Effects of oral non-protein calorie supplements on nutritional status among maintenance hemodialysis patients with protein-energy wasting: a multi-center randomized controlled trial.

Protein-energy wasting (PEW) is prevalent in maintenance hemodialysis (MHD) patients, and is one of the major risk factors for poor outcomes and death. This study aimed to investigate the effects of non-protein calorie supplements on the nutritional status of MHD patients with PEW. MHD patients with PEW were enrolled in this multi-center, open-label, randomized controlled trial. Then, they were randomly assigned to the intervention group to receive the non-protein calorie supplements containing 280 kcal of energy every day for 6 months or the control group to complete all aspects of the study without receiving supplements. Patients in both groups received dietary counselling from dietitians. Data on nutritional assessments, anthropometric measurements, blood analysis and dietary recall were collected at the baseline and at six months from both groups. Statistical analyses were performed using analysis of covariance (ANCOVA) adjusted for sex and baseline values. Ninety-two MHD patients completed the study. A significant increase in the subjective global assessment (SGA) score was found in the intervention group compared with the control group (4.88 ± 1.41 vs. 4.40 ± 1.16, p = 0.044). The ratio of PEW patients (diagnosed with SGA ≤5) in the intervention group (61.2%) was also significantly lower than that in the control group (83.7%) (p < 0.001). Moreover, significant improvements in body mass index (20.81 ± 2.46 kg m-2vs. 19.51 ± 2.60 kg m-2, p < 0.001), nutrition risk screening 2002 (2.45 ± 1.40 vs. 3.12 ± 1.37, p = 0.038), mid-upper arm circumference (23.30 ± 2.78 cm vs. 21.75 ± 2.87 cm, p = 0.001), and mid-arm muscle circumference (20.51 ± 2.32 cm vs. 19.06 ± 2.92 cm, p = 0.005) were observed in the intervention group compared with the control group. Patients in the intervention group took in more dietary energy than the control group (26.96 ± 4.75 kcal per kg body weight per day vs. 24.33 ± 2.68 kcal per kg body weight per day, p < 0.001). In conclusion, non-protein calorie supplements may improve the nutritional status of MHD patients with PEW.

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)

Protein-energy malnutrition in older Australians: A narrative review of the prevalence, causes and consequences of malnutrition, and strategies for prevention.

ISSUE ADDRESSED: Protein-energy malnutrition (PEM) is a condition of involuntary weight and muscle loss caused by inadequate nutritional intake. In Australia, it is predominantly associated with chronic diseases, as are common in the older population. Given the ageing population of Australia, and the poor outcomes associated with PEM, there is a need to identify the contributing factors, and to explore strategies to prevent PEM. METHODS: Two databases were searched for pertinent keywords, including malnutrition, Australia and elderly, with relevant articles selected for inclusion. The citations and references of these articles were also searched for further articles. RESULTS: PEM is associated with increasing age and institutionalisation. The contributing factors are multifactorial, and include physiological, pathophysiological and structural causes. PEM is a significant public health issue for Australia, in terms of its consequences on both quality of life for older adults, and the burden on the healthcare system. However, there are strategies that can be implemented at the community, organisation and policy level to prevent PEM. CONCLUSION: PEM is a common problem for older Australians, and this has important physiological and public health consequences, especially in the context of the ageing Australian population. However, there is significant scope for preventing PEM. SO WHAT?: Readers can be advised that PEM is a significant public health issue that will increase in importance as the population continues to age. It is important that communities, organisations and governments develop strategies to prevent PEM.

Usual Protein Intake Amount and Sources of Nursing Home Residents with (Risk of) Malnutrition and Effects of an Individualized Nutritional Intervention: An enable Study.

Nursing home (NH) residents with (risk of) malnutrition are at particular risk of low protein intake (PI). The aim of the present analysis was (1) to characterize usual PI (total amount/day (d) and meal, sources/d and meal) of NH residents with (risk of) malnutrition and (2) to evaluate the effects of an individualized nutritional intervention on usual PI. Forty residents (75% female, 85 ± 8 years) with (risk of) malnutrition and inadequate dietary intake received 6 weeks of usual care followed by 6 weeks of intervention. During the intervention phase, an additional 29 ± 11 g/d from a protein-energy drink and/or 2 protein creams were offered to compensate for individual energy and/or protein deficiencies. PI was assessed with two 3-day-weighing records in each phase and assigned to 4 meals and 12 sources. During the usual care phase, mean PI was 41 ± 10 g/d. Lunch and dinner contributed 31 ± 11% and 32 ± 9% to daily intake, respectively. Dairy products (median 9 (interquartile range 6-14) g/d), starchy foods (7 (5-10) g/d) and meat/meat products (6 (3-9) g/d) were the main protein sources in usual PI. During the intervention phase, an additional 18 ± 10 g/d were consumed. Daily PI from usual sources did not differ between usual care and intervention phase (41 ± 10 g/d vs. 42 ± 11 g/d, p = 0.434). In conclusion, daily and per meal PI were very low in NH residents with (risk of) malnutrition, highlighting the importance of adequate intervention strategies. An individualized intervention successfully increased PI without affecting protein intake from usual sources.

Optimal Protein Intake in Pre-Dialysis Chronic Kidney Disease Patients with Sarcopenia: An Overview.

Multi-factors, such as anorexia, activation of renin-angiotensin system, inflammation, and metabolic acidosis, contribute to malnutrition in chronic kidney disease (CKD) patients. Most of these factors, contributing to the progression of malnutrition, worsen as CKD progresses. Protein restriction, used as a treatment for CKD, can reduce the risk of CKD progression, but may worsen the sarcopenia, a syndrome characterized by a progressive and systemic loss of muscle mass and strength. The concomitant rate of sarcopenia is higher in CKD patients than in the general population. Sarcopenia is also associated with mortality risk in CKD patients. Thus, it is important to determine whether protein restriction should be continued or loosened in CKD patients with sarcopenia. We may prioritize protein restriction in CKD patients with a high risk of end-stage kidney disease (ESKD), classified to stage G4 to G5, but may loosen protein restriction in ESKD-low risk CKD stage G3 patients with proteinuria <0.5 g/day, and rate of eGFR decline <3.0 mL/min/1.73 m2/year. However, the effect of increasing protein intake alone without exercise therapy may be limited in CKD patients with sarcopenia. The combination of exercise therapy and increased protein intake is effective in improving muscle mass and strength in CKD patients with sarcopenia. In the case of loosening protein restriction, it is safe to avoid protein intake of more than 1.5 g/kgBW/day. In CKD patients with high risk in ESKD, 0.8 g/kgBW/day may be a critical point of protein intake.

Estudio en vida real de efectividad de una fórmula hipercalórica hiperproteica en el mantenimiento y mejora del estado nutricional en pacientes con indicación de nutrición enteral a largo plazo / Real-life study of the effectiveness of a high calorie and high protein formula in the maintenance and improvement of nutritional state in patients with an indication of long-term enteral nutrition

La selección de la fórmula más adecuada en nutrición enteral domiciliaria a largo plazo es un tema controvertido. Nuestro objetivo fue estudiar una fórmula hipercalórica hiperproteica en pacientes con alimentación exclusivamente con sonda a largo plazo (180 días). MÉTODOS: Estudio multicéntrico observacional prospectivo en vida real con fórmula hipercalórica hiperproteica (2kcal/ml y 20% de proteínas). Se recogieron datos generales, antropométricos, analíticos y de calidad de vida mediante escala analógica visual del European Quality of Life-5 Dimensions al inicio, 60, 120 y 180 días. La tolerancia gastrointestinal se evaluó con una escala analógica visual y escala de heces de Bristol y la valoración del riesgo de desnutrición mediante NRS-2002. RESULTADOS: Un total de 51 pacientes (88,2% varones, edad media de 62,0 años), con patología oncológica en el 72,5%. No hubo diferencias en datos antropométricos, aunque sí se redujo el porcentaje de pacientes con riesgo de desnutrición del 75 al 8,3% (p < 0,0001). No se observaron diferencias en albúmina, prealbúmina, transferrina, linfocitos o hematocrito. La calidad de vida mejoró de 3,84 (1,27) a 5,37 (1,12) en la escala analógica visual (p < 0,0001). Se observó una reducción de la sintomatología gastrointestinal a lo largo del seguimiento. Tanto el número como el porcentaje de deposiciones consideradas normales según la escala de Bristol se mantuvieron estables. CONCLUSIÓN: Nuestro estudio apoya que el empleo de fórmulas hipercalóricas hiperproteicas durante un tratamiento nutricional a 6 meses permite una adecuada evolución nutricional sin riesgo de deshidratación y con una buena tolerancia, incluso mejoría de sintomatología gastrointestinal, y puede contribuir a una mejora en la calidad de vida

The selection of the most appropriate formula in long-term home enteral nutrition is a controversial issue. Our objective was to study a high protein hypercaloric enteral nutrition formula in patients with long-term feeding (180 days). METHODS: Prospective observational multicenter real-life study with high-protein hypercaloric formula (2kcal/ml and 20% protein). General, anthropometric, analytical and quality of life data were collected by visual analog scale of the European Quality of Life-5 Dimensions at the beginning, 60, 120 and 180 days. Gastrointestinal tolerance was assessed with a visual analog scale and Bristol Stool Scale and the risk of malnutrition was assessed using NRS-2002. RESULTS: 51 patients (88.2% men, mean age 62.0 years), with oncological diseases in 72.5%. No differences in anthropometric data were observed, although the percentage of patients at risk of malnutrition according to NRS 2002 was reduced from 75% to 8.3% (p < 0.0001). No differences were observed in albumin, prealbumin, transferrin, lymphocytes or hematocrit. The quality of life improved from 3.84 (1.27) to 5.37 (1.12) on the visual analog scale (p < 0.0001). A reduction in gastrointestinal symptoms was observed throughout the period of enteral nutrition. Both the number and percentage of stools considered normal according to the Bristol scale remained stable. CONCLUSION: Our study supports that the use of high-protein hypercaloric formulas during a 6-month nutritional treatment allows an adequate nutritional evolution without risk of dehydration and with a good tolerance, even improvement of gastrointestinal symptoms, and can contribute to an improvement in the quality of lifetime

Protein energy wasting; what is it and what can we do to prevent it?

Some children with declining height and BMI SDS fail to respond to optimisation of nutritional intake. As well as poor growth, they have muscle wasting and relative preservation of body fat. This is termed protein energy wasting (PEW). The process results from an interaction of chronic inflammation alongside poor nutritional intake. This review discusses the causes and potential preventative therapies for PEW.

Alimentação para uma vida saudável

Vídeo produzido pela Sesap em parceria com a SEDIS/UFRN.

Vigilância Alimentar e Nutricional

Vídeo produzido pela Sesap em parceria com a SEDIS/UFRN.

Hemodialysis-Nutritional Flaws in Diagnosis and Prescriptions. Could Amino Acid Losses be the Sharpest "Sword of Damocles"?

This review aims to highlight the strengths and weaknesses emerging from diagnostic evaluations and prescriptions in an intent to prevent progression over time of malnutrition and/or protein-energy wasting (PEW) in hemodialysis (HD) patients. In particular, indications of the most effective pathway to follow in diagnosing a state of malnutrition are provided based on a range of appropriate chemical-clinical, anthropometric and instrumental analyses and monitoring of the nutritional status of HD patients. Finally, based on the findings of recent studies, therapeutic options to be adopted for the purpose of preventing or slowing down malnutrition have been reviewed, with particular focus on protein-calorie intake, the role of oral and/or intravenous supplements and efficacy of some classes of amino acids. A new determining factor that may lead inexorably to PEW in hemodialysis patients is represented by severe amino acid loss during hemodialysis sessions, for which mandatory compensation should be introduced.

Eating during the Hemodialysis Session: A Practice Improving Nutritional Status or a Risk Factor for Intradialytic Hypotension and Reduced Dialysis Adequacy?

Historically, eating during the hemodialysis treatment has been associated with increased risk for adverse intradialytic symptoms and events, risks that have resulted in the implementation of restrictive in-center nutrition policies. Recent studies, however, have recorded a shift in clinical practice with a higher proportion of physicians following the view that administration of intradialytic meals and supplements represents a simple and effective approach to enhance caloric intake and improve nutritional status among patients on hemodialysis. This shift towards less restrictive in-center nutrition practices is mainly supported by evidence from observational studies associating intradialytic nutritional supplementation with improvements in protein-energy wasting, inflammatory state, and health-related quality of life. In sharp contrast, earlier and recent interventional studies have documented that feeding during the hemodialysis treatment provokes a rapid postprandial decline in blood pressure and raises the incidence of symptomatic intradialytic hypotension. Furthermore, other studies have shown that postprandial redistribution in intravascular volume and enhanced blood supply to the gastrointestinal circulation may interfere with the adequacy of the delivered hemodialysis. Those who defend the position that intradialytic nutritional support is beneficial do not dispute the physiology of postprandial hemodynamic response, but they argue against its clinical significance. In this article, we provide an overview of studies that explored the effect of eating during the hemodialysis treatment on intradialytic hemodynamic stability and adequacy of the delivered hemodialysis. We reason that these risks have important clinical implications that are not counteracted by anticipated benefits of this strategy on caloric intake and nutritional status.

Nutritional risk in critically ill patients: how it is assessed, its prevalence and prognostic value: a systematic review.

CONTEXT: Nutritional risk (NR) screening is the first step of nutrition care process. Few data are available in literature about its prevalence, nor, to our knowledge, is a universally accepted reference method for the intensive care unit (ICU). OBJECTIVE: The aim for this systematic review was to summarize evidence regarding the prevalence of NR and the predictive validity of different tools applied for NR screening of critically ill patients. DATA SOURCES: The PubMed, Embase, and Scopus databases were searched up to December 2019 using the subject headings related to critically ill patients and NR screening. The current systematic review is registered with PROSPERO (identifier: CRD42019129668). DATA EXTRACTION: Data on NR prevalence, predictive validity of nutritional screening tools, and interaction between caloric-protein balance and NR in outcome prediction were collected. DATA ANALYSIS: Results were summarized qualitatively in text and tables, considering the outcomes of interest. RESULTS: From 15 669 articles initially identified, 36 fulfilled the inclusion criteria, providing data from 8 nutritional screening tools: modified Nutrition Risk in the Critically Ill (mNUTRIC; n = 26 studies) and Nutritional Risk Screening-2002 (NRS-2002; n = 7 studies) were the most frequent; the NR prevalence was 55.9% (range, 16.0% to 99.5%). Nutritional risk was a predictor of 28-day and ICU mortality in 8 studies. Interactions between caloric-protein balance and NR on outcome prediction presented were scarcely tested and presented heterogeneous results (n = 8). CONCLUSIONS: Prevalence of NR in patients in the ICU varies widely; a satisfactory predictive validity was observed, especially when mNUTRIC or NRS-2002 were applied.

Preventing protein-energy malnutrition after cortical stroke enhances recovery of symmetry in forelimb use during spontaneous exploration.

Protein-energy malnutrition (PEM) commonly arises after stroke. We investigated the effects of preventing PEM on spontaneous recovery of forelimb use, infarct size, and the acute phase response in the chronic post-stroke period. Male, adult, Sprague-Dawley rats were acclimatized to control diet (12.5% protein), tested for pre-stroke forelimb use symmetry in the cylinder test, and exposed to photothrombotic cortical stroke or sham surgery. Food intake was monitored daily, and body weight weekly. Forelimb use was tested on day 4 after surgery, before assignment to control diet or PEM (0.5% protein), with subsequent testing on days 16 and 29. Blood, brain, and liver were collected on day 30. The low protein diet resulted in PEM, measured by decreased body weight (p < 0.001) and food intake (p = 0.016) and increased liver lipid (p < 0.001). Stroke (p = 0.016) and PEM (p = 0.001) independently elicited increases in serum α-2-macroglobulin concentration, whereas PEM alone decreased albumin (p < 0.001). PEM reduced recovery of forelimb use symmetry during exploration on days 16 (p = 0.024) and 29 (p = 0.013) but did not influence infarct size (p = 0.775). Stroke reduced reliance on the stroke-affected forelimb to initiate exploration up until day 29 (p < 0.001); PEM had no influence (p ≥ 0.463). Preventing post-stroke PEM appears to yield direct benefits for certain types of motor recovery. Novelty Preventing post-stroke malnutrition benefits certain types of motor recovery. An acute phase response may contribute to the poorer recovery with malnutrition.

Efficacy of compositing with snail meat powder on protein nutritional quality of sorghum-wheat buns using a rat bioassay.

BACKGROUND: Protein energy malnutrition (PEM) is an important health burden in most developing countries mainly in sub-Saharan Africa, where it contributes to high rates of child morbidity and mortality. This study evaluated the efficacy of compositing with snail meat powder (SMP) on protein nutritional quality of sorghum-wheat buns using a rat bioassay. Nine diets -seven isonitrogenous diets, based on six variations of buns and a reference diet made using skimmed milk powder, in addition to the basal diet meant to estimate the endogenous nitrogen excretion and a 16% protein rehabilitation diet - were fed to male weanling albino rats. Protein efficiency ratio (PER), and food efficiency ratio (FER), net protein retention ratio (NPRR), apparent protein digestibility (APD), and true protein digestibility (TPD), protein digestibility corrected amino acid score (PDCAAS), and digestible indispensable amino acid score (DIAAS) indices of protein quality were determined. RESULTS: Fortification with SMP significantly (P < 0.05) enhanced PER from 0.21% to 2.70%, FER from 0.02% to 0.27%, APD from 81.17% to 88.28%, and TPD from 87.48% to 95.38%. PDCAAS and DIAAS increased from 45% to 78% and 44% to 69% respectively in unfortified buns to buns fortified with 25% SMP. CONCLUSION: Complementary diets fortified with SMP promote growth and rehabilitate emaciated rats, whereas unfortified diet did not support weight gain. Thus, supplementation of buns with SMP might enhance a faster recovery in children affected by PEM. © 2020 Society of Chemical Industry.

The diagnosis and NUTRIC score of critically ill patients in enteral nutrition are risk factors for the survival time in an intensive care unit? / ¿El diagnóstico y la puntuación NUTRIC score en pacientes críticamente enfermos con nutrición enteral son factores de riesgo para el tiempo de supervivencia en una unidad de cuidados intensivos?

Objective: to investigate whether the caloric and protein deficits, the diagnosis and the NUTRIC score, behaved as risk factors associated to the survival time. Methods: prospective study with 82 critically ill patients in intensive care unit (ICU), with exclusive enteral nutritional therapy (EENT). We investigated the calorie and protein deficiencies of EENT, the NUTRIC score, and the inflammatory-nutritional index by the C-reactive protein-CRP/albumin. The data were analyzed using the Chi-square, Fisher, Mann-Whitney, Kruskal-Wallis, univariate and multiple Cox regressions and the Kaplan-Meyer method. Results: in the univariate Cox regression, one-year increase in age increased the risk of death by 4.1% (p=0.0009; HR=1.041) and one-day increase with intercurrent events, by 1.8% (p = 0.0485; HR = 1.018). In the multiple Cox regression, the clinical diagnosis (p = 0.0462, HR = 2.091) and the NUTRIC score ≥ 5 (p < 0.0001; HR = 5.740) were the variables that together were associated with the survival time. The critical caloric and protein deficits did not behave as death risk factors in this population. Kaplan-Meier curves showed that the probability of survival in 40 days was 28.1% with clinical diagnosis and 40.2% with surgical diagnosis. The mean survival time with NUTRIC score ≥ 5 was 17.4 days. The probability of survival at 40 days was 72.8% with NUTRIC score < 5 and 6.4% with NUTRIC score ≥ 5. Conclusion: caloric and protein deficits are not risk factors for mortality. Only the diagnosis and the NUTRIC score were considered risk factors associated with the survival time

Objetivo: investigar si el déficit calórico y proteico, el diagnóstico y la puntuación nutricional se comportaron como factores de riesgo asociados al tiempo de supervivencia. Métodos: estudio prospectivo con 82 pacientes en estado crítico en la Unidad de Cuidados Intensivos (UCI), con terapia nutricional enteral exclusiva (EENT). Investigamos las deficiencias de calorías y proteínas de EENT, el puntuación NUTRIC y el índice inflamatorio-nutricional por la proteína C-reactiva-CRP / albúmina. Los datos se analizaron utilizando las regresiones de Chi-cuadrado, Fisher, Mann-Whitney, Kruskal-Wallis, univariadas y múltiples de Cox y el método de Kaplan-Meyer. Resultados: en la regresión de Cox univariada, el aumento de un año en la edad aumentó el riesgo de muerte en un 4,1% (p = 0,0009; HR = 1,041) y el aumento de un día con eventos intercurrentes, en un 1,8% (p = 0,0485; HR = 1,018). En la regresión múltiple de Cox, el diagnóstico clínico (p = 0,0462, HR = 2,091) y la puntuación nutricional ≥ 5 (p < 0,0001; HR = 5,740) fueron las variables que juntas se asociaron con el tiempo de supervivencia. Los déficits críticos de calorías y proteínas no se comportaron como factores de riesgo de muerte en esta población. Las curvas de Kaplan-Meier mostraron que la probabilidad de supervivencia en 40 días fue del 28,1% con diagnóstico clínico y del 40,2% con diagnóstico quirúrgico. El tiempo medio de supervivencia con puntuación NUTRIC ≥ 5 fue de 17,4 días. La probabilidad de supervivencia a los 40 días fue del 72,8% con una puntuación nutricional < 5 y del 6,4% con una puntuación NUTRIC ≥ 5. Conclusión: los déficits calóricos y proteicos no son factores de riesgo para la mortalidad. Solo el diagnóstico y la puntuación NUTRIC se consideraron factores de riesgo asociados con el tiempo de supervivencia

Appetite and Protein Intake Strata of Older Adults in the European Union: Socio-Demographic and Health Characteristics, Diet-Related and Physical Activity Behaviours.

Considerable efforts have been directed towards stimulating healthy ageing regarding protein intake and malnutrition, yet large-scale consumer studies are scarce and fragmented. This study aims to profile older adults in the European Union (EU) according to appetite (poor/good) and protein intake (lower/higher) strata, and to identify dietary and physical activity behaviours. A survey with older (aged 65 years or above) adults (n = 1825) in five EU countries (Netherlands, United Kingdom, Finland, Spain and Poland) was conducted in June 2017. Four appetite and protein intake strata were identified based on simplified nutritional appetite questionnaire (SNAQ) scores (≤14 versus >14) and the probability of a protein intake below 1.0 g/kg adjusted BW/day (≥0.3 versus <0.3) based on the 14-item Pro55+ screener: "appi"-Poor appetite and lower level of protein intake (12.2%); "APpi"-Good appetite but lower level of protein intake (25.5%); "apPI"-Poor appetite but higher level of protein intake (14.8%); and "APPI"-Good appetite and higher level of protein intake (47.5%). The stratum of older adults with a poor appetite and lower level of protein intake (12.2%) is characterized by a larger share of people aged 70 years or above, living in the UK or Finland, having an education below tertiary level, who reported some or severe financial difficulties, having less knowledge about dietary protein and being fussier about food. This stratum also tends to have a higher risk of malnutrition in general, oral-health related problems, experience more difficulties in mobility and meal preparation, lower confidence in their ability to engage in physical activities in difficult situations, and a lower readiness to follow dietary advice. Two multivariate linear regression models were used to identify the behavioural determinants that might explain the probability of lower protein intake, stratified by appetite status. This study provides an overview and highlights the similarities and differences in the strata profiles. Recommendations for optimal dietary and physical activity strategies to prevent protein malnutrition were derived, discussed and tailored according to older adults' profiles.

Significant effects of late evening snack on liver functions in patients with liver cirrhosis: A meta-analysis of randomized controlled trials.

BACKGROUND AND AIM: Reducing post-absorptive (fasting) phase by eating late evening snacks (LESs) is a potential intervention to improve substrate utilization and reverse sarcopenia. This study analyzed the results of published randomized controlled trials and controlled clinical trials to evaluate the effects of LES on liver function of patients with cirrhosis. METHODS: A meta-analysis was conducted. The search strategy included electronic database searches, and 300 articles were searched. Eight of these articles provided qualified data for pooling and analysis. Outcomes assessments included serum albumin, total bilirubin, alanine aminotransferase, prothrombin time, and aspartate aminotransferase, complications of cirrhosis, severity of liver disease, and blood glucose levels. RESULTS: Our analysis included eight studies comprising 341 patients (167 in LES groups and 174 in control groups). The results showed that LES intervention helped to maintain liver reserves. These eight studies demonstrated that LES intervention had significant effects for liver biochemical parameters on albumin, ammonia, and prothrombin time, with respective effect sizes of 0.233, -0.425, and -0.589; liver enzymes include aspartate aminotransferase and alanine aminotransferase, with respective effect sizes of -0.320 and -0.284. Studies on clinical signs of liver dysfunction showed lower occurrence rates of ascites and hepatic encephalopathy than in the control group. LES had no significant effect on Child-Pugh score. CONCLUSIONS: The overall results of the meta-analysis indicated that having LES can improve liver function reserve for patients with liver cirrhosis, with or without hepatocellular carcinoma. LES is a promising intervention for reversing anabolic resistance and the sarcopenia of cirrhosis, resulting in an improved quality of life for patients with cirrhosis.

Exercising to offset muscle mass loss in hemodialysis patients: The disconnect between intention and intervention.

Skeletal muscle loss is the most important hallmark of protein energy wasting syndrome as it contributes to declines in physical independence, poor quality of life, and higher mortality risk in individuals with ESRD on maintenance hemodialysis (HD). As such, exercise and nutritional interventions have been investigated with the goal to preserve skeletal muscle mass and overall quality of life. Unfortunately, current efforts are unable to confirm the capacity of exercise to mitigate ESRD-associated muscle wasting. However, the inconclusive data are often accompanied by suboptimal exercise prescriptions. Exercise sessions are often implemented in-clinic during the catabolic and proinflammatory period of dialysis treatment and without concurrent nutritional support. Additionally, indirect considerations like exercise intolerance and exercise program compliance/adherence also inhibit exercise training potential. These shortcomings all stem from the current lack of understanding in skeletal muscle mass regulation within the context of ESRD and intermittent HD. As such, this review summarizes the current understanding of exercise regulation on skeletal muscle mass and ESRD-related obstacles of anabolism to contextualize the ineffectiveness of current exercise interventions for HD patients.

Protein and energy intake improved by in-between meals: An intervention study in hospitalized patients.

BACKGROUND/AIM: Disease related malnutrition is a major problem in hospitals. Malnutrition in hospitalized patients is caused by many factors. Among these factors are decreased appetite and early satiety, and reaching nutritional requirements in nutritional risk patients is a challenge when using ordinary energy and protein dense food. The aim of this study was to examine if total protein and energy intake in medical and surgical patients at nutritional risk could be improved by protein fortified and energy rich in-between meals. METHODS: An assortment of fortified in-between meals including 10 g of protein was developed based on patient preferences and served in the Departments of Lung Medicine and Abdominal Surgery for a period of three months. Nutrition intake was recorded before and after intervention. RESULTS: Food intake records were collected from a total of 92 patients, (46 before and 46 after intervention). The total amount of protein intake per in-between meal was increased from 2,6 g to 10,3 g. Total daily protein intake increased from 49% to 88% (p < 0.00) and total energy intake from 74% to 109% (p < 0.00) of requirements. CONCLUSION: Protein and energy intake for surgical and medical patients at in-between meals as well as total daily intake increased significantly. Recommended average level for individually measured requirements was reached.

Growth, Bone Health, and Cognition: Nutritional Evaluation of a Sustainable Ocean-Based Advance Protein Powder (APP).

This study evaluated an alternative ocean-based fish protein, Advanced Protein Powder (APP) as a feasible, environmentally sustainable protein source to reduce childhood malnutrition. We completed a rodent feeding study to evaluate growth and development in young growing mice on a purified diet containing APP as compared to mice-fed diets using other common protein sources - casein, whey, and soy. Results suggested APP to be an effective and safe protein source and ensured normal body growth, bone development, and brain function in APP diet-fed mice. Evidence provided in this study supports considering the use of APP to reduce malnutrition among children worldwide.