The effects of standard and branched chain amino acid enriched solutions on thermogenesis and energy expenditure in unconscious intensive care patients

Comparative characteristics of some methods for estimating energy expenditure in critically ill mechanically ventilated patients

AIM

To compare the energy expenditure (EE) assessed by ventilator-derived carbon dioxide production (EE-VCO2-ventilator) and the energy expenditure calculated from six predictive equations with the gold standard energy expenditure measured with indirect calorimetry (IC) in mechanically ventilated patients.

Comparison of Energy Expenditure in Mechanically Ventilated Septic Shock Patients in Acute and Recovery Periods via Indirect Calorimetry

BACKGROUND

Nutrition in intensive care units (ICUs) affects morbidity and mortality. We aimed to evaluate the energy expenditure of mechanically ventilated patients in early and late septic shock periods.

METHODS

This study retrospectively evaluated 28 mechanically ventilated septic shock patients (11 female/17 male) in a medical ICU. Indirect calorimetry (IC) measurement was performed for 24 hours during the acute and recovery periods of septic shock. The energy values calculated by Harris-Benedict equation (predicted resting energy expenditure [PREE]), measured by IC (measured resting energy expenditure [MREE]), and given to each patient were obtained in the acute and recovery periods.

RESULTS

The mean age was 67.46 ± 14.92 (36-91) years. The MREE was 2741.1 ± 706.3 kcal/d (38.61 ± 11.44 kcal/kg/d) and 2332.8 ± 426.6 kcal/d (32.65 ± 7.8 kcal/kg/d) in the acute and recovery periods, respectively, and showed significant differences (P = 0.001). The patients' energy intake was 1152.7 ± 207.1 kcal/d and 1542.7 ± 433.3 kcal/d in the acute and recovery periods, respectively. A significant difference existed between energy intake and MREE during the acute and recovery periods (P < 0.001 for both).

CONCLUSION

Our findings showed that energy expenditure increases in septic shock. Significant differences existed between MREE, PREE, and energy intake, which were not correlated. The MREE was higher in the acute period. Despite the increasing energy requirement, the PREE and energy intake were well below MREE. For better clinical outcomes, each patient's energy expenditure must be closely monitored and evaluated using intermittent IC measurements.

Clinical Guide for the Use of Metabolic Carts: Indirect Calorimetry--No Longer the Orphan of Energy Estimation

Critically ill patients often require nutrition support, but accurately determining energy needs in these patients is difficult. Energy expenditure is affected by patient characteristics such as weight, height, age, and sex but is also influenced by factors such as body temperature, nutrition support, sepsis, sedation, and therapies. Using predictive equations to estimate energy needs is known to be inaccurate. Therefore, indirect calorimetry measurement is considered the gold standard to evaluate energy needs in clinical practice. This review defines the indications, limitations, and pitfalls of this technique and gives practice suggestions in various clinical situations.

DNA methylation pattern in overweight women under an energy-restricted diet supplemented with fish oil

Dietary factors modulate gene expression and are able to alter epigenetic signatures in peripheral blood mononuclear cells (PBMC). However, there are limited studies about the effects of omega-3 polyunsaturated fatty acids (n-3 PUFA) on the epigenetic mechanisms that regulate gene expression. This research investigates the effects of n-3-rich fish oil supplementation on DNA methylation profile of several genes whose expression has been reported to be downregulated by n-3 PUFA in PBMC: CD36, FFAR3, CD14, PDK4, and FADS1. Young overweight women were supplemented with fish oil or control in a randomized 8-week intervention trial following a balanced diet with 30% energy restriction. Fatty acid receptor CD36 decreased DNA methylation at CpG +477 due to energy restriction. Hypocaloric diet-induced weight loss also reduced the methylation percentages of CpG sites located in CD14, PDK4, and FADS1. The methylation patterns of these genes were only slightly affected by the fish oil supplementation, being the most relevant to the attenuation of the weight loss-induced decrease in CD36 methylation after adjusting by baseline body weight. These results suggest that the n-3 PUFA-induced changes in the expression of these genes in PBMC are not mediated by DNA methylation, although other epigenetic mechanisms cannot be discarded.

Relationship between BMI and body fatness in three European countries

BACKGROUND/OBJECTIVES

Body fatness and heart disease risk factors can differ considerably between ethnities for a given body mass index (BMI). Information is lacking on differences between various Caucasian populations within Europe. The aim was to investigate the differences in anthropometrics and risk factors between adults from Iceland, Spain and Ireland.

SUBJECT/METHODS

This was a secondary analysis of the baseline data from the SEAFOODplus YOUNG intervention study, in which 324 subjects (20-40 years, BMI 27.5-32.5 kg/m(2), from Iceland, Spain and Ireland) participated. Fasting glucose, insulin, blood lipids and body compossition were measured, insulin resistance was calculated using the homeostasis model assessment of insulin resistance.

RESULTS

Although age and BMI did not differ between Spanish, Irish and Icelandic subjects, Irish subjects had significantly higher waist circumference (3.2 and 6.7 cm) and body fat percentage (4.4 and 2.0%) compared with Icelandic and Spanish participants, respectively. Irish participants had also more unfavorable cardio-metabolic risk factors compared with Spanish and Icelandic subjects. However, correction for waist attenuated the observed differences considerably, in particular for total cholesterol, low-density lipoprotein and triglycerides.

CONCLUSIONS

Despite having near identical BMI and age, our results show that study participants from different populations within Europe differ considerably in cardio-metabolic risk factors, partly due to differences in body fat distribution.

Sensory analysis and consumer surveys of fat- and salt-reduced meat products and their use in an energy-reduced diet in overweight individuals

Meat and meat products are of high nutritional value; however, they frequently provide salt and fat in high amounts, which can have negative health effects when consumed in excess. We investigated salt- and fat-reduced meat products, i.e. sensory evaluation and consumer surveys were carried out as well as a dietary intervention study was carried out in overweight individuals who used salt- and fat-reduced products as a part of an energy-restricted diet. Although differences were detected in the sensory evaluation between reduced and regular meat products, the participants in the consumer surveys and in the dietary intervention study gave good ratings for the fat and fat-reduced meat products. The intervention study led to weight loss and improved cardiovascular risk, but did not reveal side effects associated with the consumption of these products. Our study indicates that such products are well accepted by potential consumers and can be included successfully in a weight loss programme.

Effects of weight loss and seafood consumption on inflammation parameters in young, overweight and obese European men and women during 8 weeks of energy restriction

BACKGROUND/OBJECTIVES

In vitro studies have shown that long-chain n-3 polyunsaturated fatty acids (LC n-3 PUFAs) can affect inflammation; however, results from intervention studies in overweight or obese individuals are contradicting. The aim of this study was to investigate the effects of weight loss and seafood consumption on inflammation parameters during energy restriction.

SUBJECTS/METHODS

In this 8-week intervention trial, 324 subjects (aged 20-40 years, body mass index 27.5-32.5 kg/m(2) from Iceland, Spain and Ireland) were randomized to one of four energy-restricted diets (-30% relative to estimated requirements): salmon (3 x 150 g/week, 2.1 g LC n-3 PUFA per day); cod (3 x 150 g/week, 0.3 g LC n-3 PUFA per day); fish oil capsules (1.3 g LC n-3 PUFA per day); and control (sunflower oil capsules, no seafood). Body weight, high-sensitivity C-reactive protein (CRP), interleukin-6 (IL-6), glutathione reductase and prostaglandin F2 alpha (PGEF2alpha) were measured at baseline and end point.

RESULTS

Subjects experienced weight loss (-5.2+/-3.2 kg, P<0.001). Taken together for all subjects, there were significant decreases in all inflammation parameters. On a group level, salmon consumption was most effective, three of the four inflammation parameters decreased in the salmon group (high-sensitivity CRP=-32.0%; IL-6=-18.4%; PGEF2alpha=-18.5%; all P<0.05). Cod consumption decreased high-sensitivity CRP and IL-6 (-21.5 and -10.8%, respectively, both P<0.05). Changes in the other two groups were not significant, which can be partly explained by the large s.d.

CONCLUSIONS

The mean concentrations of inflammation parameters decreased during a period of weight loss and dietary intervention. In our study, salmon consumption was most effective, three of the four measured inflammation parameters decreased significantly in the salmon group.

Consumption of cod and weight loss in young overweight and obese adults on an energy reduced diet for 8-weeks

BACKGROUND AND AIMS

In a cross-European study it was recently shown that consumption of cod increases weight loss in men and also has other positive health effects. The aim of this study was to investigate whether cod consumption increases weight loss and improves cardiovascular risk factors in a dose dependent manner during an 8-week energy restriction diet in young overweight and obese healthy adults.

METHODS AND RESULTS

In this dietary intervention 126 subjects (20-40 years, BMI 27.5-32.5 kg/m(2)) comprised the group given energy-restricted diets (-30%); they were prescribed an identical macronutrient composition but different amounts of cod: the control group were given no seafood; group 1 were given 150 g cod 3 times a week; and group 2 were given 150 g cod 5 times a week. Anthropometric measurements and cardiovascular risk factors were assessed at baseline and endpoint. Body weight decreased after 8-weeks (5.0+/-2.9 kg, P<0.001), also waist circumference (5.0+/-3.2 cm, P<0.001), BMI (1.65+/-0.95 kg, P<0.001), systolic (3.4+/-8.9 mmHg, P=0.001) and diastolic blood pressure (2.4+/-6.9 mmHg, P<0.001), triglycerides (1.26+/-0.567 mmol/L, P=0.030) and insulin (1.21+/-5.31 mU/L, P=0.025). The prevalence of the metabolic syndrome dropped from 29 to 21%. According to linear models weight loss was 1.7 kg greater among subjects consuming 150 g 5x/week compared to the control group (P<0.015). The trend analysis supported a dose-response relationship between cod consumption and weight loss (P<0.001), but changes of other measured cardiovascular risk factors were similar between the groups.

CONCLUSION

A dose-response relationship between cod consumption and weight loss during an 8-week energy restriction diet is found and 5 x 150 g cod/week results in 1.7 kg greater weight loss in young overweight or obese adults than a isocaloric diet without seafood.

Moderate consumption of fatty fish reduces diastolic blood pressure in overweight and obese European young adults during energy restriction

OBJECTIVE

Dietary intervention studies suggest that a daily fish meal can improve blood pressure (BP); however, such a dietary regimen might be difficult to sustain. The objective of the present study was to investigate whether salmon consumption three times per week improves BP during energy restriction in young adults.

METHODS

In this 8-wk intervention, 324 subjects (20-40 y of age, body mass index 27.5-32.5kg/m(2), from Iceland, Spain, and Ireland) were randomized to one of four energy-restricted diets (-30% relative to estimated requirements): salmon (150g three times per week, resulting in a daily consumption of 2.1g of omega-3 long-chain polyunsaturated fatty acids [omega-3 LC-PUFAs]), cod (150g three times per week, 0.3g of omega-3 LC-PUFAs per day), fish oil capsules (1.3g of omega-3 LC-PUFAs per day), or control (sunflower oil capsules, no seafood). Body weight, diastolic BP (DBP), systolic BP (SBP), and docosahexaenoic acid (DHA) in erythrocyte membrane were measured at baseline and endpoint.

RESULTS

Participants showed weight loss (-5.2+/-3.2kg, P<0.001) and decreases in SBP (-4.4+/-8.6 mmHg, P<0.001) and DBP (-4.1+/-7.4 mmHg, P<0.001) after the intervention. The salmon (B=-2.71, P=0.032) and fish oil (B=-2.48, P=0.044) groups had significantly lower endpoint DPB than the cod group, but not significantly different from control. Lower baseline DHA (percentage) in erythrocytes was associated with greater DBP reductions (B=0.576, P=0.017).

CONCLUSION

Salmon consumption three times per week can decrease DBP similar to fish oil and significantly more than lean fish during an 8-wk energy restriction in young overweight individuals. A lower DHA content in erythrocyte membrane at baseline, which might indentify infrequent fish eaters, is associated with a greater DBP reduction in the course of an 8-wk dietary intervention providing fatty seafood.

CD36 gene promoter polymorphisms are associated with low density lipoprotein-cholesterol in normal twins and after a low-calorie diet in obese subjects

Common polymorphisms of the CD36 fatty acid transporter gene have been associated with lipid metabolism and cardiovascular disease. Association of a CD36 promoter single nucleotide polymorphism genotype with anthropometry and serum lipids was investigated in normal subjects, and in obese subjects during an 8-week low calorie diet and 6-month weight-maintenance period. 2728 normal female Twins UK subjects (mean body mass index 24.8 +/- 4.4 kg/m2; age 47.3 +/- 12.5 y) and 183 obese male and female Spanish subjects (mean body mass index 30.6 +/- 3.0 kg/m2; age 35.0 +/- 5.0 y) were genotyped for the CD36-22674 T/C (rs2151916) promoter single nucleotide polymorphism. In the Twins UK full cohort, the C-allele was associated with lower low density lipoprotein-cholesterol (p = .02, N = 2396). No associations were found in the obese Spanish subjects at baseline, but 6 months after the end of the low-calorie diet, the C-allele was associated with lower total- (p = .03) and low density lipoprotein-cholesterol (p = .01) and higher high density lipoprotein-cholesterol (p = .01). Intake of saturated fatty acids was lower in carriers of the C-allele at baseline, but not significantly so (p = .11). However, 6 months after the end of the low-calorie diet, elements of the lipid profile were correlated with saturated fatty acid intake: total cholesterol r = .21, p = .060; low density lipoprotein-cholesterol: r = .25, p = .043; high density lipoprotein-cholesterol: r = -.26, p = .007. CD36 promoter SNP allele -22674C is therefore associated with lower serum low-density lipoprotein-cholesterol in normal female twins and with improved lipid profile during weight loss and maintenance in obese subjects.

Beneficial effects of long-chain n-3 fatty acids included in an energy-restricted diet on insulin resistance in overweight and obese European young adults

AIMS/HYPOTHESIS

Epidemiological research indicates that long-chain n-3 polyunsaturated fatty acids (LC n-3 PUFA) improve insulin resistance. The aim of this study was to investigate the effects of seafood consumption on insulin resistance in overweight participants during energy restriction.

METHODS

In this 8 week dietary intervention, 324 participants (20-40 years, BMI 27.5-32.5 kg/m(2), from Iceland, Spain and Ireland) were randomised by computer to one of four energy-restricted diets (-30E%) of identical macronutrient composition but different LC n-3 PUFA content: control (n = 80; no seafood; single-blinded); lean fish (n = 80; 150 g cod, three times/week); fatty fish (n = 84; 150 g salmon, three times/week); (4) fish oil (n = 80; daily docosahexaenoic/eicosapentaenoic acid capsules, no other seafood; single-blinded). Fasting glucose, insulin, adiponectin, plasma triacylglycerol and fatty acids in erythrocyte membrane were measured at baseline and endpoint. Insulin resistance was calculated using the homeostasis model assessment of insulin resistance (HOMA-IR). Linear models with fixed effects and covariates were used to investigate the effects of seafood consumption on fasting insulin and HOMA-IR at endpoint in comparison with the control group.

RESULTS

Of the participants, 278 (86%) completed the intervention. Fish oil intake was a significant predictor of fasting insulin and insulin resistance after 8 weeks, and this finding remained significant even after including weight loss, triacylglycerol reduction, increased LC n-3 PUFA in membranes or adiponectin changes as covariates in the statistical analysis. Weight loss was also a significant predictor of improvements.

CONCLUSIONS/INTERPRETATION

LC n-3 PUFA consumption during energy reduction exerts positive effects on insulin resistance in young overweight individuals, independently from changes in body weight, triacylglycerol, erythrocyte membrane or adiponectin.

TRIAL REGISTRATION

ClinicalTrials.gov NCT00315770.

A diet rich in long chain omega-3 fatty acids modulates satiety in overweight and obese volunteers during weight loss

Long chain omega-3 fatty acids (LC n-3 FA) are considered nutritional factors with a potential to modulate food intake. Thus, the aim of the current study was to determine whether appetite could be affected by LC n-3 FA when included in a calorie-restricted diet to treat overweight or obesity. Appetite was explored in volunteers (31+/-5 years; BMI: 28.3+/-1.5 kg/m(2)) during the last 2 weeks of an 8-week energy-restricted balanced diet (weight loss=-5.9+/-3.1%) providing either a low (<260 mg/day; n=112) or a high amount (>1300 mg/day; n=121) of LC n-3 FA. Erythrocyte membrane fatty acids were measured to detect diet-related changes in fatty acids and a validated visual analogue scale (VAS) was used to measure hunger sensations directly after and 2h after a test dinner. The LC n-3 FA content in erythrocyte membrane was lower in the low LC n-3 FA group (10.5+/-2.5% vs. 12.5+/-2.6%; p<0.001) after the intervention. The VAS assessment revealed lower hunger sensations in the high LC n-3 FA group immediately after the test dinner (fullness: p=0.045) and after 120 min (fullness: p=0.008; hunger: p=0.039). Correlation analysis showed a positive relation between n-3 FA/n-6 FA ratio in erythrocyte membrane and fullness 2h postprandial (r=0.139; p=0.032). In conclusion, LC n-3 FA intake modulates postprandial satiety in overweight and obese volunteers during weight loss. Further research is needed to investigate whether LC n-3 FA improve compliance to the nutritional treatment of overweight and obesity as well as weight loss maintenance.

Randomized trial of weight-loss-diets for young adults varying in fish and fish oil content

OBJECTIVE

To investigate the effect of including seafood and fish oils, as part of an energy-restricted diet, on weight loss in young overweight adults.

DESIGN

Randomized controlled trial of energy-restricted diet varying in fish and fish oil content was followed for 8 weeks. Subjects were randomized to one of four groups: (1) control (sunflower oil capsules, no seafood); (2) lean fish (3 x 150 g portions of cod/week); (3) fatty fish (3 x 150 g portions of salmon/week); (4) fish oil (DHA/EPA capsules, no seafood). The macronutrient composition of the diets was similar between the groups and the capsule groups, were single-blinded.

SUBJECTS

A total of 324 men and women aged 20-40 years, BMI 27.5-32.5 kg/m(2) from Iceland, Spain and Ireland.

MEASUREMENTS

Anthropometric data were collected at baseline, midpoint and endpoint. Confounding factors were accounted for, with linear models, for repeated measures with two-way interactions. The most important interactions for weight loss were (diet x energy intake), (gender x diet) and (gender x initial-weight).

RESULTS

An average man in the study (95 kg at baseline receiving 1600 kcal/day) was estimated to lose 3.55 kg (95% CI, 3.14-3.97) (1); 4.35 kg (95% CI, 3.94-4.75) (2); 4.50 kg (95% CI, 4.13-4.87) (3) and 4.96 kg (95% CI, 4.53-5.40) on diet (4) in 4 weeks, from baseline to midpoint. The weight-loss from midpoint to endpoint was 0.45 (0.41-0.49) times the observed weight loss from baseline to midpoint. The diets did not differ in their effect on weight loss in women. Changes in measures of body composition were in line with changes in body weight.

CONCLUSION

In young, overweight men, the inclusion of either lean or fatty fish, or fish oil as part of an energy-restricted diet resulted in approximately 1 kg more weight loss after 4 weeks, than did a similar diet without seafood or supplement of marine origin. The addition of seafood to a nutritionally balanced energy-restricted diet may boost weight loss.

Hypothermia – it's more than a toy

PURPOSE OF REVIEW

Perioperative hypothermia triples the incidence of adverse myocardial outcomes in high-risk patients; it significantly increases blood loss and augments allogeneic transfusion requirements. Even mild hypothermia increases the incidence of surgical wound infection following colon resection and therefore the duration of hospitalization. Hypothermia adversely affects antibody- and cell-mediated immune defenses, as well as the oxygen availability in the peripheral wound tissues. Mild perioperative hypothermia changes the kinetics and action of various anesthetic and paralyzing agents, increases thermal discomfort, and is associated with delayed postanesthetic recovery.

RECENT FINDINGS

On the other hand however, therapeutic hypothermia may be an interesting approach in various settings. Lowering core temperature to 32-34 degrees C may reduce cell injury by suppressing excitotoxins and oxygen radicals, stabilizing cell membranes, and reducing the number of abnormal electrical depolarizations. Evidence in animals indicates that even mild hypothermia provides substantial protection against cerebral ischemia and myocardial infarction. Mild hypothermia has been shown to improve outcome after cardiac arrest in humans. Randomized trials are in progress to evaluate the potential benefits of mild hypothermia during aneurysm clipping and after stroke or acute myocardial infarction.

SUMMARY

This article reviews recent publications in the field of accidental as well as therapeutic hypothermia, and tries to assess what evidence is available at the present time.