Dietary composition and macronutrient storage in preterm infants

A comparison has been made of the influence of feeding own mother's milk and formula on the oxidation and accretion of energy and macronutrients in the growing preterm infant of very low birth weight (less than 1,300 g) by using the combined techniques of nutrient balance and computerized indirect calorimetry. There were 22 studies in formula-fed infants and 15 studies in premature infants fed own mother's milk. Despite their lower metabolizable energy intake, the infants fed own mother's milk grew in weight, length, and head circumference at a rate approximating those of the formula-fed group. The metabolic rate was significantly lower in the infants fed own mother's milk (56.0 +/- 0.9 v 62.6 +/- 0.8 kcal/kg/d; P less than .001). The protein intake, oxidation, and accretion were similar in the two groups. The infants fed own mother's milk had a significantly lower fat intake (P less than .001), higher fat oxidation (P less than .025) and consequently lower fat accretion (P less than .001) than the formula-fed infants. The proportional fat content of the daily weight gain was lower in the infants fed own mother's milk (16% v 33%; P less than .001) but protein content was similar (13% v 12%). The accretion of energy, fat, and protein correlated with the respective metabolizable intakes in both groups (r = .81 to .98; P less than .001), suggesting that accretion rates and hence composition of weight gain are dependent on levels of energy and macronutrient intake.

[Dietary fat emulsions of lowered caloric content]

The products such as mayonnaise for infant's and dietetic nutrition were supplemented with the most full-value and readily assimilable proteins of milk and plant origin, whereas inhibitors and components (yolk-yellow, soybean oil, etc) not very suitable for dietetic nutrition were excluded. The know how and composition of dietetic pastes with a fatness of 10-50% were those of sauces for cold dishes and desserts with a fatness of 1-10%. These products represent a stable, readily assimilable vegetative oil emulsion. They are manufactured according to a simplified (comparatively to the conventional) flow-sheet that involves two parallel processes: preparation of a vegetative oil emulsion by means of homogenization at a high pressure and preparation of a concentration aqueous suspension of excipients. Apart from the increased biological value and high quality of fatty products, the know how under consideration enables the butter and fatty industry to produce mayonnaises with a fat content under 35% and to make the best use of reiterative raw material of the milk industry.

Enteral nutrition in malnourished patients with hepatic cirrhosis and acute encephalopathy

Ten patients with histologically proven cirrhosis, admitted in grade I to II acute hepatic coma, received in addition to a standard dietary protein free "anticoma" regime, a continuous nasogastric infusion of a branched-chain amino acid enriched chemically defined enteral diet (Hepaticaid) containing an equivalent of 70 g protein/day for a mean of 7.3 days (range 3-23). No complications of therapy were observed and, specifically, the use of fine bore tubes did not provoke variceal hemorrhage. Overall positive nitrogen balance (4.3 +/- 1.7 g N/day) was observed in patients fed 7 or more days. Improvement to coma grade 0 was seen in all patients save one, who died from hepatorenal failure. While serum ammonia levels remained elevated during the study period, there was a significant increase in the branched-chain/aromatic ratio (p less than 0.01) as plasma branched-chain amino acids rose (p less than 0.05) and tyrosine levels fell (p less than 0.05).

Enteral nutrition support: formula preparation from modular ingredients

Many hospitalized patients are undernourished, and often this condition can be corrected by feeding one of a variety of commercial enteral formulas through a thin nasoenteral cannula. In a subset of tube feeding patients, nutritional requirements are unique, and needs cannot be met by a fixed composition formula. Modification, or de novo fabrication of the enteral formula is therefore required. Few reviews have adequately addressed some of the complexities of designing, mixing, and feeding these specialized diets. This report provides some of this information, and shows that considerably more education and research in this area is needed.

Titrimetric determination of ascorbic acid with 2,6-dichlorophenol indophenol in commercial liquid diets

The titrimetric determination of ascorbic acid in the presence of a variety of potentially physically and chemically interfering species in commercial liquid diets is presented. The titrant and indicator was a solution of 2,6-dichlorophenol indophenol. Iron(II), copper(II), cysteine, glutathione, sulfite, and tin(II) do not interfere.

Metabolic effects of liquid protein

In the first experiment, the liquid protein product (LP) tested would not support growth in rats when fed at the 8% protein level in an otherwise nutritionally adequate diet. The product was composed of an imbalanced mixture of amino acids which could not be used optimally for protein synthesis and which resulted in appetite depression. Total plasma nonessential amino acids increased significantly in the rats receiving LP, while total plasma essential amino acids were not significantly different. In the second experiment, the LP reducing diet caused rapid weight loss. Adequate vitamin-mineral supplementation given to the rats receiving the LP diet apparently prevented heart and plasma electrolyte abnormalities.

[Non-caloric compounds with fat-like functional properties (pseudofats)]

The review deals with the synthesis, characterization, physicochemical and physiological properties with respect to nutrition of acaloric fat-like compounds (pseudofats) with special regard to fatty acid esters of sucrose, glycerol ethers and glycerol dicarbonic acid esters. Furthermore an outlook is given of other classes of compounds that are potentially suited to substitute fat as for instance polycarbonic acid-, polyglycerol-, and polyglycol derivatives.

Differences in vitamin A content of enteral feeding solutions following exposure to a polyvinyl chloride enteral feeding system

This research was conducted to determine if there were significant differences in the vitamin A content of two enteral feeding solutions following timed exposure to a polyvinyl chloride (PVC) enteral tube feeding system. This study took place in the laboratory setting with procedures designed to simulate clinical conditions with respect to rate of flow and time of exposure. Feeding solutions (Ensure Osmolite and Vivonex High Nitrogen) were sampled, placed in PVC feeding system pouches (Vivonex Delivery System, Norwich-Eaton Pharmaceuticals, Norwich, NY) and permitted to drip from the pouches at a constant rate. Solution remaining in the pouches was sampled at intervals for a period of six hours, and all samples were analyzed for Vitamin A content using spectrophotometric methods. Statistical analysis of the data indicated no significant difference in Vitamin A content of either feeding solution following six hours of exposure to a PVC enteral tube feeding system.

[Postoperative nutrition of maxillary surgery patients with the instant formula diet]

33 patients, who underwent maxillo-facial surgery, were fed with the instant formula diet Nutricomp F via a nasogastric tube for a mean time of 10 days. According to intolerance tube feeding had to be interrupted in 3 patients. Other side effects of nutrition with Nutricomp F were diarrhea (2,9%), nausea (1,2%), vomiting (1,2%) and eructation (1,2%). The mean frequency of defecation was 0,64/day. Glucose content of the blood, water balance, body weight, serum electrolytes, liver enzymes, acid-base-balance and the protein content of the serum did not change significantly. The postoperative increase of urea content in the serum is believed to be independent from formula diet.

Metabolism in the artificially reared rat pup: effect of an atypical rat milk substitute

A substitute for rat milk [Messer et al., 1969 (1)] has been evaluated as a nutrient source to artificially feed rat pups from 4 days after birth. The rat milk substitute has a normal fat concentration, suboptimal protein concentration and a high carbohydrate concentration when compared to natural rat milk. Rat pups artificially reared on the mild substitute by intermittent infusion via miniaturized intragastric cannulae have: 1) atypical ketone body metabolism: lower than normal concentration and turnover of D-(--)-3-hydroxybutyrate in blood and less than normal amounts of D-(--)-3-hydroxybutyrate used for respiration, 2) atypical carbohydrate metabolism: higher than normal insulin and galactose concentrations in blood and a greater than normal amount of glucose used for respiration, and 3) atypical amino acid levels: the concentrations of several amino acids in blood were 60% or less than normal, and the concentration of taurine in plasma was negligible. We observed frequent head tremors, hyperreactivity to handling and about a 20% incidence of cataracts in rat pups reared on the milk substitute. We conclude this rat milk substitute is not suitable as a nutrient source for the developing rat pup.

Gastrointestinal response to oral versus gastric feeding of defined formula diets

The gastrointestinal response in rats nourished by continuous intragastric infusion of a variety of defined formula diets was compared with animals consuming the same diets orally. Two groups of rats were fed isocaloric amounts of DFD (73 kcal/day); group 1: sham-operated, orally-fed; group 2: operated, intragastrically-fed. Diets included; Vivonex (V), Flexical (F), Vital, Vivonex high nitrogen, and a control casein rat liquid formula diet (C). After 2 wk rats were killed and the liver, pancreas, and small bowel removed. The bowel was divided into eight equal segments. Mucosal weight, DNA, and protein concentration per cm segment were measured Pancreatic amylase activity (units/g), and liver weight and lipid content were measured. Weight gain was comparable in all oral-fed groups, but was decreased in all gastric-fed animals compared to the oral-fed group. Nitrogen retention was not influenced by route of feeding but was significantly lower for Vivonex and Flexical animals (p less than 0.01) in both oral-fed and gastric-fed groups. There was significant accumulation of lipid in the liver of both oral-fed and gastric-fed animals sustained on Vivonex and Vivonex high nitrogen (p less than 0.01). Most proximal intestinal segment weight and mucosal weight, protein and DNA were decreased compared to the control diet in both oral-fed and gastric-fed animals. These studies demonstrate that while the gastrointestinal response to isocaloric defined formula diets was significantly influenced by the specific diet, fewer responses were modified by feeding defined formula diets orally versus gastrically.

Gastrointestinal response to nutrient variation of defined formula diets

The gastrointestinal response to oral alimentation of low residue commercial defined formula diets or a rat liquid formula was studied. Male Sprague-Dawley rats (220-250 g) were fed isocaloric amounts (73 kcal/day) of Vivonex (V), Vivonex HN (VHN), Flexical (F), Vital (Vit), or a control Casein diet 116EC (C). Nitrogen (N) retention was calculated from N intake minus N excretion/day. After 2 weeks, rats were killed and the liver, pancreas, and small bowel removed and weighed. Pancreatic amylase activity (U g) and liver lipid were measured. The bowel was divided into eight equal segments, and mucosal weight, DNA, and protein concentration per centimeter were measured. Despite isocaloric feeding, body weight gain was lower in V and VHN groups, and higher in F and Vit groups compared to the C. Amylase specific activity was increased in V, VHN, and F groups, while the liver lipid was increased in the V and VHN groups when compared to C animals. The most proximal intestinal segment weight, mucosal weight, protein and DNA of V, VHN, and Vit groups were less than C animals, while distal segments were similar. F animals showed greater intestinal mass than C rats. These studies indicate statistically significant differences in gastrointestinal response as a result of nutrient variation of defined formula diets.

Nutritional support: formulas and delivery of enteral feeding. I. Enteral formulas

Hospital malnutrition is a recognized condition that may be treated with a variety of feeding modalities. It is possible to achieve the goal of nutritional repletion with enteral feedings. Enteral feedings can now be prescribed for more types of patients because of our ability to better manipulate nutrition sources and the availability of modules and formulas designed for special use. The lower costs associated with enteral feeding have made it an option when nutritional support is required for a patient who has a functioning gastrointestinal tract.

New preparations of the elemental diet and the clinical application

In 1978, we designed a new elemental diet, ED-AC, which modified after Vivonex-HN with the co-operation of Ajinomoto Co., Japan and Morton-Norwich Co., U.S.A.. ED-AC is now being used widely in Japan for enteral hyper-alimentation, even in case of pediatric surgery. We have new prepared another elemental diet, this time for infants, ED-P (pediatric). The ratio of amino acids in both ED was determined according the proposal of Professor Goro Inoue, Department of Nutrition, Tokushima University. The application of ED, particularly for surgical patients, has been most effective. the use of this diet for enteral hyperalimentation should find a wide application in surgical and medical practice.

[Energy requirement and nitrogen balance with a new fully balanced formula diet]

Eight healthy men received a formula diet over a period of 12 days. The acceptance of the diet was good. Gastroenterological side-effects were rarely noticed. Stool frequency was 0.5/day. To keep weight constant a caloric need of 24 +/- 3 cal/kg/BW was necessary. The nitrogen balance was regulated by feeding 59 g protein, 53 g fat and 216 g carbohydrate. The average intake of nitrogen amounted to 8.9 +/- 1.7 g/day. A daily nitrogen loss of 6.96 +/- 1.87 g/day was noticed.