Nutrición hospitalaria : organo oficial de la Sociedad Española de Nutrición Parenteral y Enteral
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A primary goal of nutritional support is to provide the energy requirements needed to sustain metabolic processes, maintain body temperature and tissue repair. The beginnings of artificial nutrition were characterized by high calorie nutritional formulae. The assimilation of physiological concepts, accumulating research data and clinical experience led to a progressive reduction of this intake. ⋯ There is also a clear need to deepen the knowledge about the optimal caloric intake in the non-critically ill patient requiring artificial nutrition. It is of great importance that these new concepts, which will arise undoubtedly, are incorporated quickly in the design of nutritional formulas produced by the pharmaceutical industry. Finally, it is important to encourage active participation in continuous educational activities in the field of Nutrition for achieving a rapid incorporation in daily practice of these new concepts of optimal caloric intake.
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Hyperglycemia is one of the main metabolic disturbances in critically-ill patients and is associated with increased morbidity and mortality. Consequently, blood glucose levels must be safely and effectively controlled, that is, maintained within a normal range, avoiding hypoglycemia on the one hand and elevated glucose concentrations on the other. To accomplish this aim, insulin is often required, avoiding protocols designed to achieve tight glycemic control. ⋯ Whenever patients require artificial feeding, the enteral route, if not contraindicated, should be used since parenteral nutrition is associated with a higher frequency of hyperglycemia and greater insulin requirements. Enteral nutrition should be administered early, preferably within the first 24 hours of admission to the intensive care unit, after hemodynamic stabilization. Specific diets for hyperglycemia, containing low glycemic index carbohydrates and fibre and enriched with monounsaturated fatty acids, can achieve good glycemic control with lower insulin requirements.
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Review Guideline
Guidelines for specialized nutritional and metabolic support in the critically-ill patient: update. Consensus SEMICYUC-SENPE: acute renal failure.
Nutritional support in acute renal failure must take into account the patient's catabolism and the treatment of the renal failure. Hypermetabolic failure is common in these patients, requiring continuous renal replacement therapy or daily hemodialysis. In patients with normal catabolism (urea nitrogen below 10 g/day) and preserved diuresis, conservative treatment can be attempted. ⋯ Depending on their hemofiltration flow, continuous renal replacement systems require high daily nitrogen intake, which can sometimes reach 2.5 g protein/kg. The amount of volume replacement can induce energy overload and therefore the use of glucose-free replacement fluids and glucose-free dialysis or a glucose concentration of 1 g/L, with bicarbonate as a buffer, is recommended. Monitoring of electrolyte levels (especially those of phosphorus, potassium and magnesium) and of micronutrients is essential and administration of these substances should be individually-tailored.
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Randomized Controlled Trial Comparative Study
Paper and pencil vs online self-administered food frequency questionnaire (FFQ) applied to university population: a pilot study.
To test the reliability of dietary intake data measured with an online food frequency questionnaires (FFQ) applied to a university population by comparing the results with those from a paper and pencil version. ⋯ The pilot testing showed that this online FFQ is a useful tool for estimating the intake of food groups in this university population. On the other hand, the differences found in the results of the absolute quantities of energy and nutrients intakes were not clear. These differences could be due to the problems that the participants had for reporting portion size in the paper and pencil FFQ as photographs of portion sizes were not presented.
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Energy requirements are altered in critically-ill patients and are influenced by the clinical situation, treatment, and phase of the process. Therefore, the most appropriate method to calculate calorie intake is indirect calorimetry. In the absence of this technique, fixed calorie intake (between 25 and 35 kcal/kg/day) or predictive equations such as the Penn State formula can be used to obtain a more accurate evaluation of metabolic rate. ⋯ Energy and protein intake in critically-ill patients is complex, since both clinical factors and the stage of the process must be taken into account. The first step is to calculate each patient's energy requirements and then proceed to distribute calorie intake among its three components: proteins, carbohydrates and fat. Micronutrient requirements must also be considered.