Jpen Parenter Enter
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Jpen Parenter Enter · Nov 2013
ReviewRecognizing malnutrition in adults: definitions and characteristics, screening, assessment, and team approach.
Appropriate recognition of malnutrition in adults requires knowledge of screening and assessment methodologies. An appreciation for the contributions of inflammation has resulted in a new etiology-based approach to defining malnutrition syndromes. The Academy of Nutrition and Dietetics and the American Society for Parenteral and Enteral Nutrition (A. ⋯ E. N. has recently been presented. Since screening delays and failures in the diagnosis and management of malnutrition are all too common, a multidisciplinary team approach is recommended to promote improved communication and quality of care.
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The estimation of caloric needs of critically ill patients is usually based on energy expenditure (EE), while current recommendations for caloric intake most often rely on a fixed amount of calories. In fact, during the early phase of critical illness, caloric needs are probably lower than EE, as a substantial proportion of EE is covered by the non-inhibitable endogenous glucose production. Hence, the risk of overfeeding is higher during the early phase than the late phase, while the risk of underfeeding is higher during the late phase of critical illness. ⋯ Available techniques to assess EE include predictive equations, calorimetry, and doubly labeled water, the reference method. The available predictive equations are often inaccurate, while indirect calorimetry is difficult to perform for several reasons, including a shortage of reliable devices and technical limitations. In this review, the authors intend to discuss the different techniques and the influence of the method used on the interpretation of the results of clinical studies.
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Jpen Parenter Enter · Nov 2013
Comparative StudyEffects on varying intravenous lipid emulsions on the small bowel epithelium in a mouse model of parenteral nutrition.
Injectable fat emulsions (FEs) are a clinically dependable source of essential fatty acids (FA). ω-6 FA is associated with an inflammatory response. Medium-chain triglycerides (MCT, ω-3 FA), fish oil, and olive oil are reported to decrease the inflammatory response. However, the effect of these lipids on the gastrointestinal tract has not been well studied. To address this, we used a mouse model of parenteral nutrition (PN) and hypothesized that a decrease in intestinal inflammation would be seen when either fish oil and MCT or olive oil were added. ⋯ The study showed that PN containing OOFE had beneficial effects to small bowel health and animal survival. Further investigation may help to enhance bowel integrity in patients restricted to PN.