Standard Protein Group Research Articles

Impact of high-protein enteral nutrition on muscle preservation in mechanically ventilated patients with severe pneumonia: a randomized controlled trial.

This study aimed to assess the effects of enteral nutrition with different protein concentrations on muscle mass in severe pneumonia patients, providing insights for enteral nutrition practice in intensive care units (ICUs). A total of 120 severe pneumonia patients admitted to Dazhou Central Hospital's ICU between June 1, 2022, and February 1, 2023, meeting inclusion criteria, were randomly assigned to either a high-protein group (n = 60, 1.8g/kg/d) or a standard-protein group (n = 60, 1.2g/kg/d). Changes in relevant indicators were monitored on days 1, 5, and 10 of ICU admission, including quadriceps and diaphragm thickness, nutritional status (prealbumin and albumin), and adverse events such as diarrhea and constipation. Autoregressive of order 1 model (AR(1)) analysis revealed a decrease in both quadriceps and diaphragm thickness over time in both groups. A significant group × time interaction was observed in quadriceps thickness. By day 10, compared to baseline, quadriceps thickness decreased in the high-protein (-0.315cm [95% CI, -0.340 to -0.289]) and standard-protein (-0.429cm [95% CI, -0.455 to -0.404]) groups. The high-protein group exhibited a lower quadriceps atrophy rate (13.97 ± 2.43%) compared to the standard-protein group (18.96 ± 2.61%), showing a significant difference (P < 0.001). No significant differences were found in diaphragmatic thickness between groups and over time. By day 10, both groups exhibited decreased diaphragmatic muscle thickness compared to baseline. The high-protein group (33.76 ± 5.09%) had a slightly lower phrenic atrophy rate compared to the standard-protein group (33.41 ± 4.53%). Both groups experienced enteral nutritional intolerance manifested as diarrhea, constipation, and other adverse events. High-protein enteral nutrition significantly improved quadriceps thickness and demonstrated good safety in severe pneumonia patients, suggesting its suitability for widespread clinical application.

Effect of high versus standard protein provision on functional recovery in people with critical illness (PRECISe): an investigator-initiated, double-blinded, multicentre, parallel-group, randomised controlled trial in Belgium and the Netherlands

Increased protein provision might ameliorate muscle wasting and improve long-term outcomes in critically ill patients. The aim of the PRECISe trial was to assess whether higher enteral protein provision (ie, 2·0 g/kg per day) would improve health-related quality of life and functional outcomes in critically ill patients who were mechanically ventilated compared with standard enteral protein provision (ie, 1·3 g/kg per day). The PRECISe trial was an investigator-initiated, double-blinded, multicentre, parallel-group, randomised controlled trial in five Dutch hospitals and five Belgian hospitals. Inclusion criteria were initiation of invasive mechanical ventilation within 24 h of intensive care unit (ICU) admission and an expected duration of invasive ventilation of 3 days or longer. Exclusion criteria were contraindications for enteral nutrition, moribund condition, BMI less than 18 kg/m2, kidney failure with a no dialysis code, or hepatic encephalopathy. Patients were randomly assigned to one of four randomisation labels, corresponding with two study groups (ie, standard or high protein; two labels per group) in a 1:1:1:1 ratio through an interactive web-response system. Randomisation was done via random permuted-block randomisation in varying block sizes of eight and 12, stratified by centre. Participants, care providers, investigators, outcome assessors, data analysts, and the independent data safety monitoring board were all blinded to group allocation. Patients received isocaloric enteral feeds that contained 1·3 kcal/mL and 0·06 g of protein/mL (ie, standard protein) or 1·3 kcal/mL and 0·10 g of protein/mL (ie, high protein). The study-nutrition intervention was limited to the time period during the patient's ICU stay in which they required enteral feeding, with a maximum of 90 days. The primary outcome was EuroQoL 5-Dimension 5-level (EQ-5D-5L) health utility score at 30 days, 90 days, and 180 days after randomisation, adjusted for baseline EQ-5D-5L health utility score. This trial was registered with ClinicalTrials.gov (NCT04633421) and is closed to new participants. Between Nov 19, 2020, and April 14, 2023, 935 patients were randomly assigned. 335 (35·8%) of 935 patients were female and 600 (64·2%) were male. 465 (49·7%) of 935 were assigned to the standard protein group and 470 (50·3%) were assigned to the high protein group. 430 (92·5%) of 465 patients in the standard protein group and 419 (89·1%) of 470 patients in the high protein group were assessed for the primary outcome. The primary outcome, EQ-5D-5L health utility score during 180 days after randomisation (assessed at 30 days, 90 days, and 180 days), was lower in patients allocated to the high protein group than in those allocated to the standard protein group, with a mean difference of -0·05 (95% CI -0·10 to -0·01; p=0·031). Regarding safety outcomes, the probability of mortality during the entire follow-up was 0·38 (SE 0·02) in the standard protein group and 0·42 (0·02) in the high protein group (hazard ratio 1·14, 95% CI 0·92 to 1·40; p=0·22). There was a higher incidence of symptoms of gastrointestinal intolerance in patients in the high protein group (odds ratio 1·76, 95% CI 1·06 to 2·92; p=0·030). Incidence of other adverse events did not differ between groups. High enteral protein provision compared with standard enteral protein provision resulted in worse health-related quality of life in critically ill patients and did not improve functional outcomes during 180 days after ICU admission. Netherlands Organisation for Healthcare Research and Development and Belgian Health Care Knowledge Centre.

The effect of protein enriched nutrition on diaphragm function in mechanically ventilated patients

ObjectivesOur primary aim was to demonstrate the effect of high protein on diaphragm muscle thickness, our secondary aim was to evaluate the correlation of diaphragm thickness fraction with rectus femoris muscle thickness in high protein patients. Patients and methodsThis study included 49 mechanically ventilated patients who were randomly divided into a standard protein (1.2g/kg/d) group and high protein group (2.0g/kg/d). Thickness of rectus femoris, thickness of peak inspiratory diaphragm, thickness of end expiratory diaphragm were measured by ultrasonography. Thickness fraction of diaphragm was calculated. ResultsIn the high protein group, thickness of peak inspiratory diaphragm values were found to be statistically significantly higher on days 3rd, 5th, 7th, and 15th (P<0.05). Thicknesses of end-expiratory diaphragm values were found to be statistically significantly higher on the 3rd, 5th and 7th days (P<0.05). Thicknesses fraction of diaphragm values were found to be statistically significantly higher on days 3rd, 5th, 7th and 15th (P<0.05) in the high protein group. Thicknesses of rectus femoris values were higher in the high protein group compared with standard protein group on the 5th, 7th, and 15th days (P<0.005). In high protein group, statistically significant correlations were found between thickness of rectus femoris and thickness fraction of diaphragm at the 3rd day (rho=0.429, P=0.032). ConclusionThis study showed that diaphragmatic muscle thicknesses were higher in patients who received 2g/kg/d protein supplement, These findings have shown that muscle atrophy can be prevented with high protein support in the intensive care unit.

Impact of postnatal nutrition on neurodevelopmental outcome in rat model of intrauterine growth restriction.

There are limited data on nutritional management of infants with intrauterine growth restriction (IUGR). Postnatal protein supplementation for promoting growth is a common clinical practice in neonatology. The present study aims to investigate the consequences of protein supplementation on long-term growth, brain and body weight, brain histology and behavioral outcome in a rat model of IUGR. Twenty-four IUGR-formed rat puppies and 12 healthy puppies were included in the study. IUGR model was established by low (10%) protein diet throughout pregnancy together with intraperitoneal injection of lipopolysaccharide (LPS). Pups were started to be fed with either standard protein (SP), or high protein (HP) diet until postnatal day (PN) 35. Puppies in the control group were given SP diet for 35 days. Six pups from each group were sacrificed at PN7, remaining six were evaluated by Morris water maze test between PN 30 to 35 days and then sacrificed at PN35. Histologic evaluation of brain tissue was performed at PN7 and PN35. IUGR group displayed lower body and brain weights at PN7 when compared with control. At PN35, SP group achieved similar brain/body weight ratios with control, whereas HP group displayed lowest brain/body weight ratio. The number of TUNEL positive cells was significantly higher and myelin basic protein and oligodendrocyte marker O4 immunoreactivity were significantly lower in HP group when compared with SP at PN35. Neuronal density in prefrontal cortex and hippocampus at PN7 were similar among SP and HP groups, but significantly lower in HP group when compared with SP at PN35. SP group displayed better results in the Morris water maze test when compared with HP group. Although postnatal HP support is associated with increase in body weight at PN35, it did not result in better brain/body weight ratios in the rat model of IUGR. In IUGR rats, HP diet was associated with increased apoptosis in brain tissue with lower neuronal density and decreased myelination when compared to SP. Furthermore, better neurodevelopmental scores were achieved by SP diet rather than HP support in IUGR.

Effects of Parenteral Protein Concentrations in Critically Ill Patients in ICU

Abstract Background: Parenteral protein supplements can prevent deterioration of acute critical illness during admission at intensive care unit (ICU). This study aimed to evaluate the effect of parenteral proteins on ICU outcome and to compare the effect of two different protein concentrations on handgrip strength in critically ill patients. Materials and Methods: This prospective comparative study included 60 acute critically ill patients who had parenteral nutrition during their ICU stay. The patients were divided into two groups: a standard protein group who received protein concentration of 1 g/kg/day (group A) and a high-protein group who received protein concentration of 2 g/kg/day (group B). The nutrition was delivered through a central line and the separate bottles technique. Results: Nitrogen balance was more negative in group B compared to group A within the first 3 days. The handgrip strength on day 7 was significantly higher in group B than group A. The forearm thickness, quadriceps muscle thickness, and overall muscle thickness were significantly higher in group B on day 7. The durations of mechanical ventilation, ICU stay, and total hospital stay were not significantly different between both groups. The protein dose was not significantly associated with the overall 2-month mortality. Conclusion: High parenteral protein intake (2 g/kg/day) associated with better handgrip strength and significant improvement of muscle thickness at the end of the 1st week of follow-up. Studies with larger sample size and longer durations of follow-up are recommended.

Body composition of extremely preterm infants fed protein-enriched, fortified milk: a randomized trial.

BackgroundCritically ill extremely preterm infants fed human milk are often underrepresented in neonatal nutrition trials aimed to determine the effects of enteral protein supplementation on body composition outcomes.MethodsMasked randomized trial in which 56 extremely preterm infants 25–28 weeks of gestation were randomized to receive either fortified milk enriched with a fixed amount of extensively hydrolyzed protein (high protein group) or fortified milk without additional protein (standard protein group).ResultsBaseline characteristics were similar between groups. In a longitudinal analysis, the mean percent body fat (%BF) at 30–32 weeks of postmenstrual age (PMA), 36 weeks PMA, and 3 months of corrected age (CA) did not differ between groups (17 ± 3 vs. 15 ± 4; p = 0.09). The high protein group had higher weight (−0.1 ± 1.2 vs. −0.8 ± 1.3; p = 0.03) and length (−0.8 ± 1.3 vs. −1.5 ± 1.3; p = 0.02) z scores from birth to 3 months CA. The high protein group also had higher fat-free mass (FFM) z scores at 36 weeks PMA (−0.9 ± 1.1 vs. −1.5 ± 1.1; p = 0.04).ConclusionsIncreased enteral intake of protein increased FFM accretion, weight, and length in extremely preterm infants receiving protein-enriched, fortified human milk.Impact Extremely preterm infants are at high risk of developing postnatal growth failure, particularly when they have low fat-free mass gains.Protein supplementation increases fat-free mass accretion in infants, but several neonatal nutrition trials aimed to determine the effects of enteral protein supplementation on body composition outcomes have systematically excluded critically ill extremely preterm infants fed human milk exclusively.In extremely preterm infants fed fortified human milk, higher enteral protein intake increases fat-free mass accretion and promotes growth without causing excessive body fat accretion.

The effect of 12 weeks of euenergetic high-protein diet in regulating appetite and body composition of women with normal-weight obesity: a randomised controlled trial.

Normal-weight obesity (NWO) syndrome is associated with metabolic diseases. The present study aimed to investigate the effects of 12 weeks of a high-protein (HP) v. a standard protein (SP) diet on appetite, anthropometry and body composition in NWO women. In this clinical trial, fifty NWO women were randomly allocated to HP (n 25) or SP (n 25) diet groups. Women in the HP and SP groups consumed 25 and 15 % of their total energy intake from protein for 12 weeks. Weight, fat mass (FM), lean body mass (LBM), waist circumference (WC) and appetite were evaluated at baseline and following their 3-month intervention. After 12 weeks, the LBM was higher in HP compared with no significant changes in the SP group (mean between-group difference = 1·5 kg; 95 % CI 3·1, 0·01; effect size (d) = 0·4). Furthermore, the HP group had lower FM (mean between-group difference -1·1 kg; 95 % CI 1, -3·3; d = -0·2), body fat percentage (BFP) (mean between-group difference -2 %; 95 % CI 0·7, -5·2; d = -0·3) and WC (mean between-group difference -1·4 cm; 95 % CI 0·6, -3·6; d = -0·2) at the end of the study in comparison with the SP group. In both groups, weight and appetite were unchanged over time without significant differences between groups. Twelve weeks of euenergetic diets with different dietary protein contents resulted in no significant weight loss in women with NWO. However, an HP diet significantly improved body composition (LBM, FM, BFP and WC) in this population.

Comparison of hs-CRP level between low calorie high protein to standard protein diet in obese individuals with weight cycling - a randomised trial

Background: Obesity is associated with various health problems. Low-grade inflammation is a condition found in obese people and contributes to the development of various diseases. The objective of this study was to compare the effects of calorie restriction diet with high-protein (HP) or standard protein (SP) to inflammation marker (hs-CRP) in obese individuals with weight cycling. Methods: 61 healthy obese men and women (25 – 49 years old) with a history of weight cycling were recruited and were randomly assigned to one of the intervention groups, HP or SP groups. Both groups were suggested to reduce their daily caloric intake by 1000 kcal with regular physical activity for 56 days. Subjects in HP group were given a daily protein intake of 22-30% from total daily caloric intake, while SP group were prescribed 12-20%. Dietary consultation was conducted through daily reminder by phone and weekly counseling. The measurement of hs-CRP level was performed prior to and at the end of the intervention. Results: 54 subjects completed the program, yet due to several reasons only 32 of them were measured for hsCRP before and after completing the program, 15 from HP group and 17 from SP group. After completing the 56-day diet program, SP group experienced reduction of hs-CRP by -0.446 + 4.239, while HP underwent increase by 0.135 + 2.389. The mean difference of change in hs-CRP level between the two groups were not statistically significant (P=0.094). Conclusion: Low calorie diet with either HP or SP for 8 weeks significantly reduced body weight (P&lt;0.001) and BMI (P&lt;0.001) in healthy obese subjects but the difference of change in the hs-CRP level between them were not significant. The protein composition of a low calorie diet may not affect the inflammatory state of obese individuals with weight cycling. Trial registration number: NCT03374150

Comparison of body composition changes between low calorie high protein diet to standard protein in obese individuals with weight cycling – a randomised trial

Background:The world prevalence of obesity in adult population in 2014 was nearly 13% while in Indonesia, it has reached 32.9% in the same year. Obesity is an established risk factors for cardiovascular diseases. A large proportion of people who had succeeded to reduce body weight failed to maintain it (weight cycling). Studies were inconclusive about the best composition in the diet for such people. The purpose of this research was to evaluate the body composition changes resulted from low calorie high protein and standard protein diet programme in obese people with history of weight cycling.Methods:This is an open-randomized clinical trial of weight loss program as a part of a larger study researching the effect of low calorie high protein diet to body composition, oxidative stress, inflammation marker and metabolic syndrome in obese with weight cycling. A total of 61 adult obese men and women with history of weight cycling were recruited. Subjects were assigned to low calorie diet and were randomly distributed into two intervention groups, namely high protein group (22-30 % of total calories intake) and standard protein group (12-20%). Anthropometry and body composition data were taken at baseline and at the end of the study. Subjects were followed up to 8 weeks with daily reminder and weekly counselling.Results:Fourty five participants completed the study. There were significant reductions in in body weight and body mass index (BMI), fat mass, fat mass percentage, muscle mass, and gain in muscle mass percentage occurred in both groups (Standard protein: P&lt;0.001; High protein: P&lt;0.001 for all variables except for fat mass P= 0,001) with no difference between group (P&gt;0.05).Conclusion:Calories deficit with either high protein or standard protein for 8 weeks brought about significant reduction in body composition

Effect of dietary protein on intake, nutrients utilization, nitrogen balance, blood metabolites, growth and puberty in growing Bhadawari buffalo (Bubalus bubalis) heifers.

Fifteen Bhadawari buffalo heifers of 207 ± 9.78 kg mean body weight were randomly distributed into three dietary groups to evaluate the effect of protein level on nutrient utilization, nitrogen (N) balance, growth rate, blood metabolites, and puberty. All animals were offered wheat straw-berseem diets supplemented with concentrate mixtures of similar energy (2.7 Mcal/kg) and different protein levels (14.3-22%). Animals of standard-protein group (SPG) were offered protein and energy as per requirement, while animals of low-protein group (LPG) and high-protein group (HPG) were fed 20% less and 20% more protein, respectively, than SPG. Feed dry matter (DM) and metabolizable energy (ME) intake (% body wt. and g/kg w(0.75)) were similar for all three diets; however, the crude protein (CP) and digestible crude protein (DCP) intake on percent body weight and per kilogram metabolic weight was higher (P < 0.05) in HPG than in SPG or LPG. Digestibility of CP, cellulose, and hemicellulose was higher (P < 0.05) in HPG versus LPG. Fecal N excretion was similar, while urinary N excretion was highest (P < 0.05) in HPG (74.83 g/day) compared with SPG (50.03 g/day) and LPG (47.88 g/day), which resulted in lower N retention in HPG than in the other dietary groups. Level of dietary N had no effect on blood metabolites viz. glucose, urea, and N. Digestible energy (DE) and ME contents of diets were identical, while DCP contents were higher (P < 0.05) in HPG than in LPG. Feed and nutrient (CP and ME) conversion efficiency to produce a unit kilogram weight gain was identical among the dietary groups. Dietary protein level had no effect on the heifer's weight and age at puberty. The mean growth rate of heifers at 240 days was higher (P > 0.05) in SPG (330.8 g/day) than in LPG (296.7 g/day), while the animals gained more weight in January to March months and the lowest weight in May to July months. Protein level had no effect on conception rate of heifers. Results revealed that 20% higher or less protein than the ICAR requirement had no significant (P > 0.05) on feed intake, nutrient conversion efficiency for weight gain, heifer growth, and puberty; however, 20% more protein increased urinary N loss.

Effect of induced Fasciola gigantica infection during pre-patency on the performance of buffalo calves fed on different percentage of protein.

Thirty growing Murrah buffalo calves (8-12months of age, 109.85±2.43) were rearedin parasite free conditions and randomly divided into three equal groups as per CRD. They were fed on iso-caloric (2.01MEMcal/Kg diet) diets containing standard protein (SP) diet at 100%, 90% of SP (medium protein, MP) and 80% of SP (low protein, LP) of the protein requirements (Kearl 1982). After 21days of feeding, each group was further subdivided into two sub-groups (A & B). Animals in sub-groups 'A' served as non-infected control, while in sub group 'B' were orally infected with Fasciola gigantica metacercarie (mc; 1,000 each). A metabolic trial of 40days post infection was carried out in control and parasitized animals. Intake of digestible dry matter, organic matter and acid detergent fibre (ADF) was significantly higher (P<0.05) in SP group compared to LP group. The digestibility of crude protein (CP) and ADF was significantly higher in SP group compared to MP and LP groups. The digestible crude protein (DCP) and total digestible nutrients (TDN) intakes (g/kgW(0.75)) were also significantly (P<0.001) higher in SP than MP and LP groups. However, DCP intake was significantly (P<0.001) lower in infected subgroups compared to control subgroups. Intake and balance (g/d) of nitrogen, calcium and phosphorus were significantly (P<0.01) higher in SP than MP and LP groups. The average daily gain of buffalo calves fed on SP Uninfected (SPU), SP Infected (SPI), MPU, MPI and LPU, LPI groups was 333, 178, 356, 144, 222 and 144g and was significantly (P<0.01) lower in animals fed LP ration. The feed conversion ratio (FCR) was also significantly (P<0.01) higher in infected sub-groups as compared to respective control groups. The results showed that a SP diet substantially improved the overall performance of buffalo calves in control and infected groups and reduced adverse effect of F. gigantica infection.

MicroRNA-130b and microRNA-374b mediate the effect of maternal dietary protein on offspring lipid metabolism in Meishan pigs

To investigate whether the effect of maternal dietary protein on offspring lipid metabolism is mediated by microRNA (miRNA), fourteen Meishan sows were fed either low-protein (LP, half of standard protein (SP) level, n 7) or SP (n 7) diets throughout gestation and lactation periods. PPAR-γ and CCAAT/enhancer-binding protein-β (C/EBP-β) protein expression was evaluated. The expression of miRNA predicted to directly target PPAR-γ and C/EBP-β in the subcutaneous fat of offspring at weaning age was determined, and the functions of these potential miRNA were verified. The results showed that piglet body weight and back fat thickness were significantly decreased in the LP group compared with the SP group (P<0·05). The protein level of PPAR-γ was significantly decreased and C/EBP-β protein expression was also decreased, though not significantly (P=0·056), in the subcutaneous fat of the LP group. Furthermore, miRNA expression analysis showed that miR-130b, targeting the PPAR-γ 3'-untranslated region (UTR), and miR-374b, targeting the C/EBP-β 3'-UTR, were significantly increased in the LP group compared with the SP group; other candidate regulatory miRNA were expressed similarly in both groups. Dual luciferase activity assay results indicated that miR-130b directly recognised and bound to the 3'-UTR of PPAR-γ and thereby suppressed PPAR-γ gene expression. Similar results were found for miR-374b and the 3'-UTR of C/EBP-β. The present study showed that miR-130b and miR-374b are involved in the effect of maternal dietary protein on offspring lipid metabolism in pigs. These results shed new light on our understanding of the maternal effect on offspring lipid deposition.

Effect of High vs Standard Early Parenteral Amino Acid Supplementation on the Growth Outcomes in Very Low Birth Weight Infants

The goal of this study was to evaluate the effect of 2 different strategies for parenteral amino acid (AA) supplementation in the range of standard doses (>1.0-1.5 g/kg/d) on growth outcomes in very low birth weight (VLBW) infants. The unit policy of AA doses on the first day of life changed from 1.5 g/kg/d (n = 56; standard protein group, SP, in 2008) to 3.0 g/kg/d (n = 53; high protein group, HP, in 2009) with a daily advance to a target dose of 3.5-4.0 g/kg/d. Daily nutritive and laboratory profiles were collected for the initial 14 days, and patient weight, height, and head circumference on postnatal day 14 and again at 36 weeks, 6 months, and 12 months of corrected age were evaluated. During the first 14 days, AA intake was greater in the HP group than in the SP group (2.9 ± 0.4 vs 2.6 ± 0.4 g/kg/d, P < .001). The HP group demonstrated a lower peak plasma glucose level during the first 3 days (116 ± 24 vs 137 ± 39 mg/dL) and a higher serum urea nitrogen level for the first 14 postnatal days than the SP group (19.2 ± 7.0 vs 14.8 ± 6.7 mg/dL) (both P < .01). From birth to postnatal 14 days and to 36 weeks, 6 months, and 12 months of corrected age, the z score changes in all growth parameters did not differ between the 2 groups. In the range of the standard AA protocol, there was no dose-response relationship between the early AA doses and the growth outcomes in VLBW infants.

Effect of increasing protein content of human milk fortifier on growth in preterm infants born at

Preterm human milk-fed infants often experience suboptimal growth despite the use of human milk fortifier (HMF). The extra protein supplied in fortifiers may be inadequate to meet dietary protein requirements for preterm infants. We assessed the effect of human milk fortified with a higher-protein HMF on growth in preterm infants. This is a randomized controlled trial in 92 preterm infants born at <31 wk gestation who received maternal breast milk that was fortified with HMF containing 1.4 g protein/100 mL (higher-protein group) or 1.0 g protein/100 mL (current practice) until discharge or estimated due date, whichever came first. The HMFs used were isocaloric and differed only in the amount of protein or carbohydrate. Length, weight, and head-circumference gains were assessed over the study duration. Length gains did not differ between the higher- and standard-protein groups (mean difference: 0.06 cm/wk; 95% CI: -0.01, 0.12 cm/wk; P = 0.08). Infants in the higher-protein group achieved a greater weight at study end (mean difference: 220 g; 95% CI: 23, 419 g; P = 0.03). Secondary analyses showed a significant reduction in the proportion of infants who were less than the 10th percentile for length at the study end in the higher-protein group (risk difference: 0.186; 95% CI: 0.370, 0.003; P = 0.047). A higher protein intake results in less growth faltering in human milk-fed preterm infants. It is possible that a higher-protein fortifier than used in this study is needed. This trial was registered with the Australian New Zealand Clinical Trials Registry (http://www.anzctr.org.au/) as ACTRN12606000525583.

Protein-enriched meal replacements do not adversely affect liver, kidney or bone density: an outpatient randomized controlled trial

BackgroundThere is concern that recommending protein-enriched meal replacements as part of a weight management program could lead to changes in biomarkers of liver or renal function and reductions in bone density. This study was designed as a placebo-controlled clinical trial utilizing two isocaloric meal plans utilizing either a high protein-enriched (HP) or a standard protein (SP) meal replacement in an outpatient weight loss program.Subjects/methods100 obese men and women over 30 years of age with a body mass index (BMI) between 27 to 40 kg/m2 were randomized to one of two isocaloric weight loss meal plans 1). HP group: providing 2.2 g protein/kg of lean body mass (LBM)/day or 2). SP group: providing 1.1 g protein/kg LBM/day. Meal replacement (MR) was used twice daily (one meal, one snack) for 3 months and then once a day for 9 months. Body weight, lipid profiles, liver function, renal function and bone density were measured at baseline and 12 months.ResultsSeventy subjects completed the study. Both groups lost weight (HP -4.29 ± 5.90 kg vs. SP -4.66 ± 6.91 kg, p < 0.01) and there was no difference in weight loss observed between the groups at one year. There was no significant change noted in liver function [AST (HP -2.07 ± 10.32 U/L, p = 0.28; SP 0.27 ± 6.67 U/L, p = 0.820), ALT (HP -1.03 ± 10.08 U/L, p = 0.34; SP -2.6 ± 12.51 U/L, p = 0.24), bilirubin (HP 0.007 ± 0.33, U/L, p = 0.91; SP 0.07 ± 0.24 U/L, p = 0.120), alkaline phosphatase (HP 2.00 ± 9.07 U/L, p = 0.240; SP -2.12 ± 11.01 U/L, p = 0.280)], renal function [serum creatinine (HP 0.31 ± 1.89 mg/dL, p = 0.380; SP -0.05 ± 0.15 mg/dL, p = 0.060), urea nitrogen (HP 1.33 ± 4.68 mg/dL, p = 0.130; SP -0.24 ± 3.03 mg/dL, p = 0.650), 24 hour urine creatinine clearance (HP -0.02 ± 0.16 mL/min, p = 0.480; SP 1.18 ± 7.53 mL/min, p = 0.400), and calcium excretion (HP -0.41 ± 9.48 mg/24 hours, p = 0.830; SP -0.007 ± 6.76 mg/24 hours, p = 0.990)] or in bone mineral density by DEXA (HP 0.04 ± 0.19 g/cm2, p = 0.210; SP -0.03 ± 0.17 g/cm2, p = 0.320) in either group over one year.ConclusionsThese studies demonstrate that protein-enriched meals replacements as compared to standard meal replacements recommended for weight management do not have adverse effects on routine measures of liver function, renal function or bone density at one year. Clinicaltrial.gov: NCT01030354.

Increased Height Gain of Children Fed a High-Protein Diet during Convalescence from Shigellosis: A Six-Month Follow-Up Study

The impact of dietary supplementation on catch-up growth was evaluated in 69 malnourished children ages 24–60 mo after recovery from shigellosis. They were fed either a high-protein (HP) diet with 15% of energy as protein, or a standard-protein (SP) diet with 7.5% energy as protein, for 3 wk in a metabolic study ward. Children were followed up bi-weekly for 6 mo by trained health assistants when anthropometric measurements and information of any illness were collected. Thirty-one children in the HP group and 28 children in the SP group completed 6-mo follow-up. The increase in height (mean ± SD) was 5.3 ± 1.0 cm vs. 4.1 ± 1.1 cm for HP and SP groups, respectively (P < 0.001), whereas increase in body weight was 1.39 ± 0.58 and 1.29 ± 0.72 kg for children fed HP and SP, respectively (P = 0.59). The proportion of children who were severely stunted (< −2 SD height-for-age) decreased from 45 to 29% in the HP group compared to 50 to 46% in the SP group (P < 0.05) at 6-mo follow-up. The number of diarrheal episodes per child tended to be lower in the HP vs. SP than in the SP group (1.9 vs. 2.3, P = 0.41). These results demonstrate that feeding an HP diet to the malnourished children during recovery from shigellosis enhanced linear growth with a modest reduction in diarrheal morbidity during the 6-mo follow-up period.

Absorption of Macronutrients from a High-Protein Diet in Children During Convalescence from Shigellosis

Absorption of macronutrients and energy intake were determined in 29 children aged 24-59 months, during convalescence from acute shigellosis. A 72 h metabolic balance study was performed to determine the absorption of carbohydrate, fat, and protein. Eighteen children received a high-protein (5 g/kg/day) diet, and 11 children received a standard-protein (2.5 g/kg/day) diet. The mean +/- SD energy intake was 612 +/- 38 kJ/kg/day for children receiving the high-protein diet, compared with 633 +/- 50 kJ/kg/day for the standard-protein group. The coefficient of carbohydrate absorption was 89 and 92% for the high-protein and standard-protein diets, respectively (p = 0.059). The coefficient of protein absorption was 80 and 71% for the high-protein and standard-protein groups, respectively, and was significantly higher in the high-protein group (p < 0.01). Absorption of fat was similar in both groups. The results of the study show better absorption of protein from a high-protein diet during convalescence, which may have a positive impact on catch-up growth of children suffering from shigellosis.