Total Caloric Requirement Research Articles

Efficacy of daily versus intermittent low glycemic index therapy diet in children with drug-resistant epilepsy: A randomized controlled trial

IntroductionThe predominant reason for the discontinuation of low glycemic index therapy (LGIT) in children with epilepsy is the dietary restrictions imposed therein. This trial intended to compare the efficacy of daily and intermittent LGIT in children with drug-resistant epilepsy (DRE). MethodsThis study was performed between February 2018 and January 2019 to compare the efficacy of daily and intermittent LGIT in children aged 1–15 years with DRE following 24 weeks of dietary therapy. Compliance, the difficulty faced by caregivers, adverse effects, impact on behaviour, and social quotient in both arms were compared. Children in the intermittent LGIT arm received a liberalized diet for two days every week (Saturday and Sunday), which also allowed medium glycemic index foods. Carbohydrate calories were allowed up to 20% of the total caloric requirement in the liberalized diet, as compared to only 10% in standard LGIT. ResultsOut of 132 children randomized (66 in each group), 122 completed 24 weeks follow up. Mean weekly seizure frequency reduction at 24 weeks in the intermittent LGIT group was comparable with that of the daily LGIT group in both intention-to-treat (ITT) and per-protocol analysis (−50.95%± 22.34% vs −47.16%± 23.41%, p=0.36 in ITT and −53.88%±20.54% vs −49.20%±21.87%, p=0.23) in per-protocol analysis for intermittent and daily LGIT group respectively). The proportion with ≥50% reduction in seizure frequency was also comparable between both groups (p=0.73 and 0.56 in ITT and per protocol analysis respectively). The proportion of patients with adverse events and satisfactory compliance rate also had a trend towards favoring intermittent LGIT (p=0.06 and 0.51, respectively), while caregiver difficulty was lower with intermittent LGIT (p=0.001). ConclusionsIntermittent LGIT is comparable to daily LGIT in terms of seizure frequency reduction after 24 weeks of dietary therapy. Trial registrationClinicalTrials.gov (Registration number- NCT03464487, https://clinicaltrials.gov/ct2/show/NCT03464487).

Atropine and Scopolamine in Maize Products from the Retail Stores in the Republic of Serbia.

The cereal grains, which represent the cultivated grasses fruits, supply almost half of the total caloric requirements for humans and provide more nourishment compared with any other class of the food. Out of many cereals used for food, maize, rice, and wheat are the most important food resources for humans, representing 94% of the total cereals consumption. According to the data of the Republic Institute of Statistics for the year 2018, the harvested areas of corn amount to 906,753 hectares. The production of about 7 million tons was achieved with an average yield of 7.7 t/ha according to the Ministry of Agriculture of the Republic of Serbia. Serbia is still among the ten largest exporters of wheat and corn in the world for the period of 2014/15–2017/18. More precisely, it ranks seventh in the export of corn. Utilization of maize products for food animal nutrition (1000 t) is 491,48, and for industrial processing (1000 t) 278,862 expressed as the total consumption (1000 t) is 769,910. Therefore, a total of 103 samples of maize products were analyzed for the presence of toxins, i.e., tropane alkaloids (TAs). The samples were collected from the retail stores in the Republic of Serbia in 2021 and analyzed for the presence of atropine and scopolamine (33 corn grits, 39 polenta, and 31 semolina samples). Therefore, the Recommendation 2015/976/EU on the monitoring of TAs in food was adopted by the EU Commission to obtain more occurrence data on TAs in food. The monitoring extent, however, is restricted because reliable analytical methods and appropriate sensitivity are limited. There was a limit of 1 g/kg for each atropine and scopolamine in cereals containing millet, sorghum, buckwheat, or their derivatives. All the samples were analyzed by the LC-MS/MS. The LOQ was set at 1.0 μg/kg. Out of the total 103 tested samples, 32 samples (31.1%) were contaminated with atropine and scopolamine in concentrations above the LOQ. The highest concentrations of the studied TAs were observed in a semolina sample-atropine: 58.80 μg/kg, scopolamine: 10.20 μg/kg. The obtained results indicate that the TAs concentrations are above the LOQ which can be considered potential human and animal health hazards.

Fructose Consumption-Free Sugars and Their Health Effects.

The excessive consumption of free sugars, including fructose, is considered a cause of overweight and metabolic syndrome throughout the Western world. In Germany, the prevalence of overweight and obesity among adults (54%, 18%) and children (15%, 6%) has risen in the past few decades and has now become stable at a high level. The causative role of fructose is unclear. This review is based on publications retrieved by a selective search in PubMed and the Cochrane Library, with special attention to international guidelines and expert recommendations. The hepatic metabolism of fructose is insulin-independent; because of the lack of a feedback mechanism, it leads to substrate accumulation, with de novo lipogenesis and gluconeogenesis. Recent meta-analyses with observation periods of one to ten weeks have shown that the consumption of fructose in large amounts leads to weight gain (+ 0.5 kg [0.26; 0.79]), elevated triglyceride levels (+ 0.3 mmol/L [0.11; 0.41]), and steatosis hepatis (intrahepatocellular fat content: + 54% [29; 79%]) when it is associated with a positive energy balance (fructose dose + 25-40% of the total caloric requirement). Meta-analyses in the isocaloric setting have not shown any comparable effects. Children, with their preference for sweet foods and drinks, are prone to excessive sugar consumption. Toddlers under age two are especially vulnerable. The effects that have been observed with the consumption of large amounts of fructose cannot be reliably distinguished from the effects of a generally excessive caloric intake. Further randomized and controlled intervention trials of high quality are needed in order to determine the metabolic effects of fructose consumed under isocaloric conditions. To lessen individual consumption of sugar, sugary dietary items such as sweetened soft drinks, fruit juice, and smoothies should be avoided in favor of water as a beverage and fresh fruit.

Basic Principles of Sports Nutrition

Proper nutrition is a key component in the preparation and training of the competitive athlete. The dietary recommendations for sports nutrition are surprisingly conventional, similar to that for the prevention of chronic disease (such as cancer, diabetes, stroke, hypertension, and cardiovascular disease). Few specialized supplements are required above a well-balanced diet of sufficient protein and carbohydrate. Total caloric requirements, macronutrient composition, and need for electrolyte/micronutrient repletion may vary from one sport to another (and between various positions within a single sport). The type and duration of the sporting event affect the utilization of energy systems, substrate availability, and the training adaptations required to optimize athleticism. Undernutrition, dehydration, and electrolyte abnormalities can reduce cognition, endurance, thermoregulation, overall performance, and recovery. A properly designed dietary program throughout training, competition, and the off-season should benefit and help protect both the recreational and the elite athlete.

Early combined parenteral and enteral nutrition for pancreaticoduodenectomy - Retrospective cohort analysis

BackgroundSuggested guidelines for nutritional support after pancreaticoduodenectomy are still controversial. Recent evidence suggests that combining enteral nutrition (EN) with parenteral nutrition (PN) improves outcome. For ten years, patients have been treated with Early Combined Parenteral and Enteral Nutrition (ECPEN) after PD. The aim of this study was to report on rationale, safety, effectiveness and outcome associated with this method.MethodsConsecutive PD performed between 2003 and 2012 were analyzed retrospectively. Early EN and PN was standardized and started immediately after surgery. EN was increased to 40 ml/h (1 kcal/ml) over 24 h, while PN was supplemented based on a daily energy target of 25 kcal/kg. Standard enteral and parenteral products were used.ResultsSixty-nine patients were nutritionally supplemented according to ECPEN. The median coverage of kcal per patients related to the total caloric requirements during the entire hospitalization (nutrition balance) was 93.4% (range: 100%–69.3%). The nutritional balance in patients with needle catheter jejunostomy (NCJ) was significantly higher than in the group with nasojejunal tube (97.1% vs. 91.6%; p < 0.0001). Mortality rate was 5.8%, while major complications (Clavien-Dindo 3–5) occurred in 21.7% of patients. Neither the presence of preoperative malnutrition nor the application of preoperative immunonutrition was associated with postoperative clinical outcome.ConclusionThis is the first European study of ECPEN after PD. ECPEN is safe and, especially in combination with NCJ, provides comprehensive coverage of caloric requirements during the postoperative phase. Clinical controlled trials are needed to investigate potential benefits of complete energy supplementation during the early postoperative phase after PD.

Lack of allergenic soy in intralipid for total parenteral nutrition

The patient, a 36-year-old woman who was 29 weeks pregnant (gravida 1, para 0), presented with small bowel obstruction that required surgery. After surgery, the patient developed ileus and could not tolerate oral feeding. After consultation with a neonatologist, it was determined that the patient needed total parenteral nutrition (TPN) with lipids (intralipid soy parenteral nutrition) to support fetal growth. The nonlipid preparation of TPN does not supply essential fats or the total caloric requirements needed for fetal growth and development. Intralipid 20% (a 20% intravenous [IV] fat emulsion) contains 20% soybean oil, 1.2% egg yolk phospholipids, 2.25% glycerin, and water for injection. The soybean oil is a refined natural product that consists of a mixture of neutral triglycerides of predominantly unsaturated fatty acids.

The caloric cost of pregnancy.

To determine the amount of extra calories a pregnant woman needs to ensure normal growth of her fetus, a study was conducted using 11 normal women who were willing to spend 1 week in the hospital during the last half of pregnancy. The women were given a constant diet of known composition which closely approximated their normal diet at home. Data on fasting weight and fluid balance, nitrogen excretion (from urine samples), 24-hour oxygen consumption and CO2 production were recorded daily. The diet consisted of 80 gm. or more of high-quality protein and supplementary vitamins and iron. 7 women were in positive caloric balance eating 1600 to 2000 Kcal/day; their mean weight gain was 6.8 kg. The other 4, who were obese or who were prone to obesity, were on a lower caloric intake of 1200 to 1600 Kcal/day; despite this, their average gestational weight gain was 10.0 kg. All babies, except for 1 (the mother had placental insufficiency due to low implantation, premature separation, and antepartum hemorrhage; her baby weighed 2.58 kg. at 38 weeks), were born at term with a birthweight of more than 3 kg. The authors concluded that pregnancy hardly imposes any increase in physical activity on the women, and whatever physical effort is exerted is offset by a reduction in physical activity. A pregnant woman requires approximately 600 Kcal. daily for her activities; this amounts to total caloric requirements of 2100, 2200 and 2300 Kcal/day in each of the 3 trimesters. 12 oz. of homogenized milk per day is adequate to meet the extra caloric requirements of a well-nourished woman during her pregnancy. The findings suggest that a normal woman need not overeat to ensure normal growth of her fetus.

Current Literature: Hypocaloric Parenteral Nutrition Support in Elderly Obese Patients

Hypocaloric nutrition support has been successfully used to achieve positive nitrogen balance in obese patients. However, advanced age is associated with changes in substrate metabolism. To evaluate the efficacy of this practice in elderly patients, we retrospectively reviewed 30 obese patients requiring parenteral nutrition support. Total caloric requirements (TCR) were calculated on the basis of the Harris‐Benedict equation. Patients were given a minimum of 1.5 g/kg/day protein, 75% of TCR when current body weight was &gt;120 and ≤150% of ideal body weight (IBW), and 60% of TCR if current body weight was &gt;150% of IBW. The patients were divided into two groups: group I (N = 18) patients were age &lt;60 and group II (N = 12) patients were ≤60 years of age. Only one of the group I patients (143.2 ± 25.7% IBW, received 18.2 ± 3.7 keal/kg/day and 1.6 ± 0.4 g/kg/day protein), but five of the group II patients (141.3 ± 14.4% IBW, received 18.3 ± 2.6 keal/kg/day and 1.7 ± 0.3 g/kg/day protein), had negative nitrogen balance (p = .025). Apparently, elderly obese patients have limited capacity to mobilize their fat stores as energy sources and may continue to undergo protein catabolism with hypocaloric high‐protein nutrition support. Therefore this form of nutrition support should be used with caution in elderly obese patients. (Am Surg 66:394–400, 2000)

Hypocaloric Parenteral Nutrition Support in Elderly Obese Patients

Hypocaloric nutritional support has been successfully used to achieve positive nitrogen balance in obese patients. However, advanced age is associated with changes in substrate metabolism. To evaluate the efficacy of this practice in elderly patients, we retrospectively reviewed 30 obese patients requiring parenteral nutrition support. Total caloric requirements (TCR) were calculated on the basis of the Harris-Benedict equation. Patients were given a minimum of 1.5 g/kg/day protein, 75 per cent of TCR when current body weight was >120 and < or =150 per cent of ideal body weight (IBW), and 60 per cent of TCR if current body weight was >150 per cent of IBW. The patients were divided into two groups: Group I (N = 18) patients were age <60 and Group II (N = 12) patients were > or =60 years of age. Only one of the Group I patients (143.2 +/- 25.7% IBW, received 18.2 +/- 3.7 kcal/kg/day and 1.6 +/- 0.4 g/kg/day protein), but five of the Group II patients (141.3 +/- 14.4% IBW, received 18.3 +/- 2.6 kcal/kg/day and 1.7 +/- 0.3 g/kg/day protein), had negative nitrogen balance (P = 0.025). Apparently, elderly obese patients have limited capacity to mobilize their fat stores as energy sources and may continue to undergo protein catabolism with hypocaloric high-protein nutrition support. Therefore, this form of nutritional support should be used with caution in elderly obese patients.

Successful intestinal transplantation for microvillus inclusion disease

Microvillus inclusion disease is a rare congenital disorder that presents with severe diarrhea in the newborn period. Multiple therapeutic attempts to control the diarrhea have failed, leading to a chronic dependence on parenteral nutrition and a high infant mortality. This report presents the first child with microvillus inclusion disease in whom small bowel transplantation has been successful, allowing for the administration of total caloric requirements via the enteral route.

Short-term oral sensory deprivation: Possible cause of binge eating in sham-feeding dogs

Six mongrel dogs (18–20 kg) were prepared with gastric and esophogeal fistulas. All dogs were studied under four experimental conditions. In conditions 1 and 3 the dogs were allowed to sham feed either a high-palatable or low-palatable meal on days 1–5 followed by a sham feed of a high-palatable or low-palatable meal on day 6. In conditions 2 and 4 the dogs were not sham fed (oral sensory deprived) on days 1–5 but were allowed to sham feed either a high-palatable or low-palatable meal on day 6. Total caloric requirement during each 6-day study was given by infusion of a liquid diet (Isocal) through the gastric fistula following the experiment. In condition 4, dogs deprived of oral sensation on days 1–5, significantly overconsumed their low-palatable meal on day 6. In condition 2, dogs deprived of oral sensation on days 1–5 also overconsumed their high-palatable meal on day 6, although this did not reach statistical significance. Dogs that received oral stimulation days 1–5 (conditions 1 and 3) did not overconsume their high- and low-palatable meals on day 6, suggesting that binge eating following short-term oral deprivation may be avoided if the diet provides adequate oral sensory stimulation. Body weights were well maintained throughout each study period and no changes were observed.

The effects on beagles of long-term administration of 20% Travamulsion fat emulsion.

The tolerance of 20% Travamulsion intravenous fat emulsion (Travenol Laboratories, Inc., Deerfield, IL) was studied using male beagle dogs. Physiologic (0.9%) saline, USP, was used as the control, and 10% Travamulsion Intravenous fat emulsion (Travenol Laboratories) as the reference article. The 20 and 10% emulsions were administered intravenously to each of eight animals for 91 days at 20 and 40 ml/kg/day, respectively. These dosages were administered over 4 hr and they correspond to approximately 4 g of lipid as soybean oil per kilogram of body weight. The saline was administered to eight animals at 40 ml/kg/day. On day 92, one-half of the animals in each group were necropsied. The remaining dogs were observed and necropsied on day 122. Toxicity was assessed on animal survival; changes in body weight, urinalysis, and hematologic, and serum biochemical analyses; ophthalmologic examination; gross pathology; and histopathology. The results obtained for the 20% Travamulsion fat emulsion correlated well with those for the 10% Travamulsion fat emulsion. The emulsions were well tolerated and all animals survived and gained weight. The 20% Travamulsion fat emulsion administered provided about 45% of the total caloric requirement of the dog, which is equal to an often used clinical dose. However, caloric administration in the form of lipid emulsion in relation to total energy required was performed at three to six times the indicated clinical rate. In addition to demonstrating that it is safe for prolonged administration, the 20% Travamulsion fat emulsion offers an advantage over the 10% Travamulsion fat emulsion in providing the same amount of calories because it produces lower serum levels of phospholipid, cholesterol, and triglyceride, and the volume of emulsion required is reduced.

The effects of intravenous administration of 10% travamulsion fat emulsion to beagle dogs for 91 consecutive days.

The tolerance of 10% Travamulsion Intravenous Fat Emulsion (Travenol Laboratories, Inc., Deerfield, IL) was studied using beagle dogs. Physiological (0.9%) saline, USP, was used as the control, and Intralipid 10% Fat Emulsion (Vitrum, Sweden) as the reference article. The emulsions were administered intravenously to each of 10 animals for 91 days at a dosage of 40 ml (approximately 4 g)/kg of body weight/day. The saline was administered to 10 animals at 40 ml/kg/day. On day 92, 7 of the 10 animals in each group were necropsied. The remainder were observed and necropsied at approximately day 160. Toxicity was assessed on the basis of animal survival; changes in body weight, hematology, and serum chemistry; gross pathology; and histopathology. The results obtained for the Travenol emulsion correlated well with those for the Vitrum emulsion. The emulsions were well tolerated and they did not produce any major clinical signs of toxicity. All animals survived and gained weight. The Travenol emulsion administered provided about 45% of the total caloric requirement of the dog which is equal to an often used clinical dose. However, the emulsion was infused at six times the indicated clinical rate. Thus, in addition to demonstrating the similarity of Travenol and Vitrum emulsions, the results of this study indicate that the Travenol emulsion is safe for prolonged administration.

Calorie and protein requirements of pediatric patients with acute nonlymphocytic leukemia.

The calorie and protein requirements wer studied in 6 pediatric patients with acute nonlymphocytic leukemia treated in a laminar air flow unit. Calorie and protein requirements were estimated from anthropometric data. Mean total caloric requirement for weight maintenance was 136% of estimated basal metabolic rate, which is much lower than the RDA for healthy children. The mean protein requirement was 108% RDA. Provision of intravenous nutrients depressed oral intake. Infection had a deleterious effect on visceral protein status as determined by serum albumin.

An estimate of the caloric requirements of the human fetus.

The caloric requirements of the human fetus have been calculated from the reported values of the fetal oxygen consumption and the composition of the new tissue deposited, both expressed as their caloric equivalents. It is estimated that the deposition of fat represents over half the caloric accretion from the 27th week of gestation until term, and approximately 90% of the caloric accretion at term. The total caloric requirement of the human fetus at term is estimated at approximately 90-100 kcsl/kg/day.

Energetics of lactation in Peromyscus maniculatus

Examination of female weights, offspring weights, and food intake during lactation indicated that Peromyscus maniculatus maniculatus support offspring by increasing food ingestion. Total caloric requirements over 21 days of lactation increased with increasing litter size and ranged from 576 kcal for a single litter of three to an average of 892 kcal for three litters of seven. Energy requirements attributed to offspring per se ranged from 253 kcal for a single litter of three to 548 kcal for litters of seven. An increased energy requirement of 134% of nonbreeding requirement for a modal litter of five was similar to that reported for several other small mammals.

Nutritional Needs of Low-Birth-Weight Infants

The goal of feeding regimens for low-birth-weight infants is to obtain a prompt postnatal resumption of growth to a rate approximating intrauterine growth because this is believed to provide the best possible conditions for subsequent normal development. This statement reviews current opinion and practices as well as earlier reviews1-5 of the feeding of the low-birth-weight infant. Caloric Requirement The basal metabolic rate of low-birth-weight infants is lower than that of full-term infants during the first week of life, but it reaches and exceeds that of the full-term infant by the second week. Daily caloric requirements reach 50 to 100 kcal/kg by the end of the first week of life and usually increase to 110 to 150 kcal/kg in subsequent active growth. A partition of the daily minimum energy requirements is shown in Table I.6 There are considerable variations from these average values, depending on both biological and environmental factors. Infants who are small for gestational age tend to have a higher basal metabolic rate than do premature infants of the same weight.7 The degree of physical activity appears to be a characteristic of the individual infant. Environmental factors may have a greater influence than biological variation in determining the total caloric requirements. The maximal response to cold stress can increase the resting rate of heat production up to 2½ times.6Calories expended for specific dynamic action and for fecal losses are dependent on the composition of the milk or formula fed, as well as on individual variations in absorption of

Experience with an elemental diet in neonatal surgery

The elemental diet Codelid 72-H has been used in 12 newborn surgical patients over the past 2 yr. The diet is easily prepared and administered and, when given in sufficient concentration, provides total caloric requirements. It allows early feeding in patients with short gut, minimizes gastroesophageal reflux, and permits feeding in the face of partial intestinal obstruction. The limitations of the diet include a low caloric value at low concentration and a high osmolality in concentrations isocaloric to milk. Prolonged feeding may result in deficiency states. The elemental diet Codelid 72-H has been used in 12 newborn surgical patients over the past 2 yr. The diet is easily prepared and administered and, when given in sufficient concentration, provides total caloric requirements. It allows early feeding in patients with short gut, minimizes gastroesophageal reflux, and permits feeding in the face of partial intestinal obstruction. The limitations of the diet include a low caloric value at low concentration and a high osmolality in concentrations isocaloric to milk. Prolonged feeding may result in deficiency states.

Variation in Endogenous Nitrogen Excretion and Dietary Nitrogen Utilization as Determinants of Human Protein Requirement

Dietary protein requirement is usually conceptualized as consisting of an amount needed to replace the individually variable endogenous nitrogen losses corrected for the biological quality of the protein eaten. This concept was reexamined by measuring the endogenous nitrogen excretion of healthy men, observing their nitrogen balances when fed an amount of high quality protein (egg white and whole egg) equal to the endogenous output, and determining the dietary level needed to attain balance. Caloric intakes were adjusted to maintain body weight constant. Daily endogenous nitrogen loss of 13 men was 2.41 g in the urine, 0.96 g in the feces, and 0.129 g from the body surface. Nine men failed to achieve nitrogen balance with diets containing 3.5 or 4.0 g of nitrogen, all but 0.5 g of which was derived from egg proteins. True minimum egg nitrogen requirement, predicted by regression analysis of balances at several levels of intake, was 4.8 g per day. Minimum requirement was not correlated with weight, lean body mass, urinary creatinine, basal metabolic expenditure or total caloric requirement. The need was affected by the magnitude of endogenous losses but more dominantly by the efficiency with which fed nitrogen was utilized. Net utilization of both egg white and whole egg was about 65% but ranged from 46 to 81%. Digestibility of the proteins was nearly complete, the difference in utilization being apparent only in the urine.

Nomogram for Calculating Caloric Intake

MISS GABLER (Mount Sinai Hospital, Chicago, Ill.) is supervisor of the premature nursery at Michael Reese Hospital and Medical Center, Chicago, Ill. DR. OH (Univ. of Santo Tomas, Manila, Philippine Islands) was director of the neonatology department of Michael Reese when this article was written. He is now associate professor of pediatrics at U.C.L.A. School of Medicine and chief of the division of neonatology at Harbor General Hospital, Torrance, Calif. The authors wish to thank Harry H. Lucy, statistician and Ann McRedmond, R.N., M.S.N., Ross Laboratory, Columbus, Ohio, for their technical assistance. must be provided. For maintenance of optimum metabolic functions and growth, LBW infants require 90 to 120 calories per kg. body weight per 24 hours(1,2). The caloric requirement should be recalculated and the formula adjusted at regular intervals. This is particularly important during the first two months of life when the infant's body weight increases rapidly which proportionately increases the total caloric requirement over a short period of time. For instance, a 1.2 kg. infant requires 120 calories per day intake nd on this intake gains 20 grams per day. By the tenth day, to maintain the weight gain and provide fo growth, he would require 140 calories per day. Thus, unless the caloric intake and requirements are calculated and feedings adjusted at oneor two-week intervals, an infant would be given smaller feedings than required by his increased body weight. To eliminate the timeconsuming task of calculation in longhand with its many possibilities for mathematical errors, we have devised two nomograms-graphs that involve numeric relationships-that are used in conjunction with each other. They have been in use at the pre-