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role=”button” tabindex=”0″>9:19This video explains the nitrogen balance concept. Nitrogen balance is the amount of nitrogen that gets into our body in the form of proteins …YouTube · Dr.Mungli · Apr 4, 202010 key moments in this videoMissing: condition likely produce
Balance – an overview
Nutritional Principles and Assessment of the Gastroenterology Patient
Mark Feldman MD, in Sleisenger and Fordtran’s Gastrointestinal and Liver Disease, 2021
Nitrogen (N) balance is commonly used as a proxy measure of protein balance (i.e., whether the quantity of protein [or AAs] taken in is sufficient to prevent any net loss of protein). N balance is calculated as the difference between N intake and N losses in urine, stool, skin, and body fluids. In the clinical setting, it can be conveniently calculated as follows for adults:
Every 6.25 g of administered protein (or AAs) contains approximately 1 g of N. The additional 4 g of N loss incorporated into the equation is intended to account for the insensible losses from the other sources listed and because urinary urea N only accounts for approximately 80% of total urinary nitrogen. N balance is a suitable surrogate for protein balance, because roughly 98% of total body N is in protein, regardless of one’s health.
A positive N balance (i.e., intake > loss) represents anabolism and a net increase in total body protein, whereas a negative N balance represents net protein catabolism. For example, a negative N balance of 1 g/day represents a 6.25 g/day loss of body protein, which is equivalent to a 30 g/day loss of hydrated lean tissue. In practice, N balance studies tend to be artificially positive because of overestimation of dietary N intake and underestimation of losses due to incomplete urine collections and unmeasured outputs. It is best to wait at least 4 days after a substantial change in protein delivery before N balance is determined, because a labile N pool exists and this tends to dampen and retard changes that otherwise would be observed as a result of altered protein intake.
Nutritional Care of the Spinal Cord–Injured Patient
Christine L. Hammer, … James S. Harrop, in Benzel’s Spine Surgery, 2-Volume Set (Fourth Edition), 2017
Nitrogen Balance and Nitrogen Turnover
Nitrogen balance (NB), or nitrogen equilibrium, occurs when nitrogen intake equals nitrogen output (NB = 0).24 A positive NB or anabolic state exists when nitrogen intake exceeds nitrogen output. A net 24-hour positive NB of 2 to 4 g is optimal for anabolism. When nitrogen excretion is greater than nitrogen intake, a negative NB or catabolic state exists.
NB can be calculated by subtracting the total nitrogen output from the total nitrogen intake. The total nitrogen intake is determined by dividing the daily protein intake (grams) from both enteral and parenteral sources by 6.25.78 Nitrogen output consists primarily of urine urea nitrogen (UUN). An aliquot of a 24-hour urine collection is assayed for its urea nitrogen content by a standard enzymatic laboratory technique (Beckman Astra; Beckman Instruments, Fullerton, CA).3 This value, plus 4 (the constant used for nitrogen losses from the skin and feces), is subtracted from the grams of nitrogen intake during the same 24-hour period to calculate the NB, as demonstrated in the following equation:
The provision of inadequate calories forces the body to break down muscle mass to meet energy demands. This muscle breakdown results in the nitrogenous by-products urea, creatinine, and 3-methylhistidine, which are excreted in the urine.31 Endogenous protein stores are also used as an amino acid supply when insufficient exogenous protein is provided; therefore, increasing calorie and protein deliveries can minimize net protein losses. Glucocorticoid administration also can increase the catabolism of protein. In this situation, the catabolized protein fuels gluconeogenesis.26
After non-SCI major trauma and surgery, REE and nitrogen excretion levels are parallel. However, in patients with SCI, calorie needs decrease, whereas urinary nitrogen losses, primarily from muscle tissue,9 increase in proportion to the severity of the SCI.9 This negative NB arises in the spinal cord–injured population despite more-than-adequate calorie and protein administration.6,30 The phenomenon has also been observed in severe cases of botulism poisoning that have resulted in muscle paralysis.86
Nitrogen losses after SCI are obligatory and persist for at least 7 weeks.6,9,87 Peak negative NB has been previously observed in patients with SCI during the third week after injury, despite adequate delivery of predicted and measured calories.34 Cooper and Hoen9 reported that urinary nitrogen excretion of greater than 25 g/day during the first 2 postinjury weeks is a poor prognostic sign for the eventual functional return of paralyzed muscles. In some patients the administration of growth hormone has reduced nitrogen loss.88 Growth hormone studies after SCI, however, have not been conducted.
During the first week after injury, many patients with SCI have been observed to experience a transiently positive NB.6 This observation may reflect a delay in protein losses. Dietrick and Shorr89 evaluated four conscientious objectors who were immobilized in pelvic girdles and leg casts for 6 to 7 weeks on a metabolism ward. All four subjects showed an increase in nitrogen excretion and negative NBs. This, however, took 4 to 5 days to develop. From the data they presented, it is concluded that acute immobilization could contribute to the increased nitrogen excretion observed in paralyzed patients that begins approximately 1 week after injury. Rodriguez and coworkers34 showed an obligatory negative NB in 11 of 12 patients with SCI, despite excessive feedings, and the only patient who did not have a negative NB had an incomplete myelopathy. They concluded that relying on NB determinations to calculate nutritional requirements in patients with SCI resulted in overfeeding.
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Metabolism in Surgical Patients
Courtney M. Townsend JR., MD, in Sabiston Textbook of Surgery, 2022
Biology of Acute Catabolism: Protein Wasting and Nitrogen Balance
The most obvious change in critical illness is the breakdown of protein within lean body mass.29,30 Unlike fats and carbohydrates, the body does not have a mechanism for the long-term storage of free amino acids and instead liberates them from structural proteins throughout the skeletal muscle.3 The degree of protein turnover can be understood in its most raw form as a daily nitrogen balance:
Nutrition and Metabolism in the Critically Ill Child with Cardiac Disease
Aaron L. Zuckerberg MD, Maureen A. Lefton-Greif PhD, in Critical Heart Disease in Infants and Children (Second Edition), 2006
Nitrogen balance reflects the equilibrium between protein intake and losses. Stress produces nitrogen losses, driven by the catabolic actions of cortisol and epinephrine. Skeletal muscle breakdown provides substrate for gluconeogenesis and also releases nonessential amino acids that are excreted in the urine as urea. All patients with PEM have a negative nitrogen balance. The magnitude of the negative balance is useful in determining the process leading to the patient’s malnourished state. In hypermetabolism, tissue is being catabolized for gluconeogenesis and wound repair. Acute negative nitrogen balance is the rule. Chronic starvation leads to a modestly negative nitrogen balance.67 Drainage of proteinaceous fluids from other body cavities will further increase nitrogen loss.
Although serum protein concentrations (particularly albumin and transferrin) have been used as biochemical markers of nutritional status, these tests are neither sensitive nor specific. Albumin and transferrin do not discriminate growth-retarded children with congenital heart disease from their normal weight cohorts.172,202 Because of a uniform water loss as well as cellular mass, isolated starvation changes plasma protein concentration only when depletion is severe. Hypermetabolism is associated with negative nitrogen balance, but hypoalbuminemia requires prolonged hypermetabolism because of the long half-life of albumin (20 days) (Table 15-4). Hypoalbuminemia in the face of a hypermetabolic state is associated with increased risk of death. The shorter half-life proteins such as retinol binding protein and prealbumin correlate better with acute changes in critically ill patients.
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Introduction to Glomerular Disease : Clinical Presentations
John Feehally DM, FRCP, in Comprehensive Clinical Nephrology, 2019
Negative Nitrogen Balance
The heavy proteinuria leads to marked negative nitrogen balance, usually measured in clinical practice by serum albumin. Nephrotic syndrome is a wasting illness, but the degree of muscle loss is masked by edema and not fully apparent until the patient is rendered edema free. Loss of 10% to 20% of lean body mass can occur. Albumin turnover is increased in response to the tubular catabolism of filtered protein rather than merely to urinary protein loss. Increasing protein intake does not improve albumin metabolism because the hemodynamic response to an increased intake is a rise in glomerular pressure, increasing urine protein losses. A low-protein diet in turn will reduce proteinuria, but also reduces the albumin synthesis rate and in the longer term may increase the risk for a worsening negative nitrogen balance.
Protein Nutrition and Status and Bariatric Surgery
V. Moizé, … J. Vidal, in Metabolism and Pathophysiology of Bariatric Surgery, 2017
NB methodology is a measure of the net status of protein metabolism. It does not provide information on the size of protein stores or nutritional status . However, it provides a holistic assessment of protein balance, allowing insight into the relationship between energy status, dietary protein, and FFM. Several factors may precipitate a negative NB in the BS setting. These include inadequate protein or energy intakes, imbalance in the nonessential/essential AA ratio, accelerated protein catabolism, and excessive diarrhea. A negative energy balance may have a negative and direct effect on the protein synthesis rate and, consequently, on SM mass.
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Nutrition and Metabolism in the Critically Ill Child With Cardiac Disease
Darla Shores MD, … Samuel M. Alaish MD, in Critical Heart Disease in Infants and Children (Third Edition), 2019
Nitrogen balance reflects the equilibrium between protein intake and losses. Stress produces nitrogen losses, driven by the catabolic actions of cortisol and epinephrine. Skeletal muscle breakdown provides substrate for gluconeogenesis and also releases nonessential amino acids that are excreted in the urine as urea. All patients with PEM have a negative nitrogen balance. The magnitude of the negative balance is useful in determining the process leading to the patient’s malnourished state. In hypermetabolism, tissue is being catabolized for gluconeogenesis and wound repair. Acute negative nitrogen balance is the rule. Chronic starvation leads to a modestly negative nitrogen balance.91 Drainage of proteinaceous fluids from other body cavities will further increase nitrogen loss.
Although serum protein concentrations (particularly albumin and transferrin) have been used as biochemical markers of nutritional status, these tests are neither sensitive nor specific. Hypermetabolism is associated with negative nitrogen balance, but hypoalbuminemia requires prolonged hypermetabolism because of the long half-life of albumin (20 days) (Table 26.5). Hypoalbuminemia in the face of a hypermetabolic state is associated with increased risk of death. The shorter half-life proteins such as retinol-binding protein and prealbumin correlate better with acute changes in critically ill patients. However, prealbumin levels can be affected by several factors. Lower levels may be seen in liver disease, or they may be falsely elevated in renal failure and steroid use. Visceral proteins such as albumin and prealbumin do not accurately reflect nutritional status and response to nutritional intervention during inflammation. During periods of inflammation the liver reprioritizes synthesis of acute-phase proteins such as C-reactive protein (CRP) over transport proteins such as prealbumin. Therefore levels of serum prealbumin and CRP are inversely related. For the postoperative infant, decreases in serum CRP level to less than 2 mg/dL have been associated with the return of anabolic metabolism and are followed by increases in serum prealbumin levels.92
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Amino Acids and Nitrogen Compounds
Martin Kohlmeier, in Nutrient Metabolism (Second Edition), 2015
Nitrogen balance: Healthy adults usually maintain constant lean body mass and neither accumulate protein nor lose protein mass. Since their combined nitrogen intake (mainly as protein) more or less equals their nitrogen losses, they are said to be in nitrogen balance.
Growing children and adolescents accumulate nitrogen and are therefore said to be in positive nitrogen balance. Starving, immobilized, and severely ill people, in contrast, break down tissue protein and lose more nitrogen than they take in; they are said to be in negative nitrogen balance.
Glucagon, catecholamines, cortisol, thyroid hormones, and cytokines promote the breakdown of tissue protein and its use for gluconeogensis. Excessive release of cytokines, such as tumor necrosis factor, interleukin 1 (IL-1), and interleukin 6 (IL-6), may be responsible for the accelerated protein catabolism in conditions such as tumor cachexia, but the details are not well understood (Tisdale, 1998). Several hormones promote protein synthesis (anabolic hormones), including insulin, insulin-like growth factor 1 (IGF-1), growth hormone, and testosterone. Muscle use and the abundance of free amino acids (especially BCAAs) are potent determinants of the rate of protein synthesis in muscle (Tipton et al., 2001). Leucine and its metabolites increase protein synthesis (Wilkinson et al., 2013) by activating a distinct signaling cascade (Anthony et al., 2001; Liu et al., 2001) that includes ribosomal protein S6 kinase (S6K1) and eukaryotic initiation factor 4E binding protein 1 (4E-BPI).
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Protein and Amino Acids in Human Nutrition
L. Hambræus, in Reference Module in Biomedical Sciences, 2014
Nitrogen Balance Studies
Nitrogen balance represents the net result of the continuous ongoing protein anabolism and catabolism in the body, but gives no information whatsoever of its etiology. The balance is influenced not only of the protein intake in relation to the nitrogen losses from the body but also by the protein quality of the dietary protein and the energy balance. Thus comparing nitrogen balance obtained with different diets and protein sources must also be related to the energy balance.
Furthermore, nitrogen balance studies do not make it possible to evaluate the etiology to the changes in protein balance, that is, low protein quality, low energy intake, or endogenous changes in the regulation of protein turnover.
The facultative method for the determination of protein needs is based on the analysis of the obligatory nitrogen losses in urine, feces, and from skin and endothelium in adults. The dominant and most varying nitrogen losses in relation to protein intake occur in the urine. Thus the losses in nitrogen balance studies are in practice usually based on nitrogen analysis in 24-h urine specimens, while the losses through feces and skin are based on standard values. Originally, obligatory nitrogen losses were determined when adult males were given a protein-free diet. The validity of such data can be questioned as a protein-free diet results in protein catabolism. Consequently the so-called obligatory losses might be higher than when the person is in nitrogen balance. This is illustrated in Table 5, which shows that the lowest losses are obtained at a low-protein diet, which still maintained protein balance. The table also illustrates that urea is related to protein intake. This has been confirmed in studies under strict energy balance control over widely varying protein intakes (Young et al., 2000).
Table 5. Nitrogen losses in urine
|High-protein diet||Low-protein diet||After 2 days fasting|
|Total N loss (g N per 24 h)||17||4||9|
|Thereof in %|
Source: Adapted data from Munro, H.N., Allison, J.B. (eds.), 1964. Mammalian Protein Metabolism, vol. I. Academic Press, New York.
During pregnancy and lactation the nitrogen costs for building new tissue can be calculated in relation to the growth of fetus, placenta, and uterus during the three trimesters as well as by analyzing the milk composition and production. During growth the nitrogen in the new tissues can likewise be calculated in the facultative method.
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PROTEIN | Requirements
A.E. Bender, in Encyclopedia of Food Sciences and Nutrition (Second Edition), 2003
Nitrogen Balance Method
Nitrogen balance is the difference between nitrogen excreted from the body and nitrogen ingested in the diet (of which the greater part by far is protein). During growth, pregnancy, lactation, and recovery from convalescence, the body is in positive nitrogen balance since it is retaining nitrogen for the purpose of synthesizing new protein tissues. During dietary deprivation, most illnesses, and certain types of stress, the body loses nitrogen and is in negative balance. The healthy adult is in nitrogen equilibrium. The basis of this method of determining nitrogen requirements is to feed the subjects a series of diets with different levels of protein while measuring nitrogen excretion, then to interpolate to nitrogen equilibrium (zero nitrogen balance).
In early studies the diets included very low levels of protein and a zero level but since the nitrogen balance response is not linear throughout the entire submaintenance range, recent studies use levels around the expected range of requirements. An allowance has to be made for the variable losses of nitrogen in sweat, which are considerable in heavy work in a hot climate.
It takes some time at a given level of dietary protein to achieve a steady state, i.e., adjustments in urine output do not immediately follow changes in nitrogen intake, so that diets are fed for periods of 1–3 weeks at each intake level. These short-term nitrogen balance determinations do not take account of adaptation to low levels of dietary protein as experienced in developing countries. Long-term studies require several months, but these are usually limited to a single level of protein intake which would provide evidence that a particular diet is adequate.
It must be borne in mind that in these detailed consultations about protein (and energy) requirements and recommendations, the FAO is largely concerned with the adequacy of diets in poorly fed populations of developing countries. In the well-fed western world there is never a problem of protein shortage in healthy people as long as enough food is consumed to satisfy hunger. The fundamental physiological considerations, of course, still apply.
Direct nitrogen balance studies are the currently accepted method of determining protein requirements but they suffer from the lack of long-term balance studies, the absence of independent validation of an optimal state of protein nutrition, and lack of knowledge of the functional significance of the size of the total nitrogen pool and rate of turnover of tissue proteins. There are no functional indicators of protein inadequacy at a stage before clinically detectable changes occur.
The limitations of the data are indicated by the small numbers of studies at the time of the 1985 report – nine short-term studies of single protein sources on a total of 93 subjects, eight short-term studies on the typical mixed diets of eight countries on a total of 73 subjects, and six long-term studies, 24–89 days, five on egg and one on milk, on a total of 34 subjects.
The short-term studies provide an estimate of a mean daily requirement of 0.63 g of highly digestible good-quality protein – a figure slightly higher than the 1973 ‘safe level.’ The long-term studies suggest that 0.58 g kg−1 is a reasonable estimate.
From all the available results it is suggested that 0.6 g per kg of body weight per day is the average requirement for good-quality proteins such as meat, milk, egg, and fish.
The coefficient of variation was 12.5%, i.e., 2 sd equals 25%. This provides the currently accepted figure of 0.75 g of protein per kg of body weight per day as the safe level of intake for an adult.
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Frequently Asked Questions About which condition is most likely to produce negative nitrogen balance?
If you have questions that need to be answered about the topic which condition is most likely to produce negative nitrogen balance?, then this section may help you solve it.
What brings about a poor nitrogen balance?
A person may experience a negative nitrogen balance under certain conditions, such as starvation, extreme calorie restriction, or poor protein quality (such as when their diet is deficient in essential amino acids).
Who is most likely to have an imbalance of nitrogen?
In contrast to starving, immobile, and seriously ill people, who break down tissue protein and lose more nitrogen than they take in, growing children and adolescents accumulate nitrogen and are therefore said to be in positive nitrogen balance.
Which of the following scenarios would result in a negative nitrogen balance?
People who are starving or experiencing other severe stresses, such as burns, injuries, infections, and fever, suffer from a negative nitrogen status because their nitrogen excretion exceeds their nitrogen intake.
Which of the ensuing circumstances will cause a negative nitrogen balance?
Kidney disease is one of the following conditions that would lead to a negative nitrogen balance.
What does a low nitrogen balance mean?
The patient is said to be anabolic or “in positive nitrogen balance” if more nitrogen (protein) is provided than lost; the patient is said to be catabolic or “in negative nitrogen balance” if more nitrogen is provided than lost.
What signs or symptoms point to an imbalance in nitrogen?
A protracted negative nitrogen balance may result in a drop in plasma protein levels, edema, anemia, decreased infection resistance, increased susceptibility to certain toxic substances, the onset of fatty liver, or possibly other serious consequences.
The meaning of negative N balance
Nitrogen balance is the difference between nitrogen input and output; when less nitrogen is ingested than is being excreted, it is referred to as a negative nitrogen balance.
Which statement about the quizlet’s negative energy balance is accurate?
Which of the following statements about negative energy balance is true? It takes place when there is an increase in energy expenditure.
This quiz will ask you which of the following carries a negative charge.
Electrons are particles that have a negative charge.
What about negative energy balance is accurate?
A mild negative energy balance is healthy as it can result in weight loss, which is beneficial to overweight people. This is what inspires the ideas of dieting and fasting. A negative energy balance indicates that more energy is being expended by the person through activity than energy is being consumed through food.
Which of the following best describes a situation with a negative energy balance?
wasting illness, anorexia, starvation, and self-inflicted weight loss.
Which of the following results in a negative charge on an object?
Because electrons have a negative charge, when they are added to or removed from an object, it acquires an electrical charge; when they are added to an object, it acquires a negative charge; when they are removed from an object, it acquires a positive charge.
Which of the following statements is true?
The negatively charged examples include starch sol and gold sol.
What has a higher chance of creating a negative charge?
Was this answer helpful? Because chlorine (2,8,7) is a non-metal with the highest electronegativity among the given elements, it is most likely to form a negative ion with charge?1.
Which of the following factors is in charge of the nucleus’ negative charge?
The majority of an atom’s mass is found in its nucleus, which is located close to the center and is made up of protons and neutrons. Protons have a positive charge, while neutrons have no charge. Electrons surround the nucleus and have a smaller mass and negative charge than protons and neutrons.
Who or which of the following is a negative ion?
As a result, the negative ion is referred to as an anion, and the positive ion as a cation.