is important in the care of critically ill children as they are at higher risk of malnutrition and have a higher incidence of complications and mortality. The aim of this study was to review the delivery of enteral feeding to critically ill paediatric patients in the Paediatric Intensive Care Unit in a tertiary hospital in Malaysia.MethodsThis cross‐sectional study was conducted in 53 subjects (30 males and 23 females) who were recruited on the day of admission and remained in the study until they were discharged, deceased or for a maximum of 14 days of Paediatric Intensive Care Unit stay. The median age of subjects was 10.2 (interquartile range 5.1–50.5) months old.ResultsEnteral nutrition was initiated within 21.0 (interquartile range 5.3–33.8) hours after admission and was interrupted in 66% of patients during the study, with a median duration of 11.5 (interquartile range 6.1–28.3) hours for each patient. The overall duration of enteral feeding interruptions was 20% of the total feeding time. The main reasons for interruptions were medical procedures (55%) and non‐gastrointestinal complications (27%). Twenty‐two (43.2%) of the patients were malnourished when admitted to the Paediatric Intensive Care Unit. The feeding initiation time, referral to the dietitian, and the frequency and duration of feeding interruptions were all positively associated with cumulative energy and protein deficits.ConclusionsMalnutrition among critically ill children in the Paediatric Intensive Care Unit was prevalent; energy and protein deficits were substantial. Strategies to improve the delivery of nutritional support to this group of patients should be planned and implemented by multidisciplinary clinical teams.

PWE-179 Nutritional Assessment and Management in Patients with Decompensated Liver Disease

IntroductionGood nutrition is an effective intervention in decompensated liver disease1. Protein Energy Malnutrition (PEM) is found in 65–90% of patients with advanced liver disease and almost 100% of those awaiting...

Elevated C-reactive protein and cognitive deficits in individuals with bipolar disorder

BackgroundSome individuals with bipolar disorder have cognitive deficits even when euthymic. In previous studies, we found an association between elevated levels of C-reactive protein (CRP), a marker of inflammation, and reduced cognitive functioning in schizophrenia. This issue has not been examined in bipolar disorder. MethodsWe measured the levels of high sensitivity CRP in serum samples from 107 individuals with bipolar disorder. Cognitive functioning was measured with the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and the Trail Making Test Part A and WAIS Information and Letter Number Sequencing. We estimated the odds of RBANS scores <=70 for participants whose CRP levels were above the 75th and the 90th percentile of the level of non-psychiatric controls. We also examined the association between cognitive scores and CRP levels. Covariates included demographic factors, mood symptom severity, cigarette smoking status, and body mass index. ResultsThere was a significantly increased odds of low RBANS total score for individuals who had a CRP level higher than the 90th percentile (OR=4.32, p=.018) and the 75th percentile (OR=3.07, p=.04)) of the control group. There was an inverse relationship between CRP levels and performance on RBANS total (t=−2.48, p=.015); RBANS immediate memory (t=−2.16, p=.033); RBANS attention (t=−2.18, p=.032); RBANS language (t=−2.13, p=.036); Trail Making A (t=−2.39, p=.019). LimitationsFactors which we did not measure such as diet, allergen exposure, and underlying autoimmune disorders may contribute to CRP levels. ConclusionsInflammation may play a major role in the cognitive deficits associated with bipolar disorder.

Periprocedural cessation of nutrition in the intensive care unit: opportunities for improvement

Delivery of enteral nutrition (EN) to ICU patients is commonly interrupted for diagnostic and therapeutic procedures. We investigated this practice in a cohort of trauma and surgical ICU patients. This was a retrospective single-center study conducted in a 15-bed trauma ICU of a university-affiliated teaching hospital. Descriptive statistics were used. Of 69 patients assessed, 41 had 121 planned procedures over a mean ICU length of stay of 18.7days (SD 9.6days). EN was stopped prior to 108 (89%, 95% CI 82-94%) of these 121 procedures, and 102 of these cessation episodes were related to the planned procedure. EN was stopped in 37 patients for a mean cumulative duration of 30.8h (SD 22.7h) per patient, which represented 7.9% (SD 6.9%) of the mean total time spent in the ICU leading to a mean energy and protein deficit of 7.2% (SD 8.5%) and 7.7% (SD 9.6%), respectively. Of the 121 planned procedures, 27 (22%, 95% CI 16-31%) were postponed beyond the scheduled day. For 32 (31%, 95% CI 23-41%) of the 102 EN cessation episodes, EN was stopped without a documented order and 23 (23%, 95% CI 16-32%) episodes were not deemed necessary based on the institution's guidelines. In this ICU cohort, EN cessation for planned procedures was frequent and led to a nutritional deficit due to long periods without EN being delivered. Postponement of procedures and clinically unnecessary EN cessation were important factors that prevented delivery of planned nutrition. EN cessation practice should be a focus for improving EN delivery in ICU patients.

The Safety and Efficacy of Parenteral Nutrition Among Pediatric Patients With Burn Injuries*

Although enteral nutrition is the ideal mode of nutritional support following burn injury, it is often interrupted during episodes of severe sepsis and hemodynamic instability, leading to significant energy and protein deficits. Parenteral nutrition is not commonly used in burn centers due to concerns that it will lead to hyperglycemia, infection, and increased mortality. However, parenteral nutrition is often utilized in our burn unit when goal rate enteral nutrition is not feasible.To determine the safety and efficacy of a standardized protein-sparing parenteral nutrition protocol in which glucose infusion is limited to 5-7 mg/kg/hour. Retrospective observational study. Pediatric burn hospital. A retrospective medical record review of all children admitted to our hospital with burns ≥ 30% total body surface area was conducted. Only patients admitted within one week of injury and who survived > 24 hours after admission were included in this study. None. Of the 105 patients who met the inclusion criteria, 96 (91%) received parenteral nutrition or a combination of parenteral nutrition and enteral nutrition at some point during their care. Nine patients received only enteral nutrition. Demographic data were similar between groups. Protein intake was significantly higher in the parenteral nutrition group. Incidence of catheter-related blood infections did not differ between groups. Use of parenteral nutrition was not associated with blood or respiratory infections. Overall mortality rate was low (4%), as most patients (96%) achieved wound closure and were discharged home. Judicious use of parenteral nutrition is a safe and effective means of nutritional support when goal enteral nutrition cannot be achieved. A hypocaloric, high-nitrogen parenteral nutrition solution can reduce energy and protein deficits while minimizing complications commonly associated with parenteral nutrition usage.

Effects of protein energy supplementation during pregnancy on fetal growth: a review of the literature focusing on contextual factors

BackgroundMaternal diet during pregnancy is one of the most important factors associated with adequate fetal growth. There are many complications associated with fetal growth restriction that lead to lifelong effects. The aim of this review was to describe the studies examining the effects of protein energy supplementation during pregnancy on fetal growth focusing on the contextual differences.MethodsRelevant articles published between 2007 and 2012 were identified through systematic electronic searches of the PubMed, Science Direct, and EBSCO database and the examination of the bibliographies of retrieved articles. The search aimed to identify studies examining pregnant women receiving protein and/or energy during pregnancy and to assess fetal growth measures. Data of effectiveness and practical aspects of protein energy supplementation during pregnancy were extracted and compiled.ResultsTwenty studies (11 randomized controlled trials, 8 controlled before and after, and 1 prospective study) were included in this review. Positive outcomes in infants and women cannot be expected if the supplementation is not needed. Therefore, it is essential to correctly select women who will benefit from dietary intervention programs during pregnancy. However, there is currently no consensus on the most effective method of identifying these women. The content of protein in the supplements considering total diet is also an important determinant of fetal growth. Balanced protein energy supplementation (containing up to 20% of energy as protein) given to pregnant women with energy or protein deficit appears to improve fetal growth, increase birth weight (by 95–324 g) and height (by 4.6–6.1 mm), and decrease the percentage of low birth weight (by 6%). Supplements with excess protein (>20% of energy as protein) provided to women with a diet already containing adequate protein may conversely impair fetal growth. There is also no consensus on the best time to start supplementation.ConclusionsStrong quality studies examining adequate criteria to screen women who would benefit from supplementation, time to start supplementation, and type of supplements are warranted.

NGF and APP Interplay: Focus on YENPTY Motif of Amyloid Precursor Protein and Y682 Residue

NGF and APP Interplay: Focus on YENPTY Motif of Amyloid Precursor Protein and Y682 Residue Cholinergic deficits originated from NGF metabolism disruption, represent one of the early changes in Alzheimer’s disease, where abnormal deposition of β-amyloid peptide (Aβ) and phosphorylated Tau define the neuropathological hallmarks of the disorder. A failure in NGF maturation can promote pro-apoptotic pathway activation, through p75 receptor; while lack of NGF signalling can generate an atypical TrkA receptor phosphorylation resulting in neuronal cell death and Aβ toxicity. These evidences suggest a complex interaction between TrkA, p75, and Aβ, whose exact cellular mechanisms remain still elusive. Here, we provide a general overview on the current knowledge on NGF and APP interplay, focusing on the events that mediate NGF signalling impairment, and, mostly, on the role of APP Tyrosine 682 phosphorylation whose absence in APPY682G mice impairs APP/TrkA interaction and leads to cholinergicneurodegeneration.

1396 Can Early Parenteral Lipid and High Dose Amino Acid Administration Improve Growth in VLBW Infants?

IntroductionThe beneficial effects of early nutrition in preterm infants are well known. Nonetheless, almost all very low birth weight (VLBW; BW < 1500g) infants develop a protein and energy deficit...

132 Early Lipid and High Dose Amino Acid Administration Increases Anabolism in Vlbw Infants

IntroductionThe beneficial effects of early nutrition in preterm infants are well known. Nonetheless, almost all VLBW infants (BW< 1500g) develop a protein and energy deficit in the first week of...

Early postnatal low-protein nutrition, metabolic programming and the autonomic nervous system in adult life

Protein restriction during lactation has been used as a rat model of metabolic programming to study the impact of perinatal malnutrition on adult metabolism. In contrast to protein restriction during fetal life, protein restriction during lactation did not appear to cause either obesity or the hallmarks of metabolic syndrome, such as hyperinsulinemia, when individuals reached adulthood. However, protein restriction provokes body underweight and hypoinsulinemia. This review is focused on the regulation of insulin secretion and the influence of the autonomic nervous system (ANS) in adult rats that were protein-malnourished during lactation. The data available on the topic suggest that the perinatal phase of lactation, when insulted by protein deficit, imprints the adult metabolism and thereby alters the glycemic control. Although hypoinsulinemia programs adult rats to maintain normoglycemia, pancreatic β-cells are less sensitive to secretion stimuli, such as glucose and cholinergic agents. These pancreatic dysfunctions may be attributed to an imbalance of ANS activity recorded in adult rats that experienced maternal protein restriction.

Using Induced Stem Cells from Patients, Scientists Restore Muscle Protein Deficits in Model for Limb Girdle Muscular Dystrophy

Using Induced Stem Cells from Patients, Scientists Restore Muscle Protein Deficits in Model for Limb Girdle Muscular Dystrophy

El desarrollo pesquero y la integración regional

Latin America is presented as one of the world's most important areas in terms of fishing resources Oceanic. Ibero-American fishing produces almost as much fish as is necessary to cover the entire regional protein deficit, however, more than 70% of that production is exported to the best-fed countries on the planet. It is important to appreciate that in the face of the food problem in Latin America, the fishing sector is presented as an effective short-term alternative and its development possibilities are economically and technically viable with optimal prospects, although it is true that various problems must be addressed for their due promotion. In this paper we analyze the favorable factors and limiting aspects of fishing development.

High-carbohydrate/low-protein–induced hyperinsulinemia does not improve protein balance in children after cardiac surgery

ObjectiveIn pediatric cardiac surgery, fluid-restricted low-protein (LoProt) diets account for cumulative protein deficits with increased morbidity. In this setting, we aimed to inhibit proteolysis by a high-carbohydrate (HiCarb)-intake–induced hyperinsulinemia and improve protein balance. MethodsThe effect of a HiCarb/LoProt (glucose 10 mg · kg−1 · min−1/protein 0.7 g · kg−1 · d−1) versus a normal-carbohydrate (NormCarb)/LoProt (glucose 7.5 mg · kg−1 · min−1/protein 0.3 g · kg−1 · d−1) enteral diet on whole-body protein breakdown and balance was compared in a prospective, randomized, single-blinded trial in 24 children after cardiac surgery. On the second postoperative day, plasma insulin and amino acid concentrations, protein breakdown (endogenous rate of appearance of valine), protein synthesis (non-oxidative disposal of valine), protein balance, and the rate of appearance of urea were measured by using an isotopic infusion of [1-13C]valine and [15N2]urea. ResultsThe HiCarb/LoProt diet led to a serum insulin concentration that was three times higher than the NormCarb/LoProt diet (596 pmol/L, 80–1833, and 198 pmol/L, 76–1292, respectively, P = 0.02), without differences in plasma glucose concentrations. There were no differences in plasma amino acid concentrations, non-oxidative disposal of valine, and endogenous rate of appearance of valine between the groups, with a negative valine balance in the two groups (−0.65 μmol · kg−1 · min−1, −1.91 to 0.01, and −0.58 μmol · kg−1 · min−1, −2.32 to −0.07, respectively, P = 0.71). The serum cortisol concentration in the HiCarb/LoProt group was lower compared with the NormCarb/LoProt group (204 nmol/L, 50–544, and 532 nmol/L, 108–930, respectively, P = 0.02). ConclusionIn children with fluid restriction after cardiac surgery, a HiCarb/LoProt diet compared with a NormCarb/LoProt diet stimulates insulin secretion but does not inhibit proteolysis further and therefore cannot be advocated for this purpose.

Association between C-reactive protein and cognitive deficits in elderly men and women: a meta-analysis

Certain risk factors for cognitive decline appear modifiable. A potentially modifiable marker of inflammation, C-reactive protein may be associated with cognitive deficits, although not all studies have found a relationship between C-reactive protein and cognitive ability. Further, few research papers have examined whether gender may affect any association between C-reactive protein and cognitive deficit. To better understand the association between C-reactive protein, cognitive deficit, and gender in elderly people, we meta-analyzed cross-sectional studies that reported cognitive ability assessed by the Mini-Mental State Examination or an equivalent measure, C-reactive protein concentrations, and gender. While we identified no studies containing only male subjects, the two identified studies containing both female and male subjects (n = 2,525) showed an effect size for cognition of -0.1809 (95% confidence interval, -0.2652 to -0.0967, p = 0.000025) between high and low C-reactive-protein groups. In contrast, the two identified studies containing only female subjects (n = 1,754) showed an effect size for cognition of 0.0345 (95% confidence interval, -0.0594 to 0.1285, not significant). In the context of a small number of source studies and lack of an all-male group, these results suggest that any association between C-reactive protein and cognitive deficits may be stronger in elderly men than in elderly women.

Nutritional status of growth faltered children aged 0-6 years in rural Rangareddy district

Background: Malnutrition continues to affect children aged 0-6 years in large numbers in India. Many of these children lack proper nutrition at birth and in early childhood, which results in growth faltering. Growth monitoring is a good tool for visualization of growth in children, but episodes of growth faltering among healthy as well as malnourished children has failed to catch the attention of the Anganwadi workers so far. Objectives: (1) To assess the magnitude of growth faltering among 0-6 years children in an adopted village of MediCiti Institute of Medical Sciences (MIMS) and (2) To study their nutritional status. Materials and Methods: A large village in the field practice area of MediCiti Institute of Medical Sciences was conveniently selected. All children enrolled in three Anganwadis of the village were studied for growth faltering episodes and breast-feeding and dietary practices by interviewing their mothers through a predesigned and pre-tested proforma. Anthropometric measurements were taken. Data was analyzed using Epi Info Version 3.5.3. Results: Sixty growth-faltered children were analyzed. The mean number of episodes of growth faltering was 1.13 episodes per child and 10% children's growth had faltered on more than one occasion. Most of them belonged to poor socio-economic status. Late initiation of breast-feeding was present in about 55% of these children, and they showed an overall dietary calorie and protein deficit. About 47% of the children were underweight, 57% were stunted, and 25% were wasted. Conclusion: Growth of children aged 0-6 years may be improved by focusing on breast-feeding and nutrition. Further research is required to establish the correlates of growth faltering.

Protein status elicits compensatory changes in food intake and food preferences

Background: Protein is an indispensable component within the human diet. It is unclear, however, whether behavioral strategies exist to avoid shortages.Objective: The objective was to investigate the effect of a low protein status compared with a high protein status on food intake and food preferences.Design: We used a randomized crossover design that consisted of a 14-d fully controlled dietary intervention involving 37 subjects [mean ± SD age: 21 ± 2 y; BMI (in kg/m2): 21.9 ± 1.5] who consumed individualized, isoenergetic diets that were either low in protein [0.5 g protein · kg body weight (BW)−1 · d−1] or high in protein (2.0 g protein · kg BW−1 · d−1). The diets were followed by an ad libitum phase of 2.5 d, during which a large array of food items was available, and protein and energy intakes were measured.Results: We showed that in the ad libitum phase protein intake was 13% higher after the low-protein diet than after the high-protein diet (253 ± 70 compared with 225 ± 63 g, P < 0.001), whereas total energy intake was not different. The higher intake of protein was evident throughout the ad libitum phase of 2.5 d. In addition, after the low-protein diet, food preferences for savory high-protein foods were enhanced.Conclusions: After a protein deficit, food intake and food preferences show adaptive changes that suggest that compensatory mechanisms are induced to restore adequate protein status. This indicates that there are human behavioral strategies present to avoid protein shortage and that these involve selection of savory high-protein foods. This trial was registered with the Dutch Trial register at http://www.trialregister.nl as NTR2491.

Factors that influence pig production in Central Uganda - Case study of Nangabo Sub-County, Wakiso district

Aim: To study the factors affecting pig production in Nangabo Sub-County, Wakiso District, Central Uganda. Materials and Methods: A total of 11% (1350/12783) of all households in the Nangabo Sub-County kept pigs. The th systematic sampling technique was used to complete the list of all pig farming households. This was done by taking 10 farming household until 10% of all the farming households were sampled. A total of 135 farmers were interviewed with semistructured questionnaire. Questionnaire data was entered into Microsoft Excel worksheet and trans-ferred into Statistical Package for Social Scientists Results: Results indicated that 49.6 % of the pigs were raised in the semi-intensive system while 31%, 12% and 8% of the farmers kept pigs on intensive, tethering and free range rearing systems respectively. Farmers that raised their pigs on what is hereby referred to as semi-intensive and intensive management systems allowed their pigs up to five and two hours of open foraging respectively. Ninety eight percent of the farmers provided housing to their pigs and the commonest pig houses were local mud houses and a few of them were tree shades. Majority of farmers (85.2%) watered their pigs at least once a day. The major factors limiting pig production were; diseases and parasites mainly helminthosis and African swine fever (ASF). Others included; high costs of inputs, lack of capital, unstable availability of feed resources, inadequate advisory services and feed price fluctuation (maize bran, sow and weaner), lack of good quality breeding stock, poor and unorganized marketing, lack of enough land, high costs of veterinary medicines and inability to keep records. Additionally, lack of enough water and uncontrolled pig movement grossly limited the pig production in Wakiso district. Most Ugandans keep their pigs in periurban areas of Uganda. It was however, noted that there were important limitations for pig production in the country. To improve pig production and reduce animal protein deficit, knowledge on constraints to pig production was important to inform pig sector promotion stakeholders. Conclusion: Limitations to pig farming including parasites and diseases, ASF, nutritional deficiencies, high cost of inputs like building materials, drugs and veterinary services, inadequate capital and failure of farmers to access credit services, expensive feeds among others were identified and should be addressed to meet national animal protein requirements.

Synaptic protein deficits are associated with dementia irrespective of extreme old age

Recent evidence shows that despite high incidence of dementia in the very old, they exhibit significantly lower levels of Alzheimer's disease (AD) neuropathology relative to younger persons with dementia. The levels and distributions of some synaptic proteins have been found to be associated with dementia severity, even in the oldest-old, but the molecular and functional nature of these deficits have not been studied in detail. The objective of this study was to assess the relationship of dementia with gene and protein expression of a panel of synaptic markers associated with different synaptic functions in young-, middle-, and oldest-old individuals. The protein and messenger RNA (mRNA) levels of 7 synaptic markers (complexin-1, complexin-2, synaptophysin, synaptobrevin, syntaxin, synaptosomal-associated protein 25 (SNAP-25), and septin-5) were compared in the brains of nondemented and demented individuals ranging from 70 to 103 years of age. One hundred eleven brains were selected to have either no significant neuropathology or only AD-associated pathology (neuritic plaques [NPs] and neurofibrillary tangles [NFTs]). The cohort was then stratified into tertiles as young-old (70–81 years old), middle-old (82–88), and oldest-old (89–103). The brains of persons with dementia evidenced significantly lower levels of gene and protein expression of synaptic markers regardless of age. Importantly, dementia was associated with reductions in all measured synaptic markers irrespective of their role(s) in synaptic function. Although other dementia-associated hallmarks of AD neuropathology (neuritic plaques and neurofibrillary tangles) become less prominent with increasing age, synaptic marker abnormalities in dementia remain constant with increasing age and may represent an independent substrate of dementia spanning all ages.

Bornean orangutans on the brink of protein bankruptcy

Protein is a limiting resource that is essential to the growth, maintenance and reproduction of tropical frugivores, yet few studies have examined how wild animals maintain protein balance. During chronic periods of fruit scarcity, Bornean orangutans (Pongo pygmaeus) often catabolize their own fat reserves despite unusually low metabolic requirements. Such energy deficits suggest a marginal existence, and raise the possibility that orangutans also endure periods of negative protein balance. To test this hypothesis, we conducted the first study of protein cycling in a wild primate. Our five year analysis of urinary metabolites revealed evidence of protein recycling when fruit was scarce. During these periods, orangutans consumed more leaves and bark, proteinaceous but tough foods that yielded a mean daily intake of 1.4 g protein kg(-1) metabolic mass. Such an amount is inadequate for humans and one-tenth the intake of mountain gorillas, but sufficient to avert, perhaps narrowly, a severe protein deficit. Our findings highlight the functional and adaptive value of traits that maximize protein assimilation during periods of ecological exigency.