The Effect of Ramadan Intermittent Fasting on Food Intake, Anthropometric Indices, and Metabolic Markers among Premenopausal and Postmenopausal Women: A Cross-Sectional Study.

Background and objectives: Ramadan intermittent fasting (RIF) is a monthlong practice in which Muslims fast during the whole day from sunrise to sunset. During this month, fasting people change their dietary behavior and alter their eating hours from day to night. The objective of the current study was to examine the effect of RIF on dietary consumption, anthropometric indices, and metabolic markers in healthy premenopausal (PRE-M) and postmenopausal (POST-M) Saudi women. Materials and Methods: The study included 62 women (31 PRE-M, 21-42 years, and 31 POST-M, 43-68 years). A structured questionnaire was used to collect socioeconomic data. Physical activity, anthropometric, dietary, and biochemical assessments were assessed before and at the end of the third week of Ramadan. Results: Socioeconomic data varied among participants. For both groups, observing RIF was associated with significantly (at either p ≤ 0.01 or p ≤ 0.05) lower intake of calories, macronutrients, minerals (excluding Na), and vitamins than before RIF. For the PRE-M group, the percentage of overweight participants decreased significantly (p ≤ 0.01) during Ramadan, while the percentage of obese participants remained unchanged. In contrast, for the POST-M group, the percentage of overweight participants increased significantly (p ≤ 0.05) during Ramadan, but dropped at the end of Ramadan. Following RIF, waist-to-hip ratio, body fat, and fat mass (FM) decreased in both groups. High-density lipoprotein cholesterol (HDL-C), fasting blood glucose (FBG), triglycerides (TG), and blood pressure (SBP, DBP) were generally maintained at acceptable normal levels in most participants before and at the end of RIF. However, low-density lipoprotein cholesterol (LDL-C) at the end of RIF was significantly lower than before, particularly in POST-M women. Age, occupation, and monthly income were the most important predictors for the changes in nutritional status and body fat upon RIF. Conclusions: observing RIF by PRE-M and POST-M Saudi women was associated with significant improvements in variable health indicators, with a few exceptions, and may help lower risk factors for chronic diseases, particularly among POST-M women. However, further studies with a larger sample size are required to determine and confirm the exact effect of RIF on these groups.

Nutritional and Physicochemical Characteristics of Innovative High Energy and Protein Fruit- and Date-Based Bars.

With the increasing global nutritional bar market, developing and formulating innovative high-energy and protein bars to compensate for nutrients using date fruits is beneficial for health-conscious individuals. The current research was undertaken to study the composition and physicochemical characteristics of innovative high-energy and high-protein bars using two combinations of Sukkari dates or fruit mixtures as a base. Fifty percent of either Sukkari date paste or dried fruit mixture (25% raisin, 12.5% fig, and 12.5% apricot) combined with other different ingredients was used to produce a date-based bar (DBB) or fruit-based bar (FBB). Proximate composition, sugar content, amino and fatty acid profiles, minerals and vitamins, phytochemicals, antioxidant activity, and visual color parameters of the DBB and the FBB were determined and statistically compared. Proximate analysis revealed higher moisture and fat content in the FBB than the DBB, while ash and crude fiber were higher in the DBB than the FBB. The protein content in the DBB and the FBB was not statistically different. Both prepared bars exuded around 376-378 kcal 100 g-1 fresh weight. Sugar profile analysis of the DBB and the FBB showed dependable changes based on date or fruit content. Fructose, glucose, and maltose contents were higher in the FBB than in the DBB, while sucrose content was higher in the DBB than in the FBB. The DBB showed significantly higher content in Ca, Cu, Fe, Zn, Mn, and Se and significantly lower content in Mg, K, and Na than the FBB, with no variation in phosphorus content. The DBB and the FBB contained both essential (EAA) and non-essential (NEAA) amino acids. The DBB scored higher Lysine, Methionine, Histidine, Threonine, Phenylalanine, Isoleucine, and Cystine contents than the FBB, while the FBB scored only higher Leucine and Valine contents than the DBB. Seventeen saturated fatty acids were identified in the DBB and the FBB, with Palmitic acid (C16:0) as the predominant fatty acid. Oleic acid (C18:1n9c) was predominant among seven determined monounsaturated fatty acids. Linoleic fatty acid (C18:2n6c) was predominant among eight identified polyunsaturated fatty acids. In addition, α-Linolenic (C18:3n3) was detected in a considerable amount. However, in both the DBB and the FBB, the content and distribution of fatty acids were not remarkably changed. Regarding phytochemicals and bioactive compounds, the FBB was significantly higher in total phenolic content (TPC), total flavonoids (TF), and total flavonols (TFL) contents and scavenging activity against DPPH and ABTS free radicals than the DBB. The DBB and the FBB showed positive a* values, indicating a reddish color. The b* values were 27.81 and 28.54 for the DBB and the FBB, respectively. The DBB is affected by the lower L* value and higher browning index (BI) to make its color brownish. Sensory evaluation data showed that panelists significantly preferred the DBB over the FBB. In conclusion, processing and comparing these bars indicated that using Sukkari dates is a nutrient-dense, convenient, economical, and better sugar alternative that helps combat the calorie content. Thus, scaling up the use of dates instead of fruits in producing high-energy and protein bars commercially is highly recommended.

Date Palm Fruit (Phoenix dactylifera) and Its Promising Potential in Developing Functional Energy Bars: Review of Chemical, Nutritional, Functional, and Sensory Attributes.

Snack bars, known as energy bars, are widely consumed worldwide as highly nutritive on-the-go products. Due to the date fruit's significant nutritional and functional characteristics, it can be an exceptional choice for developing snack bars. Dates contain a wide range of macro- and micronutrients known for their strong bioactive properties. The functional properties of date fruit have been demonstrated in the literature and include antioxidant, anti-inflammatory, anti-tumor, antihypertensive, and antimicrobial activities. This review summarizes the available studies investigating the potential application of dates for developing nutritive and functional snack bars. Date paste was used as a main ingredient at 55-90% concentrations. In addition, protein sources were used to provide protein-rich snack bars, as date fruit is considered high in carbohydrates and low in protein. Skim milk powder was the most common and favorable protein source, delivering significant amounts of protein with limited negative effects on sensory attributes. Incorporating other ingredients, such as cereals or legumes, was also explored; adding such dry ingredients can promote positive nutritional effects along with improving sensory attributes, mainly in terms of the bars' textures. Dry ingredients can significantly lower moisture content, reducing the bars' fracturability to acceptable ranges. Reduced moisture content can also significantly enhance the shelf-life stability, as observed by limited microbial growth. Furthermore, the incorporation of bioactive or functional ingredients such as fruit peels, plant seeds, or plant leaf extracts was also reported; such ingredients promoted significant enhancements in the contents of phenolics or flavonoids, for instance, leading to an increase in the bars' antioxidant potential. Though dates are rich in such bioactive components, incorporating additional bioactive ingredients can boost the dates' functional properties. In conclusion, this review shows the high potential of the application of dates for developing nutritious and functional snack bars. Taking this into account, the snack bar market has grown remarkably over the past decade; thus, providing well-balanced, nutritious, and functional date-based bars in markets worldwide is expected to show positive consumer acceptance.

Biological Assessment of Stevioside and Sucralose as Sucrose Substitutes for Diabetics on STZ-Induced Diabetes in Rats.

Numerous food organizations have identified excessive calorie consumption and accompanying ailments as significant health risks associated with high sugar consumption. Administering stevioside (ST), sucralose (SU), and the two synergically (SU+ST) affected normal rats' weight gain. In the current study, SU showed the highest undesired effect. Indeed, administering the three treatments to diabetic rats (DR) did not improve the rats' weight gain. Although, insulin injection synergically with the treatments improved the weight gain, as recorded after three weeks. The best-improving rate was observed in the ST group. After the administration of ST and ST+SU to the DR, the blood glucose level (GL) was positively affected, with SU having no effects on reducing the GL. A considerable reduction in serum insulin (SIL) was noted in the DR+SU group. On the contrary, ST did not negatively affect the SIL, rather an improvement was recorded. In addition, giving SU did not significantly affect the ALT level in the DR or normal rats (NR). A significant improvement in total bilirubin (TBILI) was observed when insulin was injected with ST or SU in DR groups. Further, triglycerides (TG) after administering ST, SU, or ST+SU to NR had no significant difference compared to the control group (NR). Although, the three treatments markedly but not significantly lowered TG in the DR. For total cholesterol (CHO), both DR and NR had no significant effect after the three treatments. No histopathological alterations were recorded in the NR group. Diffuse and severe atrophy of the islands of Langerhans due to depletion of their cells and mild papillary hyperplasia of the pancreatic ducts were represented by a slightly folded ductal basement membrane and newly formed ductules in STZ-DR. Simultaneous atrophy and absence of the cells of islands of Langerhans besides ductal hyperplasia were evident in DR+SU. Hyperplastic ductal epithelium and atrophic Langerhans cells were seen in DR+SU+In. Degeneration and mild atrophy were observed in the islands of Langerhans structures. There was essentially no noticeable change after utilizing ST. A slight shrinkage of the Langerhans' islets was detected in DR+ST. In DR+ST+In, no histopathological alterations in the islands of Langerhans were recorded. Congestion in the stromal blood vessels associated with degenerative and necrotic changes in the cells of the islands of Langerhans in DR+SU+ST was observed. In NR+SU, congestion of the blood vessels associated with mild atrophy in the islands of Langerhans and dilatation in stromal blood vessels was noticed. In conclusion, ST is safe, and SU should be taken cautiously, such as mixing with ST and/or taken at a very low concentration to avoid its drastic effect on the human body.

Effect of Various Intermittent Fasting Protocols on Hyperglycemia-Induced Cognitive Dysfunction in Rats.

Diabetes mellitus is a highly prevalent metabolic disorder that causes cognitive decline. Here, we investigated the impact of various intermittent fasting protocols on type 2 diabetes mellitus (T2DM)-induced cognitive dysfunction in a rodent model. Male Sprague-Dawley rats (aged 3 months) were randomly assigned to five groups (n = 6 per group) and T2DM was induced by streptozotocin (60 mg/kg, IM). The control group was untreated. Cognitive function was tested (Y-maze, novel object recognition, and elevated plus maze tests) and glucose was assessed. The T2DM rats exhibited significantly higher blood glucose, which is associated with cognitive dysfunction. Compared to the validated animal model of T2DM in rats, various intermittent fasting protocols decreased blood glucose and improved cognitive function. These results indicate that various intermittent fasting protocols may be a potential strategy for managing the hyperglycemia-associated cognitive dysfunction.

Nephroprotective Effect of Fennel (Foeniculum vulgare) Seeds and Their Sprouts on CCl4-Induced Nephrotoxicity and Oxidative Stress in Rats.

Functional and nutritional characteristics of seed sprouts and their association with oxidative stress-related disorders have recently become a focus of scientific investigations. The biological activities of fennel seeds (FS) and fennel seed sprouts (FSS) were investigated in vitro and in vivo. The total phenolic content (TPC), total flavonoids (TF), total flavonols (TFF), and antioxidant activity (AOA) of FS and FSS were examined. HPLC and GC-MS analyses for FS and FSS were carried out. Consequently, the nephroprotective and antioxidative stress potential of FS and FSS extracts at 300 and 600 mg kg-1 on CCl4-induced nephrotoxicity and oxidative stress in rats was investigated. In this context, kidney relative weight, blood glucose level (BGL), lipid profile, kidney function (T. protein, albumin, globulin, creatinine, urea, and blood urea nitrogen (BUN)), and oxidative stress biomarkers (GSH, CAT, MDA, and SOD) in the rat's blood as well as the histopathological alteration in kidney tissues were examined. Results indicated that the sprouting process of FS significantly improved TPC, TF, TFL, and AOA in vitro. HPLC identified nineteen compounds of phenolic acids and their derivatives in FS. Thirteen phenolic compounds in FS and FSS were identified, the highest of which was vanillic acid. Six flavonoids were also identified with a predominance of kaempferol. GC-MS indicated that the trans-anethole (1-methoxy-4-[(E)-prop-1-enyl]benzene) component was predominant in FS and FSS, significantly increasing after sprouting. In in vivo examination, administering FS and FSS extracts ameliorated the BGL, triglycerides (TG), total cholesterol (CHO), and their derivative levels compared to CCl4-intoxicated rats. A notable improvement in FS and FSS with 600 mg kg-1 compared to 300 mg kg-1 was observed. A dose of 600 mg FSS kg-1 reduced the TG, CHO, and LDL-C and increased HDL-C levels by 32.04, 24.62, 63.00, and 67.17% compared to G2, respectively. The atherogenic index (AI) was significantly improved with 600 mg kg-1 of FSS extracts. FS and FSS improved kidney function, reduced malondialdehyde (MDA), and restored the activity of reduced glutathione (GSH), superoxide dismutase (SOD), and catalase (CAT). Both FS and FSS extracts attenuated the histopathological alteration in CCl4-treated rats. Interestingly, FSS extract presented better efficiency as a nephroprotection agent than FS extract. In conclusion, FSS can potentially restore oxidative stability and improve kidney function after acute CCl4 kidney injury better than FS. Therefore, FS and FSS extracts might be used for their promising nephroprotective potential and to help prevent diseases related to oxidative stress. Further research on their application in humans is highly recommended.

Salicornia bigelovii, S. brachiata and S. herbacea: Their Nutritional Characteristics and an Evaluation of Their Potential as Salt Substitutes.

Excessive sodium (salt) intake in our diet is a main contributor to hypertension and a major risk factor for cardiovascular illnesses. As a result, research has made great efforts to develop salt alternatives, and Salicornia spp. offers a very high potential in the food industry for its promising functional characteristics. This review focuses on the nutritional profile, health effects and commercial potential of three specific species of the Salicornia genus: S. bigelovii, S. brachiata and S. herbacea. It also addresses the methods that are used to produce them as salt substitutes. Owing to the antinutritional and anti-inflammatory effects of its bioactive compounds, Salicornia spp. can serve as an organic biological preservative in foods with better consumer appeal when compared with chemical preservatives that are common in the food industry. Overall, the commercial use of these underutilized species will help to improve food security.

Nutritional, Physicochemical, and Organoleptic Properties of Camel Meat Burger Incorporating Unpollinated Barhi Date Fruit Pulp.

The chemical composition of unpollinated Barhi date fruit (UBDF) (at khalal maturity stage) pulp and its effect as fiber source or fat replacer on the quality characteristics of camel meat burgers were investigated. The UBDF was characterized by high total carbohydrate, fiber, and mineral contents. It contains substantial amounts of fiber (19.60%) and low-fat content. Prepared UBDF pulp was added to camel meat burger as a fiber source at 2.5, 5, 7.5, 10, and 15% instead of camel meat and as a fat replacer at 50, 75, and 100% instead of camel-back fat during manufacturing of camel meat burgers. Chemical composition, mineral content, instrumental color, cooking characteristics, and organoleptic properties were evaluated. Results indicated that adding UBDF as fiber source significantly reduced moisture and protein contents and increased total carbohydrates, including fiber content. In camel meat burgers, K and Ca significantly increased in UBDF level-dependent manure. Adding UBDF as a fat replacer significantly increased moisture and total carbohydrate contents, while a significant reduction in fat content has been remarked. Increasing the levels of UBDF pulp as either fiber source or fat replacer in camel burgers improved (p < 0.05) shrinkage, cooking loss, and cooking yield in roasted camel burger level-dependent manure. The incorporation of UBDF pulp in camel burgers increased the lightness (L ∗) values and decreased the redness (a ∗) and yellowness (b ∗) significantly. The formulated camel burgers with different UBDF pulp levels revealed better organoleptic characteristics than normal camel meat burgers. Interestingly, adding UBDF as fiber source at 7.5-15% presented overall acceptability of more than 90% compared to the control sample of 81.7%. In the same context, adding UBDF as a fat replacer at 100% replacing the level of added fats scored overall acceptability of more than 93.60% compared to the control sample of 67.4%. Generally, according to the results of this study, it could be concluded that UBDF pulp could be used as a functional additive to produce high-fiber and/or low-fat camel meat burgers.

Preparation and characterization of sequilhos-type biscuits added with almond flour of Acrocomia intumescens.

Acrocomia intumescens ("macaúba") is a species that during processing generates a large amount of waste. The use of this residue for the production of flour for incorporation into food products is a way to minimize the cost and nutritionally enrich the final product. This work aimed to develop and analyze, in terms of physico-chemical and microbiological properties, cookies with macaúba almond cake residual flour. Sequilhos formulations were obtained using three different proportions of flour (2, 4 and 6%). The analysis of the flour allowed to find 4.29% of moisture, 1.13% of acidity, 5.33 of pH, 44.46% of carbohydrates, 28.74% of lipids, 20.06% of proteins and 2.45% of ash. In the analysis of the sequilhos formulations, the following values were found: moisture (5.03 to 8.13%), acidity (0.10 to 0.14%), pH (5.52 to 5.93), carbohydrates (67.17 to 73.37%), lipids (18.77 to 31.77%), proteins (0.85 to 1.92%), ash (0.83 to 0.94%) and total energy value (137.57 to 172,50 Kcal/100g). In microbiological analyzes it was highlighted that the sequilhos presented adequate sanitary conditions. The results indicate almond flour as an ingredient to be incorporated in the preparation of sequilhos, which in turn, presented satisfactory physico-chemical properties and microbiological results.

Jellyfish as Food: A Narrative Review.

Studies toward a sustainable future conducted by international organizations uniformly agree about having to change some of our present consumer behaviors. Regarding food, suggestions include eating locally farmed, less industrialized and renewable food to promote health and circularity, and limiting waste. Jellyfish are frequently sorted and discarded after being caught with fish in fishing nets and gear. In contrast, we propose utilizing this by-catch as food. This review discusses the economic value and sustainability of jellyfish, the technologies used to prepare them for human consumption, their nutritional profile and health impacts and, finally, consumer acceptability and sensory evaluation of jellyfish food products. This discussion is critical for promoting jellyfish as an important aquatic resource to support blue and circular economies.

Consumer Behaviour and Attitude towards the Purchase of Organic Products in Riobamba, Ecuador.

The development of organic agriculture has been promoted worldwide to improve the nutritional health of families, and Ecuador is no exception. The aim of this research was to identify the behaviour and attitudes of consumers toward the commercialization of organic products in the city of Riobamba. This will help us to understand in what situations the consumers access these foods, the producer position in relation to the market, and to know their attitude towards these products. The study used a quantitative approach, and is descriptive, incorporating the deductive method and a non-experimental design. The techniques used were a survey as a source of data collection, with a sample including 195 consumers. Linear regression was applied to test the hypotheses; this made it possible to identify those demographic and cultural factors that determine, to a lesser extent, consumer purchase behaviour in regard to organic products. The study determined that motivation, emotions, and feelings are significantly related to the consumer's attitude and purchase of organic products.

Gastroprotective Effects of Spirulina platensis, Golden Kiwifruit Flesh, and Golden Kiwifruit Peel Extracts Individually or in Combination against Indomethacin-Induced Gastric Ulcer in Rats.

This study was conducted to investigate the therapeutic effect of hydro-alcoholic extract of Spirulina platensis (SP), golden kiwifruit (Actinidia chinensis) flesh (KF), and golden kiwifruit peel (KP) individually or in combination (SFP) on indomethacin-induced gastric ulcer in rats. Negative control rats (GI) were orally administered distilled water in parallel with other treatments. The positive control rat group (GII) was administered 30 mg kg-1 indomethacin to induce gastric ulcers. The KF and KF extracts were used individually or together with SP in treating indomethacin-induced gastric ulcerated rat groups. Gastric ulcerated rat's groups GIII, GIV, GV, GVI, and GVII were orally administered at 30 mg kg-1 rat body weight as total phenolic content (TPC) equivalent from SP, KF, KP, SPF extracts, and Lansoprazole (30 mg kg-1, as reference drug) daily up to 14 days, respectively. The relevant biochemical parameters, antioxidant biomarkers, and histopathological examination were examined. Remarkably, treating rats with SP, KF, KP, and SFP extracts markedly reduced gastric juice and stomach volume expansion induced by indomethacin. The SP significantly retrieved the pH of gastric juice to a regular rate compared to GI. The ulcer index (UI) was significantly attenuated by SP, KF, KP, and SFP administration. The protection index percentage (PI %) was 80.79, 54.51, 66.08, 75.74, and 74.86% in GIII, GIV, GV, GVI, and GVII, respectively. The gastric mucin content was significantly better attenuated by 95.7 in GIII compared to its content in GI. Lansoprazole increased mucin content by 80.3%, which was considerably lower than SP and SFP. SP, KF, KP, SFP, and Lansoprazole improved the reform of gastric mucosal-increased secreted mucus by 95.6, 61.3, 64.8, 103.1, and 80.2% in GIII, GIV, GV, GVI, and GVII, respectively. Interestingly, SFP efficiently increased vit. B12 level by 46.0% compared to other treatments. While Lansoprazole administrating did not significantly attenuate vit. B12 level. The SP and SFP improved iron and Hemoglobin (HB) levels depending on treatment. SP, KF, KP, and SFP significantly decreased the malondialdehyde (MDA) and increased reduced glutathione (GSH) as well as superoxide dismutase (SOD) levels in blood and stomach tissues. The most potent effect was observed with SP, and SFP was even better than Lansoprazole. Histopathologically, treating rats with SP extract showed a marked reduction of gastric damage and severity changes induced by indomethacin. KP was much better than KF in lessening gastric histopathological damages caused by indomethacin. SFP significantly alleviates gastric histopathological alterations. The lansoprazole-treated group (GVII) greatly relieved the gastric histopathological changes and recorded mild focal necrosis and desquamation of the mucosa in addition to mild oedema in the serosal layer. In conclusion, the presented results proved the antiulcer potential of SP and A. chinensis extracts against an indomethacin-induced gastric ulcer in rats, which may be due to their antioxidant and anti-inflammation efficiency. Thus, these data suggested that SP, KF, KP, and SFP extracts as natural and safe alternatives have a gastroprotective potential against indomethacin-induced gastric ulceration. The antioxidative and anti-inflammatory properties are probable mechanisms.

Phenolic Profile, Antioxidant Activity, and Ameliorating Efficacy of Chenopodium quinoa Sprouts against CCl4-Induced Oxidative Stress in Rats.

Quinoa (Chenopodium quinoa) is classified as one of the pseudo-cereal grains rich in both macronutrients and micronutrients. This study tracks changes in the polyphenol composition of red quinoa (RQ) and yellow quinoa (YQ) seeds during germination. The antioxidant bioactivity of raw and germinated seed was also determined in vitro. Phenolic acids and their derivatives and flavonoids were identified by using HPLC-DAD and quantified after 0, 3, and 6 days of germination. Subsequently, the extracts of 6-day-old quinoa sprouts were prepared to biologically evaluate their functional properties against CCl4-induced oxidative stress in rats. The results indicated that antioxidant activity (AOA) of total phenolic compounds (TPC), and flavonoids significantly increased in RQ and YQ sprouts during germination up to 9 days. RQ sprouts exhibited stronger bioactive compound diversity than YQ sprouts as observed in HPLC analysis. Among the 11 and 8 quantified polyphenols, ferulic acid and quercetin were predominant phenolic acid and flavonoid in RQ and YQ sprouts, respectively. After 6 days of germination, 16 and 8 polyphenols were detected and quantified in RQ and YQ sprouts, respectively. Interestingly, the treatment of rats at a dose of 30 mg of Gallic acid Equivalent (GAE) kg-1 significantly reduced fasting blood glucose (FBG), alanine aminotransferase (ALT), aspartate aminotransferase AST, and total bilirubin (TIBIL) and improved liver inflammation. Furthermore, RQ and YQ sprouts improved the blood profile by significantly decreasing low-density lipoproteins (LDL) and very low-density lipoproteins (VLDL) and increasing high-density lipoproteins (HDL). Moreover, RQ and YQ sprout extracts significantly reduced malonaldehyde (MDA) and efficiently enhanced the reduced glutathione (GSH) and superoxide dismutase (SOD) activities in oxidative stress-induced rats as compared to CCl4-rats. In conclusion, red quinoa sprouts (RQS) and yellow quinoa sprouts (YQS) provide naturally synthesized polyphenols, possessing superior antioxidant activity, and their ethanolic extracts have promising effects and potential health benefits to counter induced oxidative stress. Incorporating quinoa sprouts as functional food ingredients should be considered and scaling-up its production is beneficial.

An evaluation of enteral nutrition practices and nutritional provision in children during the entire length of stay in critical care.

BACKGROUND: Provision of optimal nutrition in children in critical care is often challenging. This study evaluated exclusive enteral nutrition (EN) provision practices and explored predictors of energy intake and delay of EN advancement in critically ill children. METHODS: Data on intake and EN practices were collected on a daily basis and compared against predefined targets and dietary reference values in a paediatric intensive care unit. Factors associated with intake and advancement of EN were explored. RESULTS: Data were collected from 130 patients and 887 nutritional support days (NSDs). Delay to initiate EN was longer in patients from both the General Surgical and congenital heart defect (CHD) Surgical groups [Median (IQR); CHD Surgical group: 20.3 (16.4) vs General Surgical group: 11.4 (53.5) vs Medical group: 6.5 (10.9) hours; p ≤ 0.001]. Daily fasting time per patient was significantly longer in patients from the General Surgical and CHD Surgical groups than those from the Medical group [% of 24 h, Median (IQR); CHD Surgical group: 24.0 (29.2) vs General Surgical group: 41.7 (66.7) vs Medical group: 9.4 (21.9); p ≤ 0.001]. A lower proportion of fluids was delivered as EN per patient (45% vs 73%) or per NSD (56% vs 73%) in those from the CHD Surgical group compared with those with medical conditions. Protein and energy requirements were achieved in 38% and 33% of the NSDs. In a substantial proportion of NSDs, minimum micronutrient recommendations were not met particularly in those patients from the CHD Surgical group. A higher delivery of fluid requirements (p < 0.05) and a greater proportion of these delivered as EN (p < 0.001) were associated with median energy intake during stay and delay of EN advancement. Fasting (31%), fluid restriction (39%) for clinical reasons, procedures requiring feed cessation and establishing EN (22%) were the most common reasons why target energy requirements were not met. CONCLUSIONS: Provision of optimal EN support remains challenging and varies during hospitalisation and among patients. Delivery of EN should be prioritized over other "non-nutritional" fluids whenever this is possible.

Delivery of enteral nutrition after the introduction of practice guidelines and participation of dietitians in pediatric critical care clinical teams.

Provision of optimal nutrition is often difficult to achieve in the critically ill child, but can improve with better nutritional support practices. This study evaluated the joint impact of the introduction of enteral feeding practice guidelines and participation of dietitians in daily ward rounds on enteral nutrition (EN) intake and practices in children in intensive care. Nutritional intake and EN practices were audited before (period A) and after (period B) the introduction of enteral feeding practice guidelines and participation of dietitians in daily ward rounds in a pediatric intensive care unit. Information was collected on a daily basis and nutritional intake was compared with predefined targets and the United Kingdom dietary reference values. There were 65 patients and 477 nutritional support days in period A and 65 patients and 410 nutritional support days in period B. Basal metabolic rate (BMR) energy requirements were achieved in a larger proportion of nutritional support days in period B (BMR achieved [% nutritional support days]; period A: 27% vs period B: 48.9%; P<0.001). In patients admitted for nonsurgical reasons, median energy, protein, and micronutrient intake improved significantly. In the same group, the percentage of daily fluid intake delivered as EN increased post implementation (period A: median=66.8%; interquartile range=40.9 vs period B: median=79.6%; interquartile range=35.2; P<0.001). No significant changes were seen in patients admitted for corrective heart surgery. Implementation of better EN support practice can improve nutritional intake in some patients in critical care, but can have limited benefit for children admitted for corrective heart surgery.