Current opinion in clinical nutrition and metabolic care
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This review covers the recent studies that have served to further our understanding of the nature of the relationship between perioperative hyperglycemia and nosocomial infection. On the one hand hyperglycemia can be a consequence of the systemic inflammatory response, and can serve as a marker of the severity of stress and the degree of immunocompetence resulting from infection or injury. Strong evidence is, however, emerging that hyperglycemia in the perioperative period can also be a significant risk factor for the development of nosocomial infection.
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Overreaction of the acute phase response is responsible for the two major complications to surgery, sepsis and thrombosis, but also most likely for the leading sequela to surgery, adhesion formation. The gastrointestinal tract, especially the colon, is a major player in the acute phase response and responsible for important immune functions with important interactions between the commensal flora, mucosal cells and the mucosa/gut associated lymphoid tissues. These responses can effectively be modulated by enteral nutrition, provided it is properly composed and administered. ⋯ Furthermore, much supports that the formula given should contain what has been called colonic food, e.g. plant fibres, and have a low content of saturated fat. Use of antibiotics with deleterious effects on the commensal flora should also be limited as much as possible. Lack of compliance with these requests seems to explain the lack of consistency in clinical experience of enteral nutrition, when tried in connection with trauma and clinical surgery.