Observed differences in nutrition management at two time points spanning a decade in critically ill trauma patients with and without head injury.

BACKGROUND: Nutritional needs of trauma patients admitted to the intensive care unit may differ from general critically ill patients, but most current evidence is based on large clinical trials recruiting mixed populations. OBJECTIVE: The aim of the study was to investigate nutrition practices at two time points that span a decade in trauma patients with and without head injury. METHODS: This observational study recruited adult trauma patients receiving mechanical ventilation and artificial nutrition from a single-centre intensive care unit between February 2005 to December 2006 (cohort 1), and December 2018 to September 2020 (cohort 2). Patients were categorised into head injury and non-head injury subgroups. Data regarding energy and protein prescription and delivery were collected. Data are presented as median [interquartile range]. Wilcoxon rank-sum test assessed the differences between cohorts and subgroups, with a P value ≤ 0.05. The protocol was registered with the Australian and New Zealand Clinical Trials Registry (Trial ID: ACTRN12618001816246). RESULTS: Cohort 1 included 109 patients, and 112 patients were included in cohort 2 (age: 46 ± 19 vs 50 ± 19 y; 80 vs 79% M). Overall, nutrition practice did not differ between head-injured and non-head-injured subgroups (all P > 0.05). Energy prescription and delivery decreased from time point one to time point two, regardless of subgroup (Prescription: 9824 [8820-10 581] vs 8318 [7694-9071] kJ; Delivery: 6138 [5130-7188] vs 4715 [3059-5996] kJ; all P < 0.05). Protein prescription did not change from time point one to time point two. Although protein delivery remained constant from time point one to time point two in the head injury group, protein delivery reduced in the non-head injury subgroup (70 [56-82] vs 45 [26-64] g/d, P < 0.05). CONCLUSION: In this single-centre study, energy prescription and delivery in critically ill trauma patients reduced from time point one to time point two. Protein prescription did not change, but protein delivery reduced from time point one to time point two in non-head injury patients. Reasons for these differing trajectories require exploration. STUDY REGISTRATION: Trial registered at www.anzctr.org.au. TRIAL ID: ACTRN12618001816246.

Research progress and future study on physicochemical, nutritional, and structural characteristics of canola and rapeseed feedstocks and co-products from bio-oil processing and nutrient modeling evaluation methods.

This article aims to review research progress and provide future study on physicochemical, nutritional, and molecular structural characteristics of canola and rapeseed feedstocks and co-products from bio-oil processing and nutrient modeling evaluation methods. The review includes Canola oil seed production, utilization and features; Rapeseed oil seed production and canola oil seed import in China; Bio-processing, co-products and conventional evaluation methods; Modeling methods for evaluation of truly absorbed protein supply from canola feedstock and co-products. The article provides our current research in feedstocks and co-products from bio-oil processing which include Characterization of chemical and nutrient profiles and ruminal degradation and intestinal digestion; Revealing intrinsic molecular structures and relationship between the molecular structure spectra features and nutrient supply from feedstocks and co-products using advanced vibrational molecular spectroscopy technique. The study focused on advanced vibrational molecular spectroscopy which can be used as a fast tool to study molecular structure features of feedstock and co-products from bio-oil processing. The article also provides future in depth study areas. This review provides an insight as how to use advanced vibrational molecular spectroscopy for in-depth analysis of the relationship between molecular structure spectral feature and nutrition delivery from canola feedstocks and co-products from bio-oil processing.

Dry Nutrition Delivery System Based on Defatted Soybean Particles and Its Application with ß-Carotene.

Many nutrition delivery systems (NDSs) have been developed for the encapsulation, protection, and delivery of bioactive compounds, such as ß-carotene. Most of those systems were prepared in solution, which is inconvenient for transportation and storage in the food industry. In the present work, we constructed an environmentally friendly dry NDS based on defatted soybean particles (DSPs) by milling a ß-carotene-DSP mixture. The loading efficiency of the NDS reached 89.0%, and the cumulative release rate decreased from 15.1% (free ß-carotene) to 6.0% within 8 h. The stability of ß-carotene in the dry NDS was found to have increased in a thermogravimetric analysis. Stored for 14 days at 55 °C or under UV irradiation, the retaining rates of ß-carotene in the NDS increased to 50.7% and 63.6%, respectively, while they were 24.2% and 54.6% for the free samples. The bioavailability of ß-carotene was improved by the NDS too. The apparent permeability coefficient of the NDS reached 1.37 × 10-6 cm/s, which is 12 times that of free ß-carotene (0.11 × 10-6 cm/s). Besides being environmentally friendly, the dry NDS can facilitate carriage, transportation, or storage in the food industry, and similar to other NDSs, it improves the stability and bioavailability of nutrients.

Transforming agrifood systems in a win-win for health and environment: evidence from organic rice-duck coculture.

BACKGROUND: Rice-duck coculture is an ecological agricultural mode; however, the nutritional and environmental benefits of transforming from conventional rice monoculture to rice-duck coculture are unknown. Based on survey data and the life-cycle assessment approach, this study conducted a carbon footprint evaluation of conventional rice monoculture (CR), organic rice monoculture (OR), and organic rice-duck coculture (ORD) using different functional units. RESULTS: The carbon footprint per hectare of ORD (7842 ± 284 kg CO2 eq ha-1 ) was slightly lower than that of CR (7905 ± 412 kg CO2 eq ha-1 ), while higher than that of OR (7786 ± 235 kg CO2 eq ha-1 ). Although the rice yield of ORD was slightly lower than that of CR, its nutrient density unit (NDU) did not decrease significantly due to the additional duck yield. Thus, the carbon footprint per NDU of ORD was significantly lower than that of OR by 24.3% (P < 0.05) and was 5.8% higher than that of CR, but this was not statistically significant. Due to the higher economic profits of ORD, its unit of carbon footprint per economic profit was significantly reduced (by 47.1-75.7%) compared with the other two farming modes, while the net ecosystem economic budget was significantly increased by 98.5-341.9% (P < 0.05). CONCLUSION: Transforming from a rice monoculture to a coculture system will contribute to a win-win situation for human health and environmental sustainability. This study highlighted the abundant nutritional output function of the rice-duck coculture and analyzed the urgency and necessity of transitioning from traditional agriculture to ecological agriculture from the production and consumption perspectives. © 2022 Society of Chemical Industry.

Towards Achieving Nutrition Goal in Critically Ill Patients: Need a Simple Yet Effective Bedside Tool.

How to cite this article: Wali S, Gutte SH, Gurjar M. Towards Achieving Nutrition Goal in Critically Ill Patients: Need a Simple Yet Effective Bedside Tool. Indian J Crit Care Med 2023;27(6):379-380.

Regulated anthocyanin release through novel pH-responsive peptide hydrogels in simulated digestive environment.

The instability of anthocyanins significantly reduces their bioavailability as food nutrients. This proof-of-concept study aimed to develop efficient carriers for anthocyanins to overcome this challenge. Characterization of the hydrogels via SEM (scanning electron microscope) and rheological analysis revealed the formation of typical gel structures. MTT (methyl thiazolyl tetrazolium) and hemolysis assays confirmed that their high biocompatibility. Encapsulation efficiency analysis and fluorescence microscopy images demonstrated successful and efficient encapsulation of anthocyanins by pH-responsive hydrogels. Stability studies further validated the effect of peptide hydrogels in helping anthocyanin molecules withstand factors such as gastric acid, high temperatures, and heavy metals. Subsequently, responsive studies in simulated gastric (intestinal) fluid demonstrated that the pH-responsive peptide hydrogels could protect anthocyanin molecules from gastric acid while achieving rapid and complete release in intestinal fluid environments. These results indicate that these peptide hydrogels could stabilize anthocyanins and facilitate their controlled release, potentially leading to personalized delivery systems.

Nutrition delivery of a model-based ICU glycaemic control system.

BACKGROUND: Hyperglycaemia is commonplace in the adult intensive care unit (ICU), associated with increased morbidity and mortality. Effective glycaemic control (GC) can reduce morbidity and mortality, but has proven difficult. STAR is a proven, effective model-based ICU GC protocol that uniquely maintains normo-glycaemia by changing both insulin and nutrition interventions to maximise nutrition in the context of GC in the 4.4-8.0 mmol/L range. Hence, the level of nutrition it provides is a time-varying estimate of the patient-specific ability to take up glucose. METHODS: First, the clinical provision of nutrition by STAR in Christchurch Hospital, New Zealand (N = 221 Patients) is evaluated versus other ICUs, based on the Cahill et al. survey of 158 ICUs. Second, the inter- and intra- patient variation of nutrition delivery with STAR is analysed. Nutrition rates are in terms of percentage of caloric goal achieved. RESULTS: Mean nutrition rates clinically achieved by STAR were significantly higher than the mean and best ICU surveyed, for the first 3 days of ICU stay. There was large inter-patient variation in nutrition rates achieved per day, which reduced overtime as patient-specific metabolic state stabilised. Median intra-patient variation was 12.9%; however, the interquartile range of the mean per-patient nutrition rates achieved was 74.3-98.2%, suggesting patients do not deviate much from their mean patient-specific nutrition rate. Thus, the ability to tolerate glucose intake varies significantly between, rather than within, patients. CONCLUSIONS: Overall, STAR's protocol-driven changes in nutrition rate provide higher nutrition rates to hyperglycaemic patients than those of 158 ICUs from 20 countries. There is significant inter-patient variability between patients to tolerate and uptake glucose, where intra-patient variability over stay is much lower. Thus, a best nutrition rate is likely patient specific for patients requiring GC. More importantly, these overall outcomes show high nutrition delivery and safe, effective GC are not exclusive and that restricting nutrition for GC does not limit overall nutritional intake compared to other ICUs.

Nutrition delivery, workload and performance in a model-based ICU glycaemic control system.

BACKGROUND AND OBJECTIVE: Hyperglycaemia is commonplace in the adult intensive care unit (ICU), and has been associated with increased morbidity and mortality. Effective glycaemic control (GC) can reduce morbidity and mortality, but has proven difficult. STAR is a model-based GC protocol that uniquely maintains normoglycaemia by changing both insulin and nutrition interventions, and has been proven effective in controlling blood glucose (BG) in the ICU. However, most ICU GC protocols only change insulin interventions, making the variable nutrition aspect of STAR less clinically desirable. This paper compares the performance of STAR modulating only insulin, with three simpler alternative nutrition protocols in clinically evaluated virtual trials. METHODS: Alternative nutrition protocols are fixed nutrition rate (100% caloric goal), CB (Cahill et al. best) stepped nutrition rate (60%, 80% and 100% caloric goal for the first 3 days of GC, and 100% thereafter) and SLQ (STAR lower quartile) stepped nutrition rate (65%, 75% and 85% caloric goal for the first 3 days of GC, and 85% thereafter). Each nutrition protocol is simulated with the STAR insulin protocol on a 221 patient virtual cohort, and GC performance, safety and total intervention workload are assessed. RESULTS: All alternative nutrition protocols considerably reduced total intervention workload (14.6-19.8%) due to reduced numbers of nutrition changes. However, only the stepped nutrition protocols achieved similar GC performance to the current variable nutrition protocol. Of the two stepped nutrition protocols, the SLQ nutrition protocol also improved GC safety, almost halving the number of severe hypoglycaemic cases (5 vs. 9, P = 0.42). CONCLUSIONS: Overall, the SLQ nutrition protocol was the best alternative to the current variable nutrition protocol, but either stepped nutrition protocol could be adapted by STAR to reduce workload and make it more clinically acceptable, while maintaining its proven performance and safety.