Protein Supplementation Research Articles

Targeting strategies for balanced energy and protein (BEP) supplementation in pregnancy: study protocol for the TARGET-BEP cluster-randomized controlled trial in rural Bangladesh

BackgroundThe World Health Organization (WHO) recommends balanced energy and protein (BEP) supplementation be provided to all pregnant women living in undernourished populations, usually defined as having a prevalence > 20% of underweight women, to reduce the risk of stillbirths and small-for-gestational-age neonates. Few geographies meet this threshold, however, and a large proportion of undernourished women and those with inadequate gestational weight gain could miss benefiting from BEP. This study compares the effectiveness of individual targeting approaches for supplementation with micronutrient-fortified BEP vs. multiple micronutrient supplements (MMS) alone as control in pregnancy in improving birth outcomes.MethodsThe TARGET-BEP study is a four-arm, cluster-randomized controlled trial conducted in rural northwestern Bangladesh. Eligible participants are married women aged 15–35 years old identified early in pregnancy using a community-wide, monthly, urine-test-based pregnancy detection system. Beginning at 12–14 weeks of gestation, women in the study area comprising 240 predefined sectors are randomly assigned to one of four intervention arms, with sector serving as the unit of randomization. The interventions involving daily supplementation through end of pregnancy are as follows: (1) MMS (control); (2) BEP; (3) targeted BEP for those with pre-pregnancy body mass index (BMI) < 18.5 kg/m2 and MMS for others; (4) targeted BEP for those with pre-pregnancy BMI < 18.5 kg/m2, MMS for others, and women with inadequate gestational weight gain switched from MMS to BEP until the end of pregnancy. Primary outcomes include birth weight, low birth weight (< 2500 g), and small for gestational age, defined using the 10th percentile of the INTERGROWTH-21st reference, for live-born infants measured within 72 h of birth. Project-hired local female staff visit pregnant women monthly to deliver the assigned supplements, monitor adherence biweekly, and assess weight regularly during pregnancy. Trained data collectors conduct pregnancy outcome assessment and measure newborn anthropometry in the facility or home depending on the place of birth.DiscussionThis study will assess the effectiveness of targeted balanced energy and protein supplementation to improve birth outcomes among pregnant women in rural Bangladesh and similar settings.Trial registrationClinicalTrials.gov NCT05576207. Registered on October 5th, 2022.

Adding Branched-Chain Amino Acids and Vitamin D to Whey Protein Is More Effective than Protein Alone in Preserving Fat Free Mass and Muscle Strength in the First Month after Sleeve Gastrectomy

Objectives: Sleeve gastrectomy (SG) is one of the most commonly performed weight loss (WL) bariatric procedures. The main goal of WL is reducing total body weight (TBW) and fat mass (FM). However, TBW loss is systematically accompanied by a decline in fat-free mass (FFM), predominantly in the first post-surgical month, despite protein supplementation. Branched-chain amino acids (BCAAs) and vitamin D seem to attenuate loss of FFM and, thus, reduce the decline in muscle strength (MS). However, data on the role of an integrated supplementation with whey protein plus BCAAs plus vitamin D (P+BCAAs+Vit.D) vs. protein alone on total weight loss (TWL), fat mass (FM), fat-free mass (FFM), and (MS) in the first month after SG are lacking. Therefore, the present study aims to evaluate the impact of P+BCAAs+Vit.D vs. protein alone supplementation on TWL, FM, FFM, and MS in the first month after SG. Materials and Methods: Before SG and at 1 month afterward, we prospectively measured and compared TBW, FM, FFM, and MS in 57 patients who received either a supplementation with P+BCAAs+Vit.D (n = 31) or protein alone (n = 26). The impact of P+BCAAs+Vit.D and protein alone supplementation on clinical status was also evaluated. Results: Despite non-significant variation in TBW, FM decreased more significantly (18.5% vs. 13.2%, p = 0.023) with the P+BCAA+Vit.D supplementation compared to protein alone. Furthermore, the P+BCAA+Vit.D group showed a significantly lower decrease in FFM (4.1% vs. 11.4%, p &lt; 0.001) and MS (3.8% vs. 18.5%, p &lt; 0.001) compared to the protein alone group. No significant alterations in clinical status were seen in either group. Conclusion: P+BCAA+Vit.D supplementation is more effective than protein alone in determining FM loss and is associated with a lower decrease in FFM and MS, without interfering with clinical status in patients 1 month after SG.

An overview of alternative protein sources for ruminants in the tropical area

Abstract Investigating alternative protein sources for ruminants in tropical regions is crucial due to distinct climatic conditions and limited resources. Scientists, acknowledging the challenges, are exploring locally accessible alternatives to develop cost-effective and sustainable protein supplements for ruminant nutrition, emphasizing the importance of understanding the nutritional composition for advancing livestock husbandry sustainability. The aim of this research is to elucidate alternative local protein sources for ruminants in tropical areas and assess their effectiveness in promoting sustainable production and enhancing ruminant nutrition. Protein feed sources are essential for providing amino acids to animals and producing animal products such as meat, milk, and wool. Inadequate protein in animal feed may have a detrimental impact on rumen fermentation and animal output. Therefore, alternative protein sources have received increased attention in order to replace the main protein source. The alternative protein sources in this review were divided into five categories: agricultural biomass, fodder shrubs, biological protein and plant weeds, insect protein and agro-industry biomass. Furthermore, plant secondary compounds found in alternative protein sources might be used to modulate rumen fermentation and improve animal performance. By focusing on regional sources of protein, feed costs are reduced while availability is raised. Based on this analysis, it can be concluded that there are a number of alternative protein sources that might be used in place of primary protein sources and that they could support ruminant production in the face of several animal feed crises. However, the potential use of any protein source should be assessed in light of the country’s availability and animal production practices.

Opportunities and Challenges of Soy Proteins with Different Processing Applications

Opportunities and Challenges of Soy Proteins with Different Processing Applications

155 Standardized ileal digestibility of amino acids in soybean meal, fermented soybean meal, and soy protein concentrate fed to nursery pigs

Abstract Accurate information of amino acid (AA) digestibility in protein supplements is critical in formulating diets for nursery pigs. Soybean products are widely used in nursery pig diets due to the high crude protein (CP) concentrations. The objective of the present study was to determine the standardized ileal digestibility (SID) of AA in soybean meal, 3 sources of fermented SBM (FSBM), and soy protein concentrate (SPC) fed to nursery pigs. Ten barrows with an initial body weight of 10.5 kg (standard deviation = 0.9) were surgically fitted with T-cannulas at the distal ileum. The animals were assigned to a replicated 5 × 5 Latin square design with 10 animals, 5 experimental diets, and 5 periods to obtain 10 observations per diet. Five diets were prepared to contain SBM (48.5% CP), 3 sources of FSBM (A, B, and C; 52.6% CP, 55.1% CP, and 49.8% CP, respectively), or SPC (58.4% CP) as the sole source of AA. Each period consisted of 4 d of adaptation period and 3 d of ileal digesta collection period. The values of basal endogenous losses of AA reported in the literature were used to calculate the SID of AA by correcting the apparent ileal digestibility (AID) values. Additionally, a 2-step in vitro procedure modified for nursery pigs was conducted to determine the in vitro ileal disappearance of CP in the 5 ingredients. The AID of all indispensable AA except His and Lys in FSBM-A and FSBM-B was greater (P &amp;lt; 0.05) than that in SBM, whereas AID values for all AA except Trp in SPC did not differ from the values in SBM. The SID of Leu and Trp in FSBM-A and FSBM-B was greater (P &amp;lt; 0.05) than that in SBM or SPC. The SID of all AA in SPC was not different from that in SBM. In vitro ileal disappearance of CP in 3 sources of FSBM was greater (P &amp;lt; 0.001) than that in SBM or SPC. In conclusion, in vitro ileal disappearance of protein was greater in fermented soybean meal compared with soybean meal or soy protein concentrate whereas the standardized ileal digestibility of most amino acids was comparable among the soybean-derived ingredients.

PSI-13 Digestible and metabolizable energy concentrations in soybean meal, fermented soybean meal, and soy protein concentrate fed to nursery pigs

Abstract Accurate information of energy concentrations in protein supplements is critical in formulating diets for nursery pigs. Soybean products are widely used in nursery pig diets due to the high crude protein (CP) concentrations. The objective of the present study was to determine the digestible (DE) and metabolizable energy (ME) in soybean meal (SBM, 48.5% CP), 3 sources of fermented SBM (FSBM-A, FSBM-B, and FSBM-C; 52.6% CP, 55.1% CP, and 49.8% CP, respectively), and soy protein concentrate (SPC, 58.4% CP) fed to nursery pigs. Twelve barrows with an initial body weight of 8.7 kg (standard deviation = 0.5) were individually housed in metabolism crates. A replicated 6 × 4 incomplete Latin square design with 12 animals, 6 experimental diets, and 4 periods was employed. A basal diet contained 96.9% corn as the sole source of energy. The experimental diets were prepared by replacing the basal diet with SBM at 31%, FSBM-A at 27%, FSBM-B at 26%, FSBM-C at 29%, and SPC at 24%. Each period consisted of a 4-d adaptation period and a 4-d collection period. The marker-to-marker procedure was used for the quantitative collection of feces. Urine was collected for 96 h. The difference procedure was employed to calculate the DE and ME values of the soybean ingredients. Additionally, a 3-step in vitro assay was conducted to determine in vitro total tract disappearance of nutrients in the ingredients. The DE concentrations in FSBM-A (4,171 kcal/kg as-fed), FSBM-B (4,111 kcal/kg as-fed), FSBM-C (4,027 kcal/kg as-fed) and SPC (3,999 kcal/kg as-fed) were greater (P &amp;lt; 0.05) than that in SBM (3,724 kcal/kg as-fed). The ME concentrations in FSBM-A (3,883 kcal/kg as-fed) and FSBM-B (3,841 kcal/kg as-fed) were greater (P &amp;lt; 0.05) than that in SBM (3,528 kcal/kg as-fed) but did not differ from those in FSBM-C (3,728 kcal/kg as-fed) or SPC (3,767 kcal/kg as-fed). The DE:gross energy (GE) was greatest (P &amp;lt; 0.05) in FSBM-B but lowest (P &amp;lt; 0.05) in SBM with intermediate ratios for other 3 ingredients whereas the ME:GE and ME:DE were not different among the 5 ingredients. The in vitro total tract disappearance of dry matter and organic matter in SPC was less (P &amp;lt; 0.05) than that in other ingredients. In conclusion, fermented soybean meal and soy protein concentrate contain greater energy concentrations compared with soybean meal.

97 Effects of crude protein content and supplementing probiotics in late gestation and lactation sow diets on performance of sows and suckling pigs

Abstract The objective of this study was to investigate the effects of crude protein (CP) content and supplementation with Bacillus-based probiotics (PRO) in late gestation and lactation sow diets on performance of sows and suckling pigs. Pregnant sows (n = 120; 60 gilts and 60 2+ parity) were assigned to 4 dietary treatments in a 2 x 2 factorial arrangement (2 CP levels, with or without probiotics) from d 85 of gestation to d 21 of lactation. The experiment was conducted in 4 consecutive periods (half sows and half gilts per period). The diets consisted of 1) a corn-soybean meal (SBM)-based low CP (LCP; 12% CP) diet; 2) LCP + 0.05% probiotic (LCP-PRO); 3) a corn-SBM-based high CP (HCP; 15% CP) diet; and 4) HCP + 0.05% probiotic (HCP-PRO). The diets were formulated for 2 phases: gestation (d 85 – 115) and lactation (d 1 – 21). Sow body weight (BW) and backfat thickness were recorded on d 85 and 111 of gestation and on d 1 and 21 of lactation. Sow blood and milk were sampled on d 1 and 21 of lactation to analyze plasma urea nitrogen (PUN) concentration, and milk fat, protein, and lactose, respectively. Data were analyzed using the PROC MIXED of SAS. The statistical model included diet as fixed effect and period as random effect. There were no significant effects of CP and PRO on sow BW or backfat thickness. There was an interaction (P &amp;lt; 0.05) between CP and PRO on the number of stillbirths, where the number of stillbirths did not differ between LCP and LCP-PRO groups, while the number decreased in sows fed HCP-PRO diet compared with HCP diet. Sows fed LCP diets had reduced (P &amp;lt; 0.05) PUN concentrations on d 1 and d 21 of lactation compared with those fed HCP diets. However, no difference was found in fat, protein, or lactose content in both colostrum (d 1) and milk (d 21). Piglets from the sows fed LCP diets showed heavier (P &amp;lt; 0.05) birth weights (1.58, 1.57, 1.53, and 1.52 kg for diets 1 to 4) than those in HCP groups, however, the average daily gain (ADG) of week 1 (188, 166, 187, and 187 g for diets 1 to 4) was less (P &amp;lt; 0.05) for piglets in LCP groups than HCP groups. No other effects were observed on piglet growth. In conclusion, CP and PRO did not affect sow BW and backfat thickness. There was an interaction effect of CP and PRO on reproductive performance, where stillbirths did not differ between LCP and LCP-PRO groups; however, stillbirths decreased with PRO in HCP diet. Moreover, feeding LCP diets to sows did not influence milk nutrient contents and overall growth performance in suckling piglets.

Phenolic Compounds Profile and Antioxidant Capacity of Plant-Based Protein Supplements.

The study aimed to determine the phenolic content and antioxidant capacity of five protein supplements of plant origin. The content and profile of phenolics were determined using the UHPLC-DAD-MS method, while antioxidant capacity (ABTS and DPPH assays) and total phenolic content (TPC) were evaluated using spectrophotometric tests. In the analyzed proteins, twenty-five polyphenols were detected, including eleven phenolic acids, thirteen flavonoids, and one ellagitannin. Hemp protein revealed the highest individual phenolics content and TPC value (1620 μg/g and 1.79 mg GAE/g, respectively). Also, hemp protein showed the highest antioxidant activity determined via ABTS (9.37 μmol TE/g) and DPPH (9.01 μmol TE/g) assays. The contents of p-coumaric acid, m-coumaric acid, kaempferol, rutin, isorhamnetin-3-O-rutinoside, kaempferol-3-O-rutinoside, and TPC value were significantly correlated with antioxidant activity assays. Our findings indicate that plant-based protein supplements are a valuable source of phenols and can also be used in research related to precision medicine, nutrigenetics, and nutrigenomics. This will benefit future health promotion and personalized nutrition in the prevention of chronic diseases.

Combined Nutrition with Exercise: Fueling the Fight Against Sarcopenia Through a Bibliometric Analysis and Review.

This bibliometric analysis and review aimed to examine the current research status and trends in the combination of nutrition and exercise training for sarcopenia. Additionally, it sought to provide researchers with future research directions in this field. Relevant publications were obtained from the Web of Science Core Collection (WoSCC) database, covering the period from January 1995 to October 2023. The collected publications were analyzed using CiteSpace, VOSviewer, Bibliometrix, and Review Manager. Out of the 2528 retrieved publications, the United States emerged as the leading contributor in terms of publication volume. The University of Texas System was identified as the most productive institution. Luc J C van Loon emerged as the most published author in this field. Analysis of keywords revealed recent hot topics and emerging areas of interest, such as "gut microbiota" and "mechanisms". Upon further evaluation, resistance training (RT) and protein supplementation were identified as the most commonly employed and effective methods. RT and protein supplementation are widely recognized as effective strategies. Future research should focus on investigating the molecular aspects of sarcopenia. Moreover, the potential therapeutic role of gut microbiota in sarcopenia requires further comprehensive investigation in human subjects to establish its correlation.

Muscle protein synthesis in response to plant-based protein isolates with and without added leucine versus whey protein in young men and women

BackgroundPlant-based protein supplements often contain lower leucine and other essential amino acids (EAA), potentially making them less effective in stimulating muscle protein synthesis (MPS) than animal-based proteins. Combining plant proteins could improve the EAA profile and more effectively support MPS ObjectiveThe aim of this study was to determine the effect of a novel plant-based blend protein (PBP), PBP with added leucine (PBP+Leu) to levels equivalent to whey protein isolate (WHEY) on aminoacidemia and MPS responses in young men and women. We hypothesized that PBP+Leu would stimulate MPS equivalent to WHEY, and both would be greater than PBP MethodsWe employed a randomized, double-blind, crossover study consisting of three separate study visits to compare PBP, PBP+Leu, and WHEY. To measure MPS response to ingestion of the supplements, a primed continuous infusion of L-[ring13C6] phenylalanine was administered for 8 hours on each study visit. Skeletal muscle tissue and blood samples were collected to measure aminoacidemia and MPS ResultsAll protein supplements increased mixed MPS above postabsorptive levels (P < 0.001). However, MPS following ingestion of PBP was less than the increase following ingestion of PBP+Leu (P = 0.002) and WHEY (P = 0.046). There were no differences in MPS between PBP+Leu and WHEY (P = 0.052) ConclusionsConsumption of PBP isolate with added leucine stimulated MPS to a similar extent as whey protein in young men and women. Plant-based protein blends containing higher leucine content promote anabolism to a similar extent as animal-based proteins. Clinical trial registry number: NCT05139160 (https://classic.clinicaltrials.gov/ct2/show/NCT05139160 ). Clinical Trial Registry number and website where it was obtainedClinical trial registry number: NCT05139160 (https://classic.clinicaltrials.gov/ct2/show/NCT05139160).

PREHABILITATION BEFORE GASTROINTESTINAL CANCER SURGERY (PREHAB-GI): AN IMPLEMENTATION STUDY

BACKGROUND Surgery continues to be the primary treatment option for early-stage colorectal and upper gastrointestinal (UGI) cancers. However, up to 30-40% will experience a major complication. Prehabilitation aims to improve preoperative functional reserves through physical, nutritional, and/or psychological interventions. We aimed to evaluate the implementation of a multimodal prehabilitation program in gastrointestinal cancer surgery patients. METHODS A single-arm implementation study using a pre-post design. Colorectal or UGI cancer patients scheduled for curative intent surgery at Concord Hospital with ≥14 days pre-surgery were recruited. The intervention was face-to-face or by telehealth (COVID adaptations): a 2-4-week program consisting of i) supervised exercise, ii) dietary education and protein supplements, iii) nursing support. The primary outcome was implementation using the RE-AIM (Reach/Effectiveness/Adoption/Implementation/Maintenance) framework. Secondary outcomes included functional, nutritional, and surgical outcomes. RESULTS Over 16 months, 181 were screened; 95 (52%) were eligible. Reach: 77/95 recruited (64 colorectal, 13 UGI). The median age was 70 years; 46 (60%) were males. Median intervention duration was 16 days. Effectiveness: Functional capacity using the 6-minute walk test and 2-minute step test improved from baseline to pre-surgery; 9.3m (p=0.038) and 6.5 steps (p=&amp;lt;0.001), respectively. Self-reported moderate, vigorous and resistance training statistically increased from baseline to pre-surgery. Hospital length of stay decreased by 1.9 days (p=0.010). There was no difference in total complications and readmissions. Adoption: 91% of referrals were directly from surgeons. Implementation: 72 completed the intervention; 5 withdrew after baseline assessment. 34% of assessments and intervention were delivered by telehealth. Adherence to the intervention was high; 94% exercise, 97% nutrition, 98% nursing. Overall, participant and clinician satisfaction was high. Maintenance: The program has been adopted as standard care with modifications post-study completion. CONCLUSIONS Our study shows that multimodal prehabilitation can be successfully implemented in a real-world setting, with a trend to improve functional and surgical outcomes.

Supplementation of Acacia dealbata versus Acacia mearnsii leaf-meal has potential to maintain growth performance of lambs grazing low-quality communal rangelands in South Africa

Supplementing livestock grazing communal rangelands with leaf-meals from Acacia trees, which are currently considered as problematic invasive alien plants globally, may be a sustainable way of exploiting their desirable nutritional and anthelmintic properties. The current study evaluated worm burdens and growth performance of lambs grazing low-quality communal rangelands supplemented with leaf-meals prepared from the invasive alien plant species; Acacia mearnsii or A. dealbata. Forty, three-month-old ewe lambs weighing an average of 18.9 ± 0.60 kg were randomly allocated to four supplementary diets: (1) rangeland hay only (control), (2) commercial protein supplement plus rangeland hay, (3) A. mearnsii leaf-meal plus rangeland hay and (4) A. dealbata leaf-meal plus rangeland hay. All the supplementary diets were formulated to meet the lambs’ minimum maintenance requirements for protein. All the lambs were grazed on communal rangelands daily from 0800 to 1400 after which they were penned to allow them access to their respective supplementary diets until 08:00 the following morning. The respective supplementary diets were offered at the rate of 400 g ewe− 1 day− 1 for 60 days. Lambs fed the commercial protein supplement had the highest dry matter intake followed by those fed the Acacia leaf-meals and the control diet, respectively (P ≤ 0.05). Relative to the other supplementary diets, lambs fed the commercial protein supplement and A. dealbata leaf-meal had higher (P ≤ 0.05) final body weight and average daily gains. Dietary supplementation did not affect lamb faecal worm egg counts over the study period (P > 0.05). There was no association between supplementary diets and lamb FAMACHA© scores (P > 0.05). It was concluded that supplementation of Acacia dealbata versus Acacia mearnsii has the potential to emulate commercial protein in maintaining growth performance of lambs grazing communal rangelands in the dry season.

IT’S NEVER TOO LATE TO START: A CASE FOR PREVENTATIVE OUTPATIENT GERIATRIC SERVICES

INTRODUCTION &amp; AIMS The population is ageing and the chronic disease burden growing, seeing more older adults present to hospital with preventable non-communicable diseases. Multidisciplinary outpatient teams are well placed to manage modifiable risk factors to prevent disease progression and hospitalisations. A preventative service was launched at Concord Hospital integrating geriatrician, exercise physiologist and dietitian care to optimise the physical and mental health of older adults with chronic disease and frailty. This evaluation aims to determine the success of service implementation and feasibility of the model. METHODS Between November 2022 and June 2023, 59 patients (mean age 80.2 years (SD 6.2), 47.5% female) completed 12-weeks of concurrent exercise and diet interventions with medical oversight. Patients were assessed pre- and post-interventions. Exercise was individualised and multimodal, performed twice weekly in a supervised group. Diet was individualised with a protein supplement prescribed as appropriate. The outcomes measured were Fried Frailty Phenotype (FFP), leg strength (one repetition maximum leg press), Short Physical Performance Battery (SPPB), Geriatric Depression Scale Short Form (GDS), and Mini Nutritional Assessment Long Form (MNA). Service activity was measured monthly via rate of referral and occasions of service (OOS). Data were analysed using JASP (v.0.18.1). RESULTS Monthly rate of referral and OOS increased from 18 to 51 patients and 49 to 479 occasions respectively, indicating service demand. After 12-weeks there were significant improvements in FFP (mean difference [95%CI] -0.4 [-0.7, -0.2] points), leg strength (34.0 [27.1, 40.8] kilograms), SPPB (1.1 [0.8, 1.5] points), GDS (-1.4 [-2.2, -0.6] points) and MNA (2.6 [1.6, 3.5] points), with no effect of sex observed. CONCLUSION Initial implementation of a preventative outpatient geriatric service was successful with increasing service demand and significant physical and mental health improvements. The service model is feasible; however, further evaluation is required to determine outcomes after continued service provision.

Targeting strategies of antenatal balanced energy and protein supplementation in Addis Ababa, Ethiopia: study protocol for a randomized effectiveness study

BackgroundAntenatal balanced energy and protein (BEP) supplements have well-documented benefits for pregnancy outcomes. However, considerable practical gaps remain in the effective and cost-effective delivery of antenatal BEP supplements at scale in low- and middle-income countries.MethodsA randomized effectiveness study will be conducted in two sub-cities of Addis Ababa, Ethiopia, to evaluate the effectiveness, cost-effectiveness, and implementation of different targeting strategies of antenatal BEP supplements. Pregnant women aged 18 to 49, with a gestational age of 24 weeks or less, and attending antenatal visits in one of the nine study health facilities are eligible for enrollment. In six of the health facilities, participants will be randomized to one of three study arms: control (Arm 1), targeted BEP provision based on baseline nutritional status (Arm 2), and targeted BEP supplementation based on baseline nutritional status and monthly gestational weight gain (GWG) monitoring (Arm 3). In the remaining three facilities, participants will be assigned to universal BEP provision (Arm 4). Participants in Arms 2 and 3 will receive BEP supplements if they have undernutrition at enrollment, as defined by a baseline body mass index less than 18.5 kg/m2 or mid-upper arm circumference less than 23 cm. In Arm 3, in addition to targeting based on baseline undernutrition, regular weight measurements will be used to identify insufficient GWG and inform the initiation of additional BEP supplements. Participants in Arm 4 will receive BEP supplements until the end of pregnancy, regardless of baseline nutritional status or GWG. All participants will receive standard antenatal care, including iron and folic acid supplementation. A total of 5400 pregnant women will be enrolled, with 1350 participants in each arm. Participants will be followed up monthly during their visits to the antenatal facilities until delivery. Maternal and infant health status will be evaluated within 72 h after delivery and at 6 weeks postpartum. The effectiveness and cost-effectiveness of the different BEP targeting strategies in preventing adverse pregnancy outcomes will be compared across arms. Qualitative data will be analyzed to assess the feasibility, acceptability, and implementation of different supplementation strategies.DiscussionThis study will inform global recommendations and operational guidelines for the effective and cost-effective delivery of antenatal BEP supplements. The targeted approaches have the potential for broader scale-up in Ethiopia and other low-resource settings with a high burden of undernutrition among pregnant women.Trial registrationClinicalTrials.gov registration number: NCT06125860. Registered November 9, 2023.

The importance of developmental programming in the beef industry

The beef industry relies on multiple focused segments (e.g., cow-calf, stocker/feeder, and meat packing) to supply the world with beef. Thus, the potential impact of developmental programming on the beef industry needs to be evaluated with regards to the different production traits that drive profitability within each segment. For example, when nutrient restriction of dams occurred early in gestation embryo survival was decreased and the ovarian reserve of heifer progeny was negatively affected. Restriction during mid- to late gestation negatively impacted first service conception rates and pregnancy success of daughters. Even non-nutrient stress has been reported to impact transgenerational embryo development through the male progeny. Primary and secondary muscle fibers form during months two to eight (Days 60–240) of gestation. Therefore, external stimuli (nutrition or environmental) during this window have the potential to decrease the postnatal number of muscle fibers; which has an irreversible impact on animal growth and performance. Nutrient restriction during the last third of gestation resulted in decreased weaning weights, and in some instances decreased dry mater intake, hot carcass weight, and marbling scores. Protein supplementation during late gestation; however, increased weaning weight and ADG to weaning, but progeny of dams restricted in protein in late gestation had greater ribeye area. The importance of developmental programming is recognized; however, its precise application depends on comprehension of its integrated effects across the multiple-focused segments of the beef industry.

Effects of prilled fat supplementation in diets with varying protein levels on production performance of early lactating Nili Ravi Buffaloes.

The objective of the current study was to find out the independent and interactive effects of prilled fat supplementation with protein on the production performance of early lactating Nili Ravi buffaloes. Sixteen early lactating buffaloes (36.75 ± 5.79 d in milk; mean ± SE) received 4 treatments in 4 × 4 Latin-square design according to 2 × 2 factorial arrangements. The dietary treatments were:1) LPLF = low protein low fat, 2) LPHF = low protein high fat, 3) HPLF = high protein low fat, and 4) HPHF = high protein high fat. The dietary treatments contained 2 protein (8.7 and 11.7% CP, crude protein) and fat levels (2.6 and 4.6% EE, ether extract) on a dry matter basis. The yields of milk and fat increased with increasing protein and fat independently (p≤0.05). Energy-, protein-, and fat-corrected milk yields also increased with increasing protein and fat independently (p≤0.05). Increasing dietary protein increased the protein yield by 3.75% and lactose yield by 3.15% and increasing dietary fat supplies increased the fat contents by 3.93% (p≤0.05). Milk yield and fat-corrected milk to dry matter intake ratios were increased at high protein and high fat levels (p≤0.05). Milk nitrogen efficiency was unaffected by dietary fat (p>0.10), whereas it decreased with increasing protein supplies (p≤0.05). Plasma urea nitrogen and cholesterol were increased by increasing protein and fat levels, respectively (p≤0.05). The values of predicted methane production reduced with increasing dietary protein and fat. It is concluded that prilled fat and protein supplies increased milk and fat yield along with increased ratios of milk yield and fat-corrected milk yields to dry matter intake. However, no interaction was observed between prilled fat and protein supplementation for production parameters, body weight, BCS and blood metabolites. Predicted methane production decreased with increasing protein and fat levels.

Effects of Adjuvant Exercise and Nutrition Therapy on Muscle Fibre Biomechanics in Gastrointestinal Cancer Patients.

Patients with aggressive cancer, e.g., gastrointestinal cancer, are prone (≥50% chance) to developing cancer cachexia (CC). Little is known about the effects of CC on the biomechanical function of muscle. A promising prevention strategy was found in the form of a multi-modal therapy combining mild resistance exercise (e.g., whole-body electro-myostimulation, WB-EMS) and a protein-rich diet. In a previous study of ours, this was effective in counteracting the loss of muscle mass, yet a systematic and comprehensive assessment of active and passive single muscle fibre functions was so far absent. This pilot study investigated the biomechanical function of single muscle fibres (rectus abdominis) from the biopsies of conventionally treated (pre-)cachectic cancer ((pre-)CC) patients (m = 9), those receiving the multi-modal therapy comprising WB-EMS training and protein-rich nutrition (m = 3), and a control group (m = 5). Our findings not only align with previous findings showing the absolute force loss in CC that is accelerated by atrophy but also speak in favour of a different, potentially energy- and Ca2+-homeostasis-related effect that compromises muscle contraction (F ~0.9 mN vs. F ~0.6 mN in control patients). However, myofibrillar Ca2+ sensitivity and the quality of contraction were unaltered (pCa50: 5.6-5.8). Single fibres from the (pre-)CC patients receiving WB-EMS training and protein supplementation were significantly more compliant (p < 0.001 at ≥130% of resting length L0). Those fibres displayed a similar softness to the ones from the control patients (axial compliance ~15 m/N at ≥130% L0), while single fibres from the patients with (developing) cachexia were significantly stiffer (axial compliance ~7 m/N, p < 0.001 at ≥130% L0). Adjuvant multi-modal therapy (WB-EMS training and nutritional support) contributes to maintaining the axial compliance of single fibres and potentially improves the quality of life for patients at risk of developing CC.

Protein-enriched soup and weekly exercise improve muscle health: A randomized trial in mid-to-old age with inadequate protein intake.

Prior research has highlighted the synergistic impact of protein supplementation on muscle function post-exercise in adults; however, evidence supporting the combined effects were less robust and inconsistent on those with protein insufficiency. This investigation aims to explore efficacy of protein-enriched soup coupled with exercise on muscle health and metabolism in middle-aged and older adults with suboptimal protein intake. An open-label, 12-week, randomized controlled trial involving participants with insufficient protein intake (<1.0g/kg/day) was done. The intervention group consumed protein-enriched soup (24-30g protein daily) and 1-h weekly exercise, while controls received health education. Assessments included laboratory tests, functional assessments, and body composition. In this trial, 97 out of 100 randomized participants (mean age: 64.65±4.84years, 81.8% female) completed the study (47 in intervention group and 50 in control group). Compared results of baselines, at 1 and 3months of intervention, significant improvements in waist circumference (83.48±10.22 vs. 82.5±9.88 vs. 82.37±9.42cm, P for trend=0.046), 6-min walking distance (525.65±58.46 vs. 534.47±51.87 vs. 552.02±57.66m, P for trend=0.001), five-time sit-to-stand time (7.63±1.63 vs. 6.81±1.8 vs. 6.4±1.42s, P for trend <0.001), grip strength (26.74±6.54 vs. 27.53±6.99 vs. 28.52±7.09kg, P for trend <0.001), and MNA score (26.8±2.14 vs. 27.73±1.74 vs. 27.55±1.72, P for trend <0.001) were discerned within the intervention group. The intervention demonstrated a significant reduction in serum triglyceride (105.32±49.84 vs. 101.36±42.58 vs. 93.43±41.49mg/dL, P for trend=0.023), increased HDL-C (60.04±16.21 vs. 60±17.37 vs. 62.55±18.27mg/dL, P for trend=0.02), and DHEA-S levels (97.11±54.39 vs. 103.39±56.75 vs. 106.83±60.56μg/dL, P for trend=0.002). Serum myostatin did not differ in both groups, but serum leptin levels significantly increased (9118.88±5811.68 vs. 11508.97±7151.08 vs. 11220.80±7190.71pg/mL, P for trend=0.016) in controls. The intervention group showed greater improvements in 6min walking distance (β=0.71, 95% CI: 6.88 to 40.79, P=0.006), five-time sit-to-stand test (β=-0.87, 95% CI: -1.59 to -0.15, P=0.017), MNA score (β=0.96, 95% CI: 0.20 to 1.71, P=0.013), serum triglycerides (β=-15.01, 95% CI: -27.83 to -2.20, P=0.022), LDL-C (β=-9.23, 95% CI: -16.98 to -1.47, P=0.020), and DHEA-S levels (β=9.98, 95% CI: 0.45 to 19.51, P=0.04) than controls. Protein-enriched soup with weekly exercise over 12weeks significantly improved physical performance, lipid profile, and DHEA-S levels among middle-aged and older adults with inadequate protein intake, while studies assessing long-term benefits of the intervention are needed.

Longitudinal change of energy expenditure, body composition and dietary habits in Progressive Supranuclear Palsy patients.

Alterations in metabolic status, body composition, and food intake are present in all neurodegenerative diseases. Aim of this study was to detect the progression of these changes in Progressive Supranuclear Palsy (PSP). We conducted a longitudinal study of 15 patients with PSP. The assessments were performed at baseline (T0) and after 7(IQR = 5) months of follow-up (T1). We collected anthropometric measures including body weight, height, body mass index and waist circumference, metabolic parameters through indirect calorimeters, body composition using bioimpedance analysis, and dietary habits with a validated questionnaire. PSP-rating scale (PSP-rs) was used to evaluate disease severity and dysphagia. The majority of patients (66.66%) presented PSP-Richardson Syndrome and 33.33% the other variant syndromes of the disease. At T1 there was a decrease in intake of total daily calories (p < 0.001), proteins (p < 0.001), fibers (p = 0.001), calcium (p = 0.008), iron (p < 0.001), zinc (0.034), vitamin E (p = 0.006) and folates (p = 0.038) compared to T0. No other changes were found. As for T1 data, no significant differences were shown according to disease phenotypes or the presence of clinically significant dysphagia for solids. Within a mid-term follow up, PSP patients presented reduced caloric and proteins intake regardless the presence of dysphagia. The PSP-rs is likely not adequate to assess dysphagia, which should be investigated by specific clinical scales or instrumental examinations. With the goal of maintaining adequate nutritional status, the administration of protein and vitamin supplements should be considered even in the absence of dysphagia evidenced by the rating scales.

Common questions and misconceptions about protein supplementation: what does the scientific evidence really show?

Protein supplementation often refers to increasing the intake of this particular macronutrient through dietary supplements in the form of powders, ready-to-drink shakes, and bars. The primary purpose of protein supplementation is to augment dietary protein intake, aiding individuals in meeting their protein requirements, especially when it may be challenging to do so through regular food (i.e. chicken, beef, fish, pork, etc.) sources alone. A large body of evidence shows that protein has an important role in exercising and sedentary individuals. A PubMed search of "protein and exercise performance" reveals thousands of publications. Despite the considerable volume of evidence, it is somewhat surprising that several persistent questions and misconceptions about protein exist. The following are addressed: 1) Is protein harmful to your kidneys? 2) Does consuming "excess" protein increase fat mass? 3) Can dietary protein have a harmful effect on bone health? 4) Can vegans and vegetarians consume enough protein to support training adaptations? 5) Is cheese or peanut butter a good protein source? 6) Does consuming meat (i.e., animal protein) cause unfavorable health outcomes? 7) Do you need protein if you are not physically active? 8) Do you need to consume protein ≤ 1 hour following resistance training sessions to create an anabolic environment in skeletal muscle? 9) Do endurance athletes need additional protein? 10) Does one need protein supplements to meet the daily requirements of exercise-trained individuals? 11) Is there a limit to how much protein one can consume in a single meal? To address these questions, we have conducted a thorough scientific assessment of the literature concerning protein supplementation.