Nutritional support in pancreatic cancer patients and its effect on nutritional status: an observational regional HPB network study investigating current practice.

PURPOSE: Preoperative malnutrition is associated with poor postoperative outcomes in patients with pancreatic cancer. This study evaluated the effectiveness of current practice in nutritional support for patients with pancreatic cancer. METHODS: Observational multicenter HPB network study conducted at the Isala Clinics Zwolle, Medical Spectrum Twente, Medical Center Leeuwarden, and University Medical Center Groningen between October 2021 and May 2023. Patients with a suspected pancreatic malignancy scheduled for surgery were screened for malnutrition using the Patient-Generated Subjective Global Assessment (PG-SGA) questionnaire and referred to a dedicated dietician for nutritional support comprising pancreatic enzyme replacement therapy, dietary advice, and nutritional supplements to achieve adequate caloric and protein intake. At baseline, 1 day preoperatively, and 3 months postoperatively, the nutritional status and muscle thickness were evaluated. RESULTS: The study included 30 patients, of whom 12 (40%) classified as malnourished (PG-SGA ≥ 4) at baseline. Compared to well-nourished patients, malnourished patients were younger, were predominantly female, and had a higher body mass index, despite having lost more body weight in the past 6 months. All malnourished patients and 78% of the well-nourished patients received nutritional support. Consequently, a preoperative increase in caloric and protein intake and body weight were observed. Postoperatively, despite a further increase in caloric intake, a considerable decrease in protein intake, body weight, and muscle thickness was observed. CONCLUSION: Malnutrition is prevalent in patients undergoing pancreatic surgery. Nutritional support by a dedicated dietician is effective in enhancing patients' preoperative nutritional status. However, postoperative monitoring of adequate nutritional intake in patients could be improved.

'Effects of a home-based bimodal lifestyle intervention in frail patients with end-stage liver disease awaiting orthotopic liver transplantation': study protocol of a non-randomised clinical trial.

INTRODUCTION: Patients with end-stage liver disease awaiting orthotopic liver transplantation (OLT) are generally classified as frail due to disease-related malnutrition and a progressive decline in musculoskeletal and aerobic fitness, which is associated with poor pre-OLT, peri-OLT and post-OLT outcomes. However, frailty in these patients may be reversable with adequate exercise and nutritional interventions. METHODS AND ANALYSIS: Non-randomised clinical trial evaluating the effect of a home-based bimodal lifestyle programme in unfit patients with a preoperative oxygen uptake (VO2) at the ventilatory anaerobic threshold ≤13 mL/kg/min and/or VO2 at peak exercise ≤18 mL/kg/min listed for OLT at the University Medical Center Groningen (UMCG). The programme is patient tailored and comprises high-intensity interval and endurance training, and functional exercises three times per week, combined with nutritional support. Patients will go through two training periods, each lasting 6 weeks.The primary outcome of this study is the impact of the programme on patients' aerobic fitness after the first study period. Secondary outcomes include aerobic capacity after the second study period, changes in sarcopenia, anthropometry, functional mobility, perceived quality of life and fatigue, incidence of hepatic encephalopathy and microbiome composition. Moreover, number and reasons of intercurrent hospitalisations during the study and postoperative outcomes up to 12 months post OLT will be recorded. Finally, feasibility of the programme will be assessed by monitoring the participation rate and reasons for non-participation, number and severity of adverse events, and dropout rate and reasons for dropout. ETHICS AND DISSEMINATION: This study was approved by the Medical Research Ethics Committee of the UMCG (registration number NL83612.042.23, August 2023) and is registered in the Clinicaltrials.gov register (NCT05853484). Good Clinical Practice guidelines and the principles of the Declaration of Helsinki will be applied. Results of this study will be submitted for presentation at (inter)national congresses and publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT05853484.

Impact of Preoperative Diabetes Mellitus on Postoperative Outcomes in Elective Pancreatic Surgery and Its Implications for Prehabilitation Practice.

OBJECTIVES: Patients with pancreatic disease(s) have a high risk of developing diabetes mellitus (DM). Diabetes mellitus is associated with adverse postoperative outcomes. This study aimed to investigate the prevalence and effects of DM on postoperative outcomes in pancreatic surgery. METHODS: Subgroup analysis of a prospective cohort study conducted at an academic hospital. Patients undergoing pancreatoduodenectomy between January 2019 and November 2022 were included and screened for DM preoperatively using glycated hemoglobin (HbA1c). New-onset DM was diagnosed based on HbA1c ≥ 6.5% (48 mmol/mol). Postoperative outcomes were compared between patients with and without DM. RESULTS: From 117 patients, 29 (24.8%) were given a diagnosis of DM, and of those, 5 (17.2%) were diagnosed with new-onset DM, and 15 (51.8%) displayed poorly controlled preoperative DM (HbA 1c ≥ 7% [53 mmol/mol]). The incidence of surgical site infections (48.3% vs 27.3% in the non-DM group; P = 0.04) was higher for patients with DM. This association remained significant after adjusting for confounders (odds ratio, 2.60 [95% confidence interval, 1.03-6.66]; P = 0.04). CONCLUSIONS: One-quarter of the patients scheduled for pancreatoduodenectomy had DM; over half of them had poor glycemic control. The association between DM status and surgical site infections revealed in this study emphasizes the importance of adequate preoperative glycemic control.

Actual physical activity after major abdominal cancer surgery: Far from optimal.

BACKGROUND: Enhanced recovery after surgery protocols emphasize the importance of early postoperative mobilization. However, literature quantifying actual physical activity after major abdominal cancer surgery is scarce and inconclusive. MATERIAL AND METHODS: A single-center prospective cohort study was conducted at the University Medical Center Groningen from 2019 to 2021. Patients' postoperative physical activity was measured using an accelerometer, with the primary aim of assessing daily physical activity. Secondary aims were identifying patient-related factors associated with low physical activity and studying the consequences of low physical activity in terms of complication rate and length of hospital stay. RESULTS: 143 patients included (48 % male; mean age 65 years), 38.5 %, 24.5 %, 19.6 %, and 14 % underwent pancreatic, hepatic, colorectal, or cytoreductive surgery with hyperthermic intraperitoneal chemotherapy, respectively. Median daily step count was low; from median 71 steps on the first to 918 steps on the seventh postoperative day. An association between physical activity and age (OR 3.597, p = 0.013), preoperative weight loss ≥10 % (OR 4.984, p = 0.004), Eastern Cooperative Oncology Group performance status ≥2 (OR 4.016, p = 0.001), midline laparotomy (OR 2.851, p = 0.025), and operation duration (OR 1.003, p = 0.044) was found. An association was observed between physical activity and the occurrence of complications (OR 3.197, p = 0.039) and prolonged hospital stay (ß 4.068, p = 0.013). CONCLUSION: Postoperative physical activity is low in patients undergoing major abdominal cancer surgery and is linked to postoperative outcomes. Although physical activity should be encouraged in all patients, patient-specific risk factors were identified that can aid early recognition of patients at risk of low physical activity.

Cardiac and intramuscular adaptations following short-term exercise prehabilitation in unfit patients scheduled to undergo hepatic or pancreatic surgery: study protocol of a multinuclear MRI study.

INTRODUCTION: Short-term exercise prehabilitation programmes have demonstrated promising results in improving aerobic capacity of unfit patients prior to major abdominal surgery. However, little is known about the cardiac and skeletal muscle adaptations explaining the improvement in aerobic capacity following short-term exercise prehabilitation. METHODS AND ANALYSIS: In this single-centre study with a pretest-post-test design, 12 unfit patients with a preoperative oxygen uptake (VO2) at the ventilatory anaerobic threshold ≤13 mL/kg/min and/or VO2 at peak exercise ≤18 mL/kg/min, who are scheduled to undergo hepatopancreatobiliary surgery at the University Medical Center Groningen (UMCG), the Netherlands, will be recruited. As part of standard care, unfit patients are advised to participate in a home-based exercise prehabilitation programme, comprising high-intensity interval training and functional exercises three times per week, combined with nutritional support, during a 4-week period. Pre-intervention and post-intervention, patients will complete a cardiopulmonary exercise test. Next to this, study participants will perform additional in-vivo exercise cardiac magnetic resonance (MR) imaging and phosphorus 31-MR spectroscopy of the quadriceps femoris muscle before and after the intervention to assess the effect on respectively cardiac and skeletal muscle function. ETHICS AND DISSEMINATION: This study was approved in May 2023 by the Medical Research Ethics Committee of the UMCG (registration number NL83611.042.23, March 2023) and is registered in the ClinicalTrials.gov register. Results of this study will be submitted for presentation at (inter)national congresses and publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT05772819.

Supervised Home-Based Exercise Prehabilitation in Unfit Patients Scheduled for Pancreatic Surgery: Protocol for a Multicenter Feasibility Study.

BACKGROUND: Morbidity rates in pancreatic surgery are high, and frail patients with low aerobic capacity are especially at risk of complications and require prophylactic interventions. Previous studies of small patient cohorts receiving intra-abdominal surgery have shown that an exercise prehabilitation program increases aerobic capacity, leading to better treatment outcomes. OBJECTIVE: In this study, we aim to assess the feasibility of a home-based exercise prehabilitation program in unfit patients scheduled for pancreatic surgery on a larger scale. METHODS: In this multicenter study, adult patients scheduled for elective pancreatic surgery with a preoperative oxygen uptake (VO2) at the ventilatory anaerobic threshold ≤13 mL/kg/min or a VO2 at peak exercise ≤18 mL/kg/min will be recruited. A total of 30 patients will be included in the 4-week, home-based, partly supervised exercise prehabilitation program. The program comprises 25-minute high-intensity interval training on an advanced cycle ergometer 3 times a week. Training intensity will be based on steep ramp test performance (ie, a short-term maximal exercise test on a cycle ergometer), aiming to improve aerobic capacity. Twice a week, patients will perform functional task exercises to improve muscle function and functional mobility. A steep ramp test will be repeated weekly, and training intensity will be adjusted accordingly. Next to assessing the feasibility (participation rate, reasons for nonparticipation, adherence, dropout rate, reasons for dropout, adverse events, and patient and therapist appreciation) of this program, individual patients' responses to prehabilitation on aerobic capacity, functional mobility, body composition, quality of life, and immune system factors will be evaluated. RESULTS: Recruitment for this study began in January 2022 and is expected to be completed in the summer of 2023. CONCLUSIONS: Results of this study will provide important clinical and scientific knowledge on the feasibility of a partly supervised home-based exercise prehabilitation program in a vulnerable patient population. This might ease the path to implementing prehabilitation programs in unfit patients undergoing complex abdominal surgery, such as pancreatic surgery. TRIAL REGISTRATION: ClinicalTrials.gov NCT05496777; https://classic.clinicaltrials.gov/ct2/show/NCT05496777. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/46526.

Personalized multimodal prehabilitation reduces cardiopulmonary complications after pancreatoduodenectomy: results of a propensity score matching analysis.

BACKGROUND: The purpose of prehabilitation is to improve postoperative outcomes by increasing patients' resilience against the stress of surgery. This study investigates the effect of personalized multimodal prehabilitation on patients undergoing pancreatoduodenectomy. METHODS: Included patients were screened for six modifiable risk factors: (1) low physical fitness, (2) malnutrition, (3) low mental resilience, (4) anemia and hyperglycemia, (5) frailty, and (6) substance abuse. Interventions were performed as needed. Using 1:1 propensity score matching (PSM), patients were compared to a historical cohort. RESULTS: From 120 patients, 77 (64.2%) performed a cardiopulmonary exercise test to assess their physical fitness and provide them with a preoperative training advice. Furthermore, 88 (73.3%) patients received nutritional support, 15 (12.5%) mental support, 17 (14.2%) iron supplementation to correct for iron deficiency, 18 (15%) regulation support for hyperglycemia, 14 (11.7%) a comprehensive geriatric assessment, and 19 (15.8%) substance abuse support. Of all patients, 63% required ≥2 prehabilitation interventions. Fewer cardiopulmonary complications were observed in the prehabilitation cohort (9.2% versus 23.3%; p = 0.002). In surgical outcomes and length of stay no differences were observed. CONCLUSION: Our prehabilitation program is effective in detecting risk factors in patients; most patients required multiple interventions. Consequently, a reduction in cardiopulmonary complications was observed.

Treatment of iron deficiency in patients scheduled for pancreatic surgery: implications for daily prehabilitation practice in pancreatic surgery.

BACKGROUND: Preoperative anemia is a frequent complication in pancreatic surgical patients, and it adversely affects morbidity, mortality, and postoperative red blood cell (RBC) transfusion rates. Iron deficiency (ID) is often the underlying cause of anemia and constitutes a modifiable risk factor. METHODS: Single-center, longitudinal prospective cohort study conducted between May 2019 and August 2022 at the University Medical Center Groningen in the Netherlands. Patients scheduled for pancreatic surgery were referred to the outpatient prehabilitation clinic for preoperative optimization of patient-related risk factors. Patients were screened for anemia (< 12.0 g/dL in women and < 13.0 g/dL in men) and ID (either absolute [ferritin < 30 µg/L] or functional [ferritin ≥ 30 µg/L + transferrin saturation < 20% + C-reactive protein > 5 mg/L]). Intravenous iron supplementation (IVIS) (1,000 mg ferric carboxymaltose) was administered to patients with ID at the discretion of the consulting internist. Pre- and postoperative hemoglobin (Hb) levels were assessed, and perioperative outcomes were compared between patients receiving IVIS (IVIS-group) or standard care (SC-group). RESULTS: From 164 screened patients, preoperative anemia was observed in 55 (33.5%) patients, and in 23 (41.8%) of these patients, ID was the underlying cause. In 21 patients, ID was present without concomitant anemia. Preoperative IVIS was administered to 25 patients, out of 44 patients with ID. Initial differences in mean Hb levels (g/dL) between the IVIS-group and SC-group at the outpatient clinic and one day prior to surgery (10.8 versus 13.2, p < 0.001, and 11.8 versus 13.4, p < 0.001, respectively) did not exist at discharge (10.6 versus 11.1, p = 0.13). Preoperative IVIS led to a significant increase in mean Hb levels (from 10.8 to 11.8, p = 0.03). Fewer SSI were observed in the IVIS-group (4% versus 25.9% in the SC-group, p = 0.02), which remained significant in multivariable regression analysis (OR 7.01 (1.68 - 49.75), p = 0.02). CONCLUSION: ID is prevalent in patients scheduled for pancreatic surgery and is amendable to preoperative correction. Preoperative IVIS increased Hb levels effectively and reduced postoperative SSI. Screening and correction of ID is an important element of preoperative care and should be a standard item in daily prehabilitation practice.

Postoperative muscle loss, protein intake, physical activity and outcome associations.

BACKGROUND: Skeletal muscle loss is often observed in intensive care patients. However, little is known about postoperative muscle loss, its associated risk factors, and its long-term consequences. The aim of this prospective observational study is to identify the incidence of and risk factors for surgery-related muscle loss (SRML) after major abdominal surgery, and to study the impact of SRML on fatigue and survival. METHODS: Patients undergoing major abdominal cancer surgery were included in the MUSCLE POWER STUDY. Muscle thickness was measured by ultrasound in three muscles bilaterally (biceps brachii, rectus femoris, and vastus intermedius). SRML was defined as a decline of 10 per cent or more in diameter in at least one arm and leg muscle within 1 week postoperatively. Postoperative physical activity and nutritional intake were assessed using motility devices and nutritional diaries. Fatigue was measured with questionnaires and 1-year survival was assessed with Cox regression analysis. RESULTS: A total of 173 patients (55 per cent male; mean (s.d.) age 64.3 (11.9) years) were included, 68 of whom patients (39 per cent) showed SRML. Preoperative weight loss and postoperative nutritional intake were statistically significantly associated with SRML in multivariable logistic regression analysis (P < 0.050). The combination of insufficient postoperative physical activity and nutritional intake had an odds ratio of 4.00 (95 per cent c.i. 1.03 to 15.47) of developing SRML (P = 0.045). No association with fatigue was observed. SRML was associated with decreased 1-year survival (hazard ratio 4.54, 95 per cent c.i. 1.42 to 14.58; P = 0.011). CONCLUSION: SRML occurred in 39 per cent of patients after major abdominal cancer surgery, and was associated with a decreased 1-year survival.

Predicting timothy mineral concentrations, dietary cation-anion difference, and grass tetany index by near-infrared reflectance spectroscopy.

The mineral concentration of forage grasses plays a significant role in 2 metabolic disorders in dairy cattle production, namely, hypocalcemia (milk fever) and hypomagnesemia (grass tetany). Risks of occurrence of these 2 metabolic disorders can be evaluated by determining the dietary cation-anion difference (DCAD) and the grass tetany (GT) index of forages and specific rations. The objective of this study was to evaluate the feasibility of predicting timothy (Phleum pratense L.) mineral concentrations of Na, K, Ca, Mg, Cl, S, and P, the DCAD, and the GT index by near-infrared reflectance spectroscopy (NIRS). Timothy samples (n = 1,108) were scanned using NIRS and analyzed for the concentration of 7 mineral elements. Calculations of the DCAD were made using 3 different formulas, and the GT index was also calculated. Samples were divided into calibration (n = 240) and validation (n = 868) sets. The calibration, cross-validation, and prediction for mineral concentrations, the DCAD, and the GT index were performed using modified partial least squares regression. Concentrations of K, Ca, Mg, Cl, and P were successfully predicted with coefficients of determination of prediction (R(P)2) of 0.69 to 0.92 and coefficients of variation of prediction (CV(P)) ranging from 6.6 to 11.4%. The prediction of Na and S concentrations failed, with respective R(P)2 of 0.58 and 0.53 and CV(P) of 82.2 and 12.9%. The 3 calculated DCAD and the GT index were predicted successfully, with R(P)2 >0.90 and CV(P) <20%. Our results confirm the feasibility of using NIRS to predict K, Ca, Mg, and Cl concentrations, as well as the DCAD and the GT index, in timothy.

Timothy silage with low dietary cation-anion difference fed to nonlactating cows.

Decreasing the dietary cation-anion difference (DCAD) by using anion sources before calving reduces hypocalcemia in cows at calving. Reduced DCAD from CaCl2-fertilized timothy hay achieves similar results, but the effects of feeding low-DCAD forage as silage have not been determined. The objective of this study was to evaluate the effect of low-DCAD timothy silage on dry cows. Six nonlactating and nonpregnant Holstein cows were used in a replicated 3 x 3 Latin square. Treatments were 1) control diet (DCAD = 232 mEq/kg of dry matter, DM); 2) low-DCAD diet using a low-DCAD timothy silage (LDTS; DCAD = -21 mEq/kg of DM); and 3) low-DCAD diet using a fermentation by-product (LDBP; DCAD = -32 mEq/kg of DM). Differences between dietary treatments were considered statistically significant at P < or = 0.05 and tendencies were noted when 0.05 < P < 0.10. Compared with the control, feeding LDTS tended to decrease DM intake (10.6 vs. 12.5 kg/d) and decreased urinary pH (6.15 vs. 8.18) as well as apparent digestibility of DM (67 vs. 69%). Blood pH (7.37 vs. 7.42), HCO3- (25.3 vs. 27.5 mM), and base excess (0.4 vs. 3.1 mM) were decreased, and blood Cl- (29.6 vs. 29.1 mg/dL) was increased. Apparently absorbed Na and Cl were higher and apparently absorbed K, P, and digested ADF were lower for LDTS compared with the control. Both LDTS and LDBP resulted in similar DM intake. Urinary pH tended to be higher (6.15 vs. 5.98) and percentage of digested DM was lower (67 vs. 70%) with LDTS compared with LDBP. Blood ionized Ca (5.3 vs. 5.4 mg/dL) tended to be lower and blood Cl- (29.6 vs. 30.1 mg/dL) was lower, whereas blood pH (7.37 vs. 7.33), HCO3- (25.3 vs. 21.5 mM), and base excess (0.4 vs. -3.8 mM) were higher with LDTS compared with LDBP. Apparent absorption of Na, Cl, S, and P, as well as apparent digestion of acid detergent fiber, neutral detergent fiber, and N were lower, and K, Cl, S, P, Mg, and N were less retained with LDTS compared with LDBP. Results confirm that low-DCAD timothy silage can be used to produce a compensated metabolic acidosis by decreasing the DCAD of rations served to nonlactating dairy cows.

Near-infrared reflectance spectroscopy prediction of neutral detergent-soluble carbohydrates in timothy and alfalfa.

Carbohydrates in forage crops can be divided into neutral detergent-insoluble fiber and neutral detergent-soluble carbohydrates (NDSC); the latter includes organic acids (OA), total ethanol:water-soluble carbohydrates (TESC), starch, and neutral detergent-soluble fiber (NDSF). The accurate and efficient estimation of NDSC in forage crops is essential for improving the performance of dairy cattle. In the present study, visible and near-infrared reflectance spectroscopy (NIRS) were applied to evaluate the feasibility of predicting OA, TESC, starch, NDSF, NDSC, and all related constituents used to calculate these 5 carbohydrate fractions in timothy and alfalfa. Forage samples (n = 1,008) of timothy and alfalfa were taken at the first and second harvests at 2 sites in 2007; samples were dried, ground, and then scanned (400 to 2,500 nm) using an NIRSystems 6500 monochromator. A calibration (n = 60) and a validation (n = 15) set of samples were selected for each species and then chemically analyzed. Concentrations of TESC and NDSC in timothy, as well as starch in alfalfa, were successfully predicted, but many other carbohydrate fractions were not predicted accurately when calibrations were performed using single-species sample sets. Both sets of samples were combined to form new calibration (n = 120) and validation (n = 30) sets of alfalfa and timothy samples. Calibration and validation statistics for the combined sets of alfalfa and timothy samples indicated that TESC, starch, and NDSC were predicted successfully, with coefficients of determination of prediction of 0.92, 0.89, and 0.93, and a ratio of prediction to deviation (RPD) of 3.3, 3.1, and 3.6, respectively. The NDSF prediction was classified as moderately successful The NIRS prediction of OA was unsuccessful All related constituents were predicted successfully by NIRS except ethanol-insoluble residual OM, with Our results confirm the feasibility of using NIRS to predict NDSC, its fractions, and other related constituents, except for OA and ethanol-insoluble residual OM, in timothy and alfalfa forage samples.

Hay to reduce dietary cation-anion difference for dry dairy cows.

Timothy grass has a lower dietary cation-anion difference [DCAD = (Na + K) - (Cl + S)] than other cool-season grass species. Growing timothy on low-K soils and fertilizing it with CaCl2 could further decrease its DCAD. The objective of this study was to evaluate the effects of feeding low-DCAD timothy hay on dry dairy cows. Six nonpregnant and nonlactating cows were used in a replicated 3 x 3 Latin square. Treatments were as follows: 1) control diet (control; DCAD = 296 mEq/kg of dry matter); 2) low-DCAD diet based on low-DCAD timothy hay (L-HAY; DCAD = - 24 mEq/kg of dry matter); and 3) low-DCAD diet using HCl (L-HCl; DCAD = - 19 mEq/kg of dry matter). Decreasing DCAD with L-HAY had no effect on dry matter intake (11.8 kg/d) or dry matter digestibility (71.5%). Urine pH decreased from 8.21 to 5.89 when L-HAY was fed instead of the control. Blood parameters that decreased with L-HAY were base excess (- 0.4 vs. 3.8 mM) and HCO3- (23 vs. 27 mM), and blood parameters that increased were Ca2+ (5.3 vs. 5.1 mg/dL), Cl- (30.5 vs. 29.5 mg/dL), and Na+ (60.8 vs. 60.1 mg/dL). Compared with the control, L-HAY resulted in more Ca in urine (13.4 vs. 1.2 g/d). Comparing L-HAY with L-HCl, cow dry matter intake tended to be higher (11.5 vs. 9.8 kg/d), and blood pH was higher (7.37 vs. 7.31). Urine pH; total dry matter; Ca, K, P, and Mg apparent absorption; and Ca, K, Na, Cl, S, P, and Mg apparent retention were similar. Absorption as a percentage of intake of Na and Cl was lower for L-HAY as compared with L-HCl. In an EDTA-challenge test, cows fed L-HAY regained their initial level of blood Ca2+ twice as quickly as the control treatment (339 vs. 708 min); there were no differences between L-HAY and L-HCl. This experiment confirms that feeding low-DCAD hay is an effective means of decreasing the DCAD of rations and obtaining a metabolic response in dry dairy cows.

Nutritive value of timothy fertilized with chloride or chloride-containing liquid swine manure.

Chloride fertilization of timothy (Phleum pratense L.) decreases forage dietary cation-anion difference to an acceptable value [(<250 mmol(c)/kg of dry matter (DM)] for dry dairy cows (Bos taurus). However, high Cl concentrations in forages as a result of fertilization might affect nutritive value. Two experiments were used to evaluate the effects of chloride fertilization on timothy spring growth and summer regrowth by determining concentrations of crude protein and neutral detergent fiber (NDF), in vitro true digestibility of DM (IVTD), and in vitro digestibility of NDF (dNDF). In an inorganic fertilization experiment, forages grown at 4 locations were fertilized with CaCl(2) (0, 80, 160, and 240 kg of Cl/ha per yr) or NH(4)Cl (160 kg of Cl/ha per yr) in combination with 2 N application rates (70 and 140 kg of N/ha per yr). The increase in Cl fertilization rate affected forage NDF concentration (+1.4%), IVTD (-0.8%), and dNDF (-1.2%) only at the highest rate of N fertilization, but this effect was not of biological importance. Crude protein concentration was not affected by Cl fertilization. Both Cl fertilizer types had a similar impact on forage nutritive value. In an organic fertilization experiment, forages grown at 2 locations received 1 of 7 experimental treatments [unfertilized control, inorganic fertilizer, raw liquid swine manure (LSM), and liquid fractions of 4 pretreated LSM types (decanted, filtered, anaerobically digested, and flocculated)] that provided, respectively, 0, 60, 41, 44, 44, 36, and 101 kg of Cl/ha per yr. The last 6 fertilizer treatments also provided 140 kg of N/ha per yr. The IVTD, dNDF, and concentration of NDF in timothy forage were not affected by the Cl content of the different LSM types. Nitrogen fertilization increased concentration of forage NDF and decreased IVTD and dNDF, but this effect was not biologically important. In both experiments, soil types and harvests had a negligible effect on forage nutritive value. Organic or inorganic Cl fertilizers applied to decrease timothy dietary cation-anion difference have little or no effect on forage nutritive value.

Milk from forage as affected by rumen degradable protein and corn grinding when feeding corn- and alfalfa silage-based diets.

To increase the production of milk from forage (MF), a previous experiment with alfalfa silage showed the importance of a complementary combination of concentrates and forages offered. When corn silage is fed with alfalfa, increasing the rumen degradable protein (RDP) content in the diet should allow a better utilization of forage energy. To evaluate this hypothesis, 8 multiparous Holstein cows in early lactation were used in a replicated 4 x 4 Latin square design with 3-wk periods. Diets were fed as total mixed rations and were formulated to provide similar levels of net energy for lactation and crude protein but differing in RDP. Corn and alfalfa silages were used. Treatments were: 1) cracked corn-based concentrate providing low RDP [level recommended by the NRC (2001); RDP = 11.1% of dry matter (DM)]; 2) cracked corn-based concentrate providing medium RDP (RDP = 12.8% of DM); 3) cracked corn-based concentrate providing high RDP (RDP = 14.5% of DM); and 4) ground corn-based concentrate providing high RDP (RDP = 13.6% of DM). The first 3 treatments, using cracked corn, were compared on the basis of their RDP level. For these treatments, MF, calculated on a protein basis, decreased and the average of MF calculated on an energy basis and MF calculated on a protein basis tended to decrease as RDP increased. There was no difference for MF calculated on an energy basis between treatments. Increasing dietary RDP levels decreased the milk yield (from 32.8 to 30.7 kg/d) and milk protein yield (from 1,094 to 1,005 g/d) but not the milk fat yield. The milk urea N concentration increased as RDP increased. This suggests that there is no advantage of feeding RDP above the NRC recommendations when diets are based on corn and alfalfa silage. At high RDP levels (treatments 3 and 4), ground corn supported higher DM intake and yields of milk and protein than did cracked corn. Milk from forage, calculated on a protein basis, was higher and milk urea N decreased with ground corn. Even with corn silage in the diet, grinding corn grain proved to be beneficial to milk yield and MF production.

Effect of protein supply on hepatic synthesis of plasma and constitutive proteins in lactating dairy cows.

The effects of metabolizable protein (MP) supply on the synthesis of plasma total proteins and albumin, as well as total hepatic protein synthesis, were determined in 6 multicatheterized lactating Holstein cows. Three TMR formulated to supply the same amount of energy but different amounts of MP, 1,922 (low), 2,264 (medium), and 2,517 g of MP/d (high), were fed every 2 h according to a double 3 x 3 Latin square design. For the low and high MP treatments, the cows were continuously infused with [(2)H(5)]Phe (d5-Phe) into a jugular vein for 8 h (1.3 mmol/h) on d 21 of each period. Concentration and isotopic enrichment of d5-Phe were measured for free plasma Phe, plasma total proteins, and albumin on hourly samples collected between 3 and 8 h. Low MP decreased the plasma albumin concentration (32.3 vs. 33.7 +/- 0.11 g/L) but the plasma total protein concentration was unchanged (74.1 vs. 75.6 +/- 1.13 g/L). Incorporation of d5-Phe over time into both plasma total proteins and albumin was linear (R(2) > 0.98). Neither fractional nor absolute synthesis rates of plasma total proteins (6.8 vs. 6.5 +/- 0.65%/d; 168 vs. 154 +/- 19.9 g/d) or albumin (3.4 vs. 3.4 +/- 0.10%/d; 36.3 vs. 36.5 +/- 1.11 g/d) were affected by the MP supply. Net hepatic removal of Phe was lower with the low-MP diet (-12.3 vs. -20.2 +/- 1.98 mmol/h). As a result, net hepatic Phe removal used for total export protein synthesis (17.9 vs. 11.1 +/- 1.83%) and albumin synthesis (4.6 vs. 2.9 +/- 0.54%) tended to be greater at low MP. These results suggest that hepatic synthesis of plasma proteins, including albumin, is maintained in lactating dairy cows even when the protein supply is reduced.