Current opinion in clinical nutrition and metabolic care
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Curr Opin Clin Nutr Metab Care · Mar 2013
ReviewThe use of indirect calorimetry in the intensive care unit.
This review evaluates whether improvements have occurred in the value of predictive equations for use in designing nutritional therapeutic regimens in the ICU. The report also seeks to determine whether emerging strategies for nutrition therapy in the ICU change the need for an accurate measurement of energy requirements by indirect calorimetry. ⋯ The role of indirect calorimetry in the ICU should be expected to increase in the near future, as predictive equations may be too inaccurate to identify the appropriate goals of nutrition therapy.
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Curr Opin Clin Nutr Metab Care · Mar 2013
ReviewReconciling divergent results of the latest parenteral nutrition studies in the ICU.
Recent studies on the optimal modalities to feed patients during the ICU stay show divergent results. The level and the timing of energy provision is a critical issue, associated with the clinical outcome. These results questioned the clinical relevance of the recent guidelines issued by American, Canadian and European academic societies. ⋯ The critical analysis of recent prospective studies comparing various levels of calorie administration, enteral versus parenteral nutrition and enteral versus SPN confirms the recommendations to avoid underfeeding and overfeeding. Parenteral nutrition, required if enteral feeding is failing, and if adjusted up to a measured optimal level, may improve outcome. More studies on the optimal level of energy and protein administration to optimize the clinical outcome are required to fine tune current guidelines.
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Curr Opin Clin Nutr Metab Care · Nov 2012
ReviewDo we need to take calcium with vitamin D supplements to prevent falls, fractures, and death?
The 2011 report by the US Institute of Medicine (IOM) on dietary reference intakes for calcium and vitamin D is based on meta-analyses of randomized controlled trials (RCTs), which concluded that vitamin D supplements need to be taken with calcium supplements to prevent falls, fractures, and all-cause mortality. This study reviews recent meta-analyses of RCTs of vitamin D supplementation to determine whether their conclusions are consistent with the meta-analyses underpinning the IOM report. ⋯ The inconsistency in the conclusions from meta-analyses is due to limitations in the design of previous RCTs of vitamin D supplementation. Large RCTs, giving higher doses of vitamin D (without calcium), should provide a clear answer within several years as to whether vitamin D supplements are beneficial by themselves.
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Curr Opin Clin Nutr Metab Care · Nov 2012
ReviewNutritional targets to enhance exercise performance in chronic obstructive pulmonary disease.
This review presents current knowledge regarding the rationale and efficacy of nutrition as an ergogenic aid to enhance the effects of exercise and training in chronic obstructive pulmonary disease (COPD). ⋯ There is a clear need for adequately powered and controlled intervention and maintenance trials to establish the role of nutritional supplementation in the enhancement of exercise performance and training and the wider management of the systemic features of the disease.
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The pleotropic effects of vitamin D on chronic diseases have received significant attention; however, its role in acute illness is less understood. The purpose of this review is to summarize the current evidence regarding the role of vitamin D in acute stress and critical illness. ⋯ Single-point assessments of 25-hydroxyvitamin D following acute stress may provide an inaccurate assessment of vitamin D status. In such cases, measurement of binding proteins and free vitamin D metabolites may be essential to create a more realistic approximation of vitamin D status. Variations in patient responses to acute stress and critical illness may depend not only on the degree of systemic vitamin D insufficiency, but also on the individual tissue requirements.