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The nature of nutrition
Nutrition has long been considered more the domain of medicine and agriculture than of the biological sciences, yet it touches and shapes all aspects of the natural world. The need for nutrients determines whether wild animals thrive, how populations evolve and decline, and how ecological communities are structured.The Nature of Nutritionis the first book to address nutrition's enormously complex role in biology, both at the level of individual organisms and in their broader ecological interactions.
Stephen Simpson and David Raubenheimer provide a comprehensive theoretical approach to the analysis of nutrition--the Geometric Framework. They show how it can help us to understand the links between nutrition and the biology of individual animals, including the physiological mechanisms that determine the nutritional interactions of the animal with its environment, and the consequences of these interactions in terms of health, immune responses, and lifespan. Simpson and Raubenheimer explain how these effects translate into the collective behavior of groups and societies, and in turn influence food webs and the structure of ecosystems. Then they demonstrate how the Geometric Framework can be used to tackle issues in applied nutrition, such as the problem of optimizing diets for livestock and endangered species, and how it can also help to address the epidemic of human obesity and metabolic disease
Drawing on a wealth of examples from slime molds to humans,The Nature of Nutritionhas important applications in ecology, evolution, and physiology, and offers promising solutions for human health, conservation, and agriculture.
eBook
Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate
Dietary Reference Intakes
for Water, Potassium, Sodium, Chloride, and Sulfate
The Dietary Reference Intakes (DRIs) are quantitative estimates of nutrient
intakes to be used for planning and assessing diets for healthy people. This
new report, the sixth in a series of reports presenting dietary reference values
for the intakes of nutrients by Americans and Canadians, establishes
nutrient recommendations on water, potassium, and salt for health maintenance
and the reduction of chronic disease risk.
Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate
discusses in detail the role of water, potassium, salt, chloride, and sulfate in
human physiology and health. The major findings in this book include the
establishment of Adequate Intakes for total water (drinking water, beverages,
and food), potassium, sodium, and chloride and the establishment of
Tolerable Upper Intake levels for sodium and chloride. The book makes
research recommendations for information needed to advance the understanding
of human requirements for water and electrolytes, as well as
adverse effects associated with the intake of excessive amounts of water,
sodium, chloride, potassium, and sulfate. This book will be an invaluable
reference for nutritionists, nutrition researchers, and food manufacturers.
eBook
Sports nutrition for young athletes
Details best sports nutrition for young athletes, including meal plans, recipes and discussion of body mass index.
Book
The \ComPAS Trial\ combined treatment model for acute malnutrition: study protocol for the economic evaluation
Background
Acute malnutrition is currently divided into severe (SAM) and moderate (MAM) based on level of wasting. SAM and MAM currently have separate treatment protocols and products, managed by separate international agencies. For SAM, the dose of treatment is allocated by the child’s weight. A combined and simplified protocol for SAM and MAM, with a standardised dose of ready-to-use therapeutic food (RUTF), is being trialled for non-inferior recovery rates and may be more cost-effective than the current standard protocols for treating SAM and MAM.
Method
This is the protocol for the economic evaluation of the ComPAS trial, a cluster-randomised controlled, non-inferiority trial that compares a novel combined protocol for treating uncomplicated acute malnutrition compared to the current standard protocol in South Sudan and Kenya. We will calculate the total economic costs of both protocols from a societal perspective, using accounting data, interviews and survey questionnaires. The incremental cost of implementing the combined protocol will be estimated, and all costs and outcomes will be presented as a cost-consequence analysis. Incremental cost-effectiveness ratio will be calculated for primary and secondary outcome, if statistically significant.
Discussion
We hypothesise that implementing the combined protocol will be cost-effective due to streamlined logistics at clinic level, reduced length of treatment, especially for MAM, and reduced dosages of RUTF. The findings of this economic evaluation will be important for policymakers, especially given the hypothesised non-inferiority of the main health outcomes. The publication of this protocol aims to improve rigour of conduct and transparency of data collection and analysis. It is also intended to promote inclusion of economic evaluation in other nutrition intervention studies, especially for MAM, and improve comparability with other studies.
Trial Registration
ISRCTN
30393230
, date: 16/03/2017.
Journal Article
Combined Protocol for Acute Malnutrition Study (ComPAS) in rural South Sudan and urban Kenya: study protocol for a randomized controlled trial
Background
Acute malnutrition is a continuum condition, but severe and moderate forms are treated separately, with different protocols and therapeutic products, managed by separate United Nations agencies. The Combined Protocol for Acute Malnutrition Study (ComPAS) aims to simplify and unify the treatment of uncomplicated severe and moderate acute malnutrition (SAM and MAM) for children 6–59 months into one protocol in order to improve the global coverage, quality, continuity of care and cost-effectiveness of acute malnutrition treatment in resource-constrained settings.
Methods/design
This study is a multi-site, cluster randomized non-inferiority trial with 12 clusters in Kenya and 12 clusters in South Sudan. Participants are 3600 children aged 6–59 months with uncomplicated acute malnutrition. This study will evaluate the impact of a simplified and combined protocol for the treatment of SAM and MAM compared to the standard protocol, which is the national treatment protocol in each country. We will assess recovery rate as a primary outcome and coverage, defaulting, death, length of stay, average weekly weight gain and average weekly mid-upper arm circumference (MUAC) gain as secondary outcomes. Recovery rate is defined across both treatment arms as MUAC ≥125 mm and no oedema for two consecutive visits. Per-protocol and intention-to-treat analyses will be conducted.
Discussion
If the combined protocol is shown to be non-inferior to the standard protocol, updating guidelines to use the combined protocol would eliminate the need for separate products, resources and procedures for MAM treatment. This would likely be more cost-effective, increase availability of services, enable earlier case finding and treatment before deterioration of MAM into SAM, promote better continuity of care and improve community perceptions of the programme.
Trial registration
ISRCTN,
ISRCTN30393230
. Registered on 16 March 2017.
Journal Article
Role of Disease and Macronutrient Dose in the Randomized Controlled EPaNIC Trial
Early parenteral nutrition to supplement insufficient enteral feeding during intensive care (early PN) delays recovery as compared with withholding parenteral nutrition for 1 week (late PN).
To assess whether deleterious effects of early PN relate to severity of illness or to the dose or type of macronutrients.
Secondary analyses of a randomized controlled trial (EPaNIC; n = 4,640) performed in seven intensive care units from three departments in two Belgian hospitals. In part 1, all patients were included to assess the effect of the randomized allocation to early PN or late PN in subgroups of patients with increasing-on-admission severity of illness. In part 2, observationally, the association of the amount and type of macronutrients with recovery was documented in those patient cohorts still present in intensive care on Days 3, 5, 7, 10, and 14.
The primary end point was time to live discharge from the intensive care unit. For part 1, a secondary end point, acquisition of new infections, was also analyzed. All statistical analyses were performed by univariable and adjusted multivariable methods. In none of the subgroups defined by type or severity of illness was a beneficial effect of early PN observed. The lowest dose of macronutrients was associated with the fastest recovery and any higher dose, administered parenterally or enterally, was associated with progressively more delayed recovery. The amount of proteins/amino acids rather than of glucose appeared to explain delayed recovery with early feeding.
Early combined parenteral/enteral nutrition delayed recovery irrespective of severity of critical illness. No dose or type of macronutrient was found to be associated with improved outcome. Clinical trial registered with www.clinicaltrials.gov (NCT 00512122).
Journal Article