Augmented Renal Clearance, Muscle Catabolism and Urinary Nitrogen Loss: Implications for Nutritional Support in Critically Ill Trauma Patients

The main objective of this pilot study was to determine the association between augmented renal clearance (ARC), urinary nitrogen loss and muscle wasting in critically ill trauma patients. We conducted a retrospective analysis of a local database in 162 critically ill trauma patients without chronic renal dysfunction. Nutritional-related parameters and 24 h urinary biochemical analyses were prospectively collected and averaged over the first ten days after admission. Augmented renal clearance was defined by a mean creatinine clearance (CLCR) > 130 mL/min/1.73 m2. The main outcome was the cumulated nitrogen balance at day 10. The secondary outcome was the variation of muscle psoas cross-sectional area (ΔCSA) calculated in the subgroup of patients who underwent at least two abdominal CT scans during the ICU length of stay. Overall, there was a significant correlation between mean CLCR and mean urinary nitrogen loss (normalized coefficient: 0.47 ± 0.07, p < 0.0001). ARC was associated with a significantly higher urinary nitrogen loss (17 ± 5 vs. 14 ± 4 g/day, p < 0.0001) and a lower nitrogen balance (−6 ± 5 vs. −4 ± 5 g/day, p = 0.0002), without difference regarding the mean protein intake (0.7 ± 0.2 vs. 0.7 ± 0.3 g/kg/day, p = 0.260). In the subgroup of patients who underwent a second abdominal CT scan (N = 47), both ΔCSA and %ΔCSA were higher in ARC patients (−33 [−41; −25] vs. −15 [−29; −5] mm2/day, p = 0.010 and −3 [−3; −2] vs. −1 [−3; −1] %/day, p = 0.008). Critically ill trauma patients with ARC are thus characterized by a lower nitrogen balance and increased muscle loss over the 10 first days after ICU admission. The interest of an increased protein intake (>1.5 g/kg/day) in such patients remains a matter of controversy and must be confirmed by further randomized trials.

PSXI-14 Enteric methane and nitrogen emissions in cattle consuming tanniferous and non-tanniferous legumes, grass or a ration

Incorporation of legumes into forage systems has been a widely adopted strategy to increase pasture productivity and forage nutritive value, while reducing N inputs. In addition, some legumes contain beneficial chemicals like condensed tannins (CT), which could enhance the efficiency of energy and protein use in ruminants relative to other forages. We assessed (i) animal performance, (ii) methane emissions (SF6 technique), and (iii) concentration of nitrogen in urine and blood in cattle grazing a CT-containing legume (birdsfoot trefoil; BFT), a legume without tannins (cicer milkvetch; CMV), a grass (meadow brome; MB), or in cattle fed a total mixed ration (TMR). Fifteen Angus heifers were randomly assigned to one of three treatment pastures: (1) BFT, (2) CMV, and (3) MB. Each treatment had 5 spatial replications, randomly divided into three paddocks (64 × 57m), seeded with BFT, CMV or MB, and one heifer was assigned to each paddock. Five Angus heifers were randomly assigned to individual adjacent pens and received a TMR ration (25% of alfalfa hay, 25% corn silage and 50% chopped barley) during the same period. Response variables were analyzed as a split-plot design, with experimental units as the random factor and treatment as a fixed factor with day as the repeated measure. Cows grazing BFT (1.9% condensed tannins) or fed the TMR showed greater weight gains than cows grazing CMV or MB (P = 0.0006). Methane emissions did not differ among treatments (P &gt; 0.05; Table 1). Blood urea nitrogen concentrations were similar in cows grazing BFT or CMV (P = 0.1202), but greater than in animals grazing MB or fed TMR (P &lt; .0001). Urinary nitrogen concentrations were similar among treatments (P = 0.5266). These results suggest grazing tanniferous legumes enhanced BW gains with similar methane and urinary nitrogen emissions to grass and confinement alternatives and greater levels of production than grass or CMV.

Metabolic Benefit of Bulls Being Fed Moringa Leaves Twigs and Branches as a Major Concentrate Ingredient

The study was conducted to investigate nutrient metabolism and semen quality of bulls fed with moringa (Moringa oleifera) leaves, twigs, and branches as a major concentrate ingredient. Twenty-one Red Chittagong bulls of about 204 (±50) kg initial live weight (LW) were randomly divided into three equal LW groups. They were fed maize silage as a basal feedstuff for 65 days with the supplementation of concentrate mixtures at 1% of LW, consisting of either 0, 25, or 50% moringa mash on a fresh basis. Moringa mash was a sun-dried ground preparation of leaves, twigs, and branches of moringa. The results indicated that different levels of moringa in concentrate mixtures (0, 25, and 50%) did not change daily DM intake, digestibility, and LW gain of bulls (p &gt; 0.05). However, increasing dietary moringa (up to 203 g/kg DM) significantly decreased production cost of methane (CH4) (methane emission [kg/kg gain] = 1.6422—[0.0059 × moringa intake, g/kg DM], n = 12, R2 = 0.384, P = 0.032) in a similar metabolizable energy intake level (0.21 ± 0.01 MJ/kg LW). Also, higher dietary moringa significantly reduced urinary nitrogen loss (urinary nitrogen [% digested nitrogen] = 43.0 – 0.069 × moringa intake [g/kg DM]; R2 = 0.3712, P = 0.034). Thus, increasing moringa by 1 g/kg DM decreased CH4 emission by 6 g/kg gain and absorbed nitrogen loss by 0.069 %. Also, progressive motility of sperm increased significantly (33.0, 51.0, and 60.1%, respectively; p = 0.03) in bulls fed with concentrate mixtures containing moringa at 0, 25, or 50%. It may be concluded that feeding moringa mash at 203 g/kg DM may decrease energy loss as methane and urinary nitrogen loss without impacting the production of beef cattle. Feeding moringa mash to beef cattle may abate dietary energy and nitrogen loss and consequently decrease the environmental pollution.

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

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.

Development and external validation of the “Flower-FFQ”: a food frequency questionnaire designed for the Lifelines Cohort Study

Objective: Food frequency questionnaires (FFQs) assess habitual dietary intake and are relatively inexpensive to process, but may take up to 60 minutes to complete. This article describes the validation of the Flower-FFQ, which consists of four short FFQs measuring the intake of energy and macronutrients or specific (micro)nutrients/foods that can be merged into one complete daily assessment using predefined algorithms. Design: Participants completed the Flower-FFQ and validated regular-FFQ (n=401). Urinary nitrogen (n=242) and potassium excretions (n=361) were measured. We evaluated: 1) group-level bias, 2) correlations, and 3) cross-classification. Setting: Observational study. Participants: Dutch adults, 54±11(mean±SD) years. Results: Flower-FFQ1, Flower-FFQ2, Flower-FFQ3, and Flower-FFQ4 were completed in ±24, 9, 8 and 9 minutes (±50 minutes total), respectively. The regular-FFQ was completed in ±43 minutes. Mean energy (flower vs. regular: 7953 vs. 8718 kJ/day) and macronutrient intakes (carbohydrates: 204 vs. 222 g/day; protein: 75 vs. 76 g/day; fat: 74 vs. 83 g/day; ethanol: 8 vs. 12 g/day) were comparatively similar. Spearman correlations between Flower-FFQ and regular-FFQ ranged from 0.60-0.80 for macronutrients and from 0.40-0.80 for micronutrients and foods. For all micronutrients and foods, ≥78% of the participants classified in the same/adjacent quartile. The flower-FFQ underestimated urinary nitrogen and potassium excretions by 24% and 18%; 75% and 73% of the participants ranked in the same/adjacent quartile. Conclusion: Completing the Flower-FFQ required 50 minutes with a maximum of 25 minutes per short FFQ. The Flower-FFQ has a moderate to good ranking ability for most nutrients and foods and performs sufficiently to study diet-disease associations.

Effects of ractopamine hydrochloride on nutrient digestibility and nitrogen excretion of finishing beef cattle

The objective was to quantify the effects of the beta-adrenergic agonist (β-AA) ractopamine hydrochloride (Actogain, Zoetis, Parsippany, NJ) on nitrogen excretion and nutrient digestibility in feedlot cattle. In experiment 1, twelve Simmental × Angus steers were blocked by bodyweight (531 ± 16 kg) and used in a randomized complete block design. Dietary treatments included: 1) a control without β-AA (CON) or 2) 400 mg/steer/d ractopamine hydrochloride (RAC) for 35 d before slaughter. Diets contained (DM basis) 55% dry rolled corn, 20% corn silage, 15% modified wet distillers grains with solubles, and 10% supplement. For each block, total collection of feed, orts, feces and urine were conducted for two 5 d sampling periods during week 2 and 4 of RAC supplementation. No interaction (P &gt; 0.21) between treatment and collection period was observed for any parameter evaluated. Dietary treatment had no effect (P = 0.51) on DMI, but RAC had decreased fecal DM output (P = 0.04) compared with CON. Thus, RAC had greater apparent total tract DM digestibility (77.2 vs. 73.5%; P &lt; 0.01), N digestibility (72.4 vs. 69.4%; P = 0.01), and NDF digestibility (65.6 vs. 60.2%; P &lt; 0.01) than CON. Although treatment did not affect nitrogen intake (P = 0.52), RAC tended to reduce total nitrogen excretion (113.3 vs. 126.7 g/d; P = 0.10) compared with CON due to a tendency for decreased fecal nitrogen output (53.9 vs. 61.3 g/d; P = 0.10). However, dietary treatment had no effect (P = 0.53) on urinary nitrogen output or percentage of urinary nitrogen excreted as urea (P = 0.28). Experiment 2 was an in vitro experiment conducted to validate the effects of RAC on nutrient digestibility using Simmental × Angus heifers (451 ± 50 kg). Rumen fluid was collected individually by stomach tube from CON- (n = 9) and RAC-fed (n = 10) heifers to inoculate bottles containing a CON or RAC-containing substrate in a split-plot design. No interaction between rumen fluid source and in vitro substrate was observed. Greater IVDMD (P = 0.01) was observed in rumen fluid from RAC-fed heifers compared with rumen fluid from CON-fed heifers. Inclusion of RAC in the in vitro substrate increased IVDMD (P &lt; 0.01). Overall, feeding RAC increased microbial digestion of the dry-rolled corn-based finishing diet to increase total tract dry mater digestion by 5% and reduce nitrogen excretion by 10.6% in the 35 d period prior to slaughter.

Functional diversity vs monotony: The effect of a multi-forage diet as opposed to a single forage diet on animal intake, performance, welfare, and urinary nitrogen excretion

The objective of this study was to determine the effect of offering animals a multi-forage choice of fresh herbages on dry matter intake (DMI), live weight gain and animal welfare, in comparison with a monotonous diet of ryegrass (Lolium perenne L.). Twenty ram lambs [30.5 ± 0.9 kg initial live weight; mean ± standard error of the mean], were randomly allocated to either a diet consisting of diverse multi-forage choice (MF) or a single forage ryegrass (SF) diet (n = 10 per treatment) for 35 days. Both diets were fed ad libitum; however, the MF diet was composed of set dry matter ratios of: 24% chicory (Cichorium intybus L.), 30% lucerne (Medicago sativa L.), 25% plantain (Plantago lanceolata L.), and 21% ryegrass. The DMI of the MF lambs was 48% greater (P &lt; 0.01) and the within animal day-to-day coefficient of variation (CV) of intake was 26% lower (P &lt; 0.01) than the SF lambs. The average daily gain (ADG) of lambs offered the MF diet was 92% greater (P &lt; 0.01) than the lambs offered the SF diet. The within animal day-to-day CV of intake was negatively related with ADG (r = -0.59: P &lt; 0.01). The MF lamb’s urinary N concentration was 30% lower (P &lt; 0.01) than that of the SF lambs. The SF lambs spent more time (P &lt; 0.05) exhibiting stereotypic behaviors in the afternoon and spent more time observing other animals than the MF. Overall, allocating a multi-forage choice of fresh herbages as opposed to a single forage diet of ryegrass increases DMI and thereby animal performance, while potentially reducing urinary N excretion.

Nutrient intake and digestibility of selected browse plants fed in combination with Panicum maximum to West African dwarf (WAD) bucks

A study was conducted to evaluate nutrient intake and digestibility of Panicum maximum fed in combination with selected browse plants to West African dwarf (WAD) bucks. Four intact West African dwarf (WAD) bucks of mean body weight 17.50kg were used to conduct digestibility study in a 4 x 4 Latin Square design experiment. Four forage combinations, diets A, B, C and D were fed to the goats. Diet A, the control, was 100% Panicum maximuni, while diets B, C and D contained 60% Panicum maximum each plus 40% of Alchornea cordifolia, Manniophyton fulvum and Gmelina arborea, respectively. The study lasted 56 days in a 14 day x 4 change over periods. Data were collected on dry matter intake (DMI), nutrient intake and digestibility. Simple linear regression and correlation were used to assess the degree of relationship between some of the digestion components. The result of proximate analysis indicated that the diets (P. max + browse) B, C and D had significantly (p<0.05) higher dry matter (%DM) contents of 81.12, 81.09 and 80.68%, respectively, than the 75.71% for diet A (sole P.max). Crude protein content of 17.56, 15.62 and 17.52%, respectively were also higher (p<0.05) than the 8.38%for diet A. There was higher (p<0.05) ether extract content of 2.43, 2.38 and 2.32%, for diets B, C, and D, respectively than the 1.32% for diet A. The ash content of 10.71, 9.78 and 9.76% for diets B, C and D respectively, were also higher (p<0.05) than the 7.83% for diets A. Metabolizable energy (MJKg-1) values of 1.41, 1.42 and 1.42 for diets B, C and D were also higher (p<0.05) than the 1.31 for diet A. However, the crude fibre value of the diet A (27.26%) was significantly (p<0.05) higher than the 18.30, 19.30 and 18.58% for diets B, C and D. respectively. There were significant (p<0.05) differences in DMI among treatment means. Vitro significantly (p<0.05) higher for animals fed diets B(15.04). C(13.12 ) and D(14.48 ) wherein P.max was fed in combination with browse plants than in the diet A( 6.28) group fed sole Pmax. Faecal nitrogen showed no significant (p>0.05) difference among treatment means. Urinary nitrogen was significantly (p<0.05) higher in diet A group (0.39) than in diets B (0.30), C (0.34) and D (0.43) groups. There was positive nitrogen balance for all in the treatment groups. Apparent nitrogen digestibility (%) was significantly (p<0.05) higher in diets B (92.37). C (90.51) and D (97.63) groups than in diet A (79.49). Nitrogen intake (g/d) could not reliably predict faecal nitrogen (g/kgDM) in diets C and D groups. Absorbed nitrogen (g/d/WKg0.75) could not predict urinary nitrogen (g/d/WKg0.75) in any of the diets. Biological value (BV) of the diets were A (55), B (45), C (81) and D (97). The result of this study shows that the animals fed P. max + browse recorded higher DMI, nutrient intake and digestibility than the sole P.max diet. These evaluation indices were, however, mostly better in the diet B group (60% P.maximum + 40% Alchornea cordifolia). The combination of 60% P. maximum + 40% Alchornea cordifolia is therefore recommended for West African dwarf (WAD) goats reared in the humid tropics of Nigeria for optimum intake and improved nutrient utilization.