Déficit energético y proteico crítico con gran aporte de calorías provenientes de fármacos tras una semana en una unidad de cuidados intensivos / Critical deficiencies of energy and protein with a high provision of non-nutritional calories after one week in an intensive care unit

Introducción: la terapia nutricional es esencial para tratar a pacientes críticos pero, si no es la adecuada, aumenta el riesgo de desnutrición y complica la evolución. Objetivo: evaluar la adecuación de la terapia nutricional enteral en una unidad de cuidados intensivos (UCI). Métodos: se evaluó una cohorte adulta ingresada a una UCI con nutrición enteral y estancia ≥ 7 días. Al ingreso se registraron la severidad de la enfermedad y los datos socio-demográficos, clínicos y nutricionales, con cribados que incluyeron la IL-6 y la composición corporal. Diariamente se evaluó el aporte de nutrientes con respecto al 70 % óptimo de lo prescrito por las guías internacionales, para estimar el déficit energético-proteico. Resultados: se incluyeron 26 de 132 pacientes ingresados. Su probabilidad de mortalidad era del 20-25 % debido a la severidad de su enfermedad por los sistemas APACHE (16,6 ± 6,0) y SOFA (8 ± 4,4); su riesgo de desnutrición era de 5,6 ± 1,09 puntos por el NRS-2002, con 4,3 ± 1,2 de ángulo de fase. El déficit energético promedio era de -674 kcal/día, con un 13 % en aporte proteico (28 ± 11,5 g/d) y un 42 % en lípidos, y con el 17,5 % proveniente del propofol. El NUTRIC se asoció significativamente con los porcentajes de prescripción calórica alcanzados los días 3 y 7 (R2 = 0,21, p = 0,01). Conclusión: los pacientes sufrieron déficit calórico/proteico, con déficit proteico crítico de > 85,2 g/día e inadecuada relación entre calorías proteicas y no proteicas, aumentando su riesgo de complicaciones (AU)

Introduction: nutritional therapy is essential for the treatment of critically ill patients, although its right application fails frequently, which increases the risk for undernutrition and complications. Objective: to evaluate the nutritional adequacy of patients with enteral nutritional support in an intensive care unit (ICU). Methods: a cohort study was conducted including adults admitted to the ICU with enteral support and stay ≥ 7 days. Demographic data, severity of the disease, and clinical and nutritional scores, including IL-6 levels and body composition, were evaluated at admission. Nutritional intake was recorded daily in relation to the target intake according to international guidelines, for calculation of caloric and protein deficiencies Results: in all, 26 from 132 admitted patients were included. Their probability of mortality was 20-25 % due to disease severity by APACHE (16.6 ± 6.02) and SOFA (8 ± 4.4). Undernutrition risk was 5.6 ± 1.09 by NRS-2002 and 4.3 ± 1.2 by angle phase. Caloric deficiency was - 674 kcal/day, with 13 % proteins (28 ± 11.5 g/d) and 42 % lipids, including 17.5 % of non-nutrient calories from propofol. NUTRIC was significantly associated with percentages of the caloric prescription at days 3 and 7 (R2 = 0.21, p = 0.01) Conclusion: patients had a caloric/protein deficit with critical protein deficit of -85.2 g/day, and an inadequate proportion between protein calories and non-protein calories, increasing their risk of complications (AU)

Dietary fiber and the microbiota: A narrative review by a group of experts from the Asociación Mexicana de Gastroenterología.

Dietary fiber intake is one of the most influential and efficacious strategies for modulating the gut microbiota. Said fiber can be digested by the microbiota itself, producing numerous metabolites, which include the short-chain fatty acids (SCFAs). SCFAs have local and systemic functions that impact the composition and function of the gut microbiota, and consequently, human health. The aim of the present narrative review was to provide a document that serves as a frame of reference for a clear understanding of dietary fiber and its direct and indirect effects on health. The direct benefits of dietary fiber intake can be dependent on or independent of the gut microbiota. The use of dietary fiber by the gut microbiota involves several factors, including the fiber's physiochemical characteristics. Dietary fiber type influences the gut microbiota because not all bacterial species have the same capacity to produce the enzymes needed for its degradation. A low-fiber diet can affect the balance of the SCFAs produced. Dietary fiber indirectly benefits cardiometabolic health, digestive health, certain functional gastrointestinal disorders, and different diseases.

Clinical guidelines on the diagnosis and treatment of celiac disease in Mexico. / Guía clínica para diagnóstico y tratamiento de la enfermedad celíaca en México.

Celiac disease, celiac sprue, or gluten-sensitive enteropathy, is a generalized autoimmune disease characterized by chronic inflammation and atrophy of the small bowel mucosa. It is caused by dietary exposure to gluten and affects genetically predisposed individuals. In Mexico, at least 800,000 are estimated to possibly have the disease, prompting the Asociación Mexicana de Gastroenterología to summon a multidisciplinary group of experts to develop the "Clinical guidelines on the diagnosis and treatment of celiac disease in Mexico" and establish recommendations for the medical community, its patients, and the general population. The participating medical professionals were divided into three working groups and were given the selected bibliographic material by the coordinators (ART, LUD, JMRT), who proposed the statements that were discussed and voted upon in three sessions: two voting rounds were carried out electronically and one at a face-to-face meeting. Thirty-nine statements were accepted, and once approved, were developed and revised by the coordinators, and their final version was approved by all the participants. It was emphasized in the document that epidemiology and risk factors associated with celiac disease (first-degree relatives, autoimmune diseases, high-risk populations) in Mexico are similar to those described in other parts of the world. Standards for diagnosing the disease and its appropriate treatment in the Mexican patient were established. The guidelines also highlighted the fact that a strict gluten-free diet is essential only in persons with confirmed celiac disease, and that the role of gluten is still a subject of debate in relation to nonceliac, gluten-sensitive patients.

Amaranth addition to enzymatically modified wheat flour improves dough functionality, bread immunoreactivity and quality.

Consumers with gluten-related disorders require gluten-free (GF) foods to avoid an immune response. Alternative to the use of non-gluten containing grains to prepare GF bread, the gluten reactivity has been greatly reduced using a proline specific cleavage enzyme, however, the gluten functionality was lost. The aim of this study was to evaluate the effect of adding an amaranth flour blend (AFB) to enzymatically modified wheat-flour proteins on dough functionality and to evaluate the immunoreactivity and acceptability of the prepared bread. First, wheat flour (20% w/v, substrate) was hydrolyzed using 8.4 U mg-1 protein Aspergillus niger prolyl-endopeptidase (AnPEP) for 8 h at 40 °C under constant agitation. Four types of breads were prepared with the same formulation except for the type of flour (14% w.b.): wheat flour (WF), WF-AFB unmodified not incubated, WF-AFB unmodified incubated and WF-AFB modified. The protein composition and free thiols were analyzed before and after amaranth addition, and the flour and bread proteins were run using SDS-PAGE and immune-detected in blots with IgA from celiac disease patients. The immunoreactive gluten content, specific volume and bread acceptability were evaluated. The polymeric proteins and free thiol groups of WF decreased after AnPEP treatment. The electrophoretic patterns of the modified flour and bread proteins were different and the IgA-immunodetection in blots was highly reduced, particularly for the higher molecular weight subunits. The addition of AFB to the modified wheat flour prepared using AnPEP improved the dough functionality by increasing the thiol groups and allowed the preparation of a sensorially acceptable bread with only 60 mg kg-1 immunoreactive gluten.

Genetics, environment, and asthma associated with celiac disease in the extended family of an affected child. / Genética, ambiente y asma asociados a enfermedad celiaca en la familia extendida de un niño afectado.

INTRODUCTION: Celiac disease (CD) is an autoimmune enteropathy associated with gluten ingestion. In extended families of celiac patients that live in close proximity of one another, shared genetic and environmental factors can predispose them to CD. AIM: The aim of this study was to provide evidence about the genetic and environmental factors involved in the development of CD in the extended family of a pediatric patient. METHODS: The medical history, environmental conditions, and participant weight, height, and peripheral blood samples were evaluated. The HLA-DQ2/DQ8 haplotypes were genotyped through qPCR testing and the IgA anti-gliadin and anti-transglutaminase antibodies were quantified using the ELISA test. RESULTS: Twelve close-living maternal relatives of the index case participated in the study. Eight of them presented with the HLA-DQ2 haplotype, inherited from the grandfather, and 7/12 and 9/12 were positive for IgA anti-gliadin and IgA anti-transglutaminase antibodies, respectively. The main intestinal symptoms stated by the participants were abdominal bloating, excess flatulence, constipation, and gastroesophageal reflux. The most frequent extra-intestinal symptoms were fatigue, stress, and anxiety. In addition, 6/13 participants had bronchial asthma. CONCLUSION: The extended family living in close proximity of one another shared a genetic predisposition, environmental conditions, and asthma, which could have predisposed them to celiac disease.

HLA-DQ genetic risk gradient for type 1 diabetes and celiac disease in northwestern Mexico.

BACKGROUND: Type 1 diabetes (T1D) and celiac disease (CD) are the 2 most common autoimmune childhood diseases that share their HLA-DQ2 and DQ8 genetic origin. There has currently been an increase in both diseases worldwide. In children from the low-population State of Sonora (15 inhabitants/km(2)) in north-western Mexico, there is no information on their genetic risk or the distribution of the related alleles in the general population. AIMS: To compare the HLA-DQ allele frequency in a representative sample of newborns from Sonora with that of T1D and CD patients to determine the risk gradient, and to identify the presence of celiac autoimmunity in the T1D group. METHODS: The study included 397 Sonoran newborns, with 44 cases of T1D, and 25 CD cases. The CD and T1D cases were clinically diagnosed by specialists at the Hospital Infantil del Estado de Sonora, and the autoantibodies were determined by ELISA. Whole blood was collected, gDNA was extracted, and HLA-DQ2 and DQ8 were typed by PCR-SSP. The risk gradient was calculated by comparing the allele frequencies of the cases with those of the newborns. RESULTS: The Sonoran HLA-DQ risk heterodimer proportion was 16.1% for HLA-DQ2 and 13.6% for HLA-DQ8, with an HLA-DQ2:HLA-DQ8 ratio of 1.2:1. The DQ8/DQ2 genotype represented a 1:14 risk for T1D, whereas the DQ8/DQB1*0201 combination showed a 1:6 risk for CD. The prevalence of CD autoimmunity in T1D children was 7%. CONCLUSION: The Sonoran population has a distinctive HLA-DQ allele distribution due to its ancestry. The HLA-DQ8 combinations with DQ2 or one of its alleles conferred the highest risk for both diseases, and T1D and CD frequently appear together.

[Celiac disease in children from the northwest of Mexico: clinical characteristics of 24 cases]. / Enfermedad celiaca en niños del noroeste de México: características clínicas de 24 casos.

BACKGROUND: Celiac disease (CD) is an autoimmune enteropathy induced by dietary wheat gluten that can have serious consequences if not diagnosed and treated early. It is important to be familiar with other alterations associated with gluten ingestion due to the multiplicity of clinical presentations. OBJECTIVES: To describe the most common CD presentation patterns and alterations associated with gluten in children from the northwest region of Mexico, with an incipient knowledge of its prevalence. PATIENTS AND METHODS: Age, sex, family history, and gastrointestinal and extraintestinal symptoms were recorded in 24 patients within the time frame of 2006 to 2010. Biochemical and hematologic data were collected. Anti-gliadin and anti-transglutaminase antibodies were analyzed in all the cases, and haplotypes (HLA-DQ2/DQ8) and duodenal biopsy were evaluated in some of the cases. RESULTS: Of the 24 patients (14 girls and 10 boys), 13 presented with typical CD with symptoms of poor gastrointestinal absorption; 7 patients with a mean age of 5 years presented with atypical CD; 2 had disease onset with gastrointestinal and extraintestinal (neurologic) problems; and 2 with other gluten-related disorders. All of the patients had positive serology; 11/15 presented with HLA-DQ2/DQ8 and 4 with at least one allele; damaged mucosa was observed in the 6 biopsies taken. A third of the patients were anemic, 6 presented with an albumin value of<3.5g/dL, and 4 with mineral deficiencies. A total of 83% of the patients improved with a gluten-free diet. CONCLUSIONS: The presentation patterns were: 1) typical CD, 2) atypical CD, 3) CD with gastrointestinal and extraintestinal (neurologic) symptoms, and 4) gluten-related disorders other than CD.

The function of mitochondrial F(O)F(1) ATP-synthase from the whiteleg shrimp Litopenaeus vannamei muscle during hypoxia.

The effect of hypoxia and re-oxygenation on the mitochondrial complex F(O)F(1)-ATP synthase was investigated in the whiteleg shrimp Litopenaeus vannamei. A 660 kDa protein complex isolated from mitochondria of the shrimp muscle was identified as the ATP synthase complex. After 10h at hypoxia (1.5-2.0 mg oxygen/L), the concentration of L-lactate in plasma increased significantly, but the ATP amount and the concentration of ATPß protein remained unaffected. Nevertheless, an increase of 70% in the ATPase activity was detected, suggesting that the enzyme may be regulated at a post-translational level. Thus, during hypoxia shrimp are able to maintain ATP amounts probably by using some other energy sources as phosphoarginine when an acute lack of energy occurs. During re-oxygenation, the ATPase activity decreased significantly and the ATP production continued via the electron transport chain and oxidative phosphorylation. The results obtained showed that shrimp faces hypoxia partially by hydrolyzing the ATP through the reaction catalyzed by the mitochondrial ATPase which increases its activity.

Effect of supplementing sows' feed with alpha-tocopherol acetate and vitamin C on transfer of alpha-tocopherol to piglet tissues, colostrum, and milk: aspects of immune status of piglets.

The aim of this study was to investigate the effects of dietary supplementation of sows with alpha-tocopherol acetate (ATA) and vitamin C on deposition of alpha-tocopherol (AT) in piglet lymphoid organs, such as bone marrow, thymus, and spleen at birth and at weaning, as well as on indicators of immune response in piglets. Sows were given the following treatment diets: control, vitamin C 10 g/day, ATA 500 mg/kg feed, and combined vitamins (ATA 500+Vit-C 10). Supplementation with vitamins started at the beginning of pregnancy and lasted until weaning at 21+/-3 days of age. AT was determined in colostrum, milk, piglet plasma (cord blood) and tissues at birth and on day 21. Immunoglobulins were measured in piglet plasma, milk, and colostrum. Lymphocyte proliferation in response to PHA and ConA was determined in sow and piglet blood. ATA supplementation resulted in a significant increase (P<0.001) in the AT content of colostrum, milk, piglet plasma, liver, thymus, bone marrow, and spleen at weaning. The AT content of colostrum and milk significantly (P<0.001) influenced the AT content of piglet plasma and tissues at weaning (day 21). Total Ig and IgG concentrations in piglet plasma were significantly increased in piglets given the combined vitamin treatment. No effect of AT supplementation was observed on IgG and IgA in colostrum and milk. In sows, vitamin C given alone significantly increased lymphocyte response to ConA and PHA; whereas, in piglets, there was no significant effect of treatments on lymphocyte response to PHA and ConA.

Nutritional and clinical evaluation of a modified soy protein with covalently bound branched-chain amino acids in cirrhotic sprague-dawley rats.

Several studies suggested that branched-chain amino acids (BCAA) improve plasma amino acid imbalance as well as protein metabolism in patients with cirrhosis. However, commercial formulas supplemented with free BCAA have their limitations. We evaluated a modified soy protein diet with covalently bound BCAA (diet M) by comparing it with diets based on casein (diet C) or Hepatic Aid II (diet H; commercial formula) as protein sources. After 3 weeks of bile duct obstruction, 24 Sprague-Dawley rats divided into three groups received diets with 9% (w/w) protein/amino acids for 7 days. Nutritional and clinical parameters were determined. Nitrogen balance and weight gain (g)/protein intake (g) with diet M (0.19 +/- 0.31 and 1.33 +/- 1.43 g, respectively) were significantly higher (p < 0.05) than with diet H (-0.34 +/- 0.20 and -0.34 +/- 1.11 g), but comparable to those with diet C (0.04 +/- 0.38 and 0.20 +/- 0.93 g). Animals on diet M had a significantly (p < 0.05) increased plasma BCAA:aromatic amino acid ratio (1.8 +/- 0.3) as compared with those on diets H (1.3 +/- 0.1) and C (0.8 +/- 0.0). There were no significant differences in organ weight or liver function among the groups. We conclude that the BCAA-modified protein is an attractive option in the nutritional support of patients having cirrhosis.

[Enzymatic modification of the functional, nutritional and sensorial properties of soybeans for special feeding]. / Modificación enzimática de las propiedades funcionales, nutricias y sensoriales de la soya para alimentación especial.

Production of new protein-based products for special nutrition such as hypoallergenic infant formulas, fortified beverages and nutraceutics, require ideal ingredients. Protein ingredients were developed by enzymatic hydrolysis and methionine synthesis of soy protein. Hydrolysis was done at 4% (w/v) using porcine pancreatic enzymes (4% w/w), 50 degrees C, 6 h and pH 8. After drying powder was resuspended (20% w/v) and incubated with 7.6% (w/w) methionine methyl-ester, 1% (w/w) chymotrypsin and 3 M glycerol, 37 degrees C, 3 h and pH 7. Hydrolysates were fractionated by ultrafiltration (UF) before and after enrichment (E): FI > 10, 10 > FII > 3 and 3 > FIII > 1 kDa. Functional properties, amino acid content, anti-physiological factor activities and antigenicity were assayed for all the UF fractions and the soybean meal. Protein quality bioassay and sensorial test of an non-enriched fraction and an enriched fraction were performed. Functional properties were positively modified by hydrolysis and synthesis by using a minimum time and methionine added for the last reaction. After UF all the fractions under 10 kDa showed 100% solubility (pH 4 and 7), good clarity, acceptable foam capacity and negligible antigenicity and antiphysiological activities. Additionally, methionine enrichment enhanced their nutritional value, upgrading sulfur amino acid requirements for infants and adults. Because functionality and nutritional value FIII-E could be used for hypoallergenic infant formulas, FII-E for fortified soluble formulas and nutraceutics and FI-E for a semi-solid baby food.

Interactions between listeriae and lectins.

Interactions between members of the genus Listeria and lectins are described. L. monocytogenes was shown to be heterogenous with respect to agglutination by lectins. L. monocytogenes serotype 4b had a pattern of lectin binding distinct from the other listeriae. Titration of the listeriae with lectins proved to be useful in further distinguishing serotype 4b. The results show that lectins may provide useful probes as diagnostic reagents for listeriae.

Seasonal variation in the fatty acid composition and quality of sardine oil from Sardinops sagax caeruleus of the Gulf of California.

One of the few sources of long-chain n-3 polyunsaturated fatty acids is fish oil, but considerable variation may exist according to species and season. In this study, the fatty acid profiles of sardine oils from Sardinops sagax caeruleus of the Gulf of California, Mexico, were evaluated in three seasonal catch periods. Oil quality was also evaluated by peroxide and free acid values. The most abundant fatty acids found in the oils were palmitic acid (19.3%), oleic acid (14.3%), eicosapentaenoic acid (EPA, 20.4%), and docosahexaenoic acid (DHA, 12.2%). There was no significant difference in the composition and quality among the six reduction plants where the samples were obtained. However, a significant difference in the proportion of EPA and DHA in one of the catch seasons analyzed was observed.

Immunological and functional properties of the exudate gum from northwestern Mexican mesquite (Prosopis spp.) in comparison with gum arabic.

A comparison between the fine structural features of exudate gum from mesquite (Prosopis spp.) indigenous to NW Mexico and commercial gum arabic from Acacia spp. was achieved by means of immunological techniques. Their functional properties were compared from the ability to form oil-in-water emulsions and encapsulate cold press orange peel essential oil by spray drying. Fine comparison of the antigenic compounds in both materials against polyclonal rabbit antibodies, showed that the carbohydrate-rich components with slow mobility of mesquite gum are closely related to the faster ones of gum arabic. Also, close identity was observed for the components in the proteic fraction of both gums. Similar tannin concentrations were found in both materials (approximately 0.43%) with only dark coloured samples bearing higher amounts (approximately 1.9%). Gum arabic retained nearly 100% of the quantity of orange peel essential oil emulsified in water before spray drying, while mesquite gum did so for 90.6% of the citrus oil. From these results it is believed that mesquite gum might be a suitable replacement of gum arabic in arid regions of the world were Prosopis trees have widespread occurrence.

Hydrophobic interactions between gliadin and proteins and celiac disease.

Gliadin-protein interaction and its relationship to the pathogenesis hypotheses of celiac disease was investigated. Wheat germ agglutinin was not immunodetected in gliadin preparations. Peptic-tryptic gliadin digest was used to study the gliadin-protein interactions by crossed immunoelectrophoresis and affinity blotting. Biotinylated gliadin digest interacted with IgG and bovine serum albumin but not with several glycoproteins. Since albumin and IgG light chains are not glycosylated, this interaction is not lectin-like, neither completely immunological because of recognition of the IgG Fc fraction. Immobilized and boiled IgG was not recognized by gliadin digest as a lectin. Gliadin digest fractions from T-gel chromatography reduced the fluorescence intensity of cis-parinaric acid bound to albumin. The gliadin-protein interaction is not lectin-like or completely immunological but hydrophobic. Hydrophobicity of gliadins may contribute to the pathogenic events that result in celiac disease.

Affinity methods with lectins: a tool to identify canine alkaline phosphatase isoenzymes.

Affinity methods were used to characterize selective interactions of alkaline phosphatase (ALP) isoenzymes from different dog tissues with lectins. Specific lectins were used to identify liver, intestinal and steroid-induced ALP isoenzymes in serum from dogs with Cushing syndrome or steroid-treated dogs. For the first approach, 12 lectins were assayed by affinity dots. Selective interactions were found among wheat germ agglutinin (WGA), jacalin, con A (concanavalin A) and Helix pomatia agglutinin (HPA) and several ALP-containing samples. These four reactive lectins were assayed by line electrophoresis with lectins in holes. A strong reactivity of con A with all isoenzymes was found, although the patterns were different. WGA interacted with intestinal, bone marrow extracts and Cushing syndrome serum. Jacalin changed the electrophoretic patterns of intestinal and liver ALP, and Cushing serum. Finally, by crossed electrophoresis with lectins in gels, it was possible to distinguish among hepatic or intestinal ALPs and the steroid-induced isoenzyme in serum. Affinity electrophoresis with lectins provided a clear separation and identification of the different dog ALP isoenzymes.