Protein intake and outcome of critically ill patients: analysis of a large international database using piece-wise exponential additive mixed models

Background Proteins are an essential part of medical nutrition therapy in critically ill patients. Guidelines almost universally recommend a high protein intake without robust evidence supporting its use. Methods Using a large international database, we modelled associations between the hazard rate of in-hospital death and live hospital discharge (competing risks) and three categories of protein intake (low: < 0.8 g/kg per day, standard: 0.8–1.2 g/kg per day, high: > 1.2 g/kg per day) during the first 11 days after ICU admission (acute phase). Time-varying cause-specific hazard ratios (HR) were calculated from piece-wise exponential additive mixed models. We used the estimated model to compare five different hypothetical protein diets (an exclusively low protein diet, a standard protein diet administered early (day 1 to 4) or late (day 5 to 11) after ICU admission, and an early or late high protein diet). Results Of 21,100 critically ill patients in the database, 16,489 fulfilled inclusion criteria for the analysis. By day 60, 11,360 (68.9%) patients had been discharged from hospital, 4,192 patients (25.4%) had died in hospital, and 937 patients (5.7%) were still hospitalized. Median daily low protein intake was 0.49 g/kg [IQR 0.27–0.66], standard intake 0.99 g/kg [IQR 0.89– 1.09], and high intake 1.41 g/kg [IQR 1.29–1.60]. In comparison with an exclusively low protein diet, a late standard protein diet was associated with a lower hazard of in-hospital death: minimum 0.75 (95% CI 0.64, 0.87), and a higher hazard of live hospital discharge: maximum HR 1.98 (95% CI 1.72, 2.28). Results on hospital discharge, however, were qualitatively changed by a sensitivity analysis. There was no evidence that an early standard or a high protein intake during the acute phase was associated with a further improvement of outcome. Conclusions Provision of a standard protein intake during the late acute phase may improve outcome compared to an exclusively low protein diet. In unselected critically ill patients, clinical outcome may not be improved by a high protein intake during the acute phase. Study registration ID number ISRCTN17829198

Effect of amino acid supplementation and choline chloride for low protein diet on nitrogen efficiency and methane emission of dairy cows

Ruminants are one of the largest anthropogenic methane and nitrous oxide emissions. Therefore, the hypothesis was to study the effects of reducing dietary crude protein (CP) level on environmental contaminators when rumen-protected amino acids and choline chloride were supplemented. Sixty Holstein dairy cows were used during the experiment. Test diets were: (1) CD = Control diet with16.2 g of crude protein/ Kg of DM); (2) LM = Low protein diet with 14.2 g of crude protein/ Kg of DM + methionine ; (3) LL = Low protein diet with 14.2 g of crude protein/ Kg of DM + lysine; (4) LML = Low protein diet with 14.2 g of crude protein/ Kg of DM + methionine + lysine; (5) LMLC = Low protein diet with 14.2 g of crude protein/ Kg of DM + methionine + lysine + choline. Dry matter and NDF intake were not different, but the control group received higher CP and ADF compared with other groups (P < 0.05). Fecal CP and ADF of control group were lower (P < 0.05), but no differences were observed for fecal dry matter (DM) and NDF. Milk yield and protein content were higher for LML and LMLC like control group (P < 0.05). Nitrogen intake, urinary N, urinary urea N and total excreta N decreased (P < 0.05) when animals fed low protein. There was no difference in ruminal pH and acetate to propionate ratio, whereas the ruminal ammonia-N decreased with the low protein (P < 0.05). The 120-h gas production test, showed no difference on the kinetics of digestion and in vitro methane emission. However, the inclusion of DMI in the calculations revealed that low protein can reduce (P < 0.05) methane emission. Overall, our findings indicated that low protein can be compensated for by adding rumen-protected amino acids, not only to maintain the animal performance, but also to decrease nitrogen excretion and methane emission.

Adherence to Mediterranean-DASH Intervention for Neurodegenerative Delay Diet Can Decreased Risk of Age Associated Poor Muscle Strength; A Cross- Sectional from Kurdish Cohort Study

The Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet aims to reduce dementia and the decline in brain health that often occurs as people get older. Loss of muscle strength (sarcopenia) is a geriatric syndrome that has associated with the loss of skeletal muscle mass and strength. The current study aimed to investigate the association between adherence to MIND diet and decrease the risk of age-associated poor muscle strength. This cross-sectional study was performed using data from Ravansar's non-communicable diseases (RaNCD) cohort study on 3181 adults (48.5% men) aged 35–65 years. The dietary intake of the studied participants was assessed by the use of a 114-item food frequency questionnaire (FFQ) developed by RaNCD cohort study. The MIND diet and the major dietary patterns were computed based on their dietary intake and three dietary patterns were identified including plant-based diet, high protein diet, and unhealthy diet. Hand grip strength (HGS) was measured using a hand-held hydraulic handgrip dynamometer and poor HGS was defined as HGS less than 32.8 and 20.5 kg in men and women, respectively. We found that greater adherence to MIND diet was associated with lower risk of poor HGS (OR: 0.65; CI 95%: 0.51-0.83). Furthermore, participants who were in third tertiles of plant- based and high protein diet were more likely 37% and 33% lower risk of poor HGS (OR: 0.63; CI 95%: 0.5-0.79), (OR: 0.67; CI 95%: 0.54-0.84), respectively. On the other hand, greater following to unhealthy diet was related to higher risk of poor HGS (OR: 1.39; CI 95%: 1.11-1.74). Overall, our findings provide that adhere to plant- based and high protein diet, as well as MIND diet had protective effects on age related poor HGS, while adherence to unhealthy diet can developed age related poor HGS.

Effect of different protein based feed on the growth of mahseer

For the proper growth of fish, it is necessary to feed the fish with a proper and balanced diet. A study was conducted to find out the effect of different protein-based diets on fingerlings of Tor putitora (mahseer). A feed with dietary protein levels of 35%, 40%, 45%, and 50% were prepared. The effect of different protein-based feed on weight gain, standard growth rate (SGR), food conversion ratio (FCR), percent weight gain, food conversion efficiency (FCE), and protein efficiency ratio (PER) was studied. An increase was observed in the growth rate with an increase in protein concentration up to 45%. The fingerlings fed a 45% protein diet shown the highest growth, followed by 50%, 40%, and 35%. The SGR value was greatest for 45% protein diet (8.56) followed by 50% and 40%, while the least values were observed for 35% protein feed (1.57). The same trend was observed for FCE. The highest PER values was observed in fishes fed 45% protein-based feed (0.65) followed by 50% (0.56), 40% (0.38) and35% (0.17). The food conversion ratio was lowest for 45% protein diet (3.41), while the greatest for 35% protein feed (16.85). It was concluded that a 45% protein-based diet was the best feed formulation for higher production of Tor putitora. However, research on the same percentage of protein diet is recommended for yearlings.

Formulasi Pangan Fungsional Tinggi Kalori Tinggi Protein: Biskuit Ubi Jalar-Ikan Gabus (Big@Bus)

Peningkatan kasus TB merupakan tantangan bagi tenaga kesehatan dan sektor terkait dalam pencegahan dan penanganan TB secara terpadu dan komprehensif. Propinsi DKI di urutan kedua teratas di Indonesia. Perkembangan penanggulangan TB belum menggembirakan dan permasalahan TB masih belum dapat diselesaikan. Dalam menangani permasalahan untuk penderita TB, selain istirahat dan obat, diperlukan diet yang sehat dan tepat untuk membantu pemulihan penderita TB. Dietnya adalah Diet Tinggi Kalori Tinggi Protein. Sumber protein hewani yang memiliki potensi besar adalah ikan gabus (Ophiocephalus striatus). Selain sumber makanan tinggi protein, diet yang diharapkan bisa mempercepat proses penyembuhan TB dengan diet tinggi kalori. Dari kelompok umbi-umbian, ada ubi jalar yang berasa manis, mengandung karbohidrat kompleks disertai vitamin dan mineral yang mudah dicerna. Makanan tambahan berbasis pangan lokal yaitu biskuit dengan suplementasi tepung ikan gabus dan ubi jalar dapat menjadi pilihan sebagai PMT Pemulihan TB. Dalam penelitian ini metode yang digunakan adalah metode eksperimen. Pelaksanaan penelitian adalah formulasi biskuit ikan gabus dengan penambahan tepung ubi jalar (Formula Pangan BIG@BUS). Hasil uji organoleptik oleh panelis diketahui bahwa warna dari tepung dan rasa dari biskuit mendapatkan rata-rata tertinggi dari penilaian panelis. Sedangkan aroma tepung dan tekstur dari biskuit mendapatkan nilai rerata terendah dari panelis. Hasil pemeriksaan kandungan zat gizi pemeriksaan untuk tepung menjadi biskuit terjadi penurunan kadar zat gizi karena perubahan bentuk dan proses pengolahannya, kecuali kadar Lemak.Kata Kunci: Ikan Gabus, Ubi, TB

Comprehensive miRNA and DNA Microarray Analyses Reveal the Response of Hepatic miR-203 and Its Target Gene to Protein Malnutrition in Rats

Adequate protein nutrition is essential for good health. Effects of protein malnutrition in animals have been widely studied at the mRNA level with the development of DNA microarray technology. Although microRNAs (miRNAs) have attracted attention for their function in regulating gene expression and have been studied in several disciplines, fewer studies have clarified the effects of protein malnutrition on miRNA alterations. The present study aimed to elucidate the relationship between protein malnutrition and miRNAs. Six-week old Wistar male rats were fed a control diet (20% casein) or a low-protein diet (5% casein) for two weeks, and their livers were subjected to both DNA microarray and miRNA array analysis. miR-203 was downregulated and its putative target Hadhb (hydroxyacyl-CoA dehydrogenase β subunit), known to regulate β-oxidation of fatty acids, was upregulated by the low-protein diet. In an in vitro experiment, miR-203 or its inhibitor were transfected in HepG2 cells, and the pattern of Hadhb expression was opposite to that of miR-203 expression. In addition, to clarifying the hepatic miRNA profile in response to protein malnutrition, these results showed that a low-protein diet increased Hadhb expression through downregulation of miR-203 and induced β-oxidation of fatty acids.

EFFECT OF HIGH PROTEIN DIET IN ACTIVITY OF ANTIOXIDANTS AND LEVEL OF INFLAMMATION ON SPRINT ATHLETE

This study aims to analyze the effect of a low-carbohydrate high-protein diet to increase the level of antioxidant, decrease inflammation and improve performance of athlete. The research was carried out by experimental research methods, within the design of "Randomized Control Group Pretest Posttest Design".A sample was taken from 20 people who met the inclusion and exclusion criteria from 30 teenage athletes in PASI East Java sprints. The Data were collected by measuring the sprint results by finish photo camera and laboratory examinations to determine the levels of antioxidants (SOD) and the inflammation degree (TNF α)in blood. The data were analyzed using multivariate technique (Manova) Hotelling's method (T2). Hypothesis testing using α0.05. The results and conclusions of the study stated that the normal diet had no effect on the variables of sprint running speed, SOD and TNF-α levels. While low-carbohydrate and high-protein diet can increase SOD levels of 211.44 /gHb, reduce (TNF α) at least 0.309 pg/ml, and the average increase in antioxidant activity caused by low-carbohydrate-high-protein diet is 24,989 / gHb higher than normal diet, the decrease in the degree of inflammation is 0.196 pg/ml, however, it has no effect on the speed of sprint.

Effect of high protein diet in activity of antioxidants and level of inflammation on sprint athlete

This study aims to analyze the effect of a low-carbohydrate high-protein diet to increase the level of antioxidant, decrease inflammation and improve performance of athlete. The research was carried out by experimental research methods, within the design of “Randomized Control Group Pretest Posttest Design”. A sample was taken from 20 people who met the inclusion and exclusion criteria from 30 teenage athletes in PASI East Java sprints. The Data were collected by measuring the sprint results by finish photo camera and laboratory examinations to determine the levels of antioxidants (SOD) and the inflammation degree (TNF-α) in blood. The data were analyzed using multivariate technique (Manova) Hotelling’s method (T2). Hypothesis testing using α = 0.05. The results and conclusions of the study stated that the normal diet had no effect on the variables of sprint running speed, SOD and TNF-α levels. While low-carbohydrate and high-protein diet can increase SOD levels of 211.44/gHb, reduce (TNF-α) at least 0.309 pg/ml, and the average increase in antioxidant activity caused by low-carbohydrate-high-protein diet is 24.989/gHb higher than normal diet, the decrease in the degree of inflammation is 0.196 pg/ml, however, it has no effect on the speed of sprint.

LOW WEIGHT GAIN, BETTER GLYCAEMIA AND NO CENTRAL OBESITY ACHIEVED THROUGH A HIGH-PROTEIN DIET

A compendium of metabolic diseases associated with unhealthy habits plague the modern world today. Weight gain, hyperglycemia and excess adiposity are some of the metabolic diseases plaguing our modern society. Unhealthy dietary habits coupled with a sedentary lifestyle are recognized as important factors for the development of some metabolic illnesses. Cardiovascular diseases, diabetes mellitus, hypertension, and dyslipidemia were recognized as stemming from metabolic dysregulation due to the consumption of excess calories from certain macronutrients. Our objective in this study is to find out which diet most affects circulating blood glucose levels, body weight, and visceral fat tissue deposition. 35 male Sprague - Dawley rats were separated into five groups and were given five distinct diets for the duration of 8 weeks. The five diets are normal rat feed, high-fat, high-protein, high-sugar, and high-starch. The feeding provided was ad libitum with tap water given as drinking water. Every week, each rat was weighed, and blood were sampled for glucose. Post-sacrifice, mesenteric fat was harvested, fixed, and stained for histological analysis. The results revealed a high-protein diet significantly reduces body weight gain, improved blood sugar with no development of central obesity. At the same time, a high-fat diet was shown to be a promoter of mesenteric fat tissue hypertrophy. It was concluded that the consumption of a high-protein diet was found to achieve low weight gain, better glycaemia with no central obesity.