Essential mixed cryoglobulinemia type II

We report a rare case of essential mixed cryoglobulinemia type II with membrano-proliferative glomerulonephritis (MPGN) type I in which HCV was not found. Long-term history of palindromic rheumatism, skin leukocytoclastic vasculitis attacks and micro-normocytic anemia preceded the appearance of cryoglobulinemia. Cryoprecipitate consisted of monoclonal IgMk-RF and polyclonal IgG (essential mixed type II). The newly appreciated cryoglobulinemia was associated with Coombs positive hemolytic anemia. The MPGN in this case had a benign course and responded to complex simple therapies including prevention of exposure to cold, low antigen content diet, treatment of provoking factors such as UTI, and maximal dose of ACE inhibitor. Responsiveness of skin vasculitis to colchicine therapy was restored after a two-month colchicine withdrawal period and therefore corticosteroid and immunosuppressive therapy was postponed.

Rapid detection of the addition of soybean proteins to cheese and other dairy products by reversed-phase perfusion chromatography

The undeclared addition of soybean proteins to milk products is forbidden and a method is needed for food control and enforcement. This paper reports the development of a chromatographic method for routine analysis enabling the detection of the addition of soybean proteins to dairy products. A perfusion chromatography column and a linear binary gradient of acetonitrile-water-0.1% (v/v) trifluoroacetic acid at a temperature of 60 degrees C were used. A very simple sample treatment consisting of mixing the sample with a suitable solvent (Milli-Q water or bicarbonate buffer (pH=11)) and centrifuging was used. The method enabled the separation of soybean proteins from milk proteins in less than 4 min (at a flow-rate of 3 ml/min). The method has been successfully applied to the detection of soybean proteins in milk, cheese, yogurt, and enteral formula. The correct quantitation of these vegetable proteins has also been possible in milk adulterated at origin with known sources of soybean proteins. The application of the method to samples adulterated at origin also leads to interesting conclusions as to the effect of the processing conditions used for the preparation of each dairy product on the determination of soybean proteins.

Validation the use of refractometer and mathematic equations to measure dietary formula contents for clinical application

BACKGROUND AND AIMS

Gastric residual volumes are widely used to evaluate gastric emptying for patients receiving enteral feeding, but controversy exists about what constitutes gastric residual volume. We have developed a method by using refractometer and derived mathematical equations to calculate the formula concentration, total residual volume (TRV), and formula volume. In this study, we like to validate these mathematical equations before they can be implemented for clinical patient care.

METHODS

Four dietary formulas were evaluated in two consecutive validation experiments. Firstly, dietary formula volume of 50, 100, 200, and 400 ml were diluted with 50 ml water, and then the Brix value (BV) was measured by the refractometer. Secondly, 50 ml of water, then 100 ml of dietary formula were infused into a beaker, and followed by the BV measurement. After this, 50 ml of water was infused and followed by the second BV measurement. The entire procedure of infusing of dietary formula (100 ml) and waster (50 ml) was repeated twice and followed by the BV measurement.

RESULTS

The formula contents (formula concentration, TRV, and formula volume) were calculated by mathematical equations. The calculated formula concentrations, TRVs, and formula volumes measured from mathematic equations were strongly close to the true values in the first and second validation experiments (R2>0.98, P<0.001).

CONCLUSIONS

Refractometer and the derived mathematical equations may be used to accurately measure the formula concentration, TRV, and formula volume and served as a tool to monitor gastric emptying for patients receiving enteral feeding.

Treatment of active Crohn's disease in children using partial enteral nutrition with liquid formula: a randomised controlled trial

BACKGROUND AND AIMS

Total enteral nutrition (TEN) with a liquid formula can suppress gut inflammation and induce remission in active Crohn's disease. The mechanism is obscure. Studies have suggested that long term nutritional supplementation with a liquid formula (partial enteral nutrition (PEN)) may also suppress inflammation and prevent relapse. The aim of this study was to compare PEN with conventional TEN in active Crohn's disease.

PATIENTS AND METHODS

Fifty children with a paediatric Crohn's disease activity index (PCDAI)>20 were randomly assigned to receive 50% (PEN) or 100% (TEN) of their energy requirement as elemental formula for six weeks. The PEN group was encouraged to eat an unrestricted diet while those receiving TEN were not allowed to eat. The primary outcome was achievement of remission (PCDAI<10). Secondary analyses of changes in erythrocyte sedimentation rate (ESR), C reactive protein, albumin, and platelets were performed to look for evidence of anti-inflammatory effects.

RESULTS

Remission rate with PEN was lower than with TEN (15% v 42%; p=0.035). Although PCDAI fell in both groups (p=0.001 for both), the reduction was greater with TEN (p=0.005). Moreover, the fall in PCDAI with PEN was due to symptomatic and nutritional benefits. With both treatments there were significant improvements in relation to abdominal pain, "sense of wellbeing", and nutritional status. However, only TEN led to a reduction in diarrhoea (p=0.02), an increase in haemoglobin and albumin, and a fall in platelets and ESR.

CONCLUSIONS

TEN suppresses inflammation in active Crohn's disease but PEN does not. This suggests that long term nutritional supplementation, although beneficial to some patients, is unlikely to suppress inflammation and so prevent disease relapse.

Effects of multiple pulmonary aspirations of enteral solutions on lung tissue damage

BACKGROUND & AIM

The aim of this study was to compare the pulmonary histopathologic effects of enteral solutions with various lipid content, after multiple aspirations in rats.

METHODS

Thirty Wistar albino rats were randomly assigned to one of three groups (n = 10). Saline solution (0.9%) (group C, control), Impact (lipid content, 28 g/l; group I), Pulmocare (lipid content, 93.3g/l; group P) were injected into the lung through the trachea, in a volume of 0.8 ml/kg. The aspiration procedure was performed three times in total, in every 2 days. After seven days from the first aspiration, rats were killed, and lungs were examined for histopathologic examination.

RESULTS

Alveolar histiocytes were statistically higher in left lungs of the group I than the left ones of the control group (P < 0.05). Lipid-laden alveolar macrophages were significantly higher in left lungs of groups I and, P than left lungs of the control group (P<0.05).

CONCLUSION

Lung tissue damage occurring after multiple pulmonary aspirations of Impact and Pulmocare, is histopathologically similar to each other, and is in the form of lipoid pneumonia. In cases of multiple pulmonary aspirations, volume of the aspirate and chronicity of the aspiration look like major impact factors rather than the amount of the lipid.

A chronic dietary toxicity study of DAG (diacylglycerol) in Beagle dogs

The potential chronic toxic effects of DAG (diacylglycerol) when administered orally for 12 months were evaluated in this dietary study in Beagle dogs. DAG is a cooking oil which contains >80% diglycerides, <20% triglycerides and 5% monoglycerides. For this study, a special diet was prepared with no dietary fat so that all of the dietary fat could be provided by DAG, at various concentrations together with a control oil. The control oil, TG (triacylglycerol), was prepared to contain >85% triglycerides, <10% diglycerides and 5% monoglycerides. The fatty acid composition for DAG and TG was closely matched. Dietary concentrations of 0% DAG/9.5% TG (TG control), 1.5% DAG/8.0% TG, 5.5% DAG/4.0% TG, and 9.5% DAG/0% TG were presented daily, seven days per week, for 52 weeks. A second concurrent control group received the standard basal diet (Certified Canine LabDiet 5007, which has a fat content of 9.5%). The basal diet, control article-treated and DAG-treated groups each consisted of four male and four female dogs. Treatment was initiated in prejuvenile (2.5-month-old) dogs. Statistical evaluations compared the DAG-treated groups both to the basal diet and 9.5% TG control groups. The clinical condition of the animals, body weights, body weight gains and food consumption were unaffected by DAG. Hematology and urinalysis parameters were unaffected. No serum chemistry changes indicative of a toxic effect were observed. There were no effects noted on ECG data. No test article-related gross or histopathologic findings or changes in organ weights were observed. While there were no identifiable differences between the effects of TG and DAG, both caused some differences relative to the basal diet (lower food consumption, higher alkaline phosphatase, cholesterol and triglycerides). These differences were not toxicologically significant and were attributed to the differences in the diet rather than the fat source. Thus, DAG at dietary concentrations up to 9.5% for one year had no effect on normal canine growth and development, in comparison to TG.

The Glycemic Index of standard and diabetes-specific enteral formulas

A recent meta-analysis showed that foods with a low Glycemic Index (GI) have a clinically useful effect on glycemic control in patients with diabetes. Although diabetes-specific enteral formulas are commonly used for diabetic patients with insufficient oral intake, not much is known about the GI of these formulas. Therefore the purpose of this study was to assess the GI of several diabetes-specific formulas and to compare them with standard formulas. The randomised, double blinded, crossover study included twelve products which were tested in 7-10 individuals from a pool of 14 healthy volunteers. After an overnight fast, volunteers were given a portion of a product containing 25 grams of carbohydrate or the reference feed (200 ml containing 25 gram glucose) on different occasions in random order. Postprandial blood glucose levels were measured in venous whole blood for two hours after intake of the products and positive incremental area under the curve (AUC) was calculated for both the products and the reference feed. The GI of the test products was determined by dividing AUC (test products) by the AUC (reference feed). Enteral formulas varied widely in their GI values with the diabetes-specific enteral formulas being characterized by a significant (P=0.004) lower GI (average +/-SEM: 19.4 +/- 1.8) than standard formulas (42.1 +/- 5.9). However, there was an overlap between the two types of formulas. Three of the diabetes-specific formulas had significantly lower GI than 3 of the standard products. Although there is some overlap with the GI of diabetes-specific and standard formulas, certain diabetes-specific formulas had very low GI values, which may be clinically beneficial due to better glycemic control. Therefore the use of diabetes-specific formulas with a low GI should be the preferred option for the nutritional management of diabetic patients in need of nutritional support.

Assessment of ascorbic acid stability in different multilayered parenteral nutrition bags: critical influence of the bag wall material

BACKGROUND

The recent development of multilayered bags has minimized ascorbic acid oxidation in parenteral nutrition (PN) admixtures. However, the gas-barrier property of multilayered bags depends on their plastic material. This study compared ascorbic acid stability in different multilayered bags under experimental conditions.

METHODS

Oxygen permeability of a newly developed 6-layered bag (6-L) was compared with a highly mechanical-resistant 3-layered bag (3-L(R)) and a highly flexible 3-layered bag (3-L(F)) using gas chromatography. Ascorbic acid stability was assessed by iodine titration in bags filled with 2.5 L H(2)O and 40 g carbohydrates after setting residual O(2) content at < or =1 or > or =5 ppm. The effect of storage at 4 degrees C, 21 degrees C, and 40 degrees C on ascorbic acid stability was assessed over 48 hours in a complete PN admixture (ie, 330 g carbohydrates, 100 g lipids, 96 g amino acids and trace elements) using high-pressure liquid chromatography.

RESULTS

Oxygen permeability was markedly reduced in 6-L bags (0.5 mL O(2) /m(2)/d) compared with 3-L(R) (150 mL O(2) /m(2)/d) and 3-L(R) (1500 mL O(2)/m(2)/d). Accordingly, ascorbic acid was more stable in 6-L bags (half-life [T(1/2)] = 16 days up to 40 degrees C) than in 3-L(R) (T(1/2) = 9 days at 4 degrees C, 47 hours at 21 degrees C and 29 hours at 40 degrees C) and 3-L(F) (T(1/2) = 15 hours at 4 degrees C, 10 hours at 21 degrees C, and 6 hours at 40 degrees C). During the first 6 hours after PN admixture compounding, an additive ascorbic acid loss of 4.6 +/- 0.5 mg/L/ppm O(2) occurred because of residual O(2) in the bag.

CONCLUSIONS

The new combination of plastic layers and careful O(2) monitoring during the filling process allowed near to complete prevention of ascorbic acid degradation in multilayered PN bags during 48 hours, regardless of the storage temperature.

Monitoring bolus nasogastric tube feeding by the Brix value determination and residual volume measurement of gastric contents

BACKGROUND

Critically ill patients do not always tolerate nasogastric tube feeding. Gastric residual volumes (GRVs), obtained by aspiration from a nasogastric tube, are widely used to evaluate feeding tolerance and gastric emptying, but controversy exists about what constitutes the true GRV (diet formula or digestive juice) and how it should affect management. In this pilot study, we used the Brix value (BV) measurement of gastric contents to monitor both GRV and food content in patients receiving nasogastric feeding.

METHODS

Forty-three patients receiving bolus nasogastric feeding were monitored for 24 hours before entry into the study and then divided into 2 groups according to traditional use of GRV; patients with low GRVs (< 75 mL) were placed in group 1, whereas patients with higher GRVs (> 75 mL) were placed in group 2. All subjects were given 250 mL of polymeric formula by bolus nasogastric infusion, followed by BV measurement of gastric contents at 0, 30, 60, 120, and 180 minutes. All gastric fluid was aspirated after 180 minutes of feeding; the volume was recorded and BV measurement made, then reinstilled with an added 30 mL of dilutional water, after which a final aspiration and BV measurement was performed. Calculated GRV and volume of formula remaining in the stomach was determined by derived equations.

RESULTS

Serial BV measurements decreased in both groups after bolus feeding. For patients in group 2, the decrease was less such that at 180 minutes, the mean BV for gastric contents was significantly higher than for those patients in group 1 (10.1 vs 5.1, respectively; p < .01). Aspirated GRV, calculated GRV, and volume of formula remaining in the stomach at 180 minutes were significantly greater for patients in group 2 compared with those in group 1. Use of refractometry in combination with traditional use of GRV identified 4% (1/25) of patients in group 1 with low GRVs who might have possible gastric dysmotility (> 20% of initial 250-mL volume of formula remaining at 180 minutes) and ensured that 72% (13/18) of patients in group 2 with higher GRVs had sufficient gastric emptying (< 20% of initial 250 mL volume of formula remaining).

CONCLUSION

This pilot study raises the feasibility that refractometry and the BV measurement of gastric juice may be a promising tool for bedside monitoring of tolerance and gastric emptying in patients receiving nasogastric feeding, providing valuable complementary information to traditional use of GRV.

Parenteral nutrition with standard solutions in paediatric intensive care patients

BACKGROUND

Paediatric intensive care patients often require parenteral nutrition (PN). Only very few standard mixtures are available for infants and children. Individual PN solutions need to be compounded manually on the ward, if preparation by the hospital pharmacy is not feasible. Since manual compounding is associated with a greater risk of compounding errors and microbial contamination, the use of standard solutions might be a preferable alternative.

METHODS

We evaluated the use of standard solutions on the paediatric intensive care unit of the von Hauner Children's Hospital at the University of Munich over a period of 8 months. PN solutions were either prescribed individually or as standard solutions. We evaluated the frequency of standard solution prescriptions and their modification, compared nutrient intakes with standard vs. individual PN solutions as well as the occurrence of laboratory anomalies.

RESULTS

Standard PN solutions were prescribed in 68% of cases, individual PN solutions in 32%. Modifications of standard PN solutions were performed in 54%. The intake of a number of macronutrients and electrolytes was similar with individual and standard PN, but calcium and phosphate intakes were lower with individual total PN. Electrolyte imbalances occurred slightly more often with individual PN than with standard PN (34% vs. 26%, respectively).

CONCLUSION

Standard PN solutions were used in the majority of patients on a paediatric intensive care unit. We did not detect indications for inadequacy of standard solutions in the majority of patients reviewed.

Effects of enteral feeding on antroduodenal motility in healthy volunteers with 2 different fiber-supplemented diets: a 24-hour manometric study

BACKGROUND

Antroduodenal motility during enteral nutrition remains poorly understood. The aim of the study was to evaluate antroduodenal motor activity during intermittent intragastric feeding and between enteral solutions supplemented with new recommended soluble or standard insoluble fibers.

METHODS

Two 24-hour antroduodenal manometric studies were performed with a interval of 1 week in 8 healthy volunteers. Two similar enteral diets except for fiber (soluble vs insoluble) were separately assessed in random order at 2 intervals (lunch and dinner) for 2 hours each. Phase III was studied during three 6 hour-periods (after lunch, after dinner, and at night). The other quantitative manometric parameters were studied before (1 hour), during (2 hours), and after (2 hours) lunch and dinner.

RESULTS

During the 2-hour postinfusion period, phase III reoccurred in 14 cases during the day and in 16 cases during the night. Phase III was always interrupted during feeding, which reoccurred in 14 cases during the 2-hour postinfusion period and in 16 cases during the after-dinner period. Nocturnal phase III was more frequent, lasted longer, with a lower amplitude than the diurnal phase. Addition of either soluble or insoluble fiber did not appear to have an influence on phase III or on the antroduodenal motor activity.

CONCLUSIONS

Intragastric feeding interrupted phase III at the antroduodenal stage during infusion but was correlated with interdigestive motility. Antroduodenal motility did not significantly change either during or after intragastric feeding. The addition of either soluble or insoluble fiber does not seem to have an influence on gastroduodenal motor response to intermittent intragastric feeding.

Enteral Nutrition by a Forward Surgical Team in Afghanistan

OBJECTIVES

The modern practice of trauma surgery is a global physiologic approach to caring for the injured patient. Included in that approach is consideration of the traumatized patient's nutritional needs and implementing early enteral feeding. This is routine practice in the United States but logistically impractical when using commercial enteral feeding formulas in the austere environment of a Forward Operating Base in Afghanistan.

METHODS

At a Forward Operating Base in southern Afghanistan, injured patients who were not expected to be taking a regular diet by 72 hours after injury are started on early enteral feedings. This is through nasogastric, gastrostomy, or jejunostomy tube, using formulas of pureed food available in the theater from local sources and supplemented with ingredients from US Army Meals-Ready-to-Eat. Preparation, nutritional calculation, and delivery are discussed.

RESULTS

The injured soldiers and Afghan nationals tolerated early enteral feedings with no complications encountered related to the feeding portal, infusion, or ingredients.

CONCLUSIONS

Early enteral feeding of traumatized patients in the far forward environment of southeastern Afghanistan is practical with the use of ingredients found locally in-theater.

Heritability of progeny size in a terrestrial isopod: transgenerational environmental effects on a life history trait

Maternal effects, the environment that mothers provide to their offspring, their provision of nutrients and the environment that offspring of the same clutch share, have come to be recognized as an important influence on offspring fitness. In addition, in invertebrates, maternal effects and common environment may change according to a mother's diet. We tested for the changes in quantitative genetic parameters in a half-sib design where mothers were fed diets varying in nutrient content. Surprisingly, we found that not only maternal and common environmental variance changed with experimental diets but also there were significant changes in narrow-sense heritabilities, with corresponding h(2) values of 0.61 (high protein), 0.08 (high carbohydrate) and 0.001 (equal carbohydrate:protein). Our results show how an environmentally driven evolutionary process could occur in nature, since the response to selection could change dramatically according to the composition of the diet that females are ingesting.

Arsenic Species in Solutions for Parenteral Nutrition

BACKGROUND

In spite of its high toxicity, arsenic is a common contaminant in pharmaceuticals. This is stated by pharmacopoeias' monographs where it is not generically included with other heavy metals, but has its own specifications. Arsenic should not exceed 0.1 mg/L in most pharmaceutical products for IV administration. This limit, however, was established without taking into consideration the specific arsenic species which contribute to this amount. In this work, the presence of arsenite and arsenate species in solutions of amino acids, salts, vitamins, and lipids commercialized for IV administration was investigated.

METHODS

The measurements were done by hydride generation atomic absorption spectrometry.

RESULTS

The results showed that all commercial formulations contain both arsenic species in some level; however, the total arsenic content exceeded the allowed limit in only a few samples. Calcium gluconate, sodium bicarbonate, heparin, and vitamin solutions were the most contaminated, presenting total arsenic concentration ranging from 62 to 249 microg/L. The most important finding, however, was the different ratios As(V)/As(III) among the formulations. Whereas practically only As(V) was found in ampoules containing water for injection and salt solutions (NaCl, KC1, phosphates), As(III) predominated in solutions of vitamins, gluconate, and glucose. As these are reducing substances, we investigated the possibility of their reaction with As(V) and its conversion into As(III). The heating of As(V) in the presence of gluconate, glucose, ascorbic acid, methionine, isoleucine, sodium chloride, and pure water, in autoclave for 15 minutes, showed that, whereas no As(III) was found in pure water and sodium chloride solution, approximately 50% of As(V) was converted into As(III) in the remainder of the solutions.

CONCLUSIONS

The results showed that As(V), the main species in these formulations, may be converted into As(III), depending on the presence of reducing substances among the formulation constituents.

Impact of the hypocaloric diet using food substitutes on the body weight and biochemical profile

Recent studies using balanced hypocaloric diets with food substitutes in some meals, have presented positive results. There are no studies with the Brazilian population on the efficacy of using food substitute, together with a hypocaloric diet. Main objective of this study was to verify the effects of a hypocaloric diet using food substitutes as meal replacement on the body weight, lipid profile, and glucose and insulin plasma levels. Seventy eight subjects of both genders were selected, 20-50 years old, and a body weight index between 25 kg/m2 and 35 kg/m2. The study lasted for six months and it was divided in 2 phases of three months each- mass reduction for 3 months and 3 months for maintenance. The sample was randomly divided in two groups: Group A (control- 3 months of general nutritional and physical orientation followed by 3 months with 1 meal replacement) and Group B (intervention- 2 meals replacement a day plus nutritional and physical orientation for 3 months followed by 3 months with 1 meal replacement). Anthropometric measurements, percent body fat (%BF), biochemical profile and intake survey were performed at moments 0, 3 and 6 months. Both groups showed a significant decrease in %BF, weight, and consequently in their BMI, in the third and sixth month of follow up. However, weight loss in group B was higher than in group A. At the end of the treatment, 0 and 25.0% of the patients of the group A and B, respectively, presented a weight loss higher than 10% of the initial weight. Comparing the triglycerides, LDL-cholesterol and glucose levels, between the beginning and after the three and six months of treatment, there was a significant reduction in the individuals only in group B. In conclusion, the use of food substitutes as meal replacement, together with a balanced, hypocaloric diet, proved to be efficient in weight loss for Brazilian overweighed individuals.

Determination of chromium, selenium, and molybdenum in a therapeutic diet

Monitoring both the trace element and main element content of drugs forms part of their quality control. Chromium, selenium and molybdenum were determined in therapeutic diet samples by inductively coupled plasma/mass spectrometry (ICP-MS) and electrothermal atomic absorption spectrometry (ET-AAS). Samples were digested by high pressure microwave digestion or by ashing in oven. ICP-MS measurements have demonstrated that the chromium determination in liquid therapeutic diet should be estimated on the basis of 53Cr. In solid samples in some cases the value for Cr was elevated in comparison with the Cr content found by ET-AAS. The content of selenium can be determined on the basis of 77Se or 82Se after appropriate interference correction. Molybdenum content was determined on the basis of 95Mo. Control measurements were made by ET-AAS. For quality assurance purposes some of the samples were analyzed by a control laboratory.

Generation of furosine and color in infant/enteral formula-resembling systems

The extent of the Maillard reaction was studied by measuring furosine and color formation in infant and enteral formula-resembling model systems prepared by mixing calcium caseinate, laboratory-obtained or commercial whey protein with lactose or dextrinomaltose (ingredients similar to those used in infant and enteral formula manufacture) and heating the mixture at 100, 120, or 140 degrees C for 0-30 min. The furosine determination was performed by HPLC and the color determination by measuring colorimetric parameters L, a, and b in a reflection photometer. The first steps of the Maillard reaction could be followed by furosine determination when initial ingredients had low thermal damage. Hence, furosine may be an indicator of low thermal damage in ingredients with <100 mg/100 g of protein. At the concentrations used in these model systems, similar to those in infant and enteral formulas, furosine values (indirect measure of lysine losses) were higher in lactose than in dextrinomaltose systems, in which only glucose, maltose, maltotriose, and maltotetraose among all of the sugars present showed reactivity with casein. Finally, the advanced steps could be followed by color determination when the initial ingredients had high thermal damage or the model systems were heated at high temperature or for a long time. Among the parameters assayed, b was the most sensitive.

Glutamine in commercial liquid nutritional products

Total glutamine concentrations in commercial nutritional products have been determined by enzymatic hydrolysis followed by HPLC quantification of free glutamine and free pyroglutamic acid. Hydrolysis was accomplished by a published three-enzyme (Pronase, leucine aminopeptidase, prolidase), 20-h/37 degrees C digestion. Glutamine was determined as its FMOC derivative by reverse phase HPLC-fluorescence, and pyroglutamic acid was determined directly by organic acid HPLC-UV. Approximately 4.11% of the released glutamine is converted to pyroglutamic acid during the 20-h digestion. Experimental ratios of enzyme hydrolysis glutamine to acid hydrolysis glutamic acid + glutamine + pyroglutamic acid (GLX) indicate that the method recovers >90% of the protein-bound glutamine. The nutritional products with casein dominant intact protein systems typically deliver >9 g of glutamine/100 g of protein, or approximately 40 g of glutamine/100 g of GLX.

Is fibre supplementation in paediatric sip feeds beneficial?

The usefulness of a paediatric fibre containing sip feeds specifically formulated for paediatrics has not been evaluated. In an open, prospective, parallel study the efficacy, safety and tolerance of a paediatric fibre-containing sip feed designed for children weighing 8-20 kg (1-6 years) was compared with a fibre-free sip feed in 60 children with chronic illness. The subjects either received a trial sip feed containing 150 kcal (100 ml)(-1) and 2.0 g (100 ml)(-1) of fibre or a fibre-free equivalent control sip feed for 12 weeks. Blood biochemistry, haematology, anthropometry, tolerance and food intake data were estimated during week 1 and 12. The fibre intake was higher (P < 0.0001) and laxative usage decreased in the fibre-containing sip feed group. The sip feed provided almost 50% of fibre intake in the trial group. There were no differences in sip feed tolerance, anthropometry, nutritional biochemistry or haematology between the two groups. Sip feeds provide an important source of fibre for sick children with normal gut function requiring nutritional support.

Effect of diet and animal care/housing protocols on body weight, survival, tumor incidences, and nephropathy severity of F344 rats in chronic studies

Diet is an important environmental factor affecting body weight, survival, and age-related diseases of rodents. The NIH-07 open formula diet was the diet used in the National Toxicology Program's (NTPs) rodent carcinogenicity studies from 1980 to 1994. In 1994 the NTP began using a new diet designated the NTP-2000 diet. This paper compares body weight, survival, tumor incidence, and nephropathy severity in untreated control groups of Fischer 344 (F344) rats fed the NTP-2000 or NIH-07 diets, using data from 22 separate 2-year feed and inhalation studies. The feed studies were conducted in 3 different facilities, and all the inhalation studies were conducted in a single facility. During feed studies, rats were group housed in polycarbonate cages and fed diets in powder (mash) form, while in inhalation studies, rats were housed individually in wire mesh cages, and fed diets in pelleted form. Survival was significantly (p<0.05) higher in groups fed NTP-2000 diet compared to the corresponding groups fed NIH-07 diet, irrespective of sex or housing conditions. Use of the NTP-2000 diet was also associated with a decreased incidence of pituitary gland tumors in both sexes and decreased incidences of adrenal pheochromocytoma and preputial gland tumors in males. The incidence and severity of nephropathy was also decreased in animals receiving the NTP-2000 diet, especially males. The decreased nephropathy severity and the decreased incidence of pituitary gland tumors are likely the major factors contributing to the improved survival of rats receiving the NTP-2000 diet relative to those given the NIH-07 diet. These data also support earlier findings that decreased incidences of adrenal pheochromocytoma are associated with reduced nephropathy severity in male F344 rats. Throughout the two-year study female rats receiving the NTP-2000 diet were significantly (p<0.05) lighter than those receiving the NIH-07 diet. However, it is uncertain if this difference can be attributed to the NTP-2000 diet, since implementation of this diet by the NTP approximately coincided with changes in the F344 rat production colony that resulted in somewhat lighter animals being provided to the NTP. Controls from inhalation studies and feed studies differed significantly (p<0.01) in the incidence of a variety of tumors, irrespective of diet. This suggests that differences in animal care and housing protocols may impact tumor incidence in F344 rats, most notably pituitary gland and testis tumors.

Nutritional modulation of neonatal outcomes

In humans, growth and development continues until early adulthood when bone, muscle, and nervous tissue reaches final stages of maturity. Adequate levels of nutritional intake and utilization are critical to optimize ongoing growth. The goal of nutritional therapy for premature or ill neonates has been to provide sufficient nutrients to allow growth to continue at rates seen in utero. Functional immaturity of the gut in the premature infant makes absorption and utilization of nutritional substrates difficult. Premature infants are at risk for developing necrotizing enterocolitis, a potentially lethal bowel disorder. The etiology of necrotizing enterocolitis is not well understood, and a number of theories of causation have been proposed. Breast milk, the optimal source of nutrition for the neonate, is believed to confer some protection against necrotizing enterocolitis. A number of breast milk components have been credited with antiinflammatory properties. Breast milk is recognized for its benefits, yet for preterm infants breast milk alone does not promote adequate growth. A number of breast milk supplements have been investigated to facilitate growth and development and to prevent necrotizing enterocolitis. This article addresses development of the fetal gastrointestinal system, focusing on the biological mediators for normal function and the role of human breast milk and its additives in optimizing neonatal growth. The possible etiologies of necrotizing enterocolitis are discussed in terms of the relationship between this disease and enteral feeding practices.

Auditory brainstem evoked response in juvenile rats fed rat milk formulas with high docosahexaenoic acid

Previous studies found that juvenile offspring of rats fed high docosahexaenoic acid (DHA; 22:6n-3) diets through gestation and lactation had longer auditory brainstem-evoked response (ABR) accompanied by higher 22:6n-3 and lower arachidonic acid (ARA; 20:4n-6) in brain. In the present study, ABR was assessed in juvenile rats fed high-DHA diets only postnatally.

METHODS

Rat pups were fed rat milk formulas with varying amounts of DHA and ARA to 19 days of age followed by diets with the corresponding fatty acids. The high-DHA group was fed 2.3% of fatty acids as DHA, the DHA + ARA group was fed DHA and ARA at 0.6 and 0.4% of fatty acids, levels similar to those in some infant formulas, and the unsupplemented group was fed no DHA or ARA. ABR and fatty acid and monoamine levels in brain were measured on postnatal days 26-28. Statistical analyses were measured by ANOVA.

RESULTS

ARA and DHA levels in brain increased with supplementation. ABR was shorter in the high-DHA group than the DHA + ARA group and not different from the unsupplemented or dam-reared suckling group. Norepinephrine levels in the inferior colliculus were lower in the high-DHA group than the DHA + ARA group and higher in all formula groups compared to the dam-reared group.

CONCLUSION

In contrast to the longer ABR in juvenile offspring of rats fed high-DHA through gestation and lactation, ABR was shorter in juvenile rats fed high-DHA diets only after birth than rats fed ARA + DHA. Further studies are needed to understand the relationship between dietary DHA, norepinephrine, and auditory system development over a range of DHA intakes and discrete periods of development.

Microbial, nutritional and physical quality of commercial and hospital prepared tube feedings in Saudi Arabia

OBJECTIVE

Blenderized tube feedings (BTF) may present disadvantages over commercially prepared formulas (CPF). This study compares the microbial safety, nutritional content, and physical properties of BTF versus CPF.

METHODS

A total of 18 samples of BTF were collected from 3 hospitals in the Kingdom of Saudi Arabia from August 1999 through to November 1999. Samples of a CPF were collected for comparison. All samples were analyzed for nutritional content, microbial quality (aerobic plate counts, coliform counts, microorganism growth) and physical characteristics (viscosity, osmolality).

RESULTS

The nutrient content of BTF varied significantly within and between sites. The average intra site variability for all sites ranged from 16-50%. The average variability of the CPF was 4-7%. Between sites, the mean concentration of most nutrients varied by 2-3 fold. The BTF had considerable differences between actual and expected nutrient concentrations, reaching statistical significance in 12 nutrients. The measured concentration of most nutrients in the CPF was within 10% of expected values. The BTF samples had higher viscosity and osmolality than the CPF. All samples of BTF had detectable aerobic plate counts that increased significantly over 4 hours (p<0.0005). Coliform contamination varied between sites, with 100% contamination at one site. No aerobic plate counts or coliform counts were detected in the CPF samples.

CONCLUSION

There is a high degree of variability in nutrient content and physical properties with BTF. Furthermore, BTF are highly contaminated, increasing the risk of nosocomial infections. For these reasons, CPF should replace BTF.

[Effects of different diet composition on the expression of UCP2 mRNA in different tissues of rat]

OBJECTIVE

In order to explore effect of different diet composition on uncoupling proteins 2 (UCP2)-gene expression in rat brown adipose tissue, white adipose tissue and skeletal muscle.

METHODS

Male Wistar rats were fed with different diets (including basic diet, high protein, high fat, high calorie 1 and 2 diet) for 2 months. The effects of the different diets on weight, the ratio of fat to body weight and free fatty acids were observed. Reverse transcription-polymerase chain reaction (RT-PCR) technique was used to measure the expression of UCP2 mRNA in rat brown adipose tissue, white adipose tissue and skeletal muscle.

RESULTS

Body weight, the ratio of rat to body weight and free fatty acids in high calorie 1 and 2 diet groups are obviously higher than that in groups of basic diet, high protein, high fat diet (P < 0.05), but there is no significant difference between the last three groups (P > 0.05). UCP2 gene expression in white adipose tissue increases in high calorie diet 1 group and high calorie diet 2 group, and no significant difference in basic diet, high protein and high fat group with equal energy is observed. The expression of UCP2 mRNA between brown adipose tissue and muscle is similar in all groups.

CONCLUSION

Energy can induce UCP2 mRNA expression in rat white adipose tissue, and expression level is related to store energy in body, but the expression of UCP2 mRNA in brown adipose tissue and muscle is unrelated to diet composition.