[On the issue of optimizing protein and energy supply for patients with acute cerebrovascular accident]. / K voprosu ob optimizatsii belkovogo i energeticheskogo obespecheniya patsientov s ostrym narusheniem mozgovogo krovoobrashcheniya.

OBJECTIVE: To study the severity of systemic metabolic dysfunction in various types of stroke and determine the parameters of optimal energy and protein supply for this category of patients in the presence of severe neurological deficit (National Institutes of Health Stroke Scale - NIHSS score of 15 points or more) during different periods of the disease. MATERIAL AND METHODS: The retrospective study included 512 patients with acute cerebrovascular accident (ACVA) who received nutritional support (NS) for 10 days or more: 367 (71.7%) people with ischemic stroke (IS) and 145 (28.3%) - with hemorrhagic stroke (HS). The course of stroke in all patients included in the study was accompanied by severe and extremely severe neurological disorders (15 points or more on the NIHSS scale). Energy expenditure and the severity of the catabolic reaction of the body were studied by dynamic assessment of indirect calorimetry indicators and actual nitrogen losses. RESULTS: More than 99% of patients received tube feeding. Using the method of indirect calorimetry, the ranges of energy expenditure during stroke were determined: for IS - 1600-2100 kcal/day (24-26 kcal/kg/day), for HS - 1900-2600 kcal/day (26-30 kcal/kg/day) in depending on the period of the disease. The average nitrogen losses at all stages of the disease in patients with IS and HS were comparable. In IS, these amounts were 19 g/day (0.25 g/kg/day), which corresponds to 119 g/day of protein (1.56 g/kg/day of protein), and in HS patients lost an average of 18.9 g/day of nitrogen (0.24 g/kg/day) or 118 g/day of protein (1.5 g/kg/day of protein). The maximum nitrogen losses were observed in the period from 10 to 20 days of illness and amounted to 24.7 g/day in patients with HS (0.31 g/kg/day or 1.93 g/kg/day protein), and in patients with IS - 24.5 g/day (0.29 g/kg/day or 1.81 g/kg/day protein). CONCLUSION: An identified trend towards a decrease in mortality in patients with acute stroke with energy supply in the amount of 27-28 kcal/kg/day and protein consumption in the amount of 1.3-1.4 g/kg/day compared with patients receiving 20-21 kcal/kg /day and 1-1.2 g/kg/day of protein requires further prospective randomized studies.

Effect of Steam Pressure Toasting Duration on Snowbird Faba Bean Seeds and the Impact on the Intestinal and Metabolic Characteristics in Dairy Cows.

The response of feedstuffs to thermal processing depends on the type of feed and the thermal processing methods being applied. Steam pressure toasting (SPT) has been used to modify the nutrient degradability and enhance the nutritional quality of pulses, including faba bean seeds (FBS). Strategic feeding approaches are essential for balancing diets and maintaining adequate nutrition, especially in high-performing ruminants. This research aimed to determine the effects of SPT duration in FBS on the intestinal and metabolic characteristics of dairy cows. Faba Bean seeds (three harvesting years) were processed at 121 °C for 0, 30, 60, 90, and 120 min. Rumen degradation and intestinal digestion were determined using the in situ and modified in vitro three-step techniques. The true protein supplied to the small intestine was also determined using the NRC and DVE systems. Our results showed a reduced total digested DM (TDDM) with longer SPT duration (quadratic, p = 0.02). The intestinally digested crude protein (IADP) increased from 62 to 220 g/kg DM with 0 to 120 min of SPT, respectively (p < 0.01), whereas the total tract digestible starch (TDSt) gradually decreased from 321 to 182 g/kg DM based on SPT time (p < 0.01). On the other hand, the truly digested protein in the small intestine (DVE) and the total metabolizable protein (MP) increased from 138 to 282 g/kg DM and 129 to 282 g/kg DM, respectively, with 0 to 120 min of SPT (quadratic, p < 0.01). The Feed Milk Value (FMV), based on both the DVE/OEB and NRC dairy nutrition systems, also increased with SPT (Quadratic, p < 0.01). The processing of FBS with SPT at 121 °C effectively reduced the highly degradable protein fraction in the rumen, shifting to a higher rumen undegraded protein (RUP) which was able to reach the small intestine. In the current study, the total MP, DVE, and FMV in dairy cows showed an overall increase with SPT in FBS.

Protein Requirement Changes According to the Treatment Application in Neurocritical Patients.

Objective: Exploring protein requirements for critically ill patients has become prominent. On the other hand, considering the significant impact of coma therapy and targeted temperature management (TTM) on the brain as well as systemic metabolisms, protein requirements may plausibly be changed by treatment application. However, there is currently no research on protein requirements following the application of these treatments. Therefore, the aim of this study is to elucidate changes in patients' protein requirements during the application of TTM and coma therapy. Methods: This study is a retrospective analysis of prospectively collected data from March 2019 to May 2022. Among the patients admitted to the intensive care unit, those receiving coma therapy and TTM were included. The patient's treatment period was divided into two phases (Phase 1: application and maintenance of coma therapy and TTM; Phase 2: tapering and cessation of treatment). In assessing protein requirements, the Urine Urea Nitrogen (UUN) method was employed to estimate the nitrogen balance, offering insight into protein utilization within the body. The patient's protein requirement for each phase was defined as the amount of protein required to achieve a nitrogen balance within ±5, based on the 24-hour collection of UUN. Changes in protein requirements between phases were analyzed. Results: Out of 195 patients, 107 patients with a total of 214 UUN values were included. The mean protein requirement for the entire treatment period was 1.84 ± 0.62 g/kg/day, which is higher than the generally recommended protein supply of 1.2 g/kg/day. As the treatment was tapered, there was a statistically significant increase in the protein requirement from 1.49 ± 0.42 to 2.18 ± 0.60 in phase 2 (p < 0.001). Conclusion: Our study revealed a total average protein requirement of 1.84 ± 0.62g during the treatment period, which falls within the upper range of the preexisting guidelines. Nevertheless, a notable deviation emerged when analyzing the treatment application period separately. Hence, it is recommended to incorporate considerations for the type and timing of treatment, extending beyond the current guideline, which solely accounts for the 'severity by disease.

Dietary protein oscillation: effects on digestibility, nutrient balance and estimated microbial protein synthesis in lactating dairy cows.

Various studies with growing ruminants report increases in nitrogen use efficiency (NUE) when feeding oscillating (OS) dietary CP, whereas limited research with lactating dairy cows demonstrates a lack of improvement in NUE when feeding OS diets. We hypothesised that a total mixed ration (TMR) delivering OS CP (48-h phases of 134 and 171 g CP/kg DM, respectively) compared to a static CP TMR (ST; 152 g CP/kg DM) would result in similar or increased urinary purine derivative excretion (as a marker of microbial protein synthesis (MPS)) and greater urinary nitrogen excretion in lactating dairy cows. Responses in intake, production, apparent total tract digestibility (ATTD), nutrient balance, and estimated MPS were evaluated using faecal and urine collection in 12 multiparous cows (172 ± 39 d in milk) in a randomised complete block design, where total urinary output was estimated indirectly. All measurements were taken during d 8 (at 1700) to d 16 (at 1700) of the 16-d study that followed a 28-d period in which cows already received their respective treatments. Dry matter intake, yields of milk, protein, fat, lactose, and fat- and protein-corrected milk were similar for ST and OS. Milk composition, BW, and body condition score also did not differ between treatments, except for a tendency for increased milk urea concentration with OS (13.7 vs 12.4 mg/dL). Feed efficiency, NUE and ATTD of organic matter, NDF, CP and gross energy did not differ, but ATTD of crude fat (658 vs 627 g/kg) and starch (980 vs 975 g/kg) increased, and ATTD of DM (702 vs 691 g/kg) tended to increase with OS. Milk energy as a proportion of digested energy tended to decrease with OS (34.6 vs 37.1%), but other energy metabolism variables were not affected by treatment. Estimated urinary nitrogen excretion increased (165 vs 144 g/d), estimated urinary nitrogen as a proportion of nitrogen intake tended to increase (25.3 vs 22.7%), and milk nitrogen as a proportion of digested nitrogen decreased (47.3 vs 51.8%) in response to OS. Estimated urinary excretion of creatinine (184 vs 165 mmol/d), uric acid (29 vs 20 mmol/d) and urea (3.1 vs 2.5 mol/d) increased, but other nitrogen metabolism parameters were not affected by OS. Overall, oscillating dietary CP content did not affect lactational performance, milk NUE, or estimated MPS. However, ATTD of some nutrients increased, postabsorptive energy use for milk synthesis tended to decrease, and estimated urinary nitrogen losses increased with OS.

Wool keratin as a novel alternative protein: A comprehensive review of extraction, purification, nutrition, safety, and food applications.

The growing global population and lifestyle changes have increased the demand for specialized diets that require protein and other essential nutrients for humans. Recent technological advances have enabled the use of food bioresources treated as waste as additional sources of alternative proteins. Sheep wool is an inexpensive and readily available bioresource containing 95%-98% protein, making it an outstanding potential source of protein for food and biotechnological applications. The strong structure of wool and its indigestibility are the main hurdles to achieving its potential as an edible protein. Although various methods have been investigated for the hydrolysis of wool into keratin, only a few of these, such as sulfitolysis, oxidation, and enzymatic processes, have the potential to generate edible keratin. In vitro and in vivo cytotoxicity studies reported no cytotoxicity effects of extracted keratin, suggesting its potential for use as a high-value protein ingredient that supports normal body functions. Keratin has a high cysteine content that can support healthy epithelia, glutathione synthesis, antioxidant functions, and skeletal muscle functions. With the recent spike in new keratin extraction methods, extensive long-term investigations that examine prolonged exposure of keratin generated from these techniques in animal and human subjects are required to ascertain its safety. Food applications of wool could improve the ecological footprint of sheep farming and unlock the potential of a sustainable protein source that meets demands for ethical production of animal protein.

Protein intake and outcome of critically ill patients: analysis of a large international database using piece-wise exponential additive mixed models.

BACKGROUND: Proteins are an essential part of medical nutrition therapy in critically ill patients. Guidelines almost universally recommend a high protein intake without robust evidence supporting its use. METHODS: Using a large international database, we modelled associations between the hazard rate of in-hospital death and live hospital discharge (competing risks) and three categories of protein intake (low: < 0.8 g/kg per day, standard: 0.8-1.2 g/kg per day, high: > 1.2 g/kg per day) during the first 11 days after ICU admission (acute phase). Time-varying cause-specific hazard ratios (HR) were calculated from piece-wise exponential additive mixed models. We used the estimated model to compare five different hypothetical protein diets (an exclusively low protein diet, a standard protein diet administered early (day 1 to 4) or late (day 5 to 11) after ICU admission, and an early or late high protein diet). RESULTS: Of 21,100 critically ill patients in the database, 16,489 fulfilled inclusion criteria for the analysis. By day 60, 11,360 (68.9%) patients had been discharged from hospital, 4,192 patients (25.4%) had died in hospital, and 937 patients (5.7%) were still hospitalized. Median daily low protein intake was 0.49 g/kg [IQR 0.27-0.66], standard intake 0.99 g/kg [IQR 0.89- 1.09], and high intake 1.41 g/kg [IQR 1.29-1.60]. In comparison with an exclusively low protein diet, a late standard protein diet was associated with a lower hazard of in-hospital death: minimum 0.75 (95% CI 0.64, 0.87), and a higher hazard of live hospital discharge: maximum HR 1.98 (95% CI 1.72, 2.28). Results on hospital discharge, however, were qualitatively changed by a sensitivity analysis. There was no evidence that an early standard or a high protein intake during the acute phase was associated with a further improvement of outcome. CONCLUSIONS: Provision of a standard protein intake during the late acute phase may improve outcome compared to an exclusively low protein diet. In unselected critically ill patients, clinical outcome may not be improved by a high protein intake during the acute phase. Study registration ID number ISRCTN17829198.

Is the amino acid pattern in medical nutrition therapy crucial for successfully attenuating muscle mass loss in adult ICU patients? Secondary analysis of a RCT.

BACKGROUND AND AIMS: We hypothesized that in long-term immobilized intensive care unit (ICU) patients, both the quantity and quality of protein nutrition are vital in supporting muscle mass maintenance. Hence, the aim of this secondary analysis of our recently performed RCT was to calculate the intake of individual amino acids and to evaluate the potential associations of amino acid patterns with muscle mass loss during the ICU stay. METHODS: Clinical and nutritional data were collected from a recent RCT conducted in long-term immobilized, critically ill patients receiving medical nutrition therapy with either 1.8 g (interventional group) or 1.2 g (standard group) of protein/amino acids per kg body weight per day over 4 weeks. Intake of the individual amino acids as well as the sum scores of the indispensable, conditionally indispensable, and dispensable amino acids were calculated for all patients, both group specific (n = 21 in each group) and in total (n = 42), based on the detailed nutrition protocols; inter-group differences were analyzed by t-tests. Linear regression models were used to test the effects of individual amino acids and the sum scores on the extent of skeletal muscle loss by measuring the quadriceps muscle layer thickness during the study period. The significance level was adjusted for multiple testing according to the Bonferroni procedure (α = 0.002). RESULTS: In both groups, the proportion of indispensable amino acids was approximately 41% of the total exogenous protein supply, with the proportion of enteral administration slightly over 50%. The intake of conditionally indispensable amino acids (glutamine, tyrosine, cysteine, histidine, and arginine) accounted for 17% and 18% of the total amino acids in the interventional and standard groups, respectively; glutamine (5% of total amino acids) was exclusively administered enterally. The intake of dispensable amino acid varied widely, with glutamic acid, proline, and asparagine/aspartic acid representing the highest proportions (10%, 8%, and 8% of total amino acids, respectively). For all amino acids, no statistically significant association was observed between the quantitative intake and the skeletal muscle changes after terminating the intervention phase. CONCLUSION: This secondary analysis of the RCT conducted in routine clinical practice did not support our working hypothesis that the amino acid patterns of medical nutrition therapy have a statistically significant impact on the skeletal muscle loss in long-term immobilized ICU patients. Due to the limited variety of enteral/parenteral products used in this single-center study, the calculated amino acid patterns showed only small differences. Larger multi-center trials with adequate power are needed to evaluate the potential effects of the individual amino acids or defined amino acid patterns on the muscle protein metabolism in further detail. TRIAL REGISTRATION: German Clinical Trials Register (http://www.drks.de); DRKS-ID: DRKS00013594.

Nutritional therapy for hospitalized patients with COVID-19: A narrative and integrative review.

Hospitalized patients affected by coronavirus disease 19 (COVID-19) have a sustained pro-inflammatory state and recurrent gastrointestinal symptoms that correlate with a decline in the nutritional status, which is directly related to poor immune response and clinical evolution. Nutritional therapy has proven crucial in COVID-19 treatment through the provision of adequate amounts of nutrients. Since the beginning of the pandemic, medical societies have mobilized to provide practical nutritional guidelines to support decision-making; despite this, there are only a few studies dedicated to compiling the most relevant recommendations. In this narrative review, we aimed to summarize and stratify the current scientific literature on nutritional support for hospitalized COVID-19 patients. We carried out a literature review from three databases between January 2020 and July 2021, using nutrition therapy (or medical nutrition or enteral nutrition or parental nutrition or nutritional support) and COVID-19 (SARS-CoV-2 infection) as the search terms. Only those studies that evaluated adult hospitalized patients with admissions to wards, specific clinics, or intensive care units were included. The nutritional intervention considered was that of specific nutritional support via oral, enteral, or parenteral modes. A total of 37 articles were included. In general, the nutritional care provided to COVID-19 patients follows the same premises as for other patients, i.e., it opts for the most physiological route and meets nutritional demands based on the clinical condition. However, some protocols that minimize the risk of contamination exposure for the health team have to be considered. Energy requirements varied from 15 kcal/kg/day to 30 kcal/kg/day and protein goals from 1.2 g/kg/day to 2 g/kg/day. In both cases, the ramp protocol for increased supply should be considered. In cases of enteral therapy, ready-to-use diet and continuous mode are recommended. Attention to refeeding syndrome is essential when parenteral nutrition is used.

Protein provision and lower mortality in critically ill patients with COVID-19.

BACKGROUND AND AIMS: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) severely impacted the management of critically ill patients, including nutritional therapy. This study aimed to verify an association between mortality and the energy and protein provided to critically ill patients affected by the SARS-CoV-2 and receiving enteral nutrition support. METHODS: Patients with confirmed COVID-19, with >7 days of stay in the ICU, on enteral nutrition were followed from the moment of hospitalization until discharge from the ICU or death. Data about age, gender, Simplified Acute Physiology Score III (SAPS3), intensive care unit (ICU) length of stay, days on mechanical ventilation (MV), clinical endpoint outcome (discharge or death), and daily energy and protein provision were collected from electronic medical records. Cox regression analyses and Kaplan-Meyer curves were used in statistical analysis. RESULTS: Fifty-two patients (66.2 ± 13.1 years; 53.8% women) were enrolled in the present study. The mean length of hospitalizations and SAPS3 score were 17.8 ± 9.8 days and 78.7 ± 14.7, respectively; all patients needed mechanical ventilation (mean of days was 16.42 ± 9.1). For most patients (73.1%) the endpoint was death. Twenty-five percent of patients had protein supply >0.8 g/IBW/day. Survival during COVID-19 hospitalization at ICU was significantly different among patients according to protein supply (p = 0.005). Hazard Ratios (HR) for protein supply showed that a protein intake >0.8 g/IBW/day was associated with significantly lower mortality (HR 0.322, p = 0.049). CONCLUSION: Our study suggests that a protein supply at least > 0.8 g/IBW/day could be related to reduced mortality in ICU patients with COVID-19.

Dietary protein oscillation: Effects on feed intake, lactation performance, and milk nitrogen efficiency in lactating dairy cows.

Limited research with growing ruminants indicates that oscillating (OS) dietary crude protein (CP) concentration may improve nitrogen use efficiency (NUE). Our aim was to determine if a total mixed ration (TMR) based on OS CP (48-h phases of 13.4% and 16.5% CP, respectively) would increase NUE of lactating dairy cows compared with a static CP TMR (ST; 14.9% CP). The experiment was a randomized complete block design with 50 cows [150 ± 61 (mean ± SD) d in milk]. Cows were blocked by parity, days in milk, and milk protein yield. On average, diets were equal in composition over the total experiment. Cows were milked twice daily, and 8 milk samples were collected in each 4-d period. Each 48 h of low-CP (LP) and high-CP (HP) TMR offered to OS cows corresponded to milk collected at milkings 1 to 4 and 5 to 8, respectively. Dry matter intake (mean = 25.5 kg/d for both treatment groups); yields of milk (mean = 31.5 kg/d for both treatment groups), protein, fat, lactose, and fat- and protein-corrected milk (mean = 33.6 kg/d for both treatment groups); and milk concentration of protein, fat, and lactose did not differ between treatments. However, milk urea concentration was higher for OS compared with ST (12.2 vs. 11.3 mg/dL). Body weight, body condition score, NUE, and feed efficiency were unaffected by OS. Apparent total-tract digestibility of dry matter (695 vs. 677 g/kg), organic matter (714 vs. 697 g/kg), CP (624 vs. 594 g/kg), neutral detergent fiber (530 vs. 499 g/kg), and starch (976 vs. 973 g/kg) were higher for OS than for ST cows. Cows in OS responded transiently, and regression analysis of differences within block over time revealed changes in yield of milk (-531 g/d), milk protein (-25.6 g/d), and milk lactose (-16.7 g/d) in LP. Opposite effects were observed for yield of milk (+612 g/d), milk protein (+28.8 g/d), and milk lactose (+28.0 g/d) during HP. Changes in concentrations of milk protein (-0.050%/d), lactose (+0.030%/d), and urea (-3.0 mg/dL per day) during LP, and in milk lactose (-0.024%/d) and urea (+4.3 mg/dL per day) during HP, were observed. Milk yield, lactose yield, and protein yield were lower for OS than ST cows at the last milking of LP and at the first milking of HP. Milk urea concentration did not show such a lag and was lower in the last 2 milkings of LP, and higher in the last 3 milkings of HP, in OS compared with ST cows. Overall, performance and NUE were unaffected by OS treatment, but apparent total-tract digestibility and milk urea concentration increased, and transient effects on milk yield and composition occurred in OS cows.

Medical high-protein nutrition therapy and loss of muscle mass in adult ICU patients: A randomized controlled trial.

BACKGROUND & AIMS: The degradation of muscle mass and loss of functional proteins due to catabolism are associated with adverse outcomes in critically ill patients. While an adequate supply of protein within a medical nutrition concept is suggested to minimize proteolysis, the specificities on appropriate dosage and timing are still under debate. The current study aimed to evaluate the effect of two different quantities of protein as part of a standardized energetically controlled nutrition therapy for the preservation of muscle mass in the later phase of critical illness. METHODS: A randomized controlled trial was conducted in 42 critically ill patients (age 65 ± 15; 12 females; SAPS 45 ± 11; TISS 20 ± 7; SOFA-score 7 ± 3). The subjects were randomly assigned to either the intervention (1.8 g protein/kg body weight [BW]/d) or standard (1.2 g protein/kg BW/d) group. Nutrient supply via enteral and/or parenteral nutrition was calculated based on the individual energy expenditure measured by indirect calorimetry and target protein content. Quadriceps muscle layer thickness (QMLT) was observed through sonography at inclusion, and during the follow-up period, two and four weeks after inclusion. The measurement points were fixed on two sides at the midpoint and two-thirds between the anterior superior iliac spine and top of the patella. The data were analyzed descriptively wherein chi-squared tests or unpaired two-samle t-tests checked group differences. Daily changes in muscle mass were estimated using a linear mixed model. All data are shown as the mean ± standard deviation (SD). RESULTS: Actual protein intake reached 1.5 ± 0.5 g and 1.0 ± 0.5 g/kg BW/d in the intervention and standard group, respectively. Mean values of all measurements of QMLT at inclusion (day 13 ± 2 after ICU admission) were 13.5 ± 7.4 mm and 13.4 ± 7.1 mm in the intervention and standard group, respectively (P = 0.967). In both the groups, QMLT decreased over time (P < 0.001), while the estimated mean values of daily QMLT changes were -0.15 ± 0.08 mm (intervention) and -0.28 ± 0.08 mm (standard) without significant between-group differences (intervention effect, P = 0.368; time x intervention effect, P = 0.242). Illness scores and clinical outcomes showed no group differences. CONCLUSION: In this single-center trial the increased amounts of protein (1.5 g vs. 1.0 g/kg BW/d) provided through medical nutrition therapy in the late phase of critical illness did not achieve a statistically significant impact on the loss of muscle mass in long-term immobilized ICU patients. Larger multi-center trials are needed to evaluate whether observed numerical differences in muscle mass could be a true finding, and will translate into improved clinical outcomes. TRIAL REGISTRATION: German Clinical Trials Register (http://www.drks.de/), DRKS-ID: DRKS00013594.

Effects of grass and maize silage feed value, offering soybean meal with maize silage, and concentrate feed level in late pregnancy, on ewe and lamb performance.

In many countries, daily herbage accumulation on pasture declines towards zero during the winter period; thus, many pregnant ewes are housed and offered conserved forages supplemented with concentrate prior to parturition. The effects of forage type and feed value (FV), offering soybean meal with maize silage during mid and late pregnancy, and concentrate feed level in late pregnancy on the performance of ewes and their progeny (to slaughter) were evaluated. Ewes (n = 151) were assigned to one of nine treatments from mid-pregnancy until lambing. Medium FV and high FV grass silages (metabolisable energy concentrations of 10.7 and 12.0 MJ/kg DM) were offered ad libitum supplemented with either 15 or 25 kg concentrate/ewe during late pregnancy. Low and high DM maize silages (starch concentrations of 80 and 315 g/kg DM) were offered ad libitum either alone or with soybean meal (200 g/d) and supplemented with 15 kg concentrate during late pregnancy. A final treatment consisted of high FV grass silage supplemented with 5 kg soybean/ewe over the final 4 weeks of pregnancy. Ewes and lambs were put to pasture in a rotational-grazing system within 3 days of lambing. There were no interactions (P > 0.05) between grass silage FV and concentrate feed level for ewe or lamb traits. Increasing grass silage FV increased food intake (P < 0.001) during late pregnancy, ewe BW and body condition score (BCS) at lambing (P < 0.001), lamb BW at birth (P < 0.001) and weaning (P < 0.05), and reduced age at slaughter (P = 0.06). Increasing concentrate feed level increased metabolisable energy (P < 0.05) intake during late pregnancy but had no effect (P > 0.05) on ewe or lamb performance. Increasing maize DM at harvest and offering soybean meal with maize silage increased food intake (P < 0.001) and ewe BW and BCS at lambing (P < 0.05 or P < 0.01). Offering soybean meal with maize silage increased lamb BW at birth (P < 0.01) and reduced age at slaughter (P < 0.05). Reducing supplementation of high FV grass silage to 5 kg of soybean meal had no effect (P > 0.05) on animal performance. Replacing grass silage with maize silage did not affect (P > 0.05) BW gain of lambs. It is concluded that increasing the FV of the grass silage offered during pregnancy had the greatest positive impact on ewe and lamb performance.

Nutritional status and nutrition support in critically ill children in Spain: Results of a multicentric study.

OBJECTIVES: Critically ill children are often malnourished and require nutrition support (NS). Early enteral nutrition (EEN) seems to be safe in critically ill patients. However, there is a scarcity of data about the management of EEN in sick pediatric patients. The aim of this study was to analyze the nutritional status, NS characteristics, macronutrient supply, and associations between NS and outcomes in critically ill children in Spain. METHODS: This was a multicentric, prospective, cross-sectional study involving critically ill children who received NS and with an expected length of stay (LOS) in the pediatric intensive care unit of ≥3 d. Anthropometric variables, characteristics of NS, EEN, nutrient supply, and complications were recorded. RESULTS: We enrolled 86 children. Undernutrition and overweight were more prevalent in children ≤2 y of age than in older children (undernutrition: 40 versus 19%, respectively; overweight: 22.2 versus 14.3%, respectively). Being overweight was associated with a shorter PICU LOS (5.8 ± 2 versus 9.8 ± 6.5; P = 0.005). EN was the preferred method for nutrient delivery. EEN was administered to 58.1% of patients and was more common in children >2 y of age than in younger patients (73.1 versus 44.4%; P = 0.015). EEN was safe and was associated with a higher caloric intake (81.6 ± 35.3 versus 59.6 ± 36.6; P = 0.019). There was a negative correlation between mean time to EN initiation and maximum energy supply (r = -0.32; P = 0.07). CONCLUSIONS: Malnutrition was prevalent among critically ill children in Spain. Being overweight was associated with a shorter PICU LOS. EEN was safe and was associated with a higher caloric intake; however, it is rarely used in PICUs in Spain.

Calculating Protein Content of Expressed Breast Milk to Optimize Protein Supplementation in Very Low Birth Weight Infants with Minimal Effort-A Secondary Analysis.

Breast milk does not meet the nutritional needs of preterm infants, necessitating fortification. Breast milk is particularly variable in protein content, hence standardized (fixed dosage) supplementation results in inadequate supply. This was a secondary analysis of 589 breast milk protein content measurements of 51 mothers determined by mid-infrared spectroscopy during a clinical trial of higher versus lower protein supplementation in very low birth weight infants. Mothers (and breast milk samples) were divided into a test (41 mothers) and a validation cohort (10 mothers). In the test cohort, the decrease in protein content by day of lactation was modeled resulting in the breast milk-equation (BME)). In the validation cohort, five supplementation strategies to optimize protein supply were compared: standardized supplementation (adding 1.0 g (S1) or 1.42 g protein/100 mL (S2)) was compared with 'adapted' supplementation, considering variation in protein content (protein content according to Gidrewicz and Fenton (A1), to BME (A2) and to BME with adjustments at days 12 and 26 (A3)). S1 and S2 achieved 5% and 24% of adequate protein supply, while the corresponding values for A1-A3 were 89%, 96% and 95%. Adapted protein supplementation based on calculated breast milk protein content is easy, non-invasive, inexpensive and improves protein supply compared to standardized supplementation.

Infrared attenuated total reflection spectroscopic analysis and quantitative detection of forage spectral features in ruminant systems.

This study aimed to (1) access protein molecular structure profile and metabolic characteristics of model forages [Foreign sourced-origin (coded as: "FSO", n = 7 vs. Chinese sourced-origin alfalfa hay "CSO", n = 5] in ruminant systems; (2) Quantify the relationship between forage protein molecular structures and protein utilization and availability. Advanced non-invasive vibrational molecular spectroscopic technique (ATR-FTIR: Attenuated Total Reflection Fourier Transform Infrared spectroscopy) with chemometrics was applied to reveal forage protein molecular structure. Both univariate and multivariate molecular spectral analyses were applied to study molecular structure features in model forages. The molecular structure study provided the detailed protein structure profiles of Amide I and Amide II areas and height, total Amide I and II area ratios, Amide I to II height ratio as well as Amide I to II area ratio using ATR-FTIR spectroscopy. The results showed FSO and CSO had similar (P > 0.05) protein rumen degradation kinetics. However, FSO had superior quality than CSO in intestinal (IDP) and total digestible protein (TDP) and truly absorbed nutrient supply (P < 0.05). As intestinal digestion of protein, FSO was higher (P < 0.05) in protein digestion in terms of: intestinal digestibility of rumen undegraded protein (dIDP: 47.5 vs. 38.3 %RUP); Intestinal digestible protein (IDP: 17.6 vs. 13.7 %CP). As truly absorbed nutrient supply, FSO contained higher (P < 0.05) truly absorbed rumen synthesized microbial protein, absorbable rumen undegradable feed protein in the small intestine, total truly digested protein in the small intestine, metabolizable protein and Feed Milk Value (FMVDVE: 1.2 vs. 1.1 g/kg DM). The molecular structure-nutrition interactive relationship study showed that protein molecular structure profiles were highly associated to protein rumen degradation kinetics, significantly correlated to protein subfractions, protein intestinal digestion, and truly absorbed nutrient supply in ruminant systems.

Effects of early protein restriction on the growth performance and gut development of pigs fed diets with or without antibiotic.

In the livestock husbandry compensatory growth may be explored as a means to improve nutrient utilization, to reduce gut health problems due to excess protein intake, to simplify feeding strategies and thus to improve production efficiencies. This study investigated the effects of early protein restriction (EPR) and early antibiotic intervention (EAI) on growth performance, intestinal morphology, colonic bacteria, metabolites and mucosal gene expressions during the restriction phase and re-alimentation phase. A total of 64 piglets (10.04 ± 0.73 kg) were randomly divided into four treatment groups according to a 2 × 2 factorial arrangement with two levels of proteins (14% v. 20%) and two levels of antibiotics (0 v. 50 mg/kg kitasamycin and 20 mg/kg colistin sulphate). After a 30-day restriction phase with four kinds of diets, all groups were fed the same diets for another 74 days. The results showed that EPR decreased BW, average daily gain (ADG), average daily feed intake in the restriction phase (P < 0.01) and increased ADG on days 66 to 104 of the late re-alimentation phase. Early protein restriction could decrease the villus height in the jejunum (P < 0.05), while shifting to the same diets restored the villus height. Meanwhile, during the re-alimentation phase, pigs in the protein restriction groups had increased concentrations of total short chain fatty acids (P < 0.05), and modified the abundances of Firmicutes and Bacteroidetes in the colon. Furthermore, the lower microbial diversity caused by EPR was improved, and gene expression analysis indicated a better barrier function in the colon. During the whole trial, EAI had no interaction with EPR and played a dispensable role in compensatory growth. Collectively, the retardation of growth caused by EPR can be compensated for in the later stages of pig raising, and accompanied by altered intestinal morphology, microbial composition.

Effects of dietary CP and amino acid restriction on the growth dynamics of organs and body components in entire male, castrated and female pigs.

The optimized use of dietary nutrients and the accurate knowledge of the growth dynamics of body components is important for efficient pig production. This study aimed at evaluating the growth of carcass components and organs of Swiss Large White pigs from birth to 140 kg BW depending on the CP and amino acid (AA) supply. A total of 66 entire males (EM), 58 castrates (CA) and 66 female (FE) pigs were used. From 20 kg BW onwards, they had either ad libitum access to a control (C) or a diet (LP) with 20% lower CP, lysine, methionine + cystine, threonine and tryptophan content compared to C. The weight of organs, primal cuts and external fat were recorded in eight EM and eight FE; at 10 kg BW, on two EM, CA and FE each, and at 20 kg BW, on eight pigs from each sex. From 40 to 140 kg BW at 20 kg intervals, measurements were recorded on four pigs per sex and dietary treatment. The weight of each component was related to empty body (EB) using allometric regressions. Kidneys were heavier (P<0.05) in C- than LP-pigs and in EM than CA and FE. Above 21 kg EB weight, growth rate of LP-FE overpassed (P<0.05) the one of C-pigs. Consequently, LP-FE had heavier (P<0.05) lean cuts than C-pigs in the finisher period. However, LP-CA and LP-EM displayed lower (P<0.05) weights and growth rates of the lean cuts than C-CA and C-EM. Shoulder and loin weights and growth rates were reduced (P<0.05) in LP-pigs when compared to C-pigs. Growth rates of the ham were greater (P<0.05) in LP-FE than C-FE, whereas in LP-EM and LP-CA they were lower (P<0.05) than their C-counterparts. Total amounts of subcutaneous fat, backfat, ham fat and shoulder fat were lower (P<0.05) in C- than LP-pigs. The total amount of subcutaneous fat, backfat and shoulder fat of C-CA was, regardless of diet, greater (P<0.05) than of C-FE. In the LP group, this difference was even more pronounced. The amount of deposited ham fat was greater (P<0.05) in LP-CA than LP-FE, but not in C-CA v. C-FE. Differences in kidney weights suggested a greater nitrogen clearance required in C-pigs. Overall, dietary restriction and sex did not affect all body parts to the same extent. This study further suggests the possibility to reduce the CP and AA supply in FE without compromising the yield of primal lean cuts or increasing the amount of subcutaneous fat.

Effect of increased enteral protein intake on plasma and urinary urea concentrations in preterm infants born at < 32 weeks gestation and < 1500 g birth weight enrolled in a randomized controlled trial - a secondary analysis.

BACKGROUND: Feeding breast milk is associated with reduced morbidity and mortality, as well as improved neurodevelopmental outcome but does not meet the high nutritional requirements of preterm infants. Both plasma and urinary urea concentrations represent amino acid oxidation and low concentrations may indicate insufficient protein supply. This study assesses the effect of different levels of enteral protein on plasma and urinary urea concentrations and determines if the urinary urea-creatinine ratio provides reliable information about the protein status of preterm infants. METHODS: Sixty preterm infants (birthweight < 1500 g; gestational age < 32 weeks) were enrolled in a randomized controlled trial and assigned to either a lower-protein group (median protein intake 3.7 g/kg/d) or a higher-protein group (median protein intake 4,3 g/kg/d). Half the patients in the higher-protein group received standardized supplementation with a supplement adding 1.8 g protein/100 ml milk, the other half received individual supplementation depending on the respective mother's milk macronutrient content. Plasma urea concentration was determined in two scheduled blood samples (BS1; BS2); urinary urea and creatinine concentrations in weekly spot urine samples. RESULTS: The higher-protein group showed higher plasma urea concentrations in both BS1 and BS2 and a higher urinary urea-creatinine-ratio in week 3 and 5-7 compared to the lower-protein group. In addition, a highly positive correlation between plasma urea concentrations and the urinary urea-creatinine-ratio (p < 0.0001) and between actual protein intake and plasma urea concentrations and the urinary urea-creatinine-ratio (both p < 0.0001) was shown. CONCLUSIONS: The urinary urea-creatinine-ratio, just like plasma urea concentrations, may help to estimate actual protein supply, absorption and oxidation in preterm infants and, additionally, can be determined non-invasively. Further investigations are needed to determine reliable cut-off values of urinary urea concentrations to ensure appropriate protein intake. TRIAL REGISTRATION: Clinicaltrials.gov; NCT01773902 registered 15 January 2013, retrospectively registered.

Nutritional and Phytochemical Content of High-Protein Crops.

Sustainable sources of high-protein plants could help meet future protein requirements. Buckwheat, green pea, fava bean, hemp, and lupin were analyzed by proximate analysis and inductively coupled plasma mass spectrometry to determine their macro- and micronutrient contents, and liquid chromatography-mass spectrometry was used to elucidate the phytochemical profiles. The protein contents ranged from 20 to 43% (w/w), and all samples were found to be rich in insoluble fiber: 9-25% (w/w). The selected crops had a favorable micronutrient profile, with phosphorus levels ranging from 2.22 ± 0.05 to 9.72 ± 0.41 g kg-1, while iron levels ranged from 20.23 ± 0.86 to 69.57 ± 7.43 mg kg-1. The crops contained substantial amounts of phytophenolic compounds. In particular, buckwheat was a rich source of pelargonidin (748.17 ± 75.55 mg kg-1), epicatechin (184.1 ± 33.2 mg kg-1), quercetin (35.66 ± 2.22 mg kg-1), caffeic acid (41.74 ± 22.54 mg kg-1), and 3-hydroxyphenylacetic acid (63.64 ± 36.16 mg kg-1); hemp contained p-coumaric acid (84.02 ± 8.10 mg kg-1), cyanidin (58.43 ± 21.01 mg kg-1), protocatechualdehyde (34.77 ± 5.15 mg kg-1), and gentisic acid (31.20 ± 1.67 mg kg-1); and fava bean was the richest source of ferulic acid (229.51 ± 36.58 mg kg-1) and its 5-5' (39.99 ± 1.10 mg kg-1) and 8-5 dimers (58.17 ± 6.68 mg kg-1). Demonstrating that these crops are rich sources of protein, fiber, and phytochemicals could encourage higher consumption and utilization of them as healthy and sustainable ingredients in the food and drink industry.