MediDrink Plus is an FSMP intended for the nutritional management of disease-related malnutrition.
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The numerous beneficial effects of a high energy intake include preventing the breakdown of proteins and going against cata-
bolic metabolism. Read more
A high protein intake helps keep albumin levels up and lower immune suppression caused by therapy, amongst other benefits. Read more
Decreasing the level of acute phase proteins and inflammatory cytokines is only one of the num
ber of benefits a high Omega-3 intake brings. Read more
According to current research providing energy from non-carbohydrate sources may have an indirect antiproliferative effect in cancer. Read more
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High protein |
A higher protein intake is also highly important for patients, for a number of reasons.
Also, a reduced nutritional intake combined with metabolic changes often lead to chronic negative protein balance in patients suffering from cachexia. 2
Containing 16 grams of protein per 200ml, MediDrink Plus supplies this majorly beneficial high protein intake.
Study:
Disease-related malnutrition is common, detrimentally affecting the patient and healthcare economy. Although use of high protein oral nutritional supplements (ONS) has been recommended to counteract the catabolic effects of disease and to facilitate recovery from illness, there has been a lack of systematically obtained evidence to support these recommendations.
Materials and Methods:
This systematic review involved 36 randomized controlled trials (RCT), and a series of meta-analyses of high protein ONS (>20% energy from protein).
Results:
The study demonstrated a range of effects across settings and patient groups in favour of the high protein ONS group. These included reduced complications (odds ratio (OR) 0.68 (95%CI 0.55-0.83), p<0.001, 10 RCT, n=1830); reduced readmissions to hospital (OR 0.59 (95%CI 0.41-0.84), p=0.004, 2 RCT, n=546); improved grip strength (1.76 kg (95%CI 0.36-3.17), p<0.014, 4 RCT, n=219); increased intake of protein (p<0.001) and energy (p<0.001) with little reduction in normal food intake and improvements in weight (p<0.001). There was inadequate information to compare standard ONS (<20% energy from protein) with high protein ONS (>20% energy from protein).
Conclusions:
This systematic review and meta-analysis provides evidence that high protein oral nutritional supplements produce clinical benefits, with economic implications.
Study:
The objective of the study was to investigate which dairy protein is able to positively influence the protein metabolic response to exercise in patients with chronic obstructive pulmonary disease (COPD).
Patients and Methods:
Eight COPD patients and 8 healthy subjects performed a cycle test 2 days while ingesting casein or whey protein. Whole body protein breakdown (WbPB), whole body protein synthesis (WbPS) and net protein synthesis (NetPS) were measured.
Results:
NetPS was higher during casein feeding in patients with COPD due to lower WbPB (p<0.05). In the healthy group, WbPS and NetPS were higher during casein than during whey feeding (p<0.01). Post-exercise, lower NetPS values were found independent of protein type in both groups.
Conclusions:
Casein resulted in more protein anabolism than whey protein which was maintained during and following exercise in COPD. Optimizing protein intake might be of importance for muscle maintenance during daily physical activities in COPD.
Study:
The objective of the study was to examine the net whole-body protein synthesis response to two milk protein meals with comparable absorption rates (hydrolyzed casein (hCAS) vs. hydrolyzed whey (hWHEY)) and the effects of co-ingesting leucine in patients with chronic obstructive pulmonary disease (COPD).
Patients and Methods:
Twelve COPD patients (GOLD stage II-IV) with nutritional depletion, were studied following intake of a 15 g hCAS or hWHEY protein meal with or without leucine-co-ingestion, according to a double-blind randomized cross-over design. The isotopic tracers L-[ring-(2)H5]-Phenylalanine, L-[ring-(2)H2]-Tyrosine, L-[(2)H3]-3-Methylhistidine (given via continuous intravenous infusion), and L-[(15)N]-Phenylalanine (added to the protein meals) were used to measure endogenous whole-body protein breakdown (WbPB), whole-body protein synthesis (WbPS), net protein synthesis (NetPS), splanchnic extraction and myofibrillar protein breakdown (MPB). Analyses were done in arterialized-venous plasma by LC/MS/MS.
Results:
WbPS was greater after intake of the hCAS protein meal p<0.05) whereas the hWHEY protein meal reduced WbPB more (p<0.01). NetPS was stimulated comparably, with a protein conversion rate greater than 70%. Addition of leucine did not modify the insulin, WbPB, WbPS or MPB response.
Conclusions:
Hydrolyzed casein and whey protein meals comparably and efficiently stimulate whole-body protein anabolism, while whole body protein synthesis was greater after hydrolyzed casein intake in COPD patients with nutritional depletion. Leucine co-ingestion produced no additional effect.
Study:
Dietary, environmental and genetic events may influence host susceptibility to inflammatory bowel diseases (IBD). Transforming growth factor beta 2 (TGF-beta 2), a multifunctional cytokine present in human and bovine milk, plays a critical role in the development of tolerance, the prevention of autoimmunity. The objective of this study was to determine whether a diet containing TGF-beta 2 modulates intestinal injury and immune responses in an interleukin-10 knockout (IL-10-/-) mouse model of IBD.
Materials and Methods:
Five-week-old IL-10-/- mice (in BALB/c background) were fed either an enteral diet (Diet-A) containing TGF-beta 2 or a control enteral diet (Diet-B) not rich in TGF-beta 2. Mice were weighed weekly, monitored for illness and euthanized after eight weeks on the diet.
Results:
Final weights were 28 +/- 1.2 g (58.2% gain) for Diet-A mice and 23 +/- 1.6 g (32.9% gain) for Diet-B mice (p=0.0194). The hematocrits were 48.3% for Diet-A compared to 42% for Diet-B mice (p=0.0021). Mice on Diet-A had significantly lower serum TNF-alpha concentrations. Forty-four percent of mice on Diet-B developed severe diarrhea and rectal prolapse compared with none on Diet-A. Evaluation of intestinal pathology (score 0-4) revealed that animals fed Diet-A had a score of 2.1 +/- 0.4 compared to 3.2 +/- 0.36 in the Diet-B group (p=0.040). The acute phase protein, serum amyloid A (SAA), was 3.8 times higher in the Diet-B group (p=0.0038).
Conclusions:
IL-10-/- mice fed a TGF-beta 2 containing diet gained more weight, did not develop diarrhea or prolapse, had lower pathological scores, and lower SAAs. These data further support the use of TGF-beta 2 containing enteral diets as one mode of therapy for Crohn's disease.
Study:
The objective of the publication is to report improvement of nutritional status by protein supplements in the patient with protein-losing enteropathy.
Patient:
The patient was a female whose age was 25 and underwent medical treatment of Crohn's disease, an inflammatory bowl disease, after diagnosis of cryptogenic multifocal ulcerous enteritis. The weight was 33.3 kg (68% of IBW) in the severe underweight and suffered from ascites and subcutaneous edema with hypoalbuminemia (1.3 g/dL) at the time of hospitalization. The patient consumed food restrictively due to abdominal discomfort. Despite various attempts of oral feeding, the levels of calorie and protein intake fell into 40-50% of the required amount, which was 800-900 kcal/d (24-27 kcal/kg/d) for calorie and 34 g/d (1 g/kg/d) for protein.
Therapy:
It was planned to supplement the patient with caloric supplementation (40-50 kcal/kg) and protein supplementation (2.5 g/kg) to increase body weight and improve hypoproteinemia. It was also planned to increase the level of protein intake slowly to target 55 g/d in about 2 weeks starting from 10 g/d and monitored kidney load with high protein supplementation. The weight loss was 1.0 kg when the patient was discharged from the hospital (hospitalization periods of 4 weeks), however, serum albumin was improved from 1.3 g/dL to 2.5 g/dL and there was no abdominal discomfort. She kept supplement of protein at 55 g/d for 5 months after the discharge from the hospital and kept it at 35 g/d for about 2 months and then 25 g/d. The body weight increased gradually from 32.3 kg (65% of IBW) to 44.0 kg (89% of IBW) by 36% for the period of F/u and serum albumin was kept above 2.8 g/dL without intravenous injection of albumin. The performance status was improved from 4 points of 'very tired' to 2 points of 'a little tired' out of 5-point scale measurement and the use of diuretic stopped from the time of 4th month after the discharge from the hospital owing to improvement in edema and ascites. During this period, the results of blood test such as BUN, Cr, and electrolytes were within the normal range.
Conclusions:
In conclusion, hypoproteinemia and weight loss were improved by increasing protein intake through utilization of protein supplements in protein-losing enteropathy.
Study:
A casein-based formula containing TGF-beta has been successfully used in adolescents during acute episodes of Crohn's disease. This study examined the capacity of a TGF-beta containing diet to control the intestinal inflammation in HLA-B27 transgenic rats, and compared its effects with a similar diet devoid of TGF-beta.
Materials and Methods:
Three groups of rats were studied. HLA-B27/hbeta2M transgenic rats were fed with a casein-based rat-adapted diet containing TGF-beta or a control casein-based diet without TGF-beta. Fischer control animals were fed the latter. Body weight, dietary intake, tissue weights, fecal samples, leukocyte counts, and acute phase response were analyzed. Intestinal inflammation was assessed by histology, myeloperoxidase, and mRNA expression of cytokines. Breakdown of muscle protein was examined.
Results:
The test diet improved diarrhea increasing the fecal dry matter and the colonic inflammation as shown by a lower inflammatory score (2.43±1.13 vs 4.42±0.53, p<0.05), lower mucosal thickness (431.25 ±72.29 vs 508.57±81.32 μm, p=0.08) and decreased interferon-gamma mRNA expression. The test diet also decreased leukocytosis and the acute phase response and improved the muscle catabolic response.
Conclusions:
The TGF-beta containing diet has a beneficial effect in an animal model of intestinal inflammation.
Study:
A known barrier for ONS use among elderly is the volume that needs to be consumed, resulting in low compliance and thus reduced effectiveness. This randomized controlled intervention trial aimed to investigate the effects of a low-volume, energy- and nutrient-dense ONS on nutritional status, functionality, and quality of life (QoL) of nursing home residents.
Patients and Methods:
Nursing home residents affected by malnutrition or at risk of malnutrition were randomly assigned to intervention (IG) and control group (CG), receiving 2 × 125 mL ONS (600 kcal, 24 g protein) per day and routine care, respectively, for 12 weeks. Nutritional (weight, body mass index [BMI], upper arm and calf circumferences, MNA-SF) and functional parameters (handgrip strength, gait speed, depressive mood [GDS], cognition [MMSE], activities of daily living [Barthel ADL]) as well as QoL (QUALIDEM) were assessed at baseline (T1) and after 12 weeks (T2). ONS intake was registered daily and compliance calculated.
Results:
A total of 77 residents (87±6 years, 91% female) completed the study; 78% had dementia (MMSE <17) and 55% were fully dependent (ADL≤30). Median compliance was 73% (IQR 23.5%-86.5%) with median intake of 438 (141-519) kcal/day. Body weight, BMI, and arm and calf circumferences increased in the IG (n=42) and did not change in the CG (n=35). Changes of all nutritional parameters except MNA-SF significantly differed between groups in favor of the IG (p<0.05). GDS, handgrip strength, and gait speed could not be assessed in 46%, 38%, and 49% of participants at T1 and/or T2, because of immobility and cognitive impairment. In residents able to perform the test at both times, functionality remained stable in IG and CG, except for ADLs, deteriorating in both groups. From 10 QoL categories, "positive self-perception" increased in IG (78 [33-100] to 83 [56-100]; p<0.05) and tended to decrease in CG (100 [78-100] to 89 [56-100]; p=0.06), "being busy" significantly dropped in CG (33 [0-50] to 0 [0-50]; p<0.05).
Conclusions:
Low-volume, nutrient- and energy-dense ONS were well accepted among elderly nursing home residents with high functional impairment and resulted in significant improvements of nutritional status and, thus, were effective to support treatment of malnutrition.
Study:
The aim was to study the effects of oral nutritional supplements (OS) on body weight, body composition, nutritional status, and cognition in elderly patients with Alzheimer's disease (AD) in a prospective, randomized, controlled study at geriatric wards and day care centers in the Toulouse area, France.
Patients and Methods:
Ninety-one subjects with AD aged 65 and older at risk of undernutrition were evaluated using the Mini Nutritional Assessment. After randomization, 46 patients (intervention group) received 3-month OS. The other 45 patients (control group) received usual care. Weight, body composition (evaluated using dual-energy x-ray absorptiometry), cognitive function, activities of daily living, eating behavior, and dietary intakes were evaluated at the beginning of the study and at 3 months and 6 months. Supplement compliance was recorded each day.
Results:
Between baseline and 3 months, energy and protein intakes significantly improved in the intervention group, resulting in a significant increase in weight and fat-free mass, but no significant changes were found for dependence, cognitive function, or biological markers. The nutritional benefit was maintained in the intervention group after discontinuation of OS at 3 months.
Conclusions:
Three-month daily OS significantly improves body weight. It is practicable and effective, and the patients accepted it well. The improvement that was observed even in the control group showed that caregiver education is an important factor in maintaining the nutritional status of patients with AD. Moreover, regular courses of OS may help maintain the increase in fat-free mass and improve the nutritional status of these patients.
Study:
The aim of this prospective observational study was to improve the precision and reliability of estimates of the association between preoperative serum albumin concentration and surgical outcomes.
Patients and Methods:
A total of 54,215 major non-cardiac surgery cases from the National VA Surgical Risk Study were included. Patients were followed up for 30 days postoperatively. Multiple logistic regression models were developed to evaluate serum albumin level as a predictor of 30-day operative mortality and morbidity in relation to 61 other preoperative patient risk variables.
Results:
A decrease in serum albumin from concentrations greater than 46 g/L to less than 21 g/L was associated with an exponential increase in mortality rates from less than 1% to 29% and in morbidity rates from 10% to 65%. In the regression models, albumin level was the strongest predictor of mortality and morbidity for surgery as a whole and within several subspecialties selected for further analysis. Albumin level was a better predictor of some types of morbidity, particularly sepsis and major infections, than other types.
Conclusions:
Serum albumin concentration is a better predictor of surgical outcomes than many other preoperative patient characteristics. It is a relatively low-cost test that should be used more frequently as a prognostic tool to detect malnutrition and risk of adverse surgical outcomes, particularly in populations in whom comorbid conditions are relatively frequent.
