Protein Intake In Patients Research Articles

Feasibility of two levels of protein intake in patients with colorectal cancer: findings from the Protein Recommendation to Increase Muscle (PRIMe) randomized controlled pilot trial

Low muscle mass (MM) predicts unfavorable outcomes in cancer. Protein intake supports muscle health, but oncologic recommendations are not well characterized. The objectives of this study were to evaluate the feasibility of dietary change to attain 1.0 or 2.0 g/kg/day protein diets, and the preliminary potential to halt MM loss and functional decline in patients starting chemotherapy for stage II-IV colorectal cancer. Patients were randomized to the diets and provided individualized counseling. Assessments at baseline, 6 weeks, and 12 weeks included weighed 3-day food records, appendicular lean soft tissue index (ALSTI) by dual-energy X-ray absorptiometry to estimate MM, and physical function by the Short Physical Performance Battery (SPPB) test. Fifty patients (mean ± standard deviation: age, 57 ± 11 years; body mass index, 27.3 ± 5.6 kg/m2; and protein intake, 1.1 ± 0.4 g/kg/day) were included at baseline. At week 12, protein intake reached 1.6 g/kg/day in the 2.0 g/kg/day group and 1.2 g/kg/day in the 1.0 g/kg/day group (P= 0.012), resulting in a group difference of 0.4 g/kg/day rather than 1.0 g/kg/day. Over one-half (59%) of patients in the 2.0 g/kg/day group maintained or gained MM compared with 44% of patients in the 1.0 g/kg/day group (P= 0.523). Percent change in ALSTI did not differ between groups [2.0 g/kg/day group (mean ± standard deviation): 0.5% ± 4.6%; 1.0 g/kg/day group:-0.4% ± 6.1%; P= 0.619]. No differences in physical function were observed between groups. However, actual protein intake and SPPB were positively associated (β= 0.37; 95% confidence interval 0.08-0.67; P= 0.014). Individualized nutrition counselling positively impacted protein intake. However, 2.0 g/kg/day was not attainable using our approach in this population, and group contamination occurred. Increased protein intake suggested positive effects on MM and physical function, highlighting the potential for nutrition to attenuate MM loss in patients with cancer. Nonetheless, muscle anabolism to any degree is clinically significant and beneficial to patients. Larger trials should explore the statistical significance and clinical relevance of protein interventions.

#2969 One-year longitudinal changes in nutritional parameters associated with low-protein diets in patients starting with incremental PD

Abstract Background and Aims Starting peritoneal dialysis (PD) with an incremental approach, that is, a low dose of PD (1-2 dwells a day in continuous ambulatory PD and until 5 sessions a week in automated PD) based on residual kidney function, is a common strategy to increase the acceptance of dialysis for patients affected by advanced chronic kidney disease (CKD) requiring renal replacement therapy. However, no study has provided evidence on the optimal protein intake in patients treated with a low dose of PD. Indeed, patients starting dialysis require an increased protein intake to supply protein loss by dialysis. On the other hand, patients beginning with a low dose of dialysis and a high protein intake may lead to toxins accumulation and metabolic acidosis. Therefore, the maintenance of protein restriction could be indicated as long as malnutrition does not occur. Method The I-COPE study was designed to assess in 24 PD units in Italy the time to full-dose PD in patients undergoing integrated conservative therapy with low-dose PD. Patients who reached full-dose, switched to hemodialysis, received transplant, or died were censored. No specific recommendation on protein intake was included in the study protocol due to the lack of guidelines on this issue, so the prescription was left to decision of each participating center. This is an ad-interim analysis of the I-COPE study aimed at evaluating the longitudinal changes at one year of BMI and serum albumin. Two groups of nutritional interventions were identified a posteriori: non-low protein diet (NLPD, dietary protein intake > 0.6 g/Kg/day) vs low protein diet (LPD, dietary protein intake ≤ 0.6 g/Kg/day) on two visits after baseline (months 6 and 12). We used a mixed linear regression model to evaluate changes in variables over time in the two diet groups, assuming an unstructured covariance matrix; this was done to consider the correlation between repeated measures and missing points for patients not completing the analysis. Results The I-COPE study included 222 patients (age 63.6 ± 14.2 ys, males 65.3%, diabetes 29.2%). LPD was prescribed in 46.3%, while NLPD in 53.7%. At baseline, no intergroup difference was reported for age (P = 0.51), gender (P = 0.94), and diabetes (P = 0.11). 150 patients had at least an evaluation after baseline. The mixed regression model showed no difference in BMI (P = 0.668) and serum albumin (P = 0.297) adjusted for age, gender, diabetes, and GFR at the start of dialysis. As depicted in Fig. 1, serum albumin level was maintained at 12 months in either group. Conclusion We provide first-time observation that LPD may be safely associated with stable serum albumin and BMI over one year of incremental PD treatment. Therefore, in patients with advanced CKD requiring renal replacement therapy, LPD combined with a low dose of PD may provide a suitable nutritional approach to reduce waste metabolic products without increasing the risk of malnutrition.

Access to a pre-sleep protein snack increases daily energy and protein intake in surgical hospitalized patients

Background & aimIn hospitalized patients, daily protein intake remains far below WHO requirements for healthy adults (0.8 g·kg-1·d-1) as well as ESPEN guidelines for patients (1.2-1.5 g·kg-1·d-1). Providing access to a pre-sleep protein dense snack between dinner and going to bed may serve as a great opportunity to increase daily energy and protein intake in hospitalized patients. However, it remains to be assessed whether protein provision prior to sleep effectively increases protein intake, or may reduce food intake throughout the remainder of the day(s). The present study evaluated the impact of giving access to a pre-sleep snack on daily energy and protein intake in patients throughout their hospitalization. MethodsPatients admitted to the surgical wards of the Maastricht University Medical Centre+ were randomly allocated to usual care (n=51) or given access to a pre-sleep snack (n=50). The pre-sleep snack consisted of 103 g cheese cubes (30 g protein) provided between 7:30 and 9:30 PM, prior to sleep. All food provided and all food consumed was weighed and recorded throughout (2-7 days) hospitalization. Daily energy and protein intake and distribution were calculated. Data were analyzed by independent T-Tests with P<0.05 considered as statistically significant. ResultsDaily energy intake was higher in the pre-sleep group (1353±424 kcal·d-1) when compared to the usual care group (1190±402 kcal·d-1; P=0.049). Providing patients access to a pre-sleep snack resulted in a 17% (11±9 g) higher daily protein intake (0.81±0.29 g·kg-1·d-1) when compared to the usual care group (0.69±0.28 g·kg-1·d-1; P=0.045). Protein intake at breakfast, lunch, and dinner did not differ between the pre-sleep and usual care groups (all P>0.05). ConclusionProviding access to a pre-sleep protein snack, in the form of protein dense food items such as cheese, represents an effective dietary strategy to increase daily energy and protein intake in hospitalized patients. Patients consuming pre-sleep protein snacks do not compensate by lowering energy or protein intake throughout the remainder of the days. Pre-sleep protein dense food provision should be implemented in hospital food logistics to improve the nutritional intake of patients. Trial register noNL8507 (https://trialsearch.who.int/)

Protein intake and its relationship with frailty in chronic kidney disease.

Patients with chronic kidney disease (CKD) are susceptible to frailty because of a range of nutrition-related factors. While protein restriction is commonly advised to preserve kidney function in patients with CKD, insufficient protein intake could potentially exacerbate frailty risk. This study aimed to elucidate the relationship between frailty and protein intake in patients with CKD. This cross-sectional study enrolled patients with CKD stage 3-5. Frailty and prefrailty were assessed using the Japanese version of the Cardiovascular Health Study (J-CHS) criteria. To estimate dietary protein intake, Maroni's formula based on 24-h urine collection was used. The potential association between frailty/pre-frailty and protein intake was investigated using a logistic regression analysis. Ninety-seven individuals with CKD were included in the study, with a median age of 73.0years (interquartile range: 67.0, 82.0). Among them, 34 were women (35.1%), and the estimated glomerular filtration rate (eGFR) was 36.3mL/min/1.73 m2 (interquartile range: 26.9, 44.1). Frailty and pre-frailty were identified in 13.4% and 55.7% of participants, respectively. Comparing the groups, protein intake in the frailty/pre-frailty group (0.83g/kgBW/day [0.72, 0.93]) was lower than that in the robust group (0.89g/kgBW/day [0.84, 1.19], p = 0.002). Upon logistic regression analysis, protein intake exhibited an independent association with frailty/pre-frailty (odds ratio: 0.72, 95% confidence interval: 0.59-0.89, p = 0.003). Reduced protein intake in patients with CKD is associated with frailty and pre-frailty. It is advisable to ensure that patients with CKD who are at risk of frailty consume an adequate amount of protein.

Skeletal Muscle Mass, Serum Branched Chain Amino Acid Levels, And Dietary Protein Intake In Patients With Advanced Heart Failure

Skeletal Muscle Mass, Serum Branched Chain Amino Acid Levels, And Dietary Protein Intake In Patients With Advanced Heart Failure

Total Protein Intake in Patients with PKU: Adequacy Evaluation According to the European PKU Guidelines from 2017

In PKU, the protein requirements are contentious. In 2018, we evaluated the protein intake in patients with PKU. Ninety-nine early treated patients aged 19.3 ± 8.2 years (54% males) were studied. A total of 24 had hyperphenylalaninemia (HPA), 48 mild and 27 classical PKU. All had an annual nutritional status evaluation. A total of 83% were on diet therapy only, and 17% were on diet with tetrahydrobiopterin therapy. Anthropometry, metabolic control and nutritional intake [total protein (TP, g/kg), natural protein (NP, g/kg), protein equivalent from protein substitutes (PE, g/kg)] were collected. TP adequacy (TPA) was calculated as a % of WHO (2007) safe levels of protein intake. Results were compared with the European PKU Guidelines (EPG). The median % contribution NP of TP intake was 53% [31–100]. Most patients (78%) had a TP intake above the EPG recommendations. The median TPA was 171% [146–203], with 79% [51–165] from NP and 84% [0–109] from PE. A TPA of 100–140% was observed in 16 (16%) patients. Only n = 6 (6%) patients had a TPA &lt; 100%. These results emphasize the heterogeneity of PKU. More research is needed to understand the necessity of a single protein recommendation for all, as a ‘one-size-fits-all’ solution might not be appropriate.

Amino acid profiles, disease activity, and protein intake in adult patients with Crohn's disease.

Crohn's disease (CD) is an immune-mediated inflammatory disorder of the gastrointestinal tract with a relapsing-remitting course. Amino acids (AAs) may play critical roles in the intestinal manifestations of disease, due to their involvement in many metabolic and immune functions. The present study aimed to explore serum AA concentrations in adult patients with CD, looking into their variations due to disease activity, surgery and protein content of diet. Eventually, the link between AAs and inflammatory markers was also assessed. Consecutive adult patients aged 18-65 years with diagnosis of CD were recruited. All participants underwent anthropometry and were instructed to fill in a 3-day food record to assess protein intake. Disease activity was clinically defined using the Crohn's Disease Activity Index (CDAI), while blood samples were taken to analyze serum AA profile and inflammatory markers. A total of 103 patients with CD (61 men and 42 women; age:39.9 ± 13.9 years, BMI: 23.4 ± 3.51 kg/m2) were included. Tryptophan levels were found to be remarkably decreased in most subjects, unrelated to disease activity. On the contrary, concentration of lysine, leucine, valine and glutamine decreased in active versus quiescent CD patients, while aspartic acid, glutamate and glycine increased. The latter AAs were also directly correlated with CDAI and serum interleukin (IL)- 1β concentration. Considering the total protein intake, expressed as g/kg/body weight, we observed a reduction in some essential AAs in patients with unmet protein requirements compared to patients who met the recommendation. In conclusion, specific AAs varied according to disease activity and protein intake, adjusted to body weight and disease status. Glu and Asp concentrations raised with increasing IL-1β. However, extensive research is needed to understand the mechanisms underpinning the link between variation in serum AAs, disease activity and protein intake in patients with CD.

“More2Eat” in patients at nutritional risk during hospital stay lowers the risk of three-month mortality

Malnutrition is a common problem among hospitalized patients due to increased nutrient requirements and reduced food intake or uptake of nutrients. The aim of this prospective cohort study was to investigate the association of nutritional risk status (at or not at risk by NRS-2002) as well as energy and protein intake, use of oral nutritional supplements (ONS) and snack meals in at risk patients during hospitalization and adverse outcomes (length of stay (LOS), readmissions and mortality) at three-months follow-up. Data were collected at baseline and at three-months follow-up in patients hospitalized at 31 units at a Danish University Hospital. Diet records were performed at baseline by using the nurses' quartile nutrition recording methods. Data about disease and clinical outcomes were collected from electronic medical records at baseline and three-months follow-up. A total of 318 patients were included. Patients at nutritional risk (n=149, 47%) had higher risk of longer LOS (≥20 days (OR=4.24 [1.81;9.95] and ≥30 days OR=2.50 [1.22;5.14])), having one readmission (OR=1.86 [1.15;3.01]) and death (OR=2.56 [1.27;5.20]) compared to patients not at nutritional risk (n=169, 53%). A longer LOS was associated with patients who achieved ≥75% of energy and protein requirements, consumed snack meals incl. and excl. oral nutritional supplements. Readmissions in patients at nutritional risk during the three-months were not associated with food intake during the index hospitalization. Mortality was observed in 43 of the 318 (13.5%) hospitalized patients. A lower mortality was associated with increased energy and protein intake in patients at nutritional risk. The results of this study indicate a longer LOS, higher readmission rate and increased mortality in patients at nutritional risk compared to patients not at risk. Patients at nutritional risk had lower risk of three-month mortality and longer LOS during index hospitalization with increased energy and protein intake. Readmissions in patients at nutritional risk were not affected by food intake. The association of nutritional risk with poorer outcomes indicates that good nutritional care including constant attention to food-intake during hospitalization can be beneficial regarding mortality.

Relationship between preoperative nitrogen balance and energy and protein intake in patients with esophageal cancer.

Nitrogen balance (NB) is an important indicator of protein utilization in the body, and a positive NB is essential for maintaining and improving nutritional status. However, information is lacking on the target values of the energy and protein levels required to maintain positive NB in cancer patients. This study aimed to verify the energy and protein requirements for positive NB in preoperative esophageal cancer patients. This study included patients for esophageal cancer surgery who were admitted for radical surgery. Urine urea nitrogen (UUN) levels were measured based on 24-h urine storage. Energy and protein intakes were calculated from the dietary intake during hospitalization and the amount administered from enteral and parenteral nutrition. The characteristics of the positive and negative NB groups were compared, and patients' characteristics related to UUN excretion were analyzed. Seventy-nine patients with esophageal cancer were included, and 46% of patients were negative NB. All patients with energy intake ≥30 kcal/kg/day and protein intake ≥1.3 g/kg/day had positive NB. Whereas, in the group with energy intake ≥30 kcal/kg/day and protein intake <1.3 g/kg/day, 67% of patients were positive NB. There was a significant positive relation between UUN excretion and retinol-binding protein in multiple regression analyses adjusted for several patients' characteristics (β = 0.28, p = 0.048). In preoperative esophageal cancer patients, 30 kcal/kg/day of energy and 1.3 g/kg/day of protein were the guideline values for positive NB. Good short-term nutritional status was a factor associated with increased UUN excretion.

Handgrip strength, albumin concentration and protein intake in patients of hemodialysis at hospital presidente estrella ureña in santiago, dominican republic

Handgrip strength, albumin concentration and protein intake in patients of hemodialysis at hospital presidente estrella ureña in santiago, dominican republic

Nutritional counseling for patients with incurable cancer: Systematic review and meta-analysis

This systematic review aims to determine whether nutritional counseling by registered dietitians and/or nutritional specialists is recommended for adult patients with incurable advanced or recurrent cancer who are refractory to or intolerant of anticancer therapy. This systematic review analyzed randomized controlled trials (RCTs) of nutritional counseling in cancer patients older than 18 years, primarily those with stage 4 cancer. Nutrition counseling was performed by registered dietitians and/or nutritional specialists using any method, including group sessions, telephone consultations, written materials, and web-based approaches. We searched the Medline (PubMed), Medline (OVID), EMBASE (OVID), CENTRAL, Emcare, and Web of Science Core Collection databases for articles published from 1981 to 2020. Two independent authors assessed the risk of bias used the Cochrane Risk of Bias 2 tool. Meta-analysis was performed for results and outcomes that allowed quantitative integration. This systematic review protocol was registered with the International Prospective Register of Systematic Reviews (ID: CRD42021288476) and registered in 2021. The search yielded 2376 studies, of which 7 assessed 924 patients with cancer aged 24-95 years. Our primary outcome of quality of life (QoL) was reported in 6 studies, 2 of which showed improvement with nutritional counseling. Our other primary outcome of physical symptoms was reported in two studies, one of which showed improvement with nutritional counseling. Quantitative integration of both QoL and physical symptoms was difficult. A meta-analysis of energy and protein intake and body weight was performed for secondary outcomes. Results showed that nutrition counseling increased energy and protein intake, but total certainty of evidence (CE) was low. Bodyweight was not improved by nutrition counseling. Nutrition counseling is shown to improve energy and protein intake in patients with incurable cancer. Although neither nutrient intake can be strongly recommended because of low CE, nutrition counseling is a noninvasive treatment strategy that should be introduced early for nutrition intervention for patients with cancer. This review did not find sufficient evidence for the effect of nutrition counseling on QoL, a patient-reported outcome. Overall, low-quality and limited evidence was identified regarding the impact of nutrition counseling for patients with cancer, and further research is needed.

The Impact of Higher Protein Intake in Patients with Prolonged Mechanical Ventilation.

Prolonged mechanical ventilation (PMV) is associated with poor outcomes and a high economic cost. The association between protein intake and PMV has rarely been investigated in previous studies. This study aimed to investigate the impact of protein intake on weaning from mechanical ventilation. Patients with the PMV (mechanical ventilation ≥6 h/day for ≥21 days) at our hospital between December 2020 and April 2022 were included in this study. Demographic data, nutrition records, laboratory data, weaning conditions, and survival data were retrieved from the patient’s electronic medical records. A total of 172 patients were eligible for analysis. The patients were divided into two groups: weaning success (n = 109) and weaning failure (n = 63). Patients with daily protein intake greater than 1.2 g/kg/day had significant shorter median days of ventilator use than those with less daily protein intake (36.5 vs. 114 days, respectively, p < 0.0001). Daily protein intake ≥1.065 g/kg/day (odds ratio: 4.97, p = 0.033), daily protein intake ≥1.2 g/kg/day (odds ratio: 89.07, p = 0.001), improvement of serum albumin (odds ratio: 3.68, p = 0.027), and BMI (odds ratio: 1.235, p = 0.014) were independent predictor for successful weaning. The serum creatinine level in the 4th week remained similar in patients with daily protein intake either >1.065 g/kg/day or >1.2 g/kg/day (p = 0.5219 and p = 0.7796, respectively). Higher protein intake may have benefits in weaning in patients with PMV and had no negative impact on renal function.

Plant-Based Diets Improve Maternal-Fetal Outcomes in CKD Pregnancies.

Reducing protein intake in patients with chronic kidney disease (CKD) limits glomerular stress induced by hyperfiltration and can prevent the progression of kidney disease; data in pregnancy are limited. The aim of this study is to analyze the results obtained in CKD patients who followed a plant-based moderately protein-restricted diet during pregnancy in comparison with a propensity-score-matched cohort of CKD pregnancies on unrestricted diets. A total of 52 CKD pregnancies followed up with a protein-restricted plant-based diet (Torino, Italy) were matched with a propensity score based on kidney function and proteinuria with CKD pregnancies with unrestricted protein intake (Cagliari Italy). Outcomes included preterm (<37 weeks) and very preterm (<34 weeks) delivery and giving birth to a small-for-gestational-age baby. The median age in our cohort was 34 years, 63.46% of women were primiparous, and the median body mass index (BMI) was 23.15 kg/m2 with 13.46% of obese subjects. No statistical differences were found between women on a plant-based diet and women who were not in terms of age, parity, BMI, obesity, CKD stage, timing of referral, or cause of CKD. No differences were found between the two groups regarding the week of delivery. However, the combined negative outcome (birth before 37 completed gestational weeks or birth-weight centile <10) occurred less frequently in women following the diet than in women in the control group (61.54% versus 80.77%; p = 0.03). The lower risk was confirmed in a multivariable analysis adjusted for renal function and proteinuria (OR: 0.260 [Q1:0.093–Q3:0.724]; p = 0.010), in which the increase in proteinuria from the first to the last check-up before delivery was lower in patients on plant-based diets (median from 0.80 to 1.87 g/24 h; p: ns) than in controls (0.63 to 2.39 g/24 h p < 0.0001). Plant-based, moderately protein-restricted diets in pregnancy in patients with CKD are associated with a lower risk of preterm delivery and small-for-gestational-age babies; the effect may be mediated by better stabilization of proteinuria.

Năng lượng và protein khẩu phần ăn ở bệnh nhân COVID-19 nặng được điều trị bằng liệu pháp oxy mũi dòng cao

Objectives: To observe the energy and protein intake in patients with respiratory failure due to COVID-19 treated by high-flow nasal cannula (HFNC) oxygenation. Subjects and methods: 120 consecutive critically ill COVID-19 patients requiring HFNC to prevent intubation from September 6 to October 30, 2021 were enrolled in the study. Collect the data about demographics, routes of nutrition (oral and/or parenteral), calories and protein prescribed and used, and documented clinical outcomes. Results: COVID-19 patients receiving HFNC oxygenation therapy received 1,163 ± 269.7 kcal/day (20.8 ± 6.4 kcal/kg/day) and 45.7 ± 18.0 grams of protein/day (0.8 ± 0.4 g/kg/day). No patient received tube feeding (enteral nutrition), while 50 patients with oral nutrition received 1,046.7 ± 251.4 kcal/day and 33.6 ± 8.3 grams protein/day. 70 patients received oral and parenteral nutrition, providing 1,247.2 ± 252.1 kcal/day and 54.4 ± 18.0 grams of protein/day. 89.2% of patients did not meet dietary energy requirements, while 67.5% of patients did not meet dietary protein requirements. The rate of intubation after HFNC treatment was significantly higher in the combined oral and parenteral nutrition group than in the oral feeding group alone (p &lt; 0.001). The length of hospital stay was 15 days (10 - 20 days), with no difference in length of hospital stay in both groups. 54 patients died, and the mortality rate in the combination group was statistically significantly higher than in the oral group alone (p &lt; 0.001). Conclusion: The use of HFNC oxygenation therapy in COVID-19 patients was associated with significantly underfeeding. To achieve optimal calorie and protein intake, parenteral nutrition may be considered. * Keywords: High-flow nasal cannula (HFNC); Nutritional support; Underfeeding.

Clinical implications of low estimated protein intake in patients with heart failure.

BackgroundA higher protein intake has been associated with a higher muscle mass and lower mortality rates in the general population, but data about protein intake and survival in patients with heart failure (HF) are lacking.MethodsWe studied the prevalence, predictors, and clinical outcome of estimated protein intake in 2516 patients from the BIOlogy Study to TAilored Treatment in Chronic Heart Failure (BIOSTAT‐CHF) index cohort. Protein intake was calculated in spot urine samples using a validated formula [13.9 + 0.907 * body mass index (BMI) (kg/m2) + 0.0305 * urinary urea nitrogen level (mg/dL)]. Association with mortality was assessed using multivariable Cox regression models. All findings were validated in an independent cohort.ResultsWe included 2282 HF patients (mean age 68 ± 12 years and 27% female). Lower estimated protein intake in HF patients was associated with a lower BMI, but with more signs of congestion. Mortality rate in the lowest quartile was 32%, compared with 18% in the highest quartile (P < 0.001). In a multivariable model, lower estimated protein intake was associated with a higher risk of death compared with the highest quartile [hazard ratio (HR) 1.50; 95% confidence interval (CI) 1.03–2.18, P = 0.036 for the lowest quartile and HR 1.46; 95% CI 1.00–2.18, P = 0.049 for the second quartile].ConclusionsAn estimated lower protein intake was associated with a lower BMI, but signs of congestion were more prevalent. A lower estimated protein intake was independently associated with a higher mortality risk.

Formulation of the Menu of a General Hospital After Its Conversion to a "COVID Hospital": A Nutrient Analysis of 28-Day Menus.

AimThe aim of the present study was to modify the hospital menu to increase energy and protein provision in COVID-19 patients.MethodsAfter the conversion of our hospital to a COVID-19 hospital, eggs, and comfort foods such as vanilla pudding were added to the menu to boost energy and protein intake of patients. All meals of the standard menu of the hospital, i.e., breakfast, lunch, and dinner were recorded for 14 consecutive days during two periods: pre-COVID-19 and after being converted to a “COVID hospital.” The menus were analyzed with the use of the USDA database.ResultsThe total content of energy (1,873 ± 87 vs. 2,489 ± 137 Kcal), protein (97 ± 11 vs. 126.4 ± 18.7 g), fat (55 ± 9 vs. 74.1 ± 12.8 g), and carbohydrate (241.0 ± 16.0 vs. 323.0 ± 16.0 g) of the provided menus was increased in the COVID-19 period compared to the pre-COVID period. The leucine provision was also increased (4.8 ± 1.08 vs. 7.2 ± 1.3 g). Changes in protein and leucine were greater for breakfast (10 vs. 21 g protein and 0.8 vs. 1.7 g of leucine). The menu during COVID-29 provided more vitamin C (69.5 vs. 109.4 mg), thiamine (1.5 vs. 1.6 mg), riboflavin (2.1 vs. 2.6 mg), niacin (20.6 vs. 27.2 mg), pantothenic Acid (5.7 vs. 7.9 mg), vitamin B6 (2 vs. 2.6 mg), folate (274 vs. 334 μg), B12 (4.8 vs. 6.2 μg), choline (296 vs. 458 mg) as well as vitamins A (8,564 vs. 21,258 IU), D (3.9 vs. 4.7 μg), and K (59.3-111.5 μg). As far as micronutrients are concerned, the provisions of calcium (972 vs. 1375 mg), iron (10.2-12.8 mg), magnesium (236 vs. 294 mg), phosphorus (1,325 vs. 1,807 mg), copper (1.0 vs. 1.3 mg), manganese (2.1 vs. 2.4 mg) and selenium (148 vs. 183 μg) were increased during the COVID-19 period.ConclusionSimple menu changes and addition of comfort foods can substantially boost the nutrient content of a hospital diet, which in concert with provision of oral nutritional supplements could have an impact on patients’ nutritional status.

The Association Between Total Protein Intake and All-Cause Mortality in Middle Aged and Older Korean Adults With Chronic Kidney Disease

Background and AimsOver the past decades, the optimum protein intake for patients with chronic kidney disease (CKD) has been an important, controversial issue. Dietary protein restriction has been commonly recommended for patients with CKD for preserving kidney function. However, evidence of the associations between long-term protein intake and mortality is not consistent in patients with CKD. Therefore, we aimed to examine the associations between total protein intake and all-cause mortality in Korean adults with CKD.MethodsFrom three sub-cohorts of the Korean Genome and Epidemiology Study (KoGES) starting from 2001, total 3,892 participants with eGFR < 60 mL/min/1.73 m2 (CKD stage 3–5) were included in this study. Dietary data were collected using food-frequency questionnaires at baseline. Deaths were followed from 2001 to 2019. Cox proportional hazards regression model was used to evaluate the association between protein intake and all-cause mortality.ResultsDuring a median follow-up (min-max) of 11.1 years (0.3–15.1), 602 deaths due to all causes of mortality were documented. After adjustment for covariates, higher total protein intake was not associated with all-cause mortality [highest vs. lowest quintile of total protein intake (g/kg/day) and proportion (%) (Q5 vs. Q1), HR = 1.14 (0.75–1.72), and HR = 0.87 (0.67–1.13)] in CKD stage 3–5 patients.ConclusionDietary protein intake was not associated with mortality from all causes in patients with CKD. Further research is needed to establish optimal protein intake levels and examine the impact of the dietary source of protein on various health outcomes and mortality in CKD.

Effect of Nutrition Counseling on Protein Intake on Patients with Chronic Kidney Failure who Undergo Hemodialization in Cut Mutia Hospital, Aceh Utara

Patients with kidney failure in outpatient hemodialysis rooms often experience malnutrition and have decreased quality of life. Moroever, they frequently have incorrect knowledge about nutritional intake, especially protein. One way to deal with nutritional problems in kidney patients in outpatient hemodialysis rooms is nutrition counseling to provide knowledge about food handling/control. This counseling aims to enable patients to change their nutritional intake, especially protein. Thus, their nutritional and health status gets better and improved. This study aims to determine the effect of nutritional counseling on protein intake in patients with chronic kidney failure at the Cut Mutia Hospital, Aceh Utara. This research employed a descriptive-analytical method with a quasi-experimental design and a one-group pretest-posttest design. The research sample was 28 chronic kidney failure patients in outpatient hemodialysis rooms at RSUD Cut Mutia Aceh Utara. They were divided into two groups: 14 patients in a treatment group and 14 patients in a control group. The patients received nutrition counseling for 30 minutes in the pre-test and post-test. The data were analyzed using a statistical test of the dependent T-test. The average protein intake in the treatment group before and after the nutritional counseling is 40.60 grams, and the average protein intake after the control group is 52.91 grams. The nutritional counseling significantly affects the protein intake of patients with chronic kidney failure in outpatient hemodialysis rooms at Cut Mutia Hospital, Aceh Utara (p = 0.00).

Serum Protein Levels as Biomarkers of Muscle Strength in Patients with End-Stage Systolic Heart Failure

Purpose Patients with heart failure (HF) are at increased risk of unintentional weight loss, principally loss of skeletal muscle mass, which may exacerbate patients’ impairments in physical functioning. Serum protein levels have been proposed as biomarkers of cardiac cachexia based upon their purported relationship with protein balance and nutritional status. However, it is not known whether the serum protein markers albumin and prealbumin are related to muscle strength and dietary protein intake in patients with HF. Methods We retrospectively analyzed a dataset prospectively collected between 5/2016-3/2020 from patients with end-stage systolic HF ±21 days from left ventricular (LVAD) implantation. Each visit included venous blood draw for serum albumin and prealbumin levels, hydraulic hand dynamometer for handgrip strength and dietary protein intake collection for 3 days followed by analysis in the Food Processor® software. All data collection was repeated at 3 and 6 months after LVAD implantation (±14 days), with study participation ending after either the 6 month visit or heart transplantation, whichever occurred first. Pearson correlations and linear mixed effects models were constructed using SAS and adjusted for 24-hour averaged protein intake. Results The cohort was 89.7% (35/39) male, with mean age 57±11.6 years. There was a positive correlation between baseline albumin levels and baseline handgrip strength (r=0.48, p=0.002, n=38), but no correlation between baseline prealbumin levels and handgrip strength (r=0.01, p=0.94, n=38). There was a positive association across all data for albumin and handgrip strength (n=90 values, p Conclusion In patients with HF undergoing left ventricular assist device (LVAD) evaluation, serum albumin levels could be used as a biomarker of muscle strength, independent of the dietary protein intake. Serum albumin and prealbumin levels do change over the medium-term, showing a stepwise increase at 3 and 6 months of LVAD support, with the greatest increase during the first 3 months.

Feeding Pattern Followed by Hospitals for Patients with Dengue Fever: An Observational Study

Background: Dengue is an acute viral infection and occurs in three different conditions- Dengue fever (DF),dengue hemorrhagic fever (DHF) and dengue shock syndrome. Supportive and symptomatic treatment isindicated during infection, however less is known about feeding care obligatory in its management.Objective: it was aimed to study feeding care offered to DF patients admitted to hospitals.Materials and Method: An observational study was conducted on 48 patients (16 children and 32 adults)diagnosed for dengue fever and admitted to hospital (3 -government and 2-private hospitals were included)during the months of January to May. Details regarding medical symptoms, body temperature, state ofconsciousness, food tolerance and food intake from day 1 to day 5 was obtained. Oral intake of water andIV infused were recorded.Results: Relationship existed between symptoms, state of consciousness and tolerance to food and water;accordingly patients were classified as seriously sick, moderately sick and mildly sick. Patients with bodytemperature ?102°F, abdomen pain, hepatomegaly and dehydration was associated with food intolerance andnon-responsiveness (seriously sick), they took significantly longer time to develop food tolerance comparedto their counterpart with less serious conditions (p ? 0.0001). Severity of sickness affected hospital stay,severely sick patients stayed longer as compared to the mildly sick (children 4.67±0.94 vs 4±0; adults6.43±3.16 vs 3.67± 1.11 days).Majority of adults (71.9%) and children (56.3%) received normal diet. Energy and protein intake of patients(adults and children) in all the three groups were markedly lower than the RDA. Energy intake increasedsignificantly from 1st to 5th day in all three groups. Differences in energy intake (adults-5.0±2.6 Kcals to18.0±6.5 and children 10.0±3.8 - 29.0±6.8 Kcal/kg/day) was extremely significant (p? 0.001) among severelysick compared to the moderately (adults 11.0±1.6- 17.0±4.9 and children 20.0±2.9- 23.0±6.9 Kcal/kg/day)and mildly sick patients (adults 17.0±2.1- 21.0±3.8 and children 38.0±7.8- 39.0±5.7 Kcal/kg/day). Proteinintake among both adults and children was very low. All patients regardless of the conditions received IVfluids at time of hospital admission. Severely sick received higher volumes of IV infusions and less quantityof oral fluids compared to the moderate and mildly sick. With improvement in conditions, it crisscrossedwith reduced IV infusions and increased oral intakes. Each patient had different fluid needs and varied eachday.Conclusion: Presently, diet management ofDF patient is less judicious. In view of poortolerance and unconsciousness that prevail,food selection should be carefully managed.Easily digestible and nutritious drinks suchas fruits juices and soups should be included to complement for improving electrolytedisturbance and dehydration. Data base shouldbe developed about feeding requirements forDF patients.