scholarly journals Does high protein intake cause tubular injury in very preterm neonates?

2021 ◽  
Author(s):  
Henny Adriani Puspitasari ◽  
Partini Pudjiastuti Trihono ◽  
Pustika Amalia Wahidiyat
Keyword(s):  
Protein Intake ◽  
High Protein Diet ◽  
High Protein ◽  
Glomerular Sclerosis ◽  
Preterm Neonates ◽  
Formula Milk ◽  
High Protein Intake ◽  
Neutrophil Gelatinase Associated Lipocalin ◽  
Very Preterm ◽  
Low Protein

Abstract Background: Very preterm birth rate was 10.8% of all preterm in Asia. Early aggressive nutritional strategies in very preterm neonates is important for catching up growth; however, preterm kidneys have fewer, immature functional nephrons. Studies have showed that high protein intake induces nephron hypertrophy, proteinuria, and glomerular sclerosis through single nephron glomerular hyperfiltration (SNGHF), which leads to glomerulotubular injury. Aim: to analyse the correlation between protein intake and glomerulotubular injury in very preterm neonates. Method: A prospective cohort study was conducted in neonatal units of two hospitals in Jakarta. Urine samples were taken three times at post-natal ages 0-48 hours (T1), 72 hours (T2), and 21 days (T3) for determining the urinary neutrophil gelatinase-associated lipocalin to creatinine (uNGAL/Cr) ratio. Protein intake were given in accordance with local guideline while considering the clinical condition of participants. Protein levels from formula milk were recorded daily from 14-21 days of age, while breastmilk protein was measured twice by using a human milk analyser. Urinary NGAL (uNGAL) was tested with an ELISA. Glomerulotubular injury was defined as a uNGAL/Cr ratio ≥1 SD (22.74 ng/mg) at post-natal age 21 days. High protein intake was defined as average protein intake ≥ 3 g/kg/day. Results: Fifty-nine very preterm neonates were recruited, of which 39 completed the study. Glomerulotubular injury was found in 9 of 39 participants (23%). The proportion of glomerulotubular injury in very preterm neonates who had received high protein intake vs low protein intake was 5 of 29 vs 4 of 10 participants, respectively. The median of uNGAL/Cr ratio was not significantly different in the high vs low protein intake group (3.54 (range: 0.69-89.16) ng/mg vs (6.88 (range: 0.32-66.64)) ng/mg, respectively. The uNGAL/C ratio was not correlated with protein intake. However, it was inversely correlated with gestational age and birth weight. Conclusions: The proportion of glomerulotubular injury in very preterm neonates given high protein diet was 5 of 29. The uNGAL/Cr ratio was increased at the post-natal age of 72 hours and decreased in 21 days in both high and low protein intake groups. High protein intake was not correlated with glomerulotubular injury.

scholarly journals Does High Protein Intake Cause Glomerular Injury in Very Preterm Neonates?

2020 ◽  
Author(s):  
Henny Puspitasari ◽  
Partini Trihono ◽  
Pustika Wahidiyat
Keyword(s):  
Protein Intake ◽  
High Protein Diet ◽  
High Protein ◽  
Glomerular Sclerosis ◽  
Preterm Neonates ◽  
Glomerular Injury ◽  
Formula Milk ◽  
High Protein Intake ◽  
Very Preterm ◽  
Low Protein

Abstract Background: Very preterm birth rate was 10.8% of all preterm in Asia. Early aggressive nutritional strategies in very preterm neonates is important for catching up growth; however, preterm kidneys have fewer, immature functional nephrons. Studies have showed that high protein intake induces nephron hypertrophy, proteinuria, and glomerular sclerosis through single nephron glomerular hyperfiltration (SNGHF), which leads to glomerulotubular injury. Aim: to analyse the correlation between protein intake and glomerulotubular injury in very preterm neonates. Method: A prospective cohort study was conducted in neonatal units of two hospitals in Jakarta. Urine samples were taken three times at post-natal ages 0-48 hours (T1), 72 hours (T2), and 21 days (T3) for determining the urinary neutrophil gelatinase-associated lipocalin to creatinine (uNGAL/Cr) ratio. Protein intake were given in accordance with local guideline while considering the clinical condition of participants. Protein levels from formula milk were recorded daily from 14-21 days of age, while breastmilk protein was measured twice by using a human milk analyser. Urinary NGAL (uNGAL) was tested with an ELISA. Glomerulotubular injury was defined as a uNGAL/Cr ratio ≥1 SD (22.74 ng/mg) at post-natal age 21 days. High protein intake was defined as average protein intake ≥ 3 g/kg/day.Results: Fifty-nine very preterm neonates were recruited, of which 39 completed the study. Glomerulotubular injury was found in 9 of 39 participants (23%). The proportion of glomerulotubular injury in very preterm neonates who had received high protein intake vs low protein intake was 5 of 29 vs 4 of 10 participants, respectively. The median of uNGAL/Cr ratio was not significantly different in the high vs low protein intake group (3.54 (range: 0.69-89.16) ng/mg vs (6.88 (range: 0.32-66.64)) ng/mg, respectively. The uNGAL/C ratio was not correlated with protein intake. However, it was inversely correlated with gestational age and birth weight.Conclusions: The proportion of glomerulotubular injury in very preterm neonates given high protein diet was 5 of 29. The uNGAL/Cr ratio was increased at the post-natal age of 72 hours and decreased in 21 days in both high and low protein intake groups. High protein intake was not correlated with glomerulotubular injury.

scholarly journals Protein intake and outcome of critically ill patients: analysis of a large international database using piece-wise exponential additive mixed models

Critical Care ◽  
2022 ◽  
Vol 26 (1) ◽  
Author(s):  
Wolfgang H. Hartl ◽  
Philipp Kopper ◽  
Andreas Bender ◽  
Fabian Scheipl ◽  
Andrew G. Day ◽  
...  
Keyword(s):  
Hospital Discharge ◽  
Critically Ill ◽  
Acute Phase ◽  
Critically Ill Patients ◽  
Protein Intake ◽  
High Protein ◽  
Protein Diet ◽  
High Protein Intake ◽  
Low Protein ◽  
Standard Protein

Abstract Background Proteins are an essential part of medical nutrition therapy in critically ill patients. Guidelines almost universally recommend a high protein intake without robust evidence supporting its use. Methods Using a large international database, we modelled associations between the hazard rate of in-hospital death and live hospital discharge (competing risks) and three categories of protein intake (low: < 0.8 g/kg per day, standard: 0.8–1.2 g/kg per day, high: > 1.2 g/kg per day) during the first 11 days after ICU admission (acute phase). Time-varying cause-specific hazard ratios (HR) were calculated from piece-wise exponential additive mixed models. We used the estimated model to compare five different hypothetical protein diets (an exclusively low protein diet, a standard protein diet administered early (day 1 to 4) or late (day 5 to 11) after ICU admission, and an early or late high protein diet). Results Of 21,100 critically ill patients in the database, 16,489 fulfilled inclusion criteria for the analysis. By day 60, 11,360 (68.9%) patients had been discharged from hospital, 4,192 patients (25.4%) had died in hospital, and 937 patients (5.7%) were still hospitalized. Median daily low protein intake was 0.49 g/kg [IQR 0.27–0.66], standard intake 0.99 g/kg [IQR 0.89– 1.09], and high intake 1.41 g/kg [IQR 1.29–1.60]. In comparison with an exclusively low protein diet, a late standard protein diet was associated with a lower hazard of in-hospital death: minimum 0.75 (95% CI 0.64, 0.87), and a higher hazard of live hospital discharge: maximum HR 1.98 (95% CI 1.72, 2.28). Results on hospital discharge, however, were qualitatively changed by a sensitivity analysis. There was no evidence that an early standard or a high protein intake during the acute phase was associated with a further improvement of outcome. Conclusions Provision of a standard protein intake during the late acute phase may improve outcome compared to an exclusively low protein diet. In unselected critically ill patients, clinical outcome may not be improved by a high protein intake during the acute phase. Study registration ID number ISRCTN17829198

scholarly journals Efficacy and consequences of very-high-protein diets for athletes and exercisers

2011 ◽  
Vol 70 (2) ◽  
pp. 205-214 ◽  
Author(s):  
Kevin D. Tipton
Keyword(s):  
Protein Intake ◽  
High Protein Diet ◽  
Kidney Damage ◽  
High Protein ◽  
Absolute Amount ◽  
Negative Consequences ◽  
High Protein Intake ◽  
High Protein Diets ◽  
Protein Diets ◽  
Very High

Athletes and exercisers have utilised high-protein diets for centuries. The objective of this review is to examine the evidence for the efficacy and potential dangers of high-protein diets. One important factor to consider is the definition of a ‘high-protein diet’. There are several ways to consider protein content of a diet. The composition of the diet can be determined as the absolute amount of the protein (or other nutrient of interest), the % of total energy (calories) as protein and the amount of protein ingested per kg of body weight. Many athletes consume very high amounts of protein. High-protein diets most often are associated with muscle hypertrophy and strength, but now also are advocated for weight loss and recovery from intense exercise or injuries. Prolonged intake of a large amount of protein has been associated with potential dangers, such as bone mineral loss and kidney damage. In otherwise healthy individuals, there is little evidence that high protein intake is dangerous. However, kidney damage may be an issue for individuals with already existing kidney dysfunction. Increased protein intake necessarily means that overall energy intake must increase or consumption of either carbohydrate or fat must decrease. In conclusion, high protein intake may be appropriate for some athletes, but there are potential negative consequences that must be carefully considered before adopting such a diet. In particular, care must be taken to ensure that there is sufficient intake of other nutrients to support the training load.

High protein intake stimulates glomerular prostaglandin formation in remnant kidneys

1987 ◽  
Vol 252 (6) ◽  
pp. F1088-F1094 ◽  
Author(s):  
R. A. Stahl ◽  
S. Kudelka ◽  
U. Helmchen
Keyword(s):  
Dietary Protein ◽  
Protein Intake ◽  
Renal Mass ◽  
Filtration Rate ◽  
High Protein ◽  
Bolus Administration ◽  
Cyclooxygenase Inhibitor ◽  
Synthesis Inhibitor ◽  
High Protein Intake ◽  
Low Protein

Reduction of renal mass in the rat results in an increased glomerular prostaglandin (PG) and thromboxane (TX) formation that modulates renal hemodynamics. To evaluate whether dietary protein intake could exert effects on renal PG and TX formation after reduction of approximately 70% of renal mass, rats with remnant kidneys were placed on either a high-protein (HP) or a low-protein (LP) diet. After 2 wk on the diet, proteinuria, glomerular filtration rate (GFR), urinary PGE2 excretion, and glomerular PGE2, 6-keto PGF1 alpha, and TxB2 biosynthesis were significantly greater in the rats on HP diets. Two-wk administration of the thromboxane synthesis inhibitor UK 38485 reduced renal TxB2 formation by approximately 70%. In addition, chronic UK 38485 treatment significantly inhibited papillary PGE2 production. Neither chronic nor bolus administration of UK 38485 had an effect on proteinuria or GFR in rats on HP diets. Chronic UK 38485 treatment, however, reduced GFR and proteinuria in rats on LP diets. The bolus administration of UK 38485 did not alter GFR in animals receiving a LP diet. The cyclooxygenase inhibitor indomethacin reduced GFR only in rats on HP diets. The data demonstrate that HP intake stimulates renal prostanoid formation. The increased prostaglandin formation on HP intake modulates GFR in these rats.

scholarly journals Effect of resistance training exercise combined with high protein diet on body weight and muscle mass in underweight adolescent males

2021 ◽  
Vol 27 (1) ◽  
pp. 041-052
Author(s):  
Wittawas Sajjapong ◽  
◽  
Preeya Leelahagul ◽  
Sitha Pongphibool ◽  
Narupon Thongsuk ◽  
...  
Keyword(s):  
Body Weight ◽  
Resistance Training ◽  
Protein Intake ◽  
High Protein Diet ◽  
High Protein ◽  
Protein Diet ◽  
Protein Supplements ◽  
High Protein Intake ◽  
Training Exercise ◽  
Resistance Training Exercise

Introduction: Many underweight males take commercial protein supplements to increase their body weight and build muscle. Nonetheless, commercial protein supplements may cause adverse effects. This study aimed to determine the effects of resistance training exercise combined with a high protein diet on body weight and muscle mass in underweight adolescent males. Methods: A repeated measures design study was conducted on nine males aged 12-15 years with low body weight. Energy and protein requirements were calculated, and energy and protein consumptions were measured for each meal during the high protein diet without exercise (HP) period and the high protein diet with resistance exercise (HPE) period. Subjects engaged in three resistance training sessions each week during HP-E period, for eight weeks. Dietary intake, body composition, blood biochemistry, physical fitness, and self-esteem were assessed. Results: In HP-E period, resistance training exercise combined with a high protein intake (2.14 g/kg/d) increased body weight and lean tissue mass (LTM) by 0.5 kg and 0.5 kg, respectively. Resistance training during HP-E period increased arm, leg, and trunk muscle strength by 20.2%, 7.2%, and 14.5%, respectively, more than high protein diet alone during HP period. High protein intake in HP-E period did not affect blood urea nitrogen (BUN) and creatinine levels (11.0 mg/dL and 0.70 mg/dL, respectively). Conclusion: Eight weeks of resistance training combined with a high protein diet increased body weight and LTM without adverse effects. In particular, resistance exercise predominantly increased muscle strength. Kidney function was not affected by high protein consumption throughout this study.

scholarly journals Relative Protein Intake and Physical Function in Older Adults: A Systematic Review and Meta-Analysis of Observational Studies

Nutrients ◽  
2018 ◽  
Vol 10 (9) ◽  
pp. 1330 ◽  
Author(s):  
Hélio Coelho-Júnior ◽  
Luiz Milano-Teixeira ◽  
Bruno Rodrigues ◽  
Reury Bacurau ◽  
Emanuele Marzetti ◽  
...  
Keyword(s):  
Older Adults ◽  
Physical Function ◽  
Physical Functioning ◽  
Protein Intake ◽  
Observational Studies ◽  
Meta Analysis ◽  
High Protein ◽  
High Protein Intake ◽  
Low Protein ◽  
Very High

(1) Background: The present work aims to conduct a systematic review and meta-analysis of observational studies, in order to investigate the association of relative protein intake and physical function in older adults; (2) Methods: Observational studies, that investigated the association between protein intake and physical function in older adults, were retrieved from MEDLINE, SCOPUS, CINAHL, AgeLine, EMBASE, and Cochrane-CENTRAL. Two independent researchers conducted study selection and data extraction; (3) Results: Very high protein intake (≥1.2 g/kg/day) and high protein intake (≥1.0 g/kg/day) groups showed better lower limb physical functioning and walking speed (WS) performance, respectively, in comparison to individuals who present relative low protein (<0.80 g/kg/day) intake. On the other hand, relative high protein intake does not seem to propitiate a better performance on isometric handgrip (IHG) and chair rise in comparison to relative low protein intake. In addition, there were no significant differences in the physical functioning of high and middle protein intake groups; (4) Conclusions: In conclusion, findings of the present study indicate that a very high (≥1.2 g/kg/day) and high protein intake (≥1.0 g/kg/day) are associated with better lower-limb physical performance, when compared to low protein (<0.80 g/kg/day) intake, in community-dwelling older adults. These findings act as additional evidence regarding the potential need to increase protein guidelines to above the current recommendations. However, large randomized clinical trials are needed to confirm the addictive effects of high-protein diets (≥1.0 g/kg/day) in comparison to the current recommendations on physical functioning. All data are available in the Open ScienceFramework.

scholarly journals Inhibitory effect of high protein intake on nephrocalcinogenesis in female rats

1992 ◽  
Vol 67 (2) ◽  
pp. 223-233 ◽  
Author(s):  
J. G. H. Sterck ◽  
J. Ritskes-Hoitinga ◽  
A. C. Beynen
Keyword(s):  
Protein Intake ◽  
Inhibitory Effect ◽  
High Protein ◽  
Female Rats ◽  
High Protein Intake ◽  
Low Protein ◽  
Background Diet ◽  
Calcium Magnesium ◽  
High Protein Diets ◽  
Protein Diets

Increased intakes of protein have been shown to reduce kidney calcification (nephrocalcinosis) in female rats. Two questions were addressed in the present study. First, can protein-induced inhibition of nephrocalcinosis be demonstrated when the diets used are balanced for calcium, magnesium and phosphorus in the added protein? Second, can the protein effect be explained by the frequently observed magnesiuria after giving high-protein diets? Nephrocalcinosis was induced in female rats by giving purified diets containing 151 g casein/kg and either an increased concentration of P (6 v. 2 g/kg) or a decreased concentration of Mg (0·1 v. 0·4 g/kg). To these diets 151 g ovalbumin/kg was added at the expense of glucose, and the diets were balanced for Ca, Mg and P in ovalbumin. The diets were given for 29 d. In rats fed on the diet containing 151 g protein/kg, an increased intake of P or a decreased intake of Mg caused nephrocalcinosis as measured chemically by analysis of kidney Ca as well as histologically by scoring kidney sections stained according to Von Kossa's method. The addition of ovalbumin to the diet prevented the induction of nephrocalcinosis. High P intake and low Mg intake with the low-protein diets induced enhanced loss of albumin in urine, suggesting that nephrocalcinosis caused kidney damage. Increased protein intake with a non-calcinogenic diet also caused increased albumin excretion in urine. Irrespective of the composition of the background diet, increased protein intake caused increased urinary excretion of Mg. When all dietary groups were considered, differences in nephrocalcinosis and urinary Mg output were not proportionally related.Nephrocalcinosis: Phosphorus: Magnesium: Protein: Rat

scholarly journals Protein intake pattern over the day and its association with low total protein intake in Dutch community-dwelling older adults

2020 ◽  
pp. 1-13
Author(s):  
Teuni H Rooijackers ◽  
Marga C Ocké ◽  
Linda M Hengeveld ◽  
Marjolein Visser ◽  
Jolanda MA Boer
Keyword(s):  
Older Adults ◽  
Total Protein ◽  
Protein Intake ◽  
Community Dwelling ◽  
High Protein ◽  
Cross Sectional ◽  
High Protein Intake ◽  
Total Protein Intake ◽  
Low Protein ◽  
Dietary Record

Abstract Objective: Investigate protein intake patterns over the day and their association with total protein intake in older adults. Design: Cross-sectional study utilising the dietary data collected through two non-consecutive, dietary record-assisted 24-h recalls. Days with low protein intake (n 290) were defined using the RDA (<0·8 g protein/kg adjusted BW/d). For each day, the amount and proportion of protein ingested at every hour of the day and during morning, mid-day and evening hours was calculated. Amounts and proportions were compared between low and high protein intake days and related to total protein intake and risk of low protein intake. Setting: Community. Participants: 739 Dutch community-dwelling adults ≥70 years. Results: The mean protein intake was 76·3 (sd 0·7) g/d. At each hour of the day, the amount of protein ingested was higher on days with a high protein intake than on days with a low protein intake and associated with a higher total protein intake. The proportion of protein ingested during morning hours was higher (22 v. 17 %, P < 0·0001) on days with a low protein intake, and a higher proportion of protein ingested during morning hours was associated with a lower total protein intake (P < 0·0001) and a higher odds of low protein intake (OR 1·04, 95 % CI 1·03, 1·06). For the proportion of protein intake during mid-day or evening hours, opposite but weaker associations were found. Conclusions: In this sample, timing of protein intake was associated with total protein intake. Additional studies need to clarify the importance of these findings to optimise protein intake.

Food and protein intake, glucagon, and distribution of alpha-aminoisobutyrate in the rat

1980 ◽  
Vol 238 (4) ◽  
pp. E358-E363
Author(s):  
J. K. Tews ◽  
A. E. Harper
Keyword(s):  
Dietary Protein ◽  
Protein Intake ◽  
Control Diet ◽  
High Protein Diet ◽  
High Protein ◽  
Protein Diet ◽  
Tissue Water ◽  
Low Protein ◽  
Protein Diets ◽  
Different Tissues

Distribution of alpha-aminoisobutyric acid (AIB) in the rat was modified by food, dietary protein, and glucagon. In rats last fed 24 h before AIB injection, AIB clearance from plasma and uptake into liver were greater in rats fed a high-protein diet (60% casein) than in rats fed the control diet (18% casein); AIB clearance from plasma and uptake into muscle were lowered by a low-protein diet (6% casein). Feeding rats lowered clearance of AIB from plasma in low- and high-protein groups. Distribution ratios (AIB concentration in tissue water/AIB in plasma) were low in all tissues but liver during the first 7 h after feeding high protein when compared to the control values; ratios were low in muscle, heart, and kidney after feeding low protein. Maximum ratios occurred at different times for different tissues; the time was delayed by the high-protein diet in all tissues but liver. Glucagon increased all ratios in rats fed the control or low-protein diets, with the smallest changes occurring in liver and muscle from low-protein rats.

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