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1.
Am J Kidney Dis ; 76(3 Suppl 1): S1-S107, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32829751

RESUMO

The National Kidney Foundation's Kidney Disease Outcomes Quality Initiative (KDOQI) has provided evidence-based guidelines for nutrition in kidney diseases since 1999. Since the publication of the first KDOQI nutrition guideline, there has been a great accumulation of new evidence regarding the management of nutritional aspects of kidney disease and sophistication in the guidelines process. The 2020 update to the KDOQI Clinical Practice Guideline for Nutrition in CKD was developed as a joint effort with the Academy of Nutrition and Dietetics (Academy). It provides comprehensive up-to-date information on the understanding and care of patients with chronic kidney disease (CKD), especially in terms of their metabolic and nutritional milieu for the practicing clinician and allied health care workers. The guideline was expanded to include not only patients with end-stage kidney disease or advanced CKD, but also patients with stages 1-5 CKD who are not receiving dialysis and patients with a functional kidney transplant. The updated guideline statements focus on 6 primary areas: nutritional assessment, medical nutrition therapy (MNT), dietary protein and energy intake, nutritional supplementation, micronutrients, and electrolytes. The guidelines primarily cover dietary management rather than all possible nutritional interventions. The evidence data and guideline statements were evaluated using Grading of Recommendations, Assessment, Development and Evaluation (GRADE) criteria. As applicable, each guideline statement is accompanied by rationale/background information, a detailed justification, monitoring and evaluation guidance, implementation considerations, special discussions, and recommendations for future research.


Assuntos
Terapia Nutricional/normas , Insuficiência Renal Crônica/terapia , Dieta com Restrição de Proteínas , Gorduras na Dieta/administração & dosagem , Proteínas na Dieta/administração & dosagem , Suplementos Nutricionais , Eletrólitos/administração & dosagem , Ingestão de Energia , Medicina Baseada em Evidências , Ácidos Graxos Ômega-3/administração & dosagem , Humanos , Micronutrientes/administração & dosagem , Avaliação Nutricional , Apoio Nutricional/métodos , Insuficiência Renal Crônica/dietoterapia , Vitaminas/administração & dosagem
2.
Cochrane Database Syst Rev ; 8: CD011737, 2020 08 21.
Artigo em Inglês | MEDLINE | ID: mdl-32827219

RESUMO

BACKGROUND: Reducing saturated fat reduces serum cholesterol, but effects on other intermediate outcomes may be less clear. Additionally, it is unclear whether the energy from saturated fats eliminated from the diet are more helpfully replaced by polyunsaturated fats, monounsaturated fats, carbohydrate or protein. OBJECTIVES: To assess the effect of reducing saturated fat intake and replacing it with carbohydrate (CHO), polyunsaturated (PUFA), monounsaturated fat (MUFA) and/or protein on mortality and cardiovascular morbidity, using all available randomised clinical trials. SEARCH METHODS: We updated our searches of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid) and Embase (Ovid) on 15 October 2019, and searched Clinicaltrials.gov and WHO International Clinical Trials Registry Platform (ICTRP) on 17 October 2019. SELECTION CRITERIA: Included trials fulfilled the following criteria: 1) randomised; 2) intention to reduce saturated fat intake OR intention to alter dietary fats and achieving a reduction in saturated fat; 3) compared with higher saturated fat intake or usual diet; 4) not multifactorial; 5) in adult humans with or without cardiovascular disease (but not acutely ill, pregnant or breastfeeding); 6) intervention duration at least 24 months; 7) mortality or cardiovascular morbidity data available. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed inclusion, extracted study data and assessed risk of bias. We performed random-effects meta-analyses, meta-regression, subgrouping, sensitivity analyses, funnel plots and GRADE assessment. MAIN RESULTS: We included 15 randomised controlled trials (RCTs) (16 comparisons, 56,675 participants), that used a variety of interventions from providing all food to advice on reducing saturated fat. The included long-term trials suggested that reducing dietary saturated fat reduced the risk of combined cardiovascular events by 17% (risk ratio (RR) 0.83; 95% confidence interval (CI) 0.70 to 0.98, 12 trials, 53,758 participants of whom 8% had a cardiovascular event, I² = 67%, GRADE moderate-quality evidence). Meta-regression suggested that greater reductions in saturated fat (reflected in greater reductions in serum cholesterol) resulted in greater reductions in risk of CVD events, explaining most heterogeneity between trials. The number needed to treat for an additional beneficial outcome (NNTB) was 56 in primary prevention trials, so 56 people need to reduce their saturated fat intake for ~four years for one person to avoid experiencing a CVD event. In secondary prevention trials, the NNTB was 53. Subgrouping did not suggest significant differences between replacement of saturated fat calories with polyunsaturated fat or carbohydrate, and data on replacement with monounsaturated fat and protein was very limited. We found little or no effect of reducing saturated fat on all-cause mortality (RR 0.96; 95% CI 0.90 to 1.03; 11 trials, 55,858 participants) or cardiovascular mortality (RR 0.95; 95% CI 0.80 to 1.12, 10 trials, 53,421 participants), both with GRADE moderate-quality evidence. There was little or no effect of reducing saturated fats on non-fatal myocardial infarction (RR 0.97, 95% CI 0.87 to 1.07) or CHD mortality (RR 0.97, 95% CI 0.82 to 1.16, both low-quality evidence), but effects on total (fatal or non-fatal) myocardial infarction, stroke and CHD events (fatal or non-fatal) were all unclear as the evidence was of very low quality. There was little or no effect on cancer mortality, cancer diagnoses, diabetes diagnosis, HDL cholesterol, serum triglycerides or blood pressure, and small reductions in weight, serum total cholesterol, LDL cholesterol and BMI. There was no evidence of harmful effects of reducing saturated fat intakes. AUTHORS' CONCLUSIONS: The findings of this updated review suggest that reducing saturated fat intake for at least two years causes a potentially important reduction in combined cardiovascular events. Replacing the energy from saturated fat with polyunsaturated fat or carbohydrate appear to be useful strategies, while effects of replacement with monounsaturated fat are unclear. The reduction in combined cardiovascular events resulting from reducing saturated fat did not alter by study duration, sex or baseline level of cardiovascular risk, but greater reduction in saturated fat caused greater reductions in cardiovascular events.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Gorduras na Dieta/administração & dosagem , Ácidos Graxos/administração & dosagem , Adulto , Doenças Cardiovasculares/mortalidade , Causas de Morte , Colesterol/sangue , Carboidratos da Dieta/administração & dosagem , Gorduras Insaturadas na Dieta/administração & dosagem , Proteínas na Dieta/administração & dosagem , Ingestão de Energia , Feminino , Humanos , Masculino , Infarto do Miocárdio/mortalidade , Infarto do Miocárdio/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto , Acidente Vascular Cerebral/prevenção & controle
3.
Nutr Hosp ; 34(3): 622-630, 2020 Jul 13.
Artigo em Espanhol | MEDLINE | ID: mdl-32603180

RESUMO

Introduction: The current COVID-19 pandemic mainly affects older people, those with obesity or other coexisting chronic diseases such as type-2 diabetes and high blood pressure. It has been observed that about 20 % of patients will require hospitalization, and some of them will need the support of invasive mechanical ventilation in intensive care units. Nutritional status appears to be a relevant factor influencing the clinical outcome of critically ill patients with COVID-19. Several international guidelines have provided recommendations to ensure energy and protein intake in people with COVID-19, with safety measures to reduce the risk of infection in healthcare personnel. The purpose of this review is to analyze the main recommendations related to adequate nutritional management for critically ill patients with COVID-19 in order to improve their prognosis and clinical outcomes.


Assuntos
Betacoronavirus , Infecções por Coronavirus/dietoterapia , Cuidados Críticos/métodos , Estado Terminal , Desnutrição/dietoterapia , Pandemias , Pneumonia Viral/dietoterapia , Doenças Cardiovasculares/epidemiologia , Comorbidade , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Proteínas na Dieta/administração & dosagem , Nutrição Enteral/efeitos adversos , Nutrição Enteral/métodos , Gastroenteropatias/complicações , Humanos , Inflamação/epidemiologia , Inflamação/fisiopatologia , Desnutrição/diagnóstico , Desnutrição/etiologia , Desnutrição/prevenção & controle , Metanálise como Assunto , Micronutrientes/administração & dosagem , Avaliação Nutricional , Necessidades Nutricionais , Apoio Nutricional , Obesidade/epidemiologia , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Guias de Prática Clínica como Assunto , Síndrome da Realimentação/prevenção & controle , Respiração Artificial , Sarcopenia/epidemiologia
4.
Cochrane Database Syst Rev ; 7: CD011378, 2020 07 17.
Artigo em Inglês | MEDLINE | ID: mdl-32677037

RESUMO

BACKGROUND: Foot ulcers in people with diabetes are non-healing, or poorly healing, partial, or full-thickness wounds below the ankle. These ulcers are common, expensive to manage and cause significant morbidity and mortality. The presence of a wound has an impact on nutritional status because of the metabolic cost of repairing tissue damage, in addition to the nutrient losses via wound fluid. Nutritional interventions may improve wound healing of foot ulcers in people with diabetes. OBJECTIVES: To evaluate the effects of nutritional interventions on the healing of foot ulcers in people with diabetes. SEARCH METHODS: In March 2020 we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE; Ovid Embase and EBSCO CINAHL Plus. We also searched clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant included studies as well as reviews, meta-analyses and health technology reports to identify additional studies. There were no restrictions with respect to language, date of publication or study setting. SELECTION CRITERIA: We included randomised controlled trials (RCTs) that evaluated the effect of nutritional interventions on the healing of foot ulcers in people with diabetes. DATA COLLECTION AND ANALYSIS: Two review authors, working independently, assessed included RCTs for their risk of bias and rated the certainty of evidence using GRADE methodology, using pre-determined inclusion and quality criteria. MAIN RESULTS: We identified nine RCTs (629 participants). Studies explored oral nutritional interventions as follows: a protein (20 g protein per 200 mL bottle), 1 kcal/mL ready-to-drink, nutritional supplement with added vitamins, minerals and trace elements; arginine, glutamine and ß-hydroxy-ß-methylbutyrate supplement; 220 mg zinc sulphate supplements; 250 mg magnesium oxide supplements; 1000 mg/day omega-3 fatty acid from flaxseed oil; 150,000 IU of vitamin D, versus 300,000 IU of vitamin D; 250 mg magnesium oxide plus 400 IU vitamin E and 50,000 IU vitamin D supplements. The comparator in eight studies was placebo, and in one study a different dose of vitamin D. Eight studies reported the primary outcome measure of ulcer healing; only two studies reported a measure of complete healing. Six further studies reported measures of change in ulcer dimension, these studies reported only individual parameters of ulcer dimensions (i.e. length, width and depth) and not change in ulcer volume. All of the evidence identified was very low certainty. We downgraded it for risks of bias, indirectness and imprecision. It is uncertain whether oral nutritional supplement with 20 g protein per 200 mL bottle, 1 kcal/mL, nutritional supplement with added vitamins, minerals and trace elements, increases the proportion of ulcers healed at six months more than placebo (risk ratio (RR) 0.80, 95% confidence interval (CI) 0.42 to 1.53). It is also uncertain whether arginine, glutamine and ß-hydroxy-ß-methylbutyrate supplement increases the proportion of ulcers healed at 16 weeks compared with placebo (RR 1.09, 95% CI 0.85 to 1.40). It is uncertain whether the following interventions change parameters of ulcer dimensions over time when compared with placebo; 220 mg zinc sulphate supplement containing 50 mg elemental zinc, 250 mg magnesium oxide supplement, 1000 mg/day omega-3 fatty acid from flaxseed oil supplement, magnesium and vitamin E co-supplementation and vitamin D supplementation. It is also uncertain whether 150,000 IU of vitamin D, impacts ulcer dimensions when compared with 300,000 IU of vitamin D. Two studies explored some of the secondary outcomes of interest for this review. It is uncertain whether oral nutritional supplement with 20 g protein per 200 mL bottle, 1 kcal/mL, nutritional supplement with added vitamins, minerals and trace elements, reduces the number of deaths (RR 0.96, 95% CI 0.06 to 14.60) or amputations (RR 4.82, 95% CI 0.24 to 95.88) more than placebo. It is uncertain whether arginine, glutamine and ß-hydroxy-ß-methylbutyrate supplement increases health-related quality of life at 16 weeks more than placebo (MD -0.03, 95% CI -0.09 to 0.03). It is also uncertain whether arginine, glutamine and ß-hydroxy-ß-methylbutyrate supplement reduces the numbers of new ulcers (RR 1.04, 95% CI 0.71 to 1.51), or amputations (RR 0.66, 95% CI 0.16 to 2.69) more than placebo. None of the included studies reported the secondary outcomes cost of intervention, acceptability of the intervention (or satisfaction) with respect to patient comfort, length of patient hospital stay, surgical interventions, or osteomyelitis incidence. One study exploring the impact of arginine, glutamine and ß-hydroxy-ß-methylbutyrate supplement versus placebo did not report on any relevant outcomes. AUTHORS' CONCLUSIONS: Evidence for the impact of nutritional interventions on the healing of foot ulcers in people with diabetes compared with no nutritional supplementation, or compared with a different dose of nutritional supplementation, remains uncertain, with eight studies showing no clear benefit or harm. It is also uncertain whether there is a difference in rates of adverse events, amputation rate, development of new foot ulcers, or quality of life, between nutritional interventions and placebo. More research is needed to clarify the impact of nutritional interventions on the healing of foot ulcers in people with diabetes.


Assuntos
Pé Diabético/dietoterapia , Cicatrização , Arginina/administração & dosagem , Proteínas na Dieta/administração & dosagem , Suplementos Nutricionais , Ácidos Graxos Ômega-3/administração & dosagem , Feminino , Glutamina/administração & dosagem , Humanos , Magnésio/administração & dosagem , Óxido de Magnésio/administração & dosagem , Masculino , Pessoa de Meia-Idade , Minerais/administração & dosagem , Ensaios Clínicos Controlados Aleatórios como Assunto , Oligoelementos/administração & dosagem , Valeratos/administração & dosagem , Vitaminas/administração & dosagem , Sulfato de Zinco/administração & dosagem
5.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(6): 566-571, 2020 Jun 25.
Artigo em Chinês | MEDLINE | ID: mdl-32521976

RESUMO

Objective: To evaluate the effect of oral nutritional supplementation (ONS) on the nutritional status and quality of life in patients with colorectal cancer and postoperative adjuvant chemotherapy. Methods: This study was registered in the Chinese Clinical Trial Registry (ChiCTR-TRC-13003798). A multi-center randomized controlled trial was conducted. Colorectal cancer patients who underwent radical surgery and postoperative adjuvant chemotherapy, and had nutritional risk (nutrition risk screening 2002 score ≥3) when discharge from hospital in six hospitals (Beijing Hospital, Peking University Third Hospital, Guangzhou Nanfang Hospital, Shanghai Xinhua Hospital, Shanghai Ruijin Hospital, and Shanghai The Sixth People's Hospital) from June 2013 to August 2015 were prospectively enrolled. These patients were randomly divided into the ONS group and control group. Patients in the ONS group received dietary guidance and oral nutritional supplements (2092 kJ/day, whole protein enteral nutrition) for 90 days after discharge from hospital, while patients in the control group only received dietary guidance. Anthropometric measurements (body weight, body mass index [BMI], upper arm circumference, gripping power of the dominant hand, triceps skin fold), nutrition-related laboratory tests (hemoglobin, albumin, prealbumin, total cholesterol, triglyceride), gastrointestinal function scores and quality of life (evaluated by EuroQol five dimensions questionnaire) were collected and compared at baseline (at discharge), and at 30-day, 60-day and 90-day after discharge. Results: A total of 90 patients were included into this multi-center study, of whom 5 patients dropped out, 43 patients were assigned to the ONS group and 42 patients to the control group. Compared with baseline, the body weight of patients in the ONS group increased by (1.523±0.525) kg at 60-day and (1.967±0.661) kg at 90-day, which were significantly higher than those of patients in the control group [60-day: (-0.325±0.518) kg, P=0.015; 90-day: (-0.224±0.705) kg, P=0.027, respectively]. A similar pattern was observed for BMI, the ONS group increased by (0.552±0.203) kg/m(2) at 60-day and (0.765±0.205) kg/m(2) at 90-day, which were significantly higher than those of patients in control group [60-day: (-0.067±0.202) kg/m(2), P=0.034; 90-day: (0.022±0.210) kg/m(2), P=0.013]. No significant differences of other anthropometric measurements and nutrition-related laboratory tests were found between the two groups (all P>0.05). Furthermore, there were no significant differences of improvement in gastrointestinal function and quality of life between two groups (all P>0.05). Conclusion: Oral nutritional supplements can improve the body weight and BMI of colorectal cancer patients with nutritional risk receiving postoperative adjuvant chemotherapy, though it does not improve the quality of life.


Assuntos
Neoplasias Colorretais/terapia , Proteínas na Dieta/administração & dosagem , Nutrição Enteral/métodos , Administração Oral , Antineoplásicos/administração & dosagem , Quimioterapia Adjuvante , China , Suplementos Nutricionais , Procedimentos Cirúrgicos do Sistema Digestório , Humanos , Estado Nutricional , Período Pós-Operatório , Estudos Prospectivos , Qualidade de Vida
6.
Cochrane Database Syst Rev ; 6: CD003959, 2020 06 23.
Artigo em Inglês | MEDLINE | ID: mdl-32573771

RESUMO

BACKGROUND: The ideal quantity of dietary protein for formula-fed low birth weight infants is still a matter of debate. Protein intake must be sufficient to achieve normal growth without leading to negative effects such as acidosis, uremia, and elevated levels of circulating amino acids. OBJECTIVES: To determine whether higher (≥ 3.0 g/kg/d) versus lower (< 3.0 g/kg/d) protein intake during the initial hospital stay of formula-fed preterm infants or low birth weight infants (< 2.5 kilograms) results in improved growth and neurodevelopmental outcomes without evidence of short- or long-term morbidity. Specific objectives were to examine the following comparisons of interventions and to conduct subgroup analyses if possible. 1. Low protein intake if the amount was less than 3.0 g/kg/d. 2. High protein intake if the amount was equal to or greater than 3.0 g/kg/d but less than 4.0 g/kg/d. 3. Very high protein intake if the amount was equal to or greater than 4.0 g/kg/d. SEARCH METHODS: We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 8), in the Cochrane Library (August 2, 2019); OVID MEDLINE Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE(R) Daily, and Ovid MEDLINE(R) (to August 2, 2019); MEDLINE via PubMed (to August 2, 2019) for the previous year; and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (to August 2, 2019). We also searched clinical trials databases and the reference lists of retrieved articles for randomized controlled trials (RCTs) and quasi-randomized trials. SELECTION CRITERIA: We included RCTs contrasting levels of formula protein intake as low (< 3.0 g/kg/d), high (≥ 3.0 g/kg/d but < 4.0 g/kg/d), or very high (≥ 4.0 g/kg/d) in formula-fed hospitalized neonates weighing less than 2.5 kilograms. We excluded studies if infants received partial parenteral nutrition during the study period, or if infants were fed formula as a supplement to human milk. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane and the GRADE approach to assess the certainty of evidence. MAIN RESULTS: We identified six eligible trials that enrolled 218 infants through searches updated to August 2, 2019. Five studies compared low (< 3 g/kg/d) versus high (3.0 to 4.0 g/kg/d) protein intake using formulas that kept other nutrients constant. The trials were small (n = 139), and almost all had methodological limitations; the most frequent uncertainty was about attrition. Low-certainty evidence suggests improved weight gain (mean difference [MD] 2.36 g/kg/d, 95% confidence interval [CI] 1.31 to 3.40) and higher nitrogen accretion in infants receiving formula with higher protein content (3.0 to 4.0 g/kg/d) versus lower protein content (< 3 g/kg/d), while other nutrients were kept constant. No significant differences were seen in rates of necrotizing enterocolitis, sepsis, or diarrhea. We are uncertain whether high versus low protein intake affects head growth (MD 0.37 cm/week, 95% CI 0.16 to 0.58; n = 18) and length gain (MD 0.16 cm/week, 95% CI -0.02 to 0.34; n = 48), but sample sizes were small for these comparisons. One study compared high (3.0 to 4.0 g/kg/d) versus very high (≥ 4 g/kg/d) protein intake (average intakes were 3.6 and 4.1 g/kg/d) during and after an initial hospital stay (n = 77). Moderate-certainty evidence shows no significant differences in weight gain or length gain to discharge, term, and 12 weeks corrected age from very high protein intake (4.1 versus 3.6 g/kg/d). Three of the 24 infants receiving very high protein intake developed uremia. AUTHORS' CONCLUSIONS: Higher protein intake (≥ 3.0 g/kg/d but < 4.0 g/kg/d) from formula accelerates weight gain. However, limited information is available regarding the impact of higher formula protein intake on long-term outcomes such as neurodevelopment. Research is needed to investigate the safety and effectiveness of protein intake ≥ 4.0 g/kg/d.


Assuntos
Desenvolvimento Infantil/fisiologia , Proteínas na Dieta/administração & dosagem , Fórmulas Infantis/química , Recém-Nascido de Baixo Peso/crescimento & desenvolvimento , Proteínas na Dieta/efeitos adversos , Cabeça/crescimento & desenvolvimento , Humanos , Recém-Nascido , Criança Pós-Termo , Nitrogênio/metabolismo , Ensaios Clínicos Controlados Aleatórios como Assunto , Ganho de Peso
7.
Anim Sci J ; 91(1): e13381, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32378296

RESUMO

This experiment was carried out to evaluate the effect of reduced dietary crude protein (CP) levels supplemented with or without exogenous phytase on growing pigs. Six dietary treatments arranged in a 3 × 2 factorial arrangements of 3 CP levels (containing 14%, 16%, and 18% CP) supplemented each with or without 5,000 FTU/g phytase enzyme. Thirty growing pigs (average weight of 17.80 ± 0.10 kg) were allotted to the six dietary treatments in a complete randomized design. The final weight, daily weight gain, and feed conversion ratio (FCR) increased significantly with increasing CP levels. While, phytase supplementation improved (p = .044) FCR in pigs. Total solid and volatile solid content of the slurry were higher (p = .001) in pigs fed 14% and 16% CP diets supplemented with phytase when compared with other treatment groups. Concentration of methane gas emitted was lowest (p = .001) in the slurry of pigs fed 14% CP diet with or without phytase and those fed 16% CP diet with phytase supplementation. In conclusion, reduction in dietary CP levels resulted in reduced weight gain and poor FCR. While, reduced CP with phytase supplementation reduced concentration of methane gas emitted.


Assuntos
6-Fitase , Fenômenos Fisiológicos da Nutrição Animal , Dieta com Restrição de Proteínas , Dieta/veterinária , Proteínas na Dieta/administração & dosagem , Suplementos Nutricionais , Fezes/química , Gases/metabolismo , Metano/metabolismo , Suínos/crescimento & desenvolvimento , Suínos/metabolismo , Animais , Dieta com Restrição de Proteínas/efeitos adversos , Ganho de Peso
8.
Cochrane Database Syst Rev ; 5: CD012616, 2020 May 11.
Artigo em Inglês | MEDLINE | ID: mdl-32390133

RESUMO

BACKGROUND: Malnutrition is common in patients with chronic kidney disease (CKD) on dialysis. Oral protein-based nutritional supplements are often provided to patients whose oral intake is otherwise insufficient to meet their energy and protein needs. Evidence for the effectiveness of oral protein-based nutritional supplements in this population is limited. OBJECTIVES: The aims of this review were to determine the benefits and harms of using oral protein-based nutritional supplements to improve the nutritional state of patients with CKD requiring dialysis. SEARCH METHODS: We searched the Cochrane Kidney and Transplant Register of Studies up to 12 December 2019 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov. SELECTION CRITERIA: Randomised controlled trials (RCTs) of patients with CKD requiring dialysis that compared oral protein-based nutritional supplements to no oral protein-based nutritional supplements or placebo. DATA COLLECTION AND ANALYSIS: Two authors independently assessed studies for eligibility, risk of bias, and extracted data from individual studies. Summary estimates of effect were obtained using a random-effects model, and results were expressed as risk ratios and their 95% confidence intervals (CI) for dichotomous outcomes, and mean difference and 95% CI for continuous outcomes. MAIN RESULTS: Twenty-two studies (1278 participants) were included in this review. All participants were adults on maintenance dialysis of whom 79% were on haemodialysis (HD) and 21% peritoneal dialysis. The follow-up period ranged from one to 12 months. The majority of studies were at unclear risk of selection, performance, and reporting bias. The detection bias was high for self-reported outcomes. Oral protein-based nutritional supplements probably lead to a higher mean change in serum albumin compared to the control group (16 studies, 790 participants: MD 0.19 g/dL, 95% CI 0.05 to 0.33; moderate certainty evidence), although there was considerable heterogeneity in the combined analysis (I2 = 84%). The increase was more evident in HD participants (10 studies, 526 participants: MD 0.28 g/dL, 95% CI 0.11 to 0.46; P = 0.001 for overall effect) and malnourished participants (8 studies, 405 participants: MD 0.31 g/dL, 95% CI 0.10 to 0.52, P = 0.003 for overall effect). Oral protein-based nutritional supplements also probably leads to a higher mean serum albumin at the end of the intervention (14 studies, 715 participants: MD 0.14 g/dL, 95% CI 0 to 0.27; moderate certainty evidence), however heterogeneity was again high (I2 = 80%). Again the increase was more evident in HD participants (9 studies, 498 participants: MD 0.21 g/dL, 95% CI 0.03 to 0.38; P = 0.02 for overall effect) and malnourished participants (7 studies, 377 participants: MD 0.25 g/dL, 95% CI 0.02 to 0.47; P = 0.03 for overall effect). Compared to placebo or no supplement, low certainty evidence showed oral protein-based nutritional supplements may result in a higher serum prealbumin (4 studies, 225 participants: MD 2.81 mg/dL, 95% CI 2.19 to 3.43), and mid-arm muscle circumference (4 studies, 216 participants: MD 1.33 cm, 95% CI 0.24 to 2.43) at the end of the intervention. Compared to placebo or no supplement, oral protein-based nutritional supplements may make little or no difference to weight (8 studies, 365 participants: MD 2.83 kg, 95% CI -0.43 to 6.09; low certainty evidence), body mass index (9 studies, 368 participants: MD -0.04 kg/m2, 95% CI -0.74 to 0.66; moderate certainty evidence) and lean mass (5 studies, 189 participants: MD 1.27 kg, 95% CI -1.61 to 4.51; low certainty evidence). Due to very low quality of evidence, it is uncertain whether oral protein-based nutritional supplements affect triceps skinfold thickness, mid-arm circumference, C-reactive protein, Interleukin 6, serum potassium, or serum phosphate. There may be little or no difference in the risk of developing gastrointestinal intolerance between participants who received oral protein-based nutritional supplements compared with placebo or no supplement (6 studies, 426 participants: RR 2.81, 95% CI 0.58 to 13.65, low certainty evidence). It was not possible to draw conclusions about cost or quality of life, and deaths were not reported as a study outcome in any of the included studies. AUTHORS' CONCLUSIONS: Overall, it is likely that oral protein-based nutritional supplements increase both mean change in serum albumin and serum albumin at end of intervention and may improve serum prealbumin and mid-arm muscle circumference. The improvement in serum albumin was more evident in haemodialysis and malnourished participants. However, it remains uncertain whether these results translate to improvement in nutritional status and clinically relevant outcomes such as death. Large well-designed RCTs in this population are required.


Assuntos
Proteínas na Dieta/administração & dosagem , Desnutrição/terapia , Diálise Renal , Insuficiência Renal Crônica/terapia , Albumina Sérica/metabolismo , Administração Oral , Braço/anatomia & histologia , Viés , Biomarcadores/sangue , Proteínas na Dieta/efeitos adversos , Humanos , Desnutrição/sangue , Desnutrição/etiologia , Diálise Peritoneal/estatística & dados numéricos , Placebos/administração & dosagem , Pré-Albumina/metabolismo , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Diálise Renal/estatística & dados numéricos , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/complicações , Pregas Cutâneas
9.
Cochrane Database Syst Rev ; 5: CD011737, 2020 05 19.
Artigo em Inglês | MEDLINE | ID: mdl-32428300

RESUMO

BACKGROUND: Reducing saturated fat reduces serum cholesterol, but effects on other intermediate outcomes may be less clear. Additionally, it is unclear whether the energy from saturated fats eliminated from the diet are more helpfully replaced by polyunsaturated fats, monounsaturated fats, carbohydrate or protein. OBJECTIVES: To assess the effect of reducing saturated fat intake and replacing it with carbohydrate (CHO), polyunsaturated (PUFA), monounsaturated fat (MUFA) and/or protein on mortality and cardiovascular morbidity, using all available randomised clinical trials. SEARCH METHODS: We updated our searches of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid) and Embase (Ovid) on 15 October 2019, and searched Clinicaltrials.gov and WHO International Clinical Trials Registry Platform (ICTRP) on 17 October 2019. SELECTION CRITERIA: Included trials fulfilled the following criteria: 1) randomised; 2) intention to reduce saturated fat intake OR intention to alter dietary fats and achieving a reduction in saturated fat; 3) compared with higher saturated fat intake or usual diet; 4) not multifactorial; 5) in adult humans with or without cardiovascular disease (but not acutely ill, pregnant or breastfeeding); 6) intervention duration at least 24 months; 7) mortality or cardiovascular morbidity data available. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed inclusion, extracted study data and assessed risk of bias. We performed random-effects meta-analyses, meta-regression, subgrouping, sensitivity analyses, funnel plots and GRADE assessment. MAIN RESULTS: We included 15 randomised controlled trials (RCTs) (16 comparisons, ~59,000 participants), that used a variety of interventions from providing all food to advice on reducing saturated fat. The included long-term trials suggested that reducing dietary saturated fat reduced the risk of combined cardiovascular events by 21% (risk ratio (RR) 0.79; 95% confidence interval (CI) 0.66 to 0.93, 11 trials, 53,300 participants of whom 8% had a cardiovascular event, I² = 65%, GRADE moderate-quality evidence). Meta-regression suggested that greater reductions in saturated fat (reflected in greater reductions in serum cholesterol) resulted in greater reductions in risk of CVD events, explaining most heterogeneity between trials. The number needed to treat for an additional beneficial outcome (NNTB) was 56 in primary prevention trials, so 56 people need to reduce their saturated fat intake for ~four years for one person to avoid experiencing a CVD event. In secondary prevention trials, the NNTB was 32. Subgrouping did not suggest significant differences between replacement of saturated fat calories with polyunsaturated fat or carbohydrate, and data on replacement with monounsaturated fat and protein was very limited. We found little or no effect of reducing saturated fat on all-cause mortality (RR 0.96; 95% CI 0.90 to 1.03; 11 trials, 55,858 participants) or cardiovascular mortality (RR 0.95; 95% CI 0.80 to 1.12, 10 trials, 53,421 participants), both with GRADE moderate-quality evidence. There was little or no effect of reducing saturated fats on non-fatal myocardial infarction (RR 0.97, 95% CI 0.87 to 1.07) or CHD mortality (RR 0.97, 95% CI 0.82 to 1.16, both low-quality evidence), but effects on total (fatal or non-fatal) myocardial infarction, stroke and CHD events (fatal or non-fatal) were all unclear as the evidence was of very low quality. There was little or no effect on cancer mortality, cancer diagnoses, diabetes diagnosis, HDL cholesterol, serum triglycerides or blood pressure, and small reductions in weight, serum total cholesterol, LDL cholesterol and BMI. There was no evidence of harmful effects of reducing saturated fat intakes. AUTHORS' CONCLUSIONS: The findings of this updated review suggest that reducing saturated fat intake for at least two years causes a potentially important reduction in combined cardiovascular events. Replacing the energy from saturated fat with polyunsaturated fat or carbohydrate appear to be useful strategies, while effects of replacement with monounsaturated fat are unclear. The reduction in combined cardiovascular events resulting from reducing saturated fat did not alter by study duration, sex or baseline level of cardiovascular risk, but greater reduction in saturated fat caused greater reductions in cardiovascular events.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Gorduras na Dieta/administração & dosagem , Ácidos Graxos/administração & dosagem , Adulto , Doenças Cardiovasculares/mortalidade , Causas de Morte , Colesterol/sangue , Carboidratos da Dieta/administração & dosagem , Gorduras Insaturadas na Dieta/administração & dosagem , Proteínas na Dieta/administração & dosagem , Ingestão de Energia , Feminino , Humanos , Masculino , Infarto do Miocárdio/mortalidade , Infarto do Miocárdio/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto , Acidente Vascular Cerebral/prevenção & controle
10.
J Anim Sci ; 98(5)2020 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-32386296

RESUMO

Thirty five barrows (initial body weight [BW]: 15.1 ± 1.0 kg) were used to determine the effect of partially replacing Gly + Ser with Thr in reduced crude protein (CP) diets on growth performance, protein deposition in carcass and viscera, and skin collagen abundance during the late nursery phase to 25 kg BW. Pigs were individually fed one of five iso-nitrogenous diets (n = 7) for 21 d. The basal diet met estimated essential amino acids (AA) requirements by using all essential AA plus Gly and Ser in free form (CON; 12.1% CP; as-fed, analyzed contents). The remaining four diets were formulated by reducing total Gly and Ser concentrations to 60% or 20% of the CON diet. The N removed with Gly and Ser was replaced with either crystalline Thr or Glu. Total analyzed Thr made up either 1.59% (T1; 12.5% CP) or 2.34% (T2; 12.2% CP) of the Thr-supplemented diets, and total analyzed Glu made up either 3.47% (G1; 12.7% CP) or 4.64% (G2; 12.9% CP) of the Glu-supplemented diets. Pigs were slaughtered on day 21 to determine body composition and skin collagen abundance via bright field microscopy. Overall, average daily gain (ADG) and G:F and final carcass weights were greater for pigs fed diets supplemented with Glu (G1 + G2) vs. those fed diets supplemented with Thr (T1 + T2; P < 0.05, P = 0.060, and P = 0.050 for ADG, G:F, and final carcass weight, respectively); intermediate values were observed for CON. Nitrogen retention in carcass plus viscera and the AA profile of deposited protein in the carcass were not influenced by dietary treatment. Pigs fed the T2 and G2 diets had greater retention of Thr (vs. CON and G2) and Glu (vs. CON and T2) in the viscera protein, respectively (P < 0.05). The apparent utilization efficiency of standardized ileal digestible Thr for protein deposition in carcass plus viscera was less for pigs fed T2 (15.1%) vs. those fed CON (56.7%) or G2 (58.6% ± 2.9%) diets (P < 0.001). Only pigs fed T1 had skin collagen abundance not different from CON; pigs fed G1, G2, and T2 had reduced skin collagen abundance compared with CON and T1 (P < 0.01). Using Glu as an N source when Gly and Ser were reduced to 60% and 20% of CON in reduced CP diets maintained ADG for pigs between 15 and 25 kg BW, whereas supplying Thr as a N source reduced ADG and carcass weight. When dietary Gly and Ser were supplied at 60% of CON, only Thr supplementation rescued skin collagen abundance. Therefore, supplemental Thr at excess levels is not sufficient to replace N from Gly and Ser in reduced CP diets fed to late nursery pigs, despite supporting skin collagen abundance as a secondary indicator of Gly status.


Assuntos
Composição Corporal/efeitos dos fármacos , Colágeno/metabolismo , Glicina/farmacologia , Serina/farmacologia , Suínos/fisiologia , Treonina/farmacologia , Ração Animal/análise , Animais , Dieta , Dieta com Restrição de Proteínas , Proteínas na Dieta/administração & dosagem , Proteínas na Dieta/farmacologia , Suplementos Nutricionais , Glicina/administração & dosagem , Masculino , Serina/administração & dosagem , Pele/química , Fenômenos Fisiológicos da Pele , Treonina/administração & dosagem , Vísceras , Ganho de Peso/efeitos dos fármacos
12.
Nutrients ; 12(4)2020 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-32252339

RESUMO

The present study tested the hypothesis that the liver lipid-lowering effect of insect meal (IM) is caused by its low methionine concentration. A total of fifty, male obese Zucker rats were randomly assigned to five groups of 10 rats each (casein (C), IM, IM + Met, IM + Cys, and IM + EAA). While group C received a diet with casein, the IM-fed groups received a diet with IM as the protein source. In groups IM + Met, IM + Cys and IM + EAA, the diets were additionally supplemented with methionine, cysteine and essential amino acids (EAA), respectively. Hepatic concentrations of triacylglycerols and cholesterol, and hepatic mRNA levels and activities of lipogenic and cholesterogenic enzymes were markedly lower in the IM-fed groups than in group C (p < 0.05). All of these parameters either did not differ across the IM-fed groups or were only slightly higher in groups IM + Met, IM + Cys and IM+EAA than in the group IM. In conclusion, the results indicate that a difference in the amino acid composition between IM and casein, a low concentration of methionine in IM and a reduced cysteine synthesis secondary to a decreased methionine availability resulting from feeding IM are not causative for the lipid-lowering effect of IM.


Assuntos
Aminoácidos Essenciais/metabolismo , Aminoácidos Sulfúricos/metabolismo , Proteínas na Dieta/metabolismo , Fígado/metabolismo , Obesidade/metabolismo , Aminoácidos Essenciais/administração & dosagem , Aminoácidos Sulfúricos/administração & dosagem , Animais , Caseínas/metabolismo , Cisteína/metabolismo , Proteínas na Dieta/administração & dosagem , Insetos , Lipídeos/análise , Masculino , Ratos , Ratos Zucker
13.
Am Surg ; 86(3): 232-236, 2020 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-32223803

RESUMO

A modern approach to incisional hernia is oriented toward midline restoration to re-establish abdominal wall physiology and to restore muscular strength. A high-protein diet has been demonstrated to improve muscle function and mass. The aim of this prospective study was to evaluate the effect of a high-protein diet on abdominal muscle remodeling in patients submitted to abdominal wall reconstruction (AWR). Forty-five patients submitted to elective AWR were prospectively divided into two groups depending on pre- and postoperative daily protein assumption: Group A patients were submitted to a standard 2300 kcal diet with 103 g of protein intake (males) and 1800 kcal diet with 80 g of protein intake (females) starting one month before surgery and lasting for three months postoperatively; Group B patients were submitted to the same dietary regimen plus 34 g of purified proteins daily. Patients underwent ultrasound scan preoperatively and three and six months after surgery, to evaluate the widest thickness of the rectus abdominis muscle on the transverse umbilical line. Three patients reporting hernia recurrence were excluded. No significant difference among the two groups in muscle thickness growth after surgery was observed at three months after surgery, even if a favorable trend in Group B was noted (10% vs 19%, P = not significant). At six months after surgery, Group B patients showed a significant difference in muscle thickening (13% vs 32%, P < 0.05 ). The study demonstrates a positive effect of a protein diet on the rectus abdominis muscle thickening after AWR. Further studies are needed.


Assuntos
Abdominoplastia/métodos , Proteínas na Dieta/administração & dosagem , Herniorrafia/métodos , Hérnia Incisional/cirurgia , Cicatrização/fisiologia , Parede Abdominal/diagnóstico por imagem , Parede Abdominal/cirurgia , Idoso , Estudos de Coortes , Procedimentos Cirúrgicos Eletivos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Força Muscular/fisiologia , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/cirurgia , Estudos Prospectivos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia Doppler/métodos
15.
Z Gerontol Geriatr ; 53(4): 285-289, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32291569

RESUMO

The protein intake of older people has gained increasing scientific interest as a potential factor to delay the age-associated decline in muscle mass and consequently to counteract the development of sarcopenia. The skeletal muscle of older people seems less responsive to the anabolic stimulus of protein intake. Therefore, higher protein needs are discussed to overcome this anabolic resistance and to maintain muscle mass as far as possible. Besides the total amount of protein consumed, the distribution, quality and timing in relation to physical exercise are considered relevant; however, deriving clear recommendations for clinical practice is still difficult as positive results of protein intake on muscle metabolism found in experimental trials cannot simply be transferred to everyday conditions and randomized controlled trials often failed to show improvements in muscular outcomes related to protein supplementation. The effectiveness of protein supplementation may depend on functional resources of the older persons and the habitual protein intake. There is still a need for studies with well-defined protocols and populations to further elucidate the role of protein in the prevention and treatment of sarcopenia.


Assuntos
Proteínas na Dieta/administração & dosagem , Exercício Físico , Músculo Esquelético/fisiologia , Sarcopenia/patologia , Idoso , Idoso de 80 Anos ou mais , Suplementos Nutricionais , Humanos , Força Muscular
16.
J Frailty Aging ; 9(1): 51-56, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32150214

RESUMO

BACKGROUND: The use of magnetic resonance imaging (MRI) derived functional cross-sectional area (FCSA) and intramuscular adipose tissue (IMAT) to define skeletal muscle quality is of fundamental importance in order to understand aging and inactivity-related loss of muscle mass. OBJECTIVES: This study examined factors associated with lower-extremity skeletal muscle quality in healthy, younger, and middle-aged adults. DESIGN: Cross-sectional study. SETTING AND PARTICIPANTS: Ninety-eight participants (53% female) were classified as younger (20-35 years, n=50) or middle-aged (50-65 years, n=48) as well as sedentary (≤1 day per week) or active (≥3 days per week) on self-reported concurrent exercise (aerobic and resistance). MEASUREMENTS: All participants wore an accelerometer for seven days, recorded a three-day food diary, and participated in magnetic resonance imaging (MRI) of the lower limbs. Muscle cross-sectional area (CSA) was determined by tracing the knee extensors (KE) and plantar flexors, while muscle quality was established through the determination of FCSA and IMAT via color thresholding. RESULTS: One-way analysis of variance and stepwise regression models were performed to predict FCSA and IMAT. KE-IMAT (cm2) was significantly higher among sedentary (3.74 ± 1.93) vs. active (1.85 ± 0.56) and middle-aged (3.14 ± 2.05) vs. younger (2.74 ± 1.25) (p < 0.05). Protein intake (g•kg•day-1) was significantly higher in active (1.63 ± 0.55) vs. sedentary (1.19 ± 0.40) (p < 0.05). Sex, age, concurrent exercise training status, and protein intake were significant predictors of KE FCSA (R2 = 0.71, p < 0.01), while concurrent exercise training status and light physical activity predicted 33% of the variance in KE IMAT (p < 0.01). CONCLUSION: Concurrent exercise training, dietary protein intake, and light physical activity are significant determinants of skeletal muscle health and require further investigation to mitigate aging and inactivity-related loss of muscle quality.


Assuntos
Envelhecimento/fisiologia , Proteínas na Dieta/administração & dosagem , Exercício Físico/fisiologia , Músculo Esquelético/fisiologia , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
17.
AAPS PharmSciTech ; 21(3): 101, 2020 Mar 09.
Artigo em Inglês | MEDLINE | ID: mdl-32152890

RESUMO

The hydrophobicity of bioactive molecules poses a considerable problem in the pharmaceutical and the food industry. Using food-based protein nanocarriers is one promising way to deliver hydrophobic molecules. These types of protein possess many functional properties such as surface activity, water-binding capacity, emulsification, foaming, gelation, and antioxidant activity, as well as their incorporation in the food industry as ingredients. Besides, they express low toxicity, are less expensive compared to synthetic polymers, and are biodegradable. This review aims to give a brief overview of the recent studies done using food proteins as colloidal delivery systems for hydrophobic and poorly soluble compounds.


Assuntos
Proteínas na Dieta/administração & dosagem , Proteínas na Dieta/química , Sistemas de Liberação de Medicamentos/métodos , Interações Hidrofóbicas e Hidrofílicas/efeitos dos fármacos , Nanopartículas/administração & dosagem , Nanopartículas/química , Animais , Sistemas de Liberação de Medicamentos/tendências , Géis , Humanos , Polímeros/administração & dosagem , Polímeros/química , Solubilidade , Água
18.
J Anim Sci ; 98(4)2020 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-32201878

RESUMO

Three experiments were conducted to investigate the effects of dietary crude protein (CP) level and N-carbamylglutamate (NCG) supplementation on apparent total tract digestibility (ATTD) and ileal digestibility of nutrients and digestive enzyme activity of jejunum in growing pigs. In experiment 1, 10 Duroc × Landrace × Yorkshire barrows (initial BW: 48.7 kg) were allotted to a three-period switchback design with five experimental diets and two replicate pigs per diet in each period. Diets were categorized as high CP (HP, 18% CP), moderate low CP (MLP, 15% CP), very low CP (VLP, 12% CP), and MLP and VLP with 0.1% NCG supplementation. Feces and urine were collected from day 6 to day 11 after a 5-d adaptation period. The DE, ME, and ATTD of GE, OM, CP, NDF, ADF, and P decreased (P < 0.01) with a reduction of dietary CP, but no effect of dietary treatments on pig daily N retention was detected. The NCG supplementation increased (P < 0.01) DE and ATTD of ADF of the VLP diet. In experiment 2, 10 jejunal-cannulated Duroc × Landrace × Yorkshire barrows (initial BW: 44.5 kg) were fed five diets for three periods as experiment 1. Jejunal fluid was collected on days 6 and 8 after a 5-d adaptation period. The digestive enzymes activity was not affected by dietary CP level, except for α-amylase, for which there was a decrease (P < 0.01) in pigs fed VLP diets compared to HP and MLP diets. In experiment 3, 12 ileal-cannulated Duroc × Landrace × Yorkshire barrows (initial BW: 46.7 kg) were allotted to a three-period switchback design with six diets and two replicate pigs per diet in each period. The six experimental diets consisted of five experimental diets as experiment 1 and one N-free diet. Ileal digesta was collected from day 6 to day 8 after a 5-d adaptation period. Results indicated that apparent ileal digestibility (AID) of CP and P and ileal digestibility of Arg, His, Ile, Leu, Phe, and all dispensable AA, except Pro, decreased (P < 0.01) in pigs fed VLP diet compared to HP and MLP diets, but AID of GE, OM, EE, NDF, and ADF were not affected. The supplementation of NCG in the VLP diet increased (P < 0.01) the AID of CP and ileal digestibility of Arg, His, Leu, Phe, Val, Ser, and Tyr. In conclusion, reducing dietary CP level decreased nutrient digestibility, but improved the efficiency of dietary N utilization and reduced N emission. Moderate reduction of dietary CP level had a minimal effect on nutrient digestibility and digestive enzyme activity. Additionally, NCG supplementation plays a beneficial effect on nutrient digestion only if the dietary CP level is extremely lowered.


Assuntos
Ração Animal/análise , Dieta/veterinária , Proteínas na Dieta/administração & dosagem , Glutamatos/administração & dosagem , Suínos/fisiologia , Aminoácidos/metabolismo , Fenômenos Fisiológicos da Nutrição Animal , Animais , Proteínas na Dieta/farmacologia , Suplementos Nutricionais , Digestão/efeitos dos fármacos , Metabolismo Energético/efeitos dos fármacos , Trato Gastrointestinal/metabolismo , Glutamatos/farmacologia , Íleo/metabolismo , Jejuno/metabolismo , Masculino
19.
J Dairy Sci ; 103(5): 4315-4326, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32113775

RESUMO

Protein is an expensive component of the dairy cow diet, and overfeeding protein can have adverse economic and environmental impacts. Our objective was to maintain milk production and components while decreasing dietary crude protein (CP) through use of a heat-treated, rumen-resistant sugar amino acid complex (SAAC) as the Schiff base, as an addition to low-protein diets. Dietary treatments included a negative control [NC, 146 g of CP/kg of dry matter (DM)], a positive control (PC, 163 g of CP/kg of DM), and the NC supplemented with SAAC in lieu of some barley grain (SAAD, 151 g of CP/kg of DM). Diets were fed to 30 multiparous Holstein-Friesian dairy cows for the first 50 d postpartum. Dry matter intake (DMI) was determined daily. Milk yield and content of fat, protein, lactose, and casein were recorded weekly from wk 2 to 7 of lactation. The fixed effects of treatment, week, treatment × week, month of calving, and BCS at calving, and a random effect of cow, were analyzed using the MIXED procedure of SAS (SAS Institute Inc., Cary, NC). The SAAD treatment had greater energy-corrected milk yield than did NC. The PC treatment had greater DMI than did NC, and SAAD tended to have greater DMI than did NC. We found significant treatment effects for fat percentage and yield. The NC and SAAD treatments had higher fat percentages than did PC, and SAAD had a higher fat yield than did the NC and PC treatments. Treatment effects were found for casein yield and percentage. We discovered a treatment effect for protein percentage and yield. The PC treatment had higher protein percentage than did NC and SAAD. The PC treatment had a higher protein yield than did NC, and analysis revealed no difference in protein yield between PC and SAAD. The SAAD treatment had higher total milk solids than did the NC treatment. Lactose yield tended to be higher in PC than in NC, and no differences were found between PC and NC and SAAD treatments. The PC treatment had a higher casein percentage than did NC and SAAD; however, the SAAD and PC treatments had higher casein yields than did NC. The PC treatment had a higher casein:fat ratio than did the NC and SAAD treatments. The NC and SAAD treatments had higher Cheddar cheese yields than did PC. We found no treatment × week interactions for any parameter. Supplementing low-protein dairy cow diets with a heat-treated, rumen-resistant SAAC caused beneficial effects by improving milk components and increasing cheese yield to levels similar to those found when feeding expensive and environmentally damaging high-protein diets.


Assuntos
Bovinos/fisiologia , Queijo/análise , Carboidratos da Dieta/metabolismo , Proteínas na Dieta/metabolismo , Ingestão de Alimentos , Leite/metabolismo , Aminoácidos/administração & dosagem , Aminoácidos/metabolismo , Ração Animal/análise , Animais , Dieta/veterinária , Carboidratos da Dieta/administração & dosagem , Proteínas na Dieta/administração & dosagem , Suplementos Nutricionais/análise , Feminino , Distribuição Aleatória , Sacarose/administração & dosagem , Sacarose/metabolismo
20.
J Nutr ; 150(5): 1208-1213, 2020 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-32140711

RESUMO

BACKGROUND: Due to a lack of research data on the protein requirements of the elderly in China, the estimated average requirement (EAR) and the recommended nutrient intake (RNI) of protein in the elderly remain the same as those in young and middle-aged people at 0.98 g/(kg·d). OBJECTIVE: The objective of this study was to determine the protein requirements of healthy Chinese adults >65y old through use of the indicator amino acid oxidation (IAAO) method. METHODS: Seven healthy adult men and 7 healthy adult women participated in the study, with protein intakes ranging from 0.3 to 1.8 g/(kg·d). The diets were isocaloric and provided energy at a 1.5 resting energy expenditure. Protein was given based on the lactalbumin. Phenylalanine and tyrosine were added to protein doses of 0.3-1.5 g/kg according to the highest dose of protein content [1.8 g/(kg·d)]. Phenylalanine and tyrosine concentrations were kept constant at each protein dose. The mean protein requirement was determined by applying a nonlinear mixed-effects model analysis to the F13CO2, which identified a breakpoint in F13CO2 in response to graded amounts of protein. This trial was registered with the Chinese clinical trial registry as ChiCTR-BOC-17010930. RESULTS: Protein EAR and RNI for healthy elderly Chinese adults were determined to be 0.91 and 1.17 g/(kg·d), respectively, based on the indicator amino acid oxidation technique. CONCLUSIONS: The estimates of protein requirements for Chinese adults >65 y in the present study are 3.4% and 19.4% higher than the current estimated requirements, 0.88 g/(kg·d) for EAR and 0.98 g/(kg·d) for RNI.


Assuntos
Proteínas na Dieta/administração & dosagem , Necessidades Nutricionais , Recomendações Nutricionais , Idoso , Envelhecimento/fisiologia , Aminoácidos/metabolismo , Peso Corporal , China , Ingestão de Energia , Metabolismo Energético , Feminino , Humanos , Masculino , Oxirredução , Fenilalanina/administração & dosagem , Fenilalanina/metabolismo , Tirosina/administração & dosagem
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