Clinical nutrition : official journal of the European Society of Parenteral and Enteral Nutrition
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Nutritional support in the intensive care setting represents a challenge but it is fortunate that its delivery and monitoring can be followed closely. Enteral feeding guidelines have shown the evidence in favor of early delivery and the efficacy of use of the gastrointestinal tract. Parenteral nutrition (PN) represents an alternative or additional approach when other routes are not succeeding (not necessarily having failed completely) or when it is not possible or would be unsafe to use other routes. ⋯ The papers available are very heterogeneous in quality and methodology (amount of calories, nutrients, proportion of nutrients, patients, etc.) and the different meta-analyses have not always taken this into account. Use of exclusive PN or complementary PN can lead to confusion, calorie targets are rarely achieved, and different nutrients continue to be used in different proportions. The present guidelines are the result of the analysis of the available literature, and acknowledging these limitations, our recommendations are intentionally largely expressed as expert opinions.
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Comparative Study
Assessement of resting energy expenditure of obese patients: comparison of indirect calorimetry with formulae.
Determining the caloric expenditure of overweight (Body mass index - BMI from 25-29.9 kg/m(2)) or obese (BMI> or =30 kg/m(2)) patients is a difficult task. The importance of the measurement using indirect calorimetry (IC) is to avoid the administration of an inadequate caloric load, which can increase clinical morbidity. The aim of this study was to compare the resting energy expenditure (REE) obtained by IC with that estimated by the Harris-Benedict (HB) and the Ireton-Jones (IJ) equations and a fixed amount of 21 kcal/kg of body weight, using actual, average and adjusted weights. ⋯ From these data we can conclude that even though the average values obtained with the equations utilized to predict the REE for this population, showed good correlation with those by IC, as they had the best comparative absolute results, however they demonstrated an unacceptable variability when matched to the measured REE values.
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Four preterm infants with intestinal failure and severe parenteral nutrition-associated cholestasis (PNAC) received fish-oil-based parenteral lipid as rescue treatment in substitution for the standard soybean-based lipid preparation. The progression of liver disease was halted in 3 infants and they recovered with complete resolution of PNAC. ⋯ The remaining infant with residual inflamed bowel, protracted feeding intolerance and repeated episodes of sepsis did not respond. Our findings suggest that fish-oil-based parenteral lipid emulsion may contribute to effective treatment of PNAC in selected patients, which should be further evaluated in randomized controlled trials.
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Randomized Controlled Trial
Role of glutamine administration on T-cell derived inflammatory response after cardiopulmonary bypass.
Cardiac surgery provokes an inflammatory response for which the endothelium, the myocardium, and monocytes/macrophages are primarily responsible. T cells are altered in a different way whereby the pro-inflammatory pathway is suppressed. From the results of experimental studies it was concluded that glutamine (Gln) enhances the production of T-cell cytokines in conditions of Gln deprivation. The aim of this clinical study was to evaluate the role of a perioperative Gln infusion on intracellular inflammatory T-cell cytokine expression in patients undergoing elective cardiac surgery and to evaluate the effects on systemic inflammation, organ dysfunction and ICU length of stay. ⋯ The elevation of Gln plasma levels as a result of 0.5 g/kg/day perioperative Gln infusion has no influence on the T-cell derived inflammatory response, indicating a sufficient supply of Gln. A Gln supplementation in cardiac surgery patients without a clear Gln deficiency seems not to affect the intracellular inflammatory T-cell cytokine expression.
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To investigate the relationship of neck circumference (NC) to metabolic syndrome (MetS) and obstructive sleep apnea syndrome (OSAS) and whether it adds information to that provided by waist circumference. ⋯ NC contributes to MetS likelihood beyond waist circumference and the MetS components. Regarding association with OSAS, NC is of greater value than WC among Turkish men, not women.