Porcine placenta mitigates protein–energy malnutrition-induced fatigue

ObjectiveFatigue can be caused by a deficiency of nutrition or immune function. The goal of this study was to identify the effects of porcine placenta extract (PPE) and its constituents, amino acids (glutamic acid, glycine, arginine, and proline), on protein–energy malnutrition (PEM)-induced fatigue.MethodsMice were administered a PEM diet and came to immunodeficient status. Simultaneously, the mice were administered PPE or amino acids and a forced swimming test (FST) was performed. We analyzed the levels of fatigue-related factors in serum, splenocytes, and muscles.ResultsIn the FST, PPE or amino acids significantly decreased immobility times compared with the PEM diet. PPE or amino acids also significantly decreased the serum levels of fatigue-related factors after the FST. Additionally, PPE significantly decreased the levels of fatigue-related muscle parameters after the FST. In this in vitro study, PPE increased the mRNA and protein expression of Ki-67 and promoted the proliferation of splenocytes. PPE or amino acids significantly increased the levels of intracellular calcium and the translocation into the nucleus of nuclear factor of activated T-cells cytoplasmic in stimulated splenocytes. PPE or amino acids significantly decreased the production of fatigue-related inflammatory cytokines in the stimulated splenocytes. Additionally, the translocated levels of nuclear factor-κB in the nucleus and the degradation of the inhibitory protein, IκBα, in the cytosol were inhibited by PPE or amino acids.ConclusionThese results demonstrate that PPE and its constituents regulate PEM-induced fatigue through improving levels of immunity and decreasing fatigue-related factors. PPE may be a potential agent for a recovery from fatigue.     

Are energy and protein requirements met in hospital?

Background

Malnutrition is a problem within hospitals, which impacts upon clinical outcomes. The present audit assesses whether a hospital menu meets the energy and protein standards recommended by the British Dietetic Association's (BDA) Nutrition and Hydration Digest and determines the contribution of oral nutrition supplements (ONS) and additional snacks.

Methods

Patients in a UK South West hospital were categorised as ‘nutritionally well’ or ‘nutritionally vulnerable’ in accordance with their Malnutrition Universal Screening Tool score. Energy and protein content of food selected from the menu (‘menu choice’), menu food consumed (‘hospital intake’) and total food consumed including snacks (‘overall intake’) were calculated and compared with the standards.

Results

In total , 93 patients were included. For ‘nutritionally well’ patients (n = 81), energy and protein standards were met by 11.1% and 33.3% (‘menu choice’); 7.4% and 22.2% (‘hospital intake’); and 14.8% and 28.4% (‘overall intake’). For ‘nutritionally vulnerable’ patients (n = 12), energy and protein standards were met by 0% and 8.3% (‘menu choice’); 0% and 8.3% (‘hospital intake’); and 8.3% and 16.7% (‘overall intake’). Ten percent of patients consumed ONS. Patients who consumed hospital snacks (34%) were more likely to meet the nutrient standards (P ≤ 0.001).

Conclusions

The present audit demonstrated that most patients are not meeting the nutrient standards recommended by the BDA Nutrition and Hydration Digest. Recommendations include the provision of energy/protein‐dense snacks, as well as menu, offering ONS where clinically indicated, in addition to training for staff. A food services dietitian is ideally placed to lead this, forming a vital link between patients, caterers and clinical teams.     

Are energy drinks contributing to the obesity epidemic?

The consumption of energy drinks containing sucrose and caffeine is increasing worldwide. Ten healthy women aged 18 to 22 years and fasted overnight were randomly allocated to a standardised dose of sucrose either as an "energy" drink (containing sucrose and caffeine) or lemonade on the first day and then crossed over to the alternative drink on a second day. For thirty minutes before and thirty minutes after drinking oxygen consumption and carbon dioxide production were measured in the resting subject breath-by-breath by indirect calorimetry and the rates of carbohydrate and fat oxidation calculated. Energy drink consumption apparently caused increased carbohydrate oxidation (P = 0.004) and reduced lipid oxidation (P = 0.004) compared to lemonade. The longer term effects of combined caffeine and sucrose intake, particularly in sedentary individuals, on metabolism and body fatness needs further examination.     

Will drivers for home energy efficiency harm occupant health?

The U.K. government has committed to an 80% reduction in carbon emissions by 2050, with housing accounting for 27% of total current emissions. There are several drivers both to reduce emissions from homes and to reduce fuel poverty, promoting a range of building and behavioural measures in homes. The health benefits of warmer homes in winter have been described, but there has been less consideration of the potential negative impacts of some of these measures. We examine the changes in U.K. homes, and the possible consequences for health. The main concerns for health surround the potential for poor indoor air quality if ventilation is insufficient and the possible risks of overheating in heatwave conditions. This paper notes a limited evidence base and the need for further research on the health effects of energy-efficient homes, particularly with regard to ventilation.     

Which equation best predicts energy expenditure in amyotrophic lateral sclerosis?

Objective

The purpose of this study was to compare measured resting energy expenditure (REE) with estimates from three common prediction equations with the goal of determining which equation best estimates REE in amyotrophic lateral sclerosis (ALS).

Design

Cross-sectional measurements of REE from indirect calorimetry were compared to calculations from the Harris Benedict, Mifflin-St Jeor, and Ireton-Jones equations. Additional measurements to identify predictors of REE included pulmonary function tests, fat-free mass by bioelectrical impedance, and anthropometrics.

Subjects/setting

Participants were 56 men and women with ALS. For comparison, subjects were categorized by disease progression into three groups.

Statistical analyses

Pearson correlations and paired t tests were used to compare measured REE with predicted REE from each equation, and the accuracy of each equation was quantified by the root mean squared prediction error and the percentage of REE estimates within 10% of measured values. Bias for each equation was calculated as the mean percentage difference between calculated and measured REE. Multiple linear regression was used to determine the best predictor variables for REE.

Results

Across the disease spectrum, the Harris Benedict and Mifflin-St Jeor equations provided clinically acceptable estimates of REE, whereas the Ireton-Jones equations consistently overestimated REE. The best predictors of REE among this cohort were fat-free mass, sex, and age.

Conclusions

When estimating energy requirements for patients with ALS, clinicians should choose prediction equations that incorporate sex and age as predictor variables, such as the Harris Benedict and Mifflin-St Jeor equations.     

Commentary—Food shortages: A poor man's energy Crisis†

Family sharing of maternal food supplements is a profound problem in feeding programmes. Methipak — a bitter‐sweet energy, protein and iron rich confection of wheat, fat, crude sugar and fenugreek ( Trigon‐ella foenum graecum) was identified as having potential non‐sharing characteristics. A group of 662 Baroda pregnant, lactating and non‐pregnant‐non‐lactating women were interviewed. The practice of consuming Methipak was far stronger in lactation (85%) than in pregnancy (27%). Major benefits in lactation were minimizing body‐aches, galactogogic and strengthening qualities; and in pregnancy, lessening body‐ache, easy delivery and prevention of indigestion. The major negative qualities were its “hot” and aborti‐facient nature. Important reasons for non‐consumption in low income group (main target) were inability to afford it and/or ignorance. It was consumed in the last trimester (for 1–2 months) and 10 days post‐partum (1–2 months), at the level of 50g/day in the morning. Approximately 39% shared it with the family; this was least in the low income group (20 %). It was popular among the entire family members in winter (63 %). Based on these findings, a biscuit type Methipak with long shelf life is being developed for low income group mothers.     

Do economic constraints encourage the selection of energy dense diets?

Economic constraints, by inducing the selection of low cost energy dense diets, could indirectly be responsible for the high prevalence of obesity in low socio-economic status groups. Diet optimisation by linear programming was used to test this hypothesis, by examining the relationship between the cost and the energy density (ED) of modelled diets. Models were developed that minimized the departure from the mean adult French diet estimated from a cross-sectional dietary survey. Palatability constraints were introduced into all models. The impacts of cost on ED and of ED on cost were explored by introducing and strengthening first a constraint on cost and then a constraint on ED. Forcing the cost of the linear programming diets to decrease induced a strong increase in their EDs. In contrast, forcing the ED to increase induced only a moderate decrease in diet costs. These results suggest that, although an energy dense diet can be selected at a relatively high cost, when cost is not influencing food choices, an energy dense diet will be preferentially selected to maintain habitual French dietary patterns when the budget for food is low. This supports the hypothesis that economic constraints play a role in the high prevalence of obesity in low-income people.     

Effects of the duration of the habituation period on energy intakes from low and high energy density gruels by Burkinabè infants living in free conditions

The present study was carried out in Ouagadougou (Burkina Faso) with the aim of determining if the duration of the habituation period (1, 5 or 10 days) to low and high energy density gruels affected the amounts consumed or the energy intakes from gruels consumed by 6-9-month-old infants. Thirty infants were chosen randomly among the eligible children in the study area and randomly assigned to two groups (S1 and S2). Each infant was given successively for 10 consecutive days two experimental gruels, each type of gruel being fed twice a day. The 15 infants in group S1 received low energy density gruel (G1) in the first period and high energy density gruel (G2) in the second, and the 15 infants in group S2 received G2 in the first period and G1 in the second. The two periods of 10 days were separated by 4 days during which the infant received his or her usual foods. The intakes of experimental gruels and other complementary foods were measured on days 1, 5 and 10 of each period. Whatever the type of gruel, the 10-day period of habituation did not result in an increase in the amounts consumed or in the energy intakes from these gruels. The amounts of G1 consumed on day 5 were significantly higher than those of G2 (9.0 vs 6.8 g/kg/meal; p = 0.044). Energy intakes from G2 were significantly higher than those from G1 on days 1 (28.8 vs 18.0 kJ/kg/meal; p = 0.0002), 5 (28.8 vs 19.2 kJ/kg/meal; p = 0.002) and 10 (25.9 vs 15.5 kJ/kg/meal; p = 0.0004). Daily frequencies of breastfeeding (approximately 5.6), water drinking (approximately 3.7) and meals with foods other than experimental gruels were relatively high and did not vary with the duration of the habituation period or the type of gruels. Whatever the type of gruel, the increase in the duration of the habituation period did not increase the amount consumed or energy intakes. The study confirmed that consumption of high energy density gruels led to a 60% increase in energy intakes in comparison with the consumption of low energy density gruels.     

Estimating activity energy expenditure: how valid are physical activity questionnaires?

Activity energy expenditure (AEE) is the modifiable component of total energy expenditure (TEE) derived from all activities, both volitional and nonvolitional. Because AEE may affect health, there is interest in its estimation in free-living people. Physical activity questionnaires (PAQs) could be a feasible approach to AEE estimation in large populations, but it is unclear whether or not any PAQ is valid for this purpose. Our aim was to explore the validity of existing PAQs for estimating usual AEE in adults, using doubly labeled water (DLW) as a criterion measure. We reviewed 20 publications that described PAQ-to-DLW comparisons, summarized study design factors, and appraised criterion validity using mean differences (AEE(PAQ) - AEE(DLW), or TEE(PAQ) - TEE(DLW)), 95% limits of agreement, and correlation coefficients (AEE(PAQ) versus AEE(DLW) or TEE(PAQ) versus TEE(DLW)). Only 2 of 23 PAQs assessed most types of activity over the past year and indicated acceptable criterion validity, with mean differences (TEE(PAQ) - TEE(DLW)) of 10% and 2% and correlation coefficients of 0.62 and 0.63, respectively. At the group level, neither overreporting nor underreporting was more prevalent across studies. We speculate that, aside from reporting error, discrepancies between PAQ and DLW estimates may be partly attributable to 1) PAQs not including key activities related to AEE, 2) PAQs and DLW ascertaining different time periods, or 3) inaccurate assignment of metabolic equivalents to self-reported activities. Small sample sizes, use of correlation coefficients, and limited information on individual validity were problematic. Future research should address these issues to clarify the true validity of PAQs for estimating AEE.