ESPEN Guidelines on Enteral Nutrition: Intensive care.

Enteral nutrition (EN) via tube feeding is, today, the preferred way of feeding the critically ill patient and an important means of counteracting for the catabolic state induced by severe diseases. These guidelines are intended to give evidence-based recommendations for the use of EN in patients who have a complicated course during their ICU stay, focusing particularly on those who develop a severe inflammatory response, i.e. patients who have failure of at least one organ during their ICU stay. These guidelines were developed by an interdisciplinary expert group in accordance with officially accepted standards and are based on all relevant publications since 1985. They were discussed and accepted in a consensus conference. EN should be given to all ICU patients who are not expected to be taking a full oral diet within three days. It should have begun during the first 24h using a standard high-protein formula. During the acute and initial phases of critical illness an exogenous energy supply in excess of 20-25 kcal/kg BW/day should be avoided, whereas, during recovery, the aim should be to provide values of 25-30 total kcal/kg BW/day. Supplementary parenteral nutrition remains a reserve tool and should be given only to those patients who do not reach their target nutrient intake on EN alone. There is no general indication for immune-modulating formulae in patients with severe illness or sepsis and an APACHE II Score >15. Glutamine should be supplemented in patients suffering from burns or trauma.

Energy deficit and length of hospital stay can be reduced by a two-step quality improvement of nutrition therapy: the intensive care unit dietitian can make the difference.

OBJECTIVE: Critically ill patients are at high risk of malnutrition. Insufficient nutritional support still remains a widespread problem despite guidelines. The aim of this study was to measure the clinical impact of a two-step interdisciplinary quality nutrition program. DESIGN: Prospective interventional study over three periods (A, baseline; B and C, intervention periods). SETTING: Mixed intensive care unit within a university hospital. PATIENTS: Five hundred seventy-two patients (age 59 ± 17 yrs) requiring >72 hrs of intensive care unit treatment. INTERVENTION: Two-step quality program: 1) bottom-up implementation of feeding guideline; and 2) additional presence of an intensive care unit dietitian. The nutrition protocol was based on the European guidelines. MEASUREMENTS AND MAIN RESULTS: Anthropometric data, intensive care unit severity scores, energy delivery, and cumulated energy balance (daily, day 7, and discharge), feeding route (enteral, parenteral, combined, none-oral), length of intensive care unit and hospital stay, and mortality were collected. Altogether 5800 intensive care unit days were analyzed. Patients in period A were healthier with lower Simplified Acute Physiologic Scale and proportion of "rapidly fatal" McCabe scores. Energy delivery and balance increased gradually: impact was particularly marked on cumulated energy deficit on day 7 which improved from -5870 kcal to -3950 kcal (p < .001). Feeding technique changed significantly with progressive increase of days with nutrition therapy (A: 59% days, B: 69%, C: 71%, p < .001), use of enteral nutrition increased from A to B (stable in C), and days on combined and parenteral nutrition increased progressively. Oral energy intakes were low (mean: 385 kcal*day, 6 kcal*kg*day ). Hospital mortality increased with severity of condition in periods B and C. CONCLUSION: A bottom-up protocol improved nutritional support. The presence of the intensive care unit dietitian provided significant additional progression, which were related to early introduction and route of feeding, and which achieved overall better early energy balance.

Prevalence of iodine inadequacy in Switzerland assessed by the estimated average requirement cut-point method in relation to the impact of iodized salt.

OBJECTIVE: To assess the iodine status of Swiss population groups and to evaluate the influence of iodized salt as a vector for iodine fortification. DESIGN: The relationship between 24 h urinary iodine and Na excretions was assessed in the general population after correcting for confounders. Single-day intakes were estimated assuming that 92 % of dietary iodine was excreted in 24 h urine. Usual intake distributions were derived for male and female population groups after adjustment for within-subject variability. The estimated average requirement (EAR) cut-point method was applied as guidance to assess the inadequacy of the iodine supply. SETTING: Public health strategies to reduce the dietary salt intake in the general population may affect its iodine supply. SUBJECTS: The study population (1481 volunteers, aged ≥15 years) was randomly selected from three different linguistic regions of Switzerland. RESULTS: The 24 h urine samples from 1420 participants were determined to be properly collected. Mean iodine intakes obtained for men (n 705) and women (n 715) were 179 (sd 68.1) µg/d and 138 (sd 57.8) µg/d, respectively. Urinary Na and Ca, and BMI were significantly and positively associated with higher iodine intake, as were men and non-smokers. Fifty-four per cent of the total iodine intake originated from iodized salt. The prevalence of inadequate iodine intake as estimated by the EAR cut-point method was 2 % for men and 14 % for women. CONCLUSIONS: The estimated prevalence of inadequate iodine intake was within the optimal target range of 2-3 % for men, but not for women.

L'insuffisance rénale chronique: quelle est la diète optimale

The optimal diet for chronic kidney disease (CKD) is an issue frequently brought up by patients and/or their relatives during outpatient visits. For patients without malnutrition who are motivated and supported by an experienced multidisciplinary team, the optimal protein intake of 0,6 g/kg of ideal body weight/day is recommended to halt the progression of CKD. A calorie intake of 30 to 35 kcal/kg of ideal body weight/day is necessary to reduce the risk of malnutrition from a low protein diet and to maintain a neutral nitrogen balance. A low-salt diet, namely 5 to 6 g/d, is useful to optimize the treatment of hypertension associated with CKD and to limit fluid overload. At the advanced stage of CKD, it is also necessary to restrict the intake of phosphorus and sometimes potassium. Given the complexity of optimal renal diet, coordination between general practitioners, nephrologists and dietitians is essential to foster optimal care.

Interaction between the mineral content and the occurrence number of aquatic fungi in leaves submerged in a stream in the Atlantic rainforest, São Paulo, Brazil

Leaves of Ficus microcarpa L. f., Quercus robur L., and Alchornea triplinervia (Spreng.) Muell. Arg., submerged in a stream of the Atlantic rainforest in the "Reserva Biológica do Alto da Serra de Paranapiacaba", State of São Paulo, Brazil, were collected monthly, from April to November 1990, in order to determine the number of fungal occurrences (zoosporic fungi and aquatic Hyphomycetes), and the content of total N (%), total P (%), K+ (%), Ca+2 (%), Mg+2 (%), S+3 (%), Fe+3 (ppm), Cu+3 (ppm), Mn+2 (ppm), Zn+2 (ppm), Bo (ppm), Na+2 (ppm) and Al+3 (ppm). According to the tests of Kruskal-Wallis, Mann-Whitney and Wilcoxon, the means of the mineral content of the three types of leaves were significantly different, except for Mg+2 (%), Mn+2 (ppm), Zn+2 (ppm) and Na+2 (ppm). On comparing the mineral content with the number of fungal occurrence, an independence test showed a positive correlation between the presence of zoosporic fungi on the leaves of A. triplinervia and the total nitrogen, phosphorus and S+3 content, whereas the aquatic Hyphomycetes depended on the amount of Ca+2 available. Regarding leaves of F. microcarpa, the occurrence of zoosporic fungi was linked to the S+3 level, and the presence of aquatic Hyphomycetes, to the content of K+, Ca+2, S+3 and Bo. On Q. robur leaves, zoosporic fungi showed a positive correlation with the Ca+2 content, but a negative one with Fe+3 and Al+3 levels, while the occurrence of aquatic Hyphomycetes was influenced by the content of Ca+2, Mg+2, Fe+3, Al+3, Mn+2, Zn+2 and Na+2. The correlation between the occurrence number of aquatic Hyphomycetes and a high mineral content indicates that their nutritional requirements may be more complex than those of zoosporic fungi. Further studies are still required to understand the implications of this tendency on the diversity of aquatic native mycota.

L'adaptation des agriculteurs vivriers du Sénégal au changement climatique : cas de la communauté rurale de Sessène

Le Sénégal est situé dans une zone soudano-sahélienne particulièrement exposée aux changements du climat, ce dernier rendant l’agriculture, activité principale du pays, précaire. La modification des conditions climatiques, en particulier depuis la fin des années 1960, a fortement affaibli le secteur agricole, majoritairement vivrier et pluvial. Face à l’importance de l’activité agraire vivrière du pays, il apparaît primordial de savoir comment les agriculteurs vivriers du Sénégal ont modifié ou prévoit modifier leurs pratiques en vue de satisfaire leurs besoins alimentaires dans un contexte de changement et de variabilité du climat. Cette étude a été effectuée au sein de la communauté rurale de Sessène selon une approche qualitative et à l’aide d’entretiens, de l’observation participante et d’analyse phénoménologique. Elle a permis de mettre en avant les caractéristiques générales des familles agraires et des exploitations de cette zone, de montrer comment les agriculteurs ont vécu le changement climatique et comment ils envisagent les prochaines années et enfin de discuter de leur capacité d’adaptation. Face au raccourcissement de la saison des pluies, à la diminution des précipitations, à l’intensification des évènements extrêmes et aux impacts de ces modifications sur l’environnement naturel, les agriculteurs vivriers adoptent des mesures aussi bien techniques que socio-économiques.

Ecological and Biochemical Studies On Cyanobacteria of Cochin Estuary and Their Application as Source of Antioxidants

The main objectives of the present investigation were to evaluate the qualitative and quantitative distribution of natural cyanobacterial population and their ecobiological properties along the Cochin estuary and their application in aquaculture systems as a nutritional supplement due to their nutrient-rich biochemical composition and antioxidant potential. This thesis presents a detailed account of the distribution of cyanobacteria in Cochin estuary, an assessment of physico-chemical parameters and the nutrients of the study site, an evaluation of the effect of physico-chemical parameters on cyanobacterial distribution and abundance, isolation, identification and culturing of cyanobacteria, the biochemical composition an productivity of cyanobacteria, and an evaluation of the potential of the selected cyanobacteria as antioxidants against ethanol induced lipid peroxidation. The pH, salinity and nutritional requirements were optimized for low-cost production of the selected cyanobacterial strains. The present study provides an insight into the distribution, abundance, diversity and ecology of cyanobacteria of Cochin estuary. From the results, it is evident that the ecological conditions of Cochin estuary support a rich cyanobacterial growth.

Varying the dietary supply of C and N to manipulate the manure composition of water buffalo heifers in Oman

Optimizing the composition of manure has the potential to reduce nutrient losses to the environment and to increase crop yields. In this study the effect of dietary ratios of carbon (C) to nitrogen (N) and neutral detergent fibre (NDF) to soluble carbohydrates (SC) on faeces composition of water buffalo heifers was assessed. Two digestibility trials were conducted with 12 animals each, fed one control and four test diets composed to achieve (1) high C/N and high NDF/SC ratios (HH), (2) low C/N and low NDF/SC ratios (LL), (3) high C/N and low NDF/SC ratios (HL) and (4) low C/N and high NDF/SC (LH) ratios. Faecal C/N ratios were generally lower than dietary C/N ratios, but the reduction was especially large for high C/N ratio diets (HH=55 %, HL=51 %). Faecal N concentration was positively correlated (r^2 = 0.6; P < 0.001) with N intake, but the increase in faecal N was more pronounced for diets that supplied low amounts of N. Faecal NDF concentration was positively related to NDF intake (r^2 = 0.42; P < 0.001), as well as the faecal C/N ratio (r^2 = 0.3; P < 0.001). Results demonstrate that C/N ratio and NDF concentration of buffalo manure were affected by diet composition. Diets with high C/N ratio and low NDF/SC ratio are preferable with regard to manure quality, but may not satisfy the nutritional requirements of producing animals, since N concentration in these diets was low and fibre concentration simultaneously high.

Evaluación de tecnologías sanitarias aplicada a la selección de un módulo de proteína para uso hospitalario

Introducción: La evaluación de tecnologías en salud aplicadas a la selección de un módulo de proteína para uso hospitalario, tiene como finalidad servir de apoyo en la elección de productos costo efectivos y seguros, con el fin de favorecer la toma de decisiones a los diferentes agentes que participan en la elección de alternativas terapéuticas, recomendadas en pacientes con necesidades elevadas de proteínas, como es el caso de la presente investigación. Objetivo: Aplicar un método matemático - multicriterio que permita evaluar los módulos de proteína disponibles en el mercado para la terapia nutricional institucional. Métodos: Se establecieron dos fases, una revisión de la literatura para establecer y priorizar los criterios de evaluación técnica de las diferentes ofertas de módulos de proteína, y dos se realizó una aplicación de un modelo matemático con el fin de considerar el modulo proteico para uso dentro de las instituciones hospitalarias, el cual consistió en la asignación de un valor a cada una de las variables mediante una escala diferencial semántica establecida, que permitieron calcular el peso porcentual de cada una de las variables, cuya sumatoria arrojo la calificación porcentual de cada alternativa. Resultados: Respecto a la búsqueda de criterios de evaluación técnica para las diferentes ofertas de módulos de proteína, en la literatura se identificaron las siguientes variables para evaluación, la naturaleza o equivalencia, condiciones de administración y uso, seguridad, y eficacia. La naturaleza se evaluó mediante la calificación del cómputo químico de aminoácidos corregido por digestibilidad proteica (PDCAAS) con un peso en la evaluación del 39.05%, en referencia a las condiciones de administración y uso se tuvo en cuenta factores incluidos en los sistemas de distribución por dosis unitaria con un peso del 27.61%, la eficacia fue definida por la tasa de eficiencia proteica (PER) la cual impacta el 19.53% de la calificación y finalmente, el criterio de seguridad con un 13.81% referente al empaque y etiquetado. Conclusiones: Al realizar la evaluación de cuatro alternativas de módulos de proteína, ofertadas por las diferentes casas farmacéuticas, la mayor puntuación correspondiente a las alternativas con una calificación superior al 90%, la obtuvieron dos alternativas de módulos de proteína para uso hospitalario, las cuales contienen proteínas del suero (“Whey”) y aminoácidos en combinaciones.

Major advances in fundamental dairy cattle nutrition

Fundamental nutrition seeks to describe the complex biochemical reactions involved in assimilation and processing of nutrients by various tissues and organs, and to quantify nutrient movement (flux) through those processes. Over the last 25 yr, considerable progress has been made in increasing our understanding of metabolism in dairy cattle. Major advances have been made at all levels of biological organization, including the whole animal, organ systems, tissues, cells, and molecules. At the whole-animal level, progress has been made in delineating metabolism during late pregnancy and the transition to lactation, as well as in whole-body use of energy-yielding substrates and amino acids for growth in young calves. An explosion of research using multicatheterization techniques has led to better quantitative descriptions of nutrient use by tissues of the portal-drained viscera (digestive tract, pancreas, and associated adipose tissues) and liver. Isolated tissue preparations have provided important information on the interrelationships among glucose, fatty acid, and amino acid metabolism in liver, adipose tissue, and mammary gland, as well as the regulation of these pathways during different physiological states. Finally, the last 25 yr has witnessed the birth of "molecular biology" approaches to understanding fundamental nutrition. Although measurements of mRNA abundance for proteins of interest already have provided new insights into regulation of metabolism, the next 25 yr will likely see remarkable advances as these techniques continue to be applied to problems of dairy cattle biology. Integration of the "omics" technologies (functional genomics, proteomics, and metabolomics) with measurements of tissue metabolism obtained by other methods is a particularly exciting prospect for the future. The result should be improved animal health and well being, more efficient dairy production, and better models to predict nutritional requirements and provide rations to meet those requirements.

Walking in a winter wonderland? Strategies for Early and Middle Pleistocene survival in mid-latitude Europe

Any occupation of northern Europe by Lower Palaeolithic hominins, even those occurring during full interglacials, must have addressed the challenges of marked seasonality and cold winters. These would have included the problems of: wind-chill and frostbite; duration, distribution and depth of snow-cover; reduced daylight hours; and distribution and availability of animal and plant foods. Solutions can essentially be characterised as a ‘stick or twist’ choice: i.e. year-round presence on a local scale vs. extensive annual mobility. However these options, and the ‘interim’ strategies that lie between them, present various problems, including maintaining core body temperature, meeting the energetic demands of mobility, coping with reduced resource availability and increasing patchiness, and meeting nutritional requirements. The feasibility of different winter survival strategies are explored with reference to Lower Palaeolithic palaeoenvironmental reconstructions and on-site behavioural evidence. Emphasis is placed upon possible strategies for (i) avoiding the excessive lean meat protein problem of ‘rabbit starvation’ (e.g. through exploitation of ‘residential’ species with significant winter body fat and/or by targeting specific body parts, following modern ethnographic examples, supplemented by the exploitation of winter plants); and (ii) maintaining body temperatures (e.g. through managed pyrotechnology, and/or other forms of cultural insulation). The paper concludes with a suggested winter strategy.

A comparative study of cleaning activity of two reef fishes at Fernando de Noronha Archipelago, tropical West Atlantic

Cleaner fishes are usually classified as obligate or facultative cleaners according to their diet and the extent to which their nutritional requirements in the different ontogenetic stages are gained from cleaning. While obligate cleaners clean throughout their lives and ingest mainly food taken from the clients` body surface, facultative cleaners clean only as juveniles and have a broader diet. In addition, some facultative cleaners may experience a relatively higher predation risk, and thus rarely interact with piscivorous fishes. Despite these acknowledged differences, there are very few studies that compare cleaning activity of obligate and facultative cleaners within the same area. Cleaning activity of the obligate cleaner goby Elacatinus cf. randalli and the facultative cleaner wrasse Thalassoma noronhanum were comparatively examined at Fernando de Noronha Archipelago, tropical West Atlantic. The client assemblage attended by the two cleaners differed, as the goby attended a slightly greater diversity of species (22), mostly piscivores and zoobenthivores, and the wrasse attended fewer species (19), mostly planktivores. Chromis multilineata was the most common client species of both cleaners, although body size (which is expected to be positively correlated to clients` ectoparasite load) of C. multilineata individuals attended by the goby was larger than that of the individuals attended by the wrasse. Despite such differences, T. noronhanum showed a surprisingly species-rich client assemblage when compared with other cleaners of the genus Thalassoma. In addition, the frequency and time spent on cleaning interactions, as well as the number of client species attended per 10-min period, was similar for both cleaner species, which indicate that they have important yet complimentary ecological roles in the reef community at Fernando de Noronha Archipelago.

Utilização de embriões liofilizados e flocos de Artemia na diversificação nutricional de pós-larvas do camarão marinho Litopenaes vannamei (Boone, 1931)

The objective of the current study was to evaluate the zootechnical performance (survival and growth) of Litopenaeus vannamei post-Iarvae fed an artificial shrimp diet supplemented with Artemia flakes or freeze-dried Artemia embryos. For that purpose, 20 culturing units were individually stocked with 50 shrimp post-Iarvae (average dry weight of 0,3 ± 0,03 mg) at a stocking density of 20 post-larvae per liter, and fed the experimental diets to satiation during 20 days. The experimental design consisted of four diets (T1, T2, T3 and T4) with five repetitions each. For treatments T1, T2 and T3, dietary supplements of 5mg of Artemia flakes (T1), freeze-dried Artemia embryos (T2), and of the commercial shrimp diet (T3) were offered 2 hours after the shrimp were initially fed the commercial shrimp diet. For treatment T4 (control), no additive was offered 2 hours after the initial feeding. Shrimp survival, absolut (GPA) and relative increase in weight (GPR), and specific growth rate (TCR) were used as evaluation criteria. After the experimental period, no significant statistical differences (p>0,05) in survival were observed. Regarding growth, the dietary treatment which used freeze-dried Artemia embryos as an additive (T2) presented the best results for GPA (6,7 ± 0,7 mg). There were no statistical differences within treatments T1, T3 and T4 (p>0,05). AIso, post-larvae fed freeze-dried embryos (T2) showed a relative increase in weight (2241,4%) which differed significantly (p<0,05) from T4(1911,7%) but not from T1 (1801,6%) or T3 (1946,7%). In conclusion, the results of the current study indicate that an artificial shrimp diet supplemented with freeze-dried Artemia embryos fulfils the nutritional requirements of post-larvae L. vannamei and promotes a better growth than diets not supplemented with Artemia flakes

Caracterização biométrica e acúmulo de nutrientes em porta-enxertos de caramboleira cultivada em solução nutritiva

O conhecimento sobre o crescimento e o acúmulo de nutrientes em hipobiotos de caramboleira permite melhor eficiência da adubação na produção de hipobiotos (porta-enxertos). Objetivou-se determinar o crescimento e o acúmulo de nutrientes em hipobiotos de caramboleira cultivada em solução nutritiva. O experimento constituiu de cinco tratamentos, referentes aos tempos de coleta 25; 50; 75; 100 e 125 dias após o transplantio, dispostos em delineamento inteiramente casualizado em seis repetições. As plantas utilizadas foram obtidas de sementes de frutos de caramboleira 'Malásia', cultivadas em vasos com solução nutritiva. Nos diferentes órgãos dos hipobiotos (folhas, caule e raízes), avaliou-se o crescimento e o acúmulo de nutrientes e os índices nutricionais, a cada 25 dias. O ponto de enxertia (6 mm) foi atingido aos 110 dias após o transplantio. A ordem decrescente dos nutrientes acumulados em cada hipobioto produzido é de (em mg por planta): N = 634; K = 368; Ca = 152; Mg = 106; S = 98; P = 88 (em µg por planta) de: Fe = 2.963; Mn = 2.165; B = 722; Zn =780, e Cu = 96. O acúmulo médio de nutrientes é maior nas folhas > caule = raízes. O período de maior exigência de nutrientes pelos hipobiotos é compreendido entre 25-75 dias após o transplantio. As diferentes taxas de acumulação líquida dos nutrientes, nas diferentes partes da caramboleira, nem sempre acompanham a taxa de acumulação de nutrientes do respectivo órgão.

Desempenho de Lecanicillium lecanii em meios de cultura contendo vitaminas e concentrações de extrato de levedura

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)