Effects of oral nutritional supplementation in the management of malnutrition in hospital and post-hospital discharged patients in India: a randomised, open-label, controlled trial.

BACKGROUND: Hospital malnutrition is a significant problem that still remains under-recognised and under-treated in India. The present study assessed the effects of oral nutritional supplementation (ONS) in conjunction with dietary counselling versus dietary counselling (control) alone in malnourished patients when given in hospital and post-hospital discharge. METHODS: The present study was conducted in nine private and four public hospitals. Patients from various medical wards were screened for malnutrition using modified Subjective Global Assessment (mSGA) and randomised to control (n = 106) or ONS (n = 106) for 12 weeks. Two servings (460 mL) of ONS were prescribed daily, providing 432 kcal, 16 g of protein and 28 micronutrients. The primary outcome was weight gain over 12 weeks. Other outcomes included change in body mass index (BMI), serum pre-albumin, albumin and C-reactive protein levels, energy and nutrient intakes, and handgrip strength at weeks 4, 8 and 12, as well as mSGA score at week 12. RESULTS: The mean age of patients was 39 years. Fifty-five percent were males and 90.3% were moderately malnourished (mSGA score B) at baseline. At week 12, ONS significantly improved certain parameters compared to control: weight (2.0 versus 0.9 kg; P < 0.001), BMI (0.76 versus 0.37 kg m(-2) ; P < 0.001) and energy intake per day (560 versus 230 kcal; P < 0.05). There were no differences in biochemical parameters and mSGA score between groups. Additionally, patients on ONS who were more functionally impaired at baseline had significantly greater weight gain and improved handgrip strength scores than controls. CONCLUSIONS: ONS use throughout hospital stay and post-hospital discharge significantly improved energy intake and weight in malnourished Indian patients. Those patients with poorer functional status at baseline demonstrated the most benefit.

Appetitive and Dietary Effects of Consuming an Energy-Dense Food (Peanuts) with or between Meals by Snackers and Nonsnackers.

Background. Energy-dense foods are inconsistently implicated in elevated energy intake (EI). This may stem from other food properties and/or differences in dietary incorporation, that is, as snacks or with meals. Objective. Assess intake pattern and food properties on acute appetitive ratings (AR) and EI. Design. 201 normal and overweight adults consuming a standard lunch. Test loads of 1255.2 kJ (300 kcal) were added to the lunch or provided as snack. Loads (peanuts, snack mix, and snack mix with peanuts) were energy, macronutrient, and volumetrically matched with a lunch portion as control. Participants completed meal and snack sessions of their randomly assigned load. Results. No differences were observed in daily EI or AR for meal versus snack or treatment versus control. Consumption of peanuts as a snack tended to strengthen dietary compensation compared to peanuts or other loads with a meal. Conclusions. Inclusion of an energy-dense food as a snack or meal component had comparable influence on AR and EI. Peanuts tended to elicit stronger dietary compensation when consumed as a snack versus with a meal. If substantiated, this latter observation suggests that properties other than those controlled here (energy, macronutrient content, and volume) modify AR and EI.

Effects of conjugated linoleic acid. 1. Fatty acid modification of yolks and neonatal fatty acid metabolism.

The purpose of this study was to evaluate the effects of conjugated linoleic acids (CLA) on neonatal fatty acid metabolism. In this study, layer hens (n = 40) were divided into four equal groups and subjected to the following treatments. Group A served as the control group, Group B received 1 g CLA every other day, Group C received 1 g CLA every 4th d, and Group D was sham-supplemented with 1 g safflower oil every other day. After 4 mo of feeding, Group B hens exhibited an increase in BW and egg size; however, there were no differences noted in feed consumption among the various treatment groups. At the same time, hens were inseminated with a constant dose of pooled rooster semen to evaluate changes in chick liver and yolk fatty acid metabolism during neonatal growth. At hatch and through 6 d of age, there were no significant differences in breakout data (fertility and numbers of early-, mid-, or late-dead chicks) or chick BW, respectively. However, Group B chicks exhibited an increase in liver 18:3n3 and 22:1n9 and a decrease in 20:3n6 and 22:5n3 fatty acids when compared with chicks from Groups A and D. Also noted for Group B chicks, yolk 18:0 fatty acid was higher than that for Group A and D chicks. These results suggest that CLA alters lipid metabolism in growing chicks.

Effects of conjugated linoleic acid. 2. Embryonic and neonatal growth and circulating lipids.

The present study was designed to investigate the effects of conjugated linoleic acid (CLA) on yolk usage and circulating very low density lipoproteins (VLDL) during incubation (Day 15) and through 6 d post-hatch. Eggs enriched with CLA were obtained from hens subjected to the following treatments. Group A hens served as the control group, Group B hens received 1 g CLA every other day, Group C hens received 1 g CLA every 4th d, and Group D hens were sham-supplemented with 1 g safflower oil every other day. Enrichment with CLA did not effect fertility, hatch of fertile, BW, or yolk-free BW of embryos or chicks. However, there were significant changes in relative yolk sac weight (RYW) and composition of circulating VLDL particles. Across all dietary treatments (Groups B, C, and D), 15-d embryos had smaller RYW compared with Group A embryos; this difference remained through 2 d posthatch. During that period (15 d of incubation through 2 d posthatch), however, embryos and chicks from Group B hens exhibited a unique absorption pattern such that little to no yolk was utilized between hatch and 2 d posthatch, a period normally characterized by high yolk lipid utilization. Similar to the RYW effects, VLDL particles were also altered by hen-induced treatment. Specifically, at hatch, chicks from Group A hens had the highest percentage of triglycerides (TG) within their VLDL particles compared with chicks from hens under all other treatments. This trend in VLDL particles was continued at 4 d posthatch. The present study demonstrates that CLA enrichment of eggs alters relative yolk sac absorption and the composition of circulating VLDL particles.