Current opinion in clinical nutrition and metabolic care
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Curr Opin Clin Nutr Metab Care · Mar 2014
ReviewOmega-3 fatty acids and protein metabolism: enhancement of anabolic interventions for sarcopenia.
The increased age observed in most countries, with the associated higher rates of chronic illnesses and cancer, and a diffuse sedentary lifestyle, will increase the number of patients with clinically relevant anabolic resistance, sarcopenia and its complications. The need for solutions to this major health issue is, therefore, pressing. ⋯ The review of data from recent studies on this topic suggests that dietary omega-3 fatty acid supplementation, in association with an anabolic stimulus, could potentially provide a safe, simple and low-cost intervention to counteract anabolic resistance and sarcopenia. This intervention may contribute to prevent cachexia and disabilities. Supplementation should be given in the earlier stages of sarcopenia (e.g. precachexia). Further research should, however, be performed to better understand the mechanisms involved and the best dosage and timing of administration.
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Curr Opin Clin Nutr Metab Care · Mar 2014
ReviewAre closed-loop systems for intensive insulin therapy ready for prime time in the ICU?
Recent findings suggest that the effects of tight glycemic control (TGC) performing intensive insulin therapy (IIT) in medical and surgical ICU have had conflicting results. The purpose of this review is to summarize the current evidence in humans how closed-loop systems for IIT are ready for prime time in the ICU. ⋯ The challenge in the hospital setting demonstrated that a closed-loop glycemic control system is expected to the achievement of TGC with no occurrence of hypoglycemia induced by IIT after surgery. Closed-loop glycemic control systems for IIT are now ready for prime time in the ICU.
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Curr Opin Clin Nutr Metab Care · Mar 2014
ReviewEnteral fish oil in critical illness: perspectives and systematic review.
To summarize recent research addressing the role of enteral fish oil supplementation in critical illness. ⋯ Mechanistic data suggest that administration of fish oil may help attenuate the systemic inflammatory response and allow for appropriate resolution of inflammation in critically ill patients. Recent data indicate that enteral fish oil given as a continuous infusion as part of complete nutrition improves outcome in critically ill patients, especially those with acute lung injury/acute respiratory distress syndrome. In contrast, the bolus administration of fish oil cannot be recommended as clinically beneficial in acute lung injury/acute respiratory distress syndrome patients. Recent trials indicate that pharmacologically administered nutrients should be studied in the same manner as other new drugs, with appropriate attention to early dosing trials, proper pre-enrollment patient selection, and understanding of the role of concomitant protein/calorie nutrition. More research continues to be needed to optimize the proper patient, dose, and timing of administration for enteral fish oil therapy in the ICU.
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Curr Opin Clin Nutr Metab Care · Mar 2014
ReviewNutritional-risk scoring systems in the intensive care unit.
There is a need to develop a screening tool to assist clinical staff in deciding whether or not a patient in the ICU should be given nutrition support. The purpose of this review is to analyze the recent randomized trials in this context. ⋯ As a tentative conclusion, it is recommended to provide adequate nutrition support to severely ill patients who are likely to stay in the ICU with mechanical ventilation for a week or more.
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Curr Opin Clin Nutr Metab Care · Mar 2014
ReviewImpact of the feeding route on gut mucosal immunity.
Enteral nutrition is recommended as a standard nutritional therapy in clinical settings. The rationale behind enteral nutrition may be decreased infectious morbidities compared with parenteral nutrition. However, the mechanism may not be well understood. ⋯ Because enteral nutrition is a practical way to preserve gut immunity, clinicians should make any efforts to shorten the period of enteral nutrition absence and increase the dose according to the degree of tolerance.