Corn-soy-blend fortified with phosphorus to prevent refeeding hypophosphatemia in undernourished piglets

Anne-Louise Hother Nielsen; Mikkel Lykke Jensen; Torben Martinussen; Hanne Damgaard Poulsen; Christian Mølgaard; Per Torp Sangild; André Briend; Christian Fink Hansen; Henrik Friis; Kim F. Michaelsen; Thomas Thymann

doi:10.1371/journal.pone.0170043

Corn-soy-blend fortified with phosphorus to prevent refeeding hypophosphatemia in undernourished piglets

Anne-Louise Hother Nielsen, Mikkel Lykke Jensen, Torben Martinussen, Hanne Damgaard Poulsen, Christian Mølgaard, Per Torp Sangild, André Briend, Christian Fink Hansen, Henrik Friis, Kim F. Michaelsen, Thomas Thymann

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Abstract

Background Phosphorus (P) levels in refeeding diets are very important as undernourished children are at risk of hypophosphatemia during refeeding. For this reason, conventional corn-soyblends (CSB) have been reformulated by the World Food Programme to obtain a mono-calcium-phosphate fortified product (CSB+) and a product further fortified with skim milk powder (CBS++). Methods Using a piglet model of undernourished children, we hypothesized that feeding of CSB+, CSB++ or CSB+ with added whey permeate (CSB+/wp) would help to prevent refeeding hypophosphatemia. Pigs were weaned at 4 weeks of age and undernutrition was induced with a nutritionally inadequate pure maize diet for 7 weeks, after which they were refed for 3 weeks with either CSB+ (n = 10), CSB++ (n = 10) or CSB+/wp (n = 10). For reference, a fourth group continued on the maize diet (REF, n = 10). Results Following induction of undernutrition, body weight and length were 29±5% and 67±4% (means± SD) of values in age-matched pigs fed a nutritionally adequate diet, and the mean serum P level was 1.77±0.34 mmol/l. During the first week of refeeding, P levels in the CSB+ pigs decreased to 55% of values before refeeding (P < 0.05) while values in the CSB++ and CSB+/ wp pigs were able to maintain their plasma phosphate at a similar level as before refeeding. Conclusion We conclude that fortification of CSB with only monocalcium-phosphate does not prevent hypophosphatemia. Dairy products like skim milk powder or whey permeate may represent relevant sources of phosphorus during refeeding. The content and form of phosphorus in such diets need to be carefully evaluated, and the undernourished piglet may be used to test the efficacy of such diets.

Original language	English
Article number	e0170043
Journal	P L o S One
Volume	12
Issue number	1
Number of pages	13
ISSN	1932-6203
DOIs	https://doi.org/10.1371/journal.pone.0170043
Publication status	Published - Jan 2017

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Corn-Soy-Blend Fortified with Phosphorus to Prevent Refeeding Hypophosphatemia in Undernourished PigletsFinal published version, 999 KBLicence: CC BY

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@article{d6f82755020a4b7d946a7818d184824c,

title = "Corn-soy-blend fortified with phosphorus to prevent refeeding hypophosphatemia in undernourished piglets",

abstract = "Background Phosphorus (P) levels in refeeding diets are very important as undernourished children are at risk of hypophosphatemia during refeeding. For this reason, conventional corn-soyblends (CSB) have been reformulated by the World Food Programme to obtain a mono-calcium-phosphate fortified product (CSB+) and a product further fortified with skim milk powder (CBS++). Methods Using a piglet model of undernourished children, we hypothesized that feeding of CSB+, CSB++ or CSB+ with added whey permeate (CSB+/wp) would help to prevent refeeding hypophosphatemia. Pigs were weaned at 4 weeks of age and undernutrition was induced with a nutritionally inadequate pure maize diet for 7 weeks, after which they were refed for 3 weeks with either CSB+ (n = 10), CSB++ (n = 10) or CSB+/wp (n = 10). For reference, a fourth group continued on the maize diet (REF, n = 10). Results Following induction of undernutrition, body weight and length were 29±5% and 67±4% (means± SD) of values in age-matched pigs fed a nutritionally adequate diet, and the mean serum P level was 1.77±0.34 mmol/l. During the first week of refeeding, P levels in the CSB+ pigs decreased to 55% of values before refeeding (P < 0.05) while values in the CSB++ and CSB+/ wp pigs were able to maintain their plasma phosphate at a similar level as before refeeding. Conclusion We conclude that fortification of CSB with only monocalcium-phosphate does not prevent hypophosphatemia. Dairy products like skim milk powder or whey permeate may represent relevant sources of phosphorus during refeeding. The content and form of phosphorus in such diets need to be carefully evaluated, and the undernourished piglet may be used to test the efficacy of such diets.",

author = "{Hother Nielsen}, Anne-Louise and {Lykke Jensen}, Mikkel and Torben Martinussen and Poulsen, {Hanne Damgaard} and Christian M{\o}lgaard and Sangild, {Per Torp} and Andr{\'e} Briend and Hansen, {Christian Fink} and Henrik Friis and Michaelsen, {Kim F.} and Thomas Thymann",

note = "CURIS 2017 NEXS 031",

year = "2017",

month = jan,

doi = "10.1371/journal.pone.0170043",

language = "English",

volume = "12",

journal = "PLoS Computational Biology",

issn = "1932-6203",

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T1 - Corn-soy-blend fortified with phosphorus to prevent refeeding hypophosphatemia in undernourished piglets

AU - Hother Nielsen, Anne-Louise

AU - Lykke Jensen, Mikkel

AU - Martinussen, Torben

AU - Poulsen, Hanne Damgaard

AU - Mølgaard, Christian

AU - Sangild, Per Torp

AU - Briend, André

AU - Hansen, Christian Fink

AU - Friis, Henrik

AU - Michaelsen, Kim F.

AU - Thymann, Thomas

N1 - CURIS 2017 NEXS 031

PY - 2017/1

Y1 - 2017/1

N2 - Background Phosphorus (P) levels in refeeding diets are very important as undernourished children are at risk of hypophosphatemia during refeeding. For this reason, conventional corn-soyblends (CSB) have been reformulated by the World Food Programme to obtain a mono-calcium-phosphate fortified product (CSB+) and a product further fortified with skim milk powder (CBS++). Methods Using a piglet model of undernourished children, we hypothesized that feeding of CSB+, CSB++ or CSB+ with added whey permeate (CSB+/wp) would help to prevent refeeding hypophosphatemia. Pigs were weaned at 4 weeks of age and undernutrition was induced with a nutritionally inadequate pure maize diet for 7 weeks, after which they were refed for 3 weeks with either CSB+ (n = 10), CSB++ (n = 10) or CSB+/wp (n = 10). For reference, a fourth group continued on the maize diet (REF, n = 10). Results Following induction of undernutrition, body weight and length were 29±5% and 67±4% (means± SD) of values in age-matched pigs fed a nutritionally adequate diet, and the mean serum P level was 1.77±0.34 mmol/l. During the first week of refeeding, P levels in the CSB+ pigs decreased to 55% of values before refeeding (P < 0.05) while values in the CSB++ and CSB+/ wp pigs were able to maintain their plasma phosphate at a similar level as before refeeding. Conclusion We conclude that fortification of CSB with only monocalcium-phosphate does not prevent hypophosphatemia. Dairy products like skim milk powder or whey permeate may represent relevant sources of phosphorus during refeeding. The content and form of phosphorus in such diets need to be carefully evaluated, and the undernourished piglet may be used to test the efficacy of such diets.

AB - Background Phosphorus (P) levels in refeeding diets are very important as undernourished children are at risk of hypophosphatemia during refeeding. For this reason, conventional corn-soyblends (CSB) have been reformulated by the World Food Programme to obtain a mono-calcium-phosphate fortified product (CSB+) and a product further fortified with skim milk powder (CBS++). Methods Using a piglet model of undernourished children, we hypothesized that feeding of CSB+, CSB++ or CSB+ with added whey permeate (CSB+/wp) would help to prevent refeeding hypophosphatemia. Pigs were weaned at 4 weeks of age and undernutrition was induced with a nutritionally inadequate pure maize diet for 7 weeks, after which they were refed for 3 weeks with either CSB+ (n = 10), CSB++ (n = 10) or CSB+/wp (n = 10). For reference, a fourth group continued on the maize diet (REF, n = 10). Results Following induction of undernutrition, body weight and length were 29±5% and 67±4% (means± SD) of values in age-matched pigs fed a nutritionally adequate diet, and the mean serum P level was 1.77±0.34 mmol/l. During the first week of refeeding, P levels in the CSB+ pigs decreased to 55% of values before refeeding (P < 0.05) while values in the CSB++ and CSB+/ wp pigs were able to maintain their plasma phosphate at a similar level as before refeeding. Conclusion We conclude that fortification of CSB with only monocalcium-phosphate does not prevent hypophosphatemia. Dairy products like skim milk powder or whey permeate may represent relevant sources of phosphorus during refeeding. The content and form of phosphorus in such diets need to be carefully evaluated, and the undernourished piglet may be used to test the efficacy of such diets.

U2 - 10.1371/journal.pone.0170043

DO - 10.1371/journal.pone.0170043

M3 - Journal article

C2 - 28081252

SN - 1932-6203

VL - 12

JO - PLoS Computational Biology

JF - PLoS Computational Biology

IS - 1

M1 - e0170043

ER -

Corn-soy-blend fortified with phosphorus to prevent refeeding hypophosphatemia in undernourished piglets

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