Clinical Nutrition

Editorial board

2012-04-01

Parenteral nutrition is not the false route in ICU

Pierre Singer, Claude Pichard — 2011-12-12

Summary: Large surveys auditing feeding regimen in the ICU consistently reported hypocaloric 23 enteral feedings patterns and many studies described the association between 24 energy deficit and increased complication rate. ESPEN and ASPEN experts 25 recommend early (after 48 h) or late (after 7–10 days) catch up of the 26 energy deficit with parenteral nutrition (PN) respectively, but the level of evidence 27 was poor and larger PRCT were missing. In the recent months, several ICU studies 28 have tried to answer to three critical questions: 1) how much energy to administer, 2) 29 when to start (early or late), and 3) which route should be used. However, weaknesses 30 in the study design and some mixing of the 3 questions have created confusion in the 31 message delivered. In addition, the severity of the acute illness was not always similar 32 in these studies, mixing short-term acutely ill patients (less than 4 days in the ICU) 33 with long term patients (more than 10 days in the ICU).

Comparison of aerobic exercise, diet or both on lipids and lipoproteins in adults: A meta-analysis of randomized controlled trials

George A. Kelley, Kristi S. Kelley, Susan Roberts, William Haskell — 2011-11-28

Summary: Objective: Given that previous studies have reached conflicting conclusions regarding the effects of diet (D), aerobic exercise (E) or both (DE) on blood lipid and lipoprotein concentrations in adults, the meta-analytic approach was used to address this issue.Data sources: Nine electronic databases, cross-referencing, and expert review.Study selection: Randomized controlled trials ≥4 weeks that included a D, E, DE and control (C) group in adults ≥18 years of age and in which data for one or more of the following were available: total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG).Data extraction: Dual data extraction by the first two authors.Statistical analysis: Random-effects models as well as mixed-effects models for between-group differences.Results: Seven-hundred and eighty-eight men and women from 6 studies were included. Non-overlapping 95% confidence intervals were observed for D and DE with respect to lowering TC, LDL-C and TG while reductions in E were limited to TG. No significant changes in HDL-C were observed. When compared to E, reductions in TC and LDL-C were greater for D and DE (p < 0.05 for all).Conclusions: Diet, especially DE, are superior to E for improving selected lipids and lipoproteins in adults.

The ratio of energy expenditure to nitrogen loss in diverse patient groups – A systematic review

Georg Kreymann, Mark H. DeLegge, Gabriele Luft, Mary E. Hise, Gary P. Zaloga — 2012-02-13

Summary: Background & aims: The ratio of energy expenditure to nitrogen loss respectively of energy to nitrogen provision (E/N) is considered a valuable tool in the creation of an enteral or parenteral formulation. Specific E/N ratios for parenteral nutrition (PN) have not yet been clearly defined. To determine the range of energy expenditure, nitrogen (protein) losses, and E/N ratios for various patient groups, we performed a systematic review of the literature.Methods: Medline 1950–2011 was searched for all studies on patients or healthy controls reporting energy expenditure and nitrogen loss at the same time.Results: We identified 53 studies with 91 cohorts which comprised 1107 subjects. Mean TEE ± standard deviation (SD) was 31.2 ± 7.2 kcal/kg BW/day in patients (n = 881) and 35.6 ± 4.3 kcal/kg BW/day in healthy controls (n = 266). Mean total protein loss (TPL) was 1.50 ± 0.57 g/kg BW/day in patients and 0.94 ± 0.24 g/kg BW/day in healthy controls. A non-linear significant correlation was found between TPL and the E/N ratio.Conclusion: The E/N ratio is not a constant value but decreases continuously with increasing protein loss. These variations should be considered in the nutritional support of patients.

Randomized phase III clinical trial of a combined treatment with carnitine + celecoxib ± megestrol acetate for patients with cancer-related anorexia/cachexia syndrome

2011-10-19

Summary: Background & aims: A phase III, randomized non-inferiority study was carried out to compare a two-drug combination (including nutraceuticals, i.e. antioxidants) with carnitine + celecoxib ± megestrol acetate for the treatment of cancer-related anorexia/cachexia syndrome (CACS): the primary endpoints were increase of lean body mass (LBM) and improvement of total daily physical activity. Secondary endpoint was: increase of physical performance tested by grip strength and 6-min walk test.Methods: Sixty eligible patients were randomly assigned to: arm 1, l-carnitine 4 g/day + Celecoxib 300 mg/day or arm 2, l-carnitine 4 g/day + celecoxib 300 mg/day + megestrol acetate 320 mg/day, all orally. All patients received as basic treatment polyphenols 300 mg/day, lipoic acid 300 mg/day, carbocysteine 2.7 g/day, Vitamin E, A, C. Treatment duration was 4 months. Planned sample size was 60 patients.Results: The results did not show a significant difference between treatment arms in both primary and secondary endpoints. Analysis of changes from baseline showed that LBM (by dual-energy X-ray absorptiometry and by L3 computed tomography) increased significantly in both arms as well as physical performance assessed by 6MWT. Toxicity was quite negligible and comparable between arms.Conclusions: The results of the present study showed a non-inferiority of arm 1 (two-drug combination) vs arm 2 (two-drug combination + megestrol acetate). Therefore, this simple, feasible, effective, safe, low cost with favorable cost-benefit profile, two-drug approach could be suggested in the clinical practice to implement CACS treatment.

Oral nutritional support in malnourished elderly decreases functional limitations with no extra costs

2011-10-24

Summary: Background & aims: Older people are vulnerable to malnutrition which leads to increased health care costs. The aim of this study was to evaluate the cost-effectiveness of nutritional supplementation from a societal perspective.Design: This randomized controlled trial included hospital admitted malnourished elderly (≥60 y) patients. Patients in the intervention group received nutritional supplementation (energy and protein enriched diet, oral nutritional support, calcium-vitamin D supplement, telephone counselling by a dietician) until three months after discharge from hospital. Patients in the control group received usual care (control). Primary outcomes were Quality Adjusted Life Years (QALYs), physical activities and functional limitations. Measurements were performed at hospital admission and three months after discharge. Data were analyzed according to the intention-to-treat principle and multiple imputation was used to impute missing data. Incremental cost-effectiveness ratios were calculated and bootstrapping was applied to evaluate cost-effectiveness. Cost-effectiveness was expressed by cost-effectiveness planes and cost-effectiveness acceptability curves.Results: 210 patients were included, 105 in each group. After three months, no statistically significant differences in quality of life and physical activities were observed between groups. Functional limitations decreased significantly more in the intervention group (mean difference -0.72, 95% CI-1.15; -0.28). There were no differences in costs between groups. Cost-effectiveness for QALYs and physical activities could not be demonstrated. For functional limitations we found a 0.95 probability that the intervention is cost-effective in comparison with usual care for ceiling ratios >€6500.Conclusions: A multi-component nutritional intervention to malnourished elderly patients for three months after hospital discharge leads to significant improvement in functional limitations and is neutral in costs. A follow-up of three months is probably too short to detect changes in QALYs or physical activities.

Prediction of all-cause mortality by B group vitamin status in the elderly

Yi-Chen Huang, Meei-Shyuan Lee, Mark L. Wahlqvist — 2011-10-24

Summary: Background & aims: Little is known about the direct relationship of B vitamins to mortality in the elderly. All-cause mortality by vitamin B status, using dietary (B-1, B-2, niacin, B-6) or biochemical data (erythrocyte transketolase reductase, erythrocyte glutathione reductase, plasma pyridoxal-phosphate, folate and serum B-12) was evaluated.Methods: The Taiwanese Elderly Nutrition and Health Survey (1999–2000) provided 1747 participants 65 years and over. Dietary and biochemical data were collected at baseline. Survivorship was determined until December 31, 2008.Results: Survivors had higher vitamin B-1 and niacin intakes and pyridoxal-phosphate and folate concentrations. Controlled for confounders, and relative to the lowest tertile of vitamin B-1 or B-6 intakes, the hazard ratios (95% confidence interval) for tertile 3 were 0.74 (0.58–0.95) and 0.74 (0.57–0.97); both p for trend values were <0.05. Further adjustment for dietary diversity led to insignificant findings. For pyridoxal-phosphate, compared to those with deficiency levels, the multivariable-adjusted hazard ratios (95% confidence interval) for adequacy was 0.52 (0.38–0.71) with p for trend <0.0001 and unchanged with dietary diversity adjustment.Conclusions: Higher vitamin B-1 and B-6 intakes and plasma pyridoxal-phosphate were associated with lower risk of mortality up to 10 years and could be achieved by increased dietary diversity.

Integrated nutritional intervention in the elderly after hip fracture. A process evaluation

2011-10-19

Summary: Background & aims: Within a multicentre randomized controlled trial aimed at improving the nutritional status and increase the speed of recovery of elderly hip fracture patients, we performed a process evaluation to investigate the feasibility of the intervention within the present Dutch health care system.Methods: Patients in the intervention group received nutritional counseling during 10 contacts. Oral nutritional supplements were advised as needed until three months after hip fracture surgery. The intervention was evaluated with respect to dieticians’ adherence to the study protocol, content of nutritional counseling, and patients’ adherence to recommendations given.Results: We included 66 patients (mean age of 76, range 55–92 years); 74% women. Eighty-three percent of patients received all 10 contacts as planned, but in 62% of the patients one or more telephone calls had to be replaced by face to face contacts. Nutritional counseling was complete in 91% of contacts. Oral nutritional supplementation was needed for a median period of 76 days; 75% of the patients took the oral nutritional supplements as recommended.Conclusions: Nutritional counseling in elderly hip fracture patients through face to face contacts and telephone calls is feasible. However, individual tailoring of the intervention is recommended. The majority of hip fracture patients needed >2 months oral nutritional supplements to meet their nutritional requirements.The trial was registered at clincialtrails.gov as NCT00523575.

Nutritional risk screening in surgery: Valid, feasible, easy!

Ana Isabel Almeida, Marta Correia, Maria Camilo, Paula Ravasco — 2011-10-19

Summary: Background & aims: We aimed to test the capacity in identifying patients at nutritional risk, by comparing BMI, recent %weight loss,Nutritional Risk Screening 2002(NRS-2002),Malnutrition Universal Screening Tool(MUST) and Nutritional Risk Index(NRI) with Subjective Global Assessment(SGA),considered the Standard. The main purpose was to select the most consistent screening method for effective integration in daily surgical wards’ practice.Methods: 300 surgical patients were assessed at admission: BMI(categorized by WHO’s criteria), weight loss ≥5% in previous 6 months, NRS-2002, MUST, NRI, SGA. Concordances, correlations, sensitivity, specificity, positive(PPV) and negative predictive values(NPV) were calculated to evaluate methods’ performance vs the Standard.Results: Prevalence of nutritional risk was 66% by NRS-2002 + MUST, and 87% by NRI. By SGA, 64% patients were undernourished. All methods agreed with SGA(k = 0.85–0.91,p < 0.001), except BMI & NRI(k = 0.07–0.34,p < 0.05). NRS-2002, MUST and %weight loss effectively detected patients at risk: sensitivity 0.8–0.89, specificity 0.89–0.93, PPV 81%–89%, NPV 89%–100%. Conversely, BMI & NRI were ineffective: sensitivity 0.29–0.43, specificity 0.27–0.39, PPV 24%–35%, NPV 27%–31%; %weight loss alone vs MUST/NRS-2002 was explored: sensitivity 0.79–0.87, specificity 0.85–0.89, PPV 84%–85%, NPV 87%–89%, thus successfully identifying undernutrition risk.Conclusions: In surgical patients, MUST + NRS-2002 are valid for nutritional screening; recent weight loss ≥5% also proved highly efficient; its easy/quick calculation may facilitate adherence/integration by health professionals as a minimum obligatory in clinical practice.

Underestimation of urinary albumin to creatinine ratio in morbidly obese subjects due to high urinary creatinine excretion

2011-10-24

Summary: Background & aims: Albuminuria, a chronic kidney and/or cardiovascular disease biomarker, is currently measured as albumin-to-creatinine ratio (ACR). We hypothesize that in severely obese individuals ACR might be abnormally low in spite of relatively high levels of urinary albumin due to increased creatininuria.Methods: One-hundred-eighty-four subjects were divided into tertiles based on their BMI. Fat-free mass (FFM) and fat-mass were assessed by DEXA; 24-h creatinine and albumin excretion, ACR, lipid profile and blood pressure were measured.Results: Twenty-four-hour creatinine highly correlated (R = 0.75) with FFM. Since both creatininuria and albuminuria increased with the BMI, being the increase in creatininuria preponderant in subjects with BMI>35, their ratio (AC-ratio) did not change significantly from that of subjects in the lower BMI tertile. ACR only correlated with the systolic blood pressure, while both albuminuria and cretininuria correlated (P = 0.01) with the absolute 10-year CHD risk. In subjects with BMI>35, 100 mg of albumin excreted with urine increased the CHD risk of 2%.Conclusions: Albumin-to-creatinine ratio is underestimated in severely obese individuals as a consequence of the large creatininuria, which is proportional to the increased FFM. Therefore, at least in this population 24-h albuminuria should be more reliable than ACR.

Effect of omega-3 polyunsaturated fatty acids to reverse biopsy-proven parenteral nutrition-associated liver disease in adults

Ziwei Xu, Yousheng Li, Jian Wang, Bo Wu, Jieshou Li — 2011-10-12

Summary: Background & aims: Parenteral nutrition-associated liver disease (PNALD) complicates the treatment of patients with short bowel syndrome (SBS). Some studies have shown omega-3 polyunsaturated fatty acids (ω-3 PUFAs) have favorable effects in treating PNALD in children. We, therefore, investigate the effects of ω-3 PUFAs supplemented intravenous lipid emulsion (ILE) on PNALD in adults.Methods: We performed an open-labeled study of a ω-3 PUFAs based ILE in 15 adults with SBS who developed cholestasis while receiving soybean oil-based ILE. Liver biopsies were performed before and after the initiation of ω-3 PUFAs to confirm the presence and improvement of cholestasis. Blood samples were collected every week for analysis of fatty acid composition and liver function.Results: 12 of the 15 patients had their direct bilirubin normalized within 4 weeks and our data demonstrated a significant decrease in both DB (P≤0.001) and TB (P≤0.001) after 4 weeks compared to baseline. There were ameliorations of liver function and fatty acid patterns in all patients and serial liver biopsy specimens showed progressive histologic improvement.Conclusions: Parenteral ω-3 PUFAs supplemented fat emulsions are safe and effective in the treatment of PNALD in adults.

Mental incapacity in hospitalised patients undergoing percutaneous endoscopic gastrostomy insertion

M. Rahman, K.E. Evans, N. Arif, D.A. Gorard — 2011-10-19

Summary: Background & aims: Decisions to insert percutaneous endoscopic gastrostomy (PEG) tubes may be difficult because patients have serious underlying disease, and the procedure has associated risks. Patients may also lack mental capacity to consent to PEG insertion. This study aimed to prospectively determine the prevalence of mental incapacity in hospitalised patients undergoing PEG insertion.Methods: Mental capacity was assessed using the MacArthur Competence Assessment Tool for Treatment (MacCAT-T) in 72 consecutive inpatients referred for PEG insertion. Cognitive function was measured using the Mini-Mental State Examination (MMSE). Sixty eight inpatients and 69 outpatients having diagnostic upper gastrointestinal (UGI) endoscopy were similarly studied.Results: Thirty nine of the PEG patients had suffered stroke, and none had a primary diagnosis of dementia. Seventy four % (53/72) of inpatients referred for PEG, 22% (15/68) of inpatients having UGI endoscopy, and 3% (2/69) of outpatients having UGI endoscopy, lacked mental capacity, p < 0.001. MMSE scores were normal in just 18% of inpatients having PEG, in 72% of inpatients having UGI endoscopy, and in 91% of outpatients having UGI endoscopy, p < 0.001.Conclusion: Amongst inpatients undergoing PEG insertion there is a high prevalence (three-quarters patients) of mental incapacity to consent to this important intervention. Decisions have to be made on behalf of most inpatients referred for PEG insertion.

A combination of calcium phosphate and probiotics beneficially influences intestinal lactobacilli and cholesterol metabolism in humans

Ulrike Trautvetter, Bianka Ditscheid, Michael Kiehntopf, Gerhard Jahreis — 2011-10-05

Summary: Background & aims: The study focuses on the influence of a probiotic supplement alone and in combination with a calcium supplement on faecal lactobacilli colonisation and beneficial health effects such as a lowering of blood cholesterol.Methods: Thirty-two men and women participated in the double-blind, placebo-controlled, cross-over study. All participants consumed a probiotic drink containing 1010CFU/d Lactobacillus paracasei (LPC37) for four weeks. In addition, one group consumed bread enriched with pentacalcium hydroxy-triphosphate (CaP; 1g Ca/d) and the other group had bread without CaP. After a two-week washout and a two-week placebo period, the intervention was switched for further four weeks.Results: After intervention with LPC37+CaP, total cholesterol and LDL-cholesterol concentration in plasma decreased significantly compared to LPC37 and placebo. The faecal concentration of L. paracasei and that of all lactobacilli increased significantly after LPC37+CaP and LPC37 compared to placebo. Moreover, secondary bile acids in faeces increased significantly after LPC37+CaP intervention compared to placebo.Conclusions: CaP modulates the colonisation of LPC37 in the human gut under combinatory supplementation of CaP and LPC37. The combined supplementation also decreases plasma LDL-cholesterol and the LDL/HDL ratio in healthy, moderately hypercholesterolemic men and women, which could be also due to the CaP supplementation.Clinical trial registration number: NCT01033461

Effects of dietary protein on lipid metabolism in high fructose fed humans

Murielle Bortolotti, Julien Dubuis, Philippe Schneiter, Luc Tappy — 2011-10-05

Summary: Background & aims: It has been reported that a high protein diet improves insulin sensitivity and reduces ectopic lipids in animals and humans with the metabolic syndrome. We therefore tested the hypothesis that a high dietary protein content may stimulate whole body lipid oxidation and alter post-prandial triglyceride (TG) after fructose ingestion.Methods: The post-prandial metabolism of 8 young males was studied after two 6-day periods of hyper-energetic, high fructose diet (HiFruD), and after two 6-day periods of hyper-energetic high fructose high protein diet (HiFruHiProD). The order with which these periods were applied was randomized. At the end of each period, either a low protein, 13C fructose test meal (Fru meal) or a high protein, 13C fructose test meal (HiPro Fru meal) was administered. This resulted in the monitoring of metabolic parameters at 4 occasions in random order: a) with Fru meal ingested after HiFruD, b) with HiPro Fru meal ingested after HiFruD, c) with Fru meal ingested after HiFruHiProD or d) with HiPro Fru meal ingested after HiFruHiProD. On each occasion, post-prandial TG concentrations were monitored, energy expenditure and substrate metabolism were measured by indirect calorimetry, and fructose-induced gluconeogenesis was evaluated by measuring plasma 13C-labeled glucose.Results: TG responses to fructose ingestion were significantly higher after a hyper-energetic HiFruHiProD and after HiPro Fru meals than after a Fru meal ingested after a hyper-energetic HiFruD. Compared to low protein meals, high protein meals increased post-prandial energy expenditure, inhibited post-prandial lipid oxidation, and enhanced fructose-induced gluconeogenesis. These effects were similar with HiFruD and HiFruHiProD.Conclusions: Dietary proteins did not increase lipid oxidation and increased fructose-induced post-prandial TG in healthy humans fed an hyper-energetic, high fructose diet.

Effects of the ketogenic diet on nutritional status, resting energy expenditure, and substrate oxidation in patients with medically refractory epilepsy: A 6-month prospective observational study

2011-10-05

Summary: Background & aims: This 6-month prospective, single-arm observational study was designed to assess the effects of the KD on the nutritional status, resting energy expenditure (REE), and substrate oxidation in patients with drug-resistant epilepsy.Methods: Eighteen patients with medically refractory epilepsy underwent assessment of body composition, REE, and substrate oxidation rates before and after 6 months of KD.Results: Compared with baseline, there were no statistically significant differences at 6 months in terms of height, weight, BMI z-scores, and REE. However, the respiratory quotient decreased significantly (from 0.80 ± 0.06 to 0.72 ± 0.05, p < 0.001) whereas fat oxidation was significantly increased (from 50.9 ± 25.2 mg/min to 97.5 ± 25.7 mg/min, p < 0.001). Interestingly, we found that the increase in fat oxidation was the main independent predictor of the reduction in seizure frequency (beta = −0.97, t = −6.3, p < 0.05).Conclusions: Administering a KD for 6 months in patients with medically refractory epilepsy increases fat oxidation and decreases the respiratory quotient, without appreciable changes in REE.

Food insecurity is related to glycemic control deterioration in patients with type 2 diabetes

2011-10-24

Summary: Background & aims: Poor glycemic control has been shown to play a major role in the development and progression of diabetes complications. This cross-sectional study tested the hypothesis that food insecurity may deteriorate glycemic control in patients with type 2 diabetes. The objectives of this study were to assess the prevalence of food insecurity among type 2 diabetics in a major hospital that serves the area of northern Jordan, and to investigate its relation to glycemic control.Methods: A sample of 843 patients diagnosed with type 2 diabetes participated in the study. Socioeconomic and health data were collected by interview-based questionnaire. Weight and height were measured by a trained nutritionist. Dietary assessment was done using food frequency questionnaire. Dietary data were processed using food processor software. Food insecurity was assessed by the short form of the U.S. food security survey module. Glycemic control was assessed by measuring glycosyated hemoglobin (HbA1c). Statistical procedures used to analyze the data were chi-square, and post-hoc analysis of variance.Results: About 22% of the tested sample were food secure (FS); 51% were moderately food insecure (MFIS); and 27% were severely food insecure (SFIS). Higher BMI was associated with SFIS patients. After adjusting for age, gender, income, education, and duration of diabetes, body mass index, and caloric consumption; moderate and severe food insecurity were associated with poor glycemic control (p = 0.04).Conclusion: food insecurity may be associated with glycemic control deterioration in patients with type 2 diabetes.

A novel method based on curvature analysis for estimating the dietary vitamin K requirement in adolescents

2011-10-28

Summary: Background & aims: Few studies have investigated the association between vitamin K status and bone health in adolescents. We established a novel method for estimating the vitamin K status in adolescents by curvature analysis using the serum concentrations of undercarboxylated osteocalcin (ucOC)—a sensitive biomarker of vitamin K status in the bone. We also compared the vitamin K concentrations required for good bone health and for normal blood coagulation.Method: We enrolled 1183 healthy adolescents. For the curvature analysis, we used a logarithmic regression equation obtained from vitamin K intake and serum ucOC or plasma abnormal prothrombin (PIVKA-II) concentrations (marker for blood coagulation). The cut-off point was determined to be the vitamin K intake that showed the highest curvature.Results: In adolescents, the serum ucOC concentration was negatively correlated with vitamin K intake. In the curvature analysis, requirement of vitamin K intake for good bone health and normal blood coagulation were 155–188 μg/d and 62–54 μg/d [1 μg/(kg d)], respectively; the latter result was consistent with that of a previous report.Conclusion: Our novel method is useful for estimating the vitamin K status; moreover, this method showed that bone metabolism requires more vitamin K than blood coagulation.

Reduction of serum lipids by the intake of the extract of garlic fermented with Monascus pilosus: A randomized, double-blind, placebo-controlled clinical trial

2011-10-24

Summary: Background & aims: A dietary supplement containing garlic fermented with Monascus pilosus (MGFE) may be useful to decrease the lipid concentrations in serum without serious adverse effects. The aim of the study was to assess whether MGFE decreases serum lipid contents in volunteers with mild hyperlipidemia in a randomized, double-blind, placebo-controlled, parallel-group trial.Methods: Healthy subjects (n = 55) with serum triglyceride concentrations of 120–200mg/dL were randomly assigned to take either MGFE or placebo capsules for 12wk.Results: A borderline, but not significant effect, to decrease triglyceride concentrations in serum (approximately 15% reduction at maximum, P = 0.062, in time×treatment interaction effect) was observed by the MGFE intake for 12 wk. The decreased reading exhibited a significant difference at wk-8 between the MGFE and placebo groups (unpaired t test, P = 0.007). The total cholesterol (P = 0.003) and LDL cholesterol (P = 0.001) contents in the serum and the LDL/HDL ratio (P < 0.001) were significant in time×treatment interaction effects by the MGFE intake. However, no alteration in the body fat percentage and abdominal circumference was observed.Conclusions: The intake of MGFE decreased triglyceride and cholesterol in serum with no appreciable adverse effects in normal to mildly hyperlipidemic individuals, suggesting that it may be effective to improve and prevent the metabolic syndrome.This clinical trial was registered with Clinicaltrials.gov as NCT00938249.

Tea consumption, incidence and long-term prognosis of a first acute myocardial infarction – The SHEEP study

2011-10-28

Summary: Background & aims: Results of previous studies on tea consumption and incidence or prognosis of acute myocardial infarction (AMI) are conflicting. The aim of the present study was to examine the potential role of tea consumption in the previous 12 months in primary and secondary prevention of AMI.Methods: We studied a total of 1340 individuals with a first non-fatal AMI and 2303 frequency matched control participants on age, gender and hospital catchment area including querying their tea consumption over the previous 12 months. The cohort of AMI cases was then followed for total and cardiac mortality and for non-fatal cardiovascular events with national registers over 8 years. Estimates of relative risks for a first AMI were based on odds ratios from unconditional logistic regression and Cox proportional hazards models were used to examine the prognostic importance of tea consumption in the cohort of cases.Results: The prevalence of daily tea consumption was 20.5% among cases and 21.5% among controls. Tea consumption was associated with a lower risk for a first AMI with adjustment for matching criteria alone, with an odds ratio of 0.78 (95% confidence interval, 0.64–0.95) comparing those who consumed tea daily to those never consuming tea. However, in multivariable adjusted model there was no evidence for an association, the corresponding odds ratio was 1.08(0.86–1.36). There was also no association between tea consumption and cardiac mortality and non-fatal cardiovascular events, with a corresponding adjusted hazard ratio of 0.99(0.77–1.27).Conclusions: In this epidemiological study, greater tea consumption in the previous year was associated with a lower risk of AMI. However, a clear association between tea consumption and the incidence or prognosis of AMI was not demonstrated, probably because of tea drinkers having a healthier lifestyle.

Absence of post-prandial gut anabolism after intake of a low quality protein meal

2011-09-26

Summary: Background & aims: Gut health relates to a diet with a high digestibility and quality. Limited data are available on the acute effects of low quality foods on gut metabolism and the consequences for liver metabolism.Methods: A meal with the low quality protein gelatin (tryptophan deficient and low amount of essential amino acids) was compared to a meal with the high quality protein Whey and a tryptophan supplemented gelatin meal (Gel + TRP) in healthy pigs with chronic implanted catheters. In a conscious state, amino acid, ammonia, urea, glucose and lactate fluxes across the portal drained viscera (PDV) and liver were studied for 6 h after administration of the protein meal.Results: The average net portal appearance of amino acids was 99.8 ± 14.6% of the intake in the Gel group as compared to 61.4 ± 9.0% (p = 0.022) in the Whey group. In addition, a net portal appearance of tryptophan was observed in the Gel group (p = 0.005) of about 42% of tryptophan released in the Whey group. Intestinal energy metabolism and citrulline production was not affected. Adding tryptophan to the Gel meal diminished net portal AA appearance to 41.6 ± 24.0% of the intake (p = 0.012), but did not reduce the stimulated liver urea production.Conclusions: In the post-prandial phase after intake of a low protein quality meal, net anabolism in the healthy intestine is absent. It is likely that the intestine responds with a net breakdown of endogenous (labile) proteins to secure amino acid availability for the body. Addition of the first limiting essential amino acid to this meal improved protein anabolism in the intestine. Protein quality of a meal is related to the anabolic response of the intestine during the meal.

A newly designed enteral formula containing whey peptides and fermented milk product protects mice against concanavalin A-induced hepatitis by suppressing overproduction of inflammatory cytokines

Hisae Kume, Keiko Okazaki, Taketo Yamaji, Hajime Sasaki — 2011-11-04

Summary: Background & aims: We previously reported that whey protein derived from cow milk suppressed inflammation in a variety of animal models. We developed a newly designed enteral formula using peptides prepared from whey protein and fermented milk product and investigated its ability to suppress inflammation in concanavalin A-induced hepatitis in mice.Methods: C57BL/6 mice were fed a standard formula, AIN-93M, or enteral formula for 14 days, and then were intravenously administered concanavalin A. Inflammatory cytokines in plasma, liver, and spleen and markers of hepatic function in plasma were assessed at various time points. Livers were assessed for necrosis and apoptosis.Results: After concanavalin A treatment, plasma aspartate aminotransaminase, alanine aminotransferase, TNF-α, IL-6, and IFN-γ levels were significantly lower in mice fed enteral formula than in those fed standard formula or AIN-93M. Liver TNF-α and IFN-γ, and spleen IL-6 and IFN-γ levels were lower in enteral formula-fed mice than in standard formula-fed mice 2 h after concanavalin A treatment. Necrosis and apoptosis were suppressed in the livers of enteral formula-fed mice.Conclusions: The new enteral formula is a potent novel immune-modulating diet that prevents aggravation of local inflammation by modulating systemic cytokine levels.

Malnutrition syndrome, but not body mass index, is associated to worse prognosis in heart failure patients

Gilberto Fabian Hurtado-Torres, Rosa L. Sandoval-Munro, Anamaria Bravo-Ramirez — 2012-02-02

Colín-Ramirez and coworkers, followed a population with heart failure and examined the relation between, body composition, functional capacity, -expressed mainly through hand grip strength-, and prognosis. It is interesting the finding, body composition, by means of body mass index (BMI), was not correlated with adverse prognosis in HF patients.

Response to the letter to the Editor “Malnutrition syndrome, but not body mass index, is associated to worse prognosis in heart failure patients”

Eloisa Colin-Ramírez, Arturo Orea-Tejeda, Lilia Castillo-Martínez — 2012-02-02

The authors sincerely appreciate Dr. Hurtado’s letter, his interest in our work and comments. Hurtado-Torres G et al. exposes that in our paper addressed to evaluate the prognosis impact of Body Mass Index (BMI) independently of other prognosis factor in a population of patients with stable heart failure, we were not able to demonstrate a poorer prognosis among patients with lower BMI (<20 kg/m2) compared with those obese (BMI ≥30 kg/m2) due to the fact that functional capacity at baseline, evaluated by treadmill exercise testing and expressed as Metabolic Equivalents (METs), was not statistically different among patients across BMI groups, and that both groups fell within the moderate fitness category.