Fatty acid metabolism in lambs fed citrus pulp.

In the present study, we have hypothesized that replacing barley with high proportions of dried citrus pulp in a concentrate-based diet for lambs could increase the intake of unsaturated fatty acids and could reduce the rate of the ruminal biohydrogenation of PUFA, with a consequent improvement of the intramuscular fatty acid composition. To test this hypothesis, 26 Comisana lambs were divided into 3 groups and for 56 d were fed a barley-based concentrate diet (CON; 8 lambs) or 2 diets in which barley was replaced with 24% (CIT24; 9 lambs) or 35% (CIT35; 9 lambs) dried citrus pulp. An overall improvement of the fatty acid composition of LM from lambs fed citrus pulp-containing diets was found. The PUFA/SFA ratio was lower (P < 0.05) in the LM from lambs in the CON group compared with both the CIT24 and CIT35 groups. The thrombogenic index was lower (P < 0.05) in meat from lambs fed the CIT35 diet compared with those fed the CON diet. The CIT35 diet increased the proportion of C20:5 n-3 in the LM (P < 0.05), whereas the CIT24 diet enhanced that of C22:6 -3 (P < 0.05) compared with the CON diet. Some of these results might be explained considering that feeding the CIT24 and CIT35 diets increased the intake of total fatty acids (P < 0.05) and of C18:3 n-3 (P < 0.01) compared with feeding the CON treatment. On the other hand, phenolic compounds present in citrus pulp could have inhibited the ruminal biohydrogenation of PUFA. This is supported by the fact that regardless of the level of inclusion in the diet, citrus pulp increased the proportion of rumenic acid (P < 0.001) in LM compared with the CON diet. The plasma from lambs fed both CIT24 and CIT35 diets had a greater percentage of vaccenic acid (VA; < 0.001) compared with that from lambs fed the CON diet, and the CIT35 diet increased the proportion of rumenic acid in plasma compared with the CON treatment (P < 0.05). In the ruminal fluid, stearic acid (SA) tended to decrease, and the sum of CLA tended to increase (P = 0.09) with increasing level of citrus pulp in the diets. Furthermore, the SA/(SA + VA) ratio tended to be lower (P = 0.10) in the ruminal fluid from lambs fed the CIT35 diet compared with that of the CON group. In conclusion, our results support the hypothesis that replacing barley with citrus pulp in the diet of growing lambs improves intramuscular fatty acid composition and underline the need for specific studies to clarify the mechanisms by which feeding citrus pulp affects the fatty acid metabolism in ruminants.

Effect of including carob pulp in the diet of fattening pigs on the fatty acid composition and oxidative stability of pork.

The effect of feeding pigs with carob pulp on meat quality was investigated. Nine pigs were finished on a conventional concentrate-based diet (control), while two groups received a diet comprising of the same ingredients with the inclusion of 8% or 15% carob pulp (Carob 8% and Carob 15%, respectively). Feeding carob-containing diets reduced the concentration of saturated fatty acids in the muscle, increased the concentration of monounsaturated fatty acids in meat (P < 0.01) and of n-3 polyunsaturated fatty acids (PUFAs) and reduced the n-6/n-3 PUFA ratio (P < 0.001). The meat underwent slow oxidative deterioration over 9 days of storage. However, the Carob 15% treatment increased meat susceptibility to lipid oxidation across storage (P = 0.03), while the dietary treatment did not affect meat colour stability. In conclusion, feeding pigs with carob pulp could represent a strategy,in the Mediterranean areas, to naturally improve meat nutritional value and to promote the exploitation of this local feed resource.

Influence of stall finishing duration of Italian Merino lambs raised on pasture on intramuscular fatty acid composition.

Forty male Italian Merino lambs were used to study the effects of four feeding systems on muscle fatty acids composition: S group-ten lambs were kept indoors, and fed with concentrate for all experimental period (89 days); P group-ten lambs were allowed to graze a pasture for all experimental period; PS37 group-ten lambs were allowed to graze a pasture for 52 days and shifted indoor, fed with concentrate, 37 days before slaughtered; PS14 group, where 10 lambs were fed on pasture for 75 days and shifted indoor, fed with concentrate, 14 days before slaughtered. Grazing lowered the levels of C12:0, C14:0, C16:0 and n-6 PUFA and increased n-3 PUFA and CLA isomer compared to concentrate feeding. After a short period of indoor finishing with concentrate, the fatty acid characteristics of the meat retain a part of the benefits occurring from grazing, while a longer period seems to erase almost all the benefits from grazing.

Intramuscular fatty acid composition of lambs fed diets containing alternative protein sources.

Thirty male Merinizzata italiana lambs were divided into three groups after weaning according to live weight. The diet of the three groups differed in the main protein source used in the concentrate, soybean meal for treatment SBM, faba bean for treatment FB and peas for treatment PEA. Lambs were fed ad libitum and slaughtered at about 160 days of age. Meat from the PEA group had higher proportions of the essential fatty acids C18:2 ω-6 and C18:3 ω-3 than from FB and SBM lambs and consequently its derivatives, C20:4 ω-6 and C20:5 ω-3 respectively, were higher in meat from PEA animals, compared to SBM and FB ones. The total n-3 fatty acids were highest in meat from PEA lambs and consequently PEA lambs showed a more favourable n-6/n-3 ratio. In conclusion the use of legume seeds such as peas in lamb diets positively affected intramuscular fatty acid composition.

Role of comorbidities in a cohort of patients with COPD undergoing pulmonary rehabilitation.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is often associated with other chronic diseases. These patients are often admitted to hospital based rehabilitation programmes. OBJECTIVES: To determine the prevalence of chronic comorbidities in patients with COPD undergoing pulmonary rehabilitation and to assess their influence on outcome. DESIGN: Observational retrospective cohort study. SETTING: A single rehabilitation centre. PATIENTS: 2962 inpatients and outpatients with COPD (73% male, aged 71 (SD 8) years, forced expiratory volume in 1 s (FEV(1)) 49.3 (SD 14.8)% of predicted), graded 0, 1 or >/=2 according to the comorbidity categories and included in a pulmonary rehabilitation programme. MEASUREMENTS: The authors analysed the number of self-reported comorbidities and recorded the Charlson Index. They then calculated the percentage of patients with a predefined positive response to pulmonary rehabilitation (minimum clinically important difference (MCID)), as measured by improvement in exercise tolerance (6 min walking distance test (6MWD)), dyspnoea (Medical Research Council scale) and/or health related quality of life (St George's Respiratory Questionnaire (SGRQ)). RESULTS: 51% of the patients reported at least one chronic comorbidity added to COPD. Metabolic (systemic hypertension, diabetes and/or dyslipidaemia) and heart diseases (chronic heart failure and/or coronary heart disease) were the most frequently reported comorbid combinations (61% and 24%, respectively) among the overall diseases associated with COPD. The prevalence of patients with MCID was different across the comorbidity categories and outcomes. In a multiple categorical logistic regression model, the Charlson Index (OR 0.72 (96% CI 0.54 to 0.98) and 0.51 (96% CI 0.38 to 0.68) vs 6MWD and SGRQ, respectively), metabolic diseases (OR 0.57 (96% CI 0.49 to 0.67) vs 6MWD) and heart diseases (OR 0.67 (96% CI 0.55 to 0.83) vs SGRQ) reduced the probability to improve outcomes of rehabilitation. CONCLUSIONS: Most patients with COPD undergoing pulmonary rehabilitation have one or more comorbidities. Despite the fact that the presence of comorbidities does not preclude access to rehabilitation, the improvement in exercise tolerance and quality of life after rehabilitation may be reduced depending on the comorbidity.

Interdisciplinary rehabilitation in morbidly obese subjects: an observational pilot study.

BACKGROUND AND AIM: To assess the clinical effectiveness of a interdisciplinary rehabilitation programme (CR), in a population of morbidly obese subjects we have undertaken a observational study. METHODS: The study included fifty-nine adult subjects (18 M, 60+/-10 years, BMI 47+/-8) with sleep-disturbance related symptoms and disabilities. Assessment and correction of sleep disordered breathing (SDB) abnormalities, improvement of exercise tolerance, body weight and associated psychological features were the aims of this CR, which has been carried out over a 1 month period. Lung functions, apnea/hypopnea index (AHI), 6-minute walking distance (6MWD), body weight (BW), quality of life by means of Sat-P questionnaire and serum metabolic data has been recorded at baseline (TO), at the end (Ti) and 6 months after (T2) the CR. RESULTS: The percentage of patients with AHI > 10 declined from 65% (at TO) to 20% (at both T1 and T2). 6MWD and BW significantly improved (p < 0.005) at T1 and still maintained at T2; a significant relationship (r = 0.379, p < 0.01) has been found between changes of BW and 6MWD recorded in between TO and T2. Sat-P item scores dealing with sleep efficiency, problem solving, and social interactions improved (p < 0.01) at T1 and still maintained at T2. CONCLUSIONS: This hospital-based CR provides indication for effectiveness in advanced morbidly obese subjects and warrants further controlled trials to confirm the results.

Impact of comprehensive pulmonary rehabilitation on anxiety and depression in hospitalized COPD patients.

To prospectively evaluate the effect of inpatient pulmonary rehabilitation (iPR) on anxiety and depression as outcome measures in patients with COPD, we studied 149 consecutive adults COPD referred to our iPR after an exacerbation. Patients were divided according to the GOLD staging into: Group 1 (stage 2a, n = 48, FEV1 63 +/- 9% pred.), Group 2 (stage 2b, n = 53, FEV1 42 +/- 6% pred.) and Group 3 (stage 3, n = 48, FEV1 25 +/- 7% pred.). The iPR consisted of twelve 3-hours daily sessions. Hospital Anxiety Depression (HAD) Scale as well as 6-minute walk (6MWD) with evaluation of dyspnea (D) and leg fatigue (F) at rest and end of effort, and health related quality of life by means of St. George Respiratory Questionnaire (SGRQ) were assessed before (T0) and after (T1) the iPR. 6MWD, D and F at end of effort and SGRQ total score similarly improved (p < 0.001) in all groups after iPR. The mean level of HAD-anxiety (from 9.1 +/- 4.0 to 7.7 +/- 3.5, from 9.0 +/- 4.6 to 7.2 +/- 4.6 and from 8.1 +/- 4.1 to 6.7 +/- 4.3 in group 1,2 and 3 respectively) and HAD-depression (from 9.4 +/- 3.5 to 8.2 +/- 3.5, from 9.1 +/- 4.2 to 8.2 +/- 4.5 and from 9.0 +/- 4.0 to 7.4 +/- 4.5 respectively) similarly changed (p < 0.0001) over time in all groups. The total percentage of patients with abnormal score (> 10) of HAD-anxiety (from 31% to 21%) and HAD-depression (from 30% to 22%) significantly decreased (p < 0.05) after the iPR. Inpatient pulmonary rehabilitation may improve levels of anxiety and depression as well as symptoms, exercise capacity and health related quality of life in moderate to severe COPD patients after an acute exacerbation.

Incidence and causes of non-invasive mechanical ventilation failure after initial success.

BACKGROUND: The rate of failure of non-invasive mechanical ventilation (NIMV) in patients with chronic obstructive pulmonary disease (COPD) with acute respiratory insufficiency ranges from 5% to 40%. Most of the studies report an incidence of "late failure" (after >48 hours of NIMV) of about 10-20%. The recognition of this subset of patients is critical because prolonged application of NIMV may unduly delay the time of intubation. METHODS: In this multicentre study the primary aims were to assess the rate of "late NIMV failure" and possible associated predictive factors; secondary aims of the study were evaluation of the best ventilatory strategy in this subset of patients and their outcomes in and out of hospital. The study was performed in two respiratory intensive care units (ICUs) on patients with COPD admitted with an episode of hypercapnic respiratory failure (mean (SD) pH 7.23 (0.07), PaCO(2) 85.3 (15.8) mm Hg). RESULTS: One hundred and thirty seven patients initially responded to NIMV in terms of objective (arterial blood gas tensions) and subjective improvement. After 8.4 (2.8) days of NIMV 31 patients (23%; 95% confidence interval (CI) 18 to 33) experienced a new episode of acute respiratory failure while still ventilated. The occurrence of "late NIMV failure" was significantly associated with functional limitations (ADL scale) before admission to the respiratory ICU, the presence of medical complications (particularly hyperglycaemia), and a lower pH on admission. Depending on their willingness or not to be intubated, the patients received invasive ventilation (n=19) or "more aggressive" (more hours/day) NIMV (n=12). Eleven (92%) of those in this latter subgroup died while in the respiratory ICU compared with 10 (53%) of the patients receiving invasive ventilation. The overall 90 day mortality was 21% and, after discharge from hospital, was similar in the "late NIMV failure" group and in patients who did not experience a second episode of acute respiratory failure. CONCLUSIONS: The chance of COPD patients with acute respiratory failure having a second episode of acute respiratory failure after an initial (first 48 hours) successful response to NIMV is about 20%. This event is more likely to occur in patients with more severe functional and clinical disease who have more complications at the time of admission to the ICU. These patients have a very poor in-hospital prognosis, especially if NIMV is continued rather than prompt initiation of invasive ventilation.