Current opinion in clinical nutrition and metabolic care
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Curr Opin Clin Nutr Metab Care · May 2017
ReviewTiming of the initiation of parenteral nutrition in critically ill children.
To review the current literature evaluating clinical outcomes of early and delayed parenteral nutrition initiation among critically ill children. ⋯ Although there is no consensus on the optimal timing of parenteral nutrition initiation among critically ill children, recent literature does not support the immediate initiation of parenteral nutrition on pediatric ICU admission. A common theme in the reviewed literature highlights the importance of accurate assessment of nutritional status and energy expenditure in deciding when to initiate parenteral nutrition. As with all medical interventions, the initiation of parenteral nutrition should be considered in light of the known benefits of judiciously provided nutritional support with the known risks of artificial, parenteral feeding.
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Curr Opin Clin Nutr Metab Care · Mar 2017
ReviewInfluence of nutrition therapy on the intestinal microbiome.
This review describes the relationship between nutritional therapies and the intestinal microbiome of critically ill patients. ⋯ Focus of research is shifting toward strategies that augment the intestinal environment to facilitate growth of beneficial microorganisms, strengthen colonization resistance, and maintain immune homeostasis.
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Curr Opin Clin Nutr Metab Care · Mar 2017
ReviewSphingolipids, ORMDL3 and asthma: what is the evidence?
Genome-wide association studies identified ORMDL3, a protein of the endoplasmic reticulum, as a significant asthma risk factor. ORMDL3 is one of three ORMDL proteins that integrate multiple signals to maintain sphingolipid homeostasis. Studies that investigated potential mechanisms for how increased ORMDL3 might affect asthma are summarized. ⋯ Possible mechanisms how ORMDL3 affects asthma include inhibition of sphingolipid synthesis, synergistic effects with known allergens and a combination of both.
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Curr Opin Clin Nutr Metab Care · Jan 2017
ReviewImplications of frailty screening in clinical practice.
Many frailty screening instruments have been proposed due to the lack of consensus on a unified operational definition of frailty. This review reports on recent frailty screening tools in addition to revisiting the frailty concept. ⋯ The phenotype model is rather faithfully based on biological change with aging, while the deficit model comprehensively captures risk of disability. Most of the current frailty screening tools are based on these models. Screening tools based on the former model primarily capture declines in physical functions, whereas screening tools based on the latter model involve questionnaires that examine functional impairments in multiple domains. Implementation of a model in a clinical setting depends on both the model characteristics and the clinical settings.
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Curr Opin Clin Nutr Metab Care · Sep 2016
Gastrointestinal dysmotility in the critically ill: a role for nutrition.
The role of enteral nutrition on gastrointestinal dysmotility in the critically ill remains controversial. ⋯ To improve enteral nutrition protocols, the definitions of gastrointestinal dysfunction, gastric dysmotility, and feeding intolerance should be clearly defined in the future. In the concept of integrity of the gut, enteral nutrition should not be stopped completely during gastrointestinal dysfunction but restricted to a 'minimal' trophic feeding rate. In malnourished and high-risk patients intolerant to enteral feeding supplemental parenteral nutrition should be started on day 4 or earlier.