Relationship between nutritional goals and pressure injuries in critical care patients receiving enteral nutrition.

OBJECTIVE: To examine the relationship between pressure injury (PI) development and achievement of nutritional goals (protein and caloric), as well as consider the clinical conditions, hospitalisation factors, and risk assessment for PI development in patients who are critically ill and receiving enteral nutrition (EN) in the intensive care unit (ICU). METHOD: An observational cohort study was conducted in the ICU of the University Hospital in São Paulo, Brazil. Inclusion criteria were as follows: age ≥18 years; length of ICU stay ≥24 hours; without PI at ICU admission; and receiving EN exclusively during ICU stay. The development of PI was considered the dependent variable. The Chi-squared test was applied to compare categorical variables, and the Mann-Whitney U test was used to compare continuous variables between groups of patients with and without a PI. The analysis of the achievement of nutritional goals was performed using Fisher's exact test. A significance level of 5% (p-value<0.05) and a confidence interval (CI) of 95% was adopted in all statistical tests. RESULTS: A total of 181 patients met the inclusion criteria, of whom 102 (56.4%) were male and 79 (43.6%) were female. Mean age was 55.1 years, and mean length of ICU stay was 17.5 days. PI development was associated with not achieving nutritional goals. There was a higher percentage (65.3%) of patients without a PI when both protein and caloric goals were achieved. In contrast, 45.6% of patients developed a PI when the goals were not achieved. The mean days for sedation, vasoactive drugs and mechanical ventilation were all significantly higher in patients who developed a PI (p<0.001). CONCLUSION: There was a significant association between patients developing a PI and deficits in caloric and protein intake. Patients who did not develop PIs had a greater calorie and protein intake compared with those who developed a PI.

Energy cost of physical activities in growing broilers.

1. The time-energy budget method estimates the energy used for physical activity (PA) by integrating behaviour PA patterns with energy cost for specific PAs. Nevertheless, information about individual energy cost by type of PA are not available and so this study estimated the energy cost of PA for growing broilers.2. An indirect calorimetry system for single birds was constructed to measure the variation in the rate of O2 consumption (V˙O2, L/min) and rate of CO2 production (V˙CO2, L/min) produced by these PAs.3. A total of five birds were used in a replicated trial where their body weight (BW) ranged from 1.5 to 2.5 kg to measure the increase in heat production (HP) above resting levels as a result of PA. The procedure in the chamber was divided into five steps: (1) initial baselining, (2) resting metabolic rate, (3) PA such as feeding, drinking and other standing activities, (4) removal of gas exchange produced in step 3, and (5) final baselining. The PA was recorded using a video camera fixed at the chamber's top (and outside).4. The area under V˙CO2 and V˙O2 curves was used to calculate the CO2 production (vCO2, L) and O2 consumption (vO2, L). Then, the HP (cal/kg-0.75) was calculated according to the Brouwer equation. Two observers analysed the video records to estimate the time spent for each PA (seconds and frequency).5. To calculate the energetic coefficients, the HP was regressed with the function of time spent to perform each PA allowing to estimate the energy cost for eating, drinking and stand activities, which were 0.607, 0.352 and 0.938 cal/kg-0.75/s, respectively.

Avaliação do consumo alimentar de pacientes queimados internados em um hospital público do Distrito Federal / Evaluation of food consumption of burn patients admitted to a public hospital in the Federal District

OBJETIVO: Avaliar o consumo alimentar dos pacientes queimados hospitalizados no processo de cicatrização. MÉTODO: Estudo transversal, quantitativo, com coleta de dados prospectivos. A coleta ocorreu no Hospital Regional da Asa Norte (HRAN), no período de março de 2022 a maio de 2022, com 113 dias alimentares de 24 pacientes hospitalizados. A coleta de dados foi realizada com ficha pré-estabelecida (número de prontuário, sexo, faixa etária, percentual de área queimada e tipo de queimadura). Para calcular as necessidades nutricionais, foi utilizada a equação de Toronto. A análise dos dados coletados aconteceu a partir do software Avanutri PC, sendo uma análise quantitativa dos macronutrientes (proteína, lipídios e carboidratos) e micronutrientes (zinco, vitamina C, vitamina A, vitamina E e selênio). RESULTADOS: Os recordatórios alimentares foram calculados com e sem suplementação. Nos dias com suplementação a adequação calórica aumentou, sendo que a maioria, 39,8%, conseguiu atingir mais de100% das recomendações e 29,2% conseguiu permanecer dentro de 75-100% das necessidades energéticas diária e todas as vitaminas e minerais também aumentaram sua adequação, sendo vitamina A antes da suplementação 406,1mg e após a suplementação 531,4mg, vitamina C antes 462,2mg e 626,4mg após, vitamina E 8,3mg antes e 31,2mg após, zinco 11,8mcg antes e após 18,7mcg e selênio 54,4mg antes e 99,5mg após a suplementação. CONCLUSÕES: A nutrição desempenha um papel muito importante na recuperação de pacientes queimados, contribuindo para a cicatrização de feridas, prevenção de infecções, manutenção do peso corporal e minimização de complicações. É essencial que esses pacientes recebam suplementação adequada para auxiliar seu processo de cicatrização.

OBJECTIVE: To evaluate the food consumption of hospitalized burn patients in the healing process. METHODS: Cross-sectional, quantitative study, with prospective data collection. The collection took place at the Hospital Regional da Asa Norte (HRAN), from March 2022 to May 2022, with 113 days of eating from 24 hospitalized patients. Data collection was carried out using a pre-established form (medical record number, sex, age group, percentage of burned area and type of burn). To calculate nutritional needs, the Toronto equation was used. The analysis of the collected data took place using the Avanutri PC Software, being a quantitative analysis of macronutrients (protein, lipids and carbohydrates) and micronutrients (zinc, vitamin C, vitamin A, vitamin E and selenium). RESULTS: Dietary recalls were calculated with and without supplementation, on days with supplementation caloric adequacy increased, with the majority, 39.8%, managing to achieve more than100% of recommendations and 29.2% managing to remain within 75-100% of daily energy needs and all vitamins and minerals also increased their adequacy, with vitamin A before supplementation 406.1mg and after supplementation 531.4mg, vitamin C before 462.2mg and 626.4mg after, vitamin E 8.3mg before and 31.2mg after, zinc 11.8mcg before and after 18.7mcg and selenium 54.4mg before and 99.5mg after supplementation. CONCLUSIONS: Nutrition plays a very important role in the recovery of burn patients, contributing to wound healing, preventing infections, maintaining body weight and minimizing complications. It is essential that these patients receive adequate supplementation to aid their healing process.

Selection effect for growth traits on energy requirements in beef Nelore steers.

Growth data of 77,372 Nelore steers were used to estimate the selection effect on energy requirements considering two beef production systems: cow-calf and slaughter cycles. All the animals had measures from 120 days to 7 years old. The parameters necessary to evaluate the selection effect on energy requirements were obtained by random regression analysis using Legendre polynomials. The models included additive direct and maternal effects, and animal and maternal permanent environmental effects as random terms. Contemporary group and dam age at calving (linear and quadratic effect) were included as fixed effects, and orthogonal Legendre polynomials of animal age (cubic regression) were considered random covariables. The coefficients from the model M3353_5 were used to calculate the genetic gains necessary to predict the increase in phenotypes. The selection was simulated for body weight (BW) and weight gain (WG) at different ages and energy requirements were calculated using NRC equations. The cost of feed was calculated for a cow-calf and slaughter cycle of production considering a system of Brachiaria decumbens pasture without supplementation. In slaughter system, the selection for weight of 365 days of age is the best option. In cow-calf systems, the selection W120 is the best choice.

Effect of inclusion levels of low-fat dried distillers grains in finishing diets on protein and energy intake and retention and estimation of protein and energy requirements of young Nellore bulls fed with high concentrate diets.

The objective was to evaluate the effect of including low-fat dried distillers grains (DDG) in finishing diets on protein and energy intake and retention and to estimate the protein and energy requirement of young Nellore bulls. Thirty-five animals were used: baseline (n = 4), maintenance (n = 4), and ad libitum intake (n = 27). Ad libitum animals were divided into four groups: diets with the inclusion of DDG at the levels of 0, 150, 300, and 450 g/kg (dry matter basis). At the end of the experiment, all animals were slaughtered. There was a linear reduction with increasing DDG levels in the total digestible nutrients intake (p = 0.008), metabolizable energy (ME) intake (p < 0.010), in total retained energy (p = 0.065), and in heat production (p < 0.001). Metabolizable protein (MP) intake increased linearly (p < 0.010) but retained protein did not differ (p = 0.499). Daily net energy and ME requirement for maintenance were 75.9 and 122 kcal/kg0.75 EBW, respectively. Daily MP for maintenance was 3.6 g/kg0.75 shrunk body weight. DDG inclusion in finishing diets reduces energy intake and deposition, and we recommend the equations of this study to estimate the requirements of young Nellore bulls.

Nutritional therapy for hospitalized patients with COVID-19: A narrative and integrative review.

Hospitalized patients affected by coronavirus disease 19 (COVID-19) have a sustained pro-inflammatory state and recurrent gastrointestinal symptoms that correlate with a decline in the nutritional status, which is directly related to poor immune response and clinical evolution. Nutritional therapy has proven crucial in COVID-19 treatment through the provision of adequate amounts of nutrients. Since the beginning of the pandemic, medical societies have mobilized to provide practical nutritional guidelines to support decision-making; despite this, there are only a few studies dedicated to compiling the most relevant recommendations. In this narrative review, we aimed to summarize and stratify the current scientific literature on nutritional support for hospitalized COVID-19 patients. We carried out a literature review from three databases between January 2020 and July 2021, using nutrition therapy (or medical nutrition or enteral nutrition or parental nutrition or nutritional support) and COVID-19 (SARS-CoV-2 infection) as the search terms. Only those studies that evaluated adult hospitalized patients with admissions to wards, specific clinics, or intensive care units were included. The nutritional intervention considered was that of specific nutritional support via oral, enteral, or parenteral modes. A total of 37 articles were included. In general, the nutritional care provided to COVID-19 patients follows the same premises as for other patients, i.e., it opts for the most physiological route and meets nutritional demands based on the clinical condition. However, some protocols that minimize the risk of contamination exposure for the health team have to be considered. Energy requirements varied from 15 kcal/kg/day to 30 kcal/kg/day and protein goals from 1.2 g/kg/day to 2 g/kg/day. In both cases, the ramp protocol for increased supply should be considered. In cases of enteral therapy, ready-to-use diet and continuous mode are recommended. Attention to refeeding syndrome is essential when parenteral nutrition is used.

Dietary net energy mainly affects growth performance and pork quality of finishing pigs

The present study was carried out to evaluate the effect of net energy levels in diets for barrows, from 70 to 100 kg, on performance, plasma parameters and carcass characteristics. Two experiments were carried out: in the first (Experiment I), a metabolism assay was carried out to estimate the net energy (NE) of experimental diets. Twelve crossbred barrows, averaging 85.74 ± 6.80 kg initial body weight, were distributed in a randomized block design with two metabolizable energy (ME) levels (3100 and 3500 kcal kg­1) with six replicates and one animal per experimental unit. In the second (Experiment II), 45 castrated male pigs were used, averaging 70.10 ± 1.26 kg of initial body weight distributed in a randomized block design, with five NE levels (2345, 2425, 2505, 2585, 2665 kcal kg­1), nine replicates and one animal per experimental unit. The increase in diet NE levels provided a linear reduction (p ≤ 0.00039) in average daily feed intake (ADFI). There was a quadratic effect on NE efficiency (p ≤ 0.0027), average daily gain (ADG), (p ≤ 0.0352) and the feed:gain ratio (F:G), (p ≤ 0.0024), the optimal levels being estimated at 2485, 2493 and 2533 kcal kg­1, respectively. Drip loss (DL) decreased (p ≤ 0.0001) as NE levels increased. There was also a linear decrease (p ≤ 0.0462) in the Minolta color parameter (+a*), due to the NE levels. Plasma parameters were not affected (p > 0.05) by NE levels. The dietary net energy levels affected the performance and meat quality of finishing pigs and the level of 2493 kcal kg­1 provided the best ADG.(AU)

Dietary net energy mainly affects growth performance and pork quality of finishing pigs

ABSTRACT The present study was carried out to evaluate the effect of net energy levels in diets for barrows, from 70 to 100 kg, on performance, plasma parameters and carcass characteristics. Two experiments were carried out: in the first (Experiment I), a metabolism assay was carried out to estimate the net energy (NE) of experimental diets. Twelve crossbred barrows, averaging 85.74 ± 6.80 kg initial body weight, were distributed in a randomized block design with two metabolizable energy (ME) levels (3100 and 3500 kcal kg1) with six replicates and one animal per experimental unit. In the second (Experiment II), 45 castrated male pigs were used, averaging 70.10 ± 1.26 kg of initial body weight distributed in a randomized block design, with five NE levels (2345, 2425, 2505, 2585, 2665 kcal kg1), nine replicates and one animal per experimental unit. The increase in diet NE levels provided a linear reduction (p 0.00039) in average daily feed intake (ADFI). There was a quadratic effect on NE efficiency (p 0.0027), average daily gain (ADG), (p 0.0352) and the feed:gain ratio (F:G), (p 0.0024), the optimal levels being estimated at 2485, 2493 and 2533 kcal kg1, respectively. Drip loss (DL) decreased (p 0.0001) as NE levels increased. There was also a linear decrease (p 0.0462) in the Minolta color parameter (+a*), due to the NE levels. Plasma parameters were not affected (p > 0.05) by NE levels. The dietary net energy levels affected the performance and meat quality of finishing pigs and the level of 2493 kcal kg1 provided the best ADG.

Dietary net energy mainly affects growth performance and pork quality of finishing pigs

The present study was carried out to evaluate the effect of net energy levels in diets for barrows, from 70 to 100 kg, on performance, plasma parameters and carcass characteristics. Two experiments were carried out: in the first (Experiment I), a metabolism assay was carried out to estimate the net energy (NE) of experimental diets. Twelve crossbred barrows, averaging 85.74 ± 6.80 kg initial body weight, were distributed in a randomized block design with two metabolizable energy (ME) levels (3100 and 3500 kcal kg–¹) with six replicates and one animal per experimental unit. In the second (Experiment II), 45 castrated male pigs were used, averaging 70.10 ± 1.26 kg of initial body weight distributed in a randomized block design, with five NE levels (2345, 2425, 2505, 2585, 2665 kcal kg–¹), nine replicates and one animal per experimental unit. The increase in diet NE levels provided a linear reduction (p ≤ 0.00039) in average daily feed intake (ADFI). There was a quadratic effect on NE efficiency (p ≤ 0.0027), average daily gain (ADG), (p ≤ 0.0352) and the feed:gain ratio (F:G), (p ≤ 0.0024), the optimal levels being estimated at 2485, 2493 and 2533 kcal kg–¹, respectively. Drip loss (DL) decreased (p ≤ 0.0001) as NE levels increased. There was also a linear decrease (p ≤ 0.0462) in the Minolta color parameter (+a*), due to the NE levels. Plasma parameters were not affected (p > 0.05) by NE levels. The dietary net energy levels affected the performance and meat quality of finishing pigs and the level of 2493 kcal kg–¹ provided the best ADG.

Animals selected for postweaning weight gain rate have similar maintenance energy requirements regardless of their residual feed intake classification.

Data of comparative slaughter were used to determine Nellore bulls' net energy requirements classified as efficient or inefficient according to residual feed intake (RFI) and selection lines (SL). Sixty-seven Nellore bulls from the selected (SE) and control (CO) lines of the selection program for postweaning weight gain were used. The animals underwent digestibility trials before being submitted to the finishing trial. Sixteen bulls were slaughtered at the beginning of the finishing trial, and their body composition was used as the baseline for the remaining animals. For body composition determinations, whole empty body components were weighed, ground, and subsampled for chemical analyses. Initial body composition was determined with equations developed from the baseline group using shrunk body weight, fat, and protein. The low RFI (LRFI) and CO animals had a lower dry matter (DMI) and nutrient intake (P < 0.05) than high RFI (HRFI) and SE animals, without alterations in digestibility coefficients (P > 0.05). During the finishing trial, DMI remained lower for LRFI and CO animals. Growth performance was similar between RFI classes, except for empty body weight gain that tended to be higher for LRFI than HRFI (P = 0.091). The SE animals had less fat content on the empty body (P = 0.005) than CO. Carcasses tended to be leaner for LRFI than HRFI (P = 0.080) and for SE than CO (P = 0.066) animals. LRFI animals retained more energy (P = 0.049) and had lower heat production (HP; P = 0.033) than the HRFI ones. Retained energy was not influenced by SL (P = 0.165), but HP tended to be higher for SE when compared to CO (P = 0.075) animals. Net energy requirement for maintenance (NEm) was lower for LRFI than HRFI (P = 0.009), and higher for SE than CO (P = 0.046) animals. There was an interaction tendency between RFI and SL (P = 0.063), suggesting that NEm was lower for LRFI+CO than HRFI+CO (P = 0.006), with no differences for SE (P = 0.527) animals. The efficiency of ME utilization for maintenance (km) of LRFI and HRFI animals were 62.6% and 58.4%, respectively, and for SE and CO were 59.0% and 62.1%, respectively. The breeding program for postweaning weight has not improved feed efficiency over the years, with RFI classification not being a promising selection tool for SE animals. Classification based on RFI seems to be useful in animals that have not undergone the breeding program, with LRFI animals having lower energy requirements than the HRFI ones.

Comparison of Equations to Predict Energy Requirements With Indirect Calorimetry in Hospitalized Patients.

BACKGROUND: The accuracy of methods to determine resting energy expenditure (REE) contributes toward the adequate provision of nutrition support to hospitalized patients. Indirect calorimetry (IC) is considered the gold-standard method to determine REE. The aim of this study is to evaluate the degree of agreement between the REE measured by IC (REE-IC) and REE estimated by predictive equations in intensive care unit patients. METHODS: The sample is made up of intensive care unit patients aged >18 years, both male and female, undergoing nutrition therapy. The predictive equations to estimate REE were the Harris Benedict (HB), Ireton Jones (IJ), and practical method (PM). Degree of agreement between REE-predictive equations and REE-IC was analyzed by the interclass correlation coefficient (ICC) and the Bland-Altman test. RESULTS: Average energy obtained by IC was significantly different from HB and IJ equations (P < .001). The HB equation significantly underestimated the REE-IC for body mass index (BMI) classification. Significant concordance was observed between the REE-IC and all estimate equations (P < .05). The IJ equation showed the greatest degree of concordance for BMI classification of underweight (ICC = 0.674; P = .011) and presented the least difference between the averages of the energy when compared with REE-IC (107.8 kcal/d; P < .05). CONCLUSION: The IJ equation showed better results with IC, with the greatest degree of concordance for BMI classification of underweight. Further research should develop others equations and validate tools to measure energy expenditure for accurate dietary recommendations for hospitalized patients undergoing nutrition therapy.

Digestible energy and protein requirements for maintenance and growth of pacu (Piaractus mesopotamicus): A factorial approach-based model

Results of nutrient requirements as determined in dose-response trials are valid only for fish within the same size range of that of experimental model fish. This study used the factorial approach to estimate digestible energy (DE) and digestible protein (DP) requirements for maintenance and growth of pacu (Piaractus mesopotamicus). Juvenile pacu (63.5 ± 1.27 g) were stocked in a recirculation system (26.89 ± 0.36 °C) for 58 days, and fed two daily meals. One diet contained 6.96 % lipids (LF) and another 9.98 % lipids (HF), both diets formulated to contain 32 % crude protein, theoretical dietary energy level for maintenance (52.23 kJ DE kg-0.80 d-¹), in a completely randomized, 2 × 5 factorial experimental design. The apparent digestibility coefficients of energy and protein were 84.66 ± 0.27 % and 89.20 ± 0.61 %, respectively, determined in specific assays for the HF diet, while for the LF diet, the values were 84.52 ± 0.37 % and 89.19 ± 0.16 %, respectively. The analysis of growth and carcass composition data revealed that dietary requirements of digestible energy and protein for maintenance were not influenced by dietary lipid levels; however, requirements of growth digestible energy were higher for fish fed the LF diet (1.39) than for fish fed the HF diet (1.29). The requirement of DP for growth, expressed as g of DP per g of deposited protein, were higher for fish fed the LF diet than for fish fed the HF diet (1.70 vs 1.58).(AU)

Digestible energy and protein requirements for maintenance and growth of pacu (Piaractus mesopotamicus): A factorial approach-based model

Results of nutrient requirements as determined in dose-response trials are valid only for fish within the same size range of that of experimental model fish. This study used the factorial approach to estimate digestible energy (DE) and digestible protein (DP) requirements for maintenance and growth of pacu (Piaractus mesopotamicus). Juvenile pacu (63.5 ± 1.27 g) were stocked in a recirculation system (26.89 ± 0.36 °C) for 58 days, and fed two daily meals. One diet contained 6.96 % lipids (LF) and another 9.98 % lipids (HF), both diets formulated to contain 32 % crude protein, theoretical dietary energy level for maintenance (52.23 kJ DE kg-0.80 d-¹), in a completely randomized, 2 × 5 factorial experimental design. The apparent digestibility coefficients of energy and protein were 84.66 ± 0.27 % and 89.20 ± 0.61 %, respectively, determined in specific assays for the HF diet, while for the LF diet, the values were 84.52 ± 0.37 % and 89.19 ± 0.16 %, respectively. The analysis of growth and carcass composition data revealed that dietary requirements of digestible energy and protein for maintenance were not influenced by dietary lipid levels; however, requirements of growth digestible energy were higher for fish fed the LF diet (1.39) than for fish fed the HF diet (1.29). The requirement of DP for growth, expressed as g of DP per g of deposited protein, were higher for fish fed the LF diet than for fish fed the HF diet (1.70 vs 1.58).

Balance energético y estado nutricional en niños preescolares, Huanchaco, Trujillo, Perú, 2014 / Energy balance and nutritional state in preschool children, Huanchaco, Trujillo, Perú, 2014

Introducción: El balance energético equilibrado en el organismo humano permite mantener un estado nutricional y de salud adecuado, ingestas excesivas o por defecto modifican la homeostasis y producen enfermedades. Objetivo: Determinar la asociación entre balance energético y estado nutricional en niños de instituciones educativas del distrito de Huanchaco, departamento La Libertad, Perú. Métodos: Estudio cuantitativo de corte transversal en 203 niños de 3 a 5 años en el periodo abril-junio 2014. Se evaluó el estado nutricional con los índices talla/edad, peso/edad, peso/talla usando estándares de crecimiento infantil de la Organización Mundial de la Salud 2006. El balance energético se midió con la adecuación de energía ingerida respecto a su requerimiento energético estimado, expresado en porcentaje. Se aplicó la prueba estadística Chi-cuadrado con un nivel de significancia de 5 por ciento. Resultados: Los índices para evaluar el estado nutricional fueron predominante normales. El balance energético para niños y niñas de 3 años fue 123,75 ± 46,97 por ciento y 125,82 ± 13,01 por ciento de su requerimiento respectivamente; en niños y niñas de 4 años fue de 109,90 ± 23,17 por ciento y 104,69 ± 20,96 por ciento, respectivamente y finalmente en niños de 5 años fue 105,15 ± 24,97 por ciento y en las niñas un balance energético negativo de 86,39 ± 11,99 por ciento. Existe asociación altamente significativa (p < 0,01) entre estado nutricional y balance energético. Conclusiones: El balance energético con tendencia positiva predispone hacia la obesidad para los índices peso/talla y peso/edad y el equilibrado o positivo condicionan un estado nutricional normal según talla/edad(AU)

Introduction: The balanced energy state in the human body allows maintaining a nutritional and health status; excessive or small intakes of food modify the homeostasis and produce diseases. Objective: To determine the association between energy balance and nutritional state in children from educational institutions of Huanchaco District, La Libertad, Peru. Methods: A cross-sectional quantitative study was carried out in 203 children from 3 to 5 years old in the period from April to June 2014. It was assessed the nutritional state with the indexes height/age, weight/age, weight/height using child growth standards of the World Health Organization 2006. The energy balance was measured with the adequacy of energy intake in relation to their estimated energy requirement, expressed as a percentage. Chi-square statistical test was applied with a significance level of 5 percent . Results: The indexes to assess the nutritional state were predominantly normal. The energy balance for boys and girls of 3 years old was 123.75 ± 46.97 percent and 125.82 ± 13.01 percent of their requirement respectively; in children of 4 years old it was 109.90 ± 23.17 percent and 104.69 ± 20.96 percent, respectively; and finally in 5 years old boys it was 105.15 ± 24.97 percent and in girls a negative energy balance of 86.39 ± 11.99 percent. There is a highly significant association (p< 0.01) between the nutritional state and the energy balance. Conclusions: The energy balance with positive trend predisposes toward obesity for the indexes weight/height and weight/age, and the balanced or positive condition to a normal nutritional state according to height/age(AU)

Balance energético y estado nutricional en niños preescolares, Huanchaco, Trujillo, Perú, 2014 / Energy balance and nutritional state in preschool children, Huanchaco, Trujillo, Perú, 2014

Introducción: El balance energético equilibrado en el organismo humano permite mantener un estado nutricional y de salud adecuado, ingestas excesivas o por defecto modifican la homeostasis y producen enfermedades. Objetivo: Determinar la asociación entre balance energético y estado nutricional en niños de instituciones educativas del distrito de Huanchaco, departamento La Libertad, Perú. Métodos: Estudio cuantitativo de corte transversal en 203 niños de 3 a 5 años en el periodo abril-junio 2014. Se evaluó el estado nutricional con los índices talla/edad, peso/edad, peso/talla usando estándares de crecimiento infantil de la Organización Mundial de la Salud 2006. El balance energético se midió con la adecuación de energía ingerida respecto a su requerimiento energético estimado, expresado en porcentaje. Se aplicó la prueba estadística Chi-cuadrado con un nivel de significancia de 5 por ciento. Resultados: Los índices para evaluar el estado nutricional fueron predominante normales. El balance energético para niños y niñas de 3 años fue 123,75 ± 46,97 por ciento y 125,82 ± 13,01 pior cientopor ciento de su requerimiento respectivamente; en niños y niñas de 4 años fue de 109,90 ± 23,17 por ciento y 104,69 ± 20,96 por ciento, respectivamente y finalmente en niños de 5 años fue 105,15 ± 24,97 por ciento y en las niñas un balance energético negativo de 86,39 ± 11,99 por ciento. Existe asociación altamente significativa (p < 0,01) entre estado nutricional y balance energético. Conclusiones: El balance energético con tendencia positiva predispone hacia la obesidad para los índices peso/talla y peso/edad y el equilibrado o positivo condicionan un estado nutricional normal según talla/edad(AU)

Introduction: The balanced energy state in the human body allows maintaining a nutritional and health status; excessive or small intakes of food modify the homeostasis and produce diseases. Objective: To determine the association between energy balance and nutritional state in children from educational institutions of Huanchaco District, La Libertad, Peru. Methods: A cross-sectional quantitative study was carried out in 203 children from 3 to 5 years old in the period from April to June 2014. It was assessed the nutritional state with the indexes height/age, weight/age, weight/height using child growth standards of the World Health Organization 2006. The energy balance was measured with the adequacy of energy intake in relation to their estimated energy requirement, expressed as a percentage. Chi-square statistical test was applied with a significance level of 5percent. Results: The indexes to assess the nutritional state were predominantly normal. The energy balance for boys and girls of 3 years old was 123.75 ± 46.97percent and 125.82 ± 13.01percent of their requirement respectively; in children of 4 years old it was 109.90 ± 23.17percent and 104.69 ± 20.96percent, respectively; and finally in 5 years old boys it was 105.15 ± 24.97percent and in girls a negative energy balance of 86.39 ± 11.99percent. There is a highly significant association (p< 0.01) between the nutritional state and the energy balance. Conclusions: The energy balance with positive trend predisposes toward obesity for the indexes weight/height and weight/age, and the balanced or positive condition to a normal nutritional state according to height/age(AU)

Accuracy of predictive equations versus indirect calorimetry for the evaluation of energy expenditure in cancer patients with solid tumors - An integrative systematic review study.

BACKGROUND & AIMS: Cancer is one the principal causes of death, and is considered a health issue worldwide. Cancer patients are at high risk of malnutrition due to the disease and the treatment itself. Nutritional therapy is part of a multi-modal treatment and it is important to be aware of the patient's energy expenditure to aid in decision-making for dietotherapeutic prescription. Indirect Calorimetry (IC) is the gold standard method for measuring energy expenditure (EE); but due to its often high cost in clinical practise, equations that measure energy expenditure are usually used. OBJECTIVES: To perform an integrative systematic review, searching in the literature for how predictive equations of EE behave in relation to IC in cancer patients with solid tumors, considering the overall accuracy for cancer patients, the different tumor types, and the type of anti-cancer therapy applied. METHODS: A review was carried out of systematic integrative type literature. The articles were searched for in three databases (Pubmed, Embase, and Web of Science) using descriptors accompanied by Boolean operators. Inclusion and exclusion criteria were determined, and the articles found went through selection, analysis and extraction of their results. RESULTS: A total of 688 articles were identified that underwent a thorough selection, resulting in 15 studies that included in this review. In five studies, the results showed that predictive equations underestimated the EE of cancer patients; in three studies the EE was overestimated by predictive equations, and in seven studies predictive equations underestimated or overestimated the EE. The low accuracy of predictive EE equations was present regardless of tumor type and type of anti-cancer therapy received by patients. CONCLUSION: The predictive energy expenditure equations available to date are generally not in accordance with IC results for cancer patients with solid tumors, since these individuals present clinical situations or are exposed to factors that alter EE and are not considered in these equations.

Sequential metabolizable energy plans for piglets from 7 to 30 kg / Planos sequenciais de energia metabolizável para leitões dos 7 aos 30 kg

The objective of this study was to evaluate sequential metabolizable energy (ME) plans, maintaining the lysine: calorie ratio for piglets from 7 to 30 kg. Forty eight female piglets with initial weight of 6.9 ± 1.2 kg and final weight of 30.5 ± 3.8 kg were randomly allocated in a randomized complete blocks design to three nutritional plans with eight replicates and two animals per experimental unit. Sequential plans provided four ME levels: plan 1: 3,300-3,250-3,200-3,150 kcal ME kg-1, plan 2: 3,400-3,350-3,300-3,250 kcal ME kg-1, and plan 3: 3,500-3,450-3,400-3,350 kcal ME kg-1 of feed, from 7 to 10 kg, 10 to 15 kg, 15 to 20 kg and 20 to 30 kg, respectively. From 7 to 10 kg, there was no effect (P>0.05) of the nutritional plans in the evaluated variables. From 7 to 15 kg, a higher (P 0.05) energy intake and weight gain and a better (P 0.05) feed conversion was observed in animals fed with nutritional plans 2 and 3. Nutritional plans 2 and 3 resulted in higher (P 0.05) final weight, feed intake, energy intake, digestible lysine intake, weight gain, and better feed conversion in the 7 to 20 kg, 7 to 25 kg and 7 to 30 kg. It is recommended the sequential plan containing 3,400-3,350-3,300-3,250 kcal ME kg-1 of feed from 7 to 10 kg, from 10 to 15 kg, 15 to 20 kg, and from 20 to 30 kg; respectively, equivalent to levels of 2,546-2,513-2,501-2,475 kcal net energy (NE) kg-1 of feed for piglets.(AU)

Realizou-se este estudo com o objetivo de avaliar planos sequenciais de energia metabolizável (EM), mantendo a relação lisina: caloria, para leitões dos 7 ao 30 kg. Foram utilizados 48 leitões, fêmeas, com peso inicial de 6,9 ± 1,2 kg e final de 30,5 ± 3,8 kg, distribuídos em delineamento de blocos ao acaso em três planos nutricionais, sendo: 1- 3.300-3.250-3.200-3.150 Kcal de EM kg-1 de ração; 2- 3.400-3.350-3.300-3.250 Kcal de EM kg-1 de ração; e 3- 3.500-3.450-3.400-3.350 Kcal de EM kg-1 de ração, dos 7 aos 10 kg, dos 10 aos 15 kg, dos 15 aos 20 kg e dos 20 aos 30 kg, respectivamente, com oito repetições e dois animais por unidade experimental. Dos 7 aos 10 kg, não houve efeito (P>0,05) dos planos nutricionais nas variáveis avaliadas. Observou-se, dos 7 aos 15 kg, maiores (P 0,05) consumos de energia e ganho de peso e melhor (P 0,05) conversão alimentar nos animais alimentados com os planos nutricionais 2 e 3. Os leitões alimentados com os planos nutricionais 2 e 3 apresentaram maior (P 0,05) peso final, consumos de ração, de energia, de lisina digestível, ganho de peso e melhor conversão alimentar nos períodos dos 7 aos 20 kg, dos 7 aos 25 kg e dos 7 aos 30 kg. Recomenda-se o plano sequencial contendo 3.400-3.350-3.300-3.250 Kcal de EM kg-1 de ração dos 7 aos 10 kg, dos 10 aos 15 kg, 15 aos 20 kg e dos 20 aos 30 kg, respectivamente, equivalentes aos níveis de 2.546-2.513-2.501-2.475 Kcal de energia líquida kg-1 de ração.(AU)

Sequential metabolizable energy plans for piglets from 7 to 30 kg / Planos sequenciais de energia metabolizável para leitões dos 7 aos 30 kg

ABSTRACT: The objective of this study was to evaluate sequential metabolizable energy (ME) plans, maintaining the lysine: calorie ratio for piglets from 7 to 30 kg. Forty eight female piglets with initial weight of 6.9 ± 1.2 kg and final weight of 30.5 ± 3.8 kg were randomly allocated in a randomized complete blocks design to three nutritional plans with eight replicates and two animals per experimental unit. Sequential plans provided four ME levels: plan 1: 3,300-3,250-3,200-3,150 kcal ME kg-1, plan 2: 3,400-3,350-3,300-3,250 kcal ME kg-1, and plan 3: 3,500-3,450-3,400-3,350 kcal ME kg-1 of feed, from 7 to 10 kg, 10 to 15 kg, 15 to 20 kg and 20 to 30 kg, respectively. From 7 to 10 kg, there was no effect (P>0.05) of the nutritional plans in the evaluated variables. From 7 to 15 kg, a higher (P<0.05) energy intake and weight gain and a better (P < 0.05) feed conversion was observed in animals fed with nutritional plans 2 and 3. Nutritional plans 2 and 3 resulted in higher (P<0.05) final weight, feed intake, energy intake, digestible lysine intake, weight gain, and better feed conversion in the 7 to 20 kg, 7 to 25 kg and 7 to 30 kg. It is recommended the sequential plan containing 3,400-3,350-3,300-3,250 kcal ME kg-1 of feed from 7 to 10 kg, from 10 to 15 kg, 15 to 20 kg, and from 20 to 30 kg; respectively, equivalent to levels of 2,546-2,513-2,501-2,475 kcal net energy (NE) kg-1 of feed for piglets.

RESUMO: Realizou-se este estudo com o objetivo de avaliar planos sequenciais de energia metabolizável (EM), mantendo a relação lisina: caloria, para leitões dos 7 ao 30 kg. Foram utilizados 48 leitões, fêmeas, com peso inicial de 6,9 ± 1,2 kg e final de 30,5 ± 3,8 kg, distribuídos em delineamento de blocos ao acaso em três planos nutricionais, sendo: 1- 3.300-3.250-3.200-3.150 Kcal de EM kg-1 de ração; 2- 3.400-3.350-3.300-3.250 Kcal de EM kg-1 de ração; e 3- 3.500-3.450-3.400-3.350 Kcal de EM kg-1 de ração, dos 7 aos 10 kg, dos 10 aos 15 kg, dos 15 aos 20 kg e dos 20 aos 30 kg, respectivamente, com oito repetições e dois animais por unidade experimental. Dos 7 aos 10 kg, não houve efeito (P>0,05) dos planos nutricionais nas variáveis avaliadas. Observou-se, dos 7 aos 15 kg, maiores (P<0,05) consumos de energia e ganho de peso e melhor (P < 0,05) conversão alimentar nos animais alimentados com os planos nutricionais 2 e 3. Os leitões alimentados com os planos nutricionais 2 e 3 apresentaram maior (P<0,05) peso final, consumos de ração, de energia, de lisina digestível, ganho de peso e melhor conversão alimentar nos períodos dos 7 aos 20 kg, dos 7 aos 25 kg e dos 7 aos 30 kg. Recomenda-se o plano sequencial contendo 3.400-3.350-3.300-3.250 Kcal de EM kg-1 de ração dos 7 aos 10 kg, dos 10 aos 15 kg, 15 aos 20 kg e dos 20 aos 30 kg, respectivamente, equivalentes aos níveis de 2.546-2.513-2.501-2.475 Kcal de energia líquida kg-1 de ração.

Estimating resting energy expenditure of patients on dialysis: Development and validation of a predictive equation.

OBJECTIVES: The aims of this study were to develop and validate a resting energy expenditure (REE) predictive equation in a cohort of patients on dialysis and to test the accuracy of two previously developed specific equations to estimate REE of these patients. METHODS: A database with REE measured by indirect calorimetry (IC) of 189 patients on hemodialysis and peritoneal dialysis was used to develop and validate the new equation. The sample including only patients on hemodialysis (n = 131) was used to test the accuracy of the specific REE dialysis equations by Vilar and Byham-Gray. RESULTS: Multiple regression analysis generated two equations: REE (kcal/d) = 957.02 - 8.08 × age + 11.07 × body weight + 136.4 (if men) (R2 = 0.515) (1) REE (kcal/d) = 624.6-4.8 × age + 20.6 × fat-free, ass-fat-free mass-8.65 (if men) (R2 = 0.512) (2) In the validation group, REE by both equations did not differ from the REE measured by IC. No bias was found in the Bland-Altman analysis and the intraclass correlation coefficient and P20 test showed good reliability with measured REE. Vilar's equation overestimated REE; whereas REE generated by Byham-Gray's equation did not differ from measured REE. Proportional and systematic biases were significant for both equations. CONCLUSIONS: The new equations developed showed good accuracy and can be valuable to estimate energy needs of patients on dialysis. Byham-Gray's and Vilar's equations presented low to moderate performance to estimate REE of the patients on dialysis.

A adequação do suporte nutricional enteral na unidade de terapia intensiva não afeta o prognóstico em curto e longo prazos dos pacientes mecanicamente ventilados: um estudo piloto / Adequacy of enteral nutritional support in intensive care units does not affect the short- and long-term prognosis of mechanically ventilated patients: a pilot study

RESUMO Objetivo: Correlacionar os desfechos clínicos, em curto (tempo em ventilação mecânica e tempo de unidade de terapia intensiva) e longo prazos (capacidade funcional), dos pacientes que atingiram adequação nutricional ≥ 70% do previsto nas primeiras 72 horas de internação na unidade de terapia intensiva. Métodos: Estudo piloto prospectivo observacional, realizado em unidade de terapia intensiva de 18 leitos. Foram incluídos cem pacientes mecanicamente ventilados, recebendo suporte nutricional enteral exclusivo e submetidos à terapia intensiva por mais de 72 horas. Foram excluídos pacientes que nunca receberam nutrição enteral, gestantes, com trauma raquimedular, doadores de órgãos e casos de recusa familiar. As variáveis estudadas foram adequação nutricional ≥ 70% do previsto nas primeiras 72 horas de internação, tempo de unidade de terapia intensiva, tempo em ventilação mecânica e, após 12 meses, via contato telefônico, a capacidade de realizar Atividades da Vida Diária por meio do instrumento Lawton-Atividades de Vida Diária. Resultados: O tempo médio em ventilação mecânica foi de 18 ± 9 dias, e de internação na unidade de terapia intensiva de 19 ± 8 dias. Somente 45% dos pacientes receberem mais de 70% do alvo nutricional em 72 horas. Não houve associação entre a adequação nutricional e os desfechos em curto prazo (tempo de permanência em ventilação mecânica, tempo de internação na unidade de terapia intensiva e mortalidade), nem com os desfechos clínicos em longo prazo (capacidade funcional e mortalidade). Conclusão: Pacientes criticamente enfermos que recebem aporte calórico ≥ 70%, nas primeiras 72 horas de internação não apresentaram melhores desfechos em curto prazo ou após 1 ano.

ABSTRACT Objective: To correlate short-term (duration of mechanical ventilation and length of intensive care unit stay) and long-term (functional capacity) clinical outcomes of patients who reached nutritional adequacy ≥ 70% of predicted in the first 72 hours of hospitalization in the intensive care unit. Methods: This was a prospective observational pilot study conducted in an 18-bed intensive care unit. A total of 100 mechanically ventilated patients receiving exclusive enteral nutritional support and receiving intensive care for more than 72 hours were included. Patients who never received enteral nutrition, those with spinal cord trauma, pregnant women, organ donors and cases of family refusal were excluded. The variables studied were nutritional adequacy ≥ 70% of predicted in the first 72 hours of hospitalization, length of intensive care unit stay, duration of mechanical ventilation and the ability to perform activities of daily living after 12 months, assessed via telephone contact using the Lawton Activities of Daily Living Scale. Results: The mean duration of mechanical ventilation was 18 ± 9 days, and the mean intensive care unit length of stay was 19 ± 8 days. Only 45% of the patients received more than 70% of the target nutrition in 72 hours. There was no association between nutritional adequacy and short-term (duration of mechanical ventilation, length of stay in the intensive care unit and mortality) or long-term (functional capacity and mortality) clinical outcomes. Conclusion: Critically ill patients receiving caloric intake ≥ 70% in the first 72 hours of hospitalization did not present better outcomes in the short term or after 1 year.