A simple method for estimating nitrogen balance in hospitalized patients: a review and supporting data for a previously proposed technique.

Milan

The American Journal of Clinical Nutrition

et al. 2017

113

116

, aimed to balance energy needs. Before treatment and after 10 wk of intervention, whole-body and appendicular lean mass were measured by using dual-energy X-ray absorptiometry. Knee-extension peak power was measured with dynamometry. Results: Both groups were found to have been in a moderate negative energy balance (mean 6 SD RDA: 209 6 213 kcal/d; 2RDA 145 6 214 kcal/d; P = 0.427 for difference between the groups). In comparison with RDA, whole-body lean mass increased in 2RDA (P = 0.001; 1.49 6 1.30 kg, P , 0.001 compared with 20.55 6 1.49 kg, P = 0.149). This difference was mostly accounted for by an increase in trunk lean mass found in 2RDA (+1.39 6 1.09 kg, P , 0.001). Appendicular lean mass also decreased in RDA compared with 2RDA (P = 0.022), driven by a reduction in RDA (20.64 6 0.91 kg, P = 0.005 compared with 0.11 6 0.57 kg, P = 0.592). Adjusting for energy imbalances did not alter these findings. Knee-extension peak power was also differently affected (P = 0.012; 26.6 6 47.7 W, P = 0.015 in 2RDA compared with 211.7 6 31.0 W, P = 0.180 in RDA). Conclusions: Consumption of a diet providing 2RDA for protein compared with the current guidelines was found to have beneficial effects on lean body mass and leg power in elderly men. These effects were not explained by differences in energy balance. This trial was registered at the Australia New Zealand Clinical Trial Registry (www.anzctr.org.au) as ACTRN12616000310460.Am J Clin Nutr 2017;106:1375-83.

Section: Urine Analysismentioning

confidence: 99%

The effects of dietary protein intake on appendicular lean mass and muscle function in elderly men: a 10-wk randomized controlled trial

Milan

The American Journal of Clinical Nutrition

et al. 2017

113

116

J Parenter Enteral Nutr

“…8,[12][13][14][18][19][20] This latter fact may be explained because 56.4% of our patients were fed using the parenteral route (see &dquo;Results&dquo;). In addition, patients with enteral nutrition received highly digestible enteral products and were observed mainly for a period of 1 to 2 weeks (Table III) after the date of admission or operation, a time which frequently coincides with slower gastrointestinal transit.…”

Section: Discussionmentioning

confidence: 98%

“…We measured TNO in 124 surgical patients over 990 days (TNO, 19.22 ±8.72 g N/ day; total urinary nitrogen (TUN) 18.17 ± 8.70 g N/day; UUN, 15.17 ± 7.70 g N/day; mean gastrointestinal nitrogen (MGIN) 0.68 ± 0.49 g N/day; integumental nitrogen (ITGN), 0.34 ± 0.08 g N/day) and compared the results with the daily estimations using three different formulas: formula A, UUN + 4; formula B, UUN x 1.20 + 1.05, where 1.20 is the reciprocal of the mean ratio UUN/TUN and 1.05 the mean extraurinary nitrogen losses; and formula C, UUN x 1.0986 + 2.55, derived from the regression analysis of UUN us TNO. TNO estimated by these formulas were 19.17 ± 7.70, 19.26 ± 9.24, and 19.22 ± 8.70 g N/day, respectively.…”

mentioning

confidence: 99%

Comparison of Three Methods for the Estimation of Total Nitrogen Losses in Hospitalized Patients

Velasco¹,

Long

Otto

et al. 1990

Since the measurement of total nitrogen output (TNO) is not routinely determined in the clinical setting, its level is frequently estimated using formulas based on the urinary urea nitrogen excretion (UUN). We measured TNO in 124 surgical patients over 990 days (TNO, 19.22 +/- 8.72 g N/day; total urinary nitrogen (TUN) 18.17 +/- 8.70 g N/day; UUN, 15.17 +/- 7.70 g N/day; mean gastrointestinal nitrogen (MGIN) 0.68 +/- 0.49 g N/day; integumental nitrogen (ITGN), 0.34 +/- 0.08 g N/day) and compared the results with the daily estimations using three different formulas: formula A, UUN + 4; formula B, UUN x 1.20 + 1.05, where 1.20 is the reciprocal of the mean ratio UUN/TUN and 1.05 the mean extraurinary nitrogen losses; and formula C, UUN x 1.0986 + 2.55, derived from the regression analysis of UUN vs TNO. TNO estimated by these formulas were 19.17 +/- 7.70, 19.26 +/- 9.24, and 19.22 +/- 8.70 g N/day, respectively. The regression analyses of the estimated TNO from the three formulas versus the measured TNO indicated that formulas A, B and C were equally accurate in estimating TNO over the entire range of UUN. However, when only values of UUN greater than or equal to 30 g N were considered, a modified formula A (UUN + 6) was the best predictor of TNO. Daily audits of the differences between the estimated and measured TNO showed comparable results for the three formulas. In 28.4 to 31.1% of the observed days the differences were higher than +/- 2 g N/day, an error which is not acceptable when estimating the protein requirements in many clinical conditions.(ABSTRACT TRUNCATED AT 250 WORDS)

“…NBs were then calculated using the following equation: 12 where protein intake is measured in grams (6.25 is the conversion factor for calculating the nitrogen in a given amount of protein); 24 h UUN losses are added to an average amount of 4 grams of insensible (or nonurinary) nitrogen losses or 2 grams in the stool plus 2 grams from the skin.…”

Section: Methodsmentioning

confidence: 99%

The metabolic response to spinal cord injury

1997

The metabolic response to trauma, including neurotrauma in general, has been studied extensively, but the acute metabolic response to spinal cord injury (SCI) has not. Therefore, 12 patients with SCI are presented in whom intensive nutrition assessment and management were instituted immediately after injury. Nitrogen balance (NB), predicted energy expenditure (PEE), and actual energy expenditure (MEE) were calculated or measured in each patient. A persistent negative NB was observed in all but one of the 12 patients. The single patient who did not exhibit persistent negative NB (no positive NB from week 2 to week 4 in the face of appropriate feeding) had an incomplete myelopathy, thus implying that the degree of motor dysfunction correlates with the obligatory nature of the negative NB. The negative NB observed in several of the patients did not occur until the second or third post-injury week. In addition, calculations of PEE by successively multiplying the Harris-Benedict equation by an activity factor of 1.2 and then by a stress factor of 1.6, resulted in excessive feeding (as assessed by metabolic cart measurements; ie indirect calorimetry) in the majority of the patients. In all of the 11 patients with persistent negative NBs, protein administration in the amount of 2 g/k of ideal body weight and aggressive caloric delivery did not alter the negative pattern of the NBs. Therefore, it is concluded that the negative NB following SCI is obligatory. Furthermore, the extent of SCI (extent of myelopathy or of neurological injury) correlates with the obligatory nature of the negative NB. In addition, the results from using the above method for estimating caloric requirements and the delayed manifestation of the negative NB may cause an additional tendency to acutely overfeed SCI patients. Therefore, eliminating the activity factor of 1.2 (due to the diminished activity arising from paralysis) and a diminution of the stress factor is recommended for initial PEE calculations. Serial metabolic cart (indirect calorimetry) measurements are recommended to accurately assess the patient's subsequent metabolic requirements.