Determination of calorie and protein intake among acute and sub-acute traumatic brain injury patients

Purpose:Malnutrition is a common problem among hospitalized patients,especially among traumatic brain injury(TBI)patients.It is developed from hypermetabolism and the condition may worsen under the circumstance of underfeeding or incompatible dietary management.However,the data of nutrient intake especially calorie and protein among TBI patients were scarce.Hence,this study aimed to determine the calorie and protein intake among acute and sub-acute TBI patients receiving medical nutrition therapy in hospital Sultanah Nur Zahirah,Terengganu.Methods:This observational study involved 50 patients recruited from the neurosurgical ward.Method of 24 h dietary recall was utilized and combined with self-administered food diaries for 2-8 days.Food consumptions including calorie intake and protein intake were analyzed using Nutritionist PRO™(Woodinville,USA)and manual calculation based on the Malaysian food composition database(2015).Results:Patients consisted of 56%males and 44%females with the median age of 28.0(IQR=22.8-36.5)years,of which 92%were diagnosed as mild TBI and the remaining(8%)as moderate TBI.The Glasgow coma scale(GCS)was adopted to classify TBI severity with the score 13-15 being mild and 9-12 being moderate.The median length of hospital stay was 2(IQR=2.0e3.3)days.Calorie and protein intake improved significantly from day 1 to discharge day.However,the intake during discharge day was still considered as suboptimal,i.e.75%of calorie requirement,whilst the median protein intake was only 61.3%relative to protein requirement.Moreover,the average percentages of calorie and protein intakes throughout hospitalization were remarkably lower,i.e.52.2%and 41.0%,respectively.Conclusion:Although the calorie and protein intakes had increased from baseline,hospitalized TBI patients were still at a risk to develop malnutrition as the average intakes were considerably low as compared to their requirements.Optimum nutrient intakes especially calorie and protein are crucial to ensure optimum recovery process as well as to minimize risks of infection and complications.

The Ability of Nile Tilapia to Regulate Protein and Energy Intake Evaluated by Carbon Relative Enrichment （δ^13C）

The aim of this study was to assess the ability of Nile tilapia to balance its own diet, when two ingredient mixes were offered, using carbon stable isotopes. In order to accomplish that, 225 Nile tilapia juveniles （average initial weight 5.0 g ± 0.5 g） were distributed in five tanks, each containing a group of 45 fish. One group of fish were fed exclusively with a high protein mix （HPM; δ^13C = -22.62‰）, the second one fed only with a low protein mix （LPM; δ^13C = -14.34‰）. The other groups had free access to both mixes （free choice system）. The fish from all tanks were fed four times a day. Muscle, liver and blood samples were collected at each five days （from 2 fish/tank/collection） for 86 days, except for the fish fed with LPM （fed for a 120 days period）. The samples were analyzed in a mass spectrometer and proportions of the mixes consumed were estimated through its carbon isotope enrichment （δ^13C）. Energy intake slightly decreased after the 50th day and protein consumption increased after the same period. However, consumption did not present a clear pattern in relation to the individual weight, i.e., protein consumption patterns are mainly related to the age of the individuals and it is not clear if it is also correlated to their weight. Additionally, this technique allowed the observation of differences regarding consumption among the individuals from the experimental group.

Evaluation of the Protein Requirement in Chinese Young Adults Using the Indicator Amino Acid Oxidation Technique

Objective To accurately calculate the protein requirements in Chinese young adults using the indicator amino acid oxidation technique. Methods Nine women and ten men received a restricted daily level of protein intake （0.75, 0.82, 0.89, 0.97, and 1.05 g/kg）, along with L-[1-13C]-Ieucine. Subjects＇ protein requirement was determined by a biphasic linear regression crossover analysis of F13C02 data. In doing so, a breakpoint at the minimal rate of appearance of 13C02 expiration specific to each level of dietary protein was identified. This trial was registered with the Chinese clinical trial registry as ChiCTR-ONC-11001407. Results The Estimated Average Requirement （EAR） and the Recommended Nutrient Intake （RNI） of protein for healthy Chinese young adults were determined to be 0.87 and 0.98 g/（kg.d）, respectively, based on the indicator amino acid oxidation technique. Conclusion The EAR and RNI of mixed protein are 5% and 16% that are lower than the current proposed EAR and RNI {0.92 and 1.16 g/（kg.d）, respectively）, as determined by the nitrogen balance method. The respective EAR and RNI recommendations of 0.87 and 0.98 g/（kg.d） of mixed protein are estimated to be reasonable and suitable for Chinese young adults.

Cold weather and Kashin-Beck disease

Kashin-Beck disease(KBD)is an endemic osteoarthropathy.Its distribution region covers a long and narrow belt on the Pacific side and belongs to continental climate with short summer,long frost period,and large temperature differences between day and night.In particular,KBD patients are typically scattered in the rural areas with seasonal features such as cold winters and rainy autumns.Etiological studies have demonstrated that the carrier of pathogenic factors is the grains produced in endemic areas.Risk factors for KBD include fungal contamination of grains due to poor storage conditions associated with cold weather.The epidemiological characteristics of KBD include agricultural area,early age of onset,gender equality,family aggregation,regional differences,and annual fluctuations.A series of preventive measures have been successfully taken in the past decades.National surveillance data indicate that the annual incidence of KBD is gradually declining.

Malnutrition and non-compliance to nutritional recommendations in patients with cirrhosis are associated with a lower survival

BACKGROUND Malnutrition is frequently encountered in patients with cirrhosis and appears to significantly impact their prognosis.While evaluating the burden of malnutrition in cirrhosis is gathering momentum,as suggested by multiple recently published reports,there is still a persistent scarcity of solid data in the field,especially with regards to the role of nutritional interventions.AIM To assess the prevalence of malnutrition in patients with advanced cirrhosis and to evaluate its impact on survival.METHODS One hundred and one consecutive patients with advanced cirrhosis were screened for malnutrition using the Subjective Global Assessment(SGA)criteria and the mid-arm circumference(MAC).Malnutrition was defined as SGA class B and C and MAC<10th percentile.All patients were interviewed regarding their food intake using an adapted questionnaire.Subsequently,total energy intake was calculated and further subdivided in main nutrients.The data were then compared to the available recommendations at the time of analysis to assess adherence.RESULTS 54/79 patients(68.4%)in the decompensated group had malnutrition,while only 3/22 patients(13.6%)were malnourished in the compensated group.After a median follow-up time of 27 mo(0-53),the overall mortality was 70%.Survival was significantly lower among patients with malnutrition.The mortality rates were 50%at 1 year and 63%at 2 years for the patients with malnutrition,compared to 21%at 1 year and 30%at 2 years for patients without malnutrition(P=0.01).On multivariate analysis,the factors independently associated with mortality were age,creatinine level and adherence to the protein intake recommendations.The mortality was lower in patients with the appropriate protein intake:8%at 1 year and 28%at 2 years in the adherent group,compared to 47%at 1 year and 56%at 2 years in the non-adherent group.CONCLUSION The prevalence of malnutrition is high among patients with advanced cirrhosis and might be related in part to a low adherence to nutritional recommendations,especially with regards to protein intake.