George U. Liepa

Equations for the Estimation of Energy Expenditures in Patients with Burns with Special Reference to Ventilatory Status

There are advantages to the use of easily assessed variables for the prediction of energy expenditures of patients with burns. The purpose of this study was to determine whether height, age, sex, weight, ventilatory status, and diagnosis could be correlated with measured energy expenditures of hospitalized patients. With the use of data from 200 patients, stepwise, multivariate regression analysis derived the following equations: EEE(v) = 1925 - 10(A) + 5(W) + 281(S) + 292(T) + 851(B) (R2 = 0.43); EEE(s) = 629 - 11(A) + 25(W) - 609(O) (R2 = 0.50); where EEE = estimated energy expenditure (kcal/day), v = ventilatory dependency, s = spontaneously breathing, A = age (yr), W = body weight (kg), S = sex (male = 1, female = 0), diagnosis of T = trauma, B = burn, O = obesity present = 1, absent = 0). The equations were tested on 100 patients. Measured energy expenditures were not significantly different from calculated EEE(s) or EEE(v) (paired t test, p greater than 0.25). Energy expenditures can be accurately estimated in a variety of patients, including those with major burns with the use of easily attained information.

A Vegetarian Dietary Pattern as a Nutrient-Dense Approach to Weight Management: An Analysis of the National Health and Nutrition Examination Survey 1999-2004

BACKGROUND Population-based studies have shown that vegetarians have lower body mass index than nonvegetarians, suggesting that vegetarian diet plans may be an approach for weight management. However, a perception exists that vegetarian diets are deficient in certain nutrients. OBJECTIVE To compare dietary quality of vegetarians, nonvegetarians, and dieters, and to test the hypothesis that a vegetarian diet would not compromise nutrient intake when used to manage body weight. DESIGN Cross-sectional analysis of National Health and Nutrition Examination Survey (1999-2004) dietary and anthropometric data. Diet quality was determined using United States Department of Agricultures Healthy Eating Index 2005. Participants included adults aged 19 years and older, excluding pregnant and lactating women (N = 13,292). Lacto-ovo vegetarian diets were portrayed by intakes of participants who did not eat meat, poultry, or fish on the day of the survey (n = 851). Weight-loss diets were portrayed by intakes of participants who consumed 500 kcal less than their estimated energy requirements (n = 4,635). Mean nutrient intakes and body mass indexes were adjusted for energy, sex, and ethnicity. Using analysis of variance, all vegetarians were compared to all nonvegetarians, dieting vegetarians to dieting nonvegetarians, and nondieting vegetarians to nondieting nonvegetarians. RESULTS Mean intakes of fiber, vitamins A, C, and E, thiamin, riboflavin, folate, calcium, magnesium, and iron were higher for all vegetarians than for all nonvegetarians. Although vegetarian intakes of vitamin E, vitamin A, and magnesium exceeded that of nonvegetarians (8.3 ± 0.3 vs 7.0 ± 0.1 mg; 718 ± 28 vs 603 ± 10 μg; 322 ± 5 vs 281 ± 2 mg), both groups had intakes that were less than desired. The Healthy Eating Index score did not differ for all vegetarians compared to all nonvegetarians (50.5 ± 0.88 vs 50.1 ± 0.33, P = 0.6). CONCLUSIONS These findings suggest that vegetarian diets are nutrient dense, consistent with dietary guidelines, and could be recommended for weight management without compromising diet quality.

Effect of dietary animal and vegetable protein on gallstone formation and biliary constituents in the hamster

A gallstone-inducing diet was utilized to examine the effect of dietary proteins (casein, soybean and cottonseed) on gallstone formation. Casein produced gallstones in 100% of the animals; however, soybean or cottonseed proteins reduced gallstone incidence to 32% and 0%, respectively. In an effort to ascertain the mechanisms responsible for gallstone formation, serum cholesterol and the 3 primary biliary constituents (bile acids, phospholipids and cholesterol) were measured. Casein produced a 4-fold increase in biliary cholesterol, whereas soybean and cottonseed yielded a 3-and 2-fold increase, respectively, when compared to a commercial diet (Purina, no. 5001). Serum cholesterol was reduced by substituting dietary vegetable protein for animal protein. This study suggests that substitution of vegetable for animal protein in the diet can decrease gallstone formation in hamsters. It is proposed that this reduced gallstone formation is due to the decreased concentrations of biliary cholesterol induced by dietary modification.

Resting Energy Expenditures Measured by Indirect Calorimetry are Higher In Preadolescent Children with Cystic Fibrosis than Expenditures Calculated from Prediction Equations

OBJECTIVE This study compared measured resting energy expenditures to resting energy expenditures calculated using Harris-Benedict equations (HBEs) and the Cystic Fibrosis Consensus Committee equations (CFCCEs). DESIGN We studied 31 preadolescent boys and girls with cystic fibrosis who ranged in age from 3.25 to 12.75 years old. The patients were afebrile and not in pulmonary distress. Measured resting energy expenditures were determined using a portable metabolic measurement cart with fully automated calibration and data management. The measured resting energy expenditures obtained were compared with values obtained using HBEs and CFCCEs. RESULTS For each patient, the measured resting energy expenditure value was above the predicted resting energy expenditure values derived from HBEs (P < or = .0001) and CFCCEs (P < or = .01). APPLICATIONS The HBEs and the CFCCEs underestimated the energy expenditures of the study population by 13% and 8%, respectively. These findings support the usefulness of the measurement of energy expenditures in determining the energy needs of preadolescent patients with cystic fibrosis. In clinical practice, the resting energy expenditures would be multiplied by activity coefficients to determine the total daily energy expenditures of this population.

Effects of various dietary animal and vegetable proteins on serum and biliary lipids and on gallstone formation in the hamster

The objective of this study was to determine the effects of various dietary animal (casein, bovine albumin and egg albumin) and vegetable (soy, cottonseed and peanut) proteins on serum and biliary constitutents and gallstone formation in the hamster. Eighty-four hamsters (60±5g) were assigned to either a control group (Purina rat chow) or to one of the 6 experimental groups. Experimental diets contained 20.0% protein. With the exception of hamsters fed egg albumin, gallstone incidence was greater among hamsters fed animal proteins. Hamsters fed egg albumin exhibited a lower concentration of total serum cholesterol and HDL-cholesterol than most of the other experimental groups. There were no significant differences between experimental groups for either HDL3-cholesterol concentration or VLDL-LDL-cholesterol concentration. Bile acid concentrations within the vegetable protein-fed groups were significantly higher than within the animal protein-fed groups. Casein- and bovine albumin-fed hamsters showed a significantly higher percentage of biliary cholesterol in the bile fluid. As the percentage of biliary cholesterol increased, the percentage of bile acids was found to decrease.

Dietary protein effects on cholelithiasis in hamsters: Interaction with amino acids and bile acids

The objective of this experiment was to study the effects of dietary cottonseed protein and casein on plasma and biliary lipids, plasma amino acids and gallstones in hamsters. Thirty-four male hamsters (60 ± 5 g) were fed either the lithogenic “Dam Diet” (containing 20% casein, 74.3% sucrose and 5.7% vitamin-mineral mix) or a similar diet that contained 20% cottonseed protein for 30 days. Both diets contained protein as a protein isolate. The concentration of alpha-aminobutyric acid was significantly elevated in the casein-fed group. Significant differences in the total plasma cholesterol or lipoprotein cholesterol concentrations were not observed between the two dietary groups.A significant elevation in the absolute concentration of biliary cholesterol was observed in the casein-fed hamsters. Cottonseed protein-fed animals exhibited a significantly elevated concentration of bile acids. The ratio of glycochenodeoxycholic:glycocholic acid was significantly higher in the cotton-seed protein-fed group. This study reports that an elevated concentration of biliary cholesterol with a concomitant decrease in bile acid concentration yields a condition favorable to gallstone formation. It is proposed that cottonseed protein may have a specific effect on the bile acid pool by increasing the ratio of glycochenodeoxycholic acid:glycocholic acid which, in turn, prevents formation of cholesterol gallstones.

A Validation of Equations for Predicting the Energy Expenditures of Hospitalized Patients

Abstract Indirect calorimetry most accurately determines energy expenditures (EE) for the purpose of establishing nutrient requirements in hospitalized patients. However, the high costs associated with clinically using indirect calorimetry have renewed interest in predictive energy expenditure equations. We compared measured energy expenditures (MEEs) to those calculated by two commonly used equations: the Harris Benedict (HB) with a disease related adjustment factor of 1.2 (HB1.2) and the Ireton-Jones (IJ) in 120 patients (53 female/67 male). Patients were categorized according to the following diagnoses: burn (18%), non-burn trauma (30%), and non-trauma/non-burn (52%). Forty-one percent of the patients were ventilator dependent (VD). Overall there was no significant difference between the HB1.2 and the MEE. The HB1.2 correlated significantly with the MEE (r = 0.643, p=

Effects of ω-3 and ω-6 fatty acid-rich oils on the cardiovascular system of thermally injured rabbits: changes in plasma triglycerides, plasma cholesterol, relative blood viscosity, platelet count, and bleeding time

New Zealand white male rabbits were studied to determine how supplements of soybean oil, soybean + MaxEPA oil, or MaxEPA oil affected their cardiovascular status when they were burned. Plasma triglyceride concentrations increased at 2 hours after burn injury (28 days after supplement administration) and declined by the end of the study in all three experimental groups of rabbits. These same animals showed no noticeable differences in the plasma concentrations of total cholesterol or in the high-density lipoprotein cholesterol subfractions. Plasma low-density/very-low-density lipoprotein cholesterol levels remained unchanged at 2 hours after burn injury/sham treatment but increased by the end of the study in all three experimental groups of rabbits. The mean platelet number was significantly higher in burned/sham treated rabbits given soybean oil supplement as compared with numbers in those given either soybean oil + MaxEPA oil or MaxEPA oil supplement. Plasma relative viscosity was highest in the soybean oil-supplemented rabbits, decreased in animals fed soybean oil + MaxEPA, and lowest in MaxEPA oil-supplemented rabbits. Mean bleeding time was lowest in soybean oil-fed rabbits. The bleeding time was higher in rabbits fed soybean oil+MaxEPA oil and highest in MaxEPA oil-supplemented animals. Platelet number and plasma viscosity were highest in the soybean oil-supplemented rabbits and lowest in the MaxEPA oil-supplemented group. The reverse pattern occurred when bleeding time was established. Overall results obtained suggest that supplementation with oils rich in omega-3 and omega-6 fatty acids may have significant effects on the cardiovascular health of burned male New Zealand white rabbits.

The Effect of Nutrition Education on Anemic African American Children Enrolled in the WIC Program

Abstract Anemia is a serious problem for children who live in poverty in the United States. One group of particular concern is African American children. Findings from past studies indicate that African American children normally have lower Hemoglobin (Hb) concentrations when compared to Caucasian children of the same age. Studies over the last two decades have shown that the WIC Program (Special Supplemental Food Program for Women, Infants, and Children) has played an instrumental role in lowering the rate of anemia among participating children ages six months to five years. Fifty-one health records of African American children ages 1–5 were examined. Of this sample, n=47 were follow-up participants and n=4 were new WIC enrollees. Hb concentrations were compared at the beginning and end of the six month certification period of the following groups: control (n=25); experimental (n=12); and mixed experimental (n=14). The experimental group received individual counseling pertaining to iron rich foods at the beginning of the certification period, attended two special iron nutrition education classes, and were mailed a newsletter with menu ideas which contained iron rich foods. The mixed experimental group received the individual counseling and attended one of the iron classes. Pretest mean Hb values from each group were as follows: control 10.6; experimental 10.4; and mixed experimental 10.5. The post test mean scores of the three groups showed increases in Hb concentrations of 1.09, 1.25, and .70 g/dl respectively. A statistical difference was found among the control and experimental group. This study showed that concentrated nutrition education did have a positive effect on increasing the Hb concentrations among the groups tested. Because the control group showed to be significant, this leads one to believe that the WIC program as a whole reduced the rates of anemia.