Nutrition
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Review
The route of nutritional support in the critically ill: physiological and economical considerations.
Although it generally is accepted that early enteral nutrition is of benefit to critically ill patients, there is little evidence to support this assertion. Nevertheless, enteral nutrition has many advantages over total parenteral nutrition (TPN), the latter being associated with several complications. Animal studies have shown that injury and infection can lead to gut atrophy and increased mucosal permeability. ⋯ There are few absolute contraindications to early enteral feeding and with motivated staff, the use of prokinetics, and the availability of jejunal feeding tubes, the majority of intensive care patients can be fed enterally. Enteral feeding is more cost effective than TPN, but TPN remains a common therapeutic intervention in the intensive care unit and represents a significant burden on health care budgets. Nutrition support teams have led to savings, particularly by identifying patients who have been inappropriately prescribed TPN and also by preventing excessive enteral feeding.
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Recent findings suggest that many human fetuses have to adapt to a limited supply of nutrients and in doing so they permanently change their physiology and metabolism. These "programmed" changes may be the origins of a number of diseases in later life, including coronary heart disease and the related disorders stroke, diabetes, and hypertension.