Current opinion in clinical nutrition and metabolic care
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Obese individuals have impaired respiratory function relative to their normal-weight counterparts. Despite these negative effects, obesity is paradoxically associated with better survival in individuals with chronic obstructive pulmonary disease (COPD). The purpose of this review is to describe this 'obesity paradox', to discuss the effects of obesity on respiratory function, and to speculate as to whether obesity-related alterations in respiratory mechanics can influence the natural history of COPD. ⋯ Obese patients with COPD do not appear to be at a disadvantage during exercise relative to lean COPD patients. Obesity may be associated with improved survival in COPD but specific mechanisms for this paradox remain to be elucidated.
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Curr Opin Clin Nutr Metab Care · Nov 2010
ReviewVitamin B12: the forgotten micronutrient for critical care.
To analyse the anti-inflammatory and antioxidant properties of vitamin B12 and evaluate current evidence on vitamin B12 status in the critically ill with systemic inflammation. ⋯ Despite evidence from animal studies, so far there are no clinical intervention trials that have studied vitamin B12 as a pharmaconutrient strategy for critical care. Well designed animal and clinical studies are required to clarify several outstanding questions on the optimal posology, safety, and efficacy of high-dose vitamin B12 in the critically ill.
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Curr Opin Clin Nutr Metab Care · Sep 2010
ReviewThe impact of nutrition on cirrhotic patients awaiting liver transplantation.
To review the most recent aspects of nutrition therapy of cirrhotic patients on the waiting list for liver transplantation. ⋯ We report the latest findings on nutrition care of patients with end-stage liver disease on the waiting list for liver transplantation such as the impact of the nutritional status on outcome, probiotic and branched-chain amino acid supplementation, as well as the use of immunomodulating formula. Another important strategy that has been shown to improve these patients' nutritional care is the offering of nocturnal meals and micronutrient supplementation.
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Curr Opin Clin Nutr Metab Care · Mar 2010
ReviewComparisons of different insulin infusion protocols: a review of recent literature.
To provide an update on the currently available insulin infusion protocols for treatment of hyperglycemia in critically ill patients and to discuss the major differences and similarities among them. ⋯ Insulin infusion is the most effective method for controlling hyperglycemia in critically ill patients. Clinicians should utilize a validated insulin infusion protocol that is well tolerated, and is most appropriate and practical for their institution based on the resources that are available.
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Curr Opin Clin Nutr Metab Care · Mar 2010
ReviewNutrition and clinical outcome in intensive care patients.
In the setting of ICU, the characteristics of patients have changed during the last decade. Patients are older, frequently overweight or obese, present with more chronic diseases and undernutrition. These conditions are characterized by reduced muscle mass and vulnerable homeostasis. This review sustains the hypothesis that an early and optimal nutritional support, combining enteral and parenteral nutrition, could improve the clinical outcome of ICU patients. ⋯ It is hypothesized that supplemental parenteral nutrition, together with insufficient enteral nutrition, could optimize the nutritional therapy by preventing the onset of early energy deficiency, and thus, could allow to reduce the side-effects of undernutrition and promote better chances of recovery after the ICU stay.