Animal and vegetable protein intake and malnutrition in older adults: a multicohort study

OBJECTIVES

Malnutrition is a global concern in older adults, as it negatively affects morbidity and mortality. While higher animal protein intake may help prevent and treat malnutrition, it might also increase the risk of chronic diseases and death. Conversely, vegetable protein intake might have a lower anabolic effect and not be as effective to improve nutritional status. We studied whether animal and vegetable protein intake are associated with changes in nutritional status in older adults.

DESIGN

We used pooled data from two Spanish cohorts: the Seniors-ENRICA 1 and Seniors-ENRICA 2.

SETTINGS AND PARTICIPANTS

2,965 community-dwelling adults aged 62-92 years.

MEASUREMENTS

Protein intake was estimated at baseline via an electronic, validated diet history. Nutritional status was assessed at baseline and after 2.6 years with the GLIM (Global Leadership Initiative on Malnutrition) phenotypic criteria: weight loss, low body mass index, and reduced muscle mass. The odds of improvements in nutritional status were assessed with logistic regression models, extensively adjusted for potential confounders.

RESULTS

Higher animal and vegetable protein intake were associated with improvements in nutritional status [odds ratios (95% confidence intervals) per 0.25 g/kg/day were 1.15 (1.00, 1.32) and 1.77 (1.35, 2.32), respectively]. Cereal protein intake drove most of the latter association [2.07 (1.44, 2.98)]. Replacing 0.25 g/kg/day of total animal protein, meat, or fish protein (but not dairy or egg protein) with vegetable protein was associated with improvements in nutritional status [1.54 (1.13, 2.09), 1.70 (1.20, 2.41), and 1.77 (1.18, 2.64), respectively].

CONCLUSIONS

Higher animal and, especially, vegetable protein intake were associated with improvements in nutritional status in older adults. Replacing total animal protein, meat, or fish protein with vegetable protein may help improve malnutrition.

Benefits and side effects of protein supplementation and exercise in sarcopenic obesity: A scoping review

BACKGROUND

Protein supplements have been widely used among those who are struggling with sarcopenic obesity among older adults. However, despite their popularity, there is still a lack of concrete evidence on both the potential benefits and side effects of protein supplementation and exercise on sarcopenic obesity (SO).

OBJECTIVE

Thus, we aimed to determine the impacts of protein supplementation and exercise in older adults with sarcopenic obesity.

METHOD

A systematic database search was conducted for randomised controlled trials, quasi experimental study and pre-post study design addressing the effects of protein supplementation in improving sarcopenic obesity among older adults. This scoping review was conducted based on PRISMA-Scr guidelines across PubMed, Embase, Web of Science and Cochrane Library databases. To assess record eligibility, two independent reviewers performed a rigorous systematic screening process.

RESULTS

Of the 1,811 citations identified, 7 papers met the inclusion criteria. Six studies were randomised controlled trials and one study was a pre-post test study design. The majority of studies discussed the use of both protein supplements and exercise training. The included studies prescribed protein intake ranging from 1.0 to 1.8 g/kg/BW/day for the intervention group, while the duration of exercise performed ranged from 2 to 3 times per week, with each session lasting for 1 hour. Whey protein supplementation has been shown to be effective in improving sarcopenic conditions and weight status in SO individuals. The combination of exercise training especially resistance training and the used of protein supplement provided additional benefits in terms of lean muscle mass as well as biomarkers. The study also revealed a lack of consistency in exercise design among interventions for sarcopenic obesity.

CONCLUSION

Overall, it appears to be a promising option for SO individuals to improve their sarcopenic condition and weight status through the combination of resistance exercise and whey protein supplementation. However, it also highlights the need for caution when it comes to high amounts of protein intake prescription. Future research is warranted to investigate the optimal exercise design for this population, given the limited research conducted in this specific area.

The Effect of Oral Protein Supplementation on the Growth of Very Low Birth Weight Preterm Infants Admitted to the Neonatal Intensive Care Unit: A Randomized Clinical Trial

BACKGROUND

During NICU admission, extra-uterine growth retardation that can affect the neurodevelopmental outcome is a challenging problem in extremely preterm infants. This trial aimed to determine the effect of additional enteral protein supplementation on the growth velocity of the anthropometric parameters.

METHOD

In this randomized controlled trial, 77 preterm infants (gestational age ≤33 weeks and birth weight <1500 g) who reached full enteral feeding with either fortified breast milk or preterm formula were included. They were randomized to receive either 4-<5 g/kg/day protein through extra protein supplementation (intervention) or 3-<4 g/kg/day protein. Weight gain, as well as length and head circumference growth, were monitored daily and weekly, respectively. Venous blood gas, blood urea nitrogen (BUN), and albumin levels were checked weekly.

RESULTS

Five out of 77 participants were excluded due to feeding intolerance. Analyses were conducted on 36 neonates with protein intake of 3.66 ± 0.22 gr/kg/day and 36 with extra protein intake. Baseline characteristics were similar between the groups. An additional protein supply of 0.89 gr/kg/day, resulting in an average protein intake of 4.55 ± 0.18 in the intervention group, increased the postnatal weight gain, linear growth, and head circumference growth (7.98 gr/kg/day, 0.347 cm/week, and 0.38 cm/week, respectively). The albumin levels were significantly increased, but the BUN levels were not significantly increased in the intervention group. None of the patients developed necrotizing enterocolitis or significant acidosis.

CONCLUSION

Protein supplementation significantly improves the growth of the anthropometric parameters. An increase in serum albumin and no increase in serum urea can indicate the anabolic effect of extra protein. Protein supplementation can add to routine feeding protocols of VLBW infants without any short-term adverse effect; however, further study for evaluation of long-term complications is needed.

Similar performance after intake of carbohydrate plus whey protein and carbohydrate only in the early phase after non-exhaustive cycling

The aim of the present study was to compare performance five hours after a 90-min endurance training session when either carbohydrate only or carbohydrate with added whey hydrolysate or whey isolate was ingested during the first two hours of the recovery period.

METHODS

Thirteen highly trained competitive male cyclists completed three exercise and diet interventions (double-blinded, randomized, crossover design) separated by one week. The 90-min morning session (EX1) included a 60 min time-trial (TT₆₀ ). Immediately and one hour after exercise, participants ingested either 1) 1.2 g carbohydrate∙kg^-1 ∙h^-1 (CHO), 2) 0.8 g carbohydrate∙kg^-1 ∙h^-1 + 0.4 g isolate whey protein∙kg^-1 ∙h^-1 (ISO) or 3) 0.8 g carbohydrate∙kg^-1 ∙h^-1 + 0.4 g hydrolysate whey protein∙kg^-1 ∙h^-1 (HYD). Additional intakes were identical between interventions. After five hours of recovery, participants completed a time-trial performance (TT_P ) during which a specific amount of work was performed. Blood and urine were collected throughout the day.

RESULTS

TT_P did not differ significantly between dietary interventions (CHO: 43:54±1:36, ISO: 46:55±2:32, HYD: 44:31±2:01 min). Nitrogen balance during CHO was lower than ISO (p<0.0001) and HYD (p<0.0001), with no difference between ISO and HYD (p=0.317). In recovery, the area under the curve for blood glucose was higher in CHO compared to ISO and HYD. HR, VO₂ , RER, glucose, and lactate during EX2 were similar between interventions.

CONCLUSION

Performance did not differ after five hours of recovery whether carbohydrate only or isocaloric carbohydrate plus protein was ingested during the first two hours. Correspondingly, participants were not in negative nitrogen balance in any dietary intervention.

Effects of pigeon pea leaves and concentrate mixture on feed intake, milk yield, and composition of crossbred dairy cows fed native pasture hay

Protein supplements are expensive and not easily accessible under small-scale livestock production systems in Ethiopia and other developing countries, which necessitates investigating the alternative protein sources for cost-effective livestock production. Pigeon pea (Cajanus cajan L. Millsp) leaves (PPLs) are rich in protein and are well-suited for feeding small ruminants; however, the effect of inclusion of PPL in the concentrate mixture (CM) on the performance of dairy cows was not well documented. This experiment was conducted to evaluate the effect of supplementation of PPL and CM to native pasture hay-based rations on feed intake, milk yield and composition, and blood metabolites of crossbred dairy cows (Holstein × Zebu). A 4 × 4 Latin square design with three replications, balanced for carryover effects, was used for this study. The treatments included native pasture hay provided ad libitum as a basal diet, supplemented with a CM alone (T1), the inclusion of 10% of PPL in the CM (T2), 20% PPL in the CM (T3), or 30% PPL in the CM (T4). Supplements were isocaloric and isonitrogenous. Total DM intake (hay + supplement intake) was similar (P > 0.05) among treatments. Hay intake was greater (P = 0.05) for T1 and T2 than for T4, while supplement intake was the least for T1 (P < 0.05). The treatment groups T2, T3, and T4, where PPL was included, had similar (P > 0.05) supplement intake. Feed intake, milk yield and composition, feed conversion efficiency, body condition score, serum total protein, albumin, globulin, glucose, triglyceride, urea N, creatinine, and cholesterol were similar (P > 0.05) among treatments. The inclusion of up to 30% of PPL in the CM resulted in a comparable performance of crossbred dairy cows as supplementation with CM under the conditions of the current experiment. Therefore, further study is required to evaluate the effect of the inclusion of a higher level of PPL in the concentrate mixture on the performance of lactating crossbred dairy cows.

Significance of sesame (Sesamum indicum L.) as a feed resource towards small-ruminant animal production in Southern Africa: a review

Sesamum indicum (sesame) is a small seed legume, which is of nutritional and medicinal value to livestock. Sesame is a legume with positive attributes that include drought tolerance (owing to its extensive rooting system), low input demand for growth, and reduction of soil nematodes (in crop rotation systems). Attention in research has been shifted towards usage of sesame as human food to exploitation as livestock feed because of its high levels in crude protein (CP), minerals, amino acids, and polyunsaturated fatty acids (PUFAs). However, it is underutilized as a livestock feed resource in Southern Africa. In recent years, there has been increasing interest to cultivate the crop in Southern African countries through non-governmental organizations (NGOs) initiatives. The focus of such initiatives has been mainly production without value addition of the seed. At present in Southern Africa, widespread adoption of feeding strategies based on sesame has been restricted mainly due to lack of knowledge on production, marketing and value addition, availability of the seed, and technology adoption. Technology adoption is often limited specifically when oil extraction is considered, where by-products such as the meal are useful in animal production. This paper reviews the potential use of sesame to improve growth rates, feed intake, carcass qualities, meat quality, milk quality, milk yield, and blood metabolite levels of small ruminants. Production potential, economic feasibility, and strategies of using sesame in small-ruminant feeding programs are also outlined.

Optimization of artificial urine formula for in vitro cellular study compared with native urine

Several artificial urine (AU) formulas have been developed to mimic the normal urine. Most of them are protein-free, particularly when secreted proteins (secretome) is to be analyzed. However, the normal urine actually contains a tiny amount of proteins. We hypothesized that urinary proteins at physiologic level play a role in preservation of renal cell biology and function. This study evaluated the effects from supplementation of 0-10% fetal bovine serum (FBS) into the well-established AU-Siriraj protocol on MDCK renal tubular cells. Time to deformation (T_D) was reduced by both native urine and AU-Siriraj without/with FBS compared with complete culture medium (control). Among the native urine and AU-Siriraj without/with FBS, the cells in AU-Siriraj+2.5% FBS had the longest T_D. Supplementation of FBS increased cell death in a dose-dependent manner (but still <10%). Transepithelial electrical resistance (TER) of the polarized cells in the native urine was comparable to the control, whereas that of the cells in AU-Siriraj+2.5% FBS had the highest TER. These data indicate that supplementation of 2.5% FBS into AU-Siriraj can prolong time to deformation and enhance polarization of renal tubular cells. Therefore, AU-Siriraj+2.5% FBS is highly recommended for in vitro study of cell biology and function (when secretome is not subjected to analysis).

Type of protein supplement in cryopreservation solutions impacts on the degree of ultrastructural damage in frozen-thawed human oocytes

Protein sources used as supplements of IVF culture media are known to have several implications for the function and stability of embryo culture environment. In fact, they i) transport biologically active molecules ii) chelate heavy metals, iii) regulate media pH, iii) scavenge reactive oxygen species (ROS) and iv) attenuate osmotic stress to which cells are exposed in sub-optimal culture conditions. Instead, their specific relevance to the formulation of cryopreservation solutions used for gamete and embryo cryopreservation remains uncertain. In the present work, we tested the hypothesis that different protein supplements present in cryopreservation solutions, serum or plasma protein solution (PPS), or different concentrations of the same supplement (serum), are associated with different types and/or magnitude of cryopreservation-derived cell damage. To this end, using cryopreservation solutions containing serum or PPS, donated supernumerary human mature oocytes were frozen-thawed by slow freezing and compared with fresh controls. Ultrastructural markers of oocyte quality were adopted as objective measure to assess possible damage from cryopreservation. The study results indicate that the adoption of serum minimises cell damage induced by cryopreservation. Indeed, typical hallmarks of cryodamage in human oocytes, i.e. loss of cortical granules, zona pellucida hardening and above all vacuolization, were largely reduced in oocytes cryopreserved with solutions containing serum, especially if used a higher concentration. This suggest that oocyte cryopreservation still has significant margins of improvement that may derive also from composition of cryopreservation media.

Acne located on the trunk, whey protein supplementation: Is there any association?

Whey protein is a source of protein that was isolated from milk. Whey proteins are composed of higher levels of essential amino acids. The role of diet in acne etiology has been investigated for several years. It was established that milk and milk products can trigger acneiform lesions, and recent evidence supports the role of whey protein supplements in acne. Herein, we report 6 healthy male adolescent patients developing acne located only to the trunk after the consumption of whey protein supplements for faster bodybuilding. This is the first observation which specified the location of acneiform lesions among bodybuilders. In our opinion, a trendy and common health problem is beginning among adolescents in the gyms.

Critical care: Meeting protein requirements without overfeeding energy

BACKGROUND AND AIMS

Relatively high protein input has been associated with improved clinical outcome in critical illness. However, until recently differences in clinical outcome have been examined in terms of the energy goal-versus under-feeding. Most studies failed to set the energy goal by an accurate measure or estimate of expenditure or independently set protein prescription. This leads to under-prescription of protein, possibly adversely affecting outcome. We determined whether an enteral nutrition prescription could meet local and international protein guidelines.

METHODS

Protein prescriptions of consecutive patients admitted to Southmead Hospital ICU and requiring full enteral nutrition were audited against local and international guidelines. Prescriptions were designed to not exceed energy expenditure based on a validated estimation equation, minus non-nutritional energy, and protein requirements were based on local or international guidelines of between 1.2 and 2.5 g protein/kg/d or 2-2.5/kg ideal body weight (Hamwi ideal body weight)/d.

RESULTS

From 15/1/15 to 12/4/15 139 ICU patients were prescribed full enteral nutrition. Protein prescriptions failed to meet local guidelines in 75% (p < 0.001) and international guidelines in 45-100%. Prescriptions meeting at least 90% of protein guidelines and 130 g of carbohydrate could be increased from between 0 and 55%, depending on the guideline, to between 53 and 94% using a protein supplement and 82 and 100% using a protein plus glucose supplement. Non-nutritional energy (NNE) proportionately reduces feed protein prescription and contributed 19% of energy expenditure in 10% of patients.

CONCLUSIONS

We need feeds with a lower non-protein energy: nitrogen (NPE:gN) ratio and/or protein supplementation if prescriptions are to meet protein guidelines for critical illness. NNE must be adjusted for in prescriptions to ensure protein needs are met.