Routine protein energy supplementation in adults: systematic review

Objectives: To determine whether routine oral and enteral nutritional supplementation can improve the weight, anthropometry, and survival of adult patients.

Energy expenditure after 2- to 3-hour elective surgical operations

Energy expenditure was measured by indirect calorimetry in 17 adult patients (8 women and 9 men) before surgery, 4 hours immediately after surgery , and 24 hours late after surgery in patients undergoing elective surgery of small-to-medium scope. MATERIAL AND METHODS: The total duration of surgery ranged from 2 to 3 hours. Repeated measures were performed on the same patient, so that each patient was considered to be his/her own control. All patients received a 5% dextrose solution (2000 mL/day) throughout the postoperative period. RESULTS: Men showed a reduction in CO2 production during the immediately after surgery period (257±42 mL/min) compared to before surgery (306±48 mL/min) and late after surgery (301±45 mL/min); this reduction was not observed in women. Energy expenditure was also lower in men during immediately after surgery (6.6 kJ/min). None of the other measurements, including substrate oxidation, showed significant differences. CONCLUSION: Therefore, elective surgery itself cannot be considered an important trauma that would result in increased energy expenditure. According to this study, it is not necessary to prescribe an energy supply exceeding basal expenditure during the immediate after-surgery period. The present results suggest that the energy supply prescribed during the postoperative period after elective surgery of small-to-medium scope should not exceed 5-7 kJ/min, so the patient does not receive a carbohydrate overload from energy supplementation.

Optimisation of energy provision with supplemental parenteral nutrition in critically ill patients: a randomised controlled clinical trial.

BACKGROUND: Enteral nutrition (EN) is recommended for patients in the intensive-care unit (ICU), but it does not consistently achieve nutritional goals. We assessed whether delivery of 100% of the energy target from days 4 to 8 in the ICU with EN plus supplemental parenteral nutrition (SPN) could optimise clinical outcome. METHODS: This randomised controlled trial was undertaken in two centres in Switzerland. We enrolled patients on day 3 of admission to the ICU who had received less than 60% of their energy target from EN, were expected to stay for longer than 5 days, and to survive for longer than 7 days. We calculated energy targets with indirect calorimetry on day 3, or if not possible, set targets as 25 and 30 kcal per kg of ideal bodyweight a day for women and men, respectively. Patients were randomly assigned (1:1) by a computer-generated randomisation sequence to receive EN or SPN. The primary outcome was occurrence of nosocomial infection after cessation of intervention (day 8), measured until end of follow-up (day 28), analysed by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00802503. FINDINGS: We randomly assigned 153 patients to SPN and 152 to EN. 30 patients discontinued before the study end. Mean energy delivery between day 4 and 8 was 28 kcal/kg per day (SD 5) for the SPN group (103% [SD 18%] of energy target), compared with 20 kcal/kg per day (7) for the EN group (77% [27%]). Between days 9 and 28, 41 (27%) of 153 patients in the SPN group had a nosocomial infection compared with 58 (38%) of 152 patients in the EN group (hazard ratio 0·65, 95% CI 0·43-0·97; p=0·0338), and the SPN group had a lower mean number of nosocomial infections per patient (-0·42 [-0·79 to -0·05]; p=0·0248). INTERPRETATION: Individually optimised energy supplementation with SPN starting 4 days after ICU admission could reduce nosocomial infections and should be considered as a strategy to improve clinical outcome in patients in the ICU for whom EN is insufficient. FUNDING: Foundation Nutrition 2000Plus, ICU Quality Funds, Baxter, and Fresenius Kabi.

The effect of offering an energy and protein supplement to grazing canchim beef cows either postpartum or both pre- and postpartum on lipid blood metabolites and folliculogenesis

This study was designed to evaluate the effect of nutritional supplementation offered during the pre- and postpartum periods on serum cholesterol, triglycerides and total lipids of Canchim beef cows and their relationship with folliculogenesis. Thirty cows with predicted calving date between September and October, kept in pastures of Brachiaria brizantha cv. Marandu together with their calves, were randomly distributed into three experimental groups: the first received only a mineral mixture (Control Group, CG); the second group received a concentrate with 16% crude protein/kg dry matter (DM) and 3000 kcal digestible energy/kg DM offered for 45 days prepartum and 120 days postpartum (PREG); the third group received the concentrate from parturition until the 120th day postpartum (POSG). Consumption was estimated at 1% of body weight, and each cow received approximately 4.0 kg/day (fresh weight) of supplement. Blood samples were taken and an ultrasound examination of the ovaries was performed twice a week until the 60th day postpartum. The body condition score (BCS) and the weight of the cows were recorded at 15-day intervals from calving until the 60th day postpartum. Data are presented as mean +/- SEM. Mean weight and BCS at calving were, respectively, 448 +/- 54.9 kg and 6.2 +/- 0.25 (PREG); 432 +/- 71.1 kg and 5.5 +/- 0.69 (POSG); and 434 +/- 66.4 kg and 5.5 +/- 0.69 (CG). Total cholesterol (TC), triglycerides (TRIG) and total lipids (TLIP) were measured using colorimetry until the 60th day postpartum. TC averages were PREG 186 +/- 62.6 mg/dL, POSG 159 +/- 43.1 mg/dL and CG 133 +/- 35.1 mg/dL (P < 0.05). For TRIG, the means were PREG 29 +/- 11.3 mg/dL (P < 0.05), POSG 24 +/- 8.1 mg/dL and CG 26 +/- 12.1 mg/dL (P > 0.05). Serum concentrations of TLIP were PREG 588 +/- 145.6 mg/dL, POSG 512 +/- 137.6 mg/dL and CG 452 +/- 122.4 mg/dL (P < 0.05). The first dominant follicle (DF) was identified on Day 21 +/- 10.3 (PREG), 36 +/- 28.5 (POSG) and 51 +/- 32.8 (CG) after calving. The difference between PREG and CG was significant (P < 0.05). TC was positively correlated with the calving to first estrus interval (P < 0.05). Results showed that nutritional supplementation before parturition assured good body condition at calving and suggested that it was effective at increasing cholesterol availability to maintain ovarian follicle function and to favor earlier resumption of ovarian activity. (C) 2010 Published by Elsevier B.V.

Follicular dynamics and production of oocytes in young Nellore heifers with energetic supplementation

To verify the effects of energy supplementation and fat on follicular dynamics, metabolic profile and the production of oocytes, 15 young heifers (Bos taurus indicus) with an average age of 14 months and with an initial weight of 256.35 kg were assigned to two treatments according to weight and follicular population as evaluated by ultrasonography: in T1 (1.0 × M), animals received 100% of the energy requirements for maintenance; in T2 (1.7 × M), animals received 170% of the energy requirements for maintenance, achieved by the addition of 200 g of Megalac®. After a period of adaptation to the diet, the treatments, blood collection and follicular aspirations were started using a randomized design. The dry matter intake and weight gain were lower in the 1.0 × M group than in the 1.7 × M group. No differences were found in the plasma progesterone concentrations, albumin, glucose, urea or gonadotropin (FSH and LH) levels between the groups. The mean concentrations of cholesterol were higher in the 1.7 × M group. The total number of small (<4 mm) and medium follicles (4-8 mm) was not altered by the treatments, but the number of small follicles increased on days 1 and 2 of the estrous cycle, with higher values found in the 1.7 × M group. The average of the oocytes also increased (9.50±2.1 and 12.5±4.4 for the 1.0 × M and 1.7 × M groups, respectively). The rapid increase in the amount of energy offered in the diet changes the amount of follicles and oocytes available for follicular aspiration (OPU) in young heifers without changing their metabolic profile.

Meat lipid profile of steers finished in pearl millet pasture with different rates of concentrate

The objective of this work was to evaluate the meat lipid profile from Devon beef steers finished in pearl millet (Pennisetum americanum) pasture and fed at different rates of concentrate supplementary diet. Twelve steers weighing 270 kg, at 12‑month‑average initial age, were randomly distributed into three treatments: pearl millet pasture; and pearl millet pasture plus a concentrate equivalent at 0.5 or 1.0% of body weight, with two replicates. Total contents of saturated and unsaturated fatty acids, the polyunsaturated:saturated ratio and other relevant fatty acids as the vaccenic acid, conjugated linoleic acid, omega‑3, and omega‑6 were not affected by the consumption of a concentrate supplement at 0.5 or 1.0% live weight. However, the 0.5% supplementation level reduced the concentration of dihomo‑γ‑linolenic fatty acid (C20: 3 n‑6), while the 1.0% supplementation level elevated the content of docosahexaenoic (DHA) (C22: 6 n‑3) fatty acid, and the omega‑6:omega‑3 ratio in meat. Consumption of up to 1.0% energy supplementation increases the omega‑6:omega‑3 ratio in meat from Devon steers grazing on pearl millet pasture.

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.

Consumo e digestibilidade em bovinos em pastejo durante o período das águas sob suplementação com fontes de compostos nitrogenados e de carboidratos

Objetivou-se avaliar os efeitos de diferentes formas químicas de compostos nitrogenados (proteicos e não-proteicos) e de carboidratos (amiláceos e fibra solúvel) sobre o consumo, a digestibilidade e a síntese ruminal de proteína microbiana em bovinos sob suplementação durante o período das águas. Foram utilizados cinco novilhos mestiços Holandês × Zebu, com peso vivo (PV) médio inicial de 211 ± 35 kg, fistulados no rúmen e abomaso. Os tratamentos foram: controle (somente pasto); e suplementos formulados à base de milho + farelo de soja; milho + ureia; polpa cítrica + farelo de soja; e polpa cítrica + ureia. Os suplementos foram balanceados para apresentar 30% de proteína bruta (PB), com base na matéria seca (MS), e fornecidos na quantidade de 3 g/kg PV. O experimento foi conduzido segundo delineamento em quadrado latino 5 × 5, em esquema fatorial 2 × 2 + 1, composto de duas fontes de compostos nitrogenados, duas fontes de carboidratos e tratamento controle. O consumo de pasto reduziu com o fornecimento de suplementos, com coeficiente médio de substituição de 2,11 g de MS de pasto/g de MS de suplemento. A suplementação não alterou os coeficientes de digestibilidade total e ruminação da MS nem o teor dietético de nutrientes digestíveis totais (NDT). Os animais sob suplementação apresentaram maiores coeficientes de digestibilidade total e ruminal da proteína bruta. A eficiência de síntese de proteína microbiana (EFSM), média de 123,1 g PB microbiana/kg de NDT, não foi alterada pela suplementação. Contudo, os animais sob suplementação com milho apresentaram maior EFSM em comparação aos animais sob suplementação com polpa cítrica (137,6 e 106,1 g PB microbiana/kg de NDT, respectivamente). A suplementação proteico-energética para bovinos mantidos em pastos tropicais durante o período das águas não causa benefícios nutricionais, o que reflete o alto coeficiente de substituição da forragem pelo suplemento.

Suplementação protéica energética no desempenho de novilhas em pastejo durante a fase de terminação

Para estudar o efeito da suplementação da dieta sobre o desempenho de novilhas na fase de terminação mantidas em pastagem de capim-marandu sob lotação intermitente, durante a estação chuvosa, foram utilizadas 20 novilhas cruzadas (¼ Nelore, ¼ Santa Gertrudes, ½ Braunvieh) com peso corporal médio de 300 kg e 22 meses de idade. Os tratamentos constituíram-se de dois tipos de suplementação: sal mineral (SM) ad libtum e suplemento protéico energético (SPE) fornecido a 0,3% do peso corporal (PC) por dia com avaliações realizadas a cada 28 dias, no período entre dezembro de 2006 e março de 2007 Foram avaliados o desempenho animal e as características de carcaça medidas por ultrassom. Observou-se o efeito (P=0,057) da suplementação sobre o ganho de peso dos animais suplementados, 0,700 kg/dia e 0,587 kg/dia dos animais que receberam sal-mineral. Houve efeito da suplementação na área de olho de lombo e profundidade do músculo Gluteus medius. As demais características analisadas pela técnica de ultrassom não diferiram entre si em função da suplementação. A suplementação protéica energética da dieta permite ganhos adicionais, o que reflete em aumento da deposição de músculo de novilhas mantidas em pastagem de capim-marandu durante o período das águas.

Efeito de suplementação para matrizes brangus de primeira cria

Pós-graduação em Zootecnia - FMVZ

Características da carne de bovinos suplementados no período das águas e terminados em confinamento e em pasto

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Avaliação de aditivos em dietas de frangos de corte

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)