Clinical nutrition : official journal of the European Society of Parenteral and Enteral Nutrition
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Malnutrition increases morbidity and mortality in surgical patients, and for this reason, several nutritional markers have been used as prognostic tools to identify surgical patients under a higher risk to develop complications in post-operative period. Few studies show the impact of nutritional markers after controlling for others variables, such as age and severity of disease. A new method, bioelectric impedance analysis (BIA), and its parameter, phase angle, have been described as a prognostic tool in several clinical situations, but they have never been studied in surgical population. The objective of this work is to assess the importance of nutritional variables and parameters from BIA as predictors of post-operative complications in a multivariable regression model. ⋯ Phase angle remains as an important prognostic factor for postoperative complications, even after adjusting for other individual predictors and confounders. Its utility in the identification of patients eligible for nutritional therapy has now to be evaluated.
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Randomized Controlled Trial Clinical Trial
Effects of perioperative parenteral glutamine-dipeptide supplementation on plasma endotoxin level, plasma endotoxin inactivation capacity and clinical outcome.
We evaluated perioperative plasma endotoxin, plasma soluble CD14 molecule (sCD14), plasma endotoxin inactivation capacity (EIC) changes and clinical outcome after glutamine was provided in parenteral feedings to patients on whom gastrointestinal operations were performed using a prospective, randomized, double-blind study design. ⋯ Perioperative parenteral nutrition supplemented with dipeptide alanyl-glutamine ameliorated postoperative immunodepression without direct effect on endotoxemia.
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The triglyceride (TG) fatty acyl composition in lipid emulsions influences their metabolism. Little is known about the effects of long chain omega-3 polyunsaturated fatty acids (PUFA) on lipid emulsion metabolism. We investigated possible differences between omega-3 containing emulsions in their metabolism and tissue-targeting in vivo in a mouse model, and in vitro using lipolysis and cell culture experiments. ⋯ Our data shows that 8:2 had the most efficient blood clearance but less hepatic uptake in vivo. In vitro, 8:2 had both highest hydrolysis by LpL and intracellular TG utilization in the presence of apoE. Thus, an 8:2 lipid emulsion undergoes efficient blood clearance and may direct omega-3 PUFA more towards extrahepatic tissues.
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Critically ill patients with complicated evolution are frequently hypermetabolic, catabolic, and at risk of underfeeding. The study aimed at assessing the relationship between energy balance and outcome in critically ill patients. ⋯ Negative energy balances were correlated with increasing number of complications, particularly infections. Energy debt appears as a promising tool for nutritional follow-up, which should be further tested. Delaying initiation of nutritional support exposes the patients to energy deficits that cannot be compensated later on.
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Comment Letter Randomized Controlled Trial Clinical Trial
Preoperative administration of carbohydrates and insulin results in lesser amino acid consumption.