Augmented Renal Clearance, Muscle Catabolism and Urinary Nitrogen Loss: Implications for Nutritional Support in Critically Ill Trauma Patients

The main objective of this pilot study was to determine the association between augmented renal clearance (ARC), urinary nitrogen loss and muscle wasting in critically ill trauma patients. We conducted a retrospective analysis of a local database in 162 critically ill trauma patients without chronic renal dysfunction. Nutritional-related parameters and 24 h urinary biochemical analyses were prospectively collected and averaged over the first ten days after admission. Augmented renal clearance was defined by a mean creatinine clearance (CL_CR) > 130 mL/min/1.73 m². The main outcome was the cumulated nitrogen balance at day 10. The secondary outcome was the variation of muscle psoas cross-sectional area (ΔCSA) calculated in the subgroup of patients who underwent at least two abdominal CT scans during the ICU length of stay. Overall, there was a significant correlation between mean CL_CR and mean urinary nitrogen loss (normalized coefficient: 0.47 ± 0.07, p < 0.0001). ARC was associated with a significantly higher urinary nitrogen loss (17 ± 5 vs. 14 ± 4 g/day, p < 0.0001) and a lower nitrogen balance (−6 ± 5 vs. −4 ± 5 g/day, p = 0.0002), without difference regarding the mean protein intake (0.7 ± 0.2 vs. 0.7 ± 0.3 g/kg/day, p = 0.260). In the subgroup of patients who underwent a second abdominal CT scan (N = 47), both ΔCSA and %ΔCSA were higher in ARC patients (−33 [−41; −25] vs. −15 [−29; −5] mm²/day, p = 0.010 and −3 [−3; −2] vs. −1 [−3; −1] %/day, p = 0.008). Critically ill trauma patients with ARC are thus characterized by a lower nitrogen balance and increased muscle loss over the 10 first days after ICU admission. The interest of an increased protein intake (>1.5 g/kg/day) in such patients remains a matter of controversy and must be confirmed by further randomized trials.

Optimising storage conditions and processing of sheep urine for nitrogen cycle and gaseous emission measurements from urine patches

In grazing systems, urine patches deposited by livestock are hotspots of nutrient cycling and the most important source of nitrous oxide (N2O) emissions. Studies of the effects of urine deposition, including, for example, the determination of country-specific N2O emission factors, require natural urine for use in experiments and face challenges obtaining urine of the same composition, but of differing concentrations. Yet, few studies have explored the importance of storage conditions and processing of ruminant urine for use in subsequent gaseous emission experiments. We conducted three experiments with sheep urine to determine optimal storage conditions and whether partial freeze-drying could be used to concentrate the urine, while maintaining the constituent profile and the subsequent urine-derived gaseous emission response once applied to soil. We concluded that filtering of urine prior to storage, and storage at - 20 °C best maintains the nitrogen-containing constituent profile of sheep urine samples. In addition, based on the 14 urine chemical components determined in this study, partial lyophilisation of sheep urine to a concentrate represents a suitable approach to maintain the constituent profile at a higher overall concentration and does not alter sheep urine-derived soil gaseous emissions.

Energy expenditure and feeding practices and tolerance during the acute and late phase of critically ill COVID-19 patients

BACKGROUND & AIMS

Different metabolic phases can be distinguished in critical illness, which influences nutritional treatment. Achieving optimal nutritional treatment during these phases in critically ill patients is challenging. COVID-19 patients seem particularly difficult to feed due to gastrointestinal problems. Our aim was to describe measured resting energy expenditure (mREE) and feeding practices and tolerance during the acute and late phases of critical illness in COVID-19 patients.

METHODS

Observational study including critically ill mechanically ventilated adult COVID-19 patients. Indirect calorimetry (Q-NRG+, Cosmed) was used to determine mREE during the acute (day 0-7) and late phase (>day 7) of critical illness. Data on nutritional intake, feeding tolerance and urinary nitrogen loss were collected simultaneously. A paired sample t-test was performed for mREE in both phases.

RESULTS

We enrolled 21 patients with a median age of 59 years [44-66], 67% male and median BMI of 31.5 kg/m2 [25.7-37.8]. Patients were predominantly fed with EN in both phases. No significant difference in mREE was observed between phases (p = 0.529). Sixty-five percent of the patients were hypermetabolic in both phases. Median delivery of energy as percentage of mREE was higher in the late phase (94%) compared to the acute phase (70%) (p = 0.001). Urinary nitrogen losses were significant higher in the late phase (p = 0.003).

CONCLUSION

In both the acute and late phase, the majority of the patients were hypermetabolic and fed enterally. In the acute phase patients were fed hypocaloric whereas in the late phase this was almost normocaloric, conform ESPEN guidelines. No significant difference in mREE was observed between phases. Hypermetabolism in both phases in conjunction with an increasing loss of urinary nitrogen may indicate that COVID-19 patients remain in a prolonged acute, catabolic phase.

Comparison of Methods Used to Correct Self-Reported Protein Intake for Systematic Variation in Reported Energy Intake Using Quantitative Biomarkers of Dietary Intake

BACKGROUND

Multiple methods of correcting nutrient intake for misreported energy intake have been proposed but have not been extensively compared. The availability of the Women's Health Initiative (WHI) data set, which includes several objective recovery biomarkers, offers an opportunity to compare these corrections with respect to protein intake.

OBJECTIVE

We compared 5 energy-correction methods for self-reported dietary protein against urinary nitrogen-derived protein intake.

METHODS

As part of the WHI Nutritional Biomarkers Study (NBS) 544 participants (50- to 80-y-old women) completed a FFQ and biomarker assessments using doubly labeled water (DLW) for total energy expenditure (TEE) and 24-h urinary nitrogen. Correction methods evaluated were as follows: 1) DLW-TEE; 2) the Institute of Medicine's (IOM's) estimated energy requirement (EER) TEE prediction equation based on sex, height, weight, and age; 3) published NBS total energy TEE prediction (WHI-NBS-TEE) using age, BMI, race, and income; 4) reported protein versus reported energy linear regression-based residual method; and 5) a Goldberg cutoff to exclude subjects reporting energy intakes <1.35 times their basal metabolic rate. Efficacy was evaluated using correlations obtained by regressing corrected protein against biomarker protein (6.25 × urinary nitrogen/0.81).

RESULTS

Unadjusted self-reported protein intake from the FFQ (mean = 66.7 g) correlated weakly (r = 0.31) with biomarker protein (mean = 74.9 g). DLW-TEE-corrected self-reported protein intake (mean = 90.7 g) had the strongest correlation with biomarker protein (r = 0.47). Other energy corrections yielded lower, but still significant correlations: EER, r = 0.44 (mean = 92.1 g); WHI-NBS-TEE, r = 0.37 (mean = 90.4 g); Goldberg cutoff, r = 0.36 (mean = 88.4 g); and residual method, r = 0.35 (mean = 66.7 g).

CONCLUSIONS

Our data indicate that proportional correction of reported protein intake using a measure of energy requirement from DLW-TEE or IOM-EER performed modestly better than other methods in this cohort. These energy adjustments, however, yielded corrected protein exceeding the biomarker protein, indicating that energy adjustment alone does not eliminate all self-reported protein reporting bias.

Dietary supplementation of rumen-protected methionine decreases the nitrous oxide emissions of urine of beef cattle through decreasing urinary excretions of nitrogen and urea

BACKGROUND

Two consecutive trials were carried out to study the effects of dietary supplementation of rumen-protected methionine (RPM) on nutrient digestibility, nitrogen (N) metabolism (Trial 1), and consequently the nitrous oxide (N₂ O) emissions from urine in beef cattle (Trial 2). Eight 24-month-old castrated Simmental bulls with liveweights of 494 ± 28 kg, and four levels of dietary supplementation of RPM at 0, 10, 20, and 30 g head^-1 d^-1 , were allocated in a replicated 4 × 4 Latin square for Trial 1 and the N₂ O emissions from the urine samples collected in Trial 1 were measured using a static incubation technique in Trial 2.

RESULTS

Supplementation of RPM at 0, 10, 20, and 30 g head^-1 d^-1 to a basal ration deficient in methionine (Met) did not affect the apparent digestibility of dry matter, organic matter, neutral detergent fiber, or acid detergent fiber (P > 0.05), but decreased the urinary excretions of total N (P < 0.05) and urea (P < 0.001), increased the ratio of N retention / digested N (P < 0.05) in beef cattle, and decreased the estimated cattle urine N₂ O-N emissions by 19.5%, 23.4%, and 32.6%, respectively (P < 0.001).

CONCLUSION

Supplementation of RPM to Met-deficient rations was effective in improving the utilization rate of dietary N and decreasing the N₂ O emissions from urine in beef cattle. © 2019 Society of Chemical Industry.

Increasing roughage quality by using alfalfa hay as a substitute for concentrate mitigates CH4 emissions and urinary N and ammonia excretion from dry ewes

Twelve Hu sheep × thin-tail Han crossbred dry ewes with an average body weight of 32.6 ± 0.68 kg and an age of 3 years were arranged in a 3 × 3 Latin square design, with each experimental period of 24 d to evaluate the effect of substituting alfalfa hay in a portion of concentrate on nutrient intake, digestibility, N utilisation efficiency and methane emissions. The ratios of corn straw to alfalfa to concentrate for 3 diet treatments were 60:0:40, 60:15:25 and 60:30:10, respectively. Intake and digestibility were measured for each of the ewes, which were housed in individual metabolism crates for 6 d after an adaptation period of 14 d, and the feed was offered at 1.2 MEm to ensure approximately 10% orts. Methane emissions were determined in a respiration chamber for 2 consecutive d. An increase in the levels of alfalfa as a substitute for concentrate significantly increased the roughage, NSC and ADF intake and faecal N output as a proportion of N intake and manure N output. Furthermore, this increase in alfalfa input levels decreased DE, ME and N intake; nutrient digestibility; DE/GE, ME/GE and CH4 emissions per day; CH4 output expressed as a portion of the DM, OM and GE intake; and urinary N and ammonia N output, especially between extreme treatments. Alfalfa input levels had no effect on the BW, DM and GE intake; the EB or EB/GE intake; and the retained N. This study indicated that increasing alfalfa input as a substitute for concentrate could significantly decrease the digestibility, CH4 emissions and urinary N and NH4 + -N outputs; and shift the N excretion from urine to faeces; and could sustain a similar DM intake.

Daily systemic energy expenditure in the acute phase of aneurysmal subarachnoid hemorrhage

Background: Patients with subarachnoid hemorrhage often have impaired consciousness and cannot regulate nutritional intakes themselves. Previous studies have demonstrated elevated energy expenditure in the acute phase, but it is not known whether the energy demand is constant during the first week after onset of the disease. In this study, we performed daily measurements of energy expenditure with indirect calorimetry during the first 7 days after aneurysmal subarachnoid hemorrhage in mechanically ventilated patients.Methods: Metabolic measurements were performed daily with indirect calorimetry in 26 patients with aneurysmal subarachnoid hemorrhage. All patients were intubated and mechanically ventilated. The measured value was compared to the predicted values from the Harris-Benedict equation and the Penn State University 1998 equation. Urinary nitrogen excretion was measured daily.Results: There was a significant increase in energy expenditure during days 2-3 compared to days 5-6. The Harris-Benedict equation underestimated metabolic demand. The Penn State 1998 equation was closer to the measured values, but still underestimated caloric need. Urinary nitrogen excretion increased throughout the first week from initially low values.Conclusions: There is a dynamic course in energy expenditure in patients with aneurysmal subarachnoid hemorrhage, with increasing metabolic demand during the first week of the disease. Indirect calorimetry could be used more often to help provide an adequate amount of energy.

Increasing Enteral Protein Intake in Critically Ill Trauma and Surgical Patients

BACKGROUND

Published guidelines recommend providing at least 2 g/kg/d of protein for critically ill surgical patients. It may be difficult to achieve this level of intake using standard enteral formulas, thus necessitating protein or amino acid supplementation. Herein, we report our approach to enteral protein supplementation and its relationship with urinary nitrogen excretion and serum transthyretin concentrations.

METHODS

This was a retrospective cohort study in which we reviewed critically ill trauma and surgical patients treated with supplemental enteral protein according to a protocol aiming to deliver a total of 2 g/kg/d of protein. We collected detailed nutrition data over a 2-week period after admission and obtained additional data through discharge to determine caloric and protein intake as well as complications. We also compared urine nitrogen excretion and transthyretin concentrations between these patients and a control group who did not receive supplemental protein.

RESULTS

Fifty-three subjects received early protein supplementation. Formula and protein supplement each provided ≈1.2 g/kg/d of protein by intensive care unit day 4. This resulted in a median total protein intake of 2.2 g/kg/d through day 14. One patient developed acute kidney injury, and 1 patient had 3 episodes of vomiting. By the third week, serum transthyretin concentrations increased to a median of 21 mg/dL compared with 13 mg/dL in subjects not receiving early supplementation.

CONCLUSION

It is safe to deliver supplemental protein enterally to critically ill surgical and trauma patients and reach 2 g/kg/d of protein intake during the first week of illness.

Protein Intake Estimated from Brief-Type Self-Administered Diet History Questionnaire and Urinary Urea Nitrogen Level in Adolescents

Our aim was to assess the validity of the brief-type self-administered diet history questionnaire (BDHQ15y) to estimate the protein intake in 248 Japanese secondary school students (mean age = 14.2 years), using urinary biomarkers as references. Participants provided three samples of overnight urine for measurement of urea nitrogen and creatinine levels, underwent anthropometric measurements, and answered the questionnaires. Additionally, 58 students provided 24-h urine specimens. A significant correlation was observed between excretion of urea nitrogen in overnight and 24-h urine specimens (ρ = 0.527; p < 0.001), with biases ≤5.8%. The mean daily protein intake estimated from urinary biomarkers was 76.4 ± 20.4 g/d in males and 65.4 ± 16.9 g/d in females, and the mean protein intake estimated from the BDHQ15y (PRTbdhq) was 89.3 ± 33.7 g/d in males and 79.6 ± 24.6 g/d in females. Crude and energy-adjusted coefficients of correlation between PRTbdhq and protein intake estimated from urinary biomarkers were 0.205 (p = 0.001; 0.247 for males and 0.124 for females), and 0.204 (p = 0.001; 0.302 for males and 0.109 for females), respectively. The BDHQ15y is a low-cost tool to assess protein intake of a large population, instead of a weakness of overestimation.

Recovery of phosphorus and nitrogen from human urine by struvite precipitation, air stripping and acid scrubbing: A pilot study

Sustainable and closed-loop nutrient cycling require the recovery of valuable resources from wastewater. Resource recovery from diluted wastewater streams is limited by diluted concentrations and unfavorable reaction kinetics. In comparison, source separated urine allows resource recovery from a highly concentrated nutrient stream, resulting in a more sustainable and efficient recovery practice. Different nutrient recovery methods from urine have been studied in lab-scale, but pilot or full-scale process evaluations remain sparse. In this study, recovery of struvite and ammonium sulfate from urine of pregnant women was demonstrated at a pilot-scale treatment facility by means of precipitation and air stripping/acid scrubbing. The system achieved 94% struvite precipitation efficiency but merely 55% of the crystals were removed and recovered. The low phosphorus recovery was due to the washout of small crystals that escaped the sieve and settling tank, hence requiring an improved method for crystals capture. The removal and recovery efficiencies for nitrogen were 93% and 85%, respectively. Composition analysis of the produced fertilizers indicated that struvite was the dominated precipitate and quality of the ammonium sulfate met European standards. Carbamazepine and diclofenac were added in the urine to measure the fate of pharmaceuticals in the treatment system. Very little of the spiked pharmaceuticals (<0.01%) accumulated in the produced struvite and ammonium sulfate. The overall energy demand of the pilot system was 1066 MJ per m³ urine processed or 198 MJ per kg N removed. Energy efficiency was not optimized and can be improved in many ways.

Within-Day Amino Acid Intakes and Nitrogen Balance in Male Collegiate Swimmers during the General Preparation Phase

A higher protein intake is recommended for athletes compared to healthy non-exercising individuals. Additionally, the distribution and quality (i.e., leucine content) of the proteins consumed throughout the day should be optimized. This study aimed to determine the nitrogen balance and distribution of protein and amino acid intakes in competitive swimmers during the general preparation phase. Thirteen swimmers (age: 19.7 ± 1.0 years; VO₂max: 63.9 ± 3.7 mL·kg-1·min-1, mean ± standard deviation) participated in a five-day experimental training period. Nutrient intakes were assessed using dietary records. Nitrogen balance was calculated from the daily protein intake and urinary nitrogen excretion. The intake amounts of amino acids and protein at seven eating occasions were determined. The average and population-safe intakes for zero nitrogen balance were estimated at 1.43 and 1.92 g·kg-1·day-1, respectively. The intake amounts of protein and leucine at breakfast, lunch, and dinner satisfied current guidelines for the maximization of muscle protein synthesis, but not in the other four occasions. The population-safe protein intake level in competitive swimmers was in the upper range (i.e., 1.2⁻2.0 g·kg-1·day-1) of the current recommendations for athletes. The protein intake distribution and quality throughout the day may be suboptimal for the maximization of the skeletal muscle adaptive response to training.

Low-Protein Diets Decrease Porcine Nitrogen Excretion but with Restrictive Effects on Amino Acid Utilization

Reducing dietary crude protein (CP) intake effectively decreases nitrogen excretion in growing-finishing pigs but at the expense of poor growth when dietary CP content is reduced by ≥3%. In this study, we investigated the main disadvantages of low-protein diets supplemented with lysine, methionine, threonine, and tryptophan in pigs. First, changes in the nitrogen balance in response to differences in dietary CP content (18%, 15%, and 13.5%) were investigated in barrows (40 kg). Then, barrows (40 kg) surgically fitted with catheters in the mesenteric vein, portal vein, hepatic vein, and carotid artery were used to investigate changes in amino acid (AA) metabolism in the portal-drained viscera and liver in response to differences in dietary CP content. The results showed that low-protein diets reduced fecal and urinary nitrogen excretion ( P < 0.05) meanwhile resulted in significant decreases in nitrogen retention ( P < 0.05). Moreover, a reduction in the dietary CP content from 18% to 13.5% resulted in decreases in the net portal fluxes of NH₃, glycine, and alanine as well as in the urea production in the liver ( P < 0.05), whereas their values as a percentage of nitrogen intake did not decline ( P > 0.05). The net portal fluxes of nonessential AA (NEAA) were reduced in the low-protein diet groups ( P < 0.05), while essential AA consumption in the liver increased ( P < 0.05). Thus, low-protein diets result in reductions in both nitrogen excretion and retention, and NEAA deficiency may be a major disadvantage of low-protein diets.

Simultaneous phosphorous and nitrogen recovery from source-separated urine: A novel application for fertiliser drawn forward osmosis

Re-thinking our approach to dealing with waste is one of the major challenges in achieving a more sustainable society. However, it could also generate numerous opportunities. Specifically, in the context of wastewater, nutrients, energy and water could be mined from it. Because of its exceptionally high nitrogen (N) and phosphorous (P) concentration, human urine is particularly suitable to be processed for fertiliser production. In the present study, forward osmosis (FO) was employed to mine the P and N from human urine. Two Mg²⁺-fertilisers, i.e. MgSO₄ and Mg(NO₃)₂ were selected as draw solution (DS) to dewater synthetic non-hydrolysed urine. In this process, the Mg²⁺ reverse salt flux (RSF) were used to recover P as struvite. Simultaneously, the urea was recovered in the DS as it is poorly rejected by the FO membrane. The results showed that, after concentrating the urine by 60%, about 40% of the P and 50% of the N were recovered. XRD and SEM - EDX analysis confirmed that P was precipitated as mineral struvite. If successfully tested on real urine, this process could be applied to treat the urine collected in urban areas e.g., high-rise building. After the filtration, the solid struvite could be sold for inland applications whereas the diluted fertiliser used for direct fertigation of green walls, parks or for urban farming. Finally, reduction in the load of N, P to the downstream wastewater treatment plant would also ensure a more sustainable urban water cycle.

Uptake of pharmaceuticals by sorbent-amended struvite fertilisers recovered from human urine and their bioaccumulation in tomato fruit

Struvite precipitation is a well-documented method for recovering up to 98% of phosphorus from urine, which is one of the main nutrients in fertilizers besides nitrogen and potassium. Shortcomings of this process, however, are the low nitrogen recovery ratio and the possible uptake of pharmaceuticals from urine. In this work, the NH₄⁺ adsorbent materials biochar and zeolite are coupled with struvite precipitation to increase the N-recovery of struvite from 5.7% to 9.8%. Since nitrogen is one of the main nutrients in fertilisers, this increase is of significance for its potential commercial use. In addition, urine is spiked with pharmaceuticals to measure the consequential uptake in struvite-based fertilisers and crops afterwards. Five fertilisers are prepared by nutrient recovery from spiked urine using: (1) struvite crystallisation, (2) struvite crystallisation combined with N adsorption on zeolite, (3) struvite crystallisation combined with N adsorption on biochar, (4) N adsorption on zeolite without struvite crystallisation, and (5) N adsorption on biochar without struvite crystallisation. The fertiliser with the highest purity product and the lowest uptake of pharmaceuticals was struvite combined with zeolite. Next, the contaminated struvite-sorbent fertilisers are tested in a crop trial in which the bioaccumulation of pharmaceuticals in edible plant tissue (tomatoes) is measured. This bioaccumulation in tomato fruit biomass from each of the spiked fertilisers in the crop trial was found to be lower than 0.0003% in all cases, far below the acceptable daily intake (ADI) levels (750 kg of dry tomatoes should be consumed per day to reach the ADI limit). Consequently, the subsequent risk to human health from tomato fruit grown using urine derived struvite-sorbent fertilisers is found to be insignificant.

Effects of forage types on digestibility, methane emissions, and nitrogen utilization efficiency in two genotypes of hill ewes

Thirty-six nonpregnant hill ewes (18 pure Scottish Blackface and 18 Swaledale × Scottish Blackface) aged 18 mo and weighing 48 ± 4.8 kg were allocated to 3 forage treatments balanced for genotype and BW. Each genotype was offered 3 forages (pelleted ryegrass, fresh lowland grass, and fresh hill grass) ad libitum with 6 ewes for each of the 6 genotype × diet combination treatments. Pelleted ryegrass was sourced from a commercial supplier (Drygrass South Western Ltd, Burrington, UK). Fresh lowland grass was harvested daily in the morning from a third regrowth perennial ryegrass () sward. Fresh hill grass was harvested from a seminatural hill grassland every 2 d and stored in plastic bags at 4 to 5°C until offered. The animals were individually housed in pens and offered experimental diets for 14 d before being transferred to 6 individual respiration chambers for a further 4 d, during which feed intake, fecal and urine outputs, and CH emissions were measured. There was no interaction between genotype and forage types on any variable measured. In a comparison of effects of the 3 forages, pelleted ryegrass had the greatest ( < 0.001) values in DMI, GE intake, CH emissions, N intake (NI), and fecal N (FN), urine N (UN), and manure N (MN) outputs, whereas hill grass had the lowest ( < 0.001) values in DMI, energy (GE, DE, and ME) intake, CH emissions, NI, UN, and MN. However, pelleted ryegrass had the lowest ratio in CH emissions per unit DMI ( = 0.022) or GE intake ( = 0.026) or UN excretion as a proportion of NI or MN ( < 0.001). Lowland grass had a greater ( < 0.001) digestibility of DM, OM, CP, NDF, ADF, and GE and a greater ( < 0.001) ME:GE ratio or retained N:NI ratio than pelleted ryegrass and hill grass. Genotypes of sheep had no effect on any variable in feed intake, digestibility, CH emissions, or N utilization. The CH conversion factors (CH energy/GE) for pelleted ryegrass, lowland grass, and hill grass were 4.4, 5.7, and 5.6%, respectively. All data were then pooled to develop regression equations between CH and DMI or between N excretions (FN, UN, and MN) and NI. Methane emissions and N excretions were positively related to DMI and NI ( < 0.001), respectively. However, increasing DMI could reduce CH emissions per kilogram DMI. These equations add new information in predicting enteric CH emissions and N utilization efficiency and can be used to quantify the environmental footprint of hill sheep production systems.

Critical analysis of excessive utilization of crude protein in ruminants ration: impact on environmental ecosystem and opportunities of supplementation of limiting amino acids-a review

Protein quality plays a key role than quantity in growth, production, and reproduction of ruminants. Application of high concentration of dietary crude protein (CP) did not balance the proportion of these limiting amino acids (AA) at duodenal digesta of high producing dairy cow. Thus, dietary supplementation of rumen-protected AA is recommended to sustain the physiological, productive, and reproductive performance of ruminants. Poor metabolism of high CP diets in rumen excretes excessive nitrogen (N) through urine and feces in the environment. This excretion is usually in the form of nitrous oxide, nitric oxide, nitrate, and ammonia. In addition to producing gases like methane, hydrogen carbon dioxide pollutes and has a potentially negative impact on air, soil, and water quality. Data specify that supplementation of top-limiting AA methionine and lysine (Met + Lys) in ruminants' ration is one of the best approaches to enhance the utilization of feed protein and alleviate negative biohazards of CP in ruminants' ration. In conclusion, many in vivo and in vitro studies were reviewed and reported that low dietary CP with supplemental rumen-protected AA (Met + Lys) showed a good ability to reduce N losses or NH₃. Also, it helps in declining gases emission and decreasing soil or water contamination without negative impacts on animal performance. Finally, further studies are needed on genetic and molecular basis to explain the impact of Met + Lys supplementation on co-occurrence patterns of microbiome of rumen which shine new light on bacteria, methanogen, and protozoal interaction in ruminants.

Increasing alkali supplementation decreases urinary nitrogen excretion when adjusted for same day nitrogen intake

We examined whether escalating doses of potassium bicarbonate (KHCO₃) supplements alter urinary nitrogen excretion expressed as a ratio to same day nitrogen intake (measure of muscle-protein breakdown). The ratio declined significantly from placebo to low to high dose of KHCO₃ supplementation in older adults over 3 months, suggesting muscle-sparing.

INTRODUCTION

Neutralization of dietary acid load with alkali supplementation (i.e., KHCO₃) has been hypothesized to have muscle protein-sparing effects. In controlled feeding studies with fixed nitrogen (N) intake/day, 24-h urinary N excretion is a good marker of muscle breakdown. However, in studies with self-selected diets, changes in 24-h urinary N excretion can be influenced by shifts in N intake.

METHODS

We evaluated changes in 24-h total urinary N excretion as a ratio of N excretion to concurrent N intake in 233 older men and women who participated in an 84-day KHCO₃ supplementation randomized placebo-controlled trial.

RESULTS

After adjustment for relevant cofactors, escalating doses of KHCO₃ (1 mmol/kg/day [low] or 1.5 mmol/kg/day [high]) resulted in a progressive decline in urinary N excretion/N intake compared to placebo (overall P for trend = 0.042). The 84-day change in urinary N excretion/N intake in the high-dose KHCO₃ group was statistically significantly lower compared to placebo (P = 0.012) but not compared to the low-dose KHCO₃ group (P = 0.276). The 84-day change in urinary N excretion/N intake in the low-dose KHCO₃ group did not differ significantly from placebo (P = 0.145).

CONCLUSIONS

Urinary N excretion expressed as ratio to same day N intake declined steadily with increasing doses of KHCO₃ supplementation from low 1 mmol/kg/day to high 1.5 mmol/kg/day, suggesting a nitrogen-sparing effect. Compared to urinary N excretion alone, this ratio could be a more reasonable measure of muscle protein metabolism in large-scale long-term human studies.

TRIAL REGISTRATION

Clinicaltrials.gov NCT1475214.

Comparison of Urine Urea Nitrogen Collection Times in Critically Ill Patients

Twenty-four-hour urine urea nitrogen (UUN) collections are used to assess nitrogen loss in critically ill patients but are often difficult to obtain accurately. This prospective study compared 6- and 12-hour UUN collections with 24-hour UUN collections in critically ill patients receiving continuous nutrition support. ICU patients admitted from September 1999 through January 2003 who had UUN collections as part of routine care were recruited into the study. Patients were not receiving oral diets, were receiving continuous parenteral or enteral nutrition, and had indwelling urinary catheters. We excluded patients with hepatic or renal failure. Urine samples were collected every 6 hours starting at 6:00 am and kept refrigerated until the 24-hour collection was complete. Samples were analyzed using an automated urease enzymatic reaction. Samples were multiplied by a factor of 4 (6-hour samples) or 2 (12-hour samples) to estimate 24-hour totals and then compared with actual 24-hour totals. Twenty-four patients (18 men) completed the study; 21 patients had 6-hour samples (84 samples), and 24 patients had 12-hour samples (24 samples). Estimated 24-hour UUN from 6-hour (14.7-15.7 g/d) and 12-hour (15.2 g/d) samples did not differ significantly (p > .5) from actual 24-hour totals (15.1 g/d). Shortened UUN collection times may be used to estimate 24-hour nitrogen losses in critically ill patients receiving continuous nutrition support.

Evaluation of an Artificial Neural Network to Predict Urea Nitrogen Appearance for Critically Ill Multiple-Trauma Patients

BACKGROUND

Computer-based simulated biologic neural network models have made significant strides in clinical medicine.

METHODS

To determine the predictive performance of a conventional regression model and an artificial neural network for estimating urea nitrogen appearance (UNA) during critical illness, 125 adult patients admitted to the trauma intensive care unit who required specialized nutrition support were studied. The first 100 consecutive patients were used to develop the 2 models. The first model used stepwise multivariate regression analysis. The second model entailed the use of a feeding-forward, back-propagation, supervised neural network. Bias and precision of both methods were evaluated in 25 separate patients.

RESULTS

Multivariate regression analysis revealed a significant highly correlative relationship (r(2) = .918, p < or = .01): Predicted UNA (g/d) = (0.29 x WT) + (1.20 x WBC) + (0.44 x SUN) with WT as current body weight in kg, WBC as white blood cell count in cells/mm(3), and SUN as serum urea nitrogen concentration (mg/dL). The regression method was biased toward overestimating measured UNA, whereas the neural network was unbiased. Precision (95% confidence interval) of the neural network was significantly better than the regression (3.3-7.2 g vs 7.3-11.6 g, respectively, p < .01). Regression analysis successfully predicted UNA within 3 g of measured UNA in 16% (4 of 25) of patients, whereas the neural network successfully predicted UNA in 44% (11 out of 25) of patients (p < .06).

CONCLUSIONS

These preliminary data indicate that use of an artificial neural network may be superior to conventional regression modeling techniques for estimating UNA in critically ill adult multiple-trauma patients receiving specialized nutrition support.

N-Acetylcysteine is a Highly Available Precursor for Cysteine in the Neonatal Piglet Receiving Parenteral Nutrition

BACKGROUND

Cysteine (CYS) is accepted as an indispensable amino acid for infants receiving parenteral nutrition (PN), and CYS is unstable in solution. Thus, developing a method to supply CYS in PN for neonates is needed. N-acetyl-L-cysteine (NAC) is stable in solution and safe for use in humans; therefore, NAC may be a means of supplying parenteral CYS.

METHODS

We determined the bioavailability of NAC in intravenously (IV)-fed piglets randomized to 1 of 4 diet treatments, each supplying 0.3 g/kg/d methionine and either 0.2 g/kg/d CYS (CON), 0 NAC (zeroNAC), 0.13 NAC (lowNAC), or 0.27 g/kg/d NAC (highNAC). Piglets (2 days old; 1.8 kg, n = 20) were surgically implanted with femoral and jugular catheters. On day 3 postsurgery, test diets were initiated and continued until day 8. Piglets were weighed daily. Blood was sampled 6 hours before test diet initiation and at 0, 6, 12, 18, 24, 36, 48, 60, 72, 84, 96, 108, and 120 hours. Urine was collected on ice in 24-hour sample periods.

RESULTS

Total mean weight gain was not different between groups; however, average daily gain in the zeroNAC and lowNAC groups declined significantly (p < .05) over the 5-day treatment period. Nitrogen retention was similar between the CON and highNAC groups, both were higher than the lowNAC group, and the zeroNAC treatment produced the lowest nitrogen retention. NAC percent retention was not different between lowNAC and highNAC and was 85.4% and 82.6%, respectively. Plasma NAC was higher in highNAC than lowNAC (p < .05).

CONCLUSIONS

These data demonstrate that NAC is available as a precursor for CYS to support growth and protein (nitrogen) accretion in piglets administered a parenteral solution.

Glycemia Influences on Glucose Metabolism in Sepsis During Hyperinsulinemic Clamp

BACKGROUND

We investigated glucose metabolism in septic patients during hyperglycemic clamps and compared the different levels of insulinemia and glycemia.

METHODS

In 10 non-diabetic stable septic patients on mechanical ventilation with baseline glycemia >6 mmol/L and continuous insulin infusion, 3 steps of hyperinsulinemic clamp were performed after 8 hours without caloric intake. In step 1, the targets were insulinemia of 250 mIU/L and glycemia of 5 mmol/L; in step 2, insulinemia of 250 mIU/L and glycemia of 10 mmol/L; in step 3, insulinemia of 1250 mIU/L and glycemia of 5 mmol/L. Glucose uptake was calculated as the amount of glucose per time needed to maintain the target level of glycemia. Glucose oxidation was calculated from indirect calorimetry and urinary nitrogen losses. Values are provided as means +/- SD. A two-way analysis of variance and Scheffe's method were used for statistical analysis and p < .05 was considered significant.

RESULTS

At step 1, glucose uptake was lower than at step 2 (3.8 +/- 2.48 mg/kg/min and 7.9 +/- 3.45 mg/kg/min, respectively; p < .001). Glucose oxidation was also lower at step 1 (2.6 +/- 0.98 and 4.2 +/- 1.85 mg/kg/min, respectively; p < .01). Glucose storage was low at step 1 (0.7 +/- 1.39) and increased at step 2 (3.5 +/- 2.18; p < .05). In step 3, glucose uptake was 7.0 +/- 2.1, oxidation was 3.6 +/- 1.37, and storage was 2.9 +/- 2.79. There was no significant difference in all these parameters between steps 2 and 3. Energy expenditure between steps 1, 2 and 3 did not change (2294 + 307.42, 2334 + 341.53, and 2342 + 426.67 kcal/day, respectively). Alanine in plasma dropped significantly (p < .05): 10 mmol/L (311 +/- 55.88 mmol/L) at glycemia compared with 5 mmol/L (390 +/- 76 micromol/L) at insulinemia 250 mIU/L. It did not differ significantly from the values obtained at glycemia 5 mmol/L and insulinemia 1250 mIU/L (348 +/- 70.68 mmol/L). Even if the level of cytokines in sepsis was higher, there was no correlation between the insulin level in plasma (250 and 1250 mIU/L), glycemia (5 and 10 mmol/L) and cytokine level (IL-1beta, IL-2, IL-6, IL-8 and TNFalpha).

CONCLUSION

At insulinemia 250 mIU/L, a glucose level of 10 mmol/L seems to increase glucose uptake, oxidation, and storage compared with glycemia 5 mmol/L. This glucose uptake and oxidation at glycemia 10 mmol/L is comparable with the effect of extremely high insulinemia (1250 mIU/L) clamped at glycemia 5 mmol/L. A higher level of blood glucose or a high level of insulinemia significantly increases glucose uptake but not energy expenditure.

Estimation of Benchmark Dose of Lifetime Cadmium Intake for Adverse Renal Effects Using Hybrid Approach in Inhabitants of an Environmentally Exposed River Basin in Japan

The aim of this study is to estimate the reference level of lifetime cadmium intake (LCd) as the benchmark doses (BMDs) and their 95% lower confidence limits (BMDLs) for various renal effects by applying a hybrid approach. The participants comprised 3,013 (1,362 men and 1,651 women) and 278 (129 men and 149 women) inhabitants of the Cd-polluted and nonpolluted areas, respectively, in the environmentally exposed Kakehashi River basin. Glucose, protein, aminonitrogen, metallothionein, and β₂ -microglobulin in urine were measured as indicators of renal dysfunction. The BMD and BMDL that corresponded to an additional risk of 5% were calculated with background risk at zero exposure set at 5%. The obtained BMDLs of LCd were 3.7 g (glucose), 3.2 g (protein), 3.7 g (aminonitrogen), 1.7 g (metallothionein), and 1.8 g (β₂ -microglobulin) in men and 2.9 g (glucose), 2.5 g (protein), 2.0 g (aminonitrogen), 1.6 g (metallothionein), and 1.3 g (β₂ -microglobulin) in women. The lowest BMDL was 1.7 g (metallothionein) and 1.3 g (β₂ -microglobulin) in men and women, respectively. The lowest BMDL of LCd (1.3 g) was somewhat lower than the representative threshold LCd (2.0 g) calculated in the previous studies. The obtained BMDLs may contribute to further discussion on the health risk assessment of cadmium exposure.

Screening for diets that reduce urinary nitrogen excretion and methane emissions while maintaining or increasing production by dairy cows

Farmers face complex decisions at the time to feed animals, trying to achieve production goals while contemplating social and environmental constraints. Our purpose was to facilitate such decision making for pastoral dairy farmers, aiming to reduce urinary N (UN) and methane emissions (CH4), while maintaining or increasing milk production (MP). There is a number of feeds the farmers can choose from and combine. We used 50 feeds (forages and grains) combined systematically in different proportions producing 11,526 binary diets. Diets were screened, using an a posteriori approach and a Pareto front (PF) analysis of model (Molly) outputs. The objective was to identify combinations with the best possible compromise (i.e. frontier) between UN, CH4, and MP. Using high MP and low UN as objective functions, PF included 10, 14, 12 and 50 diets, for non-lactating, early-, mid- and late-lactation periods, with cereals and beets featuring strongly. Using the same objective functions, but including ryegrass as dietary base PF included 2, 4, 8 and 4 diets for those periods. Therefore, from a wide range of diets, farmers could choose from few feeds combined into binary diets to reduce UN while maintaining or increasing MP. If the intention is maintaining pasture-based systems, there are fewer suitable options. Reducing UN will simply require dilution of N supplied by pasture by supplementing low N conserved forages. The results also evidence the risk of pollution swapping, reaching the frontier means arriving at a point where trade-off decisions need to be made. Any further reduction in UN implies an increment in CH4, or reduction in CH4 emissions increases UN. There is no perfect diet to optimize all objectives simultaneously; but if the current diet is not in the frontier some options can offset pollution swapping. The choice is with the farmers and conditioned by their context.

Salt as a mitigation option for decreasing nitrogen leaching losses from grazed pastures

BACKGROUND

The main source of nitrogen (N) leaching from grazed pastures is animal urine with a high N deposition rate (i.e. per urine patch), particularly between late summer and early winter. Salt is a potential mitigation option as a diuretic to induce greater drinking-water intake, increase urination frequency, decrease urine N concentration and urine N deposition rate, and thereby potentially decrease N leaching. This hypothesis was tested in three phases: a cattle metabolism stall study to examine effects of salt supplementation rate on water consumption, urination frequency and urine N concentration; a grazing trial to assess effects of salt (150 g per heifer per day) on urination frequency; and a lysimeter study on effects of urine N rate on N leaching.

RESULTS

Salt supplementation increased cattle water intake. Urination frequency increased by up to 69%, with a similar decrease in urine N deposition rate and no change in individual urination volume. Under field grazing, sensors showed increased urination frequency by 17%. Lysimeter studies showed a proportionally greater decrease in N leaching with decreased urine N rate. Modelling revealed that this could decrease per-hectare N leaching by 10-22%.

CONCLUSIONS

Salt supplementation increases cattle water intake and urination frequency, resulting in a lower urine N deposition rate and proportionally greater decrease in urine N leaching. Strategic salt supplementation in autumn/early winter with feed is a practical mitigation option to decrease N leaching in grazed pastures.

Dietary fibre-rich resistant starches promote ammonia detoxification in the human colon as measured by lactose-[¹⁵N₂]ureide

Three resistant starches (RSs), namely fibre of potatoes (FP), wrinkle pea starch (WPS), and high amylose maize starch (HAMS) with different dietary fibre contents, were supplemented in adults to evaluate their effects on urinary nitrogen and ammonia excretion as well as on faecal nitrogen excretion by means of lactose-[(15)N2]ureide ((15)N-LU) degradation. Twenty subjects received a regular diet either without or with the supplementation of FP, WPS, and HAMS in a randomized order. After administration of (15)N-LU, urine and faeces were collected over 48 and 72 h, respectively, whereas blood was collected after 6 h. The (15)N-abundances were measured by isotope ratio mass spectrometry. In comparison to the dry run, supplementation with RS significantly lowered renal (15)N-excretion (dry run: 43.2%, FP: 34.6%, WPS: 37.9%, HAMS: 36.4%) as well as the corresponding (15)NH3-excretion (dry run: 0.08%, FP: 0.06%, HAMS: 0.05%), clearly indicating a reduced colonic nitrogen generation at high dietary fibre intake.

Extruded soybean meal increased feed intake and milk production in dairy cows

The objective of this study was to assess the effects of 2 extruded soybean meals (ESBM) processed at 2 extruder temperatures, 149°C (LTM) and 171°C (HTM), on performance, nutrient digestibility, milk fatty acid and plasma amino acid profiles, and rumen fermentation in lactating dairy cows. Nine multiparous Holstein cows were included in a replicated 3×3 Latin square design experiment with three 28-d periods. The control diet contained 13% solvent-extracted soybean meal (SSBM; 53.5% crude protein with 74.1% ruminal degradability and 1.8% fat), which was replaced with equivalent amount (dry matter basis) of LTM (46.8%, 59.8%, and 10.0%) or HTM (46.9%, 41.1%, and 10.9%, respectively) ESBM in the 2 experimental diets (LTM and HTM, respectively). The diets met or exceeded the nutrient requirements of the cows for net energy of lactation and metabolizable protein. The 2 ESBM diets increased dry matter intake and milk yield compared with SSBM. Feed efficiency and milk composition were not affected by treatment. Milk protein yield tended to be increased by ESBM compared with SSBM. Milk urea N and urinary urea N excretions were increased by the ESBM diets compared with SSBM. Concentration of fatty acids with chain length of up to C17 and total saturated fatty acids in milk fat were generally decreased and that of C18 and total mono- and polyunsaturated fatty acids was increased by the ESBM diets compared with SSBM. Blood plasma concentrations of His, Leu, and Val were increased by HTM compared with LTM and SSBM. Plasma concentration of Met was decreased, whereas that of carnosine was increased by the ESBM diets. Treatments had no effect on rumen fermentation, but the proportion of Fibrobacter spp. in whole ruminal contents was increased by HTM compared with SSBM and LTM. Overall, data from this crossover experiment suggest that substituting SSBM with ESBM in the diet has a positive effect on feed intake and milk yield in dairy cows.

Irbesartan can improve blood lipid and the kidney function of diabetic nephropathy

AIM

Diabetic nephropathy (DN) is the most frequent cause of end-stage renal disease. The activation of the renin-angiotensin system (RAS) and lipid disorders are major risk factors in progressive chronic kidney disease. Inhibition of the RAS is one of the most widely used therapies to treat chronic kidney disease. But its effect is not sufficient, and lowered hyperlipidemia is required. Most of medications for hypertension have effects only on the blood pressure in DN. This study is to evaluate the influence of irbesartan on blood lipid, kidney function, and the pathological change of kidney, liver, and adipose tissue.

METHODS

Six-week old db/db mice were randomly assigned to control group and irbesartan group. Mice in irbesartan group were fed 40 mg/kg irbesartan each day. Eight weeks later, blood lipid, kidney function, and the pathological change of kidney, liver, and adipose tissue were measured.

RESULTS

The results indicated that the blood lipid, uric acid, urea nitrogen, and creatinine of db/db mice increased significantly. There are obvious vacuolar degeneration and ballooned hepatocytes around the central vein of db/db mouse liver. Kidney biopsy found glomerular hypertrophy of glomerular, mesangial thickening, and vacuolar degeneration. Irbesartan can decrease the blood pressure, blood lipid, and kidney lipid. But it has no effects on blood glucose and liver lipid. It can improve the function and pathological change of kidney of db/db mice. But it has no effects on pathological change of adipose tissue and liver.

CONCLUSIONS

Irbesartan can decrease blood lipid and protect the kidney of db/db mice, and is a good choice of treatment for diabetic nephropathy.

Applying Recovery Biomarkers to Calibrate Self-Report Measures of Energy and Protein in the Hispanic Community Health Study/Study of Latinos

We investigated measurement error in the self-reported diets of US Hispanics/Latinos, who are prone to obesity and related comorbidities, by background (Central American, Cuban, Dominican, Mexican, Puerto Rican, and South American) in 2010–2012. In 477 participants aged 18–74 years, doubly labeled water and urinary nitrogen were used as objective recovery biomarkers of energy and protein intakes. Self-report was captured from two 24-hour dietary recalls. All measures were repeated in a subsample of 98 individuals. We examined the bias of dietary recalls and their associations with participant characteristics using generalized estimating equations. Energy intake was underestimated by 25.3% (men, 21.8%; women, 27.3%), and protein intake was underestimated by 18.5% (men, 14.7%; women, 20.7%). Protein density was overestimated by 10.7% (men, 11.3%; women, 10.1%). Higher body mass index and Hispanic/Latino background were associated with underestimation of energy (P < 0.05). For protein intake, higher body mass index, older age, nonsmoking, Spanish speaking, and Hispanic/Latino background were associated with underestimation (P < 0.05). Systematic underreporting of energy and protein intakes and overreporting of protein density were found to vary significantly by Hispanic/Latino background. We developed calibration equations that correct for subject-specific error in reporting that can be used to reduce bias in diet-disease association studies.

Pharmacological PPARα activation markedly alters plasma turnover of the amino acids glycine, serine and arginine in the rat

The current study extends previously reported PPARα agonist WY 14,643 (30 µmol/kg/day for 4 weeks) effects on circulating amino acid concentrations in rats fed a 48% saturated fat diet. Steady-state tracer experiments were used to examine in vivo kinetic mechanisms underlying altered plasma serine, glycine and arginine levels. Urinary urea and creatinine excretion were measured to assess whole-body amino acid catabolism. WY 14,643 treated animals demonstrated reduced efficiency to convert food consumed to body weight gain while liver weight was increased compared to controls. WY 14,643 raised total amino acid concentration (38%), largely explained by glycine, serine and threonine increases. 3H-glycine, 14C-serine and 14C-arginine tracer studies revealed elevated rates of appearance (Ra) for glycine (45.5 ± 5.8 versus 17.4 ± 2.7 µmol/kg/min) and serine (21.0 ± 1.4 versus 12.0 ± 1.0) in WY 14,643 versus control. Arginine was substantially decreased (-62%) in plasma with estimated Ra reduced from 3.1 ± 0.3 to 1.2 ± 0.2 µmol/kg/min in control versus WY 14,643. Nitrogen excretion over 24 hours was unaltered. Hepatic arginase activity was substantially decreased by WY 14,643 treatment. In conclusion, PPARα agonism potently alters metabolism of several specific amino acids in the rat. The changes in circulating levels of serine, glycine and arginine reflected altered fluxes into the plasma rather than changes in clearance or catabolism. This suggests that PPARα has an important role in modulating serine, glycine and arginine de novo synthesis.

[Replacing of residue from production of palm Palm Royal Australian (Archontophoenix alexan- drae) in silage of sugar cane in diets of sheep]

The aim of this study was to evaluate the chemical composition, voluntary intake and apparent digestibility of the diets containing residue from palm heart of Australian Royal Palm (Archontophoenix alexandrae) to replace sugar cane on sheep. Twelve sheep were used with average live weight of 23.3 ± 2.8 Kg and they placed in metabolism cages and distributed in six latin square 2 x 2 in a factorial design 3 x 2 (three types of residue--sheet, bark and composed--and two levels of residue's replacement, 5% and 15%). It was observed higher intake of dry matter (DM), organic matter (OM), nonfiber carbohydrates (NFC) by substitution of composed residue. The average values of apparent digestibility of DM, OM, crude protein (CP), neutral detergent fibre correct for ash and protein (NDFap) and total digestible nutrients (TDN) were higher for sheet residue. There was interaction between type of residue and level of residue's replacement on the urinary excretion of total nitrogen (NUE), apparent nitrogen balance (BNA) and microbial nitrogen compost (NMIC). Residues from palm heart of Australian Royal Palm can be used as roughage in the ruminants'diet, and of these residues, the sheet and composed residue showed better response in the evaluated characteristics.

[Effect of electroacupuncture intervention on renal function and expression of renal beta-catenin in rats with chronic renal failure]

OBJECTIVE

To observe the effect of electroacupuncture (EA) intervention on renal function and expression of renal beta-catenin in rats with chronic renal failure (CRF), so as to reveal its mechanism underlying improvement of CRF.

METHODS

Male SD rats were randomly divided into normal, model and EA groups, with 10 rats in each group. CRF model was induced by feeding the rats with 0.5% Adenine(100 mg/d, in forage) for 21 days. EA (1-3 mA, 1.5-2 Hz) was applied to bilateral "San-yinjiao" (SP 6), "Taixi" (KI 3) and "Shenshu" (BL 23) for 20 min, once daily for 30 days. Serum creatinine (Scr) and blood urine nitrogen (BUN) contents were assayed by enzymatic method and deoxy enzymatic method, respectively, and the expression of p-catenin protein in the renal tissue was determined by Western blot.

RESULTS

Following modeling, serum Scr and BUN contents and renal p-catenin protein expression level were significantly increased in the model group in comparison with those of the normal group (P<0.05). After EA intervention, serum Scr and BUN contents and the expression of beta-catenin in the renal tissue were all significantly decreased in the EA group compared to the model group (P<0.05). In addition, the animals' body weight values of both model and EA groups were apparently lower than those of the normal group before EA treatment (P<0.05). After EA intervention, the body weight values of the EA group were markedly higher than those of the model group in spite of being still lower than normal rats (P<0.05).

CONCLUSION

EA can effectively suppress CRF-induced increase of serum Scr and BUN contents and renal beta-catenin protein expression in CRF rats, suggesting an improvement of the renal function after EA intervention by reducing the expression of beta-catenin in the renal tissue.

Reproducibility and validity of a quantitative FFQ designed for patients with type 2 diabetes mellitus from southern Brazil

OBJECTIVE

To evaluate the reproducibility and validity of a previously constructed FFQ to assess the usual diet of patients with type 2 diabetes mellitus (T2DM).

DESIGN

Cross-sectional survey using two quantitative FFQ (1-month interval) supported by a food photograph portfolio, a 3 d weighed diet record (WDR) and urinary N output measurement (as a biomarker of protein intake).

SETTING

Group of Nutrition in Endocrinology, southern Brazil.

SUBJECTS

Out-patients with T2DM.

RESULTS

From a total of 104 eligible T2DM patients, eighty-eight were included in the evaluation of FFQ reproducibility and seventy-two provided data for the validity study. The intakes estimated from the two FFQ did not differ (P > 0·05) and the correlation coefficients were significant (P < 0·01) for energy and nutrients, ranging from 0·451 (soluble fibre) to 0·936 (PUFA). Regarding the validity evaluation, data from the FFQ were higher than those from the WDR for total (28·3%), soluble (27·4%) and insoluble fibres (29·1%), and SFA (13·5%), MUFA (11·1 %) and total lipids (9·2%; all P < 0·05). There were significant correlation coefficients between the FFQ and WDR for most nutrients, when adjusted for energy intake and de-attenuated. Also, the Bland-Altman plots between the FFQ and WDR for energy and macronutrient intakes showed that the FFQ may be used as alternative method to the WDR. The validity coefficient (using the method of triads) for the FFQ protein intake was 0·522 (95% CI 0·414, 0·597).

CONCLUSIONS

This quantitative FFQ was valid and precise to assess the usual diet of patients with T2DM, according to its validity and reproducibility.

Effects of different dietary manganese levels on growth performance and N balance of growing mink (Neovision vision)

Two experiments were conducted to study the effects of dietary manganese levels on growth performance, nutrients digestibility, and N balance of minks during growing period. In experiment 1, 75 healthy male minks (60 days old) were selected and randomly divided into five groups with different types of diet. The diet was supplemented with 0 (control), 50, 100, 300, and 600 ppm of manganese as MnSO4 of dry matter (DM) in basic diet, respectively. From early July to middle September, the results showed that the final body weights of minks were significantly affected by diets (P < 0.05). Average daily gains (ADG) were significantly higher in the 300-ppm manganese group than those in other groups. The ratio of feed to body weight gain (F/G) was significantly affected by manganese level (P < 0.05). In experiment 2, 45 male minks (75 days old) with the same body weight were selected from each group of experiment 1 to carry out the nutrient digestion and N-balance tests which lasted for 4 days for the collection of the feces and urine, and the diets and treatment codes were same as in experiment 1. The results showed that no significant differences were found in DM, crude protein (CP), and crude carbohydrate (CC) digestibility among all groups (P > 0.05), but ether extract (EE) and gross energy (GE) digestibility were all the highest in the 300-ppm group. N intake and fecal N were similar among all groups (P > 0.05). Urinary N was lower in the 300-ppm group; in contrast, N retention was higher in this group (P < 0.05). In conclusion of experiment 1 and experiment 2, the diet supplemented with 300 ppm of manganese (as manganese sulfate) could improve the growth performance and increase the EE and GE digestibility of mink during the growing period and moreover reduce the nitrogen emissions to the environment, and the optimal total manganese level in mink's diet was 409.16 in DM during the growing period.

Pooled results from 5 validation studies of dietary self-report instruments using recovery biomarkers for energy and protein intake

We pooled data from 5 large validation studies of dietary self-report instruments that used recovery biomarkers as references to clarify the measurement properties of food frequency questionnaires (FFQs) and 24-hour recalls. The studies were conducted in widely differing US adult populations from 1999 to 2009. We report on total energy, protein, and protein density intakes. Results were similar across sexes, but there was heterogeneity across studies. Using a FFQ, the average correlation coefficients for reported versus true intakes for energy, protein, and protein density were 0.21, 0.29, and 0.41, respectively. Using a single 24-hour recall, the coefficients were 0.26, 0.40, and 0.36, respectively, for the same nutrients and rose to 0.31, 0.49, and 0.46 when three 24-hour recalls were averaged. The average rate of under-reporting of energy intake was 28% with a FFQ and 15% with a single 24-hour recall, but the percentages were lower for protein. Personal characteristics related to under-reporting were body mass index, educational level, and age. Calibration equations for true intake that included personal characteristics provided improved prediction. This project establishes that FFQs have stronger correlations with truth for protein density than for absolute protein intake, that the use of multiple 24-hour recalls substantially increases the correlations when compared with a single 24-hour recall, and that body mass index strongly predicts under-reporting of energy and protein intakes.

Urea recycling contributes to nitrogen retention in calves fed milk replacer and low-protein solid feed

Urea recycling, with urea originating from catabolism of amino acids and hepatic detoxification of ammonia, is particularly relevant for ruminant animals, in which microbial protein contributes substantially to the metabolizable protein supply. However, the quantitative contribution of urea recycling to protein anabolism in calves during the transition from preruminants (milk-fed calves) to ruminants [solid feed (SF)-fed calves] is unknown. The aim of this study was to quantify urea recycling in milk-fed calves when provided with low-protein SF. Forty-eight calves [164 ± 1.6 kg body weight (BW)] were assigned to 1 of 4 SF levels [0, 9, 18, and 27 g of dry matter (DM) SF · kg BW(-0.75) · d⁻¹] provided in addition to an identical amount of milk replacer. Urea recycling was quantified after a 24-h intravenous infusion of [¹⁵N₂]urea by analyzing urea isotopomers in 68-h fecal and urinary collections. Real-time qPCR was used to measure gene expression levels of bovine urea transporter B (bUTB) and aquaglyceroporin-3 and aquaglyceroporin-7 in rumen wall tissues. For every incremental gram of DM SF intake (g DM · kg(0.75)), nitrogen intake increased by 0.70 g, and nitrogen retention increased by 0.55 g (P < 0.01). Of this increase in nitrogen retention, 19% could be directly explained by urea recycling. Additionally, part of the observed increase in nitrogen retention could be explained by the extra protein provided by the SF and likely by a greater efficiency of postabsorptive use of nitrogen for gain. Ruminal bUTB abundance increased (P < 0.01) with SF provision. Aquaglyceroporin-3 expression increased (P < 0.01) with SF intake, but aquaglyceroporin-7 expression did not. We conclude that in addition to the increase in digested nitrogen, urea recycling contributes to the observed increase in nitrogen retention with increasing SF intake in milk-fed calves. Furthermore, ruminal bUTB and aquaglyceroporin-3 expression are upregulated with SF intake, which might be associated with urea recycling.

Safety and efficacy of early parenteral lipid and high-dose amino acid administration to very low birth weight infants

OBJECTIVE

To assess the efficacy and safety of early parenteral lipid and high-dose amino acid (AA) administration from birth onwards in very low birth weight (VLBW, birth weight <1500 g) infants.

STUDY DESIGN

VLBW infants (n = 144; birth weight 862 ± 218 g; gestational age 27.4 ± 2.2 weeks) were randomized to receive 2.4 g of AA kg(-1) · d(-1) (control group), or 2.4 g AA kg(-1) · d(-1) plus 2-3 g lipids kg(-1) · d(-1) (AA + lipid group), or 3.6 g AA kg(-1) · d(-1) plus 2-3 g lipids kg(-1) · d(-1) (high AA + lipid group) from birth onwards. The primary outcome was nitrogen balance. The secondary outcomes were biochemical variables, urea rate of appearance, growth rates, and clinical outcome.

RESULTS

The nitrogen balance on day 2 was significantly greater in both intervention groups compared with the control group. Greater amounts of AA administration did not further improve nitrogen balance compared with standard AA dose plus lipids and was associated with high plasma urea concentrations and high rates of urea appearance. No differences in other biochemical variables, growth, or clinical outcomes were observed.

CONCLUSIONS

In VLBW infants, the administration of parenteral AA combined with lipids from birth onwards improved conditions for anabolism and growth, as shown by improved nitrogen balance. Greater levels of AA administration did not further improve the nitrogen balance but led to increased AA oxidation. Early lipid initiation and high-dose AA were well tolerated.

Under-reporting of energy intake in elderly Australian women is associated with a higher body mass index

OBJECTIVES

Identify the extent of under-reporting of energy intake and the characteristics associated with implausible intakes in elderly women.

DESIGN

Dietary intake was assessed using a 3-day weighed food record. Protein intake was validated by 24-hour urinary nitrogen. To examine under-reporting, participants were grouped according to their energy intake and compared to the Goldberg cut-off equation. Logistic regression was performed to assess the influence of body mass index (BMI) and social-demographic factors on under-reporting.

SETTING

Community dwelling elderly women from Perth, Western Australia.

PARTICIPANTS

217 elderly women aged 70-80 years.

RESULTS

Under-reporters had a higher physical activity level (p<0.001) compared with acceptable-reporters. The under-reporters also had a higher body weight (p=0.006), body mass index (BMI) (p=0.001), waist (p=0.011), hip circumference (p<0.001), whole body fat mass (p<0.001) and percentage body fat (p<0.001) than acceptable-reporters. Under-reporters had a significantly lower intakes of protein, fat, carbohydrate and alcohol (p<0.001) and fewer reported food items, compared with acceptable reporters. However, 24-hour urinary nitrogen was only marginally different between the two groups (p=0.053). Participants with a higher BMI were more likely to under-report their energy intake (BMI=25-29.9: odds ratio=2.98[95% CI=1.46-6.09]; BMI≥30: 5.84[2.41-14.14]).

CONCLUSION

Under-reporting energy intake in elderly women was associated with a higher BMI, body fat and higher self-reported physical activity levels. A higher BMI (≥25) appears to be most significant factor in determining if elderly women will underreport their food intake and may be related to body image. These results have implications for undertaking surveys of food intake in elderly women.

A study on the migration and transformation law of nitrogen in urine in municipal wastewater transportation and treatment

Many studies suggest that the total nitrogen (TN) in urine is around 9,000 mg/L and about 80% of nitrogen in municipal wastewater comes from urine, because nitrogen mainly occurs in the form of urea in fresh human urine. Based on this fact, the study on the migration and transformation law of nitrogen in urine and its influencing factors was carried out. It can be seen from the experimental results that the transformation rate of urea in urine into ammonia nitrogen after standing for 20 days is only about 18.2%, but the urea in urine can be hydrolyzed into ammonia nitrogen rapidly after it is catalyzed directly with free urease or indirectly with microorganism. Adding respectively a certain amount of urease, activated sludge and septic-tank sludge to urine samples can make the maximum transformation rate achieve 85% after 1 day, 2 days and 6 days, respectively. In combination with some corresponding treatment methods, recycling of nitrogen in urine can be achieved. The results are of great significance in guiding denitrification in municipal wastewater treatment.

Influence of saponins and tannins on intake and nutrient digestion of alkaloid-containing foods

BACKGROUND

We hypothesized that eating a food containing saponins (SAP), or tannins (TAN) prior to foods containing the alkaloids gramine (GRA) or 5-methoxy-N,N-dimethyltryptamine (TRP) would provide benefits not possible when the alkaloid-containing foods were eaten alone.

METHODS

In Trial 1, four groups of five lambs were first offered food with SAP for 30 min followed by food with either GRA or TRP for 3.5 h in a 2 × 2 factorial arrangement of a completely randomized design that included alkaloid (GRA or TRP) with or without SAP. In Trial 2 TAN replaced SAP. All foods were isocaloric (3.3 Mcal kg⁻¹) and isonitrogenous (14% crude protein). Foods, fecal and urine samples were collected and analyzed for dry matter intake and apparent digestibility of dry matter, energy (in megajoules, MJ), nitrogen (N), and neutral detergent fiber.

RESULTS

Supplemental SAP did not affect digestibility of the parameters tested (P > 0.10). Supplemental TAN increased digestibility of N (g kg⁻¹, P = 0.04), N retained (g day⁻¹, P = 0.07), N digested (g day⁻¹, P = 0.06), and N retained/N consumed (g kg⁻¹, P = 0.07). However, digestibilities of dry matter (g kg⁻¹, P = 0.0026), energy (MJ 1000 MJ⁻¹, P = 0.003), neutral detergent fiber (g kg⁻¹, P = 0.008), and digested N retained (g kg⁻¹, P = 0.07) were lower for lambs fed TAN than for unsupplemented animals.

CONCLUSIONS

Tannin supplementation can improve retention of nitrogen in animals fed alkaloid-containing grasses such as reed canarygrass and tall fescue. Combinations of forages with complementary primary and secondary compounds enable animals to maintain intake and improve nutrient utilization.

Development and application of 15N-tracer substances for measuring the whole-body protein turnover rates in the human, especially in neonates: a review

Our research group of the Children's Hospital of the University of Rostock (Rostock group) has long-time experience in (15)N-labelling and in using yeast protein and its hydrolysates for tracer kinetic studies to evaluate parameters of the whole-body protein metabolism in premature infants. The particular advantage of applying an economically convenient, highly (15)N-enriched, and completely labelled yeast protein for evaluating protein turnover rates is the fact that the (15)N dose is spread among all proteinogenic amino acids. The absorption has been improved by hydrolysing [(15)N]yeast protein with thermitase into a mixture of amino acids, dipeptides and tripeptides so that faecal analysis becomes unnecessary when determining turnover rates. The review shows that, in contrast to the application of single (15)N-labelled amino acids with resulting overestimation of protein turnover rates, the (15)N-labelled yeast protein thermitase hydrolysate represents the amino acid metabolism more closely without causing amino acid imbalances. The (15)N-labelled yeast protein thermitase hydrolysate leads to the estimation of reliable protein turnover rates, particularly in premature infants.

Studies of the protein and the energy metabolism in man during a wintering in Antarctica

During the 29th Soviet Antarctic Expedition in Novolazarevskaya from March 1984 to March 1985, the protein and energy metabolisms were studied in six expeditioners from the German Democratic Republic. The investigations were carried out at the beginning of the expedition (May), during the polar night (July) and during the polar day (December). The effect of a special stress situation (sledge trek in April 1984) was investigated in one subject. The stable nitrogen isotope (15)N was used to study the protein metabolism. The assessment of the energy metabolism was based on the oxygen consumption, which was determined by means of a spirograph. In addition, the vital capacity, the breath minute volume, the blood pressure, etc. were measured. The following results were obtained: During the polar night, the utilisation of the dietary proteins and the whole body protein synthesis calculated by means of the (15)N excretion of the total nitrogen in urine were greater (73.6±0.9 % and 3.48±0.17 g protein d(-1) kg(-1), n=3) than the respective values during the polar day (69.7±1.2, p<0.05, n=3 and 3.05±0.07, p<0.05, n=3) and at the beginning of the expedition (69.6±1.4, p<0.02, n=5 and 2.81±0.09, p<0.01, n=5). The lowest values (58.0 % and 2.43 g protein d(-1) kg(-1)) were obtained in the subject after the trek. The resting metabolic rate (in kJ d(-1) m(-2)) was decreased during the polar night (45.6±5.0, n=4) in comparison with the polar day (61.5±11.3, n=3) and the beginning of the expedition (52.3±9.6, n=4) with p<0.01 in both cases.

Tracer kinetics and metabolic models in medicine

In the present paper, a survey of methods applied to the interpretation and evaluation of tracer kinetic data is given. For their mathematical description, both compartmental and non-compartmental models, such as the modified model of Sprinson and Rittenberg, the San Pietro-Rittenberg model, two models of the albumin metabolism and a 10-pool model of the N and protein metabolism were used. By means of single or multiple pulse, infusion and priming techniques, the N and protein metabolism in various metabolic states (e.g. healthy man, pathological and stress conditions, therapeutic treatments) were studied.

Effect of roughage to concentrate ratio of sweet sorghum (Sorghum biclor L. Moench) bagasse-based complete diet on nutrient utilization and microbial N supply in lambs

An experiment was conducted to study the effect of roughage to the concentrate ratio of complete diets containing sweet sorghum bagasse (SSB), an agro-industrial by product, as sole roughage source on nutrient utilization in ram lambs. Twenty-four Nellore × Deccani cross ram lambs aged about 3 months (average body wt. 10.62 ± 0.03 kg) were randomly allotted into four groups fed with CR-I (60R:40C), CR-II (50R:50C), CR-III (40R:60C), and CR-IV (30R:70C) complete diets. The roughage to concentrate ratio did not affect the dry matter intake (in grams/day or grams/kilogram weight(0.75)). The crude protein (P < 0.01) and ether extract (P < 0.05) digestibility of ration CR-IV was higher than CR-I and CR-II rations, whereas, the digestibility of nitrogen-free extract and fiber fractions was similar among all the rations. Experimental diets were different (P < 0.01) in digestible crude protein (DCP) content, in which the CR-I ration contained lower DCP value whereas CR-IV ration contained higher DCP value. The total digestible nutrients (TDN) and metabolizable energy (ME) values were comparable among all the experimental rations. The daily DCP intake (in grams/day) was lower (P < 0.05) in lambs fed with CR-I ration compared to CR-III and CR-IV rations and it was comparable with CR-II ration. The TDN intake (in grams/day), digestible energy, and ME intakes (in megajoules/day) were similar among the lambs fed experimental rations with different SSB to concentrate ratios. The average daily DCP intake of lambs fed with CR-II, CR-III, and CR-IV rations met the requirements whereas, the daily TDN and ME intake was met by all the lambs. The lambs on all the diets were in positive nitrogen retention. The nitrogen balance expressed as grams/day was higher (P < 0.05) in lambs fed with CR-III and CR-IV ration than those fed with CR-I ration. The daily calcium and phosphorus intake and balance were comparable on all the experimental rations. The total purine derivatives (in millimoles/day) were higher (P < 0.05) in CR-III than CR-I and comparable with CR-II and CR-IV diets. The higher (P < 0.01) microbial N supply (in grams/day) was observed in CR-III ration compared to other three rations and the efficiency of microbial synthesis was comparable among all the rations. It is concluded that sweet sorghum bagasse can be included in the complete rations at maximum level of 50 % as roughage source for rearing of ram lambs.

[Protein malnutrition in patient in the early postoperative period after uncomplicated removal of the brain tumors]

Malnutrition leads to adverse effects and may worsen clinical outcome. Surgery as a stress factor activates pathological reactions changing metabolism structure. The aim of this study was to evaluate changes of protein metabolism in patients after elective neurosurgical operation. 24 patients were prepared for elective surgery and were enrolled in this study. Evaluation of each patient included: measurement of anthropometric indices--height, weight, arm circumference and the triceps skinfold thickness, the definition of protein loss by determining the loss of nitrogen in the urine, assessment of protein catabolism, determining the violations of nutritional status upon the base of laboratory parameters. During the course of the conducted investigation significant (p < 0.05) decrease in the indices of total protein, albumin, transferrin and the absolute numbers of lymphocytes in the postoperative period was revealed. All the patients developed severe protein catabolism. It became clear that uncomplicated elective surgical intervention, together with the adopted scheme of the nutritional therapy leads to severe protein catabolism in all patients.

Fate of pharmaceuticals and bacteria in stored urine during precipitation and drying of struvite

Experiments were conducted to measure the behaviour of eight pharmaceuticals during urine treatment as part of the project 'SANIRESCH - Sustainable sanitary recycling Eschborn'. Urine was collected from 200 people in a public building via waterless urinals and NoMix toilets. It was then stored at room temperature at different pH values to analyse the extent to which bacteria and pharmaceuticals are eliminated over time. Although a partial elimination of pharmaceuticals could be detected, the storage at defined pH values cannot be advised. As the persons tested used pharmaceuticals with different structures, in different amounts and at varying intervals, this method of treatment is insufficient for removing them from urine. Precipitating the urine with MgO, washing it with saturated struvite solution and drying it at 30 °C will result in a free-flowing granular powder of struvite (NH(4)MgPO(4)·6H(2)O) that is free of pharmaceuticals and pathogens and can be used as fertiliser and a source of nitrogen, magnesium and phosphorus.

Long-term high urinary potential renal acid load and low nitrogen excretion predict reduced diaphyseal bone mass and bone size in children

BACKGROUND

Longitudinal diet assessment data in children suggest bone anabolic effects of protein intake and concurrent catabolic effects of dietary acid load. However, studies using valid biomarker measurements of corresponding dietary intakes are lacking.

OBJECTIVE

The aim of the study was to examine whether the association of long-term dietary acid load and protein intake with children's bone status can be confirmed using approved urinary biomarkers and whether these diet influences may be independent of potential bone-anabolic sex steroids.

METHOD

Urinary nitrogen (uN), urinary net acid excretion (uNAE), and urinary potential renal acid load (uPRAL) were quantified in 789 24-h urine samples of 197 healthy children who had at least three urine collections during the 4 yr preceding proximal forearm bone analyses by peripheral quantitative computed tomography. uPRAL was determined by subtracting measured mineral cations (sodium + potassium + calcium + magnesium) from measured nonbicarbonate anions (chloride + phosphorus + sulfate). In a subsample of 167 children, dehydroepiandrosterone metabolites were quantified by gas chromatography-mass spectrometry. Multivariable regression models adjusted for age, sex, pubertal stage, forearm muscle area, forearm length, and urinary calcium were run with uN and/or uPRAL or uNAE as predictors.

RESULTS

uN was positively associated with bone mineral content, cortical area, periosteal circumference, and strength strain index. uPRAL (but not uNAE) showed negative associations with bone mineral content and cortical area (P < 0.05), both with and without adjustment for the dehydroepiandrosterone-derived sex steroid androstenediol.

CONCLUSIONS

In line with dietary assessment findings, urinary biomarker analyses substantiate long-term positive effects of protein intake and concomitant negative effects of higher dietary acid load on bone status of children, independent of bone-anabolic sex steroid action.