The daily practice requires the use of indirect calorimetry to define the energy requirements of intensive care patients. In the time of COVID-19 pandemic, this practice is challenging. The purpose of this methodology paper is to provide practical guidance to health professionals to perform this measurement safely, using various metabolic monitors.
Plant-derived natural products have shown beneficial effects in many diseases associated with liver. The present study aimed to appraise the effects of Trichosanthes dioica (TD) peel extract on oxidative stress, inflammation as well as fibrosis exhibited by the ovariectomized rats in which hepatic damage had been induced by the administration of carbon tetrachloride (CCl4). The CCl4 administration in the ovariectomized rats elevated the plasma ALT, AST, and ALP level in comparison with the control while TD peel extract showed significant reduction of those activities. Besides, oxidative stress and lipid peroxidation also increased in CCl4-treated rats. TD peel extract significantly reduced the oxidative stress marker's concentration and improved the catalase and SOD activities in CCl4-administered ovariectomized rats. These results suggest that TD peel extract is capable of protecting the liver from CCl4induced damage through preventing oxidative stress, lipid peroxidation, inflammation, fibrosis and boosting the diminished cellular antioxidant defense.
Background: vitamin D is being increasingly recognized for its important non-skeletal functions including endocrine actions. This study investigated if a single, large, intramuscular post‐artum injection of vitamin D improve adiponectin levels among women with gestational diabetes mellitus (GDM). Methods: A total of 45 pregnant women with GDM participated in this randomized clinical trial. They were randomly divided into intervention and control group. The intervention group received an intramuscular injection of 300,000 IU of vitamin D during 3 to 10 days after their child delivery, but controls did not. Serum 25‐hydroxyvitamin D, fasting blood glucose, HbA1c and serum adiponectin were measured at baseline and after 3 months of intervention. Results: Serum 25 OH vitamin D increase significantly in the intervention but not in the control group from 24.25 to 62.10 (nmol/l) (p-value< 0.01). Comparison in within group showed that adiponectin level increased significantly only among intervention group after the vitamin D injection from 7.45 to 8.98 (ngr/dl) (P-value=0.01), while between group comparisons showed no significant differences in adiponectin concentration after the intervention (P-value<0.05). Between and within group comparisons reported no significant alterations in the levels of glycated hemoglobin (HbA1c) and FPG (fasting plasma glucose), as well. Conclusions: The 300,000 IU single dose of intramuscular injection of vitamin D is regarded as an effective procedure to improve vitamin D status which significantly increased the adiponectin levels among mothers with gestational diabetes after delivery. Trial registration: The trial was registered in Iranian Registry of Clinical Trials available at http://www.irct.ir. The reference number is IRCT138902113840N1.
Obesity is the most prevalent nutritional disorder. Healthy diets helps people maintain and improve their general health. This study aimed to assessment of low and very low calorie diets through determination of its effect on lipid metabolism, iron profile and kidney function in obese male rats. To achieve our aim forty five male albino rats were used and divided into 4 groups: control group, obese group with 75 calories diet, obese group with 60 calories diet and obese group with 45 calories diet. Our result showed significant disturbance of lipid, iron and kidney profile on supplementation of 75 calories diet to obese group of male rats and significant improvement in lipid, iron and kidney profile on supplementation of 60 calories diet or 45 calories diet to obese group of male rats. The results confirmed that, high fat diet able to produce significant disturbance in lipid metabolism, iron profile and kidney function while low calorie diets able to improving the disturbance in such parameter.
Summary: This research was planned to assess the protective effect of aqueous green tea extract (AGTE) in alcohol treated diabetic rats. This study was examined, whether 20% v/v of 5 g/kg.b.w alcohol intake exacerbates diabetes-induced renal damage associated with an escalated nitroxidative stress and glucose homeostasis in comparison with diabetic condition alone. The present study is primarily focused to investigate the possible toxic effects of chronic alcohol intake on kidney of streptozotocin (STZ)-induced diabetic rats. Forty albino male Wistar rats were used and randomly allocated into five groups. Diabetes was induced by a single intraperitoneal injection of STZ (50 mg/kg) in rats. Alcohol was administered through orogastric tube once daily for a period of 60 days. Impact of chronic alcohol treatment on renal function and selected metabolites of catecholamines and antioxidant metabolisms have been investigated in the kidney of STZ-induced diabetic rats. Biochemical analysis of kidneys demonstrated that chronic alcohol induced alterations in vitro gluconeogenesis, significant decrease in the body weight, and activities of antioxidant enzymes in diabetic rats. A significant increase in the levels of epinephrine and sertonine was observed between alcohol treated, diabetic control and alcohol treated diabetic rat groups. Further, excessive chronic alcohol treatment caused additive deterioration of the kidney function as evidenced by increased inducible nitric oxide synthase (iNOS) protein expression and thus nitroxidative stress and histopathological aberrations leading to aggravation of diabetic nephropathy under alcohol intoxication. Treatment with aqueous green tea extract (300 mg/kg.b.w) to diabetic rats treated with alcohol renders the protection against the decreased body weight, increased hyperglycemia, hyperlipidemia, catecholamines, nitroxidative stress and further tissue damage.
Undernourished interferes with the synthesis of antioxidants enzymes, causing oxidative stress in the brain. They will damage the cellular components of the brain and result in decreased intelligence. Pasak bumi (Eurycoma longifolia. Jack) is an endemic plant in Kalimantan that has potential as an antioxidant so it is thought to increase intelligence after undernourished through antioxidant mechanisms. This study aims to prove that the pasak bumi root can improve the spatial memory of Rattus norvegicus after undernourished through antioxidant mechanisms. The study design was post test only with control design. Four treatment groups: normal (KN), P1 = undernourished rat + placebo, P2 = undernourished rat + 70% ethanol extract pasak bumi (EPB) 7.5 mg/kgBW, P3 = undernourished rat + EPB 15 mg/kgBW. The brain oxidative stress parameters examined were SOD activity, H2O2 level, catalase activity and MDA level. Spatial memory of rats was measured by the Morris Water Maze method. Data analysis used Anova and Kruskal Wallis test with a confidence level of 95%. The results showed that the group given EPB 15 mg/kgBW had higher SOD and catalase activity and lower H2O2 and MDA levels than the other groups. Spatial memory of mice given EPB 15 mg/kgBW tended to be better than other groups even though not statistically significantly different. Conclusion: the administration of EPB 15 mg/kgBW in undernourished rats was able to improve the brain oxidative stress and tended to improve the spatial memory of rats compared to the EPB dose of 7.5 mg/kgBW.
Summary: Background & aims: Nonalcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease globally. We aim to evaluate prevalence and predictors of hepatic fibrosis among NAFLD patients, focusing on metabolic co-morbidities and dietary patterns. Methods: Quest Diagnostics laboratory data from 2017 to 2018 were used to identify NAFLD patients using a stepwise algorithm based on laboratory data and ICD-9/10 codes. Prevalence of fibrosis was assessed using a step-wise AST to platelet ratio index (APRI) algorithm. Multivariate logistic regression evaluated predictors of ≥F2 fibrosis or cirrhosis. Prevalence of fibrosis was stratified by U.S. Department of Health and Human Services geographic regions and compared with region-specific data on metabolic diseases and dietary patterns (fruit and vegetable intake) using 2017 Behavioral Risk Factor Surveillance System. Results: Among NAFLD patients, proportion of patients with APRI >2.0 was 1.58%, increasing to 3.05% (APRI > 1.5), 6.81% (APRI > 1.0), 12.67% (APRI > 0.7), and 21.87% with APRI >0.5. Increasing metabolic co-morbidities was associated with higher odds of fibrosis. Compared to patients with no metabolic co-morbidities, odds of >F2 fibrosis was OR 2.61 (95% CI 2.57–2.65, p < 0.01) and odds of cirrhosis was OR 1.76 (95% CI 1.70–1.82, p < 0.01) in patients with three metabolic co-morbidities. We observed that geographic regions with low fruit and vegetable intake and high prevalence of concurrent metabolic abnormalities to have the highest prevalence of NAFLD hepatic fibrosis. Conclusion: Increasing number of metabolic co-morbidities is associated with incremental increasing risk of hepatic fibrosis in NAFLD patients. We also observed patterns of low fruit and vegetable intake in regions with high prevalence of hepatic fibrosis. Keywords: Fatty liver, NASH, Metabolic syndrome, APRI, NAFLD
Summary: Objective: So far there is no standardised widely accepted ultrasound method for assessment of both subcutaneous adipose tissue and muscle mass in healthy subjects, patients and ICU patients. The goal is to provide an illustrated step-by-step guide of the ultrasound method developed since 2011, refined and applied during the USVALID study. Methods: We use 2 linear probes with a footprint width of 25,6 and 38,4 mm. The subject is lying relaxed with the head of bed elevated to 30°. Foam supports are placed under elbows and knees. Precise anatomical landmarks are palpated to measure the limb lengths. 3 measuring points at 50% of the thigh length and 2 measuring points at 70% of the upper arm length are marked on both sides. A gelpad is used to enable minimal compression. It is verified that the borders of the scan are blurred. Each measuring point is scanned in the short-axis and long-axis plane to more easily determine the subcutaneous adipose tissue and muscle structures especially in the presence of edema. First the quality of the scan is evaluated according to the visibility of the muscle fascia and bone surface. Then subcutaneous adipose tissue and entire muscle thickness are measured at the exact center of the scan drawing the shortest possible line from skin to bone surface. Discussion: The illustrated description of the USVALID ultrasound method enables reproducibility by other researchers for external validity. The subject's position, the location of the measuring points, the performance and evaluation of the ultrasound scans are discussed and compared to other published ultrasound methodologies.
Summary: Background: Malnutrition remains a significant ongoing issue in hospitalized patients, with cancer patients having one of the highest rates of malnutrition. Early identification with appropriate intervention is vitally important. nutritionDay is an international nutrition research study that was launched in 2006 to improve malnutrition awareness, education and research. The Canadian Nutrition Screening Tool [CNST] is validated to screen and identify patients at risk of malnutrition. In 2016, the Global Leadership Initiative on Malnutrition [GLIM] was convened to address the urgent need for simple and relevant clinical care guidelines for screening and diagnosing malnutrition. Aim: The primary aim was to determine malnutrition prevalence at the three sites of an Academic Health Sciences Centre [AHSC] by applying data gathered from nutritionDay 2011 to the GLIM two-step approach to diagnosing malnutrition. The secondary aim was to compare malnutrition prevalence between the three sites, with a specific interest in the results from AHSC-a, the cancer center, since cancer patients are known to have one of the highest rates of malnutrition The tertiary aim was to explore possible reasons for poor intake in AHSC overall. Methods: A one-day cross-sectional audit involving 264 patients at three AHSC sites was conducted in 2011 as part of the international nutritionDay research study. The unintentional weight loss and food consumption data were applied to CNST. Malnutrition diagnosis was determined using data for body mass index [BMI] and the fraction of study meal consumed. The nutritionDay adaptation of GLIM criteria to fit the nutritionDay survey was used. Statistical analysis: Categorical data are presented as actual numbers or percentages, with the groups compared by the Chi square test. Continuous variables expressed as mean ± SEM were used. One-way analysis of variance and Student t-tests were used to compare variables of interest. Significance p < 0.05, SPSS v.26 was used for analysis. Results: 44% (264/600) of patients at the AHSC participated in the nutritionDay 2011 study. 59% of patients at AHSC-a screened positive for risk of malnutrition compared to the other two sites (AHSC-b and AHSC-c),p = 0.002 and 0.014 respectively. Overall, 23% of patients would have been diagnosed as malnourished with AHSC-b at 56% compared to 17% AHSC-c [p = 0.041). Conclusion: Using the GLIM two-step approach, we report 38% of patients were at risk for malnutrition using the CNST and 1 in 4 of those identified at risk would be diagnosed as malnourished. As well, more patients at the cancer site were found to be at risk for malnutrition.
Summary: Objective: Mineral bioavailability from food is important for infants and young children. Mineral bioavailability is influenced by many factors, including e.g., the food matrix, mineral composition, and route of administration. Moreover, physiological factors, such as mineral status and use of medication (e.g., proton-pump inhibitors), are important. The aim of this research was to investigate in two separate, complementary experimental setups the bioaccessibility of calcium (Ca) and phosphorus (P) from amino acid-based medical nutrition infant formulas. Methods: Since this cannot be studied directly in infants and young children due to ethical restrictions, this was tested in a validated, dynamic, computer-controlled in vitro model of the stomach and small intestine (TIM-1). Furthermore, for comparison, two infant and two junior formulas with different mineral salt compositions from two manufacturers were tested in batch digestion experiments, mimicking intestinal feeding. Minerals were analyzed using ICP-MS. Results: Bioaccessibility of Neocate Infant formula was 51.4% ± 2.2% for Ca and 66.9 ± 5.5% for P in the dynamic in vitro model of the stomach and small intestine (TIM-1). The Ca bioaccessibility in the batch experiments ranged from 12% to 17% for the different formulas. The P bioaccessibility ranged from 50% to 61%. Conclusions: The combined experiments showed adequate Ca and P bioaccessibility in the four commercial formulas, with comparable bioaccessibility between manufacturers. The TIM-1 experiments showed the importance of the gastric phase (low pH) for solubility and bioaccessibility of the minerals.
Summary: Background: Nephrotoxicity occurs as a side effect of treating solid tumor with a single dose of cisplatin as anticancer drug because of the increase in oxidative stress. In this study, the free radicals scavenging capacity of thymoquinone (TQ) and vitamin E were tested to decrease the oxidative stress resulted from cisplatin treatment in male rats. Material and methods: Sixty male rats were divided into 6 groups. The 1st group was the negative control (G1) intraperitoneally injected only once with saline and 40 rats were injected intraperitoneally with a single dose of 20 mg/kg body weight (b.w.) of cisplatin and divided into four groups. The 2nd group (G2) was cisplatin positive control group, the 3rd group (G3), the 4th group (G4), and the 5th group (G5) were treated daily with 50 mg/kg b. w. of TQ, 1000 mg/kg b. w. vitamin E and TQ (50 mg/kg b. w.) + vitamin E (1000 mg/kg b. w.) daily, respectively. The 6th group (G6) was intraperitoneally injected once with saline then treated with same doses of TQ and vitamin E. The experiment was conducted for 30 days. Results: Cisplatin treated group (G2) showed altered biochemical parameters and severe damage in kidney tissues. Catalase, glutathione peroxidase, SOD and reduced glutathione levels were decreased, whereas lipid peroxidation was increased in the kidney tissue homogenate. Kidney and liver functions were altered as compared to the control group. Treating with TQ or vitamin E and their combination in G3, G4, and G5, respectively alleviated the effect of cisplatin injection and reduced the oxidative stress. Conclusions: TQ and Vit E could be good protective supplements may be given to cancer patients that might exposed to nephropathy during their treatment with cisplatin.
We hypothesized that gingerol supplementation would exert protective effects against high-fat diet (HFD)-induced weight gain via regulation of lipid and glucose homeostasis. To test our hypothesis, forty C57BL/6 mice were fed a standard diet (SD), SD plus gingerol (SDG), high-fat diet (HFD) and HFD plus gingerol (HFDG) for 12 weeks. Gingerol dose was 500 mg/kg/d. HFD groups presented higher total food intake (grams) as compared to SD groups (97%). Nevertheless, there were no significant differences in weight gain between the groups. Gingerol supplementation did not prevent retroperitoneal, epididymal, and brown fat gain on HFDG, as well did not change liver weight. In addition, no difference was observed on lipid profile and glucose tolerance test. These results suggest that gingerol supplementation in mice fed high-fat diet has limited effects to prevent weight and fat gain, and do not inhibit the increase on area under serum glucose curve.
Summary: Objectives: The aim of this study is to investigate the effect of oral l-Glutamine supplementation on hospitalization time, need for intensive care unit and Coronavirus Disease-19 (Covid-19) mortality. Methods: The study included 30 Covid-19 patients using l-Glutamine and 30 Covid-19 patients who did not use l-Glutamine with similar age, gender and clinical status. Diagnostic tests, laboratory examinations, clinical findings and computed thorax tomography imaging of the patients were evaluated. Results: Hospitalization time was 10.4 ± 1.9 days in Covid-19 without L-Glutamine group and 8.9 ± 1.8 days in Covid-19 with L-Glutamine group (p = 0.005). In Covid-19 without the L-Glutamine group, four patients require the ICU though no one in the other group required that (p = 0.038). Only one mortality was observed in Covid-19 without the L-Glutamine group (p = 0.999). Conclusions: Nutritional supplements such as L-Glutamine boost immune system especially by inhibition of inflammatory responses. Our results suggest adding enteral L-glutamine to the normal nutrition in the early period of Covid-19 infection may lead to a shortened hospital stay and lead to less need for ICU. Larger-scale studies are needed to evaluate the effect of adding enteral L-Glutamine to the currently used treatments in the infectious diseases especially like Covid-19.
Summary: Background & aims: Malnutrition is associated with functional decline and poorer clinical outcomes for hospitalised patients. This study aimed to survey the knowledge of clinical staff concerning identification/diagnosis and management of inpatient malnutrition and to assess attitudes and knowledge of malnutrition as a shared inter-disciplinary responsibility. Methods: A survey designed to investigate the aims was distributed to clinical staff (medical, nursing, dietitians and allied health) across three hospital campuses including acute, sub-acute and rehabilitation sites. Results: Survey responses were received from 14% (n = 302) of eligible clinical staff (116 nursing, 68 medical, 20 dietitians and 98 other allied health staff). With the exception of dietitians, responses to questions regarding skills and knowledge in the areas of malnutrition identification, diagnosis, treatment and management indicated sub-optimal knowledge. Only 60% of medical/surgical staff and 42% of nursing staff self-reported the ability to diagnose malnutrition. Responses to questions regarding responsibility for malnutrition were highly variable and suggested no significant ‘shared ownership’ of malnutrition as clinical responsibility. Conclusion: Apart from dietitians, malnutrition management skills were modest and knowledge gaps of clinical staff were marked. Confusion also existed as to the responsibility for malnutrition care for inpatients. To improve inpatient nutrition further multidisciplinary engagement and improved education may be required.
Summary: Background: The prevalence of infant colic is high and it has a significant impact on the live of the infants and their families, given that effective treatment has not been found. Objective: The aim of this study to evaluate the effects of pedilact probiotic drops for the treatment of infants colic in children. Methods: This study was carried out on 72 infants, presented with infantile colic who were admitted to the Tehran children Medical Center. These children were assigned randomly (using 2 blinded-randomized trial) into two equal groups named PRR (Probiotic receiving) and PCR (Placebo receiving) groups. The demographic information of the infants such as age and sex, maternal age, patient admission time and confounding factors such as passive smoker, family history of atopy, antibiotic use, and delivery type was recorded in both groups based on the statements provided by the mothers. The weight of the infants was also recorded. Results: There was no significant difference in the distribution of infant's sex, mother's age, type of labor, type of nutrition, quality of life and exposure to smoke between the two groups. The weight of the newborns increased in each of the two groups and there was a significant increase in the PRR group (p value < 0.0001), while in the PCR group no significant growth was observed (p value = 0.437). The frequency of crying in both groups decreased over the time, which was significant in PRR group only (p value < 0.001). There were no significant difference between PRR and PCR groups in fecal consistency and pattern of sleep on each day of 0, 7, 14, 21, and 28 (28 days p value = 0.475 and 0.086, respectively). Conclusion: Probiotic therapy significantly reduced the frequency and duration of crying and increased neonatal weight gain during the study, which can chiefly improve the quality of life.
Summary: Background: Non-alcoholic steatohepatitis (NASH), a subtype of non-alcoholic fatty liver disease (NAFLD), is a potentially progressive liver disease that can lead to cirrhosis. Obesity increases the risk of NAFLD/NASH, but this disease can also be observed in non-obese individuals. Methods: We investigated the metabolic and histopathological changes in 13 obesity-resistant Slc:Wistar/ST rats fed a high-fat and high-cholesterol (HFC) diet for 9 weeks, and also retrospectively compared the results of 41 Sprague-Dawley (SD) rats that were previously fed with the same protocol to the results of the Slc:Wistar/ST rats. Results: Of the 13 Slc:Wistar/ST rats fed an HFC diet containing 1.25% or 2.5% cholesterol, 11 (84.6%) developed histologically proven NASH without obesity, an increased visceral fat volume, insulin resistance, histopatological severe lobular inflammation and severe hepatic fibrosis. The HFC diets significantly increased the levels of mRNA encoding collagen type I alpha 1 (COL1A1), transforming growth factor-β1 (TGF-β1), tumor necrosis factor-α (TNF-α) and monocyte chemoattractant protein-1 (MCP-1). The SD rats also developed NASH without obesity, an increased visceral fat volume and insulin resistance, but the metabolic and histopathological effects, such as lower serum adiponectin levels, higher serum leptin levels, histopatological severe lobular inflammation and hepatic fibrosis, seemed to be more pronounced in the SD rats than in the Slc:Wistar/ST rats. Conclusions: These two rat models may reflect the human etiology of NASH that is influenced by dietary factors, and the obesity-resistant Slc:Wistar/ST rat model may be particularly useful for elucidating the pathophysiological mechanism of the so-called “lean NASH”. Keywords: Non-alcoholic fatty liver disease, Obesity, Wistar rat, Sprague-Dawley rat, High-fat diet, Cholesterol
Summary: Background: Non Communicable Diseases which is strongly associated with overweight and obesity have overtaken communicable diseases as the leading causes of morbidity and mortality. The changing disease pattern has been attributed to nutrition transition and inadequate exercise. This study was carried out to assess the food consumption pattern, physical activity and overweight and obesity among undergraduates of Adeleke University, Ede Osun State, Nigeria. Methods: Cross-sectional study. Undergraduate students, from a stratified random sample of Adeleke University in Ede, Osun State, Nigeria (n 268) aged 15–26 were used for the study. Pretested, structured self-administered questionnaires and anthropometric measurements were obtained from the participants. Results: Mean age of respondents was 19.8 ± 1.3 years, with a higher proportion being females (172; 64.2%). Body mass index (BMI) showed that 2.2% were underweight, 57.5% had a normal weight, 31% were overweight while 9.3% were obese. 56.7% of the respondents engage in physical activity always, and 35.8% of the respondents seldom engage in physical activity. Majority of the respondents consumed snacks daily. Using Chi square there was no association between cereals consumption and BMI (x2 = 5.415, P-value = 0.144). There was an association between intakes of vegetables and BMI (x2 = 18.342, P-value = <0.001) and there was no association between animal food and BMI (x2 = 0.031 p-value = 0.999) Conclusion: Since consuming a diet high in vegetable is associated with low BMI, Nutrition Education with emphasis on vegetable consumption is recommended.
Summary: Objective: The aim of the current study was to assess the zinc status (intake and level) and its relationship to cognitive impairment among men and women aged 65 years and above in Riyadh, Saudi Arabia. Methods: A cross-sectional single-center study was conducted in 400 participants (200 men and 200 women) aged 65 years and above. They were randomly chosen in the primary care centers in Riyadh. The impaired cognitive functions were measured using the Abbreviated Mental Test Score (AMTS). Plasma zinc concentration was analyzed using an atomic absorption spectrophotometer. Results: The mean plasma zinc concentration was 70 ± 2.34 μg/dL, 36% of studied participants had zinc deficiency. Zinc deficiency was significant more frequent in women than men (45% versus 27%, respectively) (p < 0.001). The impaired cognitive functions (AMTS ≤8) were found in 35% of participants, women were also significantly more frequent than men (40% versus 25%, respectively) (p < 0.001). The dietary zinc intake in both men and women were significantly lower than the Dietary Reference Intakes (DRI) values (p = 0.03) (p = 0.02) respectively. There was a significant positive correlation between plasma zinc concentration and AMTS with respect to overall participants and both men and women (r = 0.31, p < 0.001), (r = 0.35, p < 0.001), and (r = 0.29, p < 0.001) respectively. Conclusion: Our study indicates that zinc status may be associated with cognitive impairment measured by AMTS in the Saudi elderly population. Keywords: Zinc deficiency, Cognitive impairment, AMTS, Aging
Summary: Objectives: The Nutrition Risk in the Critically Ill score (NUTRIC) identify patients who will benefit the most from optimal nutrition therapy and it is composed by the variables age, number of comorbidities, days from hospital to Intensive Care Unit (ICU) admission, SOFA (Sequential Organ Failure Assessment), APACHE II (Acute Physiology and Chronic Health Evaluation) and interleukin-6 level (IL-6) as an optional variable. However, the APACHE II has been superseded in clinical practice by the Simplified Acute Physiology Score 3 (SAPS 3) as a measure of illness severity. Therefore, this study aimed to propose a new modification on NUTRIC scoring system by replacing APACHE II for SAPS 3, entitled as NUTRIC-S score. Method: This was a prospective observational study, carried out at two tertiary care, surgical-medical ICUs. Patients at least 18 years of age were enrolled within 24h of admission to the ICU and were followed up to hospital discharge. Patients who remained less than 24h in the ICU and those readmitted during the study period were excluded. The NUTRIC-S score predictive ability in differentiating survivors from non-survivors by using SAPS 3 instead of APACHE II, was compared to NUTRIC score (without IL-6). In order to detect the SAPS 3 cut-off points, that would represent the similar APACHE II cut-off points used in NUTRIC score, a linear regression model was performed between the two variables for the sample. Results: A total of 281 patients were enrolled in this study. The patients average age was 62.6 ± 17.0 years-old; 51.2% were female. The average BMI was 25.8 ± 5.5 Kg/m², classified into 38.8% healthy weight range, 27.4% obese, 19.9% underweight and 13.9% overweight. The correlation between NUTRIC and NUTRIC-S was R2 = 0.75 (CI 95% 0.69–0.80, p < 0.001). The ROC curve for predicting hospital mortality was 0.62 for the NUTRIC versus 0.70 for the NUTRIC-S (the difference between the areas was 0.08, 95% CI - 0.01–0.09, p = 0.14). The area under the ROC curve for APACHE II was 0.65, while for SAPS 3 it was 0.71 and 0.68 for SOFA. Patients who had NUTRIC-S score ≥5 presented a higher probability of hospital mortality (HR = 1.76, 95% CI 1.16 to 2.66, p = 0.008) whereas no such relationship was observed with NUTRIC (HR = 1.08,95% CI 0.97 to 1.21, p = 0.17). Conclusion: Compared to the NUTRIC score, the proposed NUTRIC-S scoring system is feasible and may be superior with respect to mortality prediction. NUTRIC-S can be used in those settings where APACHE II is not available.
Summary: Background & aims: The main role of the small intestine to absorb the bulk of dietary nutrients, including proteins and amino acids (AA). Enterocytes have long been considered a major player in amino acid homeostasis, especially the glutamine–citrulline–arginine crossroads. In vivo intestinal epithelium cell lines for studies of nitrogen metabolism have now reached their limitations. To push research forward, an interesting approach could be to use the explant incubation model of intestinal tissue, involving in vitro incubation of duodenal tissue biopsy specimens taken from human subjects. Methods: Eight duodenal biopsies were taken during endoscopy from patients without proven intestinal disease. Each biopsy was incubated in complete culture medium for 23 h then weighed, and cell viability was evaluated after 6 and 18 h. We then explored L-citrulline (L-CIT) production (reflecting metabolic activity) and the presence of the main enzymes involved in AA metabolism in the intestine (arginase II, glutaminase I, ornithine aminotransferase, and ornithine carbamoyltransferase). Results: Mean weight of biopsies was 12.36 ± 1.00 mg. Mortality was around 20% after 6 h and 50% after 18 h of incubation. CIT was amply produced by the biopsies, and enzymes implicated in intestinal AA metabolism were expressed in this model. Conclusions: This in vitro explant model of intestinal tissue emerges as a reliable model for conducting ex vivo investigations on AA metabolism. Keywords: Ornithine carbamoyltransferase, Amino acid, Enterocyte, Enzyme
