Current opinion in clinical nutrition and metabolic care
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Curr Opin Clin Nutr Metab Care · Mar 2006
ReviewEnteral access for nutrition in the intensive care unit.
Enteral nutrition is the preferred route for nutrition support in the intensive care unit setting. This is usually delivered through nasoenteric feeding tubes in patients with an otherwise functional gastrointestinal tract. Placement of nasoenteric feeding tubes, however, may be difficult in this setting. Nasoenteric feeding tubes may be placed by multiple methods, each with their particular advantages and disadvantages. This review summarizes the recent literature on different methods of nasoenteric feeding tube placement with emphasis on critically ill patients. ⋯ Feeding tubes can be placed using bedside, fluoroscopic, and endoscopic means. Novel bedside methods have been recently described using immediate positional feedback or new assistive methods. Endoscopic techniques have similar success rates to fluoroscopic techniques and provide data on upper gastrointestinal abnormalities. There is no clear universal standard method. When feeding tube placement is required the technique used depends on local institutional resources and expertise.
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Curr Opin Clin Nutr Metab Care · Mar 2006
ReviewAn update on parenteral lipids and immune function: only smoke, or is there any fire?
This paper synthesizes information from recent studies on the modulation of immune responses by lipid emulsions that are applied as part of parenteral nutrition. This issue is especially relevant in light of the high rate of infectious complications and disturbed inflammatory responses in patients receiving this form of nutritional support. ⋯ The characteristics of, and mechanisms behind, the effects of various parenteral lipids on immune function are becoming increasingly well understood. The practical relevance of many of these findings is not immediately clear, however, and will have to be substantiated in adequately powered trials before we can translate these findings into a tailored approach for specific clinical situations.
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Curr Opin Clin Nutr Metab Care · Jul 2005
ReviewEffects of weight loss and calorie restriction on carbohydrate metabolism.
This article provides an overview of the most recent molecular and clinical outcomes of studies that investigate the effect of weight loss and calorie restriction on carbohydrate metabolism, obtained either by dieting or bariatric surgery. It will focus on aspects of carbohydrate metabolism related to insulin action. The discussion begins by describing attempts to restrain calories by shifting the macronutrient balance from carbohydrates to a higher protein and fat content. The topics covered include insulin secretion and resistance, glucose homeostasis and allostasis, changes in the secretive patterns of adipose tissue and the entero-insular axis. ⋯ Weight loss and calorie restriction partly explain the positive changes of glucose disposal. The multistep interaction of several factors at sites of insulin action, insulin secretion, adipose tissue and the entero-insular axis needs further investigation.