Meeting the nutritional requirements of hospitalized patients: an interdisciplinary approach to hospital catering

The study served to assure the quality of our catering, to locate problems, and to define further optimization measures at the Bern University Hospital. The main objective was to investigate whether the macronutrient and energy content of the hospital food complies with the nutritional value calculated from recipes as well as with the recommendations issued by the German Nutrition Society (DGE).

THE INFLUENCE OF DIET COMPOSITION, PLANT DEFENSIVE CHEMICALS, AND WINTER SEVERITY ON THE NUTRITIONAL CONDITION OF A FREERANGING, GENERALIST HERBIVORE

Herbivory requires animals to manage intake of toxic phytochemicals. Detoxification and excretion of these chemicals prevents toxicity, but is energetically expensive. I investigated the relationship between investment in detoxification and nutritional condition for moose on Isle Royale National Park (Alces alces) during winter, using urinary indices from urine samples collected in snow. The ratio of urinary urea nitrogen:creatinine is an indicator of nutritional condition, and the ratio of glucuronic acid:creatinine is an indicator of investment in detoxification. Nutritional condition declined with greater investment in detoxification. An alternative means of managing defensive chemical intake is to diversify the diet. Microhistological analysis of fecal pellets determined diet composition. Diet diversity was weakly associated with improved nutritional condition. However, the strongest predictors of nutritional condition were winter severity and proportion of balsam fir in the diet (a dominant food for moose in this ecosystem).

Severe hepatotoxicity following ingestion of Herbalife nutritional supplements contaminated with Bacillus subtilis

BACKGROUND/AIMS: Nutritional supplements are widely used. Recently, liver injury after consumption of Herbalife preparations was reported but the underlying pathogenesis remained cryptic. METHODS: Two patients presented with cholestatic hepatitis and pruritus, and cirrhosis, respectively. Viral, alcoholic, metabolic, autoimmune, neoplastic, vascular liver diseases and synthetic drugs as the precipitating causes of liver injury were excluded. However, both patients reported long-term consumption of Herbalife products. All Herbalife products were tested for contamination with drugs, pesticides, heavy metals, and softeners, and examined for microbial contamination according to standard laboratory procedures. Bacteria isolated from the samples were identified as Bacillus subtilis by sequencing the 16S rRNA and gyrB genes. RESULTS: Causality between consumption of Herbalife products and disease according to CIOMS was scored "probable" in both cases. Histology showed cholestatic and lobular/portal hepatitis with cirrhosis in one patient, and biliary fibrosis with ductopenia in the other. No contamination with chemicals or heavy metals was detected, and immunological testing showed no drug hypersensitivity. However, samples of Herbalife products ingested by both patients showed growth of Bacillus subtilis of which culture supernatants showed dose- and time-dependent hepatotoxicity. CONCLUSIONS: Two novel incidents of severe hepatic injury following intake of Herbalife products contaminated with Bacillus subtilis emphasize its potential hepatotoxicity.

Early percutaneous endoscopic gastrostomy insertion maintains nutritional state in patients with aerodigestive tract cancer

Patients with upper aerodigestive tract (UAT) cancers often suffer from malnutrition and compromised functional ability. We compared clinical outcome with percutaneous endoscopic gastrostomy (PEG) tube feeding begun at two different time points. The records of 151 patients with UAT carcinomas were reviewed retrospectively. We included patients undergoing radical radiochemotherapy and PEG tube feeding. Subjects were evaluated before PEG insertion and at the end of the treatment. Patients (n=15, 100%) were divided into two groups according to the presence (group A) or absence (group B) of mucositis. Group A (51.7% of patients) received early PEG: before or within 2 wk of radiotherapy. Group B (48.3%) received delayed PEG: between 2 wk and 3 mo after the start of radiotherapy. Mean weight loss was 1.03 kg in group A vs. 4.0 kg in group B, P=0.004. Treatment interruptions were significantly (P=0.01) more common in group B. Early PEG placement at the beginning of radiochemotherapy in patients with UAT tumors maintains the patient's nutritional state and reduces treatment interruptions.

Relationships between structural and functional measures of nutritional status in a normally nourished population

Both anthropometric and functional measurements have been used in nutritional assessment and monitoring. Hand dynamometry is a predictor of surgical outcome and peak expiratory flow rate has been used as an index of respiratory muscle function. This study aims to measure in normal subjects the relationship between anthropometric measurements, voluntary muscle strength by hand grip dynamometry and respiratory muscle function by peak expiratory flow rate.

Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials

A system for screening of nutritional risk is described. It is based on the concept that nutritional support is indicated in patients who are severely ill with increased nutritional requirements, or who are severely undernourished, or who have certain degrees of severity of disease in combination with certain degrees of undernutrition. Degrees of severity of disease and undernutrition were defined as absent, mild, moderate or severe from data sets in a selected number of randomized controlled trials (RCTs) and converted to a numeric score. After completion, the screening system was validated against all published RCTs known to us of nutritional support vs spontaneous intake to investigate whether the screening system could distinguish between trials with a positive outcome and trials with no effect on outcome.

Evaluation of a Mixture of Corn Steep Liquor and Distillers Solubles as a Replacement for Corn and Supplement in Cattle Finishing Diets

Finishing yearling steers fed a corn-based diet containing steep liquor had statistically similar live performance as steers fed the control diet. Numerically steers fed the steep containing diet were 6% more efficient. Steers fed steep liquor tended to contain less carcass fat (as measured by intramuscular marbling) less kidney, heart and pelvic fat, and less backfat thickness. When priced at $50/ton adding steep liquor at 10% of diet dry matter reduced feed cost for gain 9%.

Evaluation of Proteferm® as a Nitrogen Supplement for Finishing Steers

Proteferm is a liquid by-product from the production of monosodium glutamate by fermentation that is 40% solids and contains 95% crude protein on a dry basis. Two trials were conducted with yearling steers to study the effects of different levels of Proteferm when added to 90% concentrate diets to replace corn and urea. Feeding Proteferm resulted in a decrease in urine pH, suggesting a metabolic acidosis that was probably caused by a negative cation–anion balance. Correcting the cation–anion imbalance resulted in an increase in feed intake and the performance of steers fed Proteferm as 1.5% of diet dry matter to be similar to the performance of control steers. Addition of sodium bicarbonate to the control diet or to the diet containing 1.5% Proteferm to produce a positive cation–anion balance did not improve performance. The results of these trials indicate that 1.5% Proteferm is the maximum that should be added to high concentrate diets fed to beef cattle without affecting performance or carcass value.

Effect of Yeast Supplement on Performance of Steer Calves

The effect of Prosponse® yeast supplement fed to newly arrived steers was evaluated at the ISU Armstrong Research Farm near Lewis, Iowa. Four pens of approximately 32 head were fed similar diets with 2 pens receiving yeast supplement and 2 pens not. Calves were weighed on delivery to the feedlot and allocated on weight and sire. Calves were on test 34 days. There was no effect on daily gain or feed to gain. Dry matter intake trended higher for the yeast supplemented calves (P=.10). These data suggest that yeast supplement may improve dry matter intake in newly arrived feedlot calves.

Use of Stockpiled Berseem Clover as a Supplement for Grazed Corn Crop Residues

In the fall of 1994, mature Charolais cross cows in midgestation were allotted to duplicate 15 acre fields containing corn crop residues or a 2-to-1 mixture of corn crop residues and berseem clover planted in 3 strips at an allowance of 2.5 acres/cow for a 140 day wintering season. Similar cows were allotted duplicate drylots. All cows were fed hay as necessary to maintain a body condition score of 5. Cows grazing corn crop residues with or without berseem clover required 2596 pounds less hay per cow than cows maintained in a drylot. There was no difference in the amounts of hay required by cows grazing corn crop residues alone or with berseem clover. Initial organic matter yield of berseem clover was nearly that of corn crop residues and did not decrease as rapidly as corn crop residues. Berseem clover had a higher organic matter digestibility than corn crop residues at the initiation of grazing. Organic matter digestibility of berseem clover, however, decreased more rapidly than corn crop residues because of weathering during the winter.

Avant-garde or supplement? Advisory bodies of transnational associations as alternatives to the League’s Minority Protection System, 1919-1939

This exegesis focuses on the work of minority committees of transnational associations in the interwar period. Most of their members considered the League system to be inefficient and supported the establishment of non-state alternatives, which included private investigations on the spot, publicity for specific problems of minorities, and attempts to reconcile representatives of ethnic minorities with those of the majority. Members of non-involved states were pre-destined especially to act as neutral moderators. Only those in close contact with League officials avoided being misused by political forces that did not seek reconciliation but border revision. They learnt that the League rules looked inadequate from the outside but turned out to be useful in coming to applicable solutions once they started their own alternative methods. Their publications and investigative journeys turned out to deepen the problems, whilst their reconciliation work became an appreciated supplement of the League system.

Protein deficiency and the growing rat lung. I. Nutritional findings and related lung volumes

We investigated the consequences of early malnutrition on milk production by dams and on body weight and structural lung growth of young rats using two models of protein restriction. Dams of the early restriction group were fed an 8% casein diet starting at parturition. Those of the delayed restriction group received a 12% casein diet from lactation d 8-14 and thereafter the 8% diet. After weaning, early restriction and delayed restriction group rats were maintained on low protein until d 49, then refed the control diet (18% casein) up to d 126. Milk was analyzed on d 12. Animals were killed at d 21, 49, and 126 for lung fixation in situ. In this report, we show that protein restriction lowered milk yield to 38% of normal. Milk lipid per gram of dry weight tended to be increased, whereas lactose and protein were significantly decreased. Pups from protein-restricted dams grew less and had lower lung volumes, effects being more serious at d 49. However, specific lung volumes (in milliliters per 100 g body weight) were constantly increased. This means that lung was either less affected than body mass or overdistended due to less connective tissue. After refeeding, both groups showed a remarkable catch-up in growth with restoration of the normal allometric relationship between lung volume and body weight. Thus, even after an early onset of protein restriction to total body, the lung is still capable to substantially recover from growth retardation.

Pilot Project: Use of Wikis to Supplement Student Orientation

Background: During the orientation process, new students are often inundated with manuals, maps, and other materials essential to their success as students. The experience can leave students feeling overwhelmed, unable to sift through the substantial amount of information that has been given to them. Wikis, in contrast, are well-suited for facilitating userinteraction with vast amounts of diverse information. [See PDF for complete abstract]