Current opinion in clinical nutrition and metabolic care
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Curr Opin Clin Nutr Metab Care · Jul 2001
ReviewPreoperative oral carbohydrate nutrition: an update.
Insulin resistance is a central feature of the metabolic response after elective surgery as well as other trauma, and has been shown to be a predictor of the length of stay after surgery. Carbohydrate treatment instead of overnight fasting before surgery has been shown to reduce postoperative insulin resistance and to reduce hospital stay approximately 20% after elective surgery. ⋯ Gastric emptying of a 50 g oral carbohydrate load using this drink is complete within 90 min after intake. Oral carbohydrate loading before surgery has confirmed previous data, using glucose and insulin infusions, that postoperative insulin resistance is reduced compared with overnight fasted patients before surgery, and this is associated with improved well-being before and after surgery.
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Curr Opin Clin Nutr Metab Care · Jul 2001
ReviewManagement of catabolism in metabolically stressed patients: a literature survey about growth hormone application.
In the effort to improve the long-term outcome in critically ill patients, the utilization of anabolic agents, such as human recombinant growth hormone, has been proposed in order to reduce catabolism and improve nutritional status. A recent multicentre study regarding the use of human recombinant growth hormone in intensive care unit patients showed an unexpected increase in the mortality rate in human recombinant growth hormone-treated patients. This finding is in contrast with previous literature data reporting either no differences or an even lower mortality rate with the administration of human recombinant growth hormone. ⋯ Our analysis suggests that the low caloric intake given to patients enrolled in the multicentre study might have been inadequate to compensate for the hypermetabolism of these patients, and could not support the prolonged and delayed administration of high doses of human recombinant growth hormone. Whether the beneficial metabolic effects of human recombinant growth hormone translate into better clinical outcomes deserves further investigation. In addition, the careful selection of patients to be treated, and close monitoring of both the adequacy of caloric support and modality of human recombinant growth hormone administration would favour the safety of human recombinant growth hormone utilization in critical care settings.