The role of ruminant urine and faeces in the recycling of nutrients by forages.

This study addresses the effect of using animal excreta on the nutritional content of forages, focusing on macro- and micro-element concentrations (nitrogen; N, phosphorus; P, sulphur; S, copper; Cu, zinc; Zn, manganese; Mn, selenium; Se) from animal feed to excreta, soil, and plants. Data were collected from pot and field trials using separate applications of sheep or cattle urine and faeces. Key findings indicate that soil organic carbon (SOC) and the type of excreta significantly influences nutrient uptake by forages, with varied responses among the seven elements defined above. Although urine contributes fewer micronutrients compared to faeces (as applied at a natural volume/mass basis, respectively), it notably improves forage yield and micronutrient accumulation, thus potentially delivering positive consequences at the farm level regarding economic performance and soil fertility when swards upon clayey soil types receive said urine in temperate agro-climatic regions (i.e., South West England in the current context). In contrast, faeces application in isolation hinders Se and Mn uptake, once again potentially delivering unintended consequences such as micronutrient deficiencies in areas of high faeces deposition. As it is unlikely that (b)ovine grazing fields will receive either urine or faeces in isolation, we also explored combined applications of both excreta types which demonstrates synergistic effects on N, Cu, and Zn uptake, with either synergistic or dilution effects being observed for P and S, depending largely on SOC levels. Additionally, interactions between excreta types can result in dilution or antagonistic effects on Mn and Se uptake. Notably, high SOC combined with faeces reduces Mn and Se in forages, raising concerns for grazed ruminant systems under certain biotic situations, e.g., due to insufficient soil Se levels typically observed in UK pastures for livestock growth. These findings underscore the importance of considering SOC and excreta nutritional composition when designing forage management to optimize nutrient uptake. It should be noted that these findings have potential ramifications for broader studies of sustainable agriculture through system-scale analyses, as the granularity of results reported herein elucidate gaps in knowledge which could affect, both positively and negatively, the interpretation of model-based environmental impact assessments of cattle and sheep production (e.g., in the case of increased yields [beneficial] or the requirement of additional synthetic supplementation [detrimental]).

Impact of breast cancer neoadjuvant chemotherapy on plasma and urine amino acid profile, plasma proteins and nitrogen metabolism.

Neoadjuvant chemotherapy (NAC) is the preferred treatment option in locally advanced breast cancer (BC). The administration of NAC is associated with a wide range of adverse effects. This pilot observational prospective study examined the effect of NAC using anthracycline + cyclophosphamide (AC) followed by paclitaxel (PTx) on a portfolio of 22 plasma and urinary amino acids, plasma proteins (albumin, prealbumin, transferrin), and products of nitrogen metabolism (urea, creatinine, uric acid) in plasma and urine. Plasma and 24-h urine samples were obtained from ten patients with early breast cancer (N1-3 N0-2 M0), at the following time points: before the start of NAC and during the AC/PTx treatment period (a total of 8 measurements at three-weekly intervals). Amino acids were analyzed using ion exchange chromatography. There were no significant differences in the measured parameters in plasma and urine between pre-NAC and during AC- and PTx-treatment. No trend was detected. A significant difference in the portfolio of plasma and urinary amino acids was found only in the pre-treatment period compared to the control group. Levels of eight plasma amino acids (8/22) were significantly reduced and those of nine urine amino acids were increased (9/22). Nitrogenous catabolites in plasma and urine were not indicative of increased protein catabolism during the anthracycline and taxane treatment periods. A slightly positive nitrogen balance was accompanied by an average weight gain of 3.3 kg (range 0-6 kg). The AC/PTx treatment regimen did not cause significant changes in the monitored laboratory parameters.

The Impact of Bariatric Surgery on Nitrogen Balance at Six months Post-surgery.

PURPOSE: Obesity, defined as abnormal or excessive fat accumulation that presents a risk to health, rose from 8.6 to 10.5% in Singapore's residents. Bariatric surgery, the primary treatment for severe obesity, induces fat and muscle loss. Adequate protein intake is vital for preventing muscle loss. This study examines nitrogen balance in individuals with obesity pre- and post-surgery. MATERIALS AND METHODS: Sixteen participants with severe obesity (BMI ≥ 32.5 kg/m2) undergoing bariatric surgery (14 sleeve gastrectomy, 2 Roux-en-Y gastric bypass) and 20 normal-weight controls (BMI < 25 kg/m2) were recruited. Nitrogen balance, calculated from dietary protein intake and urine nitrogen excretion, was assessed. Participants with obesity were re-evaluated 6 months post-surgery. Data were analyzed using parametric methods. RESULTS: At baseline, controls had a BMI of 20.8 ± 2.1 kg/m2; those with obesity had 40.9 ± 7.3. Daily calorie and protein intake for participants with obesity were not statistically significantly different from controls (calorie intake at 1467 ± 430 vs. 1462 ± 391 kcal, p = 0.9701, protein intake 74.2 ± 28.7 vs. 64.6 ± 18.3 g, p = 0.2289). Post-surgery, BMI, fat-free mass, fat mass, total energy intake, carbohydrate, and protein intake decreased significantly (p < 0.01). Protein oxidation and urine nitrogen excretion did not change after bariatric surgery. However, nitrogen balance significantly reduced from 2.62 ± 5.07 to - 1.69 ± 5.07 g/day (p = 0.025). CONCLUSION: Dietary protein intake is inadequate in individuals with obesity at 6 months post-bariatric surgery and contributes to a state of negative nitrogen balance.

Effects of replacing corn silage and soybean meal with an increasing percentage of fresh herbage on dairy cow nitrogen use efficiency and flows.

To improve sustainability, dairy farms can reduce protein-rich concentrate in the cows' diet providing fresh herbage produced on-farm. This study aimed to quantify effects of increasing the percentage of fresh herbage (0%, 25%, 50%, and 75%, on a dry matter [DM] basis) in a partial mixed ration-based diet on cow N use efficiency and excretion. The study was performed with five lactating cows, in a 4 × 4 Latin square design for four 3 week periods. Individual DM intake, milk yield, feces and urine excretions, and their N concentrations were measured daily. Dietary crude protein concentrations varied little among treatments (127 to 134 g/kg DM). DM intake and milk yield decreased linearly by 5.2 and 3.7 kg/day, respectively, while N use efficiency increased by 4.1 percentage points from 0% to 75% DM of fresh herbage in the diet. Urinary N was not influenced by the treatments, while fecal N decreased as the percentage of fresh herbage increased. This study highlights that replacing partial mixed ration with an increasing percentage of fresh herbage with slight changes in dietary N concentration increases N use efficiency and the percentage of urinary N in excreted N.

Evaluation of protocols to determine urine output and urinary urea nitrogen excretion in dairy cows with and without dietary salt supplementation.

Urine output and urinary urea-N excretion (UUNe) excretion are critical measures to accurately evaluate N metabolism in lactating dairy cows and environmental concerns related to manure N. The objectives of this study were: (1) to compare estimates of UUNe, urine output, and related variables from 3 pre-established measurement protocols (bladder catheterization, external collection cup, and spot sampling) and from dietary salt supplementation, (2) to study temporal variation in UUNe, urine output, and related variables as affected by measurement protocol, and (3) to evaluate urine specific gravity as a predictor of urine output. Twelve multiparous Holstein cows were used in a split-plot, Latin square design. Cows were randomly assigned to a diet (main plot) containing either 0.7% or 1.6% NaCl (DM basis) and then assigned to a sequence of 3 protocols (subplot) in a balanced 3 × 3 Latin square with 14-d period. For each protocol, measurements were conducted every 4 h for 3 consecutive days. Urine output was determined gravimetrically for bladder catheterization and external collection cup or based on measured cow BW, measured urinary creatinine concentration, and the assumed creatinine excretion of 29 mg/kg BW per day for spot sampling. Urine specific gravity was measured by refractometry. When averaged over a 3-d measurement period and compared with bladder catheterization, spot sampling underestimated urine output (6.8 kg/d; 20%) and UUNe (26 g/d; 13%) but exhibited greater concentration of urinary urea-N (+58 mg/dL; 10%). There were no differences in any measurements determined via bladder catheterization or external cup device protocols, except for urine output that tended to be 3.7 kg/d lower for collection cup compared with bladder catheterization. The 2 gravimetric protocols yielded lower urinary creatinine concentration than spot sampling (64.7 vs. 88.1 mg/dL) and lower creatinine excretion (25.3 mg/kg BW per day) than the value of 29 mg/kg BW per day generally assumed in the spot sampling protocol. Salt supplementation tended to increase urine output (+5.2 kg/d) and decrease urinary urea-N concentration (-93 mg/dL), urinary creatinine concentration (-9.5 mg/dL), milk protein concentration (-0.19 percentage unit) and milk protein yield (-70 g/d). There was greater temporal variation of urine output when measured via the collection cup compared with bladder catheterization in the first 2 d but not the third day of sampling, suggesting that an extended period of adaptation might have improved data quality of the collection cup protocol. The R2 of the linear regression to predict urine output with urine specific gravity was 67%, 73%, and 32% for bladder catheterization, collection cup, and spot sampling, respectively. In this study, spot sampling underestimated both urine output and UUNe, but UUNe determination did not differ between external collection cup and bladder catheterization. However, our data suggested the need to investigate the adaptation protocol, required days of measurements and the conversion of urine mass to urine volume to improve accuracy and precision of urine collection protocols.

Reducing dietary crude protein: Effects on digestibility, nitrogen balance, and blood metabolites in late-lactation Holstein cows.

Our objectives were to determine the effects of reducing dietary CP concentration on nutrient digestibility, rumen function, N balance, and serum AA concentration for dairy cows in late lactation. At the initiation of the experimental period, we stratified Holstein cows (n = 128; mean ± SD 224 ± 54 DIM) by parity and days pregnant (86 ± 25 d) and assigned them to 1 of 16 pens. For 3 wk, all cows received a covariate diet containing 16.9% CP (DM basis). For the subsequent 12 wk, we assigned pens to 1 of 4 treatments containing 16.2%, 14.4%, 13.4%, or 11.9% CP (DM basis) in a randomized complete block design. Diets were fed as a TMR once daily. To reduce dietary CP, we replaced soybean meal with soybean hulls in the concentrate mix (DM basis). Diet evaluations suggested that several EAA, especially His, limited productivity as dietary CP declined. Digestibility of DM and CP decreased linearly with dietary CP reduction. Digestibility of NDF and potentially digestible NDF tended to respond in a quadratic pattern with the greatest digestibility at intermediate treatments. The reduction in dietary CP did not affect ruminal pH, but ruminal ammonia-N and branched-chain VFA concentrations declined linearly. The concentration of milk urea-N and plasma urea-N, secretion of milk N, and excretions of fecal N, urinary N, urinary urea-N, and unaccounted N decreased linearly with the reduction in dietary CP concentration. Urinary N expressed as a percentage of N intake was unaffected by dietary CP. Serum concentrations of total essential AA and NEAA were unaffected by dietary CP concentration. However, the ratio of essential to NEAA decreased with decreasing dietary CP. Serum 3-methylhistidine concentration increased linearly with decreasing dietary CP concentration, indicating greater skeletal muscle breakdown. Although our trial confirmed that reducing dietary CP decreased absolute excretion of urinary N, diet evaluations suggested that milk protein production decreased as certain essential AA became increasingly limited. Thus, reduced-CP diets have the potential to lessen reactive-N outputs of late-lactation cows, but more research is needed to design diets that minimize deleterious effects on productivity.

Trichostrongylus colubriformis infection in Santa Inês lambs: impact on feed digestibility, blood markers, and nitrogen balance / Infecção por Trichostrongylus colubriformis em cordeiros Santa Inês: impacto na digestibilidade dos alimentos, marcadores sanguíneos e balanço de nitrogênio

Abstract This study aimed to evaluate the effects of Trichostrongylus colubriformis infection on the hemato-biochemical parameters, feed digestibility, and nitrogen balance in Santa Inês lambs. Eighteen three-month-old Santa Ines castrated male lambs (16.9 ± 1.43 kg of body weight) were randomly distributed in two experimental treatments: infected with T. colubriformis (I, n = 9) and uninfected (U, n = 9). The I group received a total of 45,000 L3 larvae of T. colubriformis (5,000 infective larvae, three times per week, for three weeks). During the experimental period, blood, feed digestibility, and nitrogen balance were evaluated. The I lambs showed a reduction in erythrocytes, hemoglobin, hematocrit, mean corpuscular volume, and total proteins, as well as an increase in platelets and eosinophils compared to those in the U group (p < 0.05). With the exception of total protein content, these values were within the normal range for the species. Furthermore, lower dry matter and organic matter digestibility were observed in the I lambs (p = 0.08). The present findings highlight that T. colubriformis infection has the potential to impair some hemato-biochemical parameters as well as feed digestibility in lambs, which could affect their productivity.

Resumo O objetivo deste estudo foi avaliar os efeitos da infecção por Trichostrongylus colubriformis nos parâmetros hemato-bioquímicos, digestibilidade aparente dos nutrientes e balanço de nitrogênio de cordeiros Santa Inês. Dezoito cordeiros Santa Inês, de três meses de idade e castrados (16,9 ± 1,43 kg de peso corporal), foram distribuídos aleatoriamente em dois tratamentos experimentais: infectados com T. colubriformis (I, n = 9) e não infectados (U, n = 9). O grupo I recebeu um total de 45.000 larvas L3 de T. colubriformis (5.000 larvas infectantes, três vezes por semana, durante três semanas). Durante o período experimental, foram avaliadas as variáveis sanguíneas, digestibilidade e balanço de nitrogênio. Os cordeiros I apresentaram redução de eritrócitos, hemoglobina, hematócrito, volume corpuscular médio e proteínas totais, além de aumento de plaquetas e eosinófilos, quando comparados ao grupo U (p< 0,05). Contudo, exceto para proteínas totais, os valores estavam dentro do intervalo normal para a espécie. Além disso, a digestibilidade da matéria seca e da matéria orgânica foi menor no grupo I de cordeiros (p = 0,08). Os presentes achados destacam que a infecção por T. colubriformis teve potencial para prejudicar alguns parâmetros hemato-bioquímicos, bem como a digestibilidade aparente da dieta, o que poderia afetar a produtividade dos cordeiros.

Substituição do resíduo da produção de palmito da Palmeira Real Australiana (Archontophoenix alexandrae) na silagem de cana-de-açúcar em dietas de ovinos / Replacing of residue from production of palm Palm Royal Australian (Archontophoenix alexandrae) in silage of sugar cane in diets of sheep

Objetivou-se avaliar a composição química, consumo voluntário e digestibilidade aparente de dietas contendo resíduo oriundo da produção de palmito da palmeira Real Australiana (Archontophoenix alexandrae) em substituição à cana-de-açúcarem ovinos. Foram utilizados 12 ovinos com peso vivo médio de 23,3 ± 2,8 kg, mantidos em gaiolas metabólicas distribuídos em seis quadrados latinos 2x2 implementado em esquema fatorial 3 x 2 (três tipos de resíduo - folha, bainha e composta - e dois níveis de substituição do resíduo, 5% e 15%). Verificou-se maior consumo de matéria seca (MS), matéria orgânica (MO), carboidratos não fibrosos (CNF) na substituição pelo resíduo composta. Os valores médios de digestibilidade aparente da MS, MO, Proteína bruta (PB), fibra insolúvel em detergente neutro corrigido para cinzas e proteína(FDNcp) e nível dietético de NDT foram maiores para o resíduo folha. Constatou- se efeito de interação entre resíduo e o nível de substituição sobre as excreções urinárias de nitrogênio total (EUN), balanço nitrogenado aparente (BNA) e compostos nitrogenados microbianos (NMIC). Resíduos da produção de palmito oriundos da palmeira Real Australiana podem ser utilizados como alimentos volumosos na dieta de animais ruminantes, sendo destes, o resíduo folha e composta os que apresentaram melhores respostas nas características avaliadas.

The aim of this study was to evaluate the chemical composition, voluntary intake and apparent digestibility of the diets containing residue from palm heart of Australian Royal Palm (Archontophoenix alexandrae) to replace sugar cane on sheep. Twelve sheep were used with average live weight of 23,3 ± 2,8 Kg and they placed in metabolism cages and distributed in six latin square 2 x 2 in a factorial design 3 x 2 (three types of residue -sheet, bark and composed - and two levels of residue’s replacement, 5% and 15%). It was observed higher intake of dry matter (DM), organic matter (OM), nonfiber carbohydrates (NFC) by substitution of composed residue. The average values of apparent digestibility of DM, OM, crude protein (CP), neutral detergent fibre correct for ash and protein (NDFap) and total digestible nutrients (TDN) were higher for sheet residue. There was interaction between type of residue and level of residue’s replacement on the urinary excretion of total nitrogen (NUE), apparent nitrogen balance (BNA) and microbial nitrogen compost (NMIC). Residues from palm heart of Australian Royal Palm can be used as roughage in the ruminants’diet, and of these residues, the sheet and composed residue showed better response in the evaluated characteristics.

Dosis de diálisis, nutrición y crecimiento en diálisis peritoneal pediátrica / Dialysis dose, nutrition and growth among pediatric patients on peritoneal dialysis

Stunting is common among pediatric patients on peritoneal dialysis. Aim: To stablish the best profile for urea kinetic variables associated to growth inchildren on chronic peritoneal dialysis (PD). Patients and Methods: Twenty patients, aged 1 month to 14 years, 13 males, were followed for 6-12 months, with monthly measurements of weight/age and height/age Z score; plasma creatinine, BUN, protein and albumin and urine and dialysate urea nitrogen, creatinine, protein and albumin. Minimum total Kt/V was 2.1. Dialysis dose (Kt/V), Protein Equivalent of Urea Nitrogen Appearence (PNA), Protein Catabolic Rate (PCR) and Nitrogen Balance (NB) were calculated. To identify the variable(s) associated to growth, the Tree Classification Model (CART) Enterprise Miner 8.1 was applied. Results: Mean total/residual Kt/V: 3.4±1.3/1.69±1.27; Daily Protein Intake (DPI) was 3.25±1.27 g/kg/day. nPNA, PCR and NB were 1.37±0.44, 0.84±0.33 and 1.86±1.25 g/kg/day, respectively. Mean heigth/age Z score was -2.3±1.19. Eleven patients showed a positive height/age delta Z (mean 0.55±0.38) and nine showed a negative growth (mean -0.50±0.42). The main variable explaining the positive growth was a Nitrogen Balance between 0.54 and 2.37 g/kg/ day, mean 1.55±0.21 (p <0.001). The second associated variable to growth was a residual Kt/V between 0.43 and 4.6 (2.02±0.49) (p <0.05). Kt/V and nPNA showed a significant correlation, but no correlation could be found between Kt/V and NB. Conclusions: Nitrogen Balance was the main variable associated to growth in pediatric PD, with values between 0.53 to 2.38 g/kg/day. The second variable was a residual Kt/V between 0.43 and 4.6. Therapy should be reassessed with NB values less than 0.54 or above 2.37 g/kg/day....

Short time L-glutamine supplementation of malnourished rats

OBJETIVO: Considerando que em pacientes desnutridos suplementados com L-glutamina, a negatividade do balanço de nitrogênio tende a diminuir, o presente estudo visou determinar se a suplementação com L-glutamina em ratos Wistar desnutridos poderia diminuir a excreção de nitrogênio urinário, melhorar a deposição de nitrogênio em diferentes tecidos e/ou alterar as concentrações plasmáticas de aminoácidos. MÉTODOS: Os animais foram divididos em grupos: 1) desnutrido protéico-energético, 2) desnutrido protéico e 3) nutrido. O nitrogênio urinário e tecidual foi determinado pelo método de Kjeldahl e as concentrações plasmáticas de aminoácido por cromatografia líquida. RESULTADOS: Pesos, nitrogênio urinário e teciduais foram significativamente reduzidos no grupo com desnutrição protéico-energética, não tendo sido encontrada melhora no grupo com suplementação aguda de glutamina. Não foram observadas mudanças nas concentrações plasmáticas de aminoácidos com a suplementação de glutamina. CONCLUSÃO: Não foi possível detectar um efeito positivo da suplementação de glutamina sobre o metabolismo de nitrogênio urinário e tecidual de ratos desnutridos.

Catabolismo muscular nos pacientes com infarto agudo do moicárdio / Muscular catabolism in patients with acute myocardial infarction

Introdução: O trauma e a sepse apresentam demanda metabólica aumentada devido à tríplice liberação hormonal com consequente aumento do catabolismo muscular. O infarto agudo do miocárdio(IAM) também pode ser considerado um trauma por apresentar as alterações hormonais características da fase aguda do estresse.Objetivo: Avaliar o grau de catabolismo muscular, quantificado pela excreção urinária de nitrogênio uréico em urina de 24 horas, nos pacientes admitidos com IAM.Métodos: Analisados prospectivamente 22 pacientes internados com IAM, sendo 12 de parede inferior e 10 de anterior, caracterizados elétrica e bioquimicamente com injúria e necrose transmural. A área do infarto foi diagnosticada pelo eletrocardiograma e confirmada pelas alterações no ecocardiograma. Foram excluídos os pacientes com insuficiência renal, IAM não transmural(ausência da onda Q evolutiva) e aqueles com mais de 48 horas de IAM. A coleta de urina de 24 horas foi realizada no 1º, 3º e 5º dias de internação para a quantificação da uréia excretada. O nitrogênio urinário foi calculado a partir da uréia, considerando-se um percentual nitrogendo de 46.66 por cento na molécula uréica. A avaliação estatística foi realizada pela análise de variância two way e pelo teste de Tukey, com nível de significância de 5 po cento.Resultados: O IAM, tanto anterior como inferior, apresenta catabolismo muscular evolutivo(terceiro dia) caracterizado como moderado(N2Dia3/Dia1, p igual 0,001). O catabolismo muscular foi idêntico mo IAM anterior e inferior (p igual 0,49). O catabolismo muscular é revertido no quinto dia.Conclusão: Os pacientes com IAM apresentaram um aumento reversível do catabolismo muscular

Catabolismo proteico en el paciente politraumatizado / Protein catabolism in a multiple trauma patient

El catabolismo proteico ha ganado importancia por la pérdida de la masa celular corporal que produce y porque se relaciona con la morbilidad y la mortalidad de los pacientes sometidos a estrés. Se estudiaron 50 pacientes quirúrgicos graves, ingresados en la sala de Terapia Intensiva del Instituto Superior de Medicina Militar "Dr Luis Díaz Soto" que presentaron una estadía mínima de 15 d y a los cuales se les midió circunferencia muscular del brazo, nitrógeno y creatinina urinaria, urea y albúmina sérica. Las determinaciones se realizaron al ingreso, a los 7 y 15 d de estadía. La circunferencia muscular del brazo y la albúmina sérica presentaron un descenso progresivo y correspondieron las cifras menores a los pacientes fallecidos; la albúmina sérica en los pacientes fallecidos a los 15 d fue de 31,6 g/L y en los que sobrevivieron de 34,1 g/L. La proteína oxidada por kilogramo en los que fallecieron fue de 2,1 y en los que sobrevivieron de 1,7 g/kg. La mortalidad total de la serie fue del 28 porciento

Efeito do tempo total de circulaçäo extracorpórea em cirurgia de revasculaçäo miocárdica sobre a perda urinária de nitrogênio na forma de uréia / Effect of total extracorporeal circulation time in myocardial revascularization surgery on urinary urea nitrogen loss

A circulação extracorpórea em cirurgia cardíaca pode ser comparada a um trauma cirúrgica mais intenso. Para verificar a influência do uso de circulação extracorpórea sobre o catabolismo protéico, foram avaliados, prospectivamente, 105 pacientes submetidos a revascularização miocárdica. Tais pacientes foram avaliados de acordo com sexo, idade, tempo de circulação extracorpórea e número de enxertos realizados. No período pós-operatório imediato, o nitrogênio urinário na forma de uréia foi analisado por meio de método enzimático. Análise estatística (análise de correlação e regressão linear múltipla) foi efetuada. Sexo, idade e tempo de circulação extracorpórea não se correlacionaram com a perda urinária de nitrogênio, mas houve correlação positiva com o maior número de enxertos na revascularização. Em conclusão, a circulação extracorpórea não influenciou a perda urinária de nitrogênio, mas houve correlação positiva com o maior número de enxertos na revascularízação. Em conclusão, a circulação extracorpórea não influenciou a perda urinária de nitrogênio. O número de enxertos mais elevado proporcionou maior perda nitrogenada.

Metabolic assessment and enteral tube feeding usage in children with acute neurological diseases

Objective: To report on acquired experience of metabolic support for children with acute neurological diseases, emphasizing enteral tube feeding usage and metabolic assessment, and also to recommend policies aimed towards improving its implementation. Design: Retrospective analysis. Setting: Pediatric Intensive Care Unit of Hospital do Servidor Publico Estadual de Sao Paulo. Subjects: 44 patients consecutively admitted to the Pediatric ICU over a period of 3 years who were given nutrition and metabolic support for at least 72 hours. Head trauma, CNS infections and craniotomy post-operative period following tumor exeresis were the main diagnoses. Measurements: Records of protein-energy intake, nutrient supply route, nitrogen balance and length of therapy. Results: From a total of 527 days of therapy, single parenteral nutrition was utilized for 34.3 per cent and single enteral tube feeding for 79.1 per cent of that period 61.4 per cent of the children were fed exclusively via enteral tube feeding, 9.1 per cent via parenteral and 39.5 per cent by both routes. The enteral tube feeding was introduced upon admission and transpyloric placement was successful in 90 per cent of the cases. Feeding was started 48 hours after ICU admission. The caloric goal was achieved on the 7th day after admission, and thereafter parenteral nutrition was interrupted. The maximum energy supply was 104.2 + 23.15 kcal/kg. The median length of therapy was 11 days (range 4-38). None of the patients on tube feeding developed GI tract bleeding, pneumonia or bronchoaspiration episodes and, of the 4 patients who were given exclusive TPN, 2 developed peptic ulcer. The initial urinary urea nitrogen was 7.11 g/m2 and at discharge 6.44 g/m2. The protein supply increased from 1.49 g/kg to 3.65 g/kg (p<0.01). The nitrogen balance increased from - 7.05 to 2.2 g (p<0.01). Conclusions: Children with acute neurological diseases are hypercatabolic and have high urinary nitrogen losses. The initial negative nitrogen balance can be increased by more aggressive feeding regimes than the usual ones. Early tube feeding was well tolerated, which permits the conclusion that it is a safe and effective method for nutrition support. Recommendations of basic rules for metabolic support are made.

Methionine supplementation of soya products: effects on nitrogen balance parameters

Soybean protein is one of the best quality foods available. Contribution of soy to human nutrition increases because of its overall positive nutritional profile, low cost, high protein and excellent functional properties. Addition of methionine to rat soybean diets improve biological value of soy protein. Few studies on methionine fortification of soya protein were carried in infants, but fortification of baby formulas with this amino acid is usually found. This study was carried out to demonstrate in malnourished children that the effect of methionine supplementation of soya milk and soy isolated protein, as well as to compare with their results to cows' milk. A total of 30 malnourished children, 1 to 3 years old, admitted to our metabolic unit and distributed in groups of 6 children were studied. They were fed experimental formulas with cows' milk, soya milk, soya milk plus methionine, soya isolated and soya isolated plus methionine. Nutrient compositions of formulas were calculated to be similar to mothers' milk. DL-methionine, 1.5 g per 100 g protein content was added to soya milk and soya isolated formulas. Two nitrogen balances, 3 days each, were carried out. Fecal and urinary nitrogen, serum proteins, creatinine and urea in serum and urine were followed during the study. Results showed differences of intake and retention of nitrogen between some of the groups, but there were no statistically significant differences on protein absorption in the groups. No differences were demonstrated in serum proteins, total nitrogen and other serum and urine parameters analyzed. Cows' milk fed children presented the highest nitrogen retention in both balance studies. The addition of methionine to the soya milk formula increased the nitrogen retention, not reaching the cows' milk levels and did not have the same effect when added to the isolate soy protein.

Nutritional and metabolic assessment of critically ill children

In a prospective study, with the objective of determining the metabolic profile, response to nutrient supply, and role of nutritional and metabolic assessment parameters in children admitted to a pediatric ICU, ll patients in the age group 2-12 were studied. The assessment was carried out during the first 72 hours of admission, and again seven days later, and included the following parameters: caloric supply; nitrogen supply; prealbumin serum level; urinary urea nitrogen; nitrogen balance and creatinine-height index. The evolution of the parameters in the two stages of the study showed the following results: The urinary urea nitrogen median value at admission was 7.5 g/m2 of corporeal surface, and did not present significant changes seven days later. There was a significant increase in caloric supply from 42.9 to 70.3 kcal/kg, and in nitrogen supply, from 4.7 to 10.2 g/m2 of corporeal surface p 0.01. The level of nitrogen balance rose from - 5.6 to 2.5 g/24h (p<0.03), and that of prealbumin, from 16.7 to 26.3 mg/dl (p<0.03). There was a significant reduction in the creatinine-height index, from 86.2 percent to 55.0 percent p 0.01. The magnitude of urinary urea nitrogenexcretion at admission varied 2.5-13.8 g/m2 Of corporeal surface. Based on this parameter, it was not possible to establish a characteristic metabolic profile for the conditions studied. Notwithstanding an increase in the protein and caloric supply, prealbumin level and nitrogen balance observed in the second stage of the study, the patients lost muscle mass and entered into a malnutrition process, probably due to intense protein catabolism and the poor response to nutrition supply that occurs in metabolic stress.

Consequencias nutricionais da substituicao parcial do farelo de soja por ureia, na dieta de ovinos. Estudo das provas de digestibilidade aparente, do balanco de nitrogenio e da cinetica da 15N-glicina / The nutricional outcome of N-soybean meal replacement by N-urea in the sheep diet. Study of apparent digestibility, N-balance and 15-N-glycine kinetics

Com o objetivo de avaliar a substituicao de uma fonte de N classica (farelo de soja) por outra de menor custo (ureia), em ouvinos, foram realizados estudos, envolvendo provas classicas de longa duracao (17 dias): prova de digestibilidade aparente (PD) + balanco de nitrogenio (BN), comparativamente a outras de curta duracao (8 horas): cinetica da 15N-glicina + balanco de N para tanto, 6 carneiros corriedale, machos, castrados, 15 meses de idade, 36 EG e VGRM fugodos foram alocados em gaiolas metabolicas individuais e passaram a receber cada uma das 3 dietas isoproteicas (15,39 por cento PB), tendo como fontes o farelo de soja apenas (D1) ou associado a ureia o,68 por cento (D2) ou 1,35 por cento (D3) de forma isocalorica (2,92Mcal ED/KG) a base de feno de Rhodes. Apos o periodo de adaptacao de 21 dias, em cada uma das dietas, "AD LI3 TUM", procedeu-se a digestibilidade aparente (PD) e balanco de N (BN) com duracao de 7 dias e os ouvinos sob consumo restrito (90 por cento do voluntario). A aceitacao da dieta foi boa indistintamente sem diferenca estatistica (P>0,05) para ganho de peso (155-204g/dia), coeficiente de digestibilidade de N (74-76 por cento ) e BN (6-7,3g/dia) O estudo do metabolismo proteico global, avaliado pela cinetica da 15N-glicina, tendo a amonia urinaria como produto final, nao apontou diferenca significativa entre as 3 dietas para fluxo de N, sintese e catabolismos proteicos. Concluiu-se, portanto, que o uso da ureia em complementacao ao farelo de soja nao trouxe prejuizos metabolico-nutricionais, segundo as provas PD/BN ou outras mais dinamicas (cinetica de 15N-glicina)

Aproveitamento protéico da dieta hospitalar em pneumopatas internados / Utilization of hospitalar dietary protein in patients with pulmonaries diseases

O aproveitamento protéico da dieta hospitalar foi analisado em seis pacientes pneumopatas internados, com idade entre 21 e 57 anos, todos apresentando déficit de peso de pelo menos 10//. A avaliaçäo antropométrica do estado nutricional mostrou significância estatística (p<0,05) para o aumento de peso ocorrido durante o estudo. A avaliaçäo do aproveitamento protéico da dieta hospitalar foi feita pelo controle da ingestäo e pela excreçäo urinária de nitrogênio. O nitrogênio foi determinado pelo método micro-Kjeldahl. Estatisticamente näo houve diferença entre o consumo de nutrientes no hospital. Houve reduçäo naexcreçäo urinária de nitrogénio com o aumento da ingestäo protéico-calórica ao nível hospitalar, melhorando a retençäo nitrogenada. A relaçäo nitrogênio urinário/nitrogênio dietético referente ao domicílio foi aproximadamente oito vezes o valor encontrado para essa relaçäo no hospital. A relaçäo nitrogênio/caloria näo-protéica mostrou-se mais adequada na dieta hospitalar do que na domiciliar, havendo significância estatística para ambas as relaçöes (p<0,05). O tratamento dietético adequado e oportuno melhorou o equilíbrio nitrogenado e o estado nutricional dos pacientes estudados