A high-protein peptide-based enteral formula improves diarrhea in tube-fed patients: A prospective multicenter study.

BACKGROUND: Diarrhea is a common problem in tube-fed patients. The relevant guidelines suggest using a peptide-based enteral formula in patients with diarrhea; however, sufficient evidence to support this recommendation is currently lacking. AIM: This study aimed to evaluate the effects of a high-protein peptide-based formula on gastrointestinal intolerance, mainly focusing on diarrhea symptoms in patients who were intolerant to polymeric formula feeding. METHODS: This prospective, single-arm, open-label, multicenter study was conducted from March 2021 to March 2022 at two tertiary-care hospitals. Patients who presented with diarrhea during tube feeding with polymeric formula were assigned to receive a high-protein peptide-based formula for ≤7 days. Stool weight and frequency were monitored at baseline, on day 3, and on day 7 (or end of the study) as the primary outcomes. RESULTS: Twenty-eight tube-fed patients with diarrhea were recruited. After switching their feeding formula from polymeric to peptide based, significant improvements in stool frequency and stool weight were observed on day 3 and day 7 compared with the baseline (median [IQR] stool frequency: 5 (2), 2.5 (3.5), and 3 (3) times/day, respectively, p <0.001; median stool weight: 500 (370), 170 (285), and 275 (385) gram/day, respectively, p = 0.015). Stool consistency was assessed using the Bristol Stool Score and showed significant improvement with time. No serious adverse events were reported. CONCLUSION: A high-protein peptide-based enteral formula was effective in reducing stool weight and frequency in patients who experienced diarrhea during tube feeding with a polymeric formula.Trial registration: TCTR20210302006.

Energy expenditure in severe sepsis or septic shock in a Thai Medical Intensive Care Unit.

BACKGROUND AND OBJECTIVES: Energy expenditure in severe sepsis/septic shock patients was measured by indirect calorimetry and the correlation of energy expenditure between indirect calorimetry and predictive equations was determined. METHODS AND STUDY DESIGN: This was a prospective, observational analytical study. Severe sepsis or septic shock patients were measured for energy expenditure over 72 hours by indirect calorimetry that was measured by a mechanical ventilator (EngströmCarestation, GE Healthcare). Predictive equations for energy expenditure by the Harris-Benedict equation (HBE), Ireton-Jones 1992 equation (IRE) and ACCP equation (ACCP) were calculated and then correlations and agreement between indirect calorimetry and predictive equations were tested. RESULTS: The 16 patients had a mean age of 71.6±5.5 years and a mean APACHE II score of 26.9±4.0. The average energy expenditure by indirect calorimetry over 72 hours per kilogram body weight was 26.7±5.3 kcal/kg/day. For predictive equations, IRE was moderately significantly correlated with indirect calorimetry over 72 hours (intraclass correlation 0.46, 95% CI -0.01 to 0.77, p=0.028), but the HBE and ACCP equations were not significantly correlated (intraclass correlation for HBE -0.52, 95% CI -0.8 to -0.06, p=0.985 and intraclass correlation for ACCP 0.29, 95% CI -0.21 to 0.68, p=0.121). CONCLUSIONS: Energy expenditure over 72 hours in severe sepsis or septic shock was about 26.7±5.3 kcal/kg/day. The use of predictive equations should be further examined in future studies.

Serum antioxidant levels and nutritional status in early and advanced stage lung cancer patients.

OBJECTIVE: Malnutrition frequently occurs in lung cancer patients. We aimed to determine nutritional status and antioxidant and mineral levels in Thai patients with lung cancer. METHODS: A prospective study with matched case-control was conducted. Nutritional status was assessed by body mass index (BMI) and subjective global assessment (SGA). Eastern Cooperative Oncology Group (ECOG) performance status was used to assess the performance. The serum antioxidant and mineral levels were determined. RESULTS: Forty-nine patients with a mean age of 58.8 (range, 35-82) who were first diagnosed with lung cancer were enrolled. They were compared with 60 healthy controls, and levels of retinol, α-tocopherol, ß-carotene, lycopene, ß-cryptoxanthin, selenium, and zinc were lower (P < 0.05). However, peroxidase activity was higher (P = 0.002) in patients. Selenium levels were higher in early stage compared to advanced stage patients (P = 0.041). Overweight patients had higher selenium levels (0.04 mg/L) than normal BMI patients (ß = 0.04, P = 0.035). Patients with SGA class C had lower selenium levels (0.03 mg/L) than those with class A (ß = -0.03, P = 0.035). The poorer ECOG performance patients had significantly lower ß-carotene (ß = -0.192, P = 0.003) and selenium (ß = -0.031, P = 0.011) levels compared with those with good ECOG performance status. CONCLUSIONS: Significantly lower levels of antioxidants and selenium were found in lung cancer patients compared to healthy controls. Levels of some antioxidants and minerals differed among categories of BMI, SGA categories, or ECOG performance status. These findings may be helpful for further studies, such as the effect of nutritional supplementation on clinical outcomes.

Serum beta-carotene, lycopene and alpha-tocopherol levels of healthy people in northeast Thailand.

Human serum contains many different antioxidants which may be important in the maintenance of antioxidant status. beta-carotene and lycopene are carotenoids with potent antioxidant activity. Carotenoids intake probably protects against cancers and may affect the risk of several chronic conditions. alpha-tocopherol is well known for its function as antioxidant and in reduction of heart disease and cancer risk. We aimed to establish baseline values for serum beta-carotene, lycopene and alpha-tocopherol concentrations in healthy northeast Thais. Fasting serum beta-carotene, lycopene and alpha-tocopherol levels from 294 subjects aged 23-75 years old in northeast Thailand were determined by high performance liquid chromatography (HPLC). The mean serum beta-carotene, lycopene and alpha-tocopherol levels were 0.53 +/- 0.32 micromol/L, 0.57 +/- 0.37 micromol/L, and 26.64 +/- 14.85 micromol/L respectively. Serum beta-carotene and lycopene levels in females (N = 118) were significantly higher than the value for males (N = 176), ie 0.60 +/- 0.31 micromol/L versus 0.48 +/- 0.32 micromol/L (p = 0.002) for beta-carotene and 0.74 +/- 0.38 micromol/L versus 0.46 +/- 0.33 micromol/L (p<0.001) for lycopene whereas alpha-tocopherol level in males (28.60 +/- 14.34 micromol/L) was significantly higher than in females (23.72 +/- 15.16 micromol/L) (p = 0.006). beta-carotene level was positively correlated with alpha-tocopherol (r = 0.22, p<0.001) and lycopene levels (r = 0.63, p<0.001). The results from this study give the baseline data of serum beta-carotene, lycopene and alpha-tocopherol levels in healthy northeast Thai population and also suggest future study on the relationship of dietary intake.

Serum vitamin A and zinc levels of healthy people in northeast Thailand.

BACKGROUND: Vitamin A and zinc are micronutrients which co-related to diseases afflicting northeast Thais. Vitamin A and zinc concentrations in serum have been studied in healthy northeast Thais between 23 and 75 years. METHODS: Vitamin A was analyzed by HPLC and zinc was determined by flame atomic absorption spectrometry. RESULTS: The average serum vitamin A level of the population (n=744) was 2.30 micromol/l (95% CI=2.25-2.35). Males had significantly higher vitamin A levels than females, i.e. 2.61 micromol/l (95% CI=2.53-2.68) vs. 2.03 micromol/l (95% CI=1.98-2.09) (p<0.0001). The vitamin A level of females tended to increase significantly with age (p<0.005), whereas in males levels were relatively constant throughout the age range studied. The average serum zinc level of the population (n=1113) was 18.20 micromol/l (95% CI=18.05-18.36). There was no significant difference in the zinc levels between males and females, i.e. 18.20 micromol/l (95% CI=17.90-18.36) vs. 18.36 micromol/l (95% CI=18.05-18.66). The zinc level tended to decrease significantly as age increased, particularly in the male population (p<0.05). CONCLUSION: The results from this study provide baseline data of serum vitamin A and zinc levels in healthy northeast Thais.

Rural-urban difference in lipid levels and prevalence of dyslipidemia: a population-based study in Khon Kaen province, Thailand.

OBJECTIVES: To determine the lipid levels and examine the effect of an urban lifestyle on dyslipidemia, by comparing the lipid levels and the prevalence of dyslipidemia of rural vs. urban dwellers in Thailand MATERIAL AND METHOD: A cross-sectional study was conducted in both rural and urban areas of Khon Kaen province. After a 12-hour fast, blood was drawn for assessment of total cholesterol (TC), triglyceride (TG), high-density lipoprotein (HDL-C) and low-density lipoprotein (LDL-C) cholesterol. The classification of dyslipidemia was based on the NCEP A TP III guidelines. RESULTS: The authors recruited 916 subjects (595 urban; 321 rural), ranging between 20 and 88 years of age. In both the men and women, the mean TC and LDL-C were significantly higher in urban vs. rural subjects (TC; 207 vs. 169 for men and 204 vs. 192 mg/dl for women and LDL-C; 120 vs. 87 for men and 122 vs. 110 mg/dl for women, p < 0.001). The rural women had a significantly higher mean TG (159 vs. 111 mg/dl, p < 0.001) but lower HDL-C (51 vs. 59, mg/dl, p < 0.001) than urban women. The TG and HDL-C between urban and rural men was not significantly different. Urban men had a significantly higher prevalence of dyslipidemia (TC > or =240 and LDL-C > or = 60 mg/dl) than rural men (25.9 vs. .3.7 per cent for TC and 16.7 vs. 3.7 percent for LDL-C, p < 0.001) while the prevalence of hypertriglyceridemia (> or =200 mg/dl) and low HDL-C (< 40 mg/dl) was significantly higher in rural women (18.2 vs. 7.9 percent for TG and 15.0 vs. 3.8 per cent of HDL-C, p < 0.001). The results were unchanged after matching for age and sex between the urban and rural populations. CONCLUSION: This present study demonstrated a significant difference in urban vs. rural lipid levels and the prevalence of dyslipidemia. Migration to urban centers and adopting an urban lifestyle is likely related to the rising lipid level and prevalence of dyslipidemia.

Plasma ascorbate and ceruloplasmin levels in Thai premature infants.

BACKGROUND: Free radicals have been implicated in the pathogenesis of some complications among premature infants. Even though ascorbate is an important anti-oxidant in human plasma, it can also act as a pro-oxidant at high concentrations in the presence of metal ions, which causes oxidative damage in premature infants. OBJECTIVE: To determine plasma ascorbate and ceruloplasmin levels in premature infants (and their mothers) and full-term infants and to compare between groups. MATERIAL AND METHOD: Premature (n = 27) and full-term infants (n = 24) and the mothers of the premature infants (n = 13) admitted to Srinagarind Hospital, Khon Kaen University, Thailand, were enrolled in the study. Plasma ascorbate and ceruloplasmin levels were determined and compared among various clinical presentations. RESULTS: Plasma ascorbate has negative correlation with gestational age of infants. Its level on day 1 of the premature infants was significantly higher than full-term group (52.62 vs 39.00 micromol/L) and then decline after birth. Premature infants receiving oxygen therapy had lower plasma ascorbate than premature infants without oxygen therapy (p = 0.017). Plasma ascorbate in premature infants who died was higher than in those that survived (p = 0.029). Premature infants with poor outcomes had a higher ratio of plasma ascorbate to ceruloplasmin than those with good outcomes (p < 0.05). CONCLUSION: This study shows that high plasma ascorbate and low ceruloplasmin levels are associated with poor outcomes of premature infants; that is, ascorbate can act as either an anti-oxidant or a pro-oxidant.