Whole-body protein turnover in malnourished patients with child class B and C cirrhosis on diets low to high in protein energy.

The purpose of this study was to determine the rate of whole-body protein turnover in moderately and severely alcoholic, malnourished, cirrhotic patients fed with different amounts of protein or energy. Six male patients (Child classes B and C) and four age- and sex-matched healthy control subjects were studied for 18 d in fasting and feeding states; a single oral dose of [(15)N]glycine was used as a tracer and urinary ammonia was the end product. The kinetic study showed that patients had higher protein catabolism while fasting (patients: 3.14 +/- 1.2 g of lean body mass/9 h; controls: 1.8 +/- 0.3 g of lean body mass/9 h; P < 0.02). Although not statistically significant, protein catabolism (grams of lean body mass/9 h) was lower with the hyperproteic/hyperenergetic diet when compared with fasting. Nitrogen retention was consistent with the lower protein-catabolism rate; a statistically significant increase in nitrogen balance was observed when patients were fed with the hyperproteic/hyperenergetic diet compared with fasting (4.3 +/- 3.2 g of nitrogen/d and -2.2 +/- 1.9 g of nitrogen/d, respectively; P < 0.01). These data indicate that Child class B and C cirrhotic patients are hypercatabolic and that long-term nutritional intervention with a hyperproteic/hyperenergetic diet is likely needed to improve their clinical and nutritional status.

Comparison of omega-3 fatty acids and sulfasalazine in ulcerative colitis.

Fish oil omega-3 fatty acids exert antiinflammatory effects on patients with ulcerative colitis. However, a comparative study in patients with mild to moderate ulcerative colitis receiving only sulfasalazine or omega-3 fatty acids has not been performed. We sought to detect changes in the inflammatory disease activity with the use of either fish oil omega-3 fatty acids or sulfasalazine in patients with ulcerative colitis. Ten patients (five male, five female; mean age = 48 +/- 12 y) with mild to moderate active ulcerative colitis were investigated in a randomized cross-over design. They received either sulfasalazine (2 g/d) or omega-3 fatty acids (5.4 g/d) for 2 m.o. Disease activity was assessed by clinical and laboratory indicators, sigmoidoscopy, histology, and whole-body protein turnover (with 15N-glycine). Treatment with omega-3 fatty acids resulted in greater disease activity as detected by a significant increase in platelet count, erythrocyte sedimentation rate, C-reactive protein, and total fecal nitrogen excretion. No major changes in protein synthesis and breakdown were observed during either treatment. In conclusion, treatment with sulfasalazine is superior to treatment with omega-3 fatty acids in patients with mild to moderate active ulcerative colitis.

[Use of proteic metabolism (15N-glycine) in the early detection of disease exacerbation in patients with non-specific ulcerative colitis]. / Utilização do metabolismo protéico (15N-glicina) na detecção precoce de agravamento da atividade da doença em pacientes portadores de retocolite ulcerativa inespecífica.

Disease activity was assessed in 10 (five males and five females) ulcerative colitis patients through the following parameters: clinical, laboratory, sigmoidoscopic and histological. Protein metabolism was also assessed with 15N-glycine and urinary ammonia as end product. Only one patient had exacerbation of the disease two months after the study started. This patient presented in the beginning of the study protein synthesis and breakdown of 4.51 and 3.47 g protein/kg/day, respectively, values higher than all other patients, showing an hypermetabolic state, suggesting an increase of the disease activity. However, this increase was not detected by others indicators and indexes utilized. These data allow to suggest the hypothesis that protein metabolism predicts precociously the exacerbation of disease activity in ulcerative colitis patients.

[Chemical and biological evaluation of ripe banana peel]. / Avaliaçao química e biológica da casca de banana madura.

Chemical and biological evaluation of ripe banana peel was conducted, aiming its potential use as a source of dietary fiber in human nutrition. Two types of flour were prepared from banana peel: a) untreated (UT), using washed and dried peel; b) treated (SMB), using peel treated with sodium metabisulfite and citric acid, in attempt to minimize the darkening of the flour. As expected, banana peel flour revealed to be an important source of fiber (NDF), corresponding about 32% of its dried weight. The addition of this flour to a basal casein diet lowered its protein digestibility and increased the fecal bulk of the rats, which are the known effects of dietary fiber. However, it did not alter the protein quality, since there was no difference in the PER values of the diets studied; in addition, the growth of the rats fed diets containing banana peel did not differ from those fed control diet. These results suggest the feasibility of technological studies aiming the development of food products with banana peel. Besides, biological assays should be realized in the elucidation of its effects in food intake and biochemical parameters.

Protein-energy status and 15N-glycine kinetic study of child a cirrhotic patients fed low- to high-protein energy diets.

In five male cirrhotic patients (Child A) and in four age- and sex-matched healthy control subjects, whole-body protein turnover was measured using a single oral dose of 15N-glycine as a tracer and urinary ammonia as end product. Subjects were studied in the fasting and feeding state, with different levels of protein and energy intake. The patients were underweight and presented lower plasma transthyretin and retinol-binding protein levels. When compared with controls, the kinetic studies showed patients to be hypometabolic in the fasting (D0) state and with the control diet [D1 = (0.85 g of protein/ 154 kJ) x kg-1.day-1]. However, when corrected by body weight, the kinetic differences between groups disappeared, whereas the N-retention in the feeding state showed better results for the patients due mainly to their efficient breakdown decrease. When fed high-level protein or energy diets [D1 = (0.9 g protein/195 kJ) and D3 = (1.56 g protein/158 kJ) x kg-1.day-1], the patients showed D0 = D1 = D2 < D3 for N-flux and (D0 = D1) < D3 (D2 is intermediary) for protein synthesis. Thus, the present data suggest that the remaining mass of the undernourished mild cirrhotic patients has fairly good protein synthesis activity and also that protein, rather than energy intake, would be the limiting factor for increasing their whole-body protein synthesis.

Effect of lactose induced diarrhea on intestinal glutaminase and muscle glutamine synthetase activities in rats.

This study was performed to evaluate the effect of lactose induced diarrhea on the key enzymes of glutamine metabolism in skeletal muscle and small intestine, in rats. As compared to weight paired controls, animals with diarrhea presented higher muscle glutamine synthetase activity associated with reduced skeletal muscle glutamine concentration with a fall in arterial glutamine and an increased intestinal glutaminase activity. These alterations are similar to those reported by others in conditions in which accelerated muscle proteolysis is likely to occur such as in sepsis and after surgery. Besides the data suggestive of an overall alterations in glutamine metabolism, an important finding of this study was the increase in specific activity of intestinal phosphate dependent glutaminase in rats with diarrhea. This enzyme has been shown not to respond to many conditions such as acidosis, alkalosis or increased glutamine ingestion through drinking water or diet.

[Metabolic response of cirrhotic patients (Child A) to the increase of protein and/or caloric intake. Nitrogen balance study]. / Resposta metabólica de pacientes cirróticos (Child A) ao aumento da ingestão protéica e/ou calórica. Estudo do balanço nitrogenado.

The dietary protein assimilation by cirrhotic undernourished patients (lower lean body mass and plasma TBPA and RBP levels) was investigated in five-adult male subjects suffering from histologically diagnosed liver cirrhosis, in its clinically mild stage (Child-Turcotte-Pugh grade A). During the 9 day-dietary study the patients received orally a sequence of complete-regional diets containing different protein-energy compositions identified as (g prot/Cal/kg/day): D0 = 0.42/20.9; D1 = 0.91/37.5; D2 = 0.99/47.9 and D3 = 1.60/40.5. The respective N-balance values (g/day) found were (mean +/- SD): low protein calorie (D0) = -4.24 +/- 2.46; normal protein calorie (D1) = 0.66 +/- 1.99; normal protein-high calorie (D2) = 1.14 +/- 2.54; high protein normal calorie (D3) = 5.12 +/- 2.48. The correspondent urea-N output (g/kg/day) were D0 = 0.22 +/- 0.100; D1 = 0.238 +/- 0.099; D = 0.20 +/- 0.063 and D3 = 0.310 +/- 0.121. The present data thus suggest that protein rather than energy intake would be the limited factor for increasing the N-retention in (mild) cirrhotic patients whom tolerate well dietary protein at either normal or elevated levels.

[Nutritional and sensory evaluation of macaroni supplemented with fish protein concentrate]. / Avaliação sensorial e nutricional de macarrão suplementado com concentrado protéico de pescado.

The present work consisted of the supplementation of macaroni with fish protein concentrate (FPC) at the levels of 5, 10, 15, and 20% in relation to wheat flour. The FPC was obtained from eviscerated and deboned trairas (Hoplias malabaricus), using boiling ethanol as a solvent at a pH range of 5.5 to 6.0. The FPC showed desirable aspects such as bright color, no off-flavor, high levels of protein (84.3 g/100 g) and lysine (484 mg/g N) and low levels of fat (0.4 mg/100 g) and moisture (8.6 g/100 g). The macaroni became slightly dark in color with increasing additions of FPC. Nevertheless, the 20% level was the only one not accepted by the testing panel, in terms of color and flavor. Weanling Wistar rats were used in the biological assay to measure the macaroni protein quality at the different supplementation levels. Analyses of PER, NPR, NPU, digestibility and retained carcass N were carried out. The protein quality of the macaroni was improved by the addition of FPC. The level of 10% was similar to the casein and no subsequent improvement in the protein quality was notified with higher levels of FPC. Due to its high lysine content, the FPC is a promising supplement for cereals. From the nutritional and sensory aspects, the 10% level of FPC was the most satisfactory for macaroni supplementation.