Cross-sectional study of nutritional intake among patients undergoing tuberculosis treatment along the Myanmar–Thailand border

ObjectiveThis study summarises nutritional intake among patients with tuberculosis (TB) along the Myanmar–Thailand border according to the local diet.SettingTB clinic along the Myanmar–Thailand border.ParticipantsCross-sectional surveys of 24-hour food recall were conducted with participants receiving anti-TB treatment. Participants were purposively selected to reflect proportion of age, sex and HIV co-infection based on historical patient records. Out of a total of 28 participants, 20 (71.4%) were men and 5 (17.9%) were co-infected with HIV.Primary and secondary outcome measuresThe primary outcome compared actual recorded intake to recommended intake. Secondary outcomes compared weight gain and body mass index (BMI) from diagnosis to time of survey.ResultsThere were no significant differences in macronutrient or micronutrient intake by sex or for patients supplementing their rations. Mean treatment length at time of survey was 20.7 weeks (95% CI: 16.5 to 24.8). A significantly higher proportion of women (8/8, 100%) met caloric requirements compared with men (9/20, 45.0%, p=0.010), but few participants met other macronutrient or micronutrient requirements, with no significant differences by sex or for patients supplementing their rations. From diagnosis to the time of the survey, participants averaged significant weight gain of 6.48 kg (95% CI: 3.87 to 9.10) and increased BMI of 2.47 kg/m2 (95% CI: 1.45 to 3.49; p=0.0001 for both). However, 50% (14/28) still had mild or more severe forms of malnutrition.ConclusionsThis cross-sectional survey of nutritional intake in patients undergoing TB treatment in a sanatorium setting demonstrates the difficulty in sufficiently meeting nutritional demands, even when providing nutritional support.

531 The Effect of Burn Wound Size on Caloric Requirements: A Correlation of Nutritional Changes to the Clinical State

Introduction Caloric intake has been a vital component for burn wound healing and recovery. The hypothesis was that caloric requirements are based on injury severity & post-burn week as predicated by indirect calorimetry (IC)/predictive equations. Methods This was a retrospective chart review of 115 burn patients (2012–2017). Caloric requirements were determined by the Curreri equation [which includes % total body surface area (TBSA)] and IC for a 5-week period provided mainly by enteral nutrition. Patients received supplements and total parenteral nutrition as needed. Results The mean ±sd age was 43±18 years, 41±18 % TBSA, Body Mass Index of 28±7 kg/m2, and mortality of 26 (23%). The major mechanisms of injury were flame/flash/explosions. There were 59 (51%) of patients with < 40 % TBSA burns, [median Injury Severity Score (ISS) 9; Apache score 14], and 56 (49%) with ≥40 % TBSA (median ISS 25; Apache score 21), p < .0001. The Respiratory Quotient (RQ) had a median of 0.94 (range 0.79 to 1.02). The median number of surgeries for the < 40 % TBSA group was 5 versus 12 for the ≥40 % TBSA, p < .0001. The Injury Factor did not differ from weeks 1–5 (1.8 for < 40 % TBSA and 2.0 for the ≥ 40 % TBSA). The Curreri equation calculation for this study was a median 3640 (range 2161–5950) calories. The Curreri equation resulted in significantly increased caloric recommendations for the ≥ 40 %TBSA compared to the < 40 %TBSA patients, p < .0001. The < 40 %TBSA group had caloric requirements ranging between 1500- 2700 calories compared to the ≥ 40 %TBSA group, whose calories ranged between 2000–3700. The total daily caloric recommendations were also significantly increased in the ≥40 %TBSA compared to the < 40 %TBSA patients. The maximum levels of resting energy expenditure (REE) from IC, total daily calories recommended by the dietitian and average calories ranged between 3000–4500 in the < 40 %TBSA group and 3600–6700 in the ≥ 40 %TBSA group. The caloric recommendations increased for all patients from week 1 to week 3 and leveled off during weeks 4–5. Conclusions Patient caloric requirements were dependent not only on the severity of the burn injury but also the post-burn hospitalization during which surgeries, debridement/grafting, and infectious complications occurred. They increased until the third week post-burn and leveled off in the recovery period. The study caloric recommendations and requirements were consistent with the REE and Curreri equation assessments.

The Combination of a Diversified Intake of Carbohydrates and Fats and Supplementation of Vitamin D in a Diet Does Not Affect the Levels of Hormones (Testosterone, Estradiol, and Cortisol) in Men Practicing Strength Training for the Duration of 12 Weeks

This study aims to verify the extent to which a diversification of carbohydrates and fats intake in a diet, together with the reduction in vitamin D deficiency, impact the levels of hormones (testosterone, estradiol, cortisol) and Sex Hormone Binding Globulin (SHGB) in men doing strength training. The research involved 55 men aged 19–35. The participants were divided into two groups following two interventional diets for 12 weeks: high-fat diet (LCHF) or high-carb diet (LFHC), which were applied to satisfy the caloric requirements of each participant. Moreover, vitamin D supplementation was included. Moreover, both before and after following interventional diets, the level of hormones in participant’s blood was examined. After 12 weeks of following interventional diets in both groups, no changes of the levels of testosterone and estradiol, as well as SHGB, were found. The cortisol level in both groups decreased; however, only in the LFHC group was the change statistically significant (p = 0.03) and amounted to −3.5% (the cortisol level on an empty stomach in this group decreased from 14.17 ± 3.35 to 13.93 ± 2.63 mcg/dl). In both groups, the supplementation of vitamin D brought about a significant change in the level of vitamin D metabolite (25 (OH) D) (p = 0.01). In the LCHF group, the level of metabolite increased by 95%, and by 58.3% in the LFHC group. The increase in vitamin D metabolite in blood was higher in the LCHF group than the LFHC group, which might have resulted from the supplementation of this vitamin.

EFFECT OF FISH-OIL-ENRICHED INTRAVENOUS LIPID EMULSION ON SYSTEMIC INFLAMMATORY RESPONSE SYNDROME IN POST INTESTINAL SURGERY CHILDREN

Intravenous lipid emulsions (IVLE) is one of the compositions of the parenteral nutrition (PN) that recommended in children who cannot meet their caloric requirements especially after small intestinal surgery and diff erentiated by their infl ammatory eff ects. The fi rst generation IVLE is proinfl ammatory, the second and the third are infl ammatory neutral, while the fourth (fi sh-oil-enriched) is anti-infl ammatory. The objective of this study is to investigate the eff ect of fi shoil enriched IVLE on systemic infl ammatory response syndrome (SIRS) in children after small intestinal surgery. A retrospective study using medical record was undertaken in children after small intestinal surgery admitted Dr. Soetomo Hospital, Surabaya in 2016-2017. Children with duodenal and jejunoileal atresia who had PN for at least three days were included. The types of IVLE used are FOLE and non-FOLE. Defi nition of SIRS was based on International Pediatric Sepsis Consensus Conference in 2005. A total of 25 children were included in this study. There were 44% children received FOLE and 48% received non-FOLE while 8% children received no IVLE. Median duration and dose of IVLE was 8 (5-15,5) days and 1,8 (1,25-2) g/kg/day. SIRS was signifi cantly more common in girls (OR 9 95%CI 1,3-63,0; p=0,036) and in the non-FOLE children (OR 8,0 95% CI 1,24 – 51,50; p=0,022).

Methods for Estimating Energy Expenditure in Critically Ill Adults

Energy expenditure (EE) is the sum of metabolic activity within the body at a given time and comprises basal EE, diet-induced thermogenesis, and physical activity. In the intensive care unit, EE is most often assessed to determine a patient’s caloric requirements. Energy expenditure also may be useful to understand disease states and the metabolic impact of interventions. Several methods for estimating EE are relevant for clinical use, including indirect calorimetry, predictive equations, exhaled carbon dioxide volume, and the Fick method. Indirect calorimetry is the preferred method for evaluating EE and is considered the gold standard for estimating EE in hospitalized patients. However, use of indirect calorimetry is not always practical or possible. Therefore, other methods of estimating EE must be considered. In this review, methods of evaluating EE in critically ill adults are examined and the benefits and limitations of each method are discussed, with practical considerations for use.

Sexual dimorphism in skeletal shape in voles (Arvicolinae): disparate selection on male bodies and female heads

Sexual dimorphism evolves as a response to different selective pressures on males and females. In mammals, sexual selection on traits that improve a male’s ability to compete for access to mates is a common cause of sexual dimorphism. In addition to body mass, adaptations in specific components of the musculoskeletal system that increase strength, stability, and agility, may improve male fighting performance. Here we test the hypotheses that males, when compared to females, are more specialized for physical competition in their skeletal anatomy and that the degree of this sexual dimorphism increases with the intensity of male–male competition. In three species of voles (Cricetidae: Arvicolinae: Microtus), we found partial support for these hypotheses. Male-biased sexual dimorphism in a set of functional indices associated with improved fighting performance was identified in the postcranial anatomy. This dimorphism was greatest in the polygynous Microtus californicus, absent in the monogamous M. ochrogaster, and intermediate in the promiscuous or socially flexible M. oeconomus. However, in the skull, we found results opposite to our predictions. Females had larger skulls relative to overall skeletal size than did males. This may be associated with selection for increased food processing efficiency, which should be highly important because of the compounding effects of increased caloric requirements during gestation and lactation, and the generally low-quality diet of voles. In addition, larger heads in females may be associated with selection for greater digging ability or for defending offspring. These results suggest disparate selective pressures on the postcranial skeletons and skulls of male and female voles.

Influence of Negative Calorie Foods on Atherogenic Indices in Overweight Women

Objective: The present study aimed to determine the effects of diet of negative calorie foods (NCF) on weight, atherogenic lipids, and atherogenic ratio and compare its efficiency with diet of low calorie foods (LCF). Materials and Methods: In this randomized clinical trial, the participants were randomly selected from inactive overweight females (age 45-75 years) by parallel assignment were distributed randomly into two groups: NCF group that received a highcarbohydrate (75%), and low-fat (10%) diet, and LCF group had a dietary recipe with 55% of carbohydrate and a little fat (30%) content. Both groups had a healthy calorie restriction (15%) from their daily caloric requirements within three months. Evaluation of body weight, atherogenic lipids (total-C, HDL-C and LDL-C), and atherogenic ratio (total-C to HDL-C) were performed pre- and postintervention for all subjects and compared to each other. Results: The results of the within-group comparison of NCF and LCF on weight (respectively, P -value= 0.04; P -value= 0.03), total-C (respectively, P -value= 0.02; P -value= 0.03), HDL-C (respectively, P -value= 0.04; P -value= 0.01) and LDL-C (respectively, P -value= 0.01; P -value= 0.03) revealed significant effects. Also, significant differences were observed between groups in atherogenic lipid profile, total-C ( P -value: 0.03), HDL-C ( P -value: 0.001), and LDL-C ( P -value: 0.03). The result of the between-group comparison was also significant in atherogenic ratio ( P -value: 0.04). Conclusion: Contrary to expectation, dietary regimen demonstrated a similar pattern of weight loss in females. The NCF when compared to the LCF, is not a healthy choice for weight loss in sedentary females with overweight.

666 The Effect of Burn Wound Size on Caloric Requirements: A Correlation of Nutritional Changes to the Clinical State

Introduction Caloric intake has been a vital component for burn wound healing and recovery. The hypothesis was that caloric requirements are based on injury severity & post-burn week as predicated by indirect calorimetry (IC)/predictive equations. Methods This was a retrospective chart review of 115 burn patients (2012–2017). Caloric requirements were determined by the Curreri equation [which includes % total body surface area (TBSA)] and IC for a 5-week period provided mainly by enteral nutrition. Patients received supplements and total parenteral nutrition as needed. Results The mean±sd age was 43±18 years, 41±18 % TBSA, Body Mass Index of 28±7 kg/m2, and mortality of 26 (23%). The major mechanisms of injury were flame/flash/explosions. There were 59 (51%) of patients with < 40 % TBSA burns, [median Injury Severity Score (ISS) 9; Apache score 14], and 56 (49%) with ≥40 % TBSA (median ISS 25; Apache score 21), p < .0001. The Respiratory Quotient (RQ) had a median of 0.94 (range 0.79 to 1.02). The median number of surgeries for the < 40 % TBSA group was 5 versus 12 for the ≥40 % TBSA, p < .0001. The Injury Factor did not differ from weeks 1–5 (1.8 for < 40 % TBSA and 2.0 for the ≥ 40 % TBSA). The Curreri equation calculation for this study was a median 3640 (range 2161–5950) calories. The Curreri equation resulted in significantly increased caloric recommendations for the ≥ 40 %TBSA compared to the < 40 %TBSA patients, p < .0001. The < 40 %TBSA group had caloric requirements ranging between 1500- 2700 calories compared to the ≥ 40 %TBSA group, whose calories ranged between 2000–3700. The total daily caloric recommendations were also significantly increased in the ≥40 %TBSA compared to the < 40 %TBSA patients. The maximum levels of resting energy expenditure (REE) from IC, total daily calories recommended by the dietitian and average calories ranged between 3000–4500 in the < 40 %TBSA group and 3600–6700 in the ≥ 40 %TBSA group. The caloric recommendations increased for all patients from week 1 to week 3 and leveled off during weeks 4–5. Conclusions Patient caloric requirements were dependent not only on the severity of the burn injury but also the post-burn hospitalization during which surgeries, debridement/grafting, and infectious complications occurred. They increased until the third week post-burn and leveled off in the recovery period. The study caloric recommendations and requirements were consistent with the REE and Curreri equation assessments. Applicability of Research to Practice There is no constant number of calories for all patients. Caloric requirements are modified by the severity of Burn %TBSA and phases of resuscitation through recovery.

Land Use Scenarios and Their Effect on Potential Crop Production: The Case of Gambella Region, Ethiopia

Agricultural intensification and cropland expansion are the key policies to increase food production in Ethiopia. Gambella is one of the regions in Ethiopia which is highly suitable for agriculture; however, the local people still face food shortages. We therefore investigated the potential for intensification and cropland expansion. In this study, we developed land use scenarios of agricultural intensification and expansion and analysed their effect on potential crop production in the region and estimated the population that could be nourished as a result. We distinguished between different degrees of intensification, ranging from low input rainfed to high input irrigated agriculture and different degrees of expansion, considering the best 30% or 50% of land to be utilized for expansion. While the results reveal that irrigation had almost no effect on potential yields, they also show that the potential calorie production in all scenarios far exceeds the current and possible future caloric requirements of Gambella’s population. For example, for the top 50% expansion scenario, calorie production increased by +428% for the low input and by +1092% for the high input scenarios. Thus, Gambella could nourish up to 21 million people and serve as a bread basket for the entire country, which could improve national food security.