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Effect of meat intake on zinc absorption, iron and zinc balance and indices of iron status
TUESDAY, OCTOBER 18 POSTER SESSION: CLINICAL NUTRITION INTERMEDIATES OF COENZYME A BIOSYNTHESIS IN COLON TISSUE: NORMAL VS INFLAMMATORY BOWEL DISEASE. J.W. Gloeckner, PhD, RD, Food Science and Human Nutrition, Colorado State University, Fort Collins, CO and R.A. Nelson, MD, PhD, Nutritional Sciences, University of Illinois, Urbana-Champaign, IL Colonic mucosal tissue removed from humans with chronic ulcerative colitis (CUC) or Crohn's disease of the colon (CD) has been shown previously to have significantly less coenzyme A (CoA) activity than that from patients with noninflammatory conditions. This study was an attempt to further investigate CoA in human idiopathic inflammatory bowel disease (IBD). Colon tissue, obtained at colectomy from 18 patients with CUC, 14 with Crohn's disease of the colon and 13 non-inflammatory conditions, was assayed for CoA, dephosphocoenzyme A (dpCoA), and 4'phosphopantetheine (PPaSH), key intermediates in the biosynthetic pathway of CoA from PA. Compounds were separated by high performance liquid chromatography and tagged with monobromobimane for fluorescence detection and quantification. Mean level of CoA determined for normal human colon was 19 9g/g tissue compared to 35 pg/g tissue from CUC patients and 109 g9/9tissue from CD patients. Mean tissue levels of dpCoA were 103 g9/9g for normal, 99 g9/9g for CUC, and 51 pg/g for CD. Mean tissue levels of PPaSH were 17 g/g in normal, 10 ug/g in CUC, and 6 g/g in CD tissue. The higher level of CoA for CD tissue differed significantly (p=O.02) by diagnosis. Directly measuring tissue levels of CoA and precursors historically has been difficult. This method successfully measured tissue levels of CoA and several intermediates in the biosynthetic pathway in both normal and diseased tissue. Additional work will be required to fully validate the method.
THE USE OF HIGH FAT DIETS FOR RAPID ADVANCEMENT OF ENTERAL FEEDINGS IN PATIENTS WITH SHORT BOWEL SYNDROME. T.L. Hays, MS, RD; L.E. Mattis, RN, MSN; J.M. Saavedra, MD; and K.G. Conner, RPh, Division of Gastroenterology and Nutrition, Johns Hopkins University School of Medicine, Baltimore, MD Low fat diets are frequently recommended for the dietary management of patients with short bowel syndrome (SBS). However, low fat feedings preclude increasing caloric density and total caloric intake in some SBS patients. We have assessed the use of high calorie, high fat diets in a group of SBS' patients in an attempt to transition them from parenteral nutrition (PN) to complete enteral nutrition (EN).
We have followed 13 SBS patients (8 females and 5 males) over the past two years in our Home Nutrition Support Service. Patients ranged in age from 1 mo to 7 years. Need for small bowel resection was attributed to: NEC (9), atresia (4), congenital short bowel (1), Hirschsprung's disease (1), and volvulus (1). Their residual small bowel after resection ranged from 7-60% of normal. In transitioning to complete EN, the initial enteral regimen consisted of slow drip feedings of protein hydrolysate formulas with high MCT oil. These feedings were increased in concentration to approximately 20 cal/oz and the rates increased daily as tolerated. Once stable, patients were followed as outpatients on a biweekly basis. At each visit, enteral feedings were advanced by either concentration or rate. Severe carbohydrate malabsorption often inhibited the advancement of formula concentration using standard formula or added carbohydrate. As a result, additional increases in caloric density were made with added MCT oil. We have concentrated formulas with MCT oil to provide up to 68 %of calories, the average being 58 + 6.6 %.Further adjustments with added soy fiber and oral rehydration solutions helped improve stool consistency and maintain electrolyte balance in some of these patients. Seven of the above patients transitioned to complete EN by 27 + 20 months (range 4-37 mo). Four patients remain on PN receiving between 30-85
%of nutrition support as EN. Two patients have died from liver failure before reaching 50 %of calories from EN.
The use of high fat diets has accelerated the advancement of enteral feedings in these patients. With this approach, the patients were able to reach 50% of their calories as enteral nutrition by 16 + 14 months (range 3-48 mo.)
Contrary to published reports supporting the use of low fat diets for SBS patients, in our population, high fat diets were successfully used to accelerate the transition of short bowel patients to cnmpnlte central ntrititnn
FACTORS PREDICTING BODY COMPOSITION IN POSTMENOPAUSAL WOMEN. C.J. Heiss, PhD, RD, C.F. Sanbom, PhD, D.L. Nichols, MS, and B.B. Alford, PhD, RD, Department of Food Science and Human Nutrition, Washington State University, Pullman, WA, Department of Nutrition and Food Sciences and Department of Kinesiology, Texas Woman's University, Denton, TX. Factors predicting body composition were determined in 52 postmenopausal caucasian women. Body composition was measured by performing a total body scan using dual energy x-ray absorptiometry (DXA). Height and weight were measured, and body mass index (BMI) was calculated. Body fat distribution was assessed by waist-to-hip ratio (WHR) and abdominal fat weight (between the iliac crest and L1) as determined by DXA. Hormones including total estradiol and testosterone and sex hormone binding globulin (SHBG) were determined by radioimmunoassay. Free androgen index (FAI) was calculated from total testosterone and SHBG. A health history questionnaire and 3 day diet record were completed by each subject. Stepwise multiple regression was performed to determine factors significantly associated with the dependent variables BMI, body weight, total fat weight, lean tissue weight, WHR, and abdominal fat weight. Age, number of children, total months breastfeeding, number of years estrogen deficient; caloric and macronutrient intakes, number of hours per week in aerobic exercise, and hormone concentrations were used as independent variables. SHBG was the only significant (negative) predictor of BMI and body weight, SHBG and caloric intake were significant (negative) predictors of total fat weight, SHBG and estradiol concentrations were significant (negative and positive, respectively) predictors of WHR, SHBG and carbohydrate intake were significant (negative) predictors of abdominal fat weight, and years estrogen deficient and SHBG were significant (negative) predictors of lean tissue weight, all at p<.05. In conclusion, SHBG seemed to be the most consistent predictor of body composition, and macronutrient intake was not a significant predictor of body composition except for caloric intake for total fat weight, and carbohydrate intake for abdominal fat weight in a negative manner in both cases.
EFFECT OF MEAT INTAKE ON ZINC ABSORPTION, IRON AND ZINC BALANCE AND INDICES OF IRON STATUS. J.R. Hunt, PhD, RD, B.S. Hoverson, S.K. Gallagher, L.K. Johnson and G.I. Lykken, PhD. USDA, ARS, Grand Forks Human Nutrition Research Center, Grand Forks, North Dakota The effects of meat intake on mineral balance, Zn absorption, and indices of nutritional status were investigated. Fourteen postmenopausal women, age (mean SD) 62.9 6.1 y, lived in a metabolic unit and consumed 3 weighed diets-high meat (HM), low meat (LM), or low meat with mineral supplements (LS)--for 7 wk each in random order. After 2 wk on each diet, Zn absorption from the entire 2-d menu was determined by extrinsic labeling with Zn-65 and whole body counting. Mineral balance was determined the last 18 d and blood collected the last d of each dietary period. The added meat in the HM diet was provided by beef, chicken, ham, and tuna, which replaced some fruit, simple sugars, and fat in the LM diet. The LM and HM diets contained, respectively, 10 and 20% protein, 61 and 52% carbohydrate, 29 and 28% fat (%of energy), and similar amounts (187 mg/2200 kcal) of ascorbic acid. For the LS diet, the LM diet was supplemented to be similar to the HM diet in K, P, Fe, Mg, and Zn. The HM, LM, and LS diets provided daily 12.1, 8.8, and 12.3 mg Fe (by analysis) and were associated with apparent absorption (diet Fe -stool Fe) of 3.1, 2.3, and 3.1 mg Fe (p<0.05), respectively. Percent apparent Fe absorption was the same on all diets (25%). The HM diet, compared to the LM or LS diets, was associated with lower serum fenitin (74 vs. 82 or 82 sg/L, p<0.02), higher Fe binding capacity (57.8 vs. 52.8 or 53.0 Ismol/L, p<0.002), and lower transferrin saturation (27.2 vs. 31.4 or 30.9%, p<0.03), with no difference in hematocrit, hemoglobin, erythrocyte Zn protoporphyrin, transferrin, or serum Fe. More Zn was absorbed from the HM diet (28% of 13.0 mg, or 3.6 mg Zn) compared to the LM (30% of 6.7 mg, or 2.0 mg Zn) or LS diet (18% of 11.6, or 2.1 mg Zn) (p<0.0001). Greater Zn absorption on the HM diet also was indicated by apparent absorption (2.1 vs. 0.2 and 0.9 mg, p<0.0002) and by urinary Zn (0.33 vs. 0.26 and 0.26 mg, p<0.0001, respectively), with no difference in plasma Zn. These results indicate no detectable difference in Fe balance with varying meat intake when Fe intake is constant. Blood indices of Fe status did not indicate better iron status with meat or iron intake, but seemed to be associated with dietary protein and carbohydrate. Zn absorptive efficiency was similar with varying meat intake, probably reflecting inhibition of Zn absorption by Zn, P, and other minerals provided by meat, which was counteracted by the enhancement of Zn absorption by meat protein. Supplementation with purified minerals, as may occur with food fortification, substantially reduced Zn absorption. The principal dietary determinants of both Fe and Zn retention from meat were the elemental Fe and Zn content. rather than other meat components that may affect bioavailability.
JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION / A-31
THE USE OF HIGH FAT DIETS FOR RAPID ADVANCEMENT OF ENTERAL FEEDINGS IN PATIENTS WITH SHORT BOWEL SYNDROME. T.L. Hays, MS, RD; L.E. Mattis, RN, MSN; J.M. Saavedra, MD; and K.G. Conner, RPh, Division of Gastroenterology and Nutrition, Johns Hopkins University School of Medicine, Baltimore, MD Low fat diets are frequently recommended for the dietary management of patients with short bowel syndrome (SBS). However, low fat feedings preclude increasing caloric density and total caloric intake in some SBS patients. We have assessed the use of high calorie, high fat diets in a group of SBS' patients in an attempt to transition them from parenteral nutrition (PN) to complete enteral nutrition (EN).
We have followed 13 SBS patients (8 females and 5 males) over the past two years in our Home Nutrition Support Service. Patients ranged in age from 1 mo to 7 years. Need for small bowel resection was attributed to: NEC (9), atresia (4), congenital short bowel (1), Hirschsprung's disease (1), and volvulus (1). Their residual small bowel after resection ranged from 7-60% of normal. In transitioning to complete EN, the initial enteral regimen consisted of slow drip feedings of protein hydrolysate formulas with high MCT oil. These feedings were increased in concentration to approximately 20 cal/oz and the rates increased daily as tolerated. Once stable, patients were followed as outpatients on a biweekly basis. At each visit, enteral feedings were advanced by either concentration or rate. Severe carbohydrate malabsorption often inhibited the advancement of formula concentration using standard formula or added carbohydrate. As a result, additional increases in caloric density were made with added MCT oil. We have concentrated formulas with MCT oil to provide up to 68 %of calories, the average being 58 + 6.6 %.Further adjustments with added soy fiber and oral rehydration solutions helped improve stool consistency and maintain electrolyte balance in some of these patients. Seven of the above patients transitioned to complete EN by 27 + 20 months (range 4-37 mo). Four patients remain on PN receiving between 30-85
%of nutrition support as EN. Two patients have died from liver failure before reaching 50 %of calories from EN.
The use of high fat diets has accelerated the advancement of enteral feedings in these patients. With this approach, the patients were able to reach 50% of their calories as enteral nutrition by 16 + 14 months (range 3-48 mo.)
Contrary to published reports supporting the use of low fat diets for SBS patients, in our population, high fat diets were successfully used to accelerate the transition of short bowel patients to cnmpnlte central ntrititnn
FACTORS PREDICTING BODY COMPOSITION IN POSTMENOPAUSAL WOMEN. C.J. Heiss, PhD, RD, C.F. Sanbom, PhD, D.L. Nichols, MS, and B.B. Alford, PhD, RD, Department of Food Science and Human Nutrition, Washington State University, Pullman, WA, Department of Nutrition and Food Sciences and Department of Kinesiology, Texas Woman's University, Denton, TX. Factors predicting body composition were determined in 52 postmenopausal caucasian women. Body composition was measured by performing a total body scan using dual energy x-ray absorptiometry (DXA). Height and weight were measured, and body mass index (BMI) was calculated. Body fat distribution was assessed by waist-to-hip ratio (WHR) and abdominal fat weight (between the iliac crest and L1) as determined by DXA. Hormones including total estradiol and testosterone and sex hormone binding globulin (SHBG) were determined by radioimmunoassay. Free androgen index (FAI) was calculated from total testosterone and SHBG. A health history questionnaire and 3 day diet record were completed by each subject. Stepwise multiple regression was performed to determine factors significantly associated with the dependent variables BMI, body weight, total fat weight, lean tissue weight, WHR, and abdominal fat weight. Age, number of children, total months breastfeeding, number of years estrogen deficient; caloric and macronutrient intakes, number of hours per week in aerobic exercise, and hormone concentrations were used as independent variables. SHBG was the only significant (negative) predictor of BMI and body weight, SHBG and caloric intake were significant (negative) predictors of total fat weight, SHBG and estradiol concentrations were significant (negative and positive, respectively) predictors of WHR, SHBG and carbohydrate intake were significant (negative) predictors of abdominal fat weight, and years estrogen deficient and SHBG were significant (negative) predictors of lean tissue weight, all at p<.05. In conclusion, SHBG seemed to be the most consistent predictor of body composition, and macronutrient intake was not a significant predictor of body composition except for caloric intake for total fat weight, and carbohydrate intake for abdominal fat weight in a negative manner in both cases.
EFFECT OF MEAT INTAKE ON ZINC ABSORPTION, IRON AND ZINC BALANCE AND INDICES OF IRON STATUS. J.R. Hunt, PhD, RD, B.S. Hoverson, S.K. Gallagher, L.K. Johnson and G.I. Lykken, PhD. USDA, ARS, Grand Forks Human Nutrition Research Center, Grand Forks, North Dakota The effects of meat intake on mineral balance, Zn absorption, and indices of nutritional status were investigated. Fourteen postmenopausal women, age (mean SD) 62.9 6.1 y, lived in a metabolic unit and consumed 3 weighed diets-high meat (HM), low meat (LM), or low meat with mineral supplements (LS)--for 7 wk each in random order. After 2 wk on each diet, Zn absorption from the entire 2-d menu was determined by extrinsic labeling with Zn-65 and whole body counting. Mineral balance was determined the last 18 d and blood collected the last d of each dietary period. The added meat in the HM diet was provided by beef, chicken, ham, and tuna, which replaced some fruit, simple sugars, and fat in the LM diet. The LM and HM diets contained, respectively, 10 and 20% protein, 61 and 52% carbohydrate, 29 and 28% fat (%of energy), and similar amounts (187 mg/2200 kcal) of ascorbic acid. For the LS diet, the LM diet was supplemented to be similar to the HM diet in K, P, Fe, Mg, and Zn. The HM, LM, and LS diets provided daily 12.1, 8.8, and 12.3 mg Fe (by analysis) and were associated with apparent absorption (diet Fe -stool Fe) of 3.1, 2.3, and 3.1 mg Fe (p<0.05), respectively. Percent apparent Fe absorption was the same on all diets (25%). The HM diet, compared to the LM or LS diets, was associated with lower serum fenitin (74 vs. 82 or 82 sg/L, p<0.02), higher Fe binding capacity (57.8 vs. 52.8 or 53.0 Ismol/L, p<0.002), and lower transferrin saturation (27.2 vs. 31.4 or 30.9%, p<0.03), with no difference in hematocrit, hemoglobin, erythrocyte Zn protoporphyrin, transferrin, or serum Fe. More Zn was absorbed from the HM diet (28% of 13.0 mg, or 3.6 mg Zn) compared to the LM (30% of 6.7 mg, or 2.0 mg Zn) or LS diet (18% of 11.6, or 2.1 mg Zn) (p<0.0001). Greater Zn absorption on the HM diet also was indicated by apparent absorption (2.1 vs. 0.2 and 0.9 mg, p<0.0002) and by urinary Zn (0.33 vs. 0.26 and 0.26 mg, p<0.0001, respectively), with no difference in plasma Zn. These results indicate no detectable difference in Fe balance with varying meat intake when Fe intake is constant. Blood indices of Fe status did not indicate better iron status with meat or iron intake, but seemed to be associated with dietary protein and carbohydrate. Zn absorptive efficiency was similar with varying meat intake, probably reflecting inhibition of Zn absorption by Zn, P, and other minerals provided by meat, which was counteracted by the enhancement of Zn absorption by meat protein. Supplementation with purified minerals, as may occur with food fortification, substantially reduced Zn absorption. The principal dietary determinants of both Fe and Zn retention from meat were the elemental Fe and Zn content. rather than other meat components that may affect bioavailability.
JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION / A-31