Determining Protein Requirements In The Acutely Ill Patient

2018 ◽  
Author(s):  
L John Hoffer
Keyword(s):  
Muscle Atrophy ◽  
Systemic Inflammation ◽  
Protein Energy Malnutrition ◽  
Clinical Information ◽  
Nutritional Requirements ◽  
Protein Requirement ◽  
Protein Requirements ◽  
Protein Energy ◽  
Key Words Adaptation ◽  
Normal Health

This review discusses protein requirements in disease. It begins by explaining how protein requirements are determined in normal health and the process of nutritional adaptation. It points out the salient features of diseases that increase a patient’s protein requirement, with detailed attention to the effect of systemic inflammation both to increase protein requirements and prevent normal adaptation to starvation. The review also explains and reconciles problems of uncertainty about how much protein to provide to acutely ill patients. Finally, it provides the clinical information and physiologic reasoning necessary to choose appropriate amounts of protein to provide to individual acutely ill patients. This review contains 1 figure and 59 references  Key words: adaptation, cachexia, frailty, hypoalbuminemia, inflammation, malnutrition, muscle atrophy, nutritional requirements, protein-energy malnutrition, protein requirements, systemic inflammation

Alterations In Macronutrient ­Metabolism In Starvation And Disease

2018 ◽  
Author(s):  
L John Hoffer
Keyword(s):  
Weight Loss ◽  
Muscle Atrophy ◽  
Systemic Inflammation ◽  
Protein Energy Malnutrition ◽  
Metabolic Adaptation ◽  
Clinical Approach ◽  
Protein Energy ◽  
Key Words Adaptation ◽  
Disuse Muscle Atrophy ◽  
Involuntary Weight Loss

This review explains starvation as both a physiologic process and a disease. It includes a detailed explanation of the modifying effects of metabolic adaptation and systemic inflammation, as interpreted in a clinical context. It navigates the reader through the difficult shoals of vague and conflicting terminology that burden this topic and provides current definitions and nuanced explanations of the important but frequently misunderstood terms related to starvation and its modifiers and consequences. It provides a succinct explanation of the physiology of total fasting and its clinical correlates. Finally, it explains the interactions among starvation, sarcopenia, frailty, involuntary weight loss, systemic inflammation, cachexia, and disuse muscle atrophy. The multiple and interacting causes of generalized muscle atrophy are pointed out. Inadequate appreciation of these interactions can result in failure to diagnose and treat starvation-induced diseases. A clinical approach to involuntary weight loss is outlined.   This review contains 6 figures, 2 tables and 56 references Key words: adaptation, cachexia, frailty, hypoalbuminemia, inflammation, ketosis, kwashiorkor, malnutrition, marasmus, muscle atrophy, protein-energy malnutrition, sarcopenia, starvation, systemic inflammation, weight loss

scholarly journals Reversal of Neutrophil-to-Lymphocyte Ratio Due to Nutritional Therapy in Lung Abscess Suspected Tuberculosis Patient with Severe Protein-Energy Malnutrition

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 1142-1142
Author(s):  
Christina Rusli ◽  
Nurpudji Taslim ◽  
Nurbaya Syam ◽  
Mardiana Mardiana ◽  
Agussalim Bukhari ◽  
...  
Keyword(s):  
Protein Energy Malnutrition ◽  
Nutritional Therapy ◽  
Lung Abscess ◽  
Severe Malnutrition ◽  
Nutritional Requirements ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Inflammatory Status ◽  
Protein Energy ◽  
Poor Outcomes

Abstract Objectives Severe malnutrition is associated with poor outcomes and higher mortality in Tuberculosis (TB) patients. Due to the inflammatory process, TB patients are in hypercatabolic conditions which caused increased nutritional requirements. Neutrophil-lymphocyte ratio (NLR) is an indicator of inflammatory status that can be used to determine the outcome of TB patients. Methods A 53-year-old male patient with severe protein-energy malnutrition (body mass index 14.5 kg/m,2) suffers from a lung abscess due to tuberculosis (TB) suspected being treated at the infection center of Wahidin Sudirohusodo Hospital, Makassar. Oral intake decreased due to shortness of breath and loss of appetite. Physical examination showed conjunctival anemia, loss of subcutaneous fat, lung rales, and muscle wasting. Laboratory assessments showed hypoalbuminemia (1.8 g/dl), hyponatremia (126 mmol/L), leukocytosis (26,100/ɥl), neutrophilia (19,600/ɥl, Neutrophil-to-Lymphocyte/NLR ratio 4.2), anemia (9,6 g/dl), and elevated liver enzymes (SGOT 90 U/L and SGPT 114 U/L). Results Nutrition therapy was given gradually with a target calorie of 1700–2300 kcal and protein 1.5–2 g/ideal body weight/day using regular food, high protein formula, and amino acids (parenteral nutrition). After 12 days of nutrition treatment, the patient was discharged from the hospital without shortness of breath, adequate nutritional intake, improved anthropometric parameters, and laboratory test results (leukocytes 9000/ɥl, neutrophil 4698/ɥl, NLR 1.6, albumin 3.0 g/dl, Hb 10.5 g/dl, and sodium 135 mmol/L). Conclusions Nutritional therapy is essential in TB patient's hypercatabolic states. By achieving nutritional requirements, there can be changes in the value of Neutrophil-to-Lymphocyte Ratio so that it alters the course and the outcome of TB disease. Severe malnutrition is associated with poor outcomes and higher mortality in Tuberculosis (TB) patients. TB patients are in hypercatabolic conditions due to the inflammatory process so that they have increased nutritional requirements. Neutrophil-lymphocyte ratio (NLR) is an indicator of inflammatory status that can be used to determine the outcome of TB patients. Funding Sources The author(s) received no financial support for the research, authorship, and/or publication of this article.

IMPROVEMENT THE PROPERTIES OF YOGHURT USING LEGUMES TO THERAPY PROTEIN ENERGY MALNUTRITION

2018 ◽  
Vol 3 (5) ◽  
pp. 79-88
Author(s):  
Abtsam M.F. Badr ◽  
D.A.M. Amer ◽  
M.Y.A. El- Hawary ◽  
A.M.A. Naem
Keyword(s):  
Protein Energy Malnutrition ◽  
Protein Energy

scholarly journals Sarcopenic Obesity in Liver Cirrhosis: Possible Mechanism and Clinical Impact

2021 ◽  
Vol 22 (4) ◽  
pp. 1917
Author(s):  
Hiroki Nishikawa ◽  
Hirayuki Enomoto ◽  
Shuhei Nishiguchi ◽  
Hiroko Iijima
Keyword(s):  
Liver Cirrhosis ◽  
Current Knowledge ◽  
Protein Energy Malnutrition ◽  
Public Health Problem ◽  
Diagnostic Value ◽  
Sarcopenic Obesity ◽  
Important Public Health Problem ◽  
Alcoholic Fatty Liver ◽  
Protein Energy ◽  
Clinical Consequences

The picture of chronic liver diseases (CLDs) has changed considerably in recent years. One of them is the increase of non-alcoholic fatty liver disease. More and more CLD patients, even those with liver cirrhosis (LC), tend to be presenting with obesity these days. The annual rate of muscle loss increases with worsening liver reserve, and thus LC patients are more likely to complicate with sarcopenia. LC is also characterized by protein-energy malnutrition (PEM). Since the PEM in LC can be invariable, the patients probably present with sarcopenic obesity (Sa-O), which involves both sarcopenia and obesity. Currently, there is no mention of Sa-O in the guidelines; however, the rapidly increasing prevalence and poorer clinical consequences of Sa-O are recognized as an important public health problem, and the diagnostic value of Sa-O is expected to increase in the future. Sa-O involves a complex interplay of physiological mechanisms, including increased inflammatory cytokines, oxidative stress, insulin resistance, hormonal disorders, and decline of physical activity. The pathogenesis of Sa-O in LC is diverse, with a lot of perturbations in the muscle–liver–adipose tissue axis. Here, we overview the current knowledge of Sa-O, especially focusing on LC.

scholarly journals Dynamic Oral Texture Properties of Selected Indigenous Complementary Porridges Used in African Communities

Foods ◽  
2019 ◽  
Vol 8 (6) ◽  
pp. 221 ◽  
Author(s):  
James Makame ◽  
Tanita Cronje ◽  
Naushad M. Emmambux ◽  
Henriette De Kock
Keyword(s):  
Young Children ◽  
Low Income ◽  
Nutrient Intake ◽  
Control Method ◽  
Protein Energy Malnutrition ◽  
Public Health Problem ◽  
Major Public Health Problem ◽  
Texture Properties ◽  
Protein Energy ◽  
Infants And Young Children

Child malnutrition remains a major public health problem in low-income African communities, caused by factors including the low nutritional value of indigenous/local complementary porridges (CP) fed to infants and young children. Most African children subsist on locally available starchy foods, whose oral texture is not well-characterized in relation to their sensorimotor readiness. The sensory quality of CP affects oral processing (OP) abilities in infants and young children. Unsuitable oral texture limits nutrient intake, leading to protein-energy malnutrition. The perception of the oral texture of selected African CPs (n = 13, Maize, Sorghum, Cassava, Orange-fleshed sweet potato (OFSP), Cowpea, and Bambara) was investigated by a trained temporal-check-all-that-apply (TCATA) panel (n = 10), alongside selected commercial porridges (n = 19). A simulated OP method (Up-Down mouth movements- munching) and a control method (lateral mouth movements- normal adult-like chewing) were used. TCATA results showed that Maize, Cassava, and Sorghum porridges were initially too thick, sticky, slimy, and pasty, and also at the end not easy to swallow even at low solids content—especially by the Up-Down method. These attributes make CPs difficult to ingest for infants given their limited OP abilities, thus, leading to limited nutrient intake, and this can contribute to malnutrition. Methods to improve the texture properties of indigenous CPs are needed to optimize infant nutrient intake.

scholarly journals Study of NT-pro-BNP and Hs-Troponin I biomarkers for early detection of children’s heart function of protein-energy malnutrition

2019 ◽  
Vol 11 (2) ◽  
Author(s):  
Herlina Dimiati ◽  
Abdus Samik Wahab ◽  
Mohammad Juffrie ◽  
Madarina Julia ◽  
Basri A. Gani
Keyword(s):  
Troponin I ◽  
Heart Function ◽  
Protein Energy Malnutrition ◽  
Area Under The Curve ◽  
Left Ventricular ◽  
The Body ◽  
Chromatography Method ◽  
Blood Electrolytes ◽  
Ventricular Mass ◽  
Protein Energy

The Protein Energy Malnutrition (PEM) is the condition of a lack of carbohydrate and protein stores in the body that trigger chronic failure nutrient intake and body maintenance function caused to impact the heart functions. The NT-pro-BNP and Hs- Troponin I proteins were found as the indicator of cardiac dysfunction. The sixty subjects of PEM, analyzed by standard of Indonesia Healt Ministry as well as nutritional status. The blood electrolytes examined by laboratory assay and the levels of Hs-Troponin 1 and NT-Pro-BNP were analyzed by Immune-Chromatography method. Assessing of the ventricular mass with the seeing the peak of the diastolic flow rate of left ventricular that estimated by the curve of the receiver operating characteristic and the area under the curve (P<0.05). The result has shown that the PEM decreased in the left ventricular mass for impaired heart function and systolic disorder. The Hs- Troponin I (90.9%) has better sensitivity than NT-pro-BNP (85.5%) if the merger of those markers possesses the lowest sensitivity (81.8%). These proteins have good biomarkers in heart function, mainly in cases where PEM is present.

scholarly journals Faulty Breast Feeding Practice : A Risk Factor in Malnourished Children

2015 ◽  
Vol 14 (2) ◽  
pp. 43-47
Author(s):  
Sukhendu Shekhar Sen ◽  
Jhulan Das Sharma ◽  
Dhananjoy Das ◽  
Shahed Iqbal ◽  
Md Badruddoza
Keyword(s):  
Breast Feeding ◽  
Protein Energy Malnutrition ◽  
Control Group ◽  
Case Group ◽  
Feeding Practice ◽  
Prelacteal Feeding ◽  
College Hospital ◽  
Major Health Problem ◽  
Protein Energy ◽  
Breast Fed

Background: The predominant form of malnutrition is commonly called proteincalorie malnutrition. Protein Energy Malnutrition (PEM) is still a major health problem in children of developing countries including Bangladesh. The causes of malnutrition are multifactorial including nutritional factors, socioeconomic factors, health status of the mothers and repeated infections in children.Objective: To explore the information regarding the breast feeding practices of children suffering from Protein-Energy Malnutrition.Methods: This case control study was conducted in Chittagong Medical College Hospital from November 2006 to April 2007. A total of 65 controls and 65 cases were selected consecutively for the purpose of the study. Their mothers were interviewed with help of structured questionnaire containing all the variables of interest to attain the study objectives. The test statistics used to analyze the data were descriptive statistics and Chi-square (c2) or Fisher’s Exact Probability Test.Results: A significantly higher frequency of cases (67.7%) were given pre-lacteal feed, predominantly honey and sugar-water compared to control group (41.5%) (p = 0.008). Nearly 100% of controls were given colostrums compared to 75% of the cases. About one-third (31.3%) of the cases was exclusively breast-fed in comparison to 58.5% of the control group (p = 0.003). Over onequarter (27.7%) of the control were breast-fed upto 6 months of age, as opposed to only 1.5% cases (p < 0.001). Duration of predominant breast feeding for more than 6 months of age was also significantly higher in control group than that in case group (p = 0.001). Breast milk substitutes demonstrate their significant presence in cases (38.5%) than that in controls (9%) (p = 0.003).Conclusion: The study showed that rejection of colostrums, practice of prelacteal feeding, delayed initiation of breast feeding, early cessation of exclusive breast feeding and use of formula milk all were significantly higher in the malnourished group of children than those in their normal counterpart.Chatt Maa Shi Hosp Med Coll J; Vol.14 (2); Jul 2015; Page 43-47

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