Current opinion in clinical nutrition and metabolic care
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Curr Opin Clin Nutr Metab Care · Jan 2003
ReviewAltered amino acid metabolism in chronic obstructive pulmonary disease: new therapeutic perspective?
Wasting of muscle mass, commonly present in patients with chronic obstructive pulmonary disease, is a complex process involving changes in the control of intermediary metabolism as well as in muscle cell status. Although research exploring intermediary metabolism in chronic obstructive pulmonary disease is still in its infancy, there is an increased interest in a potential role for amino acids in modulating muscle anabolism. This review aims at summarizing and critically evaluating the available clinical studies examining alterations in amino acid profile in plasma and skeletal muscle of patients with chronic obstructive pulmonary disease. ⋯ Underlying mechanisms of the observed alterations in amino acid profile in chronic obstructive pulmonary disease, and the influences of disease associated mediators such as chronic low-grade inflammation and (chronic and intermittent) hypoxia are speculative and need to be explored in experimental study designs.
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In this review, topics with scientific strength, topical interest, and controversy were selected. Over the past 50 years, malnutrition has become increasingly recognized as a cause of increased morbidity and mortality in hospital patients. From 1970 to 1980, parenteral nutrition was advocated as the most appropriate form of nutritional therapy for hospital patients. ⋯ Enteral nutrition has been advocated as a way of reducing steroid dependency. Finally, enteral nutrition is routinely used to feed demented patients and those in a vegetative state. It is not clear whether this practice alters outcome or quality of life.
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To understand the principles of systematic reviewing and meta-analysis, using recent examples from the medical literature to highlight some of these points. ⋯ Especially in an era of resource restraint, we need to become more skilled at interpreting evidence from clinical research.
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Curr Opin Clin Nutr Metab Care · Sep 2002
ReviewTight control of glycaemia in critically ill patients.
This manuscript attempts to review the effects associated with hyperglycaemia in critically ill patients and the effects of various insulin regimens. The available clinical findings and pertinent experimental data are examined. ⋯ Intensive insulin therapy is probably warranted in most categories of critically ill patients, although some of the underlying mechanisms of its beneficial effects still need to be elucidated.