Current opinion in clinical nutrition and metabolic care
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Curr Opin Clin Nutr Metab Care · Mar 2016
ReviewIs early starvation beneficial for the critically ill patient?
Anorexia is a preserved evolutionally response that may be beneficial during acute illness. Yet current clinical practice guidelines recommend early and targeted enteral nutritional support. However, the optimal timing of the initiation of enteral nutrition and the caloric and protein requirements of critically ill patients is controversial. ⋯ Limiting nutrient intake during the first 48-72 h of acute illness may be beneficial; in those patients who are unable to resume an oral diet after this time period intermittent enteral nutrition targeting 20-25 cal/kg/day is recommended.
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Curr Opin Clin Nutr Metab Care · Jan 2016
ReviewProtein anabolic resistance in cancer: does it really exist?
Preventing unintentional weight and muscle loss is of crucial importance to maintain the condition and well-being of patients with cancer, improve treatment response and tolerance, and prolong survival. Anabolic resistance might explain why some cancer patients do not respond to nutritional intervention, but does recent evidence actually support this? We will discuss recent literature that casts doubt on attenuated anabolic potential in cancer. ⋯ Cancer patients have a normal anabolic potential which relates to the amount of essential amino acids in the meal. It remains to be determined if this is also the case in weak cancer patients with a short life expectancy and high systemic inflammation.
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Curr Opin Clin Nutr Metab Care · Jan 2016
ReviewInterrelationships between glutamine and citrulline metabolism.
This article analyzes the contribution of glutamine to the synthesis of citrulline and reviews the evidence that glutamine supplementation increases citrulline production. ⋯ The beneficial effects of glutamine supplementation may be partially mediated by the effects of glutamine on citrulline synthesis by the gut and the de-novo synthesis of arginine by the kidney and other tissues. Although there is no strong evidence to support that glutamine is a major precursor for citrulline synthesis in humans, glutamine has the potential to increase overall gut function and in this way increase citrulline production.
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The obesity paradox is a highly controversial concept that may be attributed to methodological limitations related to its identification. One of the primary concerns is the use of BMI to define obesity. This index does not differentiate lean versus adipose tissue compartments (i.e. body composition) confounding health consequences for morbidity and mortality, especially in clinical populations. This review will describe the past year's evidence on the obesity paradox phenomenon, primarily focusing on the role of abnormal body composition phenotypes in explaining the controversies observed in the literature. ⋯ In view of the body composition variability of patients with identical BMI, it is unreasonable to rely solely on this index to identify obesity. The consequences of a potential insubstantial obesity paradox are mixed messages related to patient-related prognostication.
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Curr Opin Clin Nutr Metab Care · Nov 2015
ReviewMicronutrient and amino acid losses in acute renal replacement therapy.
A wide range of renal replacement therapies is now available to support patients with acute kidney injury. These treatments utilize diffusion, convection or a combination of these mechanisms to remove metabolic waste products from the bloodstream. It is inevitable that physiologically important substances including micronutrients will also be removed. Here we review current knowledge of the extent of micronutrient loss, how it varies between treatment modalities and its clinical significance. ⋯ Patients with acute kidney injury are at high risk of disease-related malnutrition. The use of renal replacement therapy, although often essential for life support, results in loss of micronutrients into the filtrate or dialysate. Losses are probably greater with continuous convective treatments, but it is not yet known whether these losses are clinically significant or whether their replacement would improve patient outcomes.