Protein-energy requirements of prepubertal school-age boys determined by using the nitrogen-balance response to a mixed-protein diet.

Short-term nitrogen-balance response to a vegetable-protein mixed diet and to a milk-egg protein diet was tested in eight healthy male children 8-10 y old. They received 96, 128, 160, and 192 mg N.kg body wt-1.d-1 for 10 d while on the mixed diet and 160 mg N.kg-1.d-1 on the milk-egg diet. The mean regression equation was nitrogen balance = 0.52 (nitrogen intake) -68.3, all in mg N.kg-1.d-1. Apparent nitrogen digestibility was 82% and 86% for the mixed and milk-egg diets, respectively, when the subjects received 160 mg N.kg-1.d-1. Mean nitrogen intake for satisfactory nitrogen retention on the mixed diet was 150 mg N.kg-1.d-1; the suggested protein recommended allowance to cover 97.5% of the population was derived by using a CV of 12.5% is 1.2 g protein.kg-1.d-1. We conclude that present recommendations are adequate for short-term nitrogen retention; long-term studies are needed to evaluate the chronic safety of this protein allowance.

Protein-energy requirements of boys 12-14 y old determined by using the nitrogen-balance response to a mixed-protein diet.

Short-term nitrogen-balance response to graded intakes of a vegetable mixed-protein diet and to a milk-egg protein diet was tested in eight healthy male children aged 12-14 y. They received 72, 104, 136, and 168 mg N.kg body wt-1.d-1 for 10 d while on the mixed diet, and 160 mg N.kg-1.d-1 on the milk-egg diet. The mean regression equation was nitrogen balance = 0.64 (nitrogen intake)-74, all values are in mg N.kg-1.d-1. Apparent digestibility was 86% and 85% for the mixed and milk-egg diets when the subjects received 168 and 160 mg N.kg-1.d-1, respectively. Mean nitrogen intake for satisfactory nitrogen retention for growth on the mixed diet was 147 mg N.kg-1.d-1; the recommended protein allowance to cover 97.5% of the population, which was derived by using a CV of 12.5%, is 1.15 g protein.kg-1.d-1. We conclude that FAO/WHO/UNU recommendations are adequate, at least for short-term nitrogen retention; long-term studies are needed to evaluate the chronic safety of this protein allowance.

Energy expenditure in underweight free-living adults: impact of energy supplementation as determined by doubly labeled water and indirect calorimetry.

The effect of energy supplementation was evaluated in six underweight adults under free-living conditions. Customary energy intake (EI) over 4 wk and estimated body composition were defined. Then for 12 wk subjects were fed their customary EI under controlled conditions to assure stable energy reserve. Finally, intake was increased by a mean of 720 kcal/d for 8 wk adjusted to increase body fat from 9 to 18%. Body weight (means +/- SD) increased from 55.2 +/- 3.4 to 57.0 +/- 4.2 kg. Body fat gain was highly variable ranging from 0.6 to 3.8 kg. Energy expenditure (EE) by the factorial and doubly labeled water methods did not change. Fat storage accounted for 66% of the supplemental energy; 237 kcal/d remained unaccounted for. EE by the factorial method, which uses indirect calorimetry or isotopic measurements, were highly correlated (r = 0.8; p less than 0.01). Under the conditions of this study EI does not affect EE. The labeled water method permits the evaluation of energy expenditure in free-living conditions.

Nutritional status of alcoholic patients: it's possible relationship to alcoholic liver damage.

This study was performed to look for a possible relationship between the nutritional status and the presence of liver damage in alcoholic patients. One hundred chronic alcoholics admitted for treatment to the Alcoholism Ward, without clinical signs of liver failure, were studied. In 84, anthropometric nutritional indexes, liver function tests, and a liver biopsy were performed; in 69 patients a dietary survey was obtained. A dietary imbalance was observed in the total group; 65% of ingested calories were derived from ethanol. The intake of proteins, vitamins, and minerals was below the RDA, NAS/USA, and no differences were found between patients with and without liver damage. Neither were significant differences in daily alcohol calories or total ethanol dose found between both groups of patients. Mean anthropometric values were within 80 to 100% of commonly used standards. However, patients with alcoholic hepatitis and/or cirrhosis had a significantly higher percentage of ideal body weight, compared to alcoholics with normal livers or less severe histological alterations (109.7 +/- 20.3 versus 95.6 +/- 12.5, SD, p less than 0.005). A similar difference was observed in arm muscle areas. These findings show that overweight is associated with liver alterations in the alcoholic and should be investigated as a risk factor to develop liver damage.

Controlled trial on nutrition supplementation in outpatients with symptomatic alcoholic cirrhosis.

A controlled trial on nutrition supplementation in ambulatory patients with decompensated alcoholic liver disease was carried out during 1 year. Fifty-one patients were studied; 26 were assigned to an experimental group receiving a daily supplement of 1000 kcal and 34 g of proteins given as a casein-based enteral nutrition product and 25 to a control group receiving one placebo capsule. Patients were examined in a special clinic once a month or more if required. Sixty-eight percent of patients admitted to alcohol ingestion or had alcohol in urine samples on at least one occasion. Dietary recalls showed a significantly higher protein and caloric intake in case patients subjects (p < .0001). Nine patients died during the study, three case patients and six control patients (p = NS). The frequency of hospitalizations was significantly less in the experimental group. This difference was attributed to a reduction in severe infections. Mid-arm circumference, serum albumin concentration, and hand grip strength improved earlier in case patients, although both groups had a significant improvement in these parameters. Bilirubin and aspartate aminotransferase decreased and prothrombin time increased significantly in both groups during the study period, without differences between groups. It is concluded that nutrition support decreases nutrition-associated complications in patients with alcoholic liver disease.

Lean and fat mass as determinants of muscle strength and insulin sensitivity in Chilean elderly subjects.

PURPOSE: To report the association of lean body mass with nutritional, social and economic factors and its functional consequences in free living healthy elderly subjects. MATERIAL AND METHODS: Healthy elderly subjects of low socioeconomic level were studied. Monthly income, marital status, anthropometric measures and fall risk were assessed. Mini Nutritional Assessment score was calculated. Body composition and bone mineral density were measured by double beam X ray absorptiomentry. Fasting serum lipids, fasting and postprandial insulin and glucose levels were measured. Hand grip, quadriceps and biceps strengths and maximal inspiratory and expiratory pressures were measured. RESULTS: One hundred and nine subjects (56 women), aged 75 +/- 4 years old were studied. Lean body mass was 34.1 +/- 4 and 49.2 +/- 5.4 kg in women and men respectively (p < 0.001), fat mass was 22.8 +/- 7.1 and 20.7 +/- 6.4 kg in women and men respectively (p= NS). Lean body mass correlated with hand grip, quadriceps and biceps muscle strengths in men and with quadriceps and biceps strength in women. Men that exercised regularly had higher quadriceps strength and maximal expiratory pressure. Total body fat correlated positively with fasting and postprandial serum insulin levels. CONCLUSIONS: In this sample, lean body mass is directly related to muscle strength mostly in men. On the other hand, total fat mass is related to serum insulin levels.

Effects of nutritional supplementation and resistance training on muscle strength in free living elders. Results of one year follow.

PURPOSE: To assess the effects of a one year nutritional supplementation and resistance training program on muscle strength and walking capacity in the elderly. MATERIAL AND METHODS: Elderly subjects from two outpatient clinics received a nutritional supplement, that provided 400 Kcal, 15 g/protein and 50% of vitamin DRVs per day. Half the subjects receiving and not receiving the supplement were randomly assigned to a resistance exercise training program with two sessions per week. Every six months, body composition using DEXA, limb muscle strength, maximal inspiratory and expiratory pressures and walking capacity were assessed. RESULTS: One hundred forty nine subjects were considered eligible and 101 (31 supplemented and trained, 28 supplemented, 16 trained and 26 without supplementation nor training) completed the year of follow up. Overall compliance with the supplement was 48 22 % and trained subjects attended 56 21% of programmed sessions. No changes in fat free mass were observed in any of the groups, but fat mass increased from 22.5 7.3 to 23.2 7.3 kg in all groups (p < 0.001). Upper and lower limb strength and walking capacity increased significantly in trained subjects whether supplemented or not. Maximal inspiratory pressure and right hand grip strength increased only in the supplemented and trained group. CONCLUSIONS: Resistance training improved muscle strength and walking capacity.

[Referred morbidity and the utilization of health services in Brazilian urban areas: methodology]. / Morbidade referida e utilização de serviços de saúde em localidades urbanas brasileiras: metodologia.

The reorganization of the Brazilian health system in the last few years has been based on the decentralization of the services and the integration of preventive and curative medicine, then creating new needs in term of the health information needed for health planning. The planning and administration of a regionalized and integrated health system calls for information about the population's morbidity profile, and the description of the pattern of the utilization of the health services, which can be obtained by means of household health surveys. The methodology utilized in a household health survey carried out in the Metropolitan Area of S. Paulo, Brazil, from July 1989 to June 1990, is described. This survey has some distinct methodological characteristics, such as the sampling process that defined the domains by age and sex, allowing an analysis of populational groups less well represented in the general population, as that of less than one year of age and that of aged people, as well as the use of the results of the latest Brazilian Census in 1991 for adjusting the sample.

[Nutritive value of lupine and its potential as human food]. / Valor nutritivo del lupino y su potencial como alimento humano.

The chemical composition and some indices of protein quality were measured in two species of sweet lupine Lupinus albus and Lupinus luteus grown at the Experimental Station in Gorbea, Chile: both samples showed a high protein content (39.5 and 44.6%). The protein efficiency ratio (PER) was measured in the rat and found to be 0.48 and 0.71, respectively, as compared to 2.57 for casein. Supplementation with 0.3% DL-methionine increased significantly those values, thus indicating that lupine protein is deficient in said amino acid. In another experiment the effect of cooking-extrusion on lupine flour (L. albus) was investigated and the chemical composition, protein efficiency ratio, methionine supplementation and digestibility of the protein were measured. The chemical composition was not changed but PER increased from 0.50 for raw lupine to 0.76 for processed lupine (P less than 0.05). Both values increased significantly with the addition of 0.3% DL-methionine. The protein digestibility of the supplemented lupine was not affected by the cooking extrusion process (76.5 and 77.8%, respectively). Supplementation of wheat flour with 5, 10, 15 and 20% lupine flour increased the PER of wheat flour from 0.92, to 1.39 for wheat flour supplemented with 10% lupine flour, and to 1.60 for the 15% level of the supplement. These studies seem to support the conclusion that sweet lupine is an interesting protein resource for human nutrition.

[Biological quality of a milk substitute for school children based on refined flour subjected to enzymatic hydrolysis]. / Evaluación biológica de un sustituto lácteo para el escolar, a base harina de trigo cruda refinada, sometida a hidrólisis enzimática.

The biological quality of an experimental milk substitute based on a raw wheat flour subjected to enzymatic hydrolysis in comparison to a control product based on extruded flours and milk protein was studied in 35 <> female school age children. The girls were fed their customary diet during 2 consecutive 14 and 12 day periods, and randomized to the experimental and control products in a double blind crossover fashion. Apparent absorption of protein, energy, calcium and phosphorus was evaluated. Mean nitrogen intake from the experimental product was significantly lower (223 vs 244 mg/Kg/d p<0.0001). Absorbed nitrogen was also lower (187 vs 203 mg&kg/d p<0.0001). Energy intake and excretion were similar with both products; 96 and 95% of intake was absorbed for experimental and control products respectively. The mean calcium intake was significantly lower than the experimental product (39.7 vs 60.2 mg/kg/d p<0.0001). Absorbed calcium from the experimental product was 50% of control (20.7 vs. 39.5 mg/Kg/d p<0.0001). Phosphorus intake was also lower with the experimental product relative to control (22.0 vs 27.8 mg/Kg/d p<0.0001) and absorbed P was 13.1 vs 16.5 mg/Kg/d respectively. Both products were well tolerated. We conclude that the experimental product based on wheat flour does not differ significantly in protein and energy digestibility but calcium and phosphorus absorption and digestibility are significantly lower limiting its use in school feeding programs.

[Sensory evaluation of bread with potato flour]. / Evaluación sensorial de pan con harina de papa.

A sensory evaluation test was conducted in breads containing 2, 4, 6, 8 and 10% potato flour. The samples were sliced into equally sized pieces and served as coded randomized duplicates. All-wheat bread was used as a standard. The comparative preferences were rated on a 7-point hedonic scale (7 = very good, 1 = very bad) for appearance, flavor, texture and overall quality. The scores were statistically analyzed by the analysis of variance and the Chi square test. No significant differences were found in regard to flavor between the standard bread and bread containing from 2-10% potato flour. In the test of organoleptic quality, the bread containing 8% potato flour was rated as "good", as compared to "very good" for the all-wheat bread. However, this difference was not statistically significant. The values obtained in this study show that the incorporation of 6-8% potato flour in bread is perfectly feasible. This was obtained from a local food industry that in manufacturing the flour, used the Spartan variety potato produced in the southern region of Chile.

[Descriptive study of Fortesan: a new food product for preschool children]. / Estudio descriptivo sobre Fortesán: alimento para preescolares.

Pre-school Children acceptability of a high nutritive value and low cost new food product (Fortesán) was studied. This mixture is formed by W.S.B. powdered milk and cacao. The purpose was to establish its a acceptability by the children and their mothers, in the Santiago population. A similar study had been already performed in 1972 in another marginal urban area and in rural areas. Inicial and final heights and weights were measured, and a socio-economical and acceptability survey was performed in all cases. The same experimental group was used as a control of it self. The study lasted 4 months, from April-May 1973 until August-September 1973. The sample was formed by children from 1 to 6 years old, coming from different socioeconomical levels. Results showed a good acceptability of the product both by the mothers and their children. It also showed a good influence in the height and weight that the children reached.

Dangerous waters: outbreak of eye lesions caused by fresh water sponge spicules.

PURPOSE: To describe an extremely uncommon outbreak of eye lesions in a specific area of the Brazilian Amazonia. METHODS: Prospective noncomparative case series. Fifty-nine patients who developed eye lesions after swimming in the Araguaia river of Tocantins state in Brazil were examined. A team of ophthalmologists equipped with a slit-lamp, gonioscopic lenses, and indirect ophthalmoscopy performed full eye examination. Analysis of the flora and fauna of the river water was undertaken by a group of experts. RESULTS AND CONCLUSIONS: Eighty-three eyes were affected. The most common lesions were corneal opacities seen in 34 eyes and conjunctival nodules diagnosed in 12 eyes. Severe visual acuity loss was detected in seven children with unilateral anterior chamber lesions. Spicules of the sponge species Drulia uruguayensis and Drulia ctenosclera were found inside three blind eyes that have been enucleated for diagnostic purposes. All eye lesions could be attributed to an outbreak of foreign bodies from fresh water sponges. Organic enrichment of the water resulting from the absence of sanitation probably was the key factor, which initiated a cycle of ecological imbalance that provoked human disease.

Fluorescent serum and urinary advanced glycoxidation end-products in non- diabetic subjects.

INTRODUCTION: Advanced glycoxidation end-products (AGEs) are involved in age-related conditions and diabetic complications. Diet intake contributes to their circulating concentrations. AIM: To measure serum and urinary AGEs in non-diabetic volunteers and relate their concentration to body composition, blood chemistry and dietary ingestion. METHODS: We studied 41 adult men (31 middle-aged adults and 10 elderly). A nutritional assessment including a dietary recall designed for detection of AGE ingestion (specifically carboxymethyl-lysine(CML)), and anthropometric measurements were performed. Also serum lipoproteins, insulin, glucose, leptin and C reactive protein (CRP). AGEs were measured in serum and urine samples using size exclusion chromatography and flow injection assay (FIA); the technical procedures were first employed in 11 heterogeneous diabetics, as positive controls for this methodology. RESULTS: Serum and urinary chromatograms indicated that areas under the curve were not different in younger compared with elderly adults. AGEs did not correlate with dietary intake, body composition, nor metabolic parameters, however they correlated significantly with renal function and CRP concentration. DISCUSSION: In these non-diabetic volunteers, with low CML intake, serum and urinary concentration of AGEs were not related to dietary intake. AGEs were related to renal function and CRP, but not to body composition, lipoproteins, insulin and glucose.

[Biological, familial and metabolic characteristics of infantile and juvenile obesity]. / Características biológicas, familiares y metabólicas de la obesidad infantil y juvenil.

BACKGROUND: Obesity is the most prevalent nutritional disease in people of less than 20 years old. AIM: To report biological, familial and metabolic characteristics in obese children. PATIENTS AND METHODS: A retrospective review of 187 children seen at obesity clinics and that had a complete metabolic study. RESULTS: Ninety five prepuberal and 92 puberal children, aged 8.7 +/- 2.2 and 12.6 +/- 2.2 years old respectively, were studied. Body mass index was over 4 standard deviations in 48.4% of prepuberal children and in 39.1% of puberal children. Paternal obesity was twice more prevalent (30.2%) than in the general population. The daily caloric intake and basal metabolic rate (BMR) were within the normal range; nevertheless there was a positive caloric balance due to minimal physical activity. The mean daily fat intake was normal (26.4 +/- 8.5 and 25.3 +/- 9.1% of total calories in prepuberal and puberal children respectively). The daily fiber intake was under 70% of recommendation. The total cholesterol was over 200 mg/dl in 26.6 and 23.9% of prepuberal and puberal children. LDL cholesterol was over 130 mg/dl in 27.3 and 26.6% and triacylglycerol was over 150 mg/dl in 16.9 and 25% of prepuberal and puberal children respectively. Basal serum insulin was over 20 uIU/ml in 27.7 and 42.2% of prepuberal and puberal children, respectively. Post glucose serum insulin was over 60 uIU/ml in 40 and 63% of prepuberal and puberal children, respectively. CONCLUSIONS: Infantile and juvenile obesity is a chronic disease with a high incidence of metabolic alterations.

[A new cow's milk formula to Complementary Feeding National Program: nitrogen and caloric balance]. / Nueva fórmula láctea para el Programa Nacional de Alimentación Complementaria: balance nitrogenado y calórico.

Nitrogen, fat and energy retention were measured in 10 male infants (mean age = 6.8 mo) recovering from marasmic malnutrition while they were fed with either cow's milk based formula (LP) or a modified cow's milk formula (LPM). Their mean weight for age ratio was 72% and their weight for length ratio was 95% (NCHS standards). They went through two consecutive balance periods of 6 days each (3 d. for adaptation and 3 d. for urine and feces collection) beginning with either formula randomly. Both formulas had 85 kcal/dl with 11% protein calories in LPM and 13% in LP. Energy intake, absorption and relative retention were slightly greater with LPM than LP. Fat intake was greater under LPM than LP (5.4 vs. 4.5 g-kg-d, p < 0.025), which resulted in significant differences in fat absorption (LPM 4.3 vs. LP 3 g-kg-d, p < 0.025). Nitrogen intake was significantly lower under LPM than LP (487 vs. 571 mg-kg-d, p < 0.025) with lower urinary nitrogen excretion for LPM than for LP (304 vs. 417 mg-kg-d, p < 0.001). Apparent nitrogen retention averaged 115 mg-kg-d for LPM and only 69 mg-kg-d for LP (NS). A significant correlation was observed between nitrogen intake and nitrogen retention: r = 0.70 (y = 0.57x -167; p < 0.05) with LPM, and r = 0.77 (y = 0.63x -291, p < 0.01) with LP. A correlation was also found between energy intake and weight gain: r = 0.55 (NS) with LPM, and r = 0.88 (y = 0.26x -26; p < 0.001) with LP.(ABSTRACT TRUNCATED AT 250 WORDS)