Nutrition reviews
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Both acute and chronic fluid deficits have been shown to be associated with a number of adverse health outcomes. At the extreme, deprivation of water for more than a few days inevitably leads to death, but even modest fluid deficits may precipitate adverse events, especially in young children, in the frail elderly and in those with poor health. ⋯ Acute hypohydration may be a precipitating factor in a number of acute medical conditions in elderly persons. Increased mortality, especially in vulnerable populations, is commonly observed during periods of abnormally warm weather, with at least part of this effect due to failure to increase water intake, and this may have some important implications for those responsible for forward planning in healthcare facilities.
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Concern about the role of beverages, especially those containing sugar, in the obesity epidemic continues to escalate. Bans on sugar-sweetened beverages and chocolate milk have expanded from the school cafeteria to the ballpark and convenience store. This review describes the experience of the 2010 Dietary Guidelines Advisory Committee (DGAC) in conducting an evidence-based review of dietary exposure and health outcomes. ⋯ Fluid intake is typically not tracked in prospective, cohort longitudinal studies; thus, data are not available on fluid intake and health status from studies using the strongest epidemiologic designs. Despite public perception that beverages are linked to increased body weight compared with whole foods, evidence-based reviews of this topic do not support that liquid calories are processed differently in the body. The practical recommendation to replace caloric beverages with water as an aid to control weight is based on calorie reduction, rather than a link between added-sugar intake and obesity.
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The purpose of this paper is to succinctly review the origin of US dietary surveys, the challenges and limitations of obtaining dietary intake data, the National Nutrition Monitoring and Related Research Act of 1990, the integrated US federal food survey, and the development of the US Department of Agriculture's (USDA) automated multiple-pass method. The USDA has monitored the food consumption patterns of Americans since the late 1890 s. ⋯ Two 24-hour dietary recalls are obtained using USDA's automated multiple-pass method. By combining their respective areas of expertise, the USDA and the Department of Health and Human Services have increased research opportunities for scientists and provided data foundational for establishing programs and public policy.
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The field of research examining the link between dehydration and endurance performance is at the dawn of a new era. This article reviews the latest findings describing the relationship between exercise-induced dehydration and endurance performance and provides the knowledge necessary for competitive, endurance-trained athletes to develop a winning hydration strategy. Acute, pre-exercise body weight loss at or above 3% may decrease subsequent endurance performance. ⋯ During exercise lasting 1 h or less, dehydration does not decrease endurance performance, but athletes are encouraged to mouth-rinse with sports drinks. During exercise lasting longer than 1 h, in which fluid is readily available, drinking according to the dictates of thirst maximizes endurance performance. In athletes whose thirst sensation is untrustworthy or when external factors such as psychological stress or repeated food intake may blunt thirst sensation, it is recommended to program fluid intake to maintain exercise-induced body weight loss around 2% to 3%.
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Patients in the intensive care unit (ICU) are unable to nourish themselves orally. In addition, critical illness increases nutrient requirements as well as alters metabolism. Typically, ICU patients rapidly become malnourished unless they are provided with involuntary feeding either through a tube inserted into the GI tract, called enteral nutrition (EN), or directly into the bloodstream, called parenteral nutrition (PN). ⋯ Hence, the balanced perspective has been reached of using EN when possible but avoiding underfeeding by supplementing with PN when required. This new role for PN is currently being debated and studied. In addition, the relative merits and needs for protein, carbohydrates, lipids, and micronutrients are areas of study.