scholarly journals Feasibility of achieving different protein targets using a hypocaloric high-protein enteral formula in critically ill patients

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Pierre Singer ◽  
Itai Bendavid ◽  
Ilana BenArie ◽  
Liran Stadlander ◽  
Ilya Kagan
Keyword(s):  
Critically Ill ◽  
Nitrogen Balance ◽  
High Protein ◽  
Nitrogen Excretion ◽  
Protein Targets ◽  
Protein Target ◽  
Group A ◽  
Group B ◽  
Urinary Nitrogen Excretion ◽  
Urinary Nitrogen

Abstract Background and aims Combining energy and protein targets during the acute phase of critical illness is challenging. Energy should be provided progressively to reach targets while avoiding overfeeding and ensuring sufficient protein provision. This prospective observational study evaluated the feasibility of achieving protein targets guided by 24-h urinary nitrogen excretion while avoiding overfeeding when administering a high protein-to-energy ratio enteral nutrition (EN) formula. Methods Critically ill adult mechanically ventilated patients with an APACHE II score > 15, SOFA > 4 and without gastrointestinal dysfunction received EN with hypocaloric content for 7 days. Protein need was determined by 24-h urinary nitrogen excretion, up to 1.2 g/kg (Group A, N = 10) or up to 1.5 g/kg (Group B, N = 22). Variables assessed included nitrogen intake, excretion, balance; resting energy expenditure (REE); phase angle (PhA); gastrointestinal tolerance of EN. Results Demographic characteristics of groups were similar. Protein target was achieved using urinary nitrogen excretion measurements. Nitrogen balance worsened in Group A but improved in Group B. Daily protein and calorie intake and balance were significantly increased in Group B compared to Group A. REE was correlated to PhA measurements. Gastric tolerance of EN was good. Conclusions Achieving the protein target using urinary nitrogen loss up to 1.5 g/kg/day was feasible in this hypercatabolic population. Reaching a higher protein and calorie target did not induce higher nitrogen excretion and was associated with improved nitrogen balance and a better energy intake without overfeeding. PhA appears to be related to REE and may reflect metabolism level, suggestive of a new phenotype for nutritional status. Trial registration 0795-18-RMC.

Studies on marsupial nutrition. VI. The utilization of dietry urea by the Euro or Hill Kangaroo, Macropus robustus (Gould)

1969 ◽  
Vol 17 (2) ◽  
pp. 187 ◽  
Author(s):  
GD Brown
Keyword(s):  
Nitrogen Balance ◽  
Dietary Protein ◽  
Nitrogen Retention ◽  
Nitrogen Excretion ◽  
Microbial Protein ◽  
Digestive Physiology ◽  
Protein Nitrogen ◽  
Feeding Trials ◽  
Urinary Nitrogen Excretion ◽  
Urinary Nitrogen

Macropod marsupials, the kangaroos and wallabies, are characterized by a ruminant-like digestive physiology. One feature of digestion in eutherian species of ruminants is the ability of these animals to utilize non-protein nitrogen through the conversion of such nitrogen to microbial protein by the microorganisms in the rumen. In the present experiments with the euro or hill kangaroo (M. robustus), the utilization of dietary protein (casein) and non-protein nitrogen (urea) has been compared by means of nitrogen balance feeding trials. No consistent differences between the levels of nitrogen retention and urinary nitrogen excretion were observed for euros fed rations supplemented with either casein or urea. It is suggested that the digestion of nitrogen by the ruminant-like macropod marsupials is similar to that of eutherian species of ruminant herbivores.

EFFECTS OF VITAMIN B12 AND AUREOMYCIN ON NITROGEN RETENTION IN INFANTS

PEDIATRICS ◽  
1954 ◽  
Vol 13 (5) ◽  
pp. 462-475
Author(s):  
ROBERT KAYE ◽  
RONALD H. CAUGHEY ◽  
WALLACE W. MCCRORY
Keyword(s):  
Vitamin B12 ◽  
Nitrogen Retention ◽  
High Protein ◽  
Nitrogen Excretion ◽  
Minimum Requirement ◽  
Beneficial Effects ◽  
Low Protein ◽  
Low Nitrogen ◽  
Urinary Nitrogen Excretion ◽  
Urinary Nitrogen

The effects of vitamin B12 on weight, nitrogen and electrolyte balances were studied in six male infants. Three of the infants were offered nitrogen intakes of approximately 1.0 gm./kg./day, and the remaining three an intake of 0.1 gm./kg./ day. The effects of aureomycin were studied by the same criteria in two of the infants on low nitrogen intakes. The authors were unable to obtain unequivocal evidence that vitamin B12 exerts a nitrogen anabolic effect in infants maintained on constant intakes of high and low protein content. Vitamin B12 administration to the subjects on a high protein intake resulted in an increased urinary nitrogen excretion which may be a reflection of an enhanced rate of conversion of protein into carbohydrate or fat. Averages of the control and B12 period nitrogen retentions and weight gains in gm./kg./day were 0.235 and 11.8 for the high protein-fed subjects, and .011 and 2.4 for the low protein-fed subjects. Aureomycin did not produce beneficial effects on weight or nitrogen retention, but rather showed a tendency to augment fecal nitrogen losses. Appetite stimulation was noted in 2 of the 6 subjects given B12. A nitrogen intake of 0.1 gm./kg./day derived from cow's milk protein approximates the minimum requirement for equilibrium in male infants under the conditions of this study.

Utilization of amino acids by preruminant lambs. I. The effect of alterations in total essential amino acid intake at constant nitrogen intake

1977 ◽  
Vol 28 (5) ◽  
pp. 917 ◽  
Author(s):  
H Dove ◽  
GR Pearce ◽  
DE Tribe
Keyword(s):  
Amino Acids ◽  
Protein Synthesis ◽  
Nitrogen Balance ◽  
Control Diet ◽  
Essential Amino Acids ◽  
Conclusive Evidence ◽  
Metabolizable Energy ◽  
Nitrogen Excretion ◽  
Urinary Nitrogen Excretion ◽  
Urinary Nitrogen

Male crossbred lambs weighing 12.5 kg (period 1), 20 kg (period 2) and 30 kg (period 3) were infused per abomasum with milk-based diets in which crude protein (CP) and energy contents were constant at a given Iiveweight, but in which the proportion of CP supplied as essential amino acids (EAA) varied from 120 to 876 g EAA/kg CP. Responses in liveweight gain, nitrogen balance and metabolizable energy (ME) intake (period 1 only) were measured. A number of lambs died while receiving diets containing very high or very low proportions of EAA. Possible reasons for these deaths are discussed. In all periods liveweight gains were greatest in lambs given the control diet (513 g EAA/kg CP). In period 1 this liveweight gain was close to that expected on the basis of energy intake, but in periods 2 and 3, liveweight gains on the control diets were less than anticipated. Reductions in liveweight gain were greater for diets containing low proportions of EAA than those containing high proportions. The infusion of diets containing low proportions of EAA markedly increased urinary nitrogen excretion. The effect of diets containing high proportions was less pronounced. As a result of these effects, lambs given the control diet had the highest daily nitrogen balance in all periods. Nitrogen balance was less severely affected by the dietary changes than liveweight gain, particularly with 30 kg lambs. It is suggested that the reduced retention of apparently digested nitrogen in diets other than the control diets reflected the unsuitability of the pattern of absorbed amino acids for protein synthesis. The effect of diet on the components of energy balance in period 1 was less pronounced than its effect on nitrogen balance. The metabolizability of apparently digested energy was lower in diets other than the control diet, especially those containing low proportions of EAA. This is attributed to the energy cost of increased urinary nitrogen excretion on such diets. Alternative interpretations of the results are discussed, and it is suggested that dietary amino acids will be utilized most efficiently for protein synthesis by the tissues of the lamb when essential and non-essential amino acids are provided in approximately equal proportions. There was no conclusive evidence that this optimum proportion was different for older lambs.

Influences of diet and body condition on the nitrogen utilization in the cow

1972 ◽  
Vol 79 (2) ◽  
pp. 323-329 ◽  
Author(s):  
R. Paquay ◽  
R. De Baere ◽  
A. Lousse
Keyword(s):  
Body Condition ◽  
Nitrogen Balance ◽  
Live Weight ◽  
The Body ◽  
Metabolizable Energy ◽  
Nitrogen Excretion ◽  
Maintenance Requirements ◽  
Energy Maintenance ◽  
Urinary Nitrogen Excretion ◽  
Urinary Nitrogen

SUMMARYThe dietary and individual factors influencing the utilization of digestible nitrogen in the dry cow were studied with numerous rations fed to Friesian cows kept in metabolism stalls.Urinary nitrogen excretion and nitrogen balance were above all influenced by the level of digestible nitrogen intake. They are also correlated to metabolizable energy and digestible potassium intakes.Endogenous urinary nitrogen, estimated by extrapolation, was 30·6 mg N/kg body weight/d or 0·169 W0·73 g/d with the rations meeting approximately the energy maintenance requirements of the cow.The changes in diet accounted for 80% of the variability of nitrogen balance.A method was worked out for calculating the body condition of the cow from the live-weight variations.The changes in body condition accounted for 11% of the variability of nitrogen balance.

Effect of starch on the utilization by sheep of a straw diet supplemented with urea and minerals

1976 ◽  
Vol 27 (1) ◽  
pp. 139 ◽  
Author(s):  
JG Mulholland ◽  
JB Coombe ◽  
WR McManus
Keyword(s):  
Organic Matter ◽  
Nitrogen Retention ◽  
Nitrogen Excretion ◽  
Digestible Organic Matter ◽  
Cellulose Digestibility ◽  
Oat Straw ◽  
Total Body ◽  
Body Energy ◽  
Urinary Nitrogen Excretion ◽  
Urinary Nitrogen

Individually penned Border Leicester x Merino wethers, aged 11 months, were fed ad lib. for 16 weeks on a basal ration of ground, pelleted oat straw, urea and minerals, supplemented with 0, 5, 10, 15, 20, 30 or 40% starch. The diets contained equal percentages of nitrogen and minerals. Dry matter intake reached a maximum of 2000 g/day with 30% starch; above this starch level, digestive disturbances were observed. Organic matter digestibility was increased by the addition of starch, but cellulose digestibility was depressed by as much as 18 units with the addition of 30% starch. Up to 10% the starch level had little effect on cellulose digestibility. Liveweight change was significantly correlated with digestible organic matter intake, mean daily weight gains varying from 22 g with no starch to 104 g with 30% starch. However, a large percentage of the liveweight gain was as total body water, and body energy storage increased appreciably only when the diet contained at least 20% starch. The inclusion of 5% starch slightly depressed both intake and liveweight gain. Daily clean wool production was significantly increased at starch levels higher than 20% and ranged from 5.3 to 7.5 g/day with 0 and 40% starch respectively. Increasing levels of starch had little effect on apparent nitrogen digestibility, but resulted in a substantial increase in nitrogen retention through a reduction in urinary nitrogen excretion. Serum urea levels fell from a mean of 42 mg/100 ml during the first week to 31 mg/100 ml during subsequent periods, with no significant differences between diets. With the general exception of potassium, mineral balances were positive or close to zero throughout the experiment.

Branched-Chain Amino Acids, Nitrogen Excretion and Injury in Man

1976 ◽  
Vol 50 (5) ◽  
pp. 393-399 ◽  
Author(s):  
J. H. Wedge ◽  
R. De Campos ◽  
A. Kerr ◽  
R. Smith ◽  
Rose Farrell ◽  
...  
Keyword(s):  
Amino Acids ◽  
Venous Blood ◽  
Branched Chain Amino Acids ◽  
Nitrogen Excretion ◽  
Adult Males ◽  
Blood Concentrations ◽  
Branched Chain ◽  
Injured Patients ◽  
Urinary Nitrogen Excretion ◽  
Urinary Nitrogen

1. Venous blood concentrations of the branched-chain amino acids, valine, leucine and isoleucine, and urinary nitrogen excretion have been measured in sixteen adult males, from 2 h to 7 days after injury, and in four adults after elective skin grafts. 2. In the injured group the concentrations of these amino acids rose significantly 24 h after injury and had doubled at 4 days and remained high; in contrast the skin-graft patients showed no significant change. 3. In those injured patients with initial hyperketonaemia, defined as more than 0·2 mmol/l, the increase in concentrations of branched-chain amino acids at the fourth and seventh days after injury was significantly less than in those with normoketonaemia, and was accompanied by lower urinary nitrogen excretion throughout the whole period. 4. It is suggested that the changes in the concentration of branched-chain amino acids after injury indicate decreased uptake by muscle or excessive release due to an imbalance between protein synthesis and protein catabolism in this tissue.

scholarly journals Association of protein intake with the outcomes of critically ill patients: a post hoc analysis of the PermiT trial

2018 ◽  
Vol 108 (5) ◽  
pp. 988-996 ◽  
Author(s):  
Y M Arabi ◽  
H M Al-Dorzi ◽  
S Mehta ◽  
H M Tamim ◽  
S H Haddad ◽  
...  
Keyword(s):  
Propensity Score ◽  
Critically Ill ◽  
Nitrogen Balance ◽  
Critically Ill Patients ◽  
Protein Intake ◽  
Nitrogen Excretion ◽  
Post Hoc Analysis ◽  
Lower Protein ◽  
Protein Group ◽  
Post Hoc

ABSTRACT Background The optimal amount of protein intake in critically ill patients is uncertain. Objective In this post hoc analysis of the PermiT (Permissive Underfeeding vs. Target Enteral Feeding in Adult Critically Ill Patients) trial, we tested the hypothesis that higher total protein intake was associated with lower 90-d mortality and improved protein biomarkers in critically ill patients. Design In this post hoc analysis of the PermiT trial, we included patients who received enteral feeding for ≥3 consecutive days. Using the median protein intake of the cohort as a cutoff, patients were categorized into 2 groups: a higher-protein group (>0.80 g · kg–1 · d–1) and a lower-protein group (≤0.80 g · kg–1 · d–1). We developed a propensity score for receiving higher protein. Primary outcome was 90-d mortality. We also compared serial values of prealbumin, transferrin, 24-h urinary nitrogen, and 24-h nitrogen balance on days 1, 7, and 14. Results Among the 729 patients included in this analysis, the average protein intake was 0.8 ± 0.3 g · kg–1 · d–1 [1.0 ± 0.2 g · kg–1 · d–1 in the higher-protein group (n = 365) and 0.6 ± 0.2 g · kg–1 · d–1 in the lower-protein group (n = 364); P < 0.0001]. There was no difference in 90-d mortality between the 2 groups [88/364 (24.2%) compared with 94/363 (25.9%), propensity score–adjusted OR: 0.80; 95% CI: 0.56, 1.16; P = 0.24]. Higher protein intake was associated with an increase in 24-h urea nitrogen excretion compared with lower protein intake, but without a significant change in prealbumin, transferrin, or 24-h nitrogen balance. Conclusions In the PermiT trial, a moderate difference in protein intake was not associated with lower mortality. Higher protein intake was associated with increased nitrogen excretion in the urine without a corresponding change in prealbumin, transferrin, or nitrogen balance. Protein intake needs to be tested in adequately powered randomized controlled trials targeting larger differences in protein intake in high-risk populations.

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