Post-lunch triglyceridaemia associates with HDLc and insulin resistance in fasting normotriglyceridaemic menopausal women.

OBJECTIVES: Post-prandial hypertriglyceridaemia (P-HTG) is associated with cardiovascular disease. This association is of paramount importance during menopause, which is also related to reduced high-density lipoprotein-cholesterol (HDLc) and elevated triglyceride (TG) levels. We aimed to provide a self-assesing tool to screen for P-HTG in menopausal women who were normotriglyceridaemic at fasting and adhered to a Mediterranean-style eating pattern. METHODS: We performed oral fat loading tests (OFLT) in combination with self-measurements of diurnal capillary TG at fixed time-points (DC-TG) in 29 healthy menopausal women. TG levels >220 mg dL-1 at any given time during the OFLT served as diagnostic criteria for P-HTG. Subsequently, DC-TG profiles were examined to determine the best mealtime (breakfast, lunch or dinner), as well as optimal cut-off points to classify these women as having P-HTG according to the OFLT. Insulin resistance was defined as the upper tertile of the homeostatic model assessment of insulin resistance. RESULTS: We found that, despite having normal fasting TG levels, P-HTG was highly prevalent (approximately 40%). Moreover, self-assessed 3-h post-lunch TG levels >165 mg dL-1 increased the odds of having hypo-HDL cholesterolaemia by 14.1-fold (P = 0.026) and the odds of having insulin resistance by 31.6-fold (P = 0.007), adjusted for total fat intake in women adhering to a Mediterranean eating pattern having their highest energy intake at lunch. CONCLUSIONS: Self-assessed 3-h post-lunch TG can be used to study post-prandial TG metabolism in Southern European menopausal women who are normotriglyceridaemic at fasting. Characterising an individual's post-prandial response may help menopausal women to evaluate their risk of cardiovascular disease.

A retrospective study about the influence of early nutritional support on mortality and nosocomial infection in the critical care setting.

BACKGROUND & AIMS: To determine whether early nutritional support reduces mortality and the incidence of nosocomial infection, in critically ill patients in the current practice. METHODS: A retrospective observational study was conducted in all critically ill patients who had been prescribed nutritional support, throughout one year, in an Intensive Care Unit. The time to start and the route of delivery of nutritional support were determined by the attending clinician's assessment of gastrointestinal function and hemodynamic stability. Age, gender, severity of illness, start time and route of nutritional support, prescribed and delivered daily caloric intake for the first 7 days, whether they were a medical or surgical patient, length of stay in ICU, incidence rate of nosocomial infections and ICU mortality were recorded. Patients were classified according to whether or not they received nutritional support within 48 h of their admission to ICU and Binary Logistic Regression was performed to assess the effect of early nutritional support on ICU mortality and ICU nosocomial infections after controlling for confounders. RESULTS: Ninety-two consecutive patients were included in the study. Start time of nutritional support showed a mean of 3.1 ± 1.9 days. Patients in the early nutritional support group had a lower ICU mortality in an unadjusted analysis (20% vs. 40.4%, p = 0.033). Early nutritional support was found to be an independent predictor of mortality in the regression analysis model (OR 0,28; 95% confidence interval, 0.09 to 0,84; p = 0.023). Our study did not demonstrate any association between early nutritional support and the incidence of nosocomial infection (OR 0.77; 95%. confidence interval, 0.26 to 2,24; p = 0.63), which was related to the route of nutritional support and the caloric intake. The delayed nutritional support group showed a longer length of stay and nosocomial infections than the early group, although these differences were not statistically significant. CONCLUSIONS: Our study shows that early nutrition support reduces ICU mortality in critically ill patients, although it does not demonstrate any influence over nosocomial infection in the current practice in intensive care.

[Evaluation of a high protein diet in critical care patients]. / Evaluación de un alto aporte proteico en pacientes críticos.

OBJECTIVE: To verify the hypothesis that a high nitrogen intake leads to better nutritional results in critical patients. REFERENCE POPULATION: Patients hospitalized in the critical care unit between 1995 and 1998 with nutritional support for 14 days, excluding patients with liver and/or kidney failure. INTERVENTIONS: The calculation of the requirements was made using a computerized program for determining the eliminated nitrogen, depending on the degree of stress. At the end of the second year the formulae for calculating the requirements were changed, thus we had two groups of patients with a different protein intake. The nutritional biochemical parameters are usually analyzed on days 1, 4, and 14, as were the characteristics of the nutrition used during the first and second week of treatment in both periods. RESULTS: 32 patients were included in the first period, and 50 in the second. It was seen that there were no significant differences between them. The characteristics of the administered nutrition showed a greater caloric supply in the first week of the first period (35.14 +/- 4.4 vs. 30.04 +/- 6.1 cal/kg), with there not being any difference in the protein intake (0.26 +/- 0.04 vs. 0.24 +/- 0.09 grams of nitrogen/kg) and a greater protein intake in the second week of the second period (0.34 +/- 0.06 vs. 0.28 +/- 0.04 grams of nitrogen/kg), with there not being any differences in the caloric intake (34.08 +/- 5.6 vs. 34.13 +/- 3.1 cal/kg). The analyzed parameters did not present any significant differences between the periods. The evolution of these was similar for each period, although in the second period the transferrin improved with respect to the first period, and the decrease in the height creatinine index was stopped in the second week. The nitrogen balance could not be improved. CONCLUSIONS: The increase in the protein intake above certain limits only very slightly improves some of the nutritional biochemical parameters, without improving the nitrogen balance as a result of an increased elimination thereof.