Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition
-
Significant weight loss is a common complication of a major burn injury. Before the modern era of early enteral nutrition support, such a complication contributed significantly to impaired wound healing, raised risk of infectious morbidity, and ultimately increased mortality. ⋯ The burn patient characteristically demonstrates an increase in energy expenditure after the initial injury and period of resuscitation. Studies have demonstrated that early institution of enteral feeding can attenuate the stress response, abate hypermetabolism, and improve patient outcome.
-
The kidney is a complex and vital organ, regulating the electrolyte and fluid status of the human body. As hemodialysis (HD) and peritoneal dialysis (PD) are forms of renal replacement therapy and not an actual kidney, they do not possess the same physiologic regulation of both fluid and electrolytes. Precise regulation of fluid and electrolytes in the HD and PD population remains a constant challenge. ⋯ Ultrafiltration, a modality used in both forms of renal replacement therapy, will be defined, along with its impact on fluid status. Fluid assessment will be addressed, along with proper maintenance of fluid homeostasis. By having an understanding of the pathophysiology behind the fluid and electrolyte abnormalities that occur in end-stage renal disease, one can direct proper management with medications, diet, and alterations in dialysis to provide patients with the most optimal form of renal replacement therapy available.
-
Low-carbohydrate diets are based on an alternative theory of obesity where dietary carbohydrate, particularly unprocessed sugars, causes hyperinsulinemia, leading to insulin resistance, obesity, and cardiovascular disease. In this model, carbohydrate is viewed as a "metabolic poison" and therefore is limited in the diet. This article systematically reviews and refutes the 6 major physiologic claims made by proponents of low-carbohydrate diets. Any benefits or advantages resulting from these diets must therefore be derived from factors other than those stated by the alternative theory.
-
Over the last decade there has been considerable interest in the use of specific nutrients to alter the metabolic response to injury and infection, to improve immune function, and to prevent or reverse the severe catabolism and wasting of the lean body mass that accompanies critical illness. In this review, representative animal studies and, when available, human studies examining the potential benefits of these individual nutrients are summarized. The overview of basic investigations is by no means all-inclusive, and the emphasis of this manuscript is a review of the currently available clinical trials examining the potential benefits of combinations of these individual immunity-enhancing nutrients in human patients.