ABSTRACT
INTRODUCTION: Introduction: nutritional therapy is essential for the treatment of critically ill patients, although its right application fails frequently, which increases the risk for undernutrition and complications. Objective: to evaluate the nutritional adequacy of patients with enteral nutritional support in an intensive care unit (ICU). Methods: a cohort study was conducted including adults admitted to the ICU with enteral support and stay ≥ 7 days. Demographic data, severity of the disease, and clinical and nutritional scores, including IL-6 levels and body composition, were evaluated at admission. Nutritional intake was recorded daily in relation to the target intake according to international guidelines, for calculation of caloric and protein deficiencies. Results: in all, 26 from 132 admitted patients were included. Their probability of mortality was 20-25 % due to disease severity by APACHE (16.6 ± 6.02) and SOFA (8 ± 4.4). Undernutrition risk was 5.6 ± 1.09 by NRS-2002 and 4.3 ± 1.2 by angle phase. Caloric deficiency was -674 kcal/day, with 13 % proteins (28 ± 11.5 g/d) and 42 % lipids, including 17.5 % of non-nutrient calories from propofol. NUTRIC was significantly associated with percentages of the caloric prescription at days 3 and 7 (R2 = 0.21, p = 0.01). Conclusion: patients had a caloric/protein deficit with critical protein deficit of -85.2 g/day, and an inadequate proportion between protein calories and non-protein calories, increasing their risk of complications.
INTRODUCCIÓN: Introducción: la terapia nutricional es esencial para tratar a pacientes críticos pero, si no es la adecuada, aumenta el riesgo de desnutrición y complica la evolución. Objetivo: evaluar la adecuación de la terapia nutricional enteral en una unidad de cuidados intensivos (UCI). Métodos: se evaluó una cohorte adulta ingresada a una UCI con nutrición enteral y estancia ≥ 7 días. Al ingreso se registraron la severidad de la enfermedad y los datos socio-demográficos, clínicos y nutricionales, con cribados que incluyeron la IL-6 y la composición corporal. Diariamente se evaluó el aporte de nutrientes con respecto al 70 % óptimo de lo prescrito por las guías internacionales, para estimar el déficit energético-proteico. Resultados: se incluyeron 26 de 132 pacientes ingresados. Su probabilidad de mortalidad era del 20-25 % debido a la severidad de su enfermedad por los sistemas APACHE (16,6 ± 6,0) y SOFA (8 ± 4,4); su riesgo de desnutrición era de 5,6 ± 1,09 puntos por el NRS-2002, con 4,3 ± 1,2 de ángulo de fase. El déficit energético promedio era de -674 kcal/día, con un 13 % en aporte proteico (28 ± 11,5 g/d) y un 42 % en lípidos, y con el 17,5 % proveniente del propofol. El NUTRIC se asoció significativamente con los porcentajes de prescripción calórica alcanzados los días 3 y 7 (R2 = 0,21, p = 0,01). Conclusión: los pacientes sufrieron déficit calórico/proteico, con déficit proteico crítico de > 85,2 g/día e inadecuada relación entre calorías proteicas y no proteicas, aumentando su riesgo de complicaciones.
Subject(s)
Energy Intake , Intensive Care Units , Adult , Cohort Studies , Critical Care , Critical Illness , Humans , Nutritional SupportABSTRACT
BACKGROUND: Ultra-processed foodstuffs have been replacing traditional beans with tortillas in the Mexican diet in the last decades. Therefore, scientific support is needed to promote a return to good-quality traditional dishes. OBJECTIVES: This study aims to evaluate the amino acid digestibility and score of pinto beans (Phaseolus vulgaris) consumed with corn tortillas and guacamole in adults using the dual-tracer method. METHODS: The pinto beans were intrinsically labeled using 250 mL of 2H2O (99.8%) per 19 L pot with 3 plants. A paste of cooked beans on toasted corn tortillas and guacamole topping were administered to 3 male and 3 female adults (21-25 years old; BMI, 19-23.5 kg/m2). The protocol was plateau feeding given along with U-[13C]-spirulina protein to evaluate indispensable amino acid (IAA) digestibility using the dual-tracer method. Blood samples were taken in the plateau state. The digestibility of each IAA of the bean protein was calculated by the ratio of its enrichment in the beans to the spirulina in the meal and its appearance in plasma collected in the plateau state, as a percentage corrected by spirulina digestibility. Additionally, the digestible IAA score (DIAAS) was calculated. RESULTS: The 2H enrichment of IAA in the pinto beans was 471 parts per million excess. The isotopic enrichment of 2H and 13C in IAA at 5-8 hours presented plateau states with mean CVs of 12.2% and 13.3%, respectively. The mean digestibility of IAA from pinto beans was 77% ± 1.6%, with the lowest value for threonine. The DIAAS calculated with respect to the pattern requirement for children older than 3 years, adolescents, and adults was 83%, with methionine and cysteine being the limiting amino acids. CONCLUSIONS: A Mexican dish of pinto beans, tortillas, and guacamole is a good source of protein as evaluated in adults and could be promoted as a nutritious snack. The assay is registered with the Ethical Committee of the Centro de Investigación en Alimentación y Desarrollo, A.C. as CE/015/2019.
Subject(s)
Amino Acids , Zea mays , Adolescent , Adult , Amino Acids, Essential , Child , Child, Preschool , Digestion , Female , Humans , Ileum , Male , Young AdultABSTRACT
Objective. To evaluate the efficacy of the [(13)C]glucose breath test for measuring insulin resistance in Mexican adults with different glycemic states. Research Design and Methods. Fifty-eight adults underwent a [(13)C]glucose breath test with simultaneous measurement of total CO(2) production by indirect calorimetry, at baseline and 90 minutes after the ingestion of 15 g of dextrose and 25 mg of [(13)C]glucose. HOMA was used as a marker of insulin resistance. Results. We found an inverse correlation between HOMA and the breath test δ(13)CO(2) (), r = -0.41 (P = 0.001). After adjusting for total CO(2) production, correlations between HOMA and fasting glucose were less strong but remained significant. An ROC curve was constructed using δ(13)CO(2) () and HOMA values; the cut-off point was 9.99 δ(13)CO(2), corresponding to a sensitivity of 80.0 (95% CI: 51.9, 95.7) and a specificity of 67.4 (95% CI: 51.5, 80.9). Conclusions. The [(13)C]glucose breath test is a simple noninvasive procedure but was not sufficiently robust for an accurate diagnosis of insulin resistance. Our findings suggest that the test might be helpful in identifying individuals who are not IR, which in turn may contribute to improved diabetes prevention.
