Whey protein supplementation improves body composition by modestly increasing lean mass without influencing changes in fat mass. Body composition improvements from WP are more robust when combined with ER .

There is a shift in thinking about dietary protein requirements from daily requirements to individual meal requirements. Per meal, stimulation of muscle protein synthesis has a saturable dose relationship with the quantity of dietary protein consumed. Protein intake above the saturable dose does not further contribute to the synthetic response; the “excess” amino acids are predominantly oxidized. Given that daily dietary protein intake is finite, finding protein distribution patterns that both reduce amino acid oxidation and maximize their contribution towards protein synthesis (in theory improving net balance) could be “optimal” and is of practical scientific interest to promote beneficial changes in skeletal muscle-related outcomes. This article reviews both observational and randomized controlled trial research on the protein distribution concept. The current evidence on the efficacy of consuming an “optimal” protein distribution to favorably influence skeletal muscle-related changes is limited and inconsistent. The effect of protein distribution cannot be sufficiently disentangled from the effect of protein quantity. Consuming a more balanced protein distribution may be a practical way for adults with marginal or inadequate protein intakes (<0.80 g·kg−1·d−1) to achieve a moderately higher total protein intake. However, for adults already consuming 0.8–1.3 g·kg−1·d−1, the preponderance of evidence supports that consuming at least one meal that contains sufficient protein quantity to maximally stimulate muscle protein synthesis, independent of daily distribution, is helpful to promote skeletal muscle health.

Background: Questions remain regarding both the safety and efficacy of bariatric surgery in patients with inflammatory bowel diseases (IBD), including the effects of bariatric surgery on the course of disease. We report a case series from a tertiary care IBD referral center and review the existing literature regarding the safety and efficacy of bariatric surgery in IBD patients. Objectives: Examine the safety and efficacy of bariatric surgery in IBD patients. Explore possible effects of weight loss on postoperative IBD course. Method: We performed a retrospective review of patients at our center undergoing bariatric surgery with a concurrent IBD diagnosis, collecting baseline characteristics, surgery type, and postoperative course (including IBD outcomes and weight loss). Data from these patients were combined with available data from the existing literature to calculate standardized means with standard error, variance, and confidence intervals (CI). Results: Data from 13 patients who had undergone bariatric surgery at our facility were combined with data from 8 other studies to create a study population of 101 patients. Of these, 61 had Crohn’s disease, 37 ulcerative colitis, and 3 IBD-unspecified, with a mean preoperative BMI of 44.2 (95% CI 42.9–45.7). Following surgery, a mean excess weight loss of 68.4% was demonstrated (95% CI, 65.7–71.2). Of the 101 patients, 22 experienced early and 20 experienced late postoperative complications. Postoperatively, 10 patients experienced a flare of IBD, 20 remained in remission, and 7 patients were able to discontinue immunosuppressive therapy. Conclusions: Based on available studies, bariatric surgery appears to be both an effective and safe option for weight loss in patients with IBD.

Under stressful conditions such as energy restriction (ER) and physical activity, the RDA for protein of 0.8 g · kg−1 · d−1 may no longer be an appropriate recommendation. Under catabolic or anabolic conditions, higher protein intakes are proposed to attenuate the loss or increase the gain of whole-body lean mass, respectively. No known published meta-analysis compares protein intakes greater than the RDA with intakes at the RDA. Therefore, we conducted a systematic review and meta-analysis to assess the effects of protein intakes greater than the RDA, compared with at the RDA, on changes in whole-body lean mass. Three researchers independently screened 1520 articles published through August 2018 using the PubMed, Scopus, CINAHL, and Cochrane databases, with additional articles identified in published systematic review articles. Randomized, controlled, parallel studies ≥6 wk long with apparently healthy adults (≥19 y) were eligible for inclusion. Data from 18 studies resulting in 22 comparisons of lean mass changes were included in the final overall analysis. Among all comparisons, protein intakes greater than the RDA benefitted changes in lean mass relative to consuming the RDA [weighted mean difference (95% CI): 0.32 (0.01, 0.64) kg, n = 22 comparisons]. In the subgroup analyses, protein intakes greater than the RDA attenuated lean mass loss after ER [0.36 (0.06, 0.67) kg, n = 14], increased lean mass after resistance training (RT) [0.77 (0.23, 1.31) kg, n = 3], but did not differentially affect changes in lean mass [0.08 (−0.59, 0.75) kg, n = 7] under nonstressed conditions (no ER + no RT). Protein intakes greater than the RDA beneficially influenced changes in lean mass when adults were purposefully stressed by the catabolic stressor of dietary ER with and without the anabolic stressor of RT. The RDA for protein is adequate to support lean mass in adults during nonstressed states. This review was registered at www.crd.york.ac.uk/prospero as CRD 42018106532.

Emerging research suggests that redistributing total protein intake from 1 high-protein meal/d to multiple moderately high-protein meals improves 24-h muscle protein synthesis. Over time, this may promote positive changes in body composition. We sought to assess the effects of within-day protein intake distribution on changes in body composition during dietary energy restriction and resistance training. In a randomized parallel-design study, 41 men and women [mean ± SEM age: 35 ± 2 y; body mass index (in kg/m): 31.5 ± 0.5] consumed an energy-restricted diet (750 kcal/d below the requirement) for 16 wk while performing resistance training 3 d/wk. Subjects consumed 90 g protein/d (1.0 ± 0.03 g · kg · d, 125% of the Recommended Dietary Allowance, at intervention week 1) in either a skewed (10 g at breakfast, 20 g at lunch, and 60 g at dinner; = 20) or even (30 g each at breakfast, lunch, and dinner; = 21) distribution pattern. Body composition was measured pre- and postintervention. Over time, whole-body mass (least-squares mean ± SE: -7.9 ± 0.6 kg), whole-body lean mass (-1.0 ± 0.2 kg), whole-body fat mass (-6.9 ± 0.5 kg), appendicular lean mass (-0.7 ± 0.1 kg), and appendicular fat mass (-2.6 ± 0.2 kg) each decreased. The midthigh muscle area (0 ± 1 cm) did not change over time, whereas the midcalf muscle area decreased (-3 ± 1 cm). Within-day protein distribution did not differentially affect these body-composition responses. The effectiveness of dietary energy restriction combined with resistance training to improve body composition is not influenced by the within-day distribution of protein when adequate total protein is consumed. This trial was registered at clinicaltrials.gov as NCT02066948.

Background Limited evidence suggests that consuming a higher-protein diet during weight loss improves subjective indices of sleep in overweight and obese adults. Objective We sought to a priori assess the effects of consuming the recommended versus a higher protein Healthy US-Style Eating Pattern during energy-restriction on sleep quality indices. Design Using a randomized, parallel study design, 51 adults (mean ± SEM age: 47 ± 1 y; BMI: 32.6 ± 0.5 kg/m2) consumed a controlled USDA Healthy US-Style Eating Pattern containing 750 kcal/d less than their estimated energy requirement for 12 wk. Participants were randomly assigned to consume either 5 or 12.5 oz-equivalent (eq)/d of protein foods. The additional 7.5 oz-eq/d came from animal-based protein sources and displaced primarily grains. Objective (wrist-worn actigraphy) and subjective (Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale) sleep quality indices were measured at baseline, week 6, and week 12. Results Among all participants, body mass decreased (−6.2 ± 0.4 kg). Dietary protein intake did not affect any objective or subjective sleep quality outcomes measured (repeated measures ANOVA). Over time, objective measures of time spent in bed, time spent sleeping, sleep onset latency, and time awake after sleep onset did not change; however, sleep efficiency improved (1 ± 1%; P = 0.027). Subjectively, global sleep scores [GSS: −2.7 ± 0.4 arbitrary units (au)] and daytime sleepiness scores (−3.8 ± 0.4 au; both P &lt; 0.001) improved over time. The GSS improvement transitioned the participants from being categorized with “poor” to “good” sleep (GSS: &gt;5 compared with ≤5 au of a 0–21 au scale; baseline 7.6 ± 0.4 au, week 12: 4.8 ± 0.4 au). Conclusions Although objective sleep quality may not improve, adults who are overweight or obese and poor sleepers may become good sleepers while consuming either the recommended or a higher-protein energy-restricted Healthy US-Style Eating Pattern. This trial was registered at clinicaltrials.gov as NCT03174769.

INTRODUCTION: Ustekinumab is a monoclonal antibody used in the treatment of Crohn's Disease that acts as an antagonist to interleukin-12 and interleukin-23. It is administered as a single intravenous infusion followed by subcutaneous maintenance dosing. There is paucity of literature evaluating the efficacy of repeating an intravenous infusion to recapture response among patients experiencing secondary loss of response to ustekinumab. We report on a cohort of patients who received a second intravenous ustekinumab loading dose after secondary loss of response at a large, academic IBD center. METHODS: We performed a retrospective cohort study of patients, who lost response to ustekinumab after initial intravenous standard induction followed by subcutaneous maintenance therapy and received a second intravenous ustekinumab loading dose following the standard weight-based dosing recommendations. We analyzed clinical and demographic characteristics of this patient population, including phenotype, prior therapies, and the efficacy of ustekinumab after the second infusion, including the subsequent maintenance dose after the second infusion. Response was defined as resolution or improvement of clinical symptoms that led to a second intravenous infusion. RESULTS: Among 372 patients treated with ustekinumab between 2016 and 2019, 18 (5%) patients received a second intravenous loading dose after experiencing secondary loss of response to their initial standard intravenous regimen. These patients had all failed prior biologic therapy and were placed on ustekinumab as second line (22%), third line (27%), fourth line (33%), fifth line (6%), or sixth line therapy (11%). After the second intravenous re-induction clinical response was observed in 15 patients (83%), whereas 3 (17%) patients did not respond and ustekinumab was stopped. Clinical and demographic characteristics of patients receiving a second loading dose are shown in Table 1. Among the 15 patients remaining on ustekinumab, 5 (33%) continued every 8-week dosing, 6 (40%) utilized every 6-week dosing, and 4 (27%) required every 4-week dosing regimens. CONCLUSION: A second intravenous ustekinumab loading dose is an effective strategy to recapture the therapeutic efficacy of ustekinumab after secondary loss of response. In addition, our data suggests that escalation in dosing frequency of maintenance subcutaneous therapy after a second intravenous loading dose should be considered for an ongoing durable response to ustekinumab.

The current protein requirement estimates in children were largely determined from studies using the nitrogen balance technique, which has been criticized for potentially underestimating protein needs. Indeed, recent advances in stable isotope techniques suggests protein requirement as much as 60% higher than current recommendations. Furthermore, there is not a separate recommendation for children who engage in higher levels of physical activity. The current evidence suggests that physical activity increases protein requirements to support accretion of lean body masses from adaptations to exercise. The indicator amino acid oxidation and the 15N-end product methods represent alternatives to the nitrogen balance technique for estimating protein requirements. Several newer methods, such as the virtual biopsy approach and 2H3-creatine dilution method could also be deployed to inform about pediatric protein requirements, although their validity and reproducibility is still under investigation. Based on the current evidence, the Dietary Reference Intakes for protein indicate that children 4–13 years and 14–18 years require 0.95 and 0.85 g·kg−1·day−1, respectively, based on the classic nitrogen balance technique. There are not enough published data to overturn these estimates; however, this is a much-needed area of research.